Aging with Options™ Strategic Direction

Volunteers of America has spent more than a century anticipating and adapting to the needs of Americans. Our national presence and elderly care expertise uniquely position us to lead an initiative that will address the challenges facing the rapidly growing older American population.

With local offices across the nation, 27 of which offer senior services, we are the number one provider of affordable senior housing, the fourth largest nonprofit provider of skilled nursing care and the sixth largest provider of assisted living.

As we support seniors in their right to live in environments of their choice and continue to provide quality care, we will also help ensure that seniors remain active participants in their communities. As Volunteers of America expands opportunities in Program of All-inclusive Care for the Elderly (PACE), and Home and Community-Based Services (HCBS), we will continue to meaningfully engage with seniors to aid them in realizing their full potential in the vital role that they play in their immediate communities and beyond.

Tier One Priorities

1. Support state efforts to enable and implement PACE programs.

2. Promote access to home and community services through a national long-term care financing strategy, Medicaid improvements, direct care worker reforms and family caregiver supports.

America faces a growing long-term care crisis and needs a national strategy to help seniors maintain their independence and dignity. Most seniors must bankrupt themselves before receiving help under Medicaid after working their entire lives, and too many enter nursing homes prematurely.

Long-term services and supports reforms should: eliminate the current bias towards institutional care, enhance the capacity of seniors to live at home and stay connected to their communities, and sustain family support systems through expanded choices, increased resources and better information for decision-making.

The public sector should provide a strong, universally available foundation of support that the private sector can supplement—not unlike the three-legged retirement stool of Social Security, savings and pensions. Volunteers of America supports the Community Living Assistance Services and Supports (CLASS) Act, which would create a voluntary, budget-neutral program with premium payments during working years and a guaranteed cash benefit upon becoming disabled.

Much can and should be done to address the institutional bias in the Medicaid program and improve access to home and community-based services (HCBS). Volunteers of America supports the Empowered at Home Act, which would strengthen the Medicaid HCBS State Plan Amendment option, provide impoverishment protections for spouses of Medicaid HCBS recipients, and permit low-income beneficiaries in need of HCBS to keep more of their assets and still be eligible for Medicaid, giving them the resources to stay in the community.
In response to dangerously high rates of vacancies and turnover among direct care workers, Volunteers of America supports efforts to address this growing problem.
Family caregivers struggle with enormous financial, emotional and physical burdens to try to keep loved ones out of institutions. Volunteers of America supports refundable tax credits for persons with functional limitations and their caregivers and a Medicaid family caregiver assessment.

3. Engage in a national discussion on Medicare’s long-term sustainability.

Our nation needs to have a rational, nonpartisan discussion about the sustainability of Medicare over the long term, recognizing that Medicare spending is directly related to health care spending, and that future challenges arise primarily from the increasing number of eligible beneficiaries. Volunteers of America believes a national Medicare dialogue should be guided by these principles:

The affordability of Medicare should be protected by opposing substantial increases in beneficiary copayments, deductibles or premiums, particularly for those least able to pay;

Issues associated with chronic illness under Medicare should be recognized as a national priority. An estimated 25 percent of beneficiaries account for 85 percent of annual Medicare spending.
Serious consideration should be given to addressing the significant geographic variations in Medicare spending that are unrelated to regional differences in beneficiary health status;
Options for increasing revenues to support the program should be on the table;
Conduct analysis to determine the savings potential from improvements in and wider use of evidence-based health promotion and disease prevention programs and health information technologies and systems; and
Medicare “solvency” issues should be discussed, including: current solvency distinctions between Medicare Parts A and B; defining long-term program sustainability; and measures comparing Medicare spending relative to the Gross Domestic Product and per capita increases in similar private sector spending.

4. Increase appropriations for Older Americans Act

(OAA) programs.

The OAA funds services to keep seniors healthy and independent, including: nutrition, senior centers, home and community services, family caregiver support, protection against abuse and neglect, older worker training and employment, transportation and health promotion/disease prevention. OAA programs save tax dollars by reducing premature nursing home placement, averting malnutrition and controlling chronic health conditions.

The purchasing power of OAA funding has seriously eroded over the past eight years due to the increasing cost of providing services and a growing number of older adults in need. Funding has been stagnant except for a mandatory increase for the Senior Community Service Employment

Program (SCSEP) in order to account for the higher minimum wage level. Despite a proposed increase to $1.98 billion for FY 2009, OAA funding is still at least 12 percent less than the level needed to keep pace with inflation.

Volunteers of America urges Congress to reinvest in the core OAA programs to meet the increasing demand for assistance, and provide additional new funding for initiatives created by the 2006 reauthorization to proactively respond to the needs of a growing senior population. The

OAA programs added in the 2006 reauthorization that deserve additional funding include:

The National Center on Benefits Outreach and Enrollment (under Section 202) will marshal person-centered, cost-effective techniques to enroll seniors in a broad range of federal, state and private programs.
Within the Choices for Independence initiative, evidence-based health promotion and disease prevention programs promote education and behavioral changes to reduce the risk of injury, disease and disability, while reducing Medicare and Medicaid spending.
Civic engagement strategies (under Section 417) enable seniors to make important contributions to their communities and build the capacity of local organizations to effectively engage older adults in addressing community needs through multigenerational projects.

Tier Two Priorities Man Smiling

1. Increase funding for various aging services programs.

Volunteers of America supports new or increased appropriations for a variety of federal aging services programs that play a significant role in supporting and facilitating the independence, health and continuing community involvement of older Americans, including: (1) the Lifespan Respite Care program; (2) Real Choice Systems Change Grants; (3) Nursing Home Diversion and Aging and Disability Resource Center (ADRC) provisions under the OAA; (4) the Social Services Block Grant (SSBG); (5) Section 202 Housing for the Elderly; (6) Senior Corps programs; and (7) geriatric education and training.

We must enact legislation to promote seniors’ civic engagement.

Research demonstrates that future generations of retirees are concerned about the future of the country and want to give back. The key to meeting the challenge of an aging America is to develop the human resource capital of this demographic. Volunteers of America has been a national leader in creating opportunities for older Americans to give back to their communities.

Volunteers of America supported the passage of the Generations Invigorating Volunteerism and Education (GIVE) Act, the Encore Service Act, the Serve America Act and particularly those proposals that seek to utilize the energy and talents of older Americans to help their local communities and build the capacity of nonprofits to make the best use of volunteers.

These proposals would create a Silver Scholarship Program to award seniors who volunteer for at least 500 hours of tutoring, mentoring or care giving activities, with a $1,000 transferable education award. The program would utilize the energy and talents of older Americans to help their local communities and provide them an additional legacy for their children and grandchildren.