A QUIET CRISIS IS LOOMING FOR AMERICA'S SENIORS
Eighteen short years from now, 53 million Americans (one in six United States residents) will be aged 65 or older. Today, 12.4 percent of the U.S. population is 65 or older; in 2020, that figure will approach 20 percent. America needs to prepare for these changing demographics: this is the “Quiet Crisis.”
Senior Americans, whether rich, poor, or somewhere in the middle, face many barriers to an old age in which very basic human desires for physical safety, appropriate health care, and maximal independence are met. For some, crucial family supports will disappear as they outlive spouses or children move to distant places. For others, limited resources will prevent them from identifying and purchasing needed services. Many will lose their homes — long a symbol of their independence — due to rising property taxes and maintenance costs. Living alone, isolated from services and perhaps coping with disabilities that prevent social interactions, a large and growing number of seniors will face triple jeopardy: inadequate income, declining health and mobility, and growing isolation.
“There's a lack of affordable housing alternatives to meet
the demand, and many…do not have options.”
In the face of unprecedented growth in the proportion of the population who are seniors, we believe that this Nation has both a moral obligation and a financial imperative to establish a more rational long-term care system. A system that drives seniors to needless, premature institutionalization and expensive, preventable medical interventions will burden both seniors and those who must bear the costs for their care. Senior individuals who are able to remain in the community should receive the services they need to be as independent as possible. Those who must move from their preferred setting should have viable and affordable alternatives that ensure their well-being. Neither institutionalization nor neglect should be the only alternatives they must accept.
“…A lot of older persons live in housing without supportive
features. Over 5 million older households have one member with a functional
limitation. Over 1 million of these households report needing modifications.
These are primarily old, old persons.”
In a Nation characterized by care and compassion for the least fortunate of its citizens, the stark reality is that many seniors, after years of contributing to their country’s defense and prosperity, find themselves seriously at risk of being ignored, forgotten, or destined for a room in a skilled care facility. The simple fact is that this country lacks a national policy that addresses humanely and cost-effectively the needs and preferences of seniors who have diminished abilities to care for themselves. All too often, seniors with chronic illnesses and declining mobility have limited care and financial alternatives, when what they want is to live in their homes with appropriate support.
How the Quiet Crisis Has Developed
The Commission found that the Quiet Crisis has been developing over time as a result of numerous trends and economic factors. Some of our key findings regarding this evolution are the following:
What the Quiet Crisis Will Bring
The Commission found, based on the best research and forecasts available, that by the year 2020:
Current policies and programs for seniors are an accumulation of unrelated decisions and unintended consequences. Housing assistance programs are implemented with little reference to health care or supportive service needs. Medicare remains centered on acute care and episodic medical interventions, while the need to manage chronic care for the senior population has emerged as the most formidable challenge. Medicaid, which was designed to ensure access to health care for low-income persons, now provides an imperfect reimbursement mechanism for the Nation’s long-term care facilities and the skeleton of a payment system for much-needed home- and community-based care.
“For any older American to suffer after working hard all of
his or her life is a national disgrace.”
This Nation, despite competing demands for national resources, must respond to the critical need for affordable housing and home- and community-based supportive services, with a substantial financial commitment and effective policies. First, seniors most at risk of neglect or inappropriate institutionalization must receive the care they need. Second, all seniors, no matter what their individual circumstances and resources, should be able to continue to live where they prefer regardless of income, with the services they need to maintain personal dignity and quality of life.
“We just had a tragedy in this country where … immediately, all the money that was necessary to deal with that problem was provided…. We’ve got Baby Boomers coming. If they don’t want to deal with it now, what do you think they’re going to do then? ”
Andrew Montgomery, senior and former Chairman of the Commission on Aging for the city of Oakland, California, at hearings before the Commission, November 7, 2001, San Diego, California.
A VISION FOR AMERICA
The Seniors Commission believes that all older Americans should have anopportunity to live as independently as possible in safe and affordablehousing and in their communities of choice. No older person should have tosacrifice his or her home or an opportunity for independence tosecure necessary health care and supportive services.
The Commission further believes that:
CONVERGENCE: A CALL FOR COORDINATION OF SENIORS’ HOUSING AND HEALTH CARE
The most striking characteristic of seniors’ housing and health care in this country is the disconnection between the two fields. With few exceptions, seniors obtain their housing from one source and their health care and supportive services from a completely different source.
Witness after witness before the Commission testified to this problem and the consequences of its continuation. Through such exchanges, Commissioners came to appreciate that:
…“Even for long-time professionals, the current
‘crazy-quilt’ tapestry of services and shelter options make it difficult to
fully grasp their complexities, let alone try to access them. The result [is]
confusion amongst consumers, duplication of service delivery, government
agencies not knowing who supplies what service or that some services even exist,
reduction in qualified service workers, regulations that impede dedicated
service providers from providing the service they were hired and want to
A Call for Coordination
The Nation can no longer afford the inefficiency of the current disconnect between housing and health service systems for seniors. The time has come for coordination among Federal, state and local agencies and administrators. Coordination should begin in the halls and committee chambers of Congress and should spread through all branches of government and society.
The now distinct worlds of housing and health care must begin to acknowledge each other, listen to and speak to each other, and learn to integrate efforts for their mutual benefit and the benefit of their senior clients. Such understanding and coordination are essential underpinnings to the success of reforms proposed in this report and in many other forums.
Realities for Seniors Formed the Basis of our Recommendations
The Commission received its Mandate from Congress; however, its major messages come directly from seniors across America.
The world of seniors in America today is insufficiently reported in the print media or pictured on television — aside from the occasional special report. Advocacy groups speak well for the needs of seniors, academics detail the results of their research, and Congress and State legislative bodies contain several experts (many of whom are seniors) in the field. But public attention to the coming crisis is minimal.
Commission members resolved, therefore, to find out for themselves about the world of seniors in America today. We held public hearings in Baltimore, Maryland; Columbus, Ohio; Miami, Florida; San Diego, California; and Syracuse, New York; and we attended a community forum in Boston, Massachusetts. We heard formally and informally from many of the country’s leading authorities on housing and health care options for seniors — heads of advocacy groups, recognized experts in senior services and leaders of government at all levels. We talked with providers, consumers, financiers, and regulators. We commissioned some of the Nation’s leading researchers to conduct original studies and we listened to seniors themselves.
From this work, stretching over 12 months, we began to form the conceptual framework for our recommendations to Congress. We developed concepts that flowed from the hearings’ testimony, Commission meetings, informal conversations, and research. Five guiding principles emerged, illustrated here by testimony from hearings and supported by research and other documentation received by the Commission. The Commission’s five guiding principles are as follows:
“Monies have to be allocated for senior programs…there should be a whole senior division from U.S. HUD. We're getting older; this Nation is getting older…every year, we see less and less
money allocated…we opened our fifteenth building. It's located in the heart of
Little Havana on 22nd Avenue and Calle Ocho.
A housing crisis is on the horizon, and more housing units must be created in response. The Commission recommends the production of a variety of housing types, serving persons of low, moderate, and middle incomes, ranging from single-family home communities to service-enriched senior apartments to Continuing Care Retirement Communities.
Principle No. 2 is addressed by ten specific recommendations that include funding and modifying the Section 202 Program to keep step with the forthcoming growth in seniors population, increasing annual production to meet the needs of future generations of seniors, assuring Medicaid funding to support quality care and adequate payments across all settings. Recommendations also include modifying rural housing programs to provide ample funding to more appropriately serve seniors and assuring that home- and community-based services and supportive senior housing are available in rural areas.
…“Council for Affordable and Rural Housing (CARH) … members
own or operate affordable housing across rural America…. If there is one
thing we have learned it is that there is no more effective method of delivering
affordable housing than a public-private partnership between government and its
citizens. We have also learned that too often the special needs of seniors and
the disabled are not properly addressed...
Yesterday’s demonstration and pilot programs often become today’s most successful approaches to the delivery of service-enriched housing for seniors.
Principle No. 5 is addressed by eleven specific recommendations that include creating a clearinghouse of information about state Medicaid programs that deliver home- and community-based services and a national database of senior housing, encouraging the broader implementation of the Programs of All-Inclusive Care for the Elderly (PACE) model, developing enhanced private sector and rural housing programs, creating an incentive for the purchase of long-term care insurance and establishing a prescription drug benefit for seniors under the Medicare program.
Challenges to Meeting Future Needs
The Commission also learned that national efforts to meet the future needs of seniors will face numerous challenges. Principal among those challenges is the need for resources. Committed investment in affordable housing has declined over the past three decades12 and resources devoted to home- and community-based services pale in comparison to resources dedicated to facility-based, skilled nursing care. The Commission's key findings on the challenges to addressing the growing affordable housing and health services crisis are:
The Commission has developed more than 40 recommendations to address the health and housing challenges of a dramatically increasing senior population. A full Table of Commission Recommendations appears in the Appendix to this Report.
Though the Commission’s recommendations seek to respond to its Congressional Mandate, the Commission believes that these recommendations address the entire Nation on issues that many government leaders, providers, developers, advocates and consumers face. It is essential that these challenges be addressed proactively.
|The page was last modified on July 22, 2002|