Issue Position: Seniors and Aging

Issue Position

Hickenlooper for Colorado Values: Visionary leadership to ensure that all Coloradans have the opportunity to age well, with dignity, and where supportive services are based on choice, individual preference, and the least restrictive environment, and where quality of life is optimized in all public policies.

Key Priorities

* Access to health care resulting in reduced incidence of disability.
* Access to meaningful and rewarding work that supports living with dignity.
* Develop State plan for disease prevention and health promotion.
* Support for older adults to remain at home in their communities and quality access to transportation.
* Support access to long-term supportive care and improve coordination of end-of-life care.

"Colorado has the opportunity to lead the nation in our ability to effectively and thoughtfully address health, wellness, and quality of life issues facing a rapidly aging population."
-- John Hickenlooper

Background

Americans over 65 are the most rapidly growing age group in America. In the next decade, the over-65 cohort in the U.S. will increase by 31%. In Colorado it will increase by 54. The over-65 portion of the total population in Colorado will increase from 9.7% in 2000 to almost 17% by 2030.2 Although Colorado ranks above the national average of older adults living at or below the federal poverty level (FPL), relative to the rest of the nation, we are 27th in the country for percentage of people living at or below the federal poverty level. For older adults living below 200% of FPL, the statistic is even more concerning: Colorado ranks 40th. Moreover, Coloradans over age 65, although virtually universally covered by Medicare, are also the single largest age group of under-insured in the State.

These statistics loudly speak to the need for:

* An integrated and coordinated system of care, including an adequate number of health care providers trained in geriatrics to appropriately serve Colorado's aging population; prevention and wellness resources to forestall disability; supportive long-term care; and access to good palliative and end-of-life care;
* Accessible housing options and nutritional resources for individuals with functional limitations and personal care needs;
* Public and private transportation systems for individuals unable to operate a personal vehicle;
* Support to live with dignity and financial security, and protection from discrimination, fraud, and abuse;
* Other supportive services and opportunities that allow older adults to live in their communities with access to meaningful and rewarding work, to the fullest extent possible.

Meeting the increased needs of this growing segment of the population presents both opportunities and challenges for communities, employers, and health and human service providers across the state.

Strategies and Solutions

Access to Health Care Resulting in Reduced Incidence of Disability: Chronic diseases predominantly afflict the elderly population and are the single largest health burden to employers in the State and our nation. Premature deaths from cancer and cardiovascular disease, though declining, took the lives of 13,000 Coloradans in 2008 (Colorado Department of Public Health & the Environment statistics). Early detection, prevention and access to affordable health care before the onset of a chronic illness will be a goal of our state health care policy.

Access to Meaningful and Rewarding Work that Supports Living with Dignity: Keeping older workers employed provides opportunities to engage older adults, improve qualify of life and reduce costs. Many adults over age 65 continue paid employment or desire to do so. Engaging older Coloradans to promote a healthier quality of life and benefit the economic picture of the State will include:

* Developing incentives for Colorado businesses to keep older adults employed.
* Working with organizations to successfully engage older adults.
* Training and encouraging compensation for family and informal caregivers.
* Promoting volunteerism and civic engagement.

Disease Prevention and Health Promotion: Colorado should be a national model for healthy living, wellness, exercise, and nutrition education. State health care policy will:

* Focus on prevention of chronic disease through policies and evidence-based self-management programs designed to ensure increased self-efficacy and access to care.
* Establish criteria for measuring and evaluating the best use of public funds in providing health-related services.
* Develop tele-health solutions that consolidate and integrate client demographic and clinical records to improve cost efficiencies and quality of care.

Support for Older Adults to Remain at Home in their Communities: Whether older Coloradans live in rural or urban settings, maintaining independence requires interdependence between individuals and their communities. Staying in one's home depends on the ability to provide or obtain home maintenance services, access to transportation, personal meal and care services, health and community engagement programs, and basic home safety.

Access to Independent Housing, Nutrition and Food Security: When our Seniors are no longer able to remain in their homes, the question of where these older Coloradoans will be housed will be a significant issue that our state must address. Mechanisms for providing subsidies to finance congregate independent housing, expansion of assisted living options and other long-term rental housing options such as elder co-housing and multi-use facilities in rural areas should be examined. We should examine how the Older Coloradans Act money is currently being used and if restrictions can be eased to allow for innovative programs tailored to community needs such as wellness, prevention, housing alternatives and transportation.

Access to Transportation: We will work to improve access to transportation for older Coloradans, especially in the rural areas. Possible solutions include organizing community-based volunteer programs with stipends available for gas to drivers or a van service for appointments, shopping, and other quality of life needs.

Protection from Discrimination, Fraud, and Abuse: Continue the joint project between the American Association of Retired Persons (AARP) and the Colorado Attorney General's office, which provides information to the public on elder fraud and abuse issues. Older adults are at high risk for financial exploitation, fraud and scams. We will work to ensure that our seniors are protected.

Access to Long-Term Supportive Care: Research suggests that approximately 70% of Coloradans over the age of 65 will require some form of long-term care (LTC) during their lifetime. 3 While only 11% of Medicaid enrollees are over age 65, they consume 31% of the Medicaid budget. Of all LTC spending in Colorado, 56% goes directly to institutional care (nursing homes), at a cost to the State of about $49,000 per nursing home resident annually. By contrast, the State spends approximately $9,000 to support an older adult with supportive needs in a community-based setting. We must optimize new resources within the federal health care reform law to ensure that Colorado seniors can better utilize quality, long term care.

Improve Coordination of End-of-Life Care: There is significant overlap in the long-term care, home health, and end-of-life care populations in Colorado. As previously addressed, a significant number of Colorado's older adults will require some form of long-term care. Utilization of palliative and hospice care has been repeatedly demonstrated to improve quality of life and care while reducing costs, eliminating overuse of expensive health care resources, reducing hospital readmission and emergency room visits, providing care more consistent with patient goals and preferences, increasing satisfaction, and for some diagnoses, lengthening life.

A key to enhancing quality of the end-of-life care for older adults and their families requires State leadership to promote collaboration among providers of health care including primary, acute, long-term, palliative, and hospice care, augmented by private and publicly funded services. We will:

* Identify funding sources to solve problems like the need for home repairs and other assistance.
* Utilize public-private partnerships and federal grant dollars, to support "Aging in Place" initiatives, which provide bricks-and-mortar money for entire communities to adapt streets, buildings, and services to meet the needs of the elderly or disabled adult populations. This funding should be easily accessible to small and large projects alike, so small rural projects have the same opportunity for funding as large urban projects.
* Continue to fund programs that encourage the purchase of private long-term care policies.
* Explore alternative methods of reimbursement for home health and home care services. Service providers may not provide as many Medicaid-funded services if rates continue to be cut.
* Leverage dollars from the foundation community and private sectors, offer tuition breaks or student loan forgiveness programs for medical and nursing students focusing on geriatric or palliative care and/or those willing to work in rural or underserved communities when the economic conditions of the state budget improve.

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