Reflections on the 2015 White House Conference on Aging: One Year Later and Much More Work to Do
Gretchen E. Alkema, PhD, LCSW
Nearly every decade since the early 1960s, Democratic and Republican presidents have hosted a convening to deliberate on pressing issues and needs facing older Americans and the families who care for them. This official forum, called “The White House Conference on Aging,” has created a focal point for policy dialogue, a presidential platform to bring the highest level of political visibility to challenges and solutions in aging, and a 10-year blueprint for policy and social action. The first White House Conference on Aging in 1961 covered “20 areas bearing on the trends, conditions, and issues affecting America’s seniors.” It highlighted economic hardships that older adults and their families faced in paying for medical care. The results were an important force in creating the political will leading to Medicare and Medicaid both becoming law four years later. Subsequent conferences and their presidential decrees raised visibility on issues such as elder poverty and hunger in 1971, the growing diversity and capacity of older adults in 1981, family caregivers as a critical resource in 1995, and Baby Boomer civic engagement and technology solutions in 2005 – all of which led to specific and measurable public and/or private sector action in the years following.
In July 2014, with encouragement from various stakeholders in aging policy and the federal Commission on Long-Term Care, President Barack Obama announced his intent for a 2015 Conference. With Nora Super, the president appointed an executive director who brought an extensive policy and political background in aging, health care, and retirement both inside and outside of government. The team was laser-focused on four specific issues: elder justice, healthy aging, long-term services and supports, and retirement security. While these four issues acknowledge the unique needs of older Americans, the spirit of the event was to move the dialogue on aging away from a fear-based poverty model to one where older adults are a vibrant, natural part of American life. The event logistics further differentiated it from conferences of the past, shifting away from extensive state-based events culminating in a large delegate-driven Washington area meeting in the convention center. This sixth White House Conference on Aging was held for the first time onsite in the celebrated East Room on July 13, 2015, and utilized a more modern approach to community engagement via extensive social media. Building on this overall approach, the conference succeeded in three important ways.
First, President Obama’s attendance and remarks elevated the importance of the event and served as a call to action. He spoke forcefully on the issues at hand, acknowledging America as both a vibrant nation and one that “maximizes the contributions that older Americans can make to our country.” The president further remarked that “one of the best measures of a country is how it treats its older citizens…every citizen deserves a basic measure of security and dignity.” Honoring the anniversaries of Social Security and Medicare, he triumphed the American spirit to be bold and the need to carry that vision forward with further reform, stating:
We choose to do big things here in America. Three generations ago, we chose to end the era where seniors where left to languish in poverty. Two generations ago, we chose to end an age where Americans in their golden years didn’t have the guarantee of health care…with the anniversary of those incredible achievements, we need to recommit ourselves to finishing the work that earlier generations began.
Second, the conference outlined a vision to transform how Americans speak respectfully about vulnerable aging as well as what people need to live well and safely when facing chronic health conditions and functional limitations. Experts from academia, entertainment, private industry, health care, labor, philanthropy, and many other sectors focused on the merits of aging, including its opportunity to shape existing and emerging economies for young and old alike. The traditional narrative that aging is synonymous with being sick, poor, and alone was effectively debunked as each speaker reframed aging as a natural part of the human condition shaped by American ideals of honor, purpose, and independence.
Third, the conference moved beyond a “D.C. Beltway” debate to engaging local communities as well as “grassroots to grasstops” champions. Live streaming and an active social media presence connected 600 community “watch parties” to the conference, with the hashtag #WHCOA coming in at number 3 on Twitter’s trending list that day. Showing the power of the Internet to connect, inform, and engage across ages, the 2015 Conference upended the myth of an inherent aging-digital divide.
A final report was released on December 29, 2015, summarizing the year’s work and capturing feedback received from stakeholders and advocates across the country. Despite the positive dialogue at the conference and referenced in the final report, there was a topic glaringly absent from the day: a clear-eyed discussion of current and future long-term care costs, which is the largest and most unpredictable factor eroding retirement security for individuals and families.
While Americans today are living dramatically longer than their parents did, they are doing so with more chronic illness and daily functional challenges. Released just days after the conference concluded, a federal report shows that half of all Americans turning 65 today will one day find themselves needing a high level of help with basic daily activities like walking, eating, getting out of bed in the morning, and bathing. One in seven individuals will need a high level of assistance for five years or more – a figure that overwhelmingly affects women who not only are living longer with substantial disability but who also are serving as the primary caregivers to those in need. For older adults and their families, needing this level of assistance can take a sizeable toll on both quality of life and personal finances. The typical American faces long-term care costs in old age averaging $91,000 for men and $182,000 for women—but can be much higher, depending on the number of years individuals need high levels of help. This reality creates an unpredictable financial burden. At the same time, the number of aging Americans with high health and daily living needs is projected to grow from 6 million to almost 16 million in the next several decades.
While each experience is unique, families cover more than half of the total share of long-term care costs through out-of-pocket spending, which can deplete personal savings, retirement accounts, and other assets. In many instances, the costs exceed what families can provide, impacting family members and other unpaid caregivers. While individuals can qualify for Medicaid to cover long-term care needs when their savings are exhausted, they typically incur large out-of-pocket expenses beforehand. Few Americans have private long-term care insurance coverage today due to high premiums and inability to qualify based on presence of preexisting conditions.
Families have little ability to plan for this economic shock, which hits middle-income Americans the hardest. Yet a deeper look at these data demonstrates that long-term care is an insurable risk. Only one-sixth of older adults with severe needs will spend $100,000 or more, out-of-pocket, on long-term care. Experts agree that our nation’s way of financing long-term services and supports is unsustainable, and new realistic policy options are needed to address this problem, which impacts American families, employers, and state and federal systems.
When faced with unpredictable needs and costs, Americans generally use insurance as a tool to mitigate overwhelming financial risk. However, the current long-term care insurance market is effectively broken, leaving few alternatives to finance long-term services and supports. Therefore, to help address the long-term care financing crisis and offer policy alternatives, aproject convened and funded by The SCAN Foundation, AARP, and LeadingAge has made new research on insurance options available. The project enlisted the Urban Institute and actuary group Milliman, Inc. to simulate the impact of three insurance options with the same benefit structure. This analysis tested insurance options over three coverage periods, assessing performance across several designs including voluntary or mandatory enrollment. All options could be implemented as private and/or public products. Taken as a whole, the research creates a comparative framework for long-term care financing that can help policymakers and thought leaders explore creative solutions using this new “go-to” modeling resource.
Building from the modeling research, three separate bipartisan groups – the Bipartisan Policy Center, LeadingAge, and the Long-Term Care Financing Collaborative – released February 2016 recommendations on how to help working Americans better prepare for their future long-term care needs and associated costs. These recommendations come at a critical time as new information about the extent of the crisis is striking.
The good news is that despite these politically contentious times, these three separate sets of policy recommendations clearly outline a path forward. The SCAN Foundation reviewed each report and found these common threads:
- A multi-pronged approach is necessary—one that requires reimagining the roles of the public and private sectors;
- Structural changes and reforms in the private market—including modifications to the private insurance marketplace to provide lower-priced policies with a better distribution strategy (e.g., in the workplace) to protect against the initial costs once a person needs a high level of support;
- Targeted public solutions to address catastrophic needs—including insurance designs specifically to protect against the longer-term costs for those with high levels of need (e.g., 10 years of support for one with Alzheimer’s disease); and
- It’s time to refocus Medicaid’s role—strengthening this vital safety net program while lessening its financing role in a reformed, insurance-based long-term care financing system.
Ultimately, these reports show that the whole is greater than the sum of the parts and more refinement work is needed. Taken together, these recommendations clarify the appropriate extent of personal responsibility, create a full and meaningful space for the private market to flourish in covering early stage needs, ensure risk protection for individuals with longstanding needs, and finally take some pressure off the Medicaid program.
It has been one year since the 2015 Conference. Much work remains to create a world where older Americans and their families can count on accessing high-quality, affordable health care and supports for daily living delivered on each person’s own terms, according to that individual’s needs, values, and preferences. Most of us, as we grow older, will encounter personal challenges, such as managing chronic health conditions, needing help with daily activities, staying active despite chronic pain, failing eyesight, or hearing loss, and worrying about how to pay for care and services. Right now, there is no coordinated and easily navigated system in place to support Americans who want to live independently as they age. The challenge becomes more pressing as the population of older adults increases and costs of various health and long-term care services continue to rise. It is imperative for all of us to become a voice for change so today’s generation and those to come can grow older in a world that champions dignity and choice regardless of age, health, or ability.