As you will see, from the population pyramids below, currently in the United States, the numbers of younger, working ,adults out number people over the age of 65. This is important because working adults pay payroll taxes that support current Social Security and Medicare recipients. As you view these pyramids, notice how the working age to retirement age mix changes. Think about the support of this age wave? The look at the 20-30 age group coming. It is quite large.

 Once you put in the data click on the population pyramid graph from the drop down menu to see it visually. Source: U.S. Census Bureau, http://www.census.gov/population/international/data/idb/informationGateway.php   International Data Base

III.  Policy Framework:

Currently, the United States does not have a coordinated plan for population aging. Remember the aging phenomenon is new. Your author states that: " often generals prepare for the next war by reliving the last one."

We have no history to guide us nor role models to follow their examples. I've heard it said you can tell the pioneers by the arrows in their backs. Carving out new policy is difficult. No one wants to be wrong and waste public funds. There is little experience to guide us.

For example: Until very recently, Japan has not had a formal aging  policy because of filial responsibility. That means  traditionally families were responsible for their aging parents.  As their society becomes more Westernized (women entering the work force) they are forced to create an aging network. Today, social workers and educators from Japan  come to the U. S. to study our system.

Many policy and law makers do not understand the needs of aging people and that complicates the issue. Often their stereotypes and myths about aging get built into their programming and laws. 

This wastes public funds because these programs do not meet the needs of the elderly. There are many other reasons why we must properly frame the policy debate concerning the future of an aging society. 

IV.  Diversity Of The Elderly (differences and variety):

One of the most outstanding characteristics of the elderly population is their differences. They are not a homogeneous group ( not all alike). 

If aging starts at age 65 and the oldest (documented ) person who ever lived was 122 years, then old age, or the elderly years, can potentially span 57 years. age 122 minus 65 equals 57years.

These 57 years represent different generations with different values, beliefs, and very different needs. For example, as you learned, people over age 85 (the fastest growing segment of the elderly) are four times more likely to need services.

There is also a great diversity in economic well-being of older adults

• 25% have incomes of less than $5,000
• 20% have incomes of less than $10,000
• 25% have incomes of more than $30,000
  assets.opencrs.com/rpts/RL33387_20091104.pdf

Some elderly are very well off and others are marginal or poor.

Falling below the poverty rate are:

• 23% Hispanic        46% if they are unmarried women
• 36% blacks           63% if unmarried women
• 24% unmarried white women

There is also a relationship between income and health. Lower income populations suffer more chronic health problems. This is because they are less likely to have health insurance and thus preventative  care. They are also more likely to have a lower quality of healthful foods and crowded or inadequate living conditions.

V. Importance Of The Diversity

Society tends to see all older adults as the same with the same needs. Yet  clearly the incomes, and thus the needs, of the very old  are very different from the young more affluent elderly. When we fail to recognize the heterogeneity (differences) of our older population, social problems get distorted or not defined correctly. These misunderstandings can lead to poor policy because stereotypes of the elderly and their needs
does not create a realistic basis for policy making.

Remember, images and stereotypes affect decision making and can create programs that do not affectively target the elderly thus wasting precious public funds.

Does Gerontology Education Really Matter?
 
As a board member of a community senior center I was involved in hiring a director for the center. Although not educated in gerontology, the  person the board favored, and hired, had years of decision making experience in the aging field.

For a fund raising activity he sponsored a dance. He hired a band, catered food, set up a bar and held the event at 8 p.m. on Friday night. No one came.

Large sums of money were lost because this director lacked the basic knowledge of adult aging.  Most  elderly suffer from presbyopia, a hardening of the lens of the eye. This a condition  does do allow people to see well at night reducing their participation in night time functions.

Refer to Handout:  The Elimination of Premature Disease (also located in week 4)

Did You Know? The Elimination of Premature Disease chart shows the effects of postponing chronic diseases by either improved lifestyle, eliminating it through research or both. For example: according to this chart if we could postpone heart disease from the current average age of  50 to an average age of 65, one might never live long enough to develop the complications associated with this disease. Their natural lifespan would not allow them to develop these complications. In other words, a person would die of old age before the progression of the disease.  
Check out this article: Study Finds Healthy Habits Slash Medicare Costs  (don't confuse this with your arthor's mention of the article by Louise Russell, Is Prevention Better than Cure. She is speaking strictly about value for the tax dollar,  not quality of life. Some say a more accurate title would have been, "Is prevention better value than cure"

VI.  Highlights of Medicare: Health Insurance (don't confuse this with Medi-cal a needs based program)

1. When one is eligible for Social Security, they are automatically eligible for Medicare, a medical insurance plan for older adults. Because of rising health care costs, the aging of the boomers, and the increase in longevity, Medicare  is one our most vulnerable entitlement programs. The cost of Medicare (to the government) is increasing at 3 times the rate of inflation.
   

The major provisions of the program are funded through a payroll tax. The same tax paid into Social Security. Medicare does not cover the cost of long term or nursing homes (except for short rehabilitation stays) or home care. There are three parts to Medicare. Part A Part B and Part D (drug coverage)

• Part "A" is  hospital insurance and does not pay for prescriptions, dentists or eye doctors. For most people there is no premium (if they paid into the system for 10 years).
  
• Part "B" is optional and costs an additional $104.90 per month for most enrollees.  It covers 80% of doctor's visits, some home care, and some rehabilitate care (such as physical therapy and occupational therapy).  
  

• Medicare Part D (outpatient Prescription Drug Insurance) is the part of Medicare that provides outpatient prescription drug coverage. Part D is provided only through private insurance companies that have contracts with the government—it is never provided directly by the government (like Original Medicare is). 

For skilled nursing care Medicare Part A will pay

• Up to 100 days if you continue to meet Medicare’s requirements - that means coverage comes after a hospitalization.

• You pay nothing for the 1^st 20 days ( provided you have been hospitalized for a least 3 days and need rehabilitative services. 
• For the next 80 days the patient pay $152 per day and no benefits are available after 100 days. (2014 figures)
•  Long term custodial care is not provided and a need for nursing or rehabilitation services but be prescribed by a doctor . 

• Hospital Benefits  covered under Part A- Pays when you are Hospitalized. 
  When you are admitted you will have to pay a deductible of $1260. ( 2015 figure).
  
• After 60 days your share of costs are $310. per day and after the 90^th  
  day the cost increases to $610. per day.

All of the three parts of Medicare require a deductible (the amount the patient must pay before benefits kick in) and out of pocket co-payments (the difference between what the plan covers and the actual cost). This site has a good summary of those costs. http://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html

2. As the population of older adults increases and health care costs soar, our Government has tried to control  rising costs with something called Diagnostic Related Groups or DRG's.   DRG's consist of a chart outlining  what Medicare will pay for certain  illnesses, including  how many days a person can stay in a hospital for any specific procedure.

Medicare also tried to lower costs by using HMO's or Health Maintenance Organizations. But this option created barriers to health care for older adults. HMO's are a packaged basket of health care products. If the service one needs is not in their covered expenses, then coverage is denied. Many procedures older adults want are not covered costs for HMO's (such as multiple home visits).

Many of the non-covered items are products only older people need such as: 

• home care (most cover just a few visits)
• adaptive equipment (walkers, canes, wheelchairs etc.)
• specialized geriatric care
• long-term care/ community or institutionalized

HMO’s that have contracts with Medicare are a network of doctors, hospitals, and other health care providers that agree to give care in return for a set monthly payment from Medicare. Seniors choose to sign their Medicare benefits over to the HMO in return for their care.

Because of multiple complaints of long authorization times, service limitations, and the administration of HMO’s many customers choose to remain in a fee for service system such as straight Medicare. You may later dis-enroll from the HMO plan if you become dissatisfied with their services.

Medicare does not cover :

• services outside the U.S.
• routine physical exams
• eye exams
• hearing aids
• dental or foot care chiropractic
• immunizations or
• custodial care.

3.   Medigap Insurance

Traditional "fee-for-service" Medicare coverage (Part A and Part B) provides basic health care coverage. It can not pay all of your medical expenses and it does not pay for most long-term care.

Insurance to fill in the gaps is often called Medi-gap. Medi-gap pays for the deductibles, co-payments and non-covered expenses. 

It is difficult to summarize Medi-gap insurance  since each person can choose a level of coverage desired to suit them. The Health Care Financing Admin. publishes a booklet with information on supplementing Medicare coverage. It’s called Guide To Health Insurance For People With Medicare  and is available from any Social Security office or by writing to:

Medicare Publications, Health Care Financing Admin

7500 Security Blvd.
Baltimore, Maryland 21244-1850
 or visit them on-line 

Guide To Health Insurance For People With Medicare http://www.medicare.gov/Publications/Search/Results.asp?PubID=02110&Type=PubID&Language=English

 

Summary: 
People confuse individual aging with population aging. We have many programs in place for individual aging, such as meals on wheels, home visitors and various in-home assistance. However, population aging is not as well developed. Society is not structured for an aging population.

This is important because as the aging population grows and the working age shrinks, tax dollars to support programs such as Medicare and Social Security will be less. Keeping elders functioning in society can extend their independence and thus decrease the length of time and their reliance on social programs. Plus they continue to pay taxes and support social programs

 Perhaps cars that are adapted to older drivers, signs and labels large enough to read, or homes that accommodate an aging body would be a nice place to start. Dedicating more dollars to finding cures for chronic diseases might also delay dependence.  But a society that finds a place and purpose for older adults will be our biggest challenge.

Because today fewer than 10% of people working in the field of aging are educated in Gerontology, policies and programs put into place do not best utilize the scare resources available. Instead they reflect the stereotypes, and inaccurate assumptions that all elders are alike.

 

You can post questions regarding lecture materials to the discussion board, or visit me during office on campus or on line

   Don't forget to check the Assignment Link  for this week's  assignment.