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PSY 320 Geropsychology

PSY 320 Geropsychology. Public Policy in the Aging Society Dr. Mark Henkels WOU Political Science. PSY 320. Outline: Demographics: “The Coming Generational Storm” Typical Concerns: The Federal Budget and Entitlements

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PSY 320 Geropsychology

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  1. PSY 320 Geropsychology Public Policy in the Aging Society Dr. Mark Henkels WOU Political Science

  2. PSY 320 Outline: Demographics: “The Coming Generational Storm” Typical Concerns: The Federal Budget and Entitlements Hidden Issues: Long Term Care, Diversity, and the Elder-Friendly World Final Points: Politics and Going Beyond the Headlines

  3. PSY 320 The Coming Generational Storm: The aging of the “Baby Boomers” fosters much concern, particularly regarding whether the aged will consume the resources needed for future investment. Without a doubt, the aging of American society will powerfully affect the future.

  4. Elements of Growth: Size of Older Population POPULATION OVER 65(US Census,2004) 2000 2030 United States 35m(12.4%) 71m(19.7%)m Oregon 438,000(12.8%) 881,000(18.2%)

  5. PSY 320: The Coming Generational Storm U.S. Census: The Next Four Decades: The Older Population in the United States: 2010-2050. (May 2010)

  6. Two major demographic breakpoints: when the Boomers start reaching 65 and when they start reaching 85 <AgingStats.gov> 2012,

  7. PSY 320 The Coming Generational Storm:

  8. PSY 320 2004 Per Capita Health Care Costs National Average: $5,276 Over 65: $14,797 Over 85: $25,691 Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group.

  9. PSY 320: Dependency Ratios Number of Non-Working Age people per 100 Workers

  10. PSY 320: Federal Budget Concerns The Deficit: 2012 Estimated Deficit: $1.4 Trillion

  11. PSY 320 Federal Spending Breakdown:

  12. PSY 320 Aged Receive most Federal Mandatory Spending: Social Security, Medicare, and Much Medicaid

  13. The challenges of Social Security and Medicare challenges are visible to all Americans.Medicaid and the Older Americans Act hit senior services more directly at state and local levels.

  14. Social Security: “trust funds” exhausted in 2035.Continued revenue would provide for about 75% benefit level sustainably after.

  15. Since the trust fund is not respected, the current unsustainability of Social Security is clear. Social Security Administration, 2012

  16. Social Security is fixable (mathematically!) by simple tax or benefit adjustments.CBO estimates 1.6% payroll tax increase would pay for program for 75 years. Social Security Administration in 2005 calculated that taxing all earnings and providing corresponding benefits would pay 95% of shortfall.Changing inflation indexing of benefits is often cited as relatively simple cure.

  17. Medicare verse Medicaid Medicare: Nearly universal coverage for those over 65, plus some with disabilities and dependents • Completely federal • Funded in part by direct payroll tax Medicaid: Coverage for those with low income • Federal and state share funding - No specific revenue source

  18. Medicare: Four Parts Part A: automatic enrollment - hospital, skilled nursing, home health care, and hospice: care for acute conditions. Part B: Optional subsidized coverage General health care coverage: standard medical services and tests, outpatient services • Basically fee for service model Part D: Optional subsidized prescription drug coverage Part C(“Medicare Advantage”): managed-care/HMO-style alternative to Part B. Can include drug coverage.

  19. PSY 320 Medicare: Kaiser Family Foundation information

  20. Medicare: inextricable from larger health care issues-$36 Trillion projected actuarial liabilities (Health Care Financial Management 2010)- Costs are driven by demographics and medical prices- Constant pressure to control costs

  21. Medicare: Commonly proposed incremental budget solutions - Increase payroll tax - Care delivery reform: example: protocols at end-of-life care - Cost shifting to seniors via premium increases or benefit decreases - Change reimbursement of providers

  22. Medicare: Radical reformVoucher system: defined contribution rather than defined benefit gives government certainty in spendingPaul Ryan(R-Wi) plan would shift costs to seniors since benefit index is set below average health care expense increases

  23. Medicaid:Elderly are 25% of beneficiaries, but account for 68% of expenditures(National Governor’s Association, 2011)Long-tem care is about 48% of Medicaid spending(Kaiser Family Foundation, 2011)

  24. Distinctive Aspects of Medicaid Budget- as entitlement, costs are driven by eligibility rules and medical prices- combined federal and state funding- competes with other state and federal general fund programs for money- requirement for matching money may leave federal money unclaimed

  25. States and Medicaid Oregon must pay 38:62 match for federal Medicaid money. If Oregon cuts state funding for Medicaid by $38 million, there will be a total cut of $100 million in the program $38M state cut creates $62m federal cut = $100 Million total cut.

  26. Hidden Issues: Long-term Care People over 70 needing personal care: 2000: 10 million 2020: 15 2030: 20 Of those currently with limitations: 53% do not anticipate family help - African-Americans and Hispanics expect more family help

  27. Long Term Care: Informal Spouse are first line of caregiving: provide between 35% and 40% of chronic care Disparate by gender: 73% older men married compare to 41% older women(2001) - 37% of women and 10% of men will be caregivers

  28. Caregiving: Informal Daughters (and sons) as caregivers: new complexities: - Divorce, fractured families - Working mothers - More geographical dispersion “Sandwich generation”, especially with later childbirth, must balance dependency of old with children - Some have 70 year-old mothers and 90 year-old grandmothers

  29. Public Long Term Care Many public home care programs coordinated and supported through Older Americans Act “Area Agencies on Aging”: in Oregon work through the regional Senior and Disabled Services offices

  30. Oregon Service Options In-Home Services Relative Foster Care Adult Foster Care Homes Assisted Living Facilities Residential Care Facilities Nursing Home

  31. Long Term Care Costs The average costs in the United States (in 2009) are: $198/day for a semi-private room in a nursing home ($72,270 year) $219/day for a private room in a nursing home ($79,935 year) $3,131/month for care in an Assisted Living Facility (for a one-bedroom unit) ($37,572 year) $21/hour for a Home Health Aide $19/hour for a Homemaker services $67/day for care in an Adult Day Health Care Center National Clearinghouse for Long-term Care Information <http://www.longtermcare.gov>

  32. Challenges in long-term care Decline of family networks Workforce issues Finances - About 10% of seniors have private coverage: A 60-year-old might pay $200 a month for a policy that pays $150 a day for a maximum of three years - Basically people spend down private resources until poor enough for Medicaid to kick in

  33. Importance of Medicaid in Long term Care

  34. Policy changes will not affect all elderly the same.

  35. Hidden Issue: Economic Diversity

  36. Hidden Issues: Racial Diversity

  37. Hidden Issues: Creating an Elder Friendly World Some important considerations Transportation: - Driving: autonomy verse safety - Transit systems: adequacy, affordability and safety Workplace: - ergonomics - organizational flexibility - social factors Technology

  38. Political Impacts of the Older Voter Four Considerations: Far more reliable voters, especially in primary election. Not largest group Oldest voters are more conservative. Older voters depend on Medicare and Social Security

  39. Political Impacts of the Older Voter

  40. George Binstock, The Gerontologist, 2010

  41. George Binstock, The Gerontologist (2009)

  42. GOP VOTE 2010 Over 65: 59% 60-64: 51% 50-59: 53% 45-49: 56% 40-44: 53% 30-39: 48% 25-29: 44% 18-24: 39% George Binstock, The Gerontologist (2010)

  43. Political Impacts of the Older Voter Considerations: Cohort effect: Seniors related to McCain far more readily than to younger less traditional Obama. Generally this favors Republicans. Special issue concerns: Social Security and Medicare Are Baby Boomers bringing different values into old age?

  44. Political Impacts of the Older Voter The older voter cannot be ignored, especially in the primary election and low turnout elections (2010). The older voter may significantly change as baby boomer retire.

  45. Final Thoughts Meeting the challenges is important, but panic is not warranted. “Bending the curve” approaches can work here. Key investment area: diversity of long-term options.

  46. Final Thoughts This is a new era for humanity. New visions of the life course will be necessary.

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