PART VI. CONCLUSION: A MANDATE FOR CHANGE

In the fall of 1999, Congress created this bipartisan Commission to provide insight into the future housing, health, and supportive services needs of seniors in America. Congress asked the Commission to undertake a broad examination of the future needs of seniors and the actions necessary to meet those needs. Congress mandated a review of Federal policy and programs, as well as policies that affect the private sector and individuals.

The senior population in this country is growing at rates even beyond those anticipated. In 2020, one in six Americans will be age 65 and above; in 2030, it will be one in five. This is a dramatic increase from the start of the 20th Century, when the senior population constituted less than 5 percent of the U.S. population.¹⁴⁴

Such a profound change in the composition of the population creates a new challenge for our national policymakers and resources. As a Commission, we struggled time and again with the fact that we are a Federal commission and our recommendations need to be targeted to a Federal audience. But this "aging of America" requires actions and solutions far beyond what the Federal Government can provide. Although policy may be made at the Federal level, the implementation of solutions will be primarily at the local level. Effective solutions rest with private businesses and local governments, with volunteers and advocates, with charitable and faith-based organizations, and with social-minded investors.

We see this as a community crisis, a State problem, and a national concern — without a simple answer, without a single solution. We call for the Federal Government to lead, to act as the catalyst for change, to make it easier for local governments and the private sector to serve, and to provide the necessary support. Our Commission may be Federal in scope, but this quiet crisis affecting seniors cuts across all levels of government, all communities, all races, creeds, and cultures, and all economic strata.

The Federal role in meeting the needs of seniors is extensive. Federal health and housing programs, as well as other Federal policies, directly affect millions of seniors. Current policies already have significant shortcomings that affect the welfare of a large segment of this Nation’s senior population, however, and an even greater segment will be adversely affected in the future unless changes are made.

Existing Federal policy is fragmented — not just as it relates to programs directed at low-income seniors, but for the broader population of seniors as well. Inconsistency leads to a lack of clarity and coordination that can add needless expense, and undermines the effectiveness of well-intended efforts. For example, seniors in federally assisted housing often do not receive the health and supportive services they need and for which they are eligible. Low-income seniors living in the community often have unmet housing needs as well as inadequate or non-existent community-based services. Seniors in rural areas frequently have extremely limited housing, services, or health care options in their communities. Some low-income seniors find themselves eligible for housing assistance but ineligible for health-related assistance, because qualification standards differ among programs that were all designed to help the same people in need. Finally, seniors who do not qualify for need-based assistance often find themselves without services because gaps in programmatic coverage sometimes lead to overwhelming health-related costs. Policies must be synchronized and modernized to meet the evolving needs and demands of a new generation of seniors, and to address the crisis.

A Call To Action

Federal policy must be more responsive to the needs and desires of the next generation of seniors. The Nation must embrace consumer choice and tailor programs to fit individual needs. Americans must think residential, not institutional.

The existing senior housing stock needs to be preserved. The supply of service-enriched, affordable housing must be increased substantially to meet the growing demand. Shortages already exist, and data indicate that they will only worsen. Housing policy should also foster aging in place for homeowners and renters, by helping to ensure that housing quality is maintained and is adaptable to the needs of seniors.

The majority of today's seniors are homeowners. Programs such as Medicare and Medicaid should build on that, and look toward expanding access to community-based services to better serve all seniors, so that they can age in place to the fullest extent practicable.

Federal agencies must collaborate more closely to address the needs of future seniors in America, and address them in the least restrictive environment. Legislative and administrative action must streamline the interrelationships among agencies as they affect policies targeted to seniors. Often, even when programs theoretically match well with the needs of elders, the lack of connection at the agency level leads to ineffective implementation and inadequate utilization.

Housing is usually built without regard to service provision. Health services are usually provided without regard to housing environment. Medicare and Medicaid do not work in concert to ensure efficient, quality health care. Too much policy is developed in a vacuum rather than in an open forum; too much policy is developed to serve narrow rather than broad interests.

Comprehensive needs deserve comprehensive attention. Cross-cutting needs require cross-cutting thinking and solutions. It is, therefore, vital that the comprehensive needs of seniors be addressed in a coordinated fashion by all government agencies whose mandate includes aiding older persons.

We call on the States to meet the needs of seniors. In the case of housing, homestead exemptions, wise use of HOME funds, and Community Development Block Grants (CDBG) can ensure that seniors living in the community can remain in the community. Helping to make dollars dedicated to seniors go farther, or giving seniors a hand in maintaining or adapting their homes, is being responsive to both consumer need and choice. The creation of goals for senior housing within Low-Income Housing Tax Credits, HOME, and other State-based programs should be developed so that these financing tools can be used to develop affordable housing to meet this urgent demand. Effective use of transportation funds can help seniors remain independent in their communities by providing the necessary transportation infrastructure.

States need to avail themselves fully of Medicaid waivers to provide home and community-based services that prevent premature institutionalization and allow more seniors to remain in the place they call "home," whether that be a single-family residence, a subsidized rental apartment, or with a family member. Congress should provide the financial incentives to make this happen. While skilled nursing care will always be needed, nursing facilities should no longer be the default choice for placement of seniors with health and service needs. Steps need to be taken to ensure that a quality workforce exists to provide those services in communities and facilities.

Local government can take action by establishing senior-friendly communities that are safe and provide adequate transportation, services, housing, and supports. It can provide property tax exemptions or abatements, and use tax increment financing mechanisms as incentives to the development of affordable senior housing. Localities should endeavor to coordinate the resources already available to seniors and, working with local agencies, non-profits, and providers, establish clearinghouses of information that are both accessible and understandable to seniors. They should examine their senior population and consider their needs when developing community planning documents and tools. Larger communities, which receive allocations of HOME and CDBG funding, should target portions of these resources to promote senior housing and health services.

Government is a major partner in ensuring that the future needs of seniors are met through its policies and actions, but it is only one partner. The private sector and individuals have leading roles as well. The Government Sponsored Enterprises, such as Fannie Mae and Freddie Mac, and the financial sector must endeavor to provide the capital needed to ensure that affordable senior housing and health facilities are constructed. Doors must be open to the provision of services and the creativity of various delivery models. Financial products must be available to address the needs of seniors, including affordable long-term care insurance, secure reverse mortgages, and other financial tools and incentives to help retirees take responsibility for their own future. There is also a need for reasonably priced, quality housing constructed by the private sector that includes the option of affordable services' packages.

Community and faith-based organizations should increase their focus on senior constituents and endeavor to fill gaps for those in need. Organizations should work to educate themselves so that they can provide improved, comprehensive, and more accessible services and information to seniors and their families. Existing senior housing providers need to open their doors to the community, not just their residents.

Finally, individuals must take action. This is not a crisis where the solution rests solely with government and business. Solutions must also start at the grassroots level — with volunteers in the community and local advocates. Non-profit, voluntary, and faith-based organizations have long been the mainstay of services to seniors, particularly those with limited incomes. They need continuing support.

The Baby Boomers begin to retire in less than a decade; there is limited time to plan for the future. Smart planning will help to ensure the maximum number of choices for tomorrow’s seniors. Whether it involves investing in long-term care insurance or simply setting aside savings for uncertainty, individuals can and should plan for their own futures so that when the time comes, the Nation can marshal and maximize the resources needed to ensure that America's seniors can enjoy the best quality of life.

Congress created this Commission believing that the Nation faces a surge in the seniors population far beyond expectations. This Commission has reviewed the need, consulted with experts, and honored the seven Mandates given to us by Congress. We advise the Congress that, indeed, a crisis is on the horizon. We have identified the problem, we have shared our vision, and we have stated our recommendations. This is our Mandate for Change. To be effective, we must work together as a Nation, at all levels of government, as private and public partners, embracing the challenges set forth.

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