Challenges and Opportunities Abound

1. Challenges and Opportunities Abound Some Facts and Thought Connections from Guy Mikkelsen

2. Overview • Historic Change, what are the elements • Just the Facts, economic trends and consequences • Prevailing Winds, social realities meet public policy and programs • Seniors, what do we know about this group • Caregivers, tough assignment • Actions, Next Steps

3. Historic Change Unprecedented Social Challenges • Population Growth • Racial and Cultural Diversity • Population Age Distribution • Evolution of the Global Economy

4. ‘A rising tide lifts all the boats.’ • rhythm, patterns, cycles, chaos, control, rule, restrain, discipline, personal responsibility, accumulated disadvantage, self sufficiency, determination, challenge, opportunity, shame, fault, blame, morality, ethics, conflict, harmony, need, means testing, universal, trickle down, economic theory, ethnicity, equality, justice, community, fair, free, service, servant, distributive, commutative, solidarity, subsidiarity, representative,  

5. U.S. Population 65 Years and Over (Thousands) Source: U.S. Bureau of the Census

6. U.S. Percent of Total Population by Race

7. Population 65+ for years 2000 - 2050

8. “JUST THE FACTS” Recessions, Growth, Profits, income, wealth, Employment, and the EUbehavior’s have consequences

9. OLD Construction / Transportation Utilities Manufacturers, Wholesalers, and Retailers Personal Services / Health Care Education NEW Global High-tech Equipment / Software Computer Services Financial Services / Consulting Communications / Media Non-store Retailing Economy

10. Social Legislation- Events • Judeo-Christian traditions • Statute of Labourers 1351 • Wage and movement control, plague • Elizabethan Poor Laws • 1601 decentralized “Old Poor Law” out door relief • 1662 Settlement and Removal Act, aka, residency • 1797 Speenhamland System: means tested outdoor relief • 1834 Welfare Reform Act “New Poor Law” Centralization and workhouses, in-door relief-”crime to be poor • United States • 1824 on the Relief and Settlement of the Poor, aka YATES Report New York State • Indoor relief, control immigration • Civil War, Charity Organization Societies, Settlement Houses, 1909 White House Conf Children • Bonus Marchers, Hoover vs. FDR 7/28/32 burned camps; New Deal gave supplies, no money. • 1932: Wisconsin Unemployment ; NY Unemployment; Emergency Relief and Construction Act 1932; Federal Emergency Relief Administration (FERA) 1933. • Glass-Steagall Act 1932; Federal Reserve rediscounts • Banking Act of 1933, FDIC creation • Securities Act 1933, regulated offer and sale of securities • Securities Exchange Act 1934, regulation of financial markets and Securities Exchange Commission • Committee on Economic Security 1934; Social Security Act 1935 “Who is Harry Hopkins?” • National Housing Act 1934, 1937, 1949

11. Social Legislation-Events • Wage and Price Control Boards 1942; migration, health care, unions, women in workforce, income tax, rations • Executive Order 9066, 1942 • School Food Lunch Program 1946 • Aid to the Disabled 1950 • SSDI 1956 • November 22nd, 1963 • Great Society Programs, 1964-1968, Medicare, Medicaid, Civil Rights, Voting Rights, Model Cities, Economic Opportunity Act, Older Americans Act, Food Stamp Act 1939 and 1964 • Bretton Woods System 1944-1971 Stability vs. economic discrimination and trade warfare • SSI 1972 • Earned Income Tax Credit (EITC) 1975 • Low Income Energy Assistance 1981 • Americans With Disabilities Act 1990 • Family and Medical Leave Act of 1993 • Temporary Assistance to Needy Families, the Personal Responsibility and Work Opportunity Reconciliation Act – PWRORA – Public Law 104-193, 1996 • Gramm-Leach-Bliley 1999 overturned Glass-Steagall • Patriot Act 2001/ Executive Order 9066 1942 Government Authority in name of national security • 2010 Patient Protection and Affordable Care (PPACA) • The Dodd–Frank Wall Street Reform and Consumer Protection Act 2010, accountability and transparency in the financial system • CLASS Act, Community Living Assistance Services and Supports Act Title VIII of PPACA, withdrawn 2011 • November 23rd, 2011 , Super Committee

12. No Free Lunch

13. History Repeats Itself

14. “Roaring Something?” Source: Thomas Piketty and Emmanuel Saez, "Income Inequality in the United States, 1913-1998," Quarterly Journal of Economics, 118(1), 2003. Updated to 2008 at

15. Families “Work”, They Prevail Source: Congressional Budget Office, Average Federal Taxes by Income Group, “Average After-Tax Household Income,” June, 2010.

16. European Union and Debt Management

17. 30-40 Years A Summary • Nature of Work • Workforce • Hours worked • Stagnant wages • Off shore transfer of jobs • Consumerism • Personal Debt • Easy Credit • Governments print money • Changing Family Patterns • Mobility • Poverty • Homelessness • Availability of Drugs and Alcohol • Constant War • Decline in Private Health Insurance Coverage

18. Consequences

19. Is This Really Our Future ?

20. Prevailing Winds, AKA Trends

21. Prevailing Winds/Trends • Cost Containment: Medicare , Medicaid, AOA, SSBG • Eligibility compression, service constrictions • Eligibility phenomenon: aging in place, acuity, cost per person will increase • Client care levels: downward reclassification • Policy shifting the financial burden to the states and providers, provider at risk • Quality care rhetoric

22. Continuing “price squeeze” while actual costs increasing Lack of consistent collaboration and partnerships Decreases in local charitable giving due to job losses, stock market declines, and social uncertainty No new major revenue sources coming online as government holds line on funding Prevailing Winds/Trends

23. Converging Trends • Tidal wave of aging boomers • Deficits and declining social budgets • Economic and social preference for in-home care • Declining supply of direct care workers • Family caregivers under pressure • Sustainability of Medicare and SSA • Rising health care costs • Accumulated disadvantages for women and minorities

24. Boomers-Seniors: Now is the Time TODAY IS THE OLDEST YOU'VE EVER BEEN, YET THE YOUNGEST YOU'LL EVER BE, SO ENJOY THIS DAY

25. Senior Groupings Different Groups…Different Needs • Active Seniors • Seniors with Restrictions • Adults with Disabilities • Family Caregivers

26. “The Way We Were” • Year Age 20 2011 • 1926 1946 85 • 1931` 1951 80 • 1936 1956 75 • 1941 1961 70 • 1946 1966 65 • Think about social history, events, values, work place, living arrangements, social mores, societal expectations.

27. Shortage and Gaps • Income: • Stability of Social Security • Uncontrollable Variables • Delayed Retirement • Health Care Access/Cost • Energy Cost • Food Insecurity • Food Stamps participation rate 30-40% • Transportation • Predatory Leading • Social Roles • Division of Labor “Old Style” • Rapid pace of Social Change • Aging in Place • Housing not adapted to physical changes and needs, aka, mobility • Vulnerability: • Financial • Physical • Social Isolation • Loss • Independence • Self Worth • LOSS • Spouse • Loved ones/friends

28. Poverty is PainAging is a Woman’s Issue • Social Security “Ponzi?” NONSENSE-Easily Fixed. • 39.2 M over 65, 3.5M Poverty 9% • 35 % Poverty rate in 1960 • Without SSA 44% in Poverty • Change formula, today 32% in Poverty • 22% below 150% of Poverty $16,245 or 8.6M persons, AZ 190K persons • Average benefit payment $1081 Monthly • Direct correlation Education and Poverty . No HS 19%-College 3.8% • Women 3 Times more likely to be in poverty at all ages except age 77.?? 1934 • Women and Aging • 70% over 85 are women • 70% over 75+ incomes below poverty 1.274M • Women of Color, Black 60%, Hispanic 40% in poverty • Will be widowed 15 or more years • Future, fewer married, fewer with children, benefits and caregiver issues • Women are “caregivers” at all ages • In Home Care or a New Place to Live: • New Relationships, Safety, Help, Hope, Stories, New Stories, New Family, continuing creation. • How Many Units ?? 9,923 or 5% of need

29. 22% of those over 65 need some form of LTC Racial and ethnic diversity increase End of life issues and ethics Tomorrow's “Boomers” - different social and economic characteristics Sheer size of group formidable Higher educational levels Heart disease, cancer, strokes, pneumonia, and influenza are leading causes of death Highest needs: Walking, getting outside, light housework, bathing, transferring, meal preparation Life expectancy increases, questions of Quality of Life have greater importance Seniors Profile

30. Expect to see new POSITIVE IMAGES of AGING Gray hair portrayed as attractive Living longer and want to live in healthy, vital way Don’t have to be young to be beautiful, but have to be healthy Expect explosion of new products and services targeted to “Aging America” Time Convenience Service Quality Baby Boomers’ Beliefs & Desires

31. Really????

32. 6% use 44%

33. POOF: October 14, 2011

34. Activity of Daily Living (ADL) % of Those Who Need Assistance with at Least One ADL

35. One of Many Estimates of Future Financial Needs of LTC FACING FACTS AUTHORS: Neil Howe and Richard Jackson http://www.concordcoalition.org/facing_facts/ff_fax32.html

36. U.S.Projected ADL Need

37. Disability Forecast for MedicareEntrants, 2000-2030 Evaluating Near-Elderly Disability Trends in the U.S. using Micro-data Jay Bhattacharya Stanford University October 2002

38. Obesity and Disability • Between 1984 and 1996 the probability of disability (defined as functional limitation) has increased for those under 60 in the U.S. • Changes in the prevalence of chronic conditions (except obesity) explain little of the changes in disability prevalence. • Changes in disability prevalence for most age groups between age 25 and 58 are well explained by changes in chronic disease. • However, (with the exception of changes in obesity) it is the change in the prevalence of disability among those with chronic disease, rather than the change in disease prevalence that explains the bulk of the change in disability. • For those between 58 and 65, there is actually a smaller increase in disability than would be expected from changes in chronic disease alone. Evaluating Near-Elderly Disability Trends in the U.S. using Micro-data Jay Bhattacharya Stanford University October 2002

39. Care: Giving and Receiving

40. Not just cure but prevent, alleviate the conditions that foster illness Out flowing of healing instead of incoming wounded Connect faith and health into healing not just treating Service instead of institutional survival Community Help people balance their Biological Environmental Social Psychological Spiritual Well-Being

41. Am I a Caregiver? • Do you feel responsible for an elder/ disabled person who relies upon you for care and support, either physically or emotionally? • Do you need assistance in meeting your loved one’s care needs from time to time? • Do you find yourself frustrated and worn out by the ongoing care needs of your loved one? • Do you have difficulties in navigating the spectrum of services to find the specific things you need for your loved one? • Do you need a resource person to touch base with about what is happening with your loved one and how to manage his/her care? • If you answered YES to one or more of the questions above, You are a CAREGIVER

42. Supporting Family Caregivers Lots of Questions, No Easy Answers • Financial Stress • Do I subsidize or not, how much, what options, what services. New unanticipated financial burdens? • Physical Stress • Physical and Personal care can be difficult and stressful. Cleaning, shopping, laundry, etc...., or caring for personal physical needs can be challenging at best and stressful and very difficult at worst. • Environmental Stress • How does home need to be adapted? Cost and disruption. • Emotional Stress • Strain of balancing personal needs with caregiver needs. Feelings of frustration, guilt, anger, being overwhelmed not uncommon. • “Sandwich Generation”

43. The Elder Care Maze • De-personalized • Confusing and Inflexible • Fragmented and uncoordinated • Difficult to access • Difficult to understand • Rapidly Changing • It’s become a nearly non-negotiable MAZE!

44. Workforce Crisis Source: General Accounting Office Analysis of US Census Bureau Projections of Total Resident Population, Middle Series, December 1999.

45. The Real Caregivers are Unpaid

46. Caregivers, Another Client GroupValue of Their Care, $450 Billion 2009

47. Move Forward

48. Attitude and Choice • Pain • Suffering • Uncertainty • Anxiety • Worry • Hopelessness • Despair • Depression • Poverty • Greed • Isolation • Joy • Freedom • Celebration • Confidence • Hope • Accomplishment • Family and Community • Focus on Others • Generosity • Giving • Faith • Optimism • Dreams • Possibilities

49. POLITICAL WILL AND ACTION

50. Life and Home