Congress has finally renewed the Older Americans Act—a key piece of the social safety net for seniors. It is good that, after a decade in limbo, the law finally has been reauthorized. But before you break out the balloons and champagne, remember that keeping programs alive on paper is not the same as paying for them. And the government safety net for seniors has been fraying for years, victimized by woeful underfunding.
Congressional reauthorization of the OAA won’t change that. True, it was an important symbolic win for older adults, but it does not provide a dime to operate programs such as Meals on Wheels, information services, transportation, assistance for family caregivers, and the like. That has to happen each year when Congress passes its spending bills—an annual drama that has poorly served older adults and their families.
Perhaps, instead of taking a self-congratulatory bow for convincing Congress to renew the OAA, advocates should use this opportunity to think of alternatives to a federal safety net, self-sustaining models where seniors won’t have to count on unreliable federal dollars.
While many OAA programs are critical to the well-being of seniors, funding for most of them has been flat or even decreasing for years. From 2010-2014 the US population of those 75 and older– the ages at which people are most likely to need personal assistance– increased by 10 percent, from about 16.4 million 18.2 million. Yet funding for all programs under the OAA fell from $2.3 billion to less than $1.9 billion over that time.
Take just one program: family caregiver supports. It provides counseling and training, respite services, and other assistance for family caregivers. Congress has given it about $150 million-a-year since 2010.
There is a wide disagreement over how many family members care for older relatives or friends , but the most conservative estimate I’ve seen is about 15 million. That works out to about $10 per caregiver. Others say there are as many as 44 million family caregivers in the US. They’d be in line for about $3 on average. Either way, it is not likely to be much of a life-changer.
The Meals on Wheels program may be the best known of the OAA programs. The federal government spends about $216 million—another amount that has not changed for years. By providing critical food for homebound adults, it reduces malnutrition—a leading cause of emergency room visits and hospital admissions. But the volunteers who deliver meals also serve another important role: They often are the only person these frail seniors see regularly, and they can provide an early warning in the event things are going poorly.
Keeping people out of the hospital can help reduce Medicare costs. Helping low-income people stay at home, and avoid institutional care, can reduce Medicaid costs. Yet the program is greatly underfunded.
It is wonderful that Congress has finally reauthorized the Older American Act. I can’t imagine a society without these many of these services. But don’t expect a wave of new federal dollars to serve the growing need for home-based services for older adults. In fact, given deepening fiscal pressures faced by government, another 10 years of flat funding may be the best we can hope for.
Hand-wringing won’t help. But two initiatives might. The first is to bring more money into the nation’s system of long-term supports and services, perhaps through an enhanced public/private insurance system. More money, especially more cash, could make it possible for older adults (and younger people with disabilities) to purchase needed services and not have to rely upon underfunded federal safety net programs .
The second solution is for communities to do more to pitch in and help. If your community has a waiting list for Meals on Wheels (it probably does), organize through your neighborhood or faith community to cook. If a frail neighbor needs transportation, offer her a ride. These efforts won’t replace important government programs, but they can supplement them and help make up for their lack of funding.
Thank Congress for finally doing what it should have done years ago and reauthorizing the Older Americans Act. But don’t count on it to do much more than it has been doing when it comes to actually helping older Americans.