The 2005 White House Conference On Aging
Neglecting A Generation
From
The Alliance for Retired Americans
December 2006
815 16th Street, NW, 4th Floor North,♦Washington, DC 20006 ♦(202) 637-5399♦(202) 637-5398 www.retiredamericans.org
About the Alliance for Retired Americans
The Alliance for Retired Americans is a grassroots organization representing more than 3 million retirees and seniors nationwide. Headquartered in Washington, DC, the Alliance’s mission is to advance public policy that protects the health and economic security of older Americans by teaching seniors how to make a difference through activism.
Acknowledgements This report was researched and written by Dianna M. Porter, director for policy with the Alliance for Retired Americans.
Permission to reproduce all or part of this report is given with the provision that the following credit line be used: Reprinted [or excerpted] from The 2005 White House Conference on Aging: Neglecting a Generation with permission of the Alliance for Retired Americans.
The 2005 White House Conference on Aging: Neglecting a Generation
Table of Contents Executive Summary iii Introduction 1
Part I: The Alliance for Retired Americans and the WHCoA 1 Pre-Conference Events 1 Listening and Solutions Sessions 1 Leadership Council of Aging Organizations 2 Delegate Selection 2 Alliance for Retired Americans Preparation 2 WHCoA Policy Committee Meetings 3 The Resolutions 4 Conference Events and Alliance Actions 5 Post-Conference Activities 11 Part II: WHCoA Report and First Year Implementation 13 Transmittal Letter and Executive Summary 13 Implementation Strategies: Reported and Actual Results 15 Track I: Planning Along the Lifespan 16 Track II: Workplace of the Future 19 Track III: Our Community 19 Track IV: Health and Long Term Living 22 Track V: Civic and Social Engagement 27 Track VI: Technology and Innovation in an Emerging Senior/Boomer Marketplace 28 Cross-Cutting Issues 28 Special Populations 30 Discussion and Conclusion 31
Appendices A. History of White House Conferences on Aging 35 B. WHCoA Policy and Advisory Committee Members 37 C. Alliance for Retired Americans WHCoA Delegates and Alternates 40 D. Alliance Educational Fund WHCoA Issue Briefs 43 E. Alliance for Retired Americans WHCoA petitions 45 F. Fifty Resolutions Adopted by Conference Delegates 48
ii Executive Summary
The 2005 White House Conference on Aging (WHCoA), held on December 11-14, was the fifth such decennial conference and the first of the 21st century. White House Conferences on Aging are not merely events of the moment drawing people together for a few days; they are intended to have impact on aging policy throughout the following decade. During the conference, WHCoA delegates provide advice to the President and the Congress on national aging issues and how to deal with them.
However, a number of attempts were made by those in charge of the 2005 conference to prevent a public discourse by the delegates on these issues. Additionally, following the conference the work of the delegates was disregarded in an interim report to the states. And the final report omits many of the delegates’ recommendations that conflict with the political agenda of the White House and the Congressional leadership.
Consequently, the Alliance for Retired Americans has a two-fold purpose in issuing our own report on the first anniversary of the 2005 WHCoA. First, we believe it is important to showcase the events leading up to the conference, the structure of the conference, and the course of action taken by Alliance and other delegates during and after the conference. Second, we consider it our responsibility to provide an assessment of the final report from the WHCoA Policy Committee as evaluated against Alliance principles and delegates’ experiences.
Below are some of the significant findings from the Alliance report:
• Although background papers on the major issues were developed for delegates on a factual and neutral basis, ultimately they were rejected by the WHCoA office.
• At the conference, there was no provision for delegates to speak either on the agenda or for any other purpose as no microphones were provided on the floor.
• It is the first time that a president did not address his own White House conference.
• At every point where they might have been blocked, Alliance and other delegates wrested back some control.
• The policy committee’s post-conference interim report to the states completely ignored the work of the delegates at the conference.
• The transmittal letter with the final WHCoA report to President Bush rejects expansion of public programs saying that they will only make “real problems more difficult to solve.”
• The WHCoA executive summary says that delegates had the opportunity to submit individual implementation strategies (IS) but that is not true; conference officials diminished the significance of many strategies that arose from group discussions by re-classifying them as only individual recommendations.
iii • Conference officials combined IS after the conference without delegates’ knowledge or approval thereby diluting the impact of some emphatically worded IS.
• Parties associated with the conference made a decision to conceal adopted IS that did not conform to the agenda of the leadership in the White House and Congress; in at least two of the breakout sessions—on the Medicare and Social Security Disability Insurance programs—the implementation strategies the delegates approved overwhelmingly are missing from the report and are buried deep in the appendix as individual IS.
• Both Congress and President Bush repudiated delegates’ support for geriatric training in the months following the WHCoA by totally eliminating funding.
• Although the No. 1 resolution calling for reauthorization of the Older Americans Act was achieved in 2006, without additional funding the promise of expanded and improved services is just a hollow shell.
• The delegates strongly recommended annual Congressional oversight hearings to monitor follow-up to the conference but this strategy is concealed in the appendix.
Therefore, the Alliance for Retired Americans calls upon the Bush Administration to report to Congress on how it is responding to the recommendations of the delegates to the 2005 WHCoA. And the Alliance calls upon Congress to conduct hearings on the IS coming from the WHCoA, translate those that need legislative mandates into law, and provide oversight to ensure that they are implemented.
Similarly, the Alliance urges governors to enact solutions, monitor developments from the state perspective, and report to their constituents on at least an annual basis.
Older Americans and aging baby boomers need champions in the Senate, the House of Representatives, and in state houses. The Alliance for Retired Americans and all of its affiliates stand ready to cooperate with all to ensure that the work accomplished by the delegates to the 2005 WHCoA will not be ignored.
George Kourpias Ruben Burks Edward F. Coyle President Secretary-Treasurer Executive Director
iv Introduction The 2005 White House Conference on Aging (WHCoA), held on December 11-14, was the fifth such decennial conference and the first of the 21st century (See Appendix A for a history of previous conferences). White House Conferences on Aging are not merely events of the moment drawing people together for a few days; they are intended to have impact on aging policy throughout the following decade. During the conference, WHCoA delegates provide advice to the President and the Congress on national aging issues and how to deal with them.
The Alliance for Retired Americans is issuing this report in two parts. Part I describes the events leading up to the conference, how the conference was structured, and what actions Alliance and other delegates took during and after the conference. The development of aging policy is best understood in the context of the efforts of those selected to represent all current and future older Americans.
Part II is an assessment of the final report from the WHCoA Policy Committee to President Bush and Congress evaluated against Alliance principles and delegates’ experiences. It also notes what has been accomplished in the year since the conference ended.
Part I: The Alliance for Retired Americans and the WHCoA
The conference theme, “The Booming Dynamics of Aging: From Awareness to Action,” reflects a focus on “baby boomers,” those born between 1946 and 1964. The Older Americans Act Amendments of 2000 (P.L. 106-501) authorizing the conference stipulated that the purpose of the 2005 conference was to evaluate economic security and health care policies and programs— including Social Security, Medicare and Medicaid—and assess how well they are prepared to serve baby boomers as they become older. Delegates were charged with the responsibility to develop “not more than 50 recommendations to guide the President, Congress and federal agencies in serving older individuals.”
Pre-Conference Events Listening and Solutions Sessions The 17-member WHCoA Policy Committee was appointed in May, 2004. Four appointments each were made by the House of Representatives and the Senate, shared equally between Democrats and Republicans. The remaining nine members were appointed by President Bush, including chair Dorcas
1 Hardy, Social Security Commissioner under President Ronald Reagan. A 22- member Advisory Committee was appointed by the President in May, 2005 (See Appendix B for list of policy committee and advisory committee members).
In the nearly year and a half leading up to the conference, the WHCoA policy committee conducted or authorized “listening sessions” and later “solutions sessions” around the country. Mini-conferences on various issues were also held and reports submitted to the committee.1 At these sessions, participants were encouraged to develop and submit resolutions and recommendations to be considered at the conference.
The Alliance for Retired Americans presented testimony at a listening session for national aging organizations in September, 2004, and Alliance leaders around the country participated in similar state and local events.
Leadership Council of Aging Organizations (LCAO) The Leadership Council of Aging Organizations, a coalition of more than 50 national aging organizations, sponsored a solutions forum on May 17, 2005. Working through LCAO committees, the Alliance for Retired Americans and other organizations developed a series of resolutions that were submitted to the WHCoA from the entire LCAO. These included resolutions on: long-term care; Medicaid; Medicare; Social Security; pensions and retirement savings plans, Supplemental Security Income; older workers; the Older Americans Act (OAA); and civic engagement.
Delegate Selection Each member of Congress appointed one delegate. Governors of all 50 states, Washington D.C., Puerto Rico and the U.S. Territories appointed at least two delegates each. States with larger older populations were allowed additional appointments. The National Congress of American Indians (NCAI) also had designated delegates. Alternates were nominated in the event delegates were unable to attend. The remaining “at large” delegates were selected by the WHCoA policy committee from submitted applications. All 1,200 delegates were announced by the policy committee on August 31, 2005.
Alliance for Retired Americans Preparation The Alliance for Retired Americans had approximately 50 members as delegates (See Appendix C for list of Alliance delegates and alternates). Early in 2005, through the Alliance for Retired Americans Educational Fund, the Alliance initiated a series of briefs focusing on issues and programs that the Alliance believed should be considered at the WHCoA including Social 2 Security, the Medicare prescription drug benefit, pensions, work and retirement, housing, and long-term care (See Appendix D for a description of the briefs). Later, the Alliance submitted the issue briefs for posting on the WHCoA web site under “Input from the General Public.”
In September 2005, the Alliance convened a meeting of delegates and alternates at the Alliance legislative conference in Washington, D.C. During that meeting, the delegates heard from Bob Blancato, a member of the policy committee and executive director of the 1995 conference, who told the Alliance delegates that this conference would not recognize the “10 percent rule,” which at previous conferences allowed a minority of delegates to have their voices heard. At the 1981 WHCoA, minority points of view from at least 10 percent of delegates were included in committee reports. At the 1995 WHCoA, the rule allowed consideration of a resolution by the entire conference if 10 percent of the delegates submitted the resolution.
Alliance delegates decided to urge the members of Congress and governors who appointed them to pressure the policy committee to invoke the rule for the 2005 conference. The Alliance Board of Directors passed a resolution in October calling upon the WHCoA Policy Committee to adopt a 10 percent rule and urging President Bush and all responsible for the conduct of the conference to refrain from partisan politics.
A series of conference calls with Alliance delegates occurred to provide updates on WHCoA policy committee meetings and to plan Alliance strategies for the conference, including petitions.
Alliance delegates were active in state delegation meetings prior to the conference. They were key in alerting other delegates to the problems with the organization of the conference, the lack of democratic structures and other vital issues.
WHCoA Policy Committee Meetings The Alliance monitored the public meetings of the policy committee beginning in 2004. In 2005, the meetings became more focused. At the May 18, 2005 meeting, the committee voted to change the date of the conference from October 23-26 to December 11-14, 2005. WHCoA staff summarized the most frequently mentioned issues/concerns raised in forums around the country. They were: the workforce—addressing barriers to continuing work; long-term care policy; Social Security; financial fraud and protections; savings and pensions; coordinated social and health services; need for increased understanding of the Medicare Part D benefit; and new 3 technological products. Background papers on the major issues were to be developed for delegates on a factual and neutral basis.
At the September 20, 2005 meeting, the committee decided to combine and refine the wording of the hundreds of resolutions they received, and send the delegates 100-150 resolutions prior to the conference. In a vote taken at the conference, delegates would reduce that number to 50. After selecting the resolutions, delegates will develop implementation strategies (IS) for achieving each in breakout sessions. In a separate vote, the delegates will choose the top 10, the results to be released the final morning without ranking. The status of the background papers, called “Vision Papers,” was unresolved; the possibility of having Congressional Research Service (CRS) fact sheets was mentioned.
Background papers on the major issues were to be developed for delegates on a factual and neutral basis.
At the October 25, 2005 meeting, the number of resolutions to be submitted to the delegates was reduced to 70-80. The committee acknowledged receiving ten letters from several members of Congress and a few governors on the 10 percent rule but decided that the delegates would have sufficient input in the implementation strategies sessions without the rule.
At the November 3, 2005 meeting, the committee approved the annotated agenda with six issue tracks: • Planning Along the Lifespan; • The Workplace of the Future; • Our Community; • Health and Long-Term Living; • Civic and Social Engagement; and • Technology and Innovation in an Emerging Senior/Boomer Marketplace.
At the November 22, 2005 conference call meeting, the committee approved the 73 resolutions to be sent to delegates and posted on the web site.
The Resolutions The 73 resolutions submitted to delegates were gleaned from a synthesis document of key findings and recommendations from the public input process.2 This process resulted in a number of repetitive and overlapping
4 resolutions while possibly omitting some issues that should have been considered. For example, there was a resolution stating Enhance Availability of Housing for Older Americans and another resolution that said Enhance Affordability of Housing for Older Americans. Similarly, there were a number of resolutions pertaining to various aspects of long-term care as well as geriatric training of professional, paraprofessionals and other direct care workers. Resolutions were relegated to one of the six conference tracks plus a section for “cross-cutting” issues. The majority of resolutions—27—were placed under the health care track whereas only three resolutions were allocated to the workplace track.
The resolutions were not in the traditional format of “whereas” clauses followed by “resolved” declarations but instead consisted of a general overview followed by one sentence that stated the resolution. Many would call these sentences titles rather than resolution text. For example, following three paragraphs outlining how Social Security is funded, changing demographics and the long-term funding shortfall, the Social Security resolution simply said: Establish Principles to Strengthen Social Security. The Medicare and Medicaid resolutions just stated: Strengthen and Improve the Medicare Program; and Strengthen and Improve the Medicaid Program for Seniors.
From these, delegates were instructed to vote on at least 30 but not more than 50 resolutions. They could not amend the language of the resolutions nor introduce new ones.
An Alliance request to book a meeting room in the conference hotel was rejected by WHCoA staff.
Conference Events and Alliance Actions Day 1. Prior to the opening plenary of the conference on Monday, December 12, Alliance delegates met on Sunday evening, December 11, at a hotel near the conference hotel. An Alliance request to book a meeting room in the conference hotel was rejected by WHCoA staff.
At the Alliance meeting, many delegates expressed their displeasure with the entire process. The WHCoA did not send conference workbooks to the delegates until a few days before they were to travel to Washington—some delegates were already en route. There was also little of substance in the materials. The “Vision Papers” that were prepared and reviewed over several months largely by experts and academics were rejected in the end by the 5 WHCoA office for various reasons. Among those cited in the media and from other sources: the papers were intended only for conference staff and not delegates; they were inconsistent in style, accuracy and quality; there were unspecified “technicalities;” or they were “too advocacy oriented.”3 The fact sheets from CRS did not materialize either.
The “Vision Papers” that were prepared and reviewed over several months largely by experts and academics were rejected in the end by the WHCoA office.
Yet delegates did receive a report from the Social Security Advisory Board, appointed by President Bush and Congress, which presented proposals for addressing the long-range solvency of Social Security most of which were regressive such as reducing the COLA or changing the formula for calculating or indexing the initial benefit level. Individual private accounts were also proposed in this report even though President Bush admitted that private accounts would do nothing to improve Social Security’s long-range solvency.4
Alliance talking points and implementation strategies for topics in each of the six tracks were distributed for use in the IS sessions. With prior input of Alliance delegates, two petitions were produced for circulation among other delegates. The “Call for Democracy” petition, also referred to as the 10 percent rule petition, called upon the policy committee to allow introduction of new resolutions as long as 10 percent of the delegates agreed. The second petition, entitled “Fix Medicare Rx,” provided twelve points for improving the Part D drug benefit (See Appendix E for text of the petitions). Later, this became the basis for recommendations in the Medicare IS sessions. The Alliance provided hundreds of “10%” stickers and Alliance delegates from Wisconsin provided “Fix Medicare Rx” stickers. Armed with the Alliance implementation strategies, petitions and stickers, Alliance delegates set out to canvass their state delegations and other delegates.
Delegate voting on the resolutions began that evening. The Alliance provided a suggested selection of 30 resolutions for adoption and discussion.
There was no provision for delegates to speak either on the agenda or for any other purpose as no microphones were provided on the floor.
Day 2. The first plenary of the conference on Monday, December 12, was devoted to a series of speakers from the administration, corporations and 6 others providing background on the six tracks. Common themes included the potential of technology, opportunities for community involvement, and personal responsibility for planning, accumulating and managing the resources needed in retirement. Alliance stickers were evident on delegates throughout the conference venues.
President George W. Bush did not address the conference although he was in Washington. Instead, he traveled to a retirement community in nearby northern Virginia to promote the Medicare Part D prescription drug benefit. It is the first time that a president did not address his own White House conference.
There was no provision for delegates to speak either on the agenda or for any other purpose as no microphones were provided on the floor. The 1995 conference, in contrast, had an opening night “speak out” allowing delegates up to three minutes to address the entire conference regarding their interests and concerns.
By early afternoon on the first official day of the conference, Alliance delegates and others collected the signatures of 23 percent of the delegates on the Democracy petition. Alliance delegates also collected signatures of 15 percent of delegates on the Rx petition.
Alliance delegates attempted to publicly present these petitions at the afternoon session on Monday despite the handicap of having to speak in a cavernous room without benefit of a microphone. They were told that they were out of order and the petitions could not be accepted. Nevertheless, the petitions were placed before Chair Dorcas Hardy on the dais and subsequently disappeared. Some delegates walked out with an Alliance leader after he declared he would not remain in a room where there was no democracy.
Voting on the resolutions continued throughout the day ending in early evening.
It is the first time that a president did not address his own White House conference.
Day 3. On the morning of the second full day of the conference, Tuesday, December 13, delegates were notified of the fifty selected resolutions unranked and were directed to Implementation Strategies (IS) sessions (See
7 Appendix F for the 50 selected resolutions by ranking). Twenty-seven of the minimum 30 resolutions recommended by the Alliance were selected.
As the sessions were 2.5 hours each, delegates were able to participate in just three of the 65 IS sessions in the course of the day.5 From the sweeping language in most resolutions, delegates were instructed in the cover letter accompanying their workbook to “translate the resolutions into meaningful policies, policy changes and ACTIONS.” Additionally, delegates were to identify those who would have a responsibility for accomplishing them on the federal, state, tribal, local, business, private sector, nonprofit, community and individual levels. The IS were to describe clearly the proposed or anticipated outcome, reflect both short and long-term goals, be realistic, fiscally responsible, and meaningful to the lives of current and future generations of older persons. Other materials mentioned that the IS should also be visionary and innovative.
In each session, delegates were divided into groups to discuss the strategies, come to a consensus within the group on two or more strategies, and verbally report to the rest of the delegates in the session. The strategies were written on cards and turned in once they were presented publicly to others in the session. Facilitators were to maintain control, impart instructions and assist delegates to identify the extent of support for the proposed strategies through the use of blue adhesive dots. Armed with six dots, delegates were instructed to put them on the flip charts of the six IS they supported, no more than one dot per IS.
Other session staff in addition to the facilitator included two recorders—one who wrote the strategies on flip charts, the other entered the proposals on a laptop computer—and an issues expert. There were also overall coordinators for the six theme areas. Most conference staff were volunteers, many from the aging network, i.e., those who administer programs and provide services under the Older Americans Act (OAA).
Notwithstanding the control exerted on delegates the previous day, delegates did manage to wield their own influence particularly when it came to protecting the programs they cared about. Attendance at the sessions varied; those on Social Security, long-term care, and Medicare filled large rooms whereas other sessions, such as Supplemental Security Income, had a small but knowledgeable number of delegates attending. Despite the odds, Alliance and like-minded delegates prevailed in many of the IS sessions where Alliance strategy positions were approved. A description of what occurred in the IS sessions on Social Security and Medicare follows. 8
Social Security. The first of two IS sessions on the resolution entitled Establish Principles to Strengthen Social Security had approximately 100 delegates in attendance who were divided by conference leaders into 16 discussion groups of 5 to 8 each. There was no opportunity to speak to all assembled except for the reports from the groups. Each group selected a facilitator and reporter. After 45 minutes of discussion, they were instructed to reach a consensus on two IS and write them on 5”x 8” cards. The reporter from each group then went to a microphone and made a 1-2 minute statement on their strategies. These were recorded by the volunteers on a computer and also on flip chart pages, which were hung on the wall. The cards were turned in to the session facilitator. Ultimately, each delegate was given 6 blue dots to put on the flip charts that described the proposals they favored, one dot per proposal.
The most frequently reported strategies were consistent in most of the groups. The common themes were: oppose privatization; raise or remove the cap on earnings subject to Social Security contributions; and cover all workers including state and local public employees. All but two of the 16 groups reported opposition to private accounts in Social Security, which was applauded by others in the room. Delegates in one of the two groups reporting support for private accounts were led by the chair of President Bush’s Social Security Advisory Board who is a proponent of privatization.
The sessions were governed by rules of order developed by the policy committee. Thus, an Alliance delegate was ruled out of order when he attempted to make a motion asking for a vote by show of hands on privatization, a procedure that would have been permitted under the current edition of Robert’s Rules of Order Newly Revised. Alliance delegates spread out among the groups, lobbied other conference delegates, and the anti- privatization proposal won by a wide margin. With their blue dots, the delegates voted by about three to one to oppose privatization. The results were the same in the second Social Security IS session.
Medicare. The structure was similar in the first IS session on the resolution entitled Strengthen and Improve the Medicare Program. The strategy receiving the greatest number of blue dots stated that comprehensive drug coverage should be provided under Medicare and the government should be allowed to negotiate for lower drug prices. The strategy that received the second most dots was the entire 12 points in the Alliance Fix Medicare Rx petition. Others strategies to improve Medicare and receiving a significant number of votes included those that called for: national health care, Medicare 9 for all, and Medicare coverage of annual physical exams, hearing aids, eye glasses and foot care services.
At every point where they might have been blocked, Alliance delegates wrested back some control.
Day 4. On the morning of Wednesday, December 14, the final day of the conference, delegates were given the ranking of all 73 resolutions and the vote tally for each. The resolution Reauthorize The Older Americans Act Within the First Six Months Following the Conference was ranked No. 1 as 88 percent of the delegates voted for it. This likely reflects the high representation of delegates from the aging network at the conference. It also indicates an appreciation among delegates throughout the country of the importance of OAA services.
Although the Medicare and Medicaid resolutions made it into the top ten, the Social Security resolution was ranked as number 11. Some delegates were skeptical of the authenticity of Social Security’s placement, particularly since it was beat out of the No. 10 slot by just seven votes by a vaguely-worded resolution pertaining to improving state and local delivery systems to meet 21st century needs. However, aging network delegates had distributed “17/71” stickers encouraging votes for this resolution near the bottom of the ballot and the one on OAA reauthorization. As a result of that effort, both resolutions made it to the top ten list.
At the final plenary session, members of the policy committee described preliminary results from the IS sessions through powerpoint presentations. As with the opening plenary sessions, comments from delegates were not permitted. The transcript from this session shows that the presentation on Social Security ended with the declaration that “not to privatize” was the consensus from the Social Security sessions to which the delegates responded with resounding and sustained applause.
The Alliance for Retired Americans delegates worked diligently to ensure that the 2005 White House Conference on Aging belonged to those who truly believe in aging policies and programs that will improve the lives of America’s older population today and for years to come. At every point where they might have been blocked, Alliance delegates wrested back some control. They challenged when others were silent. Although relatively few in number, they extended their influence to other delegates to produce outcomes that recognize the enormous importance of federal and state programs. 10
There was minimal media coverage of the conference in the Washington press. However, there were at least 21 Alliance mentions in local media around the country, including some delegate profiles, during and after the conference. A 5-part cable series in Oregon on the conference included Alliance delegates.
Post-Conference Activities Immediately following the conference, several Alliance delegates participated in a forum on Capitol Hill with a number of Representatives on Medicare Part D and the widespread confusion and problems plaguing enrollment and how beneficiaries are not receiving enough help and available information.
The work of the delegates at the conference was totally ignored in the policy committee’s interim report to the states.
The Alliance continued to monitor the policy committee’s meetings and hold regular conference calls with delegates to plan next step strategies. Alliance delegates felt it was important to maintain contact with their elected officials in Congress and the states to sustain their interest in the outcome of the WHCoA. Talking points were drawn up and distributed for delegates’ use when meeting with Congressional representatives during their February 2006 recess.
The policy committee’s interim report to the states (also sent to the Territories, Puerto Rico, the District of Columbia, and the National Congress of American Indians), mandated no later than 100 days after the conference, was sent on March 15, 2006. The report consisted only of the 50 selected resolutions— highlighting the top 10—and a request to the governors to select their own priorities from the resolutions and how they are or will be implementing them. The delegates’ pre-conference workbook consisting of all 73 resolutions with their background statements was also transmitted. However, results from the IS sessions were not included. The policy committee voted against including even the powerpoint presentations from the final morning of the conference although they are on the web site. Thus, the work of the delegates at the conference was totally ignored in the policy committee’s interim report to the states.
Alliance delegates acted to influence responses from their governors through staff contacts and public meetings. As a result, Governor Edward G. Rendell of Pennsylvania wrote to Secretary of Health and Human Services Michael Leavitt requesting the IS materials in order to draft a reply. In a separate 11 letter to the National Governors Association (NGA), he asked for support for advocating release of IS materials. Other responses of note: Arizona Governor Janet Napolitano, vice chair of the NGA, followed the lead of Gov. Rendell with a similar letter. Wisconsin Health and Family Services Secretary Helene Nelson also requested the IS materials and relayed the delegates’ frustration at the constrictive nature of the conference’s activities. New York Governor George Pataki sent a response drafted by the New York delegates who called for inclusion of the discussion results from the IS sessions in the final report. In her response, Washington Governor Christine Gregoire mentioned the disappointment of the delegates that President Bush did not meet with them and her own disappointment that the WHCoA did not reinstate the 10 percent rule nor distribute materials from the implementation strategies sessions.
Although the deadline for responding was extended by two weeks to the end of April, 2006, only 25 governors, Puerto Rico and the NCAI replied. The prevailing issues identified by the governors who did reply centered on the Older Americans Act, home and community-based services and long-term care strategies including strengthening the Medicare and Medicaid programs. Other frequently mentioned issues were housing, elder abuse, treatment of mental illness among older adults, older workers, transportation, rural aging, and aging and disability resource centers.
In the days leading up to approval of the final policy committee report, Alliance delegates mobilized to defeat an attempt by some Administration representatives within the committee to include only 10 of the 50 recommendations in the main section of the report. Proponents of such a move would have relegated the policy guidance from the delegates on the other 40 resolutions, including the one on Social Security, into an appendix CD of the final report. With just three days before the committee vote, Alliance delegates acted. They contacted committee chair Hardy and their Congressional representatives articulating their anger that such a move was under consideration. They also sounded the alarm to other delegates and non- delegates. For example, after hearing from an Alliance leader in Hawaii, two- thirds of that state’s delegates made phone calls. At a post-WHCoA forum in Washington state, Alliance delegates drew up a petition calling for all 50 resolutions to be included in the main report, obtained 66 signatures, and faxed it to the committee. On June 12, 2006, after acknowledging receiving numerous calls from irate delegates, the policy committee voted 6-5 to include all 50 resolutions adopted at the WHCoA into the main report, along with strong language on how to implement the policy recommendations. On
12 June 14, 2006, the policy committee voted 15-0 to approve the final WHCoA report. Part II. WHCoA Report and First Year Implementation
The policy committee’s final report on the 2005 White House Conference on Aging was sent to the President and Congress with a transmittal letter and mailed to the delegates and governors the second week of September, 2006. The report consists of three chapters. The first is the executive summary; the second chapter includes a list of the 50 resolutions adopted by the delegates and the “strongest and strong” implementation strategies i.e., those strategies that received the greatest levels of support indicated by the number of blue dots. Placement of blue dots was the official means of voting for strategies. Lists of the delegates by state and members of the policy and advisory committees comprise the third chapter.
Other materials from the conference, including the remaining implementation strategies, are located in a seven-part appendix of approximately 1,900 pages, which is burned onto a CD. The report and appendix materials may also be obtained by downloading from the WHCoA web site.
Transmittal Letter and Executive Summary The transmittal letter with the WHCoA report to President Bush rejects expansion of public programs stating that “just adding new entitlements and funding will only make real problems more difficult to solve.” Instead, the letter calls for thinking and acting in “more modern, strategic ways….in order to provide…more choices and options.” The letter also states that there are Red States and Blue States, but “aging” is Purple and expresses a hope that the readers of the report will craft their own Purple plans and statements for the future of the nation. However, crafting a plan for the next ten years was the reason for holding the conference in the first place.
The transmittal letter with the WHCoA report to President Bush rejects expansion of public programs stating: “just adding new entitlements and funding will only make real problems more difficult to solve.”
The executive summary makes reference to a number of conference documents, which are in the appendix. However, not all the relevant ones are there. For example, the summary alludes to a synthesis document of the issues identified in the pre-conference events. It states that the policy committee’s analysis of the synthesis resulted in the creation of a summary of
13 key findings and recommendations that in turn formed the basis for the resolutions. It would be useful to see the source—either the synthesis or the summary of key findings and recommendations—from which the resolutions sprang. They are not there.
The summary mentions only the top three resolutions chosen by delegates. Following that, instead of identifying the remaining seven of the top ten resolutions, the summary then lists seven cross-cutting themes. Here again, without either the synthesis or key findings documents mentioned above, it is difficult to understand the source of these themes. The summary merely says, without evidence, that they emerged from the work of the delegates and the public input process. Yet they do not match the cross-cutting issues section listed with the six tracks nor do they clearly reflect the subject areas of the mini-conferences. This raises the questions of how they were selected and who made that determination.
The executive summary mentions that delegates had the opportunity to submit individual IS but that is not true. There is nothing in the delegates’ conference materials indicating that option nor were there public announcements to that effect. What the committee and staff have done instead is relegate all of the IS that received less than strongest and strong support, i.e., those IS with moderate and limited support, to a category in the appendix as “individual IS”. Thus, with the exception of the Social Security IS, all other IS with less than the strongest and strong support have morphed into individual IS in the appendix.
The executive summary mentions that delegates had the opportunity to submit individual IS but that is not true.
There is an ideological undercurrent in the summary, which is evident in the recurrence of the phrase “personal responsibility and accountability for planning one’s longevity” or a variation thereof. Personal responsibility is mentioned three times in the executive summary as: 1) the first cross-cutting theme purportedly emerging from the work of the delegates and nearly two years of public input; 2) a critical component of longevity, one of the reasons for taking action now; and 3) one of two “overarching philosophies” for guiding modernization of our aging policies and programs.
This “personal responsibility” language mirrors the rhetoric that has often been used to promote Social Security private accounts. Conversely, the 14 executive summary states that the fundamental responsibility of government is to help those in need.6 In the WHCoA transmittal letter and executive summary, the policy committee is preaching from a different church than the delegates attended. As can be seen in the outcomes from the selected IS sessions below, delegates consistently reaffirmed the value of various federal programs, including Social Security and Medicare, which are not programs just for those in need.
Implementation Strategies: Reported and Actual Results The implementation strategies for each resolution with the “strongest and strong” support appear in Chapter 2 of the WHCoA report following the Executive Summary. Since the report does not delineate where the demarcation between the strongest and strong IS lies, it is surmised that those listed first are the strongest. The IS that received moderate and limited support appear in the appendix as “individual” IS.
In at least two of the breakout sessions—on the Medicare
and Social Security Disability Insurance programs—the
implementation strategies the delegates approved
overwhelmingly are missing from the report. Instead, they are
buried deep in the appendix as so-called individual IS.
A disclaimer that the IS “are not intended to be an endorsement by the Policy Committee of any particular idea, recommendation or proposed solution” appears not only in the transmittal letter and summary but also on every page of the implementation strategies in Chapter 2 of the report and in the appendix.
Following is an analysis of key resolutions that were deliberated by delegates according to their placement under each of the six tracks or the cross-cutting issues section. The IS are summarized and measured against Alliance principles and policies. Steps taken to advance some of the IS in the year since the WHCoA are also noted.
In at least two of the breakout sessions—on the Medicare and Social Security Disability Insurance programs—the implementation strategies the delegates approved overwhelmingly are missing from the report. Instead, they are buried deep in the appendix as so-called individual IS. The missing implementation strategies are described more fully in the appropriate sections below.
15 Track I: Planning Along the LifeSpan
Social Security Social Security was a hot button issue for the conference even though the resolution language itself was innocuous: Establish Principles to Strengthen Social Security. It was ranked No. 11 in delegate voting. Two IS sessions were devoted to the subject. Overwhelmingly, the delegates reporting from their groups repeatedly voiced their opposition to privatization of the Social Security program through private accounts. Delegates also offered changes that would address the long term solvency of the program. Such suggestions included raising or eliminating the cap on taxable earnings and dedicating the estate tax revenues to the trust funds, solutions advocated by the Alliance for Retired Americans.
By frequency alone, opposition to private accounts in Social Security is evident in both the report’s listing of strongest and strong IS and also in the appendix. In both, the first IS states: Maintain the entire Social Security (SS) system without privatization, including survivor benefits, disability program, and current COLA formula.7 This is followed by three IS opposing privatization. This essentially reflects what took place in the sessions; IS statements opposing privatization outnumbered those supporting private accounts approximately 3 or 4 to 1 (See description of Alliance delegates participation in the Social Security IS sessions in Part I).
Social Security Disability The resolution on Social Security’s Disability Insurance (SSDI) states simply: Strengthen the Social Security Disability Insurance Program. It was ranked No. 41 in delegate selection of the top 50 resolutions.
A multiple-point implementation strategy for improving the administration of the Social Security Disability Program received the same number of votes as the others but it is not in the report. It appears in the appendix only as an abbreviated and rambling individual IS.
Delegates were divided into three groups in a single IS session on this resolution. Although delegates were not officially allowed to amend resolutions, nevertheless in this session they did agree to a change in the overview statement. Delegates approved deletion of the sentence “The Social Security Administration has been making significant strides in the modernization of the SSDI program and operations” as inappropriate since the U.S. House Ways and Means Social Security Subcommittee, the American 16 Federation of Government Employees, and others had expressed grave concerns about the SSA Commissioner’s plan to change the disability program, and because the U.S. Government Accountability Office identified the disability program as “high risk.”
Most of the IS recommendations on Social Security Disability do appear in the report including those pertaining to facilitating Return to Work. However, another multiple-point implementation strategy for improving administration of the Social Security Disability Program received the same number of votes as the others listed but it is not in Chapter 2 of the report. It appears in the appendix only as an abbreviated and rambling individual IS.
Since this approved IS does not appear in the WHCoA report or in the appendix in its entirety, it is produced here so that it appears somewhere publicly for the record. The IS states: • Cease further implementation of the Commissioner’s Disability Plan, and hold Congressional hearings that include the SSA employees AFGE representatives; • Take SSA administrative accounts off-budget, as the rest of the Trust Fund accounts were under the SSA Independent Agency legislation in the early 1990s; • Restore 17,000 SSA Full-time Equivalent positions that had been stripped from the Agency in the late 1980s by former Commissioner Hardy, as soon as possible, in order to improve the quality and timeliness of service delivery. This is to be accomplished through a supplemental request made directly to the Ways & Means Committee, as provided for in the Independent Agency legislation, without first being routed through the Office of Management & Budget; • Restore the Field Representative positions that had been eliminated as a result of the staffing cuts, in order to improve outreach to people in the communities, so that there is at least one Field Representative in each SSA Field Office; • Take approximately 500,000 SSA Title II Special Disability Workload cases, and an unknown number of Special Individuals with Disability Entitlement cases, off the back burner as soon as possible, and process them. (These cases involve entitlement as far back as January 1974, were discovered in 1992, and have largely been set aside because of SSA’s staffing shortages); • Suspend the use of “signature proxy” and hold Congressional hearings, to examine legal issues and to prevent fraud; • Immediately suspend further outsourcing of disability claims work to “third parties,” hold Congressional hearings, and reinstate the AFGE/SSA union- management committee whose activities in examining third party disability claims issues were suspended in early 1997; • Develop a comprehensive quality assurance program that, unlike the current system, counts third party errors and systems errors in the error definitions; and • Make a major effort to post earnings, which are currently contained in the “suspense” files, to the earnings records of individuals.
17 Supplemental Security Income (SSI) The SSI program provides basic safety net protection for 7 million low- income aged, blind, and disabled people who have little or no income and provides cash to meet basic needs for food, clothing and shelter. It has not been updated for several years, making it less effective in alleviating poverty.
One session was devoted to the resolution, Modernize the Supplemental Security Income (SSI) Program, which was ranked No. 30 by delegates.
The strongest and strong IS followed many of the Alliance for Retired Americans recommendations for modernizing SSI including: • Bringing the benefit above the federal poverty level; • Developing and funding an effective outreach program; • Increasing the general income and earned income exclusions; and • Restoring SSI benefits to all immigrants whose status would have entitled them to benefits prior to the 1996 welfare reform law.
It is now imperative to translate these IS into legislation that will implement the suggested improvements as most SSI recipients have no other source of income and the average benefit is 27 percent below the federal poverty level.
Retirement Savings A resolution pertaining to defined benefit pension plans and another on changing policies regarding defined contribution plans were not adopted by the delegates possibly because pension and retirement savings legislation was under consideration in Congress at the time.
One resolution on retirement savings was selected and ranked as No. 24: Provide Financial and Other Economic Incentives and Policy Changes to Encourage and Facilitate Increased Retirement Savings.
Only a few of the Alliance’s recommendations appear among the IS for this resolution. Many of the IS had an emphasis on financial education from kindergarten through high school and college and the use of retirement savings funds for long-term care services and insurance. A number of unrelated IS are clumped together as run-on statements. Among Alliance recommendations that do appear in the strongest and strong IS: expand the Saver’s Credit limit and make it refundable; and automatic enrollment in retirement plans with an opt-out provision. Elements of these IS are included in the Pension Protection Act of 2006 (P.L. 109-280) signed into law on August 17, 2006.
18 Track II: Workplace of the Future
Two resolutions pertaining to older workers were adopted by the delegates:
Promote Incentives for Older Workers to Continue Working and Improve Employment Training and Retraining Programs to Better Serve Older Workers; and Remove Barriers to the Retention and Hiring of Older Workers, Including Age Discrimination.
They were respectively ranked as Nos. 12 and 14 by delegate voting and considered together in the breakout sessions.
By organization type in these sessions, delegates representing business and industry groups equaled those from non-profit organizations. While the intent of the resolutions may have been to come up with broader IS for older worker retention in the workplace, the IS overwhelmingly concentrated on support for continuation and expansion of the Senior Community Service Employment Program—Title V in the Older Americans Act (OAA)—and maintaining a focus on community service in that program. Congress subsequently agreed: the 2006 legislation reauthorizing the OAA maintains the eligibility age at 55 or older, reaffirms the integral role of the program in community service activities, and establishes five core indicators of performance.
Among other strongest and strong IS were: employer implementation of phased retirement and flexible work options; development of technologies for less manual work; greater priority for older workers in the Workforce Investment Act (WIA); and greater access to education and training through education grants and tuition waivers. These are all recommendations supported by the Alliance for Retired Americans.
Track III: Our Community
Older Americans Act The No. 1 ranked resolution reads: Reauthorize the Older Americans Act Within the First Six Months Following the 2005 White House Conference on Aging.
Due to the intense interest of delegates in the reauthorization of the OAA, which should have occurred in 2004, three IS sessions were devoted to this resolution. 19
Many of the IS for this resolution, with multiple recommendations for improving the services authorized under the Act, were achieved in legislation in 2006. Congress passed the 16th reauthorization of the OAA in late September 2006 and it was signed by President Bush on October 17, 2006 (P.L. 109-365). The reauthorization authorizes new grants to improve transportation services for older adults, deliver mental health screening and treatment services, plan for long-term care in home and community-based settings, promote multigenerational and civic engagement volunteer activities, and improve elder abuse prevention and services.
The Leadership Council of Aging Organizations urged Congress to increase authorization levels for the OAA to at least 25 percent above the FY 2006 funding levels “to reflect inflation and ensure that the aging network has the necessary resources to adequately serve the projected growth in the numbers of older adults.” LCAO has also urged Congressional appropriators to increase OAA funding by at least 10 percent.8 However, except for an increase in the authorization levels for the National Family Caregiver Support Program and the Native American caregiver program, Congress did not increase authorization levels for any other OAA program including the newly authorized services and grants in the 2006 re-authorization.
Without additional funding, the step forward that has been made with the OAA reauthorization is twice negated without an increase in authorization levels and appropriations funding.
Appropriations for OAA programs have been virtually flat-funded for at least five years resulting in an erosion of resources for serving increasing numbers of people. As Congress is likely to make additional cuts in domestic programs amounting to $5.3 billion in the FY 2007 appropriations—they shifted that amount to the defense and homeland security appropriations bills—there will be no money for the new initiatives, and less money for existing programs, particularly if Congress does an across-the-board cut to all domestic programs. Even with efficient utilization of OAA funds, older Americans in communities throughout the country are on waiting lists for many essential services. Without additional funding, the step forward that has been made with the OAA reauthorization is twice negated without an increase in authorization levels and appropriations funding.
Transportation
20 The importance of transportation is substantiated by the ranking of No. 3 delegates gave the resolution: Ensure That Older Americans Have Transportation Options to Retain Their Mobility and Independence.
The strongest and strong IS for this resolution emphasized the need for: increased/new funding in the Older Americans Act to expand transportation options particularly in rural and underserved areas; maximizing volunteer- provided transportation through tax incentives and by addressing hindrances such as costly insurance premiums; requiring disaster preparedness planning for seniors without transportation; promotion of best practices in local transportation, and walkable communities; and counseling services for those who must give up driving and learn other modes of transportation. The Alliance for Retired Americans supports these IS and many of the over 100 additional suggestions relegated to the individual IS category in the appendix. The Older Americans Act reauthorization in 2006 did permit new grants to fund demonstration projects to develop innovative approaches for improving transportation services and resources for older persons but without increased authorization levels to fund such grants.
Housing Two resolutions to enhance the availability and affordability of housing for older Americans were discussed together. Enhance the Affordability of Housing for Older Americans was ranked No. 16 and Enhance the Availability of Housing for Older Americans was No. 27.
The IS for these two resolutions largely reflect the recommendations of the Congressionally-established Seniors Commission that examined the housing needs of older Americans in the 21st century and was published in the report “A Quiet Crisis in America.”9 The IS also incorporate many of the recommendations of the Alliance for Retired Americans in its housing issue brief. These include support for a continued federal role in senior housing and services through increased funding for federal housing and service coordination programs, and preservation of existing federally assisted housing. In addition, promotion of state and local government policies to encourage innovative housing arrangements were among the strongest IS.
The importance of housing is evident in two other resolutions pertaining to housing design: Encourage Community Designs to Promote Livable Communities that Enable Aging in Place; and Expand Opportunities for Developing Innovative Housing Designs for Seniors’ Needs, which were ranked Nos. 20 and 48 by delegates. The strongest and strong IS for these resolutions also echo the work of the Seniors Commission. 21
The 2006 Older Americans Act reauthorization does create a new section that establishes a program to provide grants for community innovations for aging in place. It also establishes a federal interagency council for coordination of programs, one of the core recommendations of the commission and supported by the Alliance.
Protection from Abuse, Neglect and Financial Crime The two resolutions pertaining to elder abuse: Create a National Strategy for Promoting Elder Justice Through the Prevention and Prosecution of Elder Abuse, and Strengthen Law Enforcement Efforts at the Federal, State, and Local Level to Investigate and Prosecute Cases of Elder Financial Crime, were ranked Nos. 15 and 45 respectively.
Both were considered together in a single breakout session and the reported IS for both are identical. The strongest and strong IS called for passage and funding of the Elder Justice Act (EJA), legislation that has been pending for several years, which would provide for a federal level Coordinating Council and Advisory Board and includes provisions for building the capacity of adult protective services in every state; national data collection and a repository of research on elder abuse; development of forensic expertise pertaining to elder abuse; training of various workers who may come in contact with elder abuse situations; and increasing protections in long-term care facilities. Another IS receiving solid approval called for an elder abuse awareness postage stamp and legislation to create financial abuse specialist teams.
Provisions in the 2006 OAA reauthorization authorize the Administration on Aging to award grants to develop coordinated systems to detect and prevent elder abuse and neglect, carry out elder abuse prevention and services, educate the public to prevent identity theft and financial exploitation of older individuals, and develop a uniform method for data collection and reporting. The Alliance for Retired Americans supports these provisions in the OAA and also passage of the EJA.
Track IV: HEALTH AND LONG TERM LIVING
Medicare The outcome of the IS sessions on the Medicare resolution as reported in the WHCoA report is perhaps the most inaccurate as can be seen below. Liberties were taken by those associated with the conference and the report. Instead of recording the implementation strategy receiving the most support 22 from delegates, they clustered it with a number of other IS some of which are unrelated. In addition, one lengthy strategy with several points and receiving significant support from delegates is not mentioned at all in the report.
There were two IS sessions scheduled for the resolution: Strengthen and Improve the Medicare Program, which was ranked No. 5. Most of the delegates’ deliberations focused on the new Medicare Part D prescription drug program created under the 2003 Medicare Modernization Act (MMA) and scheduled to start in January 2006. In the first session, the IS receiving the most votes called for comprehensive drug coverage under the Medicare program with the government negotiating for lower prices. This should appear as the strongest IS in the report and in the appendix but it does not. Instead, a similar strategy is grouped with three other IS as one disjointed IS. It is one thing for the facilitator to combine IS in the presence of delegates with their tacit consent, but for conference officials to combine IS after the sessions indicates manipulation for the purpose of either diluting the impact of some IS or expressing viewpoints different from those of the delegates.
For conference officials to combine IS after the sessions indicates manipulation for the purpose of either diluting the impact of some IS or expressing viewpoints different from those of the delegates.
Another implementation strategy offered in the Medicare session by delegates was the Alliance for Retired Americans’ 12 points for improving the Medicare Part D benefit (See the Fix Medicare Rx petition in Appendix E). This was accepted verbatim in its entirety, posted on a flip chart and received nearly as many votes (blue dots) as the IS described above. However, this strategy is missing entirely from the report. In the appendix, 10 of the 12 points are included as the 125th so-called individual IS in a list of 127. The two missing points pertain to repealing the prohibition on government negotiation of drug prices and passing legislation to give Medicare the authority and duty to negotiate; and allowing purchase of drugs from Canada and other countries with high quality standards. Here again, parties associated with the conference made a decision to conceal adopted IS that did not conform to the agenda of the leadership in the White House and Congress.
Other IS receiving significant support from delegates called for “Medicare for All” or national health coverage, and health care for all. Neither of these are mentioned in the report; they also are hidden deep in the appendix as individual IS.
23
Parties associated with the conference made a decision to conceal adopted IS that did not conform to the agenda of the leadership in Medicarethe White Prescription House and Congress.Drug Program
Another Medicare resolution ranked last by delegates as No. 50 stated: Promote Enrollment of Seniors into the Medicare Prescription Drug Program. In the WHCoA report’s list of resolutions, the phrase “With Particular Emphasis on the Limited-Income Subsidy” is added. The phrase was not included in the resolution on the ballot or the schedule of IS breakout sessions. Many delegates unhappy with the Part D prescription drug benefit avoided the IS sessions for this resolution as they did not want to take part in promoting a flawed program. If the phrase had appeared in the official ballot or on the assignment of IS breakout sessions, it might have received a greater number of votes or participation in the sessions. The phrase is also absent from the strongest and strong IS in the report and appendix.
The strongest and strong IS for this resolution proposed increased outreach education to caregivers and health care providers, adequate funding and other support for community-based organizations, elimination of the asset test, and extension of the enrollment period without penalty throughout 2006. Although the Alliance for Retired Americans believes that the Medicare Part D benefit is inadequate, it does support the IS proposed here to reach low- income individuals who could benefit from the limited coverage.
Long-Term Care (LTC) Two sessions were allocated to simultaneous consideration of two resolutions on long-term care: Develop a Coordinated, Comprehensive Long-Term Care Strategy by Supporting Public and Private Sector Initiatives that Address Financing, Choice, Quality, Service Delivery, and the Paid and Unpaid Workforce; and Foster Innovations in Financing Long-Term Care Services to Increase Options Available to Consumers.
The former was ranked No. 2, the latter No. 18 in delegate voting. The final IS for these resolutions are most notable for their length, the result of steps taken by the facilitators to combine proposed IS.
24 In contrast to some of the earlier IS sessions where it was emphasized that each group of delegates propose just two IS, facilitators in the LTC sessions allowed for groups to report nearly everything each delegate proposed.
After all the groups reported on the LTC strategy resolution, the facilitator began a process of collapsing the number of separate IS by combining them until only 8 very long IS remained. Thus, one of the IS began as “Establish a LTC policy that:” and went on with an extensive list. Consequently, everyone approved at least something from this multiple-point IS although there was no genuine consensus. This process of combining IS resulted in just 8 IS remaining for delegates to vote on with their six blue dots. Despite the wording of the resolution itself, there was very little mention of caregivers, paid and unpaid, the essential component of adequate LTC services.
Developing a single point of entry into LTC services, particularly through Aging and Disability Resource Centers (ADRCs), also received significant support as an implementation strategy. In their responses to the policy committee’s request for their plans on how states would implement the resolutions, many of the governors with ADRCs in their states, highlighted the importance of these centers. Ironically, a resolution that called for expanding the ADRCs nationwide did not make it into the top 50 resolutions. The 2006 OAA reauthorization, however, does include language calling for expansion of ADRCs in every state.
IS for the LTC financing resolution produced significant support for ways to advance the purchase of LTC insurance, which was largely promoted by delegates representing the interests of insurers. Other IS called for eliminating the “institutional bias” in the Medicaid program and the waivers for which states must apply in order to re-direct Medicaid funds to home and community-based services (HCBS). The Alliance for Retired Americans believes that there should be flexibility for providing home and community- based services. Ideally, that flexibility would function best under a social insurance model for a long-term care system that incorporates the Alliance’s LTC principles. As with the other LTC resolution described above, the IS for this resolution were the result of the facilitators combining many of the proposed IS into a few.
Medicaid The Medicaid resolution: Strengthen and Improve the Medicaid Program for Seniors was ranked No. 4 by delegates. The strongest and strong IS reflect many improvements advocated by the Alliance for Retired Americans. As with the LTC resolutions, these include calls for elimination of an 25 institutional bias in Medicaid and support for more home and community- based services with adequate government funding—no caps or block grants— and a seamless system of coordinated and quality long-term care services in cost effective settings. Many states have successfully used Medicaid HCBS waivers to expand LTC services to older people, which the Alliance supports. The Alliance opposes the manner in which some states use other Medicaid waivers such as Section 1115 and Health Insurance Flexibility and Accountability (HIFA) waivers as vehicles for scaling back benefits and reducing the overall comprehensiveness of the Medicaid program for the most vulnerable beneficiaries. Other IS called for better enforcement of the Nursing Home Reform Act of 1987 to ensure institutional settings comply with federal standards of care, which the Alliance for Retired Americans also supports.
Mental Health A resolution on mental illness, Improve Recognition, Assessment, and Treatment of Mental Illness and Depression Among Older Americans, was ranked No. 8 by delegates.
The predominant implementation strategy called for mental health parity, or equivalent coverage of services and costs, with physical health services in Medicare, Medicaid and private insurance. The strongest IS also called for affordable and quality mental health and substance abuse services in a variety of settings including senior housing and centers, workplace, and home; training and education of professionals and families; and promotion of coordination between older adult mental health research and community- based delivery. The Alliance for Retired Americans supports mental health parity in public and private coverage as a critical starting point for addressing the largely unrecognized mental health needs of the older population. The 2006 Older Americans Act reauthorization authorizes new grants for the development and operation of systems for the delivery of mental health screening and treatment and activities to increase awareness of mental health disorders among older individuals.
Geriatric and Healthcare Workforce Two resolutions pertained to the health care professions and direct care workers: Support Geriatric Education and Training for All Healthcare Professionals, Paraprofessionals, Health Profession Students, and Direct Care Workers; and Attain Adequate Numbers of Health Care Personnel in All Professional Who are Skilled, Culturally Competent, and Specialized in Geriatric. 26
They were ranked No. 6 and No. 9 respectively by delegates.
From the IS sessions devoted to these resolutions, recommendations repeatedly called for increased federal funding and mandates for training, certification, career development and continuing education of geriatric medical and other health professionals and paraprofessionals. One of the pre- WHCoA mini-conferences focused on the geriatric health care workforce.
Both Congress and President Bush repudiated delegates’ support for geriatric training in the months following the WHCoA by totally eliminating funding.
Ironically, at the same time that delegates were expressing the importance of geriatric training at the conference, the House of Representatives voted to eliminate all funding ($31.5 million) for geriatric health professions programs, including 50 geriatric education centers, in the fiscal year 2006 budget. Although the Senate would have restored funding, the House version prevailed in the final appropriations bill. This action eliminates the progress achieved over a decade of continued and increased funding for the programs. President Bush, in his fiscal year 2007 budget, did not include any funding for geriatric education programs. Both Congress and President Bush repudiated delegates’ support for geriatric training in the months following the WHCoA by totally eliminating funding.
Track V: Civic and Social Engagement
One resolution calling for Congress to Reauthorize the Community Service Act to Expand Opportunities for Volunteer and Civic Engagement Activities was ranked No. 28. The Act funds the Senior Corps programs of RSVP, Foster Grandparents and Senior Companions among others.
A broader resolution on volunteering: Develop a National Strategy for Promoting New and Meaningful Volunteer Activities and Civic Engagement for Current and Future Seniors was ranked No. 25 by delegates.
The strongest IS for this resolution included recommendations for a national commission to develop a blueprint for bringing baby boomers into sustained volunteer service in their communities, and establishment of a fund for 27 innovation to foster growth of promising practices and program models. Other IS advocated expansion of existing national volunteer programs such as the Senior Corps programs and the Americorps program. A federally funded volunteer clearinghouse and tax credits for employers who encourage volunteerism among employees were also among the strongest and strong IS. Unfortunately, many other worthwhile IS were relegated to the individual IS category in the appendix. The 2006 reauthorization of the Older Americans Act has a provision that requires state and area agencies on aging to include in their plans how they will make use of trained volunteers and also coordinate with volunteer programs such as the Corporation for National Service. The reauthorization of the national volunteer acts has not happened.
Track VI: Technology and Innovation in an Emerging Senior/Boomer Marketplace
The resolution Develop Incentives to Encourage the Expansion of Appropriate Use of Health Information Technology was ranked No. 36. Many of the IS from this session pertained to encouraging involvement of consumers and providers with incentives to participate and also removal of regulatory obstacles. None of the IS, even those classified in the so-called individual IS category, mention the importance of privacy protections for patients which the Alliance for Retired Americans supports. Measures to ensure privacy rights are particularly important for the older patient who may have cognitive or functional impairments.10 Another resolution in this track was also chosen by delegates in the top 50 resolutions but it pertained to coordination between aging and health providers rather than technology.
Cross Cutting Issues
The WHCoA Policy Committee developed several resolutions described as cross cutting—relevant to more than one of the six tracks—and they are listed separately from the other tracks.
A cross-cutting resolution that surprised many delegates for the number of votes it garnered was: Improve State and Local Based Integrated Delivery Systems to Meet 21st Century Needs of Seniors. This resolution ranked No. 10 and was widely supported by those in the aging network particularly area agencies on aging (AAAs). Consequently, the strongest IS for this resolution calls for a new title to the Older Americans Act that, through AAAs, would promote community planning and preparedness, including emergency planning, across a wide range of issues for today’s and tomorrow’s aging
28 population.11 Although a new title was not created, language authorizing grants for planning to prepare communities for the aging population was incorporated in the Older Americans Act reauthorization legislation signed by President Bush on October 17, 2006. However, future funding for this provision is not provided in the legislation.
A resolution on family caregivers, Develop a National Strategy for Supporting Informal Caregivers of Seniors to Enable Adequate Quality and Supply of Services, was ranked No. 13. The strongest and strong IS included an expanded definition of caregiver and also increased funding for the National Family Caregiver Support Program (NFCSP) under the Older Americans Act; and economic security for caregivers through various means such as tax credits, Social Security credit for caregiving years, as well as access to affordable health and long-term care insurance. These are all measures and policies supported by the Alliance for Retired Americans. A related resolution, Support Older Adult Caregivers Raising Their Relatives’ Children, was ranked No. 31. The IS proposed measures to facilitate raising grandchildren. Several IS for both these resolutions were addressed in the Older Americans Act 2006 reauthorization including authorization for increasing the appropriation for the NFCSP to $187 million in 2011 (The fiscal year 2006 appropriations for NFCSP is $156 million). Increased funding up to $7.9 million for Native American caregivers is also authorized (the FY 2006 appropriation is $6.2 million) over the next five years.
Another cross-cutting resolution pertained to responsibility for implementation of the WHCoA recommendations. That resolution with the cumbersome title—Implement a Strategy and Plan for Accountability to Sustain the Momentum, Public Visibility, and Oversight of the Implementation of 2005 WHCoA Resolutions—was ranked No. 17 by delegates.
The most frequently recurring IS here called for establishment of an official commission/board or delegate task force to monitor implementation of resolutions and make periodic reports. Alternatively, the implementation and oversight could be assigned to an existing agency which would issue an annual report and maintain the WHCoA website as a communication tool. Other strongest and strong IS would have states assume responsibility for a portion of the implementation. The delegates also strongly recommended annual Congressional oversight hearings but this strategy is concealed in the appendix. If even a minority of implementation strategies for the 50 selected resolutions are to be achieved, it will require the interest and involvement of members of Congress and their staff. The Congressional oversight strategy should have been placed at the top where delegates wanted it. 29
The delegates also strongly recommended annual Congressional oversight hearings but this strategy is concealed in the appendix.
Special Populations
A few of the resolutions focused on the concerns of segments of the older population who face unique access barriers. These individuals include those who live in rural areas, members of minority groups, and those with disabilities, whether lifelong or late onset. The relevant resolutions as ranked by the delegates include:
No. 23 Improve Access to Care for Older Adults Living in Rural Areas No. 38 Promote Economic Development Policies that Respond to the Unique Needs of Rural Seniors No. 34 Reduce Healthcare Disparities Among Minorities by Developing Strategies to Prevent Disease, Promote Health, and Deliver Appropriate Care and Wellness No. 44 Ensure Appropriate Care for Seniors with Disabilities
The rural resolutions were considered together. Delegates shared information about successful programs in their communities and states and came up with an extensive number of strategies—151 altogether for No. 23 and 95 for No. 38. These recommendations from knowledgeable delegates provide ample material for a number of Congressional and state hearings on improving access to health and other services for older Americans living in rural areas.
The healthcare disparities resolution made a number of recommendations that deserve consideration particularly by health care providers. They include: incorporation of “cultural competence” in health-related training curriculum; identification of best practices; outreach to minority communities; performance measures and benchmarks; health promotion and wellness intervention, in appropriate languages, that address individual racial, ethnic, sexual orientation, religious, national origin and disabilities needs. The so- called individual IS in the appendix contains an additional 78 strategies for this resolution.
The IS for the resolution on care for seniors with disabilities call for increased access to home and community-based rehabilitation services, disability-
30 specific training for direct service providers, and development of assistive technologies to support living in the least restrictive environment.
Discussion and Conclusion
The 2005 White House Conference on Aging should not be remembered for the efforts to control the delegates but for the way that delegates spoke up both for themselves and a future older population. Delegates made solid statements on action steps that federal, state, local and tribal governments, as well as the private sector, non-profits, individuals and their communities can take.
Although the WHCoA executive summary repeatedly emphasized planning for the future as a “personal responsibility,” the delegates reaffirmed the value of various federal programs and want them preserved and protected, not dismantled. The delegates resoundingly rejected Social Security privatization and undermining of the Medicare program through an inadequate drug benefit provided by private insurers. At the same time, they made sound recommendations for improving both programs. They also pressed for continuation of other programs through the reauthorization of the Older Americans Act and called for passage of legislation addressing other concerns such as the Elder Justice Act that would increase protections from elder abuse.
Where the work of the delegates is recorded correctly, the policy positions and action steps, to an overwhelming extent, reflect the policy positions of the Alliance for Retired Americans. In addition, it is obvious that the positions of the aging network and Native Americans are interwoven throughout the implementation strategies demonstrating the successful efforts also of these advocates. In the end, the delegates prevailed.
The OAA authorizers and appropriators must work together with
major stakeholders in the aging network to provide adequate
funding for the OAA’s services and new initiatives. If there is no
new funding for these initiatives, the promise of expanded and
improved services is just a hollow shell.
31 However, where the efforts of delegates are not accurately recorded, the actual results of the delegates’ work must be retrieved and made public. Significant improvements were proposed for the Medicare prescription drug program and the administration of the Social Security Disability Insurance program. That they are not included in the report makes it imperative that the Administration and Congress take action to set the record straight.
More than $7.4 million was expended on planning and holding the 2005 White House Conference on Aging but the outcome of the WHCoA does not end with the policy committee’s report. There have been some accomplishments in the year since the conference ended.
The thrust of a number of the resolution recommendations were included, at least partially, in the 2006 reauthorization of the Older Americans Act. For example, new OAA provisions include community as well as emergency preparedness planning for an aging population, grants for delivery of mental health prevention services and innovative approaches for improving transportation services and resources among others. However, this does not mean that these concerns have been addressed; authorization of new grants does not insure that there will be appropriations for them. Additionally, with just a few exceptions, overall authorization levels in the OAA have not been increased. The OAA authorizers and appropriators must work together with major stakeholders in the aging network to provide adequate funding for the OAA’s services and new initiatives. If there is no new funding for these initiatives, the promise of expanded and improved services is just a hollow shell.
The Pension Protection Act enacted in 2006 has a few provisions that may increase retirement savings but it does not go far enough. It includes provisions that allow employers to auto-enroll employees in 401(k) plans and encourage automatic increases in contributions. It does not, however, require employer contributions. The Act also made the Saver’s Credit permanent—it would have expired after 2006—and indexed to inflation. Yet it does not make the Saver’s Credit refundable nor does it extend eligibility to additional middle-income households.
At the WHCoA, delegates were repeatedly advised to come up with strategies that were “fiscally responsible.” While that would be a legitimate caution even in sound economic times it is important to remember that it was the proliferate spending of the Bush Administration and Congress, not older Americans, that brought the federal budget from a surplus in 2001 to massive deficits in 2006, half of which are due to tax cuts heavily favoring the very 32 wealthy.12 And older Americans did not come up with annual federal budgets that froze funding for essential programs year after year or, more frequently, severely cut or eliminated lifeline programs that would improve not only their lives but also those of their children and grandchildren. Fiscal responsibility lies with those who are elected to represent all people and that includes not subjecting them to increased economic risk. Delegates made recommendations as though there were a fiscally responsible Congress and Administration.
One year has passed since the 2005 conference, the next nine years hold greater challenges. The recommendations of the WHCoA delegates must now be translated into public policy and administrative initiatives on several levels.
Following the 1971 WHCoA, the chair of the conference, at the request of the President, created a Post-Conference Board to act as the agent of the delegates to follow up on the conference recommendations. The responsibilities of the board were to analyze the steps taken by public and private sectors to implement the conference recommendations, and recommend strategies to accelerate action consistent with the recommendations where implementation seemed inadequate. The law that enacted the 1971 conference also required the Administration to submit periodic reports to Congress on how it was implementing the conference recommendations. Congressional committees held oversight hearings and members of Congress introduced legislation addressing the recommendations. As a result of the scrutiny and actions taken, approximately 75 percent of the conference’s recommendations were partially or fully implemented.13 While there is no similar impetus following this conference, nevertheless it is imperative that there be some kind of follow-up. The thoughtful recommendations supplied by delegates who deliberated the resolution on conference follow-up (No. 17) are a place to start.
The Alliance for Retired Americans calls upon the Bush Administration to report to Congress on how it is responding to the recommendations of the delegates to the 2005 WHCoA. And the Alliance calls upon Congress to conduct hearings on the IS coming from the WHCoA, translate those that need legislative mandates into law, and provide oversight to ensure that they are implemented. Older Americans and aging baby boomers need champions in the Senate and the House of Representatives.
Similarly, governors should monitor developments from the state perspective, implement solutions that can be accomplished by the states, and report to their 33 constituents on at least an annual basis. States have the authority to expand affordable housing, improve transportation coordination and expand home and community-based services. Indeed, most governors convene annual conferences on aging and many have already indicated their resolve to maintain a focus on the WHCoA delegates’ recommendations. It would be useful if state successes are shared and made available nationally, possibly through a database of the National Governors Association.
State and local jurisdictions, the private sector, as well as educational institutions and non-profit organizations all have a role to play. Much can be accomplished in communities and workplaces. Many of the implementation strategies suggested at the WHCoA do not necessarily require an influx of funds. Ideas and concerted efforts can achieve a great deal.
As the White House Conference on Aging is a decennial event, delegates maintain their title of conference delegates for 10 years and have a responsibility to work to achieve the goals of the conference. Alliance delegates will continue to share their experiences and exert influence in their states through state conferences on aging and collaboration with other delegates, especially those from the aging network, to achieve mutual goals and raise public awareness of new concerns that must be addressed in the next several years.
It is hoped that in eight years, when plans are underway for the 2015 White House Conference on Aging, that the 2005 conference will be known not only for the achievements of the delegates at the conference but also for the concerted, and hopefully successful, efforts to bring their recommendations to full attainment.
Older Americans and aging baby boomers need champions in the Senate, the House of Representatives, and in state houses.
34 Appendix A
History of White House Conferences on Aging
Three national conferences preceded the first White House Conference on Aging in 1961. In 1950, President Harry S. Truman recognized the need to convene a conference focused solely on addressing the challenges of a rapidly growing older population. The 816 delegates to that conference made recommendations for national action. Two subsequent conferences in 1952 and 1956 included delegates from most states and territories. These and all subsequent conferences took place in Washington, D.C.
The White House Conference on Aging Act (P.L. 85-908) of 1958 authorized the 1961 White House Conference on Aging calling for a nationwide citizens’ forum to focus public attention on older Americans. Congress intended that such a conference be held every 10 years. In 1959, a National Advisory Committee, led by Dr. Arthur Flemming, Secretary of Health, Education and Welfare, began meeting. Two years of pre-conference study and analysis at the state and local levels produced recommendations considered at the conference.
President Dwight D. Eisenhower opened the conference, held January 9-12, 1961, but it was the John F. Kennedy and Lyndon B. Johnson administrations that implemented the recommendations. More than 3,000 attended, including 2,800 voting delegates. Fifty-three states and territories as well as 300 national organizations were represented. Many recommendations from the conference became law within a few years. These included enactment of Medicare and Medicaid in 1965 as Titles XVIII and XIX, respectively, of the Social Security Act. The Older Americans Act, also enacted in 1965, established the Administration on Aging and state units on aging. Other major legislation included Social Security amendments providing additional support to beneficiaries, and amendments to the 1961 Housing Act and the Community Health Facilities Act requiring special provisions for the aged. New programs were created to provide older adults with job training and volunteer opportunities.
The 1971 White House Conference on Aging took place November 28- December 2, 1971, during President Richard M. Nixon’s administration. Over 4,000 delegates attended. The primary objectives were to establish an income assistance program to reduce poverty among seniors and improving
35 transportation services for rural and urban older Americans. Approximately 75 percent of the nearly 200 recommendations were partially or fully implemented. The Supplemental Security Income program was established in 1972 as a federal-state program to provide a basic safety net for older Americans, and the blind and disabled of all ages to meet their most basic needs. During the 1970s, the Urban Mass Transit Act was amended to provide reduced fares on mass transit and transportation in rural areas for seniors and persons with disabilities. Resolutions also launched greater coordination of services among federal, state and local area agencies on aging and created a national nutrition program for seniors. The conference’s recommendations also created the House Select Committee on Aging and the Federal Council on the Aging.
The 1981 White House Conference on Aging took place November 19- December 3, 1981. It was planned and implemented under the Carter and Reagan administrations; 2,000 delegates and 1,150 observers attended. In an effort to emphasize grassroots involvement, over 9,500 community forums, single issue mini-conferences, and state conferences were held during the two years preceding the conference. New issues for consideration surfaced from the forums including elder abuse, negative stereotypes and ageism, intergenerational programs, long-term care and adult education. Approximately 700 official recommendations for legislative and administrative action were proposed but little action was taken. President Reagan’s massive cuts in domestic spending for social programs prior to the conference and his proposal to cut Social Security benefits overshadowed the WHCoA’s recommendations.
The 1995 White House Conference on Aging took place May 2-5, 1995. Over 800 pre-conference events were held throughout the country. More than 3,000 including 2,217 delegates from all the states and territories attended. Governors, members of Congress and constituent organizations including national aging organizations selected 80 percent of the delegates. In contrast to earlier conferences, the 1995 conference proposed few new initiatives. Delegates, assisted by expert advisers, concentrated instead on resolutions reaffirming support for existing programs and recommendations for strengthening each of them.
36 Appendix B
WHCoA Policy Committee Members
Dorcas R. Hardy, Chair Barbara B. Kennelly Dorcas R. Hardy and Associates National Committee to Preserve Social Washington, D.C. Security and Medicare Washington, D.C. Alejandro Aparicio, MD American Medical Association Michael O. Leavitt, Secretary Chicago, Illinois U.S. Department of Health and Human Services Robert Blancato Washington, D.C. Matz, Blancato and Associates, Inc. Washington, D.C. Rep. Howard P. “Buck” McKeon (R- CA) Senator Larry Craig (R-ID) U.S. House of Representatives U.S. Senate Washington, D.C. Washington, D.C. R. James “Jim” Nicholson, Secretary Clayton Fong U.S. Department of Veterans Affairs National Asian Pacific Center on Aging Washington, D.C. Seattle, Washington Scott Serota Thomas E. Gallagher Blue Cross and Blue Shield Association Greylock Group, Inc. Chicago, Illinois Las Vegas, Nevada Rep. Clay Shaw Jr. (R-FL) Senator Charles “Chuck” Grassley (R- U.S. House of Representatives IA) Washington, D.C. U.S. Senate Washington, D.C. Melvin Leroy Woods Rubicon Public Affairs Senator Tom Harkin (D-IA) Granite Bay, California U.S. Senate Washington, D.C.
Gail Gibson Hunt National Alliance for Caregiving Washington, D.C.
Alphonso R. Jackson, Secretary U.S. Department of Housing & Urban Development Washington, D.C.
37 WHCoA Advisory Committee Members
Michael McLendon, Chair F. Michael Gloth, MD U.S. Department of Veterans Affairs Victory Springs Senior Health Washington, D.C. Associates Reistertown, Maryland Rodolfo Arrendondo, EdD Texas Tech University Health Sciences Carolyn Doppelt Gray, JD Center Barnes and Thornburg Lubbock, Texas Washington, D.C.
Lupo Carlota, MD Carole Green Medical Acupuncture Research Institute Florida Department of Elder Affairs of America Tallahassee, Florida Lakeland, Tennessee Cynthia Hughes Harris, PhD Juanita K. Correa Florida A & M University Laguna Rainbow Corp. Tallahassee, Florida Casa Blanca, New Mexico Edward Martinez Joseph F. Coughlin, PhD San Ysidro Health Center Massachusetts Institute of Technology San Ysidro, California Age Lab, MIT Cambridge, Massachusetts Melvina McCabe, MD University of New Mexico School of Anthony M. DiLeo, JD Medicine New Orleans, Louisiana Albuquerque, New Mexico
Peggye Dilworth-Anderson, PhD Lawrence Polivka, PhD Center for Aging and Diversity, Florida Policy Exchange Center on Institute on Aging Aging Chapel Hill, North Carolina Tampa, Florida
T. Bella Dinh-Zarr, PhD Isadore Rosenfeld, MD Public Health and Transportation Weill Cornell Medical Center Washington, D.C. New York, New York
Margaret Lynn Duggar William J. Scanlon, PhD Duggar and Associates Health Policy R&D Tallahassee, Florida Washington, D.C.
Katherine Freund Sandra Schlicker, PhD Independent Transportation Washington, D.C. Network (ITN America) Westbrook, Maine
38 Joanne Schwartzberg, MD American Medical Association Chicago, Illinois
William J. Turenne, Sr. Turenne and Company Irvington, Virginia
39 Appendix C
Alliance for Retired Americans WHCoA Delegates and Alternates 2005 White House Conference on Aging
Ann Ballard James Davis Seattle, Washington Portland, Oregon
Paulette Beaudoin Chad Denham Biddeford, Maine Phoenix, Arizona
Sam Bianco Carolyn Dorman Vandling, Pennsylvania Delray Beach, Florida
Owen Bieber Tom Dwyer Alliance Board Member Alliance Board Member Byron Center, Michigan Coon Rapids, Minnesota
Elmer Blankenship, President Steve Dzielak Indiana Alliance for Retired Seattle, Washington Americans Indianapolis, Indiana Betty Flanagan Philadelphia, Pennsylvania Pearl Caldwell Cupertino, California James Forsythe Hayward, California John Carr, President Maine Alliance for Retired Nellie Fox-Edwards Americans Beaverton, Oregon York, Maine Shane Fox Judy Cato Alliance Board Member Alliance Board Member Tyler, Texas Camp Springs, Maryland Tony Fransetta, President Edward Creegan Florida Alliance for Retired Levittown, New York Americans Wellington, Florida
40 Tom Frazier Kevin Lynch, President Madison, Wisconsin Connecticut Alliance for Retired Americans Bernard Gorter West Hartford, Connecticut Milwaukie, Oregon Anne Mack Val Halamandaris Palo Alto, California Alliance Board Member Washington, D.C. Phil Mamber Alliance Board Member Al Hamai, President Randolph, Vermont Hawaii Alliance for Retired Americans Irene Martin Honolulu, Hawaii Fayette, Maine
Roger Hare Barbara Matteson West Buxton, Maine Alliance Board Member Tucson, Arizona Marilyn Higgins Spring Lake, New Jersey George McKinney Milwaukee, Wisconsin Bill Holayter Alliance Board Member Dan Mikel Shelton, Washington South St. Paul, Minnesota
Valeria Jack Oliver Montgomery Scappoose, Oregon Verona, Pennsylvania
Norma Kelsey Frank Ollivierre Des Moines, Washington Chestnut Hill, Massachuetts
Steve Kofahl Will Parry, President Everett, Washington Puget Sound Alliance Seattle, Washington Catherine Baker Knoll Harrisburg, Pennsylvania Mandy Plucker South Dakota Henry Lacayo Newbury Park, California
41 Verna Porter, President Tilly Ruth Telxeira Oregon Alliance for Retired Boston, Massachusetts Americans Portland, Oregon Genie Uebelacker Clackamas, Oregon Bruce Reeves Olympia, Washington Ruth Villa Jerome, Pennsylvania Steve Regenstreif Alliance Board Member Mike Vivirito Washington, D.C. Middle River, MD
Sandy Richards Gloria Willich New Castle, Delaware Lawrenceville, NJ
Pedro Rodriguez Laurie Young Alliance Board Member Washington, D.C. Philadelphia, Pennsylvania Phyllis Zamarripa Angelo Rotella Pueblo, Colorado Smithfield, Rhode Island
Pat Scott Des Moines, Iowa
Ed Scribner Alliance Board Member Ann Arbor, Michigan
Stephanie Stein Milwaukee, Wisconsin
Ernest Terry, President West Virginia Alliance for Retired Americans Nitro, West Virginia
42
Appendix D
Alliance for Retired Americans Educational Fund White House Conference on Aging Issue Briefs White House Conference on Aging 2005 (Feb 2005 – No. 1)
This report is the first in a series from the Alliance for Retired Americans Educational Fund, leading up to the White House Conference on Aging (WHCoA), first scheduled for October 23-26, 2005 in Washington, D.C. (later changed to December 11-14, 2005). As a framework for the series, this brief presents background on the conference, a profile of the baby boom population, which will be a major focus of the conference, a history of WHCoAs, and the reflections of a federal official who participated in the first conference in 1961. Subsequent briefs will focus on issues and programs that must be considered at the WHCoA as the nation’s boomers become retirees.
Social Security for All Ages (Apr 2005 – No. 2) This issue brief draws upon a report released earlier by the Alliance for Retired Americans Educational Fund, Social Security Under Attack. It highlights how the Social Security program works, the protections that it provides, key points about the effects of privatization and how minor adjustments will provide for promised benefits over the next 75 years.
Medicare Prescription Drug Benefit: A Guide Through the Maze (May 2005 – No. 3)
Under the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003, all Medicare beneficiaries who have Medicare Part A (Hospital Insurance) or Part B (Medical Insurance for doctor services and outpatient care) will have access to prescription drug benefits. Most individuals will obtain drug coverage through private plans. This report provides basic information individuals need to understand the prescription drug benefit, the implementation process, the decisions and actions they must take, and the resources available to them.
Medicare Rx Drug Benefit: Navigating Low-Income Assistance (June 2005 - No. 4) This report provides basic information for low-income beneficiaries, their families and their advocates about the application process for assistance and enrollment in the Medicare Part D prescription drug benefit. Retiring Into Work (July 2005 – No. 5) Working in later life often supplements other sources of retirement income, such as Social Security, pensions and savings, and it is likely to become even more important in the future. This brief explores the advantages and disadvantages of working longer and the practices that can encourage continued participation in the labor force at older ages.
An Affordable Home of One's Own (Aug 2005 - No. 6)
In an inflated housing market, many older Americans are finding it difficult to find or maintain homes that meet their physical and financial needs. As America ages, the need for affordable, quality housing is increasingly important. This brief examines the housing needs of older Americans, the status of federal housing programs, and what actions may be taken on the federal, state, and local levels to address what has been characterized as a "quiet crisis in America." Vanishing: Pensions and Savings (Sept 2005 - No. 7) The movement away from guaranteed pension benefits creates the potential for economic hardship for millions of Americans during their retirement years. This brief examines the shifting trends in employer-sponsored pension and retirement savings plans in the private sector and makes recommendations for protecting existing benefits and expanding coverage for those workers who are not participating in any plan. Long-Term Care Policy: Its Time Has Come...Again (Nov 2005 - No. 8) An increasing number of Americans will need long-term care in the future and the costs are expected to rise. Yet long-term care languishes in the health policy background despite widespread public support for action. This brief provides an overview of essential factors that should be considered in developing a long-term care policy for the nation.
44
Appendix E
Alliance for Retired Americans WHCoA Petitions
White House Conference on Aging PETITION “Call for Democracy”
We, the undersigned delegates to the 2005 White House Conference on Aging, call upon President Bush and the WHCoA Policy Committee to adopt the “10% Rule.”
Previous White House Conferences on Aging have allowed a minority of delegates to have their voices heard. At the 1981 WHCoA, minority points of view from at least 10% of delegates were included in committee reports. At the 1995 WHCoA, new resolutions could be brought before the conference with the signatures of 10% of delegates.
Since 1961, the White House Conference on Aging is a decennial event that brings in talented and experienced individuals from every state. This first WHCoA conference in the 21st century is particularly relevant for anticipating aging concerns just as the first of 77 million baby boomers turn 60.
Despite requests from delegates, Members of Congress and governors who have urged adoption of the 10% Rule, 2005 WHCoA delegates have no opportunity to introduce new resolutions. American democracy demands fairness and openness in a publicly sponsored conference. Adoption of the 10% Rule will assure that no delegate’s viewpoint will be shunted aside.
45 White House Conference on Aging PETITION “Fix Medicare Rx”
We, the undersigned delegates to the 2005 White House Conference on Aging, urge Congress to enact legislation to improve the Medicare Part D Rx Drug Program for the 43 million Medicare beneficiaries. Improvements should include the following:
1. Repeal the prohibition against Medicare (the federal government) negotiating drug prices on behalf of the 43 million Medicare beneficiaries. Pass legislation to give Medicare the authority and duty to negotiate prices with pharmaceutical manufacturing companies. This is essential to reducing the overall cost of the program, and to prevent windfall profits to drug companies.
2. Use savings to fill the so-called “donut hole” or gap in coverage between $2,250 and $5,100 in drug costs to consumers.
3. Eliminate the asset test for low-income recipients to receive the extra help.
4. Prior to May 15, 2006 eliminate or delay the penalty for late enrollment in the program.
5. Pass legislation to allow Americans to purchase drugs from Canada and other countries with high quality standards.
6. Delay the enrollment of dual eligibles for one year to avoid major issues of access for very low-income persons. These people would continue to receive assistance from Medicaid.
7. Provide every Medicare beneficiary the opportunity to make a one- time change in plan enrollment at any point in 2006.
8. Allow retirees with employer-provided benefits the change to correct enrollment mistakes in 2006.
9. Provide the Part D Rx benefit through Medicare (similarly to Part A and Part B) not through private insurance companies. The use of
46 insurance companies has made the program much too complicated by allowing different monthly premiums, different drug formularies, different co-payments, different prices, different benefit levels, etc.
10. Eliminate the prohibition against people being able to purchase Medigap insurance to cover the gaps in drug coverage.
11. Develop minimum requirements to assure that most drugs are available in all plans.
12. Develop incentives to assure that the vast majority of local pharmacies participate in the program.
47 Appendix F
Fifty Resolutions Adopted by Conference Delegates
The following 50 resolutions were selected by WHCoA delegates from 73 presented to them. They are ranked according to the number of votes each resolution received.
Resolution # 1—Title: Older Americans Act Reauthorize the Older Americans Act Within the First Six Months Following the 2005 White House Conference on Aging.
Resolution # 2 —Title: Coordinated Long Term Care Strategy Develop a Coordinated, Comprehensive Long-Term Care Strategy by Supporting Public and Private Sector Initiatives that Address Financing, Choice, Quality, Service Delivery, and the Paid and Unpaid Workforce.
Resolution # 3—Title: Transportation Options Ensure That Older Americans Have Transportation Options to Retain Their Mobility and Independence.
Resolution # 4—Title: Medicaid Program for Seniors Strengthen and Improve the Medicaid Program for Seniors.
Resolution # 5—Title: Medicare Reform for the Future Strengthen and Improve the Medicare Program.
Resolution # 6 – Title: Prepared Healthcare Workforce Support Geriatric Education and Training for All Healthcare Professionals, Paraprofessionals, Health Profession Students, and Direct Care Workers.
Resolution # 7–Title: Non-Institutional Long Term Care Promote Innovative Models of Non-Institutional Long-Term Care
Resolution # 8–Title: Responsive to Mental Illness Improve Recognition, Assessment, and Treatment of Mental Illness and Depression Among Older Americans.
Resolution # 9–Title: Capacity of the Geriatric Workforce Attain Adquate Numbers of Healthcare Personnel in All Professions Who are Skilled, Culturally Competent, and Specialized in Geriatrics.
Resolution # 10–Title: Coordination of Aging-in-Place Improve State and Local Based Integrated Delivery Systems to Meet 21st Century Needs of Seniors.
48 Resolution # 11–Title: Principles of Social Security Establish Principles to Strengthen Social Security.
Resolution # 12–Title: Incentives for Older Workers Promote Incentives for Older Workers to Continue Working and Improve Employment Training and Retraining Programs to Better Serve Older Workers.
Resolution # 13–Title: Strategy for Informal Caregivers Develop a National Strategy for Supporting Informal Caregivers of Seniors to Enable Adequate Quality and Supply of Services.
Resolution # 14–Title: Retention of Older Workers Remove Barriers to the Retention and Hiring of Older Workers, Including Age Discrimination.
Resolution # 15–Title: Protection from Abuse and Neglect Create a National Strategy for Promoting Elder Justice Through the Prevention and Prosecution of Elder Abuse.
Resolution # 16–Title: Affordable Housing Enhance the Affordability of Housing for Older Americans.
Resolution # 17–Title: Accountability for Implementation of 2005 WHCoA Recommendations Implement a Strategy and Plan for Accountability to Sustain the Momentum, Public Visibility, and Oversight of the Implementation of 2005 WHCoA Resolutions.
Resolution # 18–Title: Long-Term Care Financing Foster Innovations in Financing Long Term Care to Increase Options Available to Consumers.
Resolution # 19–Title: Coordinated Health and Aging Networks Promote the Integration of Health and Aging Services to Improve Access and Quality of Care for Older Americans.
Resolution # 20–Title: Designs for Livable Communities Encourage Community Designs to Promote Livable Communities that Enable Aging in Place.
Resolution # 21–Title: Disease Management Programs Improve the Health and Quality of Life of Older Americans Through Disease Management and Chronic Care Coordination.
Resolution # 22–Title: Healthy Nutrition Promote the Importance of Nutrition in Health Promotion and Disease Prevention and Management. Resolution # 23–Title: Care in Rural Areas
49 Improve Access to Care for Older Adults Living in Rural Areas.
Resolution # 24–Title: Increased Retirement Savings Provide Financial and Other Economic Incentives and Policy Changes to Encourage and Facilitate Increased Retirement Savings.
Resolution # 25–Title: National Strategy for Volunteering Develop a National Strategy for Promoting New and Meaningful Volunteer Activities and Civic Engagements for Current and Future Seniors.
Resolution # 26–Title: Emergency Response or Disaster Plan Encourage the Development of a Coordinated Federal, State, and Local Emergency Response Plan for Seniors in the Event of Public Health Emergencies or Disasters.
Resolution # 27–Title: Available Housing Enhance the Availability of Housing for Older Americans.
Resolution # 28–Title: National and Community Service Act Reauthorize the National and Community Service Act to Expand Opportunities for Volunteer and Civic Engagement Activities.
Resolution # 29–Title: Innovations in Aging Research Promote Innovative Evidence-Based and Practice-Based Medical and Aging Research.
Resolution # 30–Title: Supplemental Security Income Modernize the Supplemental Security (SSI) Program.
Resolution # 31–Title: Older Adult Caregivers of Children Support Older Adult Caregivers Raising Their Relatives’ Children.
Resolution # 32–Title: Veterans Healthcare Ensure Appropriate Recognition and Care for Veterans Across All Healthcare Settings.
Resolution # 34–Title: Designs of Senior Centers Encourage Redesign of Senior Centers for Broad Appeal and Community Participation.
Resolution # 34–Title: Awareness of Disparities Reduce Healthcare Disparities Among Minorities by Developing Strategies to Prevent Disease, Promote Health, and Delivery Appropriate Care and Wellness.
Resolution # 35–Title: Issues Surrounding the End of Life Educate Americans on End of Life Issues.
Resolution # 36–Title: Health Information Technology
50 Develop Incentives to Encourage the Expansion of Appropriate Use of Health Information Technology.
Resolution # 37–Title: Provider Education on Consumer Healthcare Prevent Disease and Promote Healthier Lifestyles Through Educating Providers and Consumers on Consumer Healthcare.
Resolution # 38–Title: Rural Economic Development Promote Economic Development Policies that Respond to the Unique Needs of Rural Seniors.
Resolution # 39–Title: Evidence-Based Long-Term Care Apply Evidence-Based Research to the Delivery of Health and Social Services Where Appropriate.
Resolution # 40–Title: Consumer Driven Health Education and Health Literacy Improve Health Decision Making through Promotion of Health Education, Health Literacy, and Cultural Competency.
Resolution # 41–Title: Social Security Disability Insurance Strengthen the Social Security Disability Insurance Program.
Resolution # 42–Title: Geriatric Healthcare Continuum Evaluate Payment and Coordination Policies in the Geriatric Healthcare Continuum to Ensure Continuity of Care.
Resolution # 43–Title: Shared Health Information Encourage Appropriate Sharing of Healthcare Information Across Multiple Management Systems.
Resolution # 44–Title: Care for Seniors with Disabilities Ensure Appropriate Care for Seniors with Disabilities.
Resolution #45–Title: Prosecution of Financial Crimes Strengthen Law Enforcement Efforts at the Federal, State and Local Level to Investigate and Prosecute Cases of Elder Financial Crime.
Resolution # 46–Title: Program Alignment and Performance Review Alignment of Government Programs That Deliver Services to Older Americans.
Resolution # 47–Title: Capacity for Safe Driving Support Older Drivers to Retain Mobility and Independence Through Strategies to Continue Safe Driving.
Resolution # 48–Title: Innovative Housing Designs Expand Opportunities for Developing Innovative Housing Designs for Seniors’ Needs.
51
Resolution # 49–Title: Patient Advocacy Improve Patient Advocacy to Assist Patients in and Across All Care Settings.
Resolution # 50–Title: Prescription Drug Improvements Promote Enrollment of Seniors Into the Medicare Prescription Drug Program With Particular Emphasis on the Limited-Income Subsidy.
1 The reports are included in the appendix to the main report. 2 Although the WHCoA report says the synthesis document is in the appendix, it is not. Nor does it appear on the conference website. 3 Binstock, Robert. “Social Security and Medicare: President Bush and the Delegates Reject Each Other.” Public Policy & Aging Report. Winter 2006. Vol. 16, No. 1. 4 The other report in the delegates’ workbooks from a government entity was one on technology from the Department of Commerce. U.S. Dept. of Commerce. Technology Administration. “Technology and Innovation in an Emerging Senior/Boomer Marketplace.” December 11, 2005. See also endnote No. 9 below. 5 Similar resolutions, such as those pertaining to housing designs and community designs for livable communities, were combined into a single session. Other resolutions, such as those on Social Security, Medicaid, and Medicare, were considered alone. A number of resolutions were allocated two sessions. The resolution on reauthorizing the Older Americans Act within 6 months had three sessions. 6 “The role of government may change over time, but it has and will continue to have a fundamental responsibility to help those in need irrespective of age.” pp. 19-20. WHCoA Executive Summary. 7 The Alliance for Retired Americans supports basing the COLA on the true cost-of-living of Social Security beneficiaries, derived from a more precise determination of living costs for seniors and persons with disabilities. It is unclear here whether this IS actually meant the COLA formula or if it was referring to the wage indexing method of calculating initial benefits. 8 Leadership Council of Aging Organizations: LCAO Older Americans Act Reauthorization Recommendations, February 2006; Letter to Congress, July 11, 2006. 9 “A Quiet Crisis in America.” A Report to Congress by the Commission on Affordable Housing and Health Facility Needs for Seniors in the 21st Century. Washington, D.C. June 30, 2002. The commission’s full title is frequently shortened to the “Seniors Commission.” 10 A 53-page white paper on technology written by the U.S. Department of Commerce’s Office of Technology Policy for the WHCoA devoted only one paragraph to privacy and dismissed it by stating that much of the debate over policies and process to protect privacy already took place and is embodied in the Health Insurance Portability and Accountability Act of 1996. The report concluded that while the WHCoA facilitates useful discussion, a structured analysis at the national level with a range of stakeholders is necessary. 11 The National Association of Area Agencies on Aging (n4a) issued a report in September, 2006, which found that only 46 percent of American communities have begun planning to address the needs of aging baby boomers. See: n4a, The Maturing of America—Getting Communities on Track for an Aging Population, September, 2006. 12 Center for Budget and Policy Priorities. Federal Budget Outlook. 2006. 13 U.S. Government Printing Office. Post-White House Conference on Aging reports, 1973. A Report on the Administration’s continuing response to the recommendations of the Delegates to the 1971 White House Conference on Aging, together with, Final report of the Post-Conference Board of the 1971 White House Conference on Aging-June 1973.
52