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Service Coordinators Our Silent Heroes

1/13/2021

 
At B’nai B’rith we are a proud sponsor of affordable senior housing across the country. The goal of our Senior Housing Network is to provide seniors with quality, affordable housing in a secure, supportive community environment. What makes many of our buildings special are the service coordinators who work at the properties and connect residents with services in the community that allows seniors to age in place and not move to more costly facilities. Service coordinators play a vital role in the operation of our senior housing buildings, and their work has never been more critical than during the pandemic. 

Prior to the virus, interacting with residents was a big part of service coordinators’ job. Obviously, given rules regarding social distancing, speaking with residents in close proximity has become problematic. Along with the limitations the pandemic has put on older Americans, the role of service coordination has dramatically changed. Recently, the American Association of Service Coordinators (AASC) and Harvard University’s Joint Center for Housing Studies issued a report entitled “For Older Adults in Publicly Funded Housing During the Pandemic, Service Coordinators Help Build Resilience,” detailing the ways service coordinators’ jobs have changed because of the virus. Results are based on surveys from service coordinators in June and July who are members of AASC, with 79 percent of those surveyed being people who work with individuals over 62 years old. 

For starters, service coordinators have been asked to perform work left vacant by in-person or personal care assistants that normally help residents with housekeeping, laundry and dressing. Because of the pandemic, this type of assistance has not been as accessible to residents. In addition, the study reported that many residents did not have enough food, medicine and household supplies to isolate for a week. Consequently, service coordinators worked to remedy these problems, in part by reaching out to local donor organizations and distributing resources once it reached the property. 

The study further reports that 74 percent of service coordinators found their residents exhibited more loneliness and anxiety. One service coordinator who was surveyed wrote, “I have had many conversations with residents who are very lonely, anxious and tired of being isolated. A lot of our residents have positive attitudes during this time, but it has taken a toll on their mental/emotional health. [I have] observed residents who are sad and feeling desperate to socialize.” In response, service coordinators encouraged residents to decorate their doors and created writing contests. In addition, these coordinators scheduled activities like scavenger hunts and bingo that allowed residents to enjoy themselves and practice social distancing. 

Samara Scheckler, postdoctoral fellow at the Harvard Joint Center for Housing Studies and co-author of the study said, “For older adults living in publicly-funded housing, the early months of COVID-19 highlighted the critical role service coordinators played in maintaining the stability of resident housing and health through a period of major change. With interruptions in access to food, medicine, medical care, personal assistance and social supports, service coordinators filled in many gaps. They linked residents to community resources, managed public benefits, coordinated informal supports, facilitated residents’ access to and ability to use technology, communicated emerging public health guidance and knit together peer-support networks. Service coordinators ensured residents had access to the resources needed to manage their physical and mental health and maintain their housing through intense disruption.” 

The study’s findings are similar to what the B’nai B’rith Center for Senior Services (CSS) is hearing from our Senior Housing Network. For instance, once the pandemic began we started a weekly B’nai B’rith Senior Housing Network Zoom call, and we held our yearly Senior Housing Conference and Managers and Service Coordinators Meeting virtually. These meetings provide a forum for property managers and service coordinators to share new ideas, hear success stories and speak directly with their colleagues across the country facing similar challenges. Also during these virtual meetings, issues such as social isolation were addressed using case studies and by providing resources through our website. 

Furthermore, we were able to discuss COVID-19 related scams with our building staff. As an example, we showed an email where the sender claimed to be from the Federal Bureau of Investigation (FBI) and offered five million dollars in exchange for personal identifying information. Hat-tip to our sponsored building, B’nai B’rith Chesilhurst House, for bringing this scam to CSS’s attention and giving us the opportunity to make our network aware of the problem. The Harvard/AASC study also reported service coordinators making their residents aware of scams during the pandemic. 

Throughout the pandemic, B’nai B’rith service coordinators have worked to combat social isolation and partner with community organizations to provide food to residents. B’nai B’rith Apartments in Allentown, Pennsylvania and Covenant House in Tucson, Arizona have worked with community partners to ensure residents have groceries during the pandemic. Building staff have packed up food and other supplies, and then coordinated to have them distributed to residents while practicing social distancing. Regarding social isolation, staff have orchestrated activities like painting, exercises classes and bingo, all in a safe and distant manner. Service coordinators in these buildings have also spent hours with residents on the phone and try to communicate with the residents in person when feasible. 

With all the work being done by service coordinators in federally subsidized senior housing, it’s time for Congress to appropriate additional money to be used for more service coordinators and supplies. Keep in mind only around fifty percent of federally funded senior housing buildings eligible for a service coordinator have one, and even buildings with one could use the additional help. Funds should also be allocated for increasing Wi-Fi accessibility that would enable service coordinators to speak with building residents while practicing social distancing, as well as make it easier for residents to participate in telehealth. Since the pandemic started, B’nai B’rith and AASC have advocated to Congress for maximum funding for affordable senior housing to combat the negative consequences of the pandemic. Alayna Waldrum, consultant to AASC said, “Service coordinators have been essential to the success of affordable senior housing across the country, and during the pandemic. It is imperative that Congress appropriates additional funding for resources to provide for more personal protective equipment, emergency service coordinators and increased Wi-Fi availability in senior properties. These resources would help alleviate some of the negative impacts of the virus and resulting isolation.” 
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Everyone who works with a service coordinator should take a second and appreciate the invaluable service they have performed during the pandemic. It’s not surprising that CSS has found our Senior Housing Network’s service coordinators’ experiences run parallel to the AASC/Harvard study. Ensuring residents have food, supplies, medicine and don’t suffer from social isolation are common themes. Service coordinators around the country have answered the call to best serve their residents during the pandemic and deserve our heartfelt gratitude.

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Evan Carmen, Esq. is the Legislative Director for Aging Policy at the B’nai B’rith International Center for Senior Services. He holds a B.A. from American University in political science and a J.D. from New York Law School.  Prior to joining B’nai B’rith International he worked in the Office of Presidential Correspondence for the Obama White House, practiced as an attorney at Covington and Burling, LLP, worked as an aide for New York City Council Member Tony Avella and interned for Congressman Gary Ackerman’s office. Click here to read more from Evan Carmen.

Social Security and a Changing Administration

12/15/2020

 
As we are approaching the one-year anniversary of the pandemic, it is clear that businesses have struggled to manage the effects, including the disparate policies used with their workers. As referenced in my blog "Social Security: 85 Years of Lifting Seniors out of Poverty," the pandemic has caused less payroll tax to be collected, thereby decreasing revenue to Social Security and consequently decreasing the life of the Trust Fund. Furthermore, President Donald Trump over the summer signed an executive order impacting the solvency of the Trust Fund by deferring payroll taxes for the rest of the year and advocated for the cuts to be permanent. B’nai B’rith International expressed disappointment with the executive order because the payroll tax is a significant source of revenue for Social Security and any potential cuts will erode one of our nation’s most important programs for seniors. 

​With the White House transitioning from a Trump to Biden administration, it’s important to examine how President-elect Biden’s proposed policies could impact Social Security. First, over the summer Biden campaigned against cuts to the payroll tax. Despite the pandemic, at least Social Security shouldn’t see any further decreases to revenue by a payroll tax cut. 

Secondly, Biden proposed important changes to Social Security that could impact revenue and expenses, however, according to the Urban Institute does not solve Social Security’s long-term problem of being able to pay all of its obligations. Biden campaigned on increasing Social Security benefits for widows, people 78 to 82 years old and for certain low-income workers such as people who have worked more than 30 years. Former Senator Tom Harkin and Max Richtman, president and CEO of the National Committee to Preserve Social Security and Medicare, said in the Des Moines Register, "The nonpartisan Social Security Administration has projected that a single provision of the Biden plan — increasing the minimum benefit for low-income, lifetime workers — would lift more than one-half million seniors out of poverty by 2030."

Regarding the revenue to pay for these proposals, according to the Urban-Brookings Tax Policy Center Biden proposed a payroll tax increase for income above $400,000 a year that could generate $740 billion in revenue over ten years. It’s important to remember that people are only taxed on wages up to $137,700 for the purposes of Social Security. 

Another component of Biden’s plan would potentially allow people that serve as caregivers for family members who are young or have a disability to earn Social Security credits. This would reward family caregivers who are being unfairly punished for the purposes of earning Social Security at retirement. Similar to Biden’s other proposal referenced above, the plan would be funded by raising taxes on real estate investors whose incomes exceed $400,000 a year and, according to the campaign by, "taking steps to increase tax compliance for high-income earners." 

The original purpose of Social Security was to lift seniors out of poverty. By providing needed increases to Social Security benefits, and not raising taxes on middle and low-income individuals, Biden’s proposals should be given consideration by Congress. Unfortunately, we know that life in politics is never that simple. While I expect some possible bi-partisan cooperation in Congress around COVID-19 stimulus legislation, it remains unclear what other legislation can be signed into law. However, here is to hoping a bi-partisan agreement can be reached in Congress that benefits seniors throughout the country.

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Evan Carmen, Esq. is the Legislative Director for Aging Policy at the B’nai B’rith International Center for Senior Services. He holds a B.A. from American University in political science and a J.D. from New York Law School.  Prior to joining B’nai B’rith International he worked in the Office of Presidential Correspondence for the Obama White House, practiced as an attorney at Covington and Burling, LLP, worked as an aide for New York City Council Member Tony Avella and interned for Congressman Gary Ackerman’s office. Click here to read more from Evan Carmen.

When is the Suffering too Much?

11/30/2020

 
​At his 2017 Senate hearing to become a Supreme Court Justice, Neil Gorsuch was questioned by Sen. Dianne Feinstein (D-California) regarding physician assisted death (PAD). Feinstein and Gorsuch each articulated their position on this contentious issue, serving as a microcosm for our nation’s larger debate. Should doctors be allowed to prescribe end-of-life medication to terminally ill patients to ease their suffering?

In 1994, Oregon became the first state in our country to legalize PAD by passing the Death with Dignity Act. Since then, eight states and the District of Columbia have similar laws. Generally speaking, states require patients to have a terminal illness and have less than six months to live to be prescribed end-of-life medication.

Given the sensitive nature of this topic, people have strong feelings on either side. Opponents contend that a doctor’s prognosis is not a certainty and that these laws could lead to insurance companies weighing in on end of life matters. Additionally, the patients in question might be suffering from psychological distress.

Proponents of PAD advocate that people shouldn’t be forced to physically suffer and should have the right to choose to end terminal pain on their terms. Advocates say that with only a few months left to live nobody should be forced to needlessly suffer.

Data from around the country suggests that states which allow PAD have not been used in great numbers because this practice contributes to significantly less than a percentage point of deaths. Furthermore, Hawaii’s PAD law and a proposed PAD law in Massachusetts have a mental health consultation component. Plus, patients requesting PAD must be able to understand the nature of their decision to be given end-of-life medication.

Kaiser Health News reported about Charlie and Francie Emerick, married for 66 years, who each had terminal illness and availed themselves of Oregon’s Death with Dignity law. Charlie suffered from prostate cancer and Parkinson’s disease and Francie from a weakened heart after numerous heart attacks and cancer. “You keep going, Charlie, you’re going to get worse and worse and worse,” Charlie explained about his decision, “The other can’t be worse than this.” Before being prescribed end-of-life medication, Charlie and Francie both attested to their intentions and were examined by two different doctors who concluded they had less than six months to live. Ultimately, they decided they wanted to say goodbye on their own terms. Their story was recorded as a documentary to show how the process is carried out so people would understand more about PAD.

Traditionally, there is a widely held belief that PAD breaks with Jewish law, though there is a debate in the Jewish community about whether the issue should be revisited. Last year New Jersey legalized PAD, causing a debate among rabbis about whether to support the legislation. Rabbi Mark Mallach argued that the prevailing view in the conservative Jewish movement surrounding PAD should be reconsidered and told the New Jersey Jewish News (NJJN), “Jewish law has always been organic, responding to the needs of society in every generation,” and said, “Jewish law is not frozen.” However, Rabbi Elie Mischel took a different approach telling the NJJN, “Actively speeding one’s death is clearly forbidden under Jewish law (for both Jews and gentiles), and it is a rejection of the sanctity of every moment of life.” He also said, “Though we are not obligated to do everything humanly possible to prolong someone’s life (e.g., a very ill patient has the right to forgo a risky and painful surgery that has little chance to succeed), actively taking one’s own life is never permissible.”

As more states in our country debate PAD legislation, I expect these discussions to continue as people examine where they stand on this issue. Whichever side people come down on, I suspect this matter will generate intense debate in our national discourse.

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Evan Carmen, Esq. is the Legislative Director for Aging Policy at the B’nai B’rith International Center for Senior Services. He holds a B.A. from American University in political science and a J.D. from New York Law School.  Prior to joining B’nai B’rith International he worked in the Office of Presidential Correspondence for the Obama White House, practiced as an attorney at Covington and Burling, LLP, worked as an aide for New York City Council Member Tony Avella and interned for Congressman Gary Ackerman’s office. Click here to read more from Evan Carmen.

Preparing for an Aging Prison Population

11/2/2020

 
One of the pillars of B’nai B’rith International is our Center for Senior Services (CSS), which  focuses on issues that impact older Americans.  Throughout my time working at CSS, I have written about a variety of traditional topics that touch the lives of seniors like Medicare, Medicaid and Social Security. However, I want to take this opportunity to address an issue that is probably not at the forefront of people’s minds: older Americans who are incarcerated. 

According to the National Corrections Reporting Program, in 2016, people 55 and older accounted for about 150,000 inmates in state correctional facilities. The Federal Bureau of Prisons (FBP) indicates there are currently over 18,000 inmates 56 and over in federal prisons. Clearly, there is a sizable population of older Americans incarcerated.  Are correctional facilities able to meet the needs of seniors? 

Throughout the country, there is a movement to provide distinct resources to older incarcerated Americans. The federal government opened a Memory Disorder Unit  in Massachusetts for inmates with dementia, the first of its kind.  The facility mimics a nursing home model that tries to meet the unique, specific needs of people with dementia. Also, this type of correctional facility is needed because staff at traditional prisons can’t meet the needs of dementia patients.  These prisoners often fall prey to other inmates. 

It’s not just outfitting prisons for older Americans; advocates argue criminal justice reform should include expanding “compassionate release.” Compassionate release allows elderly or infirmed inmates to be released early from prison because it would be unjust to keep them incarcerated and they don’t pose a danger to society.

​According to the Marshall Project and the New York Times, between 2013 and 2017, FBP only approved 6% of the 5,400 compassionate release applications they received. Case files demonstrate that applications usually get rejected because the inmate is a danger to society or because of the severity of the crime they committed. 

However, many criminal justice reform advocates argue that compassionate release has been too strictly applied. In December 2018, with bipartisan support, the Formerly Incarcerated Reenter Society Transformed Safely Transitioning Every Person Act (FIRST Step Act) became law and was designed to make it easier to apply for compassionate release.

Obviously, the COVID-19 pandemic has intensified calls for compassionate release.  For example, according to the FBP, during April, 268 inmates were granted compassionate release, a significantly higher percentage than the 144 inmates who were granted release from December 2018 (when the FIRST Step was signed into law) to March 2020.   Furthermore, Senators Dick Durbin, D-Ill. and Chuck Grassley, R-Iowa, introduced the COVID-19 Safer Detention Act in June, which expanded the Elderly Home Detention Pilot Program that moves elderly inmates from prison to home confinement. Durbin said, “My legislation with Senator Grassley would help ensure that the most vulnerable prisoners are quickly released or transferred to home confinement for the remainder of their sentence – just as the First Step Act intended.  This is especially critical during the COVID-19 pandemic to protect against the spread of this deadly virus.”

Our country’s judicial branch of government is also confronting the aging prison population. In Alabama, Vernon Madison was sentenced to death for killing a police officer. Madison developed dementia in his 60s after he had multiple strokes in prison. His attorneys argued that capital punishment violated the Cruel and Unusual Punishment clause of the Eighth Amendment because Madison  could not recall why he was convicted as a result of his dementia.
The Supreme Court found that Madison was legally required to receive an evaluation of whether dementia and other mental conditions barred him from the death penalty. 

“Given this trend, we may face ever more instances of state efforts to execute prisoners suffering the diseases and infirmities of old age,” wrote Supreme Court Justice Stephen Breyer in an earlier appeal.  Madison passed away before the case was resolved. 
 
​Professor Marc Stern from the University of Washington, a prison health care consultant, said, “It would be nearsighted for any state or county not to be planning for an aging prison population.” 

All inmates deserve a basic level of care in prison and older Americans who are incarcerated are no exception.  We should provide better, specialized care for seniors who are incarcerated. Introducing additional medical services will only apply a band-aid to what will be a consistent challenge as inmates continue to age. We should consider methods to reduce the overall number of older inmates in our prisons, given the care they often require. 

With recidivism rates for seniors being significantly lower than for younger people, maybe it’s time we start asking whether there is value in keeping seniors who are nonviolent offenders in prison; they are often are more costly to incarcerate. 

One thing is for sure: Our country’s prisons are graying, and we need to be better prepared.

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Evan Carmen, Esq. is the Legislative Director for Aging Policy at the B’nai B’rith International Center for Senior Services. He holds a B.A. from American University in political science and a J.D. from New York Law School.  Prior to joining B’nai B’rith International he worked in the Office of Presidential Correspondence for the Obama White House, practiced as an attorney at Covington and Burling, LLP, worked as an aide for New York City Council Member Tony Avella and interned for Congressman Gary Ackerman’s office. Click here to read more from Evan Carmen.

Social Security: 85 Years of Lifting Seniors out of Poverty

9/14/2020

 
Recently, Social Security celebrated its 85th birthday! Since its inception, the program has been woven into the fabric of our nation and let countless seniors retire with dignity and respect. In 1935, when President Franklin D. Roosevelt signed the legislation, an astonishing 50% of seniors lived in poverty.  Roosevelt said regarding Social Security, “It is, in short, a law that will take care of human needs…” Fast forward, and today the legislation keeps 15 million seniors out of poverty, which is a remarkable achievement. Presently, Social Security provides a modest benefit of $1,514 on average a month to 45 million retired Americans.  

Given the critical role Social Security plays in the lives of older Americans, it’s important to examine the health of the program moving forward. In April, the 2020 Social Security Trustees Report, which outlines the fiscal solvency of the program, indicated the Social Security Trust Funds would be sufficient to pay future obligations until 2035.  In 2035, the program can pay about 79% of its obligations. 

Sadly, the prospect of a shortfall has caused some people to say, “Social Security is going broke.” Nothing could be further from the truth. While a shortfall might exist, that doesn’t mean Social Security is going broke. Social Security is funded through the payroll tax; consequently, even if Congress did not provide a legislative fix, there would still be revenue coming into the program.  While not ideal, Social Security funding 79% of its obligation is a far cry from an account with no money.  

As everyone is aware, COVID-19 has unfortunately slowed our economy.  People might not know, though, the economic downturn has negatively impacted Social Security.  During a sluggish economy with less people are working, fewer individuals are drawing a paycheck. Thus, employers and employees are contributing less in payroll taxes.  If our government is generating less money from payroll taxes, then Social Security is receiving less revenue.   

So how does the pandemic impact the long-term future of Social Security?  The short answer: In July, Stephen Goss, Chief Actuary for the Social Security Administration, testified before the House Ways and Means Subcommittee on Social Security. He was asked to answer this question. Goss said the pandemic’s impact on Social Security depends on how long the virus lasts.  If the economy rebounds in 2021 and we don’t have a second wave, Goss said, the trusts funds short fall might only accelerate by a year. 

However, “if closure due to the pandemic extends through 2021, or if there is a permanent reduction in the level of economic activity after recovery from this recession (as has been the case for some recent economic recessions), then the negative effects on the actuarial status of the combined OASI (Old Age and Survivors Insurance Trust Fund) and DI (Disability Insurance) Trust Funds could be substantially larger,” he said. Goss also noted the conclusions drawn in the 2020 Social Security Trustees Report were not based on the pandemic.   

Regrettably, talks between the White House and Congress are stalling regarding further federal stimulus legislation in response to the virus. As a result, the president issued an executive order that could potentially cut payroll taxes for the rest of the year. Clearly, the immediate future Social Security revenue is not going to be stable, making the president’s executive order cutting payroll taxes disappointing. Many estimates predict that it could cause a loss of about $100 billion in the program’s revenue. Any potential cuts to the payroll tax could erode one of our nation’s most important programs for seniors. At a time when so many people are struggling, I do not think it’s wise to propose defunding money from Social Security, a program that lifts millions of people out of poverty. 

I am certainly not arguing against federal stimulus legislation. While the money in the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) is appreciated, it does not provide adequate funding to meet the challenges of the day. Legislation like The Health and Economic Recovery Omnibus Emergency Solutions Act (HEROES Act) and the Emergency Housing Assistance for Older Adults Act of 2020 are important bills that secure funding for all Americans, particularly seniors. So, we can provide relief to millions of Americans without threatening Social Security.  

A federal program’s 85th birthday is a good time to take stock. Social Security has brought the senior poverty rate down by about 40 percentage points — not a bad accomplishment for an 85th birthday! It is never a good time to threaten Social Security’s future; it’s an especially bad time to do so now.. As Roosevelt said, “It is, in short, a law that will take care of human needs…” 

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Evan Carmen, Esq. is the Legislative Director for Aging Policy at the B’nai B’rith International Center for Senior Services. He holds a B.A. from American University in political science and a J.D. from New York Law School.  Prior to joining B’nai B’rith International he worked in the Office of Presidential Correspondence for the Obama White House, practiced as an attorney at Covington and Burling, LLP, worked as an aide for New York City Council Member Tony Avella and interned for Congressman Gary Ackerman’s office. Click here to read more from Evan Carmen.

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