Agenda Introduction: Who can Benefit from Maryland Communities I. for a Lifetime? The Importance of Communities for a Lifetime II. What is a Community for a Lifetime? III. Home and Community Based Services: The Heart of IV. Communities for a Lifetime Initiatives on Communities for a Lifetime V. University of Maryland work on Communities for a Lifetime VI. Discussion VII.
Introduction: Who can Benefit from Maryland Communities for a Lifetime?
Family Caregivers (AARP Public Policy Institute 2014) 65 % of people needing LTSS rely exclusively on unpaid caregivers 30% of people needing LTSS supplement unpaid care with paid caregivers 59-75% of caregivers are women Average age of caregivers: 49 years old; however 25% are between 65 - 75 years old Caregivers provide approximately 20 hours a week of unpaid care Source: http://www.aarp.org/content/dam/aarp/research/public_policy_institute/ltc/2014/raising-expectations-2014-AARP-ppi-ltc.pdf
Family Caregivers Caregivers perform diverse tasks, including: personal care, medication management, health care coordination, household tasks, bill paying, transportation, companionship, emotional support, etc. Family care often affects caregivers’ physical and emotional health, own financial situation, retirement security, career, and social network. The estimated economic value of unpaid caregiving contributions in U.S. was $450 billion in 2009. Source: http://www.aarp.org/content/dam/aarp/research/public_policy_institute/ltc/2014/raising-expectations-2014-AARP-ppi-ltc.pdf
The Importance of Communities for a Lifetime
Importance of Communities for a Lifetime • Address a growing elderly population and an economic imperative associated with elder care. • Honor consumer preferences to remain at home and in the community as they age. • Address challenges to aging in the community, and provide needed supports. Improve access to existing supports for aging in the community.
Projected Aging in the U.S. (Number of Americans age 65 and older in millions; U.S. Census Bureau, 2014) 120 98 100 88 82 74 80 56 60 46 40 20 0 Year 2014 2020 2030 2040 2050 2060 Source: https://www.census.gov/content/dam/Census/library/publications/2015/demo/p25-1143.pdf
Recent Research Addressing Communities for a Lifetime The Gerontologist. Special Issue: 2015 White House Conference on Aging (April, 2015), Vol. 55 (2) The Gerontological Society of America. Public Policy & Aging Report (Winter, 2015), Vol. 25 (1) Journal of Aging & Social Policy (2014), Vol. 26 (1- 2). Generations (Winter, 2013-14), Vol. 37 (4)
Maryland In 2010, 18.6% (1,058,253) of Maryland’s 5.7 million people were 60 years or older. By 2030, 25.8% of Maryland's projected population of 6.7 million will be 60 years or older. Maryland Department of Aging http://www.aging.maryland.gov/Statistics.html
2012 Estimates of Persons 60 and Older for Maryland's Jurisdictions Source: http://msa.maryland.gov/megafile/msa/speccol/sc5300/sc5339/000113/019000/019685/unrestricted/20140780e.pdf
Maryland’s 60+ Population Percent Change Projections by Jurisdiction, 2010-2040 St. Mary's 129.38% Charles 124.70% Frederick 101.56% Cecil 101.27% Calvert 99.05% Howard 82.34% Queen Anne's 79.12% Carroll 76.11% Caroline 75.97% Montgomery 71.08% Prince George's 68.30% Harford 68.05% Kent 67.15% Washington 64.79% State of Maryland 60.78% Wicomico 56.26% Garrett 55.37% Worcester 55.16% Anne Arundel 50.40% Dorchester 47.81% Talbot 45.05% Baltimore 38.35% Somerset 36.33% Baltimore City 23.60% Allegany 22.84% Source: http://msa.maryland.gov/megafile/msa/speccol/sc5300/sc5339/000113/019000/019685/unrestricted/20140780e.pdf
Prince George’s County: Aging Statistics (ACS) 2007 ACS 1-Year 2009 ACS 1-Year 2012 ACS 1-Year Change 2007-2012 Est. Est. Est. Total Population 65 years and over 74,218 78,816 90,544 +16,326 SEX Male 40.8% 40.8% 41.7% +0.9% Female 59.2% 59.2% 58.3% -0.9% Median age (years) 73.0 72.4 72.4 -0.6 RACE/ETHNICITY One race 99.0% 99.3% 98.8% -0.2% Two or more races 1.0% 0.7% 1.2% +0.2% White 41.1% 38.1% 31.2% -9.9% African American 52.0% 54.9% 61.4% +9.4% Asian 4.4% 4.5% 4.6% +0.2% Hispanic/Latino 3.4% 3.0% 4.1% +0.7% NATIVITY Native 87.2% 84.9% 84.8% -2.4% Foreign born 12.8% 15.1% 15.2% +2.4% Not a U.S. citizen 3.1% 3.8% 4.3% +1.2% LANGUAGE SPOKEN AT HOME/ ABILITY TO SPEAK ENGLISH 89.2% 88.7% 86.8% -2.4% English only (at home) 10.8% 11.3% 13.2% +2.4% Language other than English (at home) 0.6% 0.8% 1.0% +0.4% Speak English less than very well MARITAL STATUS Married 48.1% 48.2% 46.3% -1.8% Not Married 51.9% 51.8% 53.7% +1.8% HOUSEHOLDS BY TYPE Family Households 59.2% 56.3% 58.1% -1.1% Nonfamily Households 40.8% 43.7% 41.9% +1.1% Householders Living Alone 15.7% 17.6% 16.5% +0.8%
Challenges to Aging in the Community Health problems for many elders Caregiver needs Safety concerns Housing needs Financial needs Limiting attitudes about elders
What is a Community for a Lifetime?
Conceptual Model (WHO, 2007) 18 Transportation Outdoor Spaces & Housing Buildings Community Age-friendly Social Support & city Participation Health Services Communication Respect & & Information Social Inclusion Civic Participation & Employment World Health Organization (Ed.). (2007). Global age-friendly cities: A guide . World Health Organization. Retrieved from http://whqlibdoc.who.int/publications/2007/9789241547307_eng.pdf?ua=1
Policy Levels of Influence - Federal Affordable Care Act Promotes integrated care, population health, reducing unnecessary 30 day hospital re- Federal admissions, health literacy, patient- centered services National trends prior to the Affordable Care Act State Increasing emphasis on home and community-based services (Olmsted decision), focus on self-directed services, expansion of Cash &Counseling programs (individual budget model) Administration on Aging/ Administration for Community Living County Focus on aging and disability populations, Aging and Disability Resources Centers, self- management of chronic diseases
Policy Levels of Influence – State (MD) Shift from nursing home to community services Maryland Access Point Federal (Aging and Disability Resource Centers) 2011 Maryland State Communities for a Lifetime Act (unfunded) Balancing Incentive Program Money Follows the Person County Veterans-Directed Home and Community Based Services (VD HCBS)
Policy Levels of Influence - County Local partnerships (city/county) Federal Area Agency on Aging State Hospitals County Health Department County
Maryland Definition: MD Chapter 295, SB 822 The Department [of Aging] shall recommend criteria that local jurisdictions may use to certify communities for a lifetime, including: The extent to which a community has sought and plans to expand 1. public health, prevention, and wellness programs that serve older adults; The extent to which a community has sought and plans to expand 2. affordable transportation options; The extent to which a community has sought and plans to expand 3. affordable rental housing and the ability to own affordable homes; The extent to which a community has sought and plans to expand 4. employment, civic engagement, recreation, and leisure options for older adults; and The extent to which a community has sought and plans to expand other 5. initiatives that boost the abilities of older adults to age in place. The Maryland Communities for a Lifetime Program is currently unfunded Source: http://mgaleg.maryland.gov/2011rs/chapters_noln/Ch_295_sb0822E.pdf
Home and Community Based Services: The Heart of Communities for a Lifetime
Participant Expectations & Preferences Remain at home with family and within community Participant-directed options offer: increased choice, control, and flexibility than traditional services ability to hire own workers, including family and friends if preferred
Recent Federal Initiatives to Expand Home and Community-Based Services 2007 AoA Community Living Program 2008 Veterans Directed HCBS Program 2009: Independence at Home Act 2010: Patient Protection and Affordable Care Act Community First Choice Option Balancing Incentives Program Money Follows the Person (expanded) CLASS Act (Community Living Assistance Service and Supports) . Will not be implemented.
Aging and Disability Resource Centers 2003 Maryland one of first 12 states to receive grant to develop 2013 – Maryland Maryland Access Point (MAP) program statewide Statewide public web-based data resource Statewide standards for Options Counseling Expanded population served to all individuals with a disability Central partner in Medicaid Rebalancing Programs Umbrella for other rebalancing initiatives MAP website: http://www.marylandaccesspoint.info/
What are Participant-Directed Services? Participant-directed services: long-term services and supports to help people of all ages with all types of disabilities maintain their independence and determine what personal care services work best for them.
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