It is somewhat bittersweet that I have been asked to share my thoughts on our ongoing seniors’ program. While I’ve written for the magazine in the past, I’ve now been asked to focus on aging policy and offer insights from my perspective, as a baby boomer and a B’nai B’rith staff member for 33 years.
Rachel Goldberg, who served as our director of aging policy and authored this column for many years, has moved on to the AARP, or the “big” house, as we playfully refer to the country’s largest advocacy group for seniors. For more than 13 years, Rachel was my right hand in analyzing, reporting and generally trying to make sense of the myriad changing policies and programs that affect our aging population. We are grateful for the many years she spent with us. She will be missed.
But we’re not the only ones experiencing changes. As you are no doubt aware, the entire country is in the midst of a sea change, affecting the role of the federal government in our lives. For B’nai B’rith, this presents an enormous challenge, as a new administration with an announced intention of cutting back on federal programs takes office. Not the least of these is providing low-cost housing to seniors.
I began at B’nai B’rith as the director of our Senior Citizens Housing Program. Some years earlier, a group of dedicated B’nai B’rith volunteers, all experts in the building trades, petitioned the organization to allow them, under B’nai B’rith auspices, to sponsor affordable housing for low-income seniors in their communities.
Using a remarkable program from the U.S. Department of Housing and Urban Development (HUD) that made grants available to nonprofit sponsors, this group provided the “sweat equity” and opened the first B’nai B’rith-sponsored senior community in 1971 in Wilkes-Barre, Pa. Since then, the B’nai B’rith Senior Housing Network has grown to be the largest national Jewish sponsor of HUD-assisted housing in the country. It is currently available in 28 communities nationwide, and we’re proud to say that nightly 8,000-10,000 seniors call a B’nai B’rith sponsored property home.
Obviously, we take this commitment to these communities and to our residents seriously. That’s why we work throughout the year to provide resources, training and information to the dedicated people who manage, lead and staff these properties.
Our program exists for the benefit of the residents and their extended families. That’s why we do what we do. But, we cannot do it alone. We need the government’s help because housing costs money. And we are committed to working with the federal, state and local governments to provide the resources to make affordable housing a reality.
For 30-some years, I have led the organization’s efforts to advocate for the federal housing finance program that has allowed us to build such excellent communities, and to continue to provide them to low-income residents at a fraction of market rate rents. As an advocate, I champion not only the current residents, but the tens of thousands of people currently on waiting lists for low-income housing like those we sponsor. I speak on behalf of the hundreds of thousands of boomers who will find themselves, very shortly, in retirement, and in similar need.
The “graying of America” is not something in the far-off future. It is here now and will only grow larger. Every day, more people turn 65. B’nai B’rith, along with other nonprofit groups, had been instrumental in shaping, expanding and improving HUD’s housing program for the elderly. But, the program is no longer being funded. This has put the future in jeopardy for residents, both present and future. And that is unacceptable.
The program is fiscally troubled. Affordable housing is scarce, and we need to build more for moderate and low-income people. Affordable housing appropriate for the needs of older adults, and where services can be brought to them in a more cost-efficient way, is essential. But building housing—something we absolutely must do if we want to address the long-term affordable housing crisis in this country—is more expensive than simply subsidizing rents in existing apartments.
On average, nationwide, there are more than 10 people waiting for every low-income rental unit available. In other words, we must build, but we don’t have sufficient federal resources to do it.
The key may be a combination of vigilant advocacy and a new strategy supported by recent housing research. One thing the government is very good at is counting things: From missiles bought, to meals served, to millions taxed, the government keeps a tally. But it is not as good at counting how spending in one area can save money in another.
We often say Washington works in silos: lots of communication (and counting) up and down a federal department but very little communication between them. This poses many problems, especially when people’s needs don’t fit into one of those silos. In the 1980s, the federal government established a task force across departments, including housing and health, to work on homelessness. It turned out that many of the homeless were mentally ill, had substance abuse problems, were veterans and, in some cases, all three. So, solving the problem of homelessness really meant tackling a variety of issues.
With elderly housing, we know there is a similar crossover because supportive housing for older adults, with appropriate services, is an alternative to unnecessary nursing home placements and other pricier options. Many of our residents are able to live independently with support, but without those services, many would be unable to do so; and, with no financial resources, a nursing home placement through Medicaid would be their only alternative. A month in a nursing home costs Medicaid about $8,000. A year in a nursing home costs just under $100,000. For one person! So yes, housing is expensive, but so is health care. Combining the two, taking advantage of economies of scale, work to the long-term benefit of the resident and, at the same time, saves money on health care. So, if new research on the health care savings generated by affordable housing is taken into account, building new housing doesn’t seem so expensive. And, that’s just one way in which subsidized housing can reduce health care spending.
Housing is necessary and more affordable than other options, and it meets the needs and wants of older adults. People do not want to be in a nursing home if they have more independence with some regular service support. The bottom line is that spending money on bricks and mortar can save money by reducing the amount spent on health care. Hopefully, this will help the number crunchers in Washington to see the light.
Over the years, I haven’t had many opportunities to be on the front lines of these policy debates, but I guess it’s time to get back into the game and step up to the plate.
I’m sure you are beginning to become familiar with the ways in which HUD assistance houses over 10 million individuals. This, of course, is carried out via public housing (rental housing for over 1 million low-income families, the elderly, and those with disabilities), multifamily subsidized housing (which includes Section 202 Supportive Housing for the Elderly, the Congregate Housing Services Program, and Section 811 Supportive Housing for Persons with Disabilities Program) and housing vouchers (Section 8 project-based or tenant-based rent vouchers for low-income individuals, families, the elderly and the disabled). In addition, properties are often financed or assisted financially through the FHA insurance loan programs and low-income housing tax credits.
Five HUD programs provide affordable rental housing that is designated for low-income senior households. Section 202 provides housing exclusively for older adults and people with disabilities, while four other HUD programs provide housing for all age groups but have devoted the property to housing senior residents. These include Section 236 and Section 221 (d)(3) programs, public housing and project-based Section 8 programs dedicated primarily for use by senior households. After the Section 202 program, project-based Section 8 housing provides the most housing dedicated specifically to elderly households.
As you become more familiar with how HUD works to combat poverty for individuals and families all over our country using a modest portion of the federal budget, I want to bring your attention to the estimated 2 million seniors, most often low-income single women in their mid-70s to early-80s, who are housed through HUD subsidies or call HUD-assisted facilities home. HUD, a department that long ago began prioritizing the well-being of our most vulnerable seniors, has wavered in recent years on its commitment to take care of the oldest among our nation’s poor. I have the privilege of working directly with residents and staff of our 38 low-income supportive senior housing facilities, housing about 8,000 seniors across the country. Working with these buildings has transformed my understanding of what HUD-supportive housing is, and of who lives there. One thing has become particularly clear: We must include seniors in all of our conversations about publicly-funded housing.
I was disappointed that your remarks to the Senate Banking, Housing, & Urban Affairs Committee did not include comments about affordable housing for seniors. However, I was pleased to read you indicated in your written responses to Sen. Sherrod Brown that the Section 202 program is “an important tool” for senior housing and that you will lobby President Trump for the inclusion of this vital program as part of a comprehensive infrastructure package. Across the spectrum of publicly-assisted housing, seniors are everywhere. Not only are they served by senior-specific programs, but they are a significant part of the population in every other category of HUD’s portfolio. Frankly, I am worried that within your focus on eliminating “government dependence,” you do not account that many people who benefit from HUD are retirees and disabled people whose incomes will never really improve, and whose need for housing assistance cannot be dismissed. Many of your statements spoke to the desire to get people off of public assistance and to move them towards gainful employment through a “development of innate talent” and “work requirements.” While economic success and independence are laudable goals to facilitate for the working poor, they are not realistic for fixed income older adults.
Many seniors living now in HUD assisted housing—who are in your terms “dependent” on it—have worked their entire lives and are still only able to afford housing by combining meager Social Security benefits with assistance from your department. While many of these individuals live in senior-specific facilities, about a third of households that make up public housing are senior-led homes or include a family member who is a senior. I believe it is important to remember that work should not be the sole focus when we discuss assisting those experiencing poverty. If we forget about the special needs required by millions of seniors who are now unable to work, we have committed a great injustice. I, and many senior housing advocates, believe the focus should instead be placed upon addressing the root causes of the shortage in affordable housing. We believe that accessing affordable housing is prevented by systematic issues including, but not limited to, predatory mortgage lending, a stagnant and unrepresentative COLA used for Social Security and astronomical price surges in many areas where seniors hoped to “age in place” due to gentrifying neighborhoods.
I am encouraged to know that you will be able to apply a health perspective on housing, because good health outcomes are incompatible with unstable or inappropriate housing. Further, housing can be a platform for prevention and early health intervention services. I look forward to the integration of your medical knowledge into your approach to HUD programs and hope that you will ensure “aging in place” and preventative care are tenets of your leading this department. Research tells us that ensuring the well-being of an aging person while they are healthy or maintaining a chronic condition prevents hundreds of thousands of dollars being spent at the end of that individual’s life. We know that these end-of-life prices surges can occur through Medicaid funded nursing home care or through receiving emergency medical services. We also know that this can be prevented when folks are able to “age in place” with comfort and dignity. More so, those in the supportive housing industry know that co-location of services and housing is crucial to maintaining one’s health as they age. Affordable, supportive housing not only allows people access to “healthy” aging, but helps people avoid injuries and unnecessary nursing home placements.
I think it’s only fair that a society be judged on the way it takes care of its oldest members. While we experience a growing population of seniors who are currently 75 years of age and older, the senior population, those aged 65 and over, is projected to double by the year 2030, from 35 million to 71.5 million. In 2010, more than 44,000 people aged 65 and over were homeless. In many ways, I am saddened our country has not done a better job of creating and preserving housing for older adults. However, I hope that I can appeal to you, as a man of faith, that we lift up and support our older neighbors who face significant financial barriers, and deserve a warm place to call home!
While I hope you will take my concerns to heart, I would love nothing more than for you to visit any of the 38 senior housing facilities my organization, B’nai B’rith International, sponsors across the United States from Maryland to California. We hope that a visit from you to any of our thriving communities would serve as a fact-gathering mission and support the good work that you will be leading!
Breana Clark, MSW
Medicare Part D Enrollment ends December 7th
Premiums do not accurately indicate annual out-of-pocket for 2017
You only have days left to determine whether you want to change or enroll in a Medicare Part D plan. In fact, there are only five days left. With less than a week, why would I bother talking about this on such short notice? While many have pointed to premium increases in 2017, an average of 4 percent according to Avalere, I caution you to look a little closer! By digging deeper, your wallet may be thanking you this time next year.
For 2017 plans, the benefit of paying less for a monthly premium may not outweigh the annual cost of medications you depend upon. I urge you to take the time to visit Medicare online and learn more before you choose. If you stick with me, I’ll go into how you can access the Medicare Plan Finder on the Medicare.gov website. But, before I can do that, I want to explain the reason behind my concern. If you had planned to default to your 2016 plan under the assumption a small change in your premium would be the only adjustment you’d make, you may be very disappointed.
Year-to-year costs of popular drugs are seeing major increases for the upcoming year, and Part D plans have changed the structure of their drug pricing in response. If you aren’t careful about picking a plan, or if you have added any medications this year, you could see jaw-dropping increases. For example, a co-pay for one single drug went from $7 to $350.
Several trends among insurers have made surprising shifts in cost sharing for beneficiaries possible. Some of the reasons you may be seeing this is because of:
Instructions for using the Medicare Plan Finder
Before starting, make a list of drugs you take. Then, access the Medicare Plan Finder by clicking here.
You’ll see prompts like the ones listed below:
Additionally, on each of the plans, you will see “Lower Your Drug Costs.” Once selected, you will have an opportunity to select cheaper versions of the drugs you originally input based upon their projected annual cost. (Only do this for drugs where you know you could take either.)
When comparing plans, you want to focus on the heading “Estimate of What YOU Will Pay for Drug Plan Premium and Drug Costs.” This amount is what should be used to compare to what you spent last year, and what you’re budgeting for this coming year.
When I performed this exercise, I entered medications for a variety of needs such as: lowering cholesterol and high blood pressure, treating Type II Diabetes, as well as an anti-depressant—all fairly common prescription medications. In each case, when comparing plans in my area, the cheapest premium did not correlate to the least amount paid for annual out-of-pocket. In fact, in nearly every comparison, the most expensive premium often was paired with an annual out-of-pocket expense several hundred dollars less than other plans with cheaper premiums.
More than ever, this year, it does not make sense to stay with the same plan as you selected last year without comparing. And the best news is: it’s not too late! Enrollment is still open through Wednesday, Dec. 7, 2016.
AARP Medicare Resource Guide: Understanding Your Prescription Drug Coverage
Save on drug costs: See if your income makes you eligible for extra help
Caregiver Support Bills: Protecting Social Security Benefits for Those who Leave Work to care for parents, children, Relatives
Over the last few years there have been several bills that would expand or improve social security benefits. We believe this is important because Social Security is the most secure retirement income vehicle we have, and for the majority of retirees it is their primary or only source. Some of these bills have been broadly designed to close the Social Security funding gap while addressing inadequacies in the benefit structure while others are focused on specific issues, like the lack of credit given to family caregivers.
These are people who take months or years out of the workforce to provide unpaid care to their parents, children or other relatives. For a variety of reasons, those workers have traditionally been women (though that trend is beginning to show signs of change). By staying out of the work force for a few years to take care of kids early in their careers or doing it (again) later in their careers, women’s social security benefits are disadvantaged in several ways. First, leaving the work force for any period of time can impact the trajectory of your career. In fact, this pattern of leaving the workforce and being the one primarily responsible for childcare is often cited as one non-discriminatory reason that women earn less than men. By working for lower wages, women earn less in Social Security benefits.
So, people (primarily women) are likely to see reduced benefits—and this is a population that is already likely to live longer and have lower benefits anyway! That’s one reason to find a way to give people some Social Security credit for the years they are out of the workforce. Another reason is this: as a country we want—we need—to encourage family caregiving. As many of you know, as well as I, we do not have much of a long-term care system in this country. Families with a relative who needs help with daily activities have limited options. Most Americans do not have long term disability insurance, and it can be very difficult to afford it. Medicare doesn’t cover most long-term care expenses in a home or a facility.
For many families, the most cost effective—or only—option is for someone to take off from work to care for their parent. According to AARP’s public policy institute, family caregivers provide nearly half of a trillion dollars in care each year. Though they are generally not paid, they are working, and they are providing a service both to their families and the country as a whole.
Therefore, we should find a way to prevent this critically important caregiving role from diminishing the retirement security of caregivers. Americans overwhelmingly support the idea of a Social Security caregiver credit (click here to read more about it). The caregiver credit proposals in Congress (notably those from Senator Chris Murphy and Representative Nita Lowey) include giving credit for months out of the work force, based on a formula as if the person had earned a wage (generally a percent of the average wage). There are also bills emerging this year that would do the same, but only for parental caregiving for children, which is good, but not good enough. This would certainly not replace earnings credit an average or high wage worker would have achieved back in the work force, but it can at least prevent those $0 years from slashing benefits in a “high 35” formula.
B’nai B’rith International is very pleased to see these bills as part of the conversation in Congress, even though 2016 might not be the most productive legislative year, given all attention being focused on elections. As a nation we depend on family caregivers, and the least we can do is help make sure that the men and women who perform this service are protected in retirement.
Photos via Flickr (1) (2)
Rachel Goldberg, Ph.D has been the B’nai B’rith International director of health and aging policy since 2003 and the deputy director of the B’nai B’rith International Senior Services since 2007. Before joining B'nai B'rith International, she taught politics and government at the University of Puget Sound and Georgetown University. To view some of her additional content, Click Here.
Last week the mid-Atlantic region experienced a storm so bad it qualified as a blizzard. It even got a weather service name and a twitter hashtag (#snowzilla). As with every big snow, the region’s roads were impassable and cities became paralyzed. For those in the Midwest and New England, the pre-storm shopping hysteria, the weeklong school closings, the government closings have made Washington, Baltimore and other cities an object of ridicule, and frankly we see your point. We get it. When St. Paul gets this much snow they call the storm “just another Tuesday.”
So our snow removal has been painfully slow. The blizzard conditions started late Friday, Jan. 22 and ended on Sunday, Jan. 24, but my own street didn’t see the shadow of a plow until late Monday, Jan. 25, and our street is barely passable. Friends have been posting and tweeting appalling pictures of impassable streets and sidewalks for days. Nearby, major roads are often plowed, but are down from three lanes to two. And everyone complains: why didn’t they plow ALL the lanes? And that’s where things get interesting.
Often they haven’t plowed all the lanes because if they did they would have to shove that last lane’s snow right up onto the sidewalk, making pedestrian travel difficult, dangerous or downright impossible. And who travels on the sidewalks after a snowstorm? Kids (which is why schools are closed when your street is already clear), people with disabilities and many elderly and low-income people who don’t have or use cars.
While we all seem fairly aware of the roads being critical to our everyday city and community life, it’s easy to forget the role sidewalks play until they are covered by a 6 foot snow pile left by a plow. Sidewalks are a critical part of the transportation infrastructure, especially for low-income people and people with disabilities and mobility impairments, categories that include millions of older adults.
This even helps to keep snow removal in mind in long term urban planning (like making sure there is space between the sidewalk and the road for that snow to get shoved). The issue is on the table in many communities, including mine. In Montgomery County, Maryland (where I live), the county almost got a pedestrian friendly plan that would have increased the county’s obligation to remove snow from pedestrian pathways, but it was never signed by a county executive. Montgomery County also has an advisory committee that recently did a pedestrian “walk about” tour of the area and developed more pedestrian friendly guidelines that you can read about here.
Other groups including disability groups have developed excellent resources, like Easter Seals’ Project Action, where I found a guide on pedestrian/disability friendly snow removal policies and planning.
The federal government has money (called Section 5310) allocated to efforts on disability transportation, including pedestrians. While I would like to say that includes a resource listing the right phone numbers to call for every city or county when you see an impediment to pedestrian travel or a mobility challenge, it doesn’t mean that. We do have regional contacts and state contacts listed together and the National Center for Mobility Management, and that gets you off to a good start. You can find other related resources on their main page. The Federal emphasis on transportation planning for people with mobility challenges has produced some excellent planning tools and raised awareness about best practices.
So how are we doing at actually implementing pedestrian/aging/disability friendly transportation plans? Not great. It has been clear during this week’s “snowzilla” how much tension remains between the need to plow roads and the need to maintain sidewalks. And the sidewalks often lose. We’ve seen pedestrian access to public transportation (Metro) limited because the parking lot’s snow got dumped on the sidewalks leading to the stations. In my neighborhood—already a hot spot for pedestrians being struck by cars—bus stops have been obliterated, the bus shelters are half filled with snow and often there is nowhere for riders to stand but in the slick, snow-banked roadways. So far no pedestrians have been injured in my neighborhood, but I am frankly almost as surprised as I am relieved.
But advocates know it takes more than having information about how best to do things to get them actually done. I guess we all know that.
So what do we do? Three things come to mind. First, do your part. Shovel your sidewalk as soon as you can after a storm. It’s required by law most places, and is neighborly. If you can’t shovel, ask a neighbor to help. If you can, shovel for the neighbor you know can’t. Local governments often need to do more to make sure that commercial and public areas (where no homeowner is responsible) are also plowed. In good weather, don’t block sidewalk access with a vehicle, trash can, etc., especially the curb cuts designed to let wheelchairs ease from sidewalk to street. As a driver remember that pedestrians have rights, and are easy to injure. Remember that not all pedestrians are STANDING, and some may be seated and harder to see. Be aware.
Second, if you see something wrong, tell someone. If the sidewalk is blocked, report it. If stores plowed snow into the handicapped spots, tweet about it. If you see people walking on a snowy roadway because there is no sidewalk to be found, call your city or county.
And third, after you figure out how to report these problems, think about getting more involved. Ask how you can become part of an advisory committee on transportation issues. Transportation planning is a big deal for most states and municipalities, and advocates for the elderly and disabled have made it a particular point to make sure those concerns are part of all planning, whether it’s public transportation, new road designs or services especially for the disabled. And there is plenty of information available about how planning can be done to accommodate the needs of people with mobility challenges—and how to keep the snow from trapping them at home or making them unsafe when they are out.
Last year we participated in the once-a-decade White House Conference on Aging, and the final report calls for more planning and coordination on transportation issues. Cities, states and the federal government are always planning transportation initiatives, from maintaining what exists to expanding mass transit and building new highways. All that planning needs to take into account the needs of people with mobility challenges. It was great to hear last year about the $2.5 million allocated for a plan to launch the National Aging and Disability Transportation Center at the U.S. Department of Transportation, which will “provide technical assistance to improve the availability and accessibility of transportation options that serve the needs of people with disabilities, seniors, and caregivers.”
But the kind of planning—and frankly pressure—required to make sure seniors, the disabled and pedestrians are not left out of the future of our roads and bridges requires us to get involved. There are so many issues at play, and so many future consequences of today’s decisions, that we have to make sure we represent these issues at the table. If you want to learn more about volunteering your insights, start at the National Center for Disability Management. Or call a disability rights group. Or call us—we’ll help you find the right access point for wherever you live.
Even those of us who don’t have any mobility challenges (yet) are sometimes pedestrians. It can be complicated to sort out how to support growth and safety, roads and sidewalks.
And, if you see a sidewalk covered in a snow mountain made by a snow plow, take a picture and send it to us.
Analysis From Our Experts
B'nai B'rith International has widely respected experts in the fields of: