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The State of Senior Hunger in 2021

April 26, 2023

In this report, we provide a broad overview of the extent and distribution of food insecurity among seniors (those 60 years of age and older) in the United States in 2021, along with trends over the past two decades using national, state-level, and metropolitan-level data from the December Supplement to the Current Population Survey (CPS).We concentrate on two measures of food insecurity: food insecurity and very low food security (VLFS). These are based on the full set of 18 questions in the Food Security Supplement (FSS), the module used by the United States Department of Agriculture (USDA) to establish the official food insecurity rates of households in the United States. We define food insecurity by three or more affirmative responses and very low food security as eight or more affirmative responses in households with children and six or more in households without children. All VLFS persons are also included in the food insecure category.

Hunger Among Adults Age 50-59 in 2021

April 26, 2023

In this report, we provide a broad overview of the extent and distribution of food insecurity among individuals between the ages of 50 and 59 in the United States in 2021, along with trends over the past decade and a half using national, state-level, and metropolitan-level data from the December Supplement to the Current Population Survey (CPS). This study complements the annual report on senior hunger from Ziliak and Gundersen (2023).We concentrate on two measures of food insecurity: food insecurity and very low food security (VLFS). These are based on the full set of 18 questions in the Food Security Supplement (FSS), the module used by the United States Department of Agriculture (USDA) to establish the official food insecurity rates of households in the United States. We define food insecurity by three or more affirmative responses and very low food security as eight or more affirmative responses in households with children or six or more in households without children. All VLFS persons are also included in the food insecure category.

'Caring for Caregivers' Model Addresses Needs of Those Looking After Others

April 17, 2023

The journal of the Catholic Health Association of the United States (CHA), Health Progress, has published an article, "Aging - 'Caring for Caregivers' Model Addresses Needs of Those Looking After Others," as part of its spring 2023 issue.Family caregivers in the U.S. take on around 24 hours of complex care per week. Yet, nationally, caregiver needs are severely under addressed, leading to serious health consequences for millions of caregivers. This article explains the Caring for Caregivers Model at RUSH University Medical Center, which aims to address these needs by providing skilled and emotional support for caregivers through teams of physical therapists, occupational therapists, nurses, dieticians, pharmacists, and social workers.With support from RRF Foundation for Aging, The John A. Hartford Foundation, the model is expanding as part of the Age-Friendly Health Systems movement, of which the Catholic Health Association is a founding partner.

Unmet Promises: Reverse Mortgage Servicing Challenges and How to Preserve Housing Stability for Older Adults

February 6, 2023

There are roughly 480,000 reverse mortgages currently outstanding in the United States. This number is expected to grow as baby boomers age. The program was designed to allow older homeowners to borrow against their home equity without the risk of displacement, but reverse mortgages end in foreclosure much more often than they should. Reverse mortgage borrowers who fall behind on property charges face significant hurdles to obtaining a narrow set of home retention options. Heirs struggle to access information necessary to satisfy the reverse mortgage without the need for foreclosure. Spouses who are not listed on loan documents, often termed "non-borrowing spouses," can generally remain in the home if they keep paying the property taxes, but are not eligible for loss mitigation. Servicers too often foreclose based on supposed non-occupancy when the borrower is still occupying the home. Across all of these situations, poor servicing communication and insufficient access to housing counseling exacerbate the problems.Resolving these problems is particularly important because of the effect of preventable reverse mortgage foreclosures on the racial wealth and homeownership gap. The crisis of preventable reverse mortgage foreclosures does not impact all communities equally. Historically, people of color have been more likely to take out reverse mortgages, due to the legacy of discrimination and policies that limited their wealth-building opportunities, and they are also more likely to end up in reverse mortgage foreclosure. The heirs of reverse mortgage borrowers of color may lose significant home equity if they are not able to sell or refinance the home to satisfy the loan. When it comes to addressing the racial wealth gap and racial homeownership gap, reducing the number of preventable reverse mortgage foreclosures is an important and necessary step.The FHA reverse mortgage program has not lived up to its full potential. Based on the information uncovered in this report, we call on FHA and the Consumer Financial Protection Bureau (CFPB) to act quickly to prevent any additional home losses for this vulnerable population.

The Older Workers and Retirement Chartbook

November 16, 2022

The Older Workers and Retirement Chartbook shows the risks to retirement security and disparities in retirement preparedness, and explores the links between labor market challenges facing older workers and retirement insecurity.Updated February 9, 2023The COVID-19 pandemic exacerbated the plight of many older U.S. workers who cannot afford to retire yet are stuck in bad jobs or forced to leave the labor force before they're ready.The Older Workers and Retirement Chartbook from the Economic Policy Institute and the Schwartz Center for Economic Policy Analysis documents the risks and disparities in retirement preparedness among demographic groups. It offers a comprehensive look at the connections between labor market challenges facing older workers and retirement insecurity, using 33 charts to bring light to the problem.Before the COVID-19 pandemic, 4 in 10 Americans 55 and older were in the labor force, their highest participation rate in a half-century, the chartbook finds. The upward trend in labor force participation in recent decades reflects in part greater opportunities for older workers who want to keep working—but it also reflects retirement insecurity among some workers. The authors document how many older workers who cannot afford to retire face diminishing job quality and earnings due to a loss of bargaining power."Workers may work longer to close the retirement income gap, but this is neither a fair nor a realistic solution to a broken retirement system," says Monique Morrissey, EPI economist and co-author of the report. "Policy choices have weakened unions, eroded the real value of the minimum wage, and allowed employers to shift more responsibility for retirement onto workers. These all contribute to older workers' declining bargaining power."Black, Hispanic, women, disabled, and LGBTQ workers are at greater risk of hardship at older ages because of systemic problems. Black and Hispanic workers are more likely to lack access to retirement plans or have access to less generous plans. Lower lifetime earnings make it harder for workers of color, women, and people with disabilities to save for retirement. Women's greater caregiving responsibilities and longer life spans also put them at higher risk of old-age poverty despite closing the retirement plan coverage gap with men. LGBTQ seniors face adverse effects of past and present discrimination, including less access to spousal benefits."Everyone faces significant risks as they age, even well-off Americans," explains report co-author Siavash Radpour. "It is unrealistic to expect all older workers to save enough to guard against the possibility of losing their jobs, retiring during a market downturn, being widowed or divorced, or incurring expensive medical or long-term care needs."The authors outline several targeted policies that can improve the lives of older workers, including:Enforcing age discrimination laws;Expanding the Earned Income Tax Credit to help more adults without dependent children;Lowering employer health care costs for older workers;Changing performance metrics used to evaluate training programs that lead them to favor enrolling younger workers;Creating a dedicated Older Workers Bureau in the Department of Labor to help identify and address challenges facing older workers.But targeted policies are only one part of the solution. "Retirement insecurity comes from systemic problems, and these require systemic solutions," Barbara Schuster, co-author of the chartbook, explains. "Improving working conditions for all workers is vitally important, as is strengthening social insurance programs that offer critical protections."Broader policies include:Pursuing full-employment macroeconomic policies;Protecting workers' right to collectively bargain for better wages and working conditions;Raising the minimum wage;Enacting paid leave and scheduling policies to ensure workers can take time to care for themselves and their families;Increasing caregiver supports;Fixing the patchwork unemployment system;Better protecting workers from injury and illness;Expanding and removing barriers to accessing Social Security and SSI benefits;Ensuring access to affordable health care and long-term care.

RAISE Act State Policy Roadmap for Family Caregivers: Engagement of Family Caregivers in Health Care Systems

August 23, 2022

States play a critical role in fostering the development of well-coordinated, comprehensive, and high-value health care systems that help individuals achieve good health outcomes and high quality of life, including remaining in their own communities as long as safely possible. For many people with complex conditions, achieving those goals requires coordination across both the health care and long-term services and supports (LTSS) systems, as well as the support of family or unpaid caregivers.Family caregivers have a valuable role in both health care and LTSS systems. They provide services to their family members that might otherwise need to be provided by paid caregivers. They can be the first to recognize new symptoms, as well as changes in health conditions and individuals' ability to care for themselves. They often make it possible for their family members with self-care needs to live at home. However, current health care and LTSS systems are fragmented and not well-designed to support family caregivers, often causing them to become care coordinators across multiple systems. In addition, family caregivers may need training to recognize signs and symptoms that signal a change in care needs and a defined path for bringing that information to the attention of the care team.In recent years, states have taken steps to improve family caregiver engagement in care delivery and planning. As of 2022, 45 states and territories have enacted the Caregiver Advise, Record, and Enable (CARE) Act, legislation that requires hospitals to inquire if a patient has a family caregiver and, if so, include the caregiver in the discharge process and instruct them about the medical and nursing tasks they will do at home. Although the CARE Act is enacted in 45 states and territories, it lacks enforcement, which presents an opportunity for states to better support the act. State agencies can establish policies which align with the act, that are designed to ensure that family caregivers are included in care planning both initially and throughout the care process.State Medicaid agencies have put in place services, such as structured family caregiving programs, that help family caregivers deliver and coordinate care by providing the caregiver with payment, individualized training, and a means for providing ongoing input into care planning. Area agencies on aging (AAAs) can also develop connections with home- and community-based services and health systems to assist in expanding referral systems to support caregivers. State policymakers hope that by adopting these policies they will not only help individuals achieve better health outcomes and quality of life but also help health systems reduce avoidable hospitalizations and readmissions — and ultimately contain cost by improving the delivery of care.

Systems of Cross-sector Integration and Action across the Lifespan (SOCIAL) Framework

July 4, 2022

The benefits of social connection and conversely the risks associatedwith disconnection (e.g., isolation and loneliness) are welldocumented. This evidence cuts across scientific disciplines includingmedicine, sociology, psychology, epidemiology, neuroscience,communication, and anthropology, and spans multiple scientificmethodologies including prospective longitudinal, cross-sectional,experimental, and randomized controlled trials. This has led to a rich,but complex and dynamic literature leading to questions about howto implement and how to best promote health and reduce populationhealth risk. The weight of the evidence has prompted thedevelopment of a systemic framework to address social connectionby the Foundation for Social Connections' Scientific Advisory Council,chaired by Dr. Julianne Holt Lunstad.

Measuring Your Impact on Loneliness in Later Life

July 1, 2022

What does this guidance cover?Are you working to prevent or reduce loneliness in your community? Can you articulate the difference you are making to the lives of older people?We're all working in an increasingly competitive funding environment, and we all need to be able to demonstrate robustly that we make a difference. Funders across the public, voluntery and private sectors also face their own financial pressures and need evidence that the programmes they fund are delivering real change for the people they support.This guidance offers information and advice on choosing and using a scale to measure the impact of your services on loneliness in older age.

Racial and ethnic disparities in the United States: An interactive chartbook

June 17, 2022

This interactive chartbook provides a statistical snapshot of race and ethnicity in the United States, depicting racial/ethnic disparities observed through: (1) population demographics; (2) civic engagement; (3) labor market outcomes; (4) income, poverty, and wealth; and (5) health. The chartbook also highlights some notable intersections of gender with race and ethnicity, including educational attainment, labor force participation, life expectancy, and maternal mortality. The findings are bracing, as they show how much more work we need to do to address longstanding and persistent racial inequities. Most charts include data for five racial/ethnic groups in each of the charts—white, Black, Hispanic, Asian American and Pacific Islander (AAPI), and American Indian and Alaska Native (AIAN). In the charts and text, "Americans" refers to all U.S. residents, regardless of citizenship status.As these efforts illustrate, collecting and maintaining data sources that are representative of the entire U.S. population is an essential first step toward overcoming the invisibility, neglect, and lack of understanding experienced by many communities of color. Future work on this project will involve identifying comparable data from alternative sources that fill in as much of the missing information in the chartbook as possible.Click "Download" to view this online, interactive resource.

CalAIM Community Supports: Promoting Independent Living Among Older Adults and People with Disabilities

April 26, 2022

Through CalAIM (California Advancing and Innovating Medi-Cal), a multiyear initiative to transform the Medi-Cal program, managed care plans now have the option to offer any of 14 Community Supports that provide person-centered services to address a variety of social drivers of health. Several of these Community Supports could help older adults and people with disabilities remain in their own homes, participate in their communities, and live independently in the setting of their choice.To support understanding and increased uptake of these services over time, this report provides an overview of and evidence summary for six Community Supports most relevant to supporting independent living for older adults and people with disabilities, including:Respite Services. Short-term services aimed at providing relief to caregivers of those who require occasional or temporary assistance or supervision.Nursing Facility Transition / Diversion to Assisted Living Facilities. Services that help people remain in the community by facilitating transitions from a nursing facility back into a home-like, community setting or prevent nursing facility admissions for those with imminent need.Community Transition Services / Nursing Facility Transition to a Home. Nonrecurring support, including setup expenses, to avoid further institutionalization and help people remain in the community as they return home from a licensed nursing facility.Personal Care and Homemaker Services. Supports for people needing assistance with daily activities, such as bathing, dressing, cooking, eating, and personal hygiene.Environmental Accessibility Adaptations (Home Modifications). Physical adaptations to a home when necessary to ensure health, welfare, and safety, or promote greater independence at home through improved functionality and mobility.Medically Supportive Food / Meals / Medically Tailored Meals. Meal services to help people achieve their nutritional goals at critical times (such as after a hospital or nursing facility stay) to regain and maintain their health.

How Discrimination in Health Care Affects Older Americans, and What Health Systems and Providers Can Do

April 21, 2022

Racial and ethnic discrimination has a significant impact on the health of people of color, affecting mental health and contributing to high blood pressure, negative health behaviors, and early aging. For Black older adults, the cumulative effects of race-related stress experienced over the course of a life can increase the risk for mental and physical health problems.In health care settings, experiences of discrimination can include providers dismissing a patient's symptoms or health concerns, offering different treatment based on a patient's type of insurance, or not providing care in a patient's preferred language.We analyzed findings from the Commonwealth Fund 2021 International Health Policy Survey of Older Adults to examine experiences of racial discrimination in health care settings among Latinx/Hispanic and Black older adults. (See "How We Conducted This Study" for more details.) To provide some cross-national context, we first detail the extent to which older adults in 11 high-income countries believe their national health system treats people unfairly because of race or ethnicity. We then look more in-depth at the United States and report on older Americans' experiences of discrimination and the consequences of health providers' unfair or dismissive treatment. Finally, we consider steps that U.S. health system leaders, health care educators, policymakers, and others can take to address discrimination and dismantle systemic racism in health care.

The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff

April 6, 2022

Nursing homes play a unique dual role in the long-term care continuum, serving as a place where people receive needed health care and a place they call home. Ineffective responses to the complex challenges of nursing home care have resulted in a system that often fails to ensure the well-being and safety of nursing home residents. The devastating impact of the COVID-19 pandemic on nursing home residents and staff has renewed attention to the long-standing weaknesses that impede the provision of high-quality nursing home care.With support from a coalition of sponsors, the National Academies of Sciences, Engineering, and Medicine formed the Committee on the Quality of Care in Nursing Homes to examine how the United States delivers, finances, regulates, and measures the quality of nursing home care. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff identifies seven broad goals and supporting recommendations which provide the overarching framework for a comprehensive approach to improving the quality of care in nursing homes.