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Building Healthier Communities
BUILDING Healthier COMMUNITIES FOR AN Aging POPULATION
STATES ARE FACING AN UNDENIABLE CHALLENGE FOR THE FUTURE— nearly one in five people in the U.S. will be over 65 years old by 2030. Will these seniors have access to medical care, transportation, housing, and the income to pay for it all? Fixed incomes and high health care costs associated with aging are at odds. Some state leaders are planning now to build communities that can accommodate this impending shift in demographics.
by Debra Miller and Emily McCarthy
Maryland discovered some surprising senior needs through a larger endeavor called Health Enterprise Zones, or HEZs, that targeted five impoverished areas of the state with poor health outcomes. A group of state officials, academic leaders, public health experts and community leaders came together to devise plans to improve the five communities. Under SB 234, adopted in 2012, Maryland appropriated $4 million for a period of four years for the HEZs. The law set out four goals for the HEZs: to reduce health disparities; to reduce hospital admissions and readmissions; to reduce health care costs, including emergency room visits; and to improve health outcomes, Johns Hopkins University professor Michelle Spencer said. Spencer was director of prevention and health promotion for the state Department of Health and Mental Hygiene and led the early efforts of the HEZs. “We need innovative solutions to address health disparities in our communities,” she said. “This project took the time and commitment of many people that want to see improved conditions for our citizens.”
The Annapolis Community Health Partnership, or ACHP, built a health clinic within the Morris H. Blum senior housing facility for its residents and the surrounding community to provide better access to primary care. Data from local resources revealed that in one year there were 220 medically related 911 calls from the Morris H. Blum building. In six months alone, 73 Morris H. Blum residents experienced 175 emergency department visits, with 38 resulting in admissions. Fewer than 10 Morris H. Blum residents accounted for 41 percent of those 175 emergency department visits. Spencer said the clinic has been able to reduce medical 911 calls, emergency department visits, and admissions and readmissions among the Morris H. Blum residents. In the U.S., a majority of long-term care for seniors is carried out by family and friends, or “caregivers.” But this poses additional challenges for local employers and the caregivers. Providing care can lead to missed days of work, additional out-of-pocket spending, and mental and physical stress on caregivers. According to AARP, caregivers spend $7,000 each year on average for out-of-pocket costs associated with care for another person not reimbursed by any insurance or program. What Is the AARP ACT? “We need to develop solutions that ensure a smooth transition from one facility to another, and that caregivers receive the instruction they need for the growing number of complex medical tasks they are performing at home,” said Dr. Jean Accius, vice president of Independent Living/ Long-Term Services and Supports at the AARP Public Policy Institute. To assist caregivers, AARP developed the Caregiver Advise, Record, Enable Act, or CARE Act, which they have been urging states to adopt since 2014. The AARP CARE Act features three critical components: 1) The name of the caregiver must be recorded in medical records when a patient is admitted into a hospital or rehabilitation facility. 2) The caregiver must be notified if the patient is discharged or transferred to another facility. 3) The hospital or rehabilitation facility must provide live instruction to the caregiver for any medical tasks that the caregiver will need to “One of the surprising things we discovered was that many seniors calling 911 simply wanted someone to talk to or needed help with activities of daily living. They should not have to turn to emergency services for help.”
» Michelle Spencer, Johns Hopkins University Professor and former director of prevention and health promotion for
Maryland’s Department of Health and Mental Hygiene
perform in the home. Currently, 36 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands have adopted the CARE Act. One of the earlier states to adopt the CARE Act was Oklahoma in 2014, as a way to reduce costly hospital readmissions and enable individuals to continue to live independently in their own homes. In 2013, the state spent almost $63 million for hospital readmissions within 30 days of discharge for Medicaid enrollees. “This important new law will ensure that patients are properly cared for after they are released from a hospital,” bill sponsor Rep. Harold Wright said in a press release after the bill passed. “It is critical that caregivers are given the appropriate information to ensure optimal post-release care.” AARP has maintained a strong focus on long-term care for seniors over the years, establishing the Long-Term Services and Supports Scorecard, or LTSS Scorecard, in 2011. The LTSS Scorecard measures progress across the states with 23 key performance indicators of a high-quality system of care for older adults, people with disabilities and family caregivers. In the 2017 LTSS Scorecard, Washington ranked number one, Minnesota ranked number two and Vermont ranked number three. “The overall finding from the scorecard has been that changes in the states are slow and somewhat uneven, and that there is a wide variance in services,” Accius said. “We want states to use this tool to identify opportunities for improvement.” States made significant progress in reducing inappropriate use of antipsychotic medication and improving support of family caregivers, he said. Improvements are needed in employment rates for people with disabilities and rates of transitioning longer-stay nursing home residents back into the community. State Sen. Tony Lourey is confident that Minnesota is moving in the right direction. “We are faced with an aging workforce, and we have to be prepared to keep them engaged in working, staying engaged in their community and encourage them to take care of themselves,” Lourey said. Minnesota has launched a variety of community
The CARE Act improves coordination and communication between family caregivers, their loved ones and hospitals.
initiatives that support and engage seniors. The Honoring Choices program was designed to help Minnesotans plan for the future, including the development of a written plan for loved ones and health care providers to follow. Lourey said this program is part of a larger initiative to encourage a better quality of life for seniors. “We strive to encourage conversations with seniors about the quality of life they want for their elderly years,” Lourey said. It is all about helping them create the life they want. If they can continue to work, volunteer and stay engaged in our community—that benefits everyone.” AARP hopes that states will continue these types of discussions and be open to a different approach for their state. “State resources will be challenged as this segment of the population grows. Community-based care will be a critical component for success,” Accius said. “And states need to consider partnering with the private sector and other stakeholders in the community. The conversations need to be happening now.”
Shining a Spotlight on Women Veterans
by Shawntaye Hopkins
An exhibit that features large portraits of Oregon women veterans made its debut in February then traveled the state before making its way to the East Coast.
Dubbed “I Am Not Invisible,” the exhibit aims to create a dialogue about women veterans and includes a diverse group of women, ages 27 to 102, representing each military branch from across the state.
“As a woman veteran, you often feel invisible,” said Elizabeth Estabrooks, women veterans coordinator at the
Oregon Department of Veterans’
Affairs, or ODVA, who spearheaded the project.
Today, there are more women veterans than ever before and states are working not only to recognize this population but also to create needed services and supports for them. The percentage of women and minority veterans is expected to continue increasing over the next several decades even as the overall number of veterans decreases.
Women are not new to the armed forces.
They have served since the American
Revolution when many women disguised themselves as men in order to fight. Each decade since then has presented more opportunities for women to serve in increasingly varied capacities.
Although not officially recognized as veterans until well after World War II, women comprised 9.4 percent of the total veteran population in 2015 and could comprise 16.3 percent of all living veterans by 2043, according to a report published in February 2017 by the Department of Veterans Affairs’ National Center for Veterans Analysis and Statistics, titled Women Veterans Report: The Past, Present, and Future of Women Veterans.
Estabrooks, an Army veteran, said the invisibility that women veterans often feel applies to policies, veteran affairs offices and social settings. Often data, including data about homelessness and suicide, does not accurately reflect women veterans. This can limit conversations, for example, about the high rate of suicide among women veterans compared to their civilian counterparts. The default image of a veteran is usually a white that image but rather expand it so it also includes women. She wants people to “think black women, transgender women, Latina women, immigrant women, young women, old women.” “I want people to think ‘woman’ when they think veteran in addition to thinking ‘men,’” she said. Office under the Georgia Department of Veterans Service, or GDVS. Georgia state Sen. Larry Walker III sponsored the bill. “We want to make sure that all our veterans know how much we appreciate their service and that they are taken care of, treated with respect and receive the veteran benefits they have earned,” Walker said in a Georgia Senate press release. There are about 750,000 veterans in Georgia
male. Estabrooks said she doesn’t want to replace
Percent of veteran population who are women Source: Women Veterans Report: The Past, Present, and Future of Women Veterans. and about 93,000 of those veterans are women. GDVS Assistant Commissioner Dan Holtz said an officer in the GDVS Appeals Division previously advocated for women veterans as an additional duty. Now, the new office and its director are better positioned under the GDVS Central Office and more attention is being placed every day on advocacy for women veterans. Women veterans are receiving more and more recognition across the state each year, Sin said. The third week of March has been designated Women’s Military History Week, during which the governor issues a proclama tion and events are held that recognize the achievements of women who have served in the armed forces.
Sin said statewide surveys reveal that one of the biggest problems among women veterans is lack of recognition. Programming and policies such as an initiative that launched in 2015, allowing California veterans to obtain a veteran designation on their driver’s licenses, have helped women to identify themselves as veterans and helped mend ideas about what a
veteran looks like.
The women veterans coordinator position in Oregon was created after Gov. Kate Brown signed House Bill 3479 in 2015. In the role, Estabrooks focuses on outreach, advocacy, data, research and policy. She works with community partners to help women veterans receive needed services and ensure they are not forgotten. “My role is to make sure that those connections are being made around the state and that people are thinking about women veterans,” she said. Governmental offices and positions focused on women veterans are being created at a fast pace across the states. In May, Georgia Gov. Nathan Deal signed legislation that established a Women Veterans “It’s not all about claims, it’s not all about appeals, it’s about women veterans,” Holtz said. In California, Lindsey Sin was appointed deputy secretary of Women Veterans Affairs in December 2011 to advocate for women veterans on issues, including housing, sexual assault and health care. The position has existed since the mid-1990s. But during Sin’s tenure, the office has grown and created more ways to learn about the 143,000 women veterans in the state and reach out to them, including the creation of a roster of women veterans, websites and social media.
“Women veterans are becoming a larger and larger makeup of the veterans population ... services are going to need to be aligned to the needs of women,” she said.
