AgingToday_JulyAug2019

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Covering advances in research, practice and policy nationwide www.asaging.org

JULY–AUGUST 2019 volume xl number 4

the bimonthly newspaper of the American Society on Aging t i t l f t i i t i

America’s health security preparedness: are we ready to protect our elders?

In this issue

FORUM Is America prepared for extreme longevity? page 3 AGINGWITH OPTIONS Of community and quality of life—it’s about choice page 5 IN FOCUS When disasters strike, how do older adults survive? page 7 The virtual reality−empathy connection page 13 Lessons in leading: the 2019 ASA Leadership Institute page 16

as natural disasters and disease out- breaks. Using a broad constellation of metrics, the National Health Security Preparedness Index (the Index) demon- strates that many stakeholders across sec- tors contribute to health security at state and national levels. Key sectors include public health, medical care, emergency management, public safety, nonprofit and voluntary organizations, businesses, the Experienced professionals may not be fully aware of health security resources and needs outside their immediate control and responsibility. faith community and others. Due to this complexity, even seasoned professionals may not be fully aware of health security resources and needs that lie outside their immediate control and responsibility. ters for Medicare & Medicaid Services (CMS) introduced the concept of expand- ing the definition ofMA supplemental ben- efits to consider supplemental benefits that are not necessarily medically oriented. In 2020, MA plans would be allowed to offer a broader scope of supplemental benefits to address social determinants of health, under specific guidance from CMS. The 2019 Call Letters and other related CMS rule-making notices provided more defini- tive explanations of the scope and options ‘We hear it all the time, “How do we even start a conversation?” “Whom do I contact?” ’ available for chronically ill MA beneficia- ries. This new guidance could foster more opportunities for CBOs to partner with MA plans to deliver a broader array of sup- plemental benefits.

By Alonzo L. Plough P reparedness for and resilience in the face of emergencies and disas- ters of many sorts are essential components of well-being and good health. This is particularly true for older Americans. The National Health Security Preparedness Index ( https://nhspi.org/ ) analyzes 129 measures of preparedness to identify strengths and opportunities for keeping the nation safe. What is health security? It is a condi- tion in which a nation and its people are prepared for, protected from and resil- ient to events that can adversely impact health status. The Learning Collaborative: a path to CBO−MA plan partnerships E ditor’s note: The John A. Hartford Foundation, the Administration for Community Living, and The SCAN Foundation fund the Aging and Disability Business Institute ( www.aginganddisabili- tybusinessinstitute.org ) , led by the Nation- al Association of Area Agencies on Aging (n4a). Themission of the Aging and Disabili- ty Business Institute is to build and strength- en partnerships between aging and disabil- ity community-based organizations (CBO) and the healthcare system. As a partner of the Aging and Disability Business Institute, ASA is collaborating with n4a on a series of articles and case studies in Aging Today that prepare, educate and support communi- ty-based organizations and healthcare pay- ers to provide quality care and services. Medicare Advantage (MA) has been in existence since 1997 in various itera- tions, but passage of the February 2018 CHRONIC Care Act affected several key aspects of MA programming. In the April 2018 MA Call Letter guidance, the Cen- Measuring Health Security Preparedness Health security affects day-to-day com- munity health, and determines what hap- pens before, during and after crises such

The Index supports state efforts to re- duce health security inequities by identi- fying strengths and opportunities for im- provement, and it is a tool stakeholders can use to collectively improve health se- curity. A sample of the 129 measures ana- lyzed by the Index include: the percentage of bridges that are in good or fair condi- tion; the number of healthcare providers; vaccination rates for children and adults for different infectious diseases (i.e., flu); and the percentage of state public health labs that test for contaminants, such as lead or asbestos. Together, such data can inform mean- ingful discussions and deliberations at the

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The 2019 ASA Award winner Sandra Timmermann: a lifelong advocate for older adults

T he 2019 ASA Award goes to San- dra Timmermann, whose career has intertwined nicely with her contributions to ASA and to the field of aging at large. The ASA Award is presented to an individual who has made outstanding contributions to aging-related research, administration or advocacy. Sandra Timmermann is one of those people who is driven not only to try to im- prove her corner of the world, but also her personal evolution. After a brief 1970s post- college sojourn into the “Mad Men”–like world of Madison Avenue, Timmermann realized that public relations work was not for her, and started looking for a more meaningful (and permanent) pursuit. Timmermann had, as a child, spent countless hours with her grandmother and her father’s much older sisters; she re- alized she was intrigued by aging and also had an interest in teaching, (which she says was one of the few career avenues then open to women). Timmermann com- bined these two interests by specializing in education for older adults—a brand- new concept at the time.

Sandra Timmermann

After earning a doctorate in Educa­ tional Gerontology at Teachers College, Columbia University, Timmermann land- ed a job at AARP as theAssociateDean and then Director of its Institute of Lifelong Learning. “It was my first real job in aging, and it was wonderful,” she says. “Not too many people focused on older adult learn- ing, so I was very active; I chaired the Co- alition of Adult Education Organizations, was on Capitol Hill pushing the Lifelong

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Aging Today July–August 2019

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Update

Aging

are two years and begin in March 2020; nominations will be accepted through Aug. 30, 2019. ASA is looking for candidateswith the following skill sets: an ability to ad- vance collaborations and strategic allianc- es; an ability to help grow ASA’s financial resources, including by connecting ASA with foundation and corporate donors and supporters; finance and accounting exper- tise; and marketing and social media ex- pertise. Please visit www.asaging.org/vol unteer-leadership-center#Board-of-Direc tors for more information. Continuing and expanding its educational offerings, ASA has a new course, through its collaboration with the University of Southern California’s renowned Leonard Davis School of Gerontology. The five- week curriculum, running Aug. 26–Sept. 27, will explain advanced concepts and ‘I love to witness this level of engagement, which bodes well for ASA’s future, and the future of older adults.’ The ASA−USC Collaboration Connection challenges that the unprecedented aging of our population presents; please visit www.asaging.org/advanced-concepts-ag ing-society-course-description for com- plete information on course content and to enroll. This newonline course will earn members a Certificate of Completion in Advanced Concepts in an Aging Society, and is available exclusively to ASA mem- bers, for $500. While at the Conference, I met some at- tendees who were eager to know when, where and at which hotel we would hold the next Aging in America Conference: 2020 Aging in America will be held in Atlanta, March 24–27, and our headquar- ters hotel is the Hyatt Regency Atlanta. ASA is nowwelcoming all proposals for Conference sessions; and both ASA mem- bers and non-members can submit pro- posals for consideration (go to www.asag ing.org/aia ). Sessions include 90-minute symposiums; 60-minute workshops; 60- minute informal peer group−facilitated discussions; poster sessions; morning ex- ercise sessions; and film or video sessions, all under a plethora of topic categories. Non-members will receive a one-year ASA membershipwhen registering for the Con- ference as a presenter. Registration fees are due Dec. 9, 2019, in order to confirm ses- sions—the earlier the registration, the bet- ter the price break! I look forward to seeing you all in the sunny South! n Today articles and to guest commentar- ies, which present the opinions of their authors and not necessarily those of the American Society on Aging. Letters should be no more than 350 words long. We also welcome ideas for articles you would like to see in future issues of Aging Today .  mail Aging Today, “Letters” 575 Market St., Suite 2100 San Francisco, CA 94105-2869  fax (415) 974-0300  e-mail ahood@asaging.org 2020 Aging in America Heads to Atlanta! WRITE TO US We welcome your responses both to Aging

American Society on Aging www.asaging.org Aging Today (issn 1067-8379) is published bimonthly by the American Society on Aging. Articles may be reproduced by those obtaining written permission. Postmaster: Send address changes to Aging Today, ASA, 575 Market Street, Suite 2100, San Fran- cisco, CA 94105-2869. Phones: editorial (415) 974-9619; advertising (415) 974-9600; or visit www.asaging.org/publications . For membership or other information about ASA, call (415) 974-9600, fax (415) 974-0300 or visit www.asaging.org . Subscription Price: individual non- members: $74.00/year (included with annual membership); nonmember institu- tions/libraries: $110.00/year. Subscription Aging Today is indexed in the Cumula- tive Index to Nursing and Allied Health Literature and the Areco Quarterly Index to Periodical Literature on Aging. Printed in the U.S.A. © 2018 American Society on Aging. All rights reserved. The American Society on Aging (ASA) is the essential resource to cultivate leadership, advance knowledge and strengthen the skills of those who work with, and on behalf of, older adults. Chair, Robert Espinoza, Vice President of Policy, PHI, Bronx, New York Immediate Past Chair: Robyn L. Golden, Director of Health and Aging, Rush University Medical Center, Chicago, Illinois Donna Benton, Director, USC FCSC/ LACRCA, Los Angeles, California Diane Brown, Executive Director, Medicare Strategy & Operations, Kaiser Permanente Northern California, Oakland, California Paul Greenwood, Elder Abuse Expert Witness and Teacher/Consultant, San Diego, California Anne Montgomery, Deputy Director, Center for Elder Care & Advanced Illness, Altarum, Washington, D.C. Kathy Sykes, Retired, Senior Advisor for Aging and Environmental Health, U.S. EPA, Washington, D.C. Laura Trejo, General Manager, Los Angeles Department of Aging, Los Angeles, California Peter Whitehouse, Professor of Neurology, Case Western Reserve University; and President, Intergenerational Schools International, Shaker Heights, Ohio agency rate (institutional rate only): $94.00/year. ASA Interim CEO: Cynthia D. Banks ASA Board Chair: Karyne Jones Editor: Alison Hood Senior Editor: Alison Biggar Design & Production: Michael Zipkin | Lucid Design EDITORIAL ADVISORY COMMITTEE

Inspiration, leadership and education always on track at ASA

support their registration fees and travel expenses. Sarah is a clinical assistant pro- fessor at the University of Texas at Austin School of Social Work and coordinates its Gerontology Resources and the Aging Community in Education (GRACE) Pro- gram. The GRACE Program seeks to attract more social workers into geriatrics by providing intensive internship experi- ences, educational enrichment and stu- dent funding. More professionals in the field of aging services should be as dedicated as Sarah to attracting and fostering young profes- sionals on their path in the field of aging. Watch for an article on Sarah, her com- mitment to the field and her students in the Sept.–Oct. issue of Aging Today . In June, we announced our call for 2020 ASA Board nominations, so please consid- er nominating either someone you know who would be great for board service, or nominating yourself. To serve on the ASABoard, youmust be an ASA member and retain your member- ship throughout your Board service. ASA Board members provide governance to the organization, carry out ASA’s mission, gain resources for the organization, safeguard its assets andensure its future. Board terms Call for Board Nominations NowOpen

By Karyne Jones | ASA Board Chair I want to take this chance to thank the volunteers, the ASA

Board of Directors and the intrepid ASA staff for hosting an amazing 2019 Aging in America Conference. I tried to pop into as many ses-

Karyne Jones

sions as was humanly possible, where I saw members who were incredibly en- gaged, smaller sessions that were jam- packed, standing-roomonly andmembers who stayed long after sessions ended to pepper presenters with questions. I’d also like to note that during our April 14 ASA Board of Directors meeting in New Or- leans, we approved a new strategic plan for fiscal years 2020 through 2024. I love to witness this level of engage- ment, which bodes well for both ASA’s future, and the future of older adults. So my thanks, too, go to our ASA members and their intense desire to gain new infor- mation they can take back to their com- munities to help the elders they serve. Another particularly inspirational part of the Conference for mewas to again see Sarah Swords, who since 2015 has brought about 10 of her students to the Conference, via applying for grants to

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Present at AiA20! Share your expertise and best-practice programs.

Submit a proposal to present at AiA20. Call for Proposals deadline is July 15. www.asaging.org/aia

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Aging Today July–August 2019

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FORUM

Extreme longevity: is America ready? By Deborah Carr T he number of Americans ages 85 and older will more than triple from 6 million today to 20 million

But money may not be enough to se- cure those services. Paid caregivers are in woefully short supply ( tinyurl.com/ y3dy76bw ), with an estimated 5 million di- rect care workers needed by 2020 ( tinyurl. com/zqqv6yb ). The already lean ranks ( tinyurl.com/y34ntlur ) of paid caregivers will shrink even further should national immigration policies grow more restric- tive, as immigrants (and especially wom- en) now are disproportionately employed as home health and personal care aides. Enticing new workers to these jobs is dif- ficult, given the low pay—typically less than$25,000a year ( tinyurl.com/zqqv6yb ). Increasing their wages may not be finan- cially feasible, as middle- and working- class families cannot afford this. Home health agencies cover roughly three- quarters of their workers’ wages through Medicaid and Medicare, which already face enormous financial constraints. Solutions to Care for the Oldest-Old How to care for our large and growing oldest-old population? Solutions might in- clude recruiting retired healthcare pro- viders, nurses and other caring profes- sionals topart-timepaidworkor volunteer caregiving opportunities—just as pro- grams like AARP’s Experience Corps ( tinyurl.com/yx96ulpe ) recruits older vol- unteers to share skills with vulnerable children. Other nations provide creative care models. In 2015, Japan debuted its ORANGE plan ( tinyurl.com/y23tndqh ), a “total community” approach to caring for dementia patients and their caregivers. Volunteers attend a 90-minute dementia lecture, and then receive a bright orange bib or bracelet to signify they are mem- bers of a neighborhood patrol. These vol- unteers—now 25,000 strong—walk neigh- borhoods, check on those who need home visits, distribute flyers describing demen- tia support services and assist older de- mentia patients who have wandered. Though not a substitute for round-the- clock caregivers, these volunteers fulfill a basic and emerging need. Japan also leads the way in eldercare robots, which resemble devices like the Roomba vacuum cleaner or voice- activated assistants such as Alexa. The Japanese government has invested in de- veloping devices ( tinyurl.com/yc6gaq3e ) like an electric-boosted mobility aid that an older adult can grasp when walking the neighborhood, and robotic devices that help frail older adults to get out of bed and into a wheelchair, or help to lift and lower them into bathtubs. Older Americans are not quite ready for robot caregivers ( tinyurl.com/yc6gaq3e ); while 70 percent believe that robot caregivers would lessen the national caregiving bur- den, just 37 percent of Americans ages 65 and older say they would try them. Innovative technologies and commu- nity patrols are first steps, but larger pub- lic supports are needed. Washington State recently enacted The Long Term Care Trust Act ( tinyurl.com/y4fnhyzr ),

by 2030, while the number of centenarians will quintuple to more than 300,000. Ex- treme old age means more young people will have the joy of knowing their grand- parents and even great-grandparents ( tinyurl.com/y5moljgu ). Many octogenar- ians and nonagenarians are giving back to their communities by volunteering ( tinyurl.com/y5moljgu ) in youth tutor- ing programs or meal-delivery programs. But extreme longevity also brings pro- ‘Many octogenarians and nonagenarians are giving back to their communities.’ found challenges to healthcare systems, the national safety net, loved ones car- ing for their oldest-old kin and the oldest- old, who struggle with physical or cogni- tive declines. Extreme old age often brings disease and disability ( tinyurl.com/y5y9oqv9 ). One of themost daunting challenges is the skyrocketing number of older adults with dementia, projected to increase to 16 mil- lion by 2050. Alzheimer’s patients require intensive and long-term care, and these needs increase as the disease progresses. Investments of time, money and emotion- al energy can be overwhelming, especially for older caregivers with physical health problems. When family members can no longer deliver round-the-clock care, they may enlist costly long-term-care assis- tance, either at home or in a skilled nurs- ing facility. Annual medical and long-term-care expenditures for all dementia patients to- tal $260 billion, yet Medicare and Medi­ caid cover only two-thirds of these ( tinyurl.com/yxjrzkot ). This leaves family members to cover nearly $56 billion in out-of-pocket spending, with costs ex- pected to quadruple to more than $1 tril- lion by 2050. Millions of oldest-old adults will suffer from other chronic conditions that require long-term care as well. A Lack of Caregivers The United States does not have enough young and mid-life adults to provide in- formal care to their oldest-old kin. Oldest- old adults have fewer children ( tinyurl. com/y2x5amp9 ) and those children may live miles away, be busy with paid work or have health problems that prevent them from providing care ( tinyurl.com/ y3lx37hm ). Even those who are willing and able to provide care may find some tasks too medically complex ( tinyurl.com/ y4h3g6ed ) to do at home. Some can pay out-of-pocket for a home health aide or visiting nurse, but this may not be possible for families with limited financial re- sources, especially given Medicare’s lim- ited coverage ( tinyurl.com/y4v7tmft ) of long-term-care services.

But more sweeping changes are need- ed, including the passage of federal poli- cies ( tinyurl.com/y2tv2pgw ) like the Credit for Caring Act ( tinyurl.com/y4rm zlb2 ) , which provides up to a $3,000 tax credit to help with out-of-pocket expens- es borne by caregivers. Though increased longevity is one of science’s greatest achievements, America must prepare to support its oldest-old and the families who care for them. n Deborah Carr is professor and Chair of the Sociology Department at Boston Uni- versity, editor-in-chief of Journal of Ger- ontology: Social Sciences and author of Golden Years? Social Inequality in Later Life (New York: Russell Sage, 2019).

America’s first social-insurance program to finance long-term care. Residents pay 58 cents per every $100 of income into the state’s trust. After paying into the fund for ten years (or just three if they experi- Volunteers walk neighborhoods, check on those who need home visits and help dementia patients who have wandered. ence a catastrophic health event), they are entitled to $100 per day up to a life- time cap of $36,500 to pay for home health aides, home modifications and other assistive fixes.

ASA & USC to launch a NEW online course in August 2019 American Society on Aging and the University of Southern California, Leonard Davis School of Gerontology are partnering again to bring you a new online course, Advanced Concepts in an Aging Society . This course provides important perspectives to help you understand the pressing challenges presented by the unprecedented aging of our society. Now you can choose from five different flexible 5-week courses • Managing Health and Chron- ic Conditions in Older Adults • NEW: Advanced Concepts in an Aging Society Successful participants will earn a certificate of completion from USC, and CE credits are offered from select accreditation providers. All courses take place August 27–September 28, 2019. www.asaging.org/USC-gero • Understanding Abuse and Neglect • Prevention of Abuse and Neglect • Fundamentals of Gerontology

Aging Today July–August 2019

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Advocacy, equity and politics at 2019 Aging in America New Orleans was a lively setting for the 2019 Aging in America Con- ference, which was jam-packed with sessions on pragmatic issues like new supplemental benefits under Medicare Advantage plans, how older adults can avoid financial scams and fraud and more. Other workshops were more aspirational in tone, addressing what it might take to bring equality and equity to all older adults, and how to fix long-term care. The General Sessions and other selected events are covered briefly on pages 4, 15 and 16; for a more in-depth look at Con- ference happenings, visit AgeBlog on the ASA website at www.asaging. org/blog/aging-america-2019-news .

The 2019 ASA Award winners feted at Aging in America The 2019 ASA Award winners were announced at the 2019 Aging in America Confer- ence’s opening General Session onMonday, April 15. Pictured left to right: ASAHall of Fame Award winner Jim Sykes; winner of the ASA Award, Sandra Timmermann; Gloria Cavanaugh Award for Excellence in Training and Education recipients Tamara Sieckman and Clinton Vaughn, representing the Money Smart for Older Adults program; MindAlert Award recipient J. Benjamin Unkle, representing Birdsong Tablet; RosarioMendoza, representing Award for Excellence inMulticultural Aging winner Latino Age Wave Colorado | Conectores de Montbello; Mental Health and Aging Award winner Frederic Blow; and Graduate Student Research Award winner Eun-Hye Grace Yi.

plan to continue ASA’s advocacy focus during her term as Public Policy Co- Chair. “Let’s have a voice of ASA on Capi- tol Hill,” urged Herr. General Session 1: Confronting Prejudice and Fear Around Aging and Politics Lisa Marsh Ryerson, president, AARP Foundation, does not take her work help- ing elders lightly, and inspired attendees with a rabble-rousing call to collective ac- tion on the part of vulnerable elders dur- ing the AARP Foundation–sponsored ses- sion, “Blame, Fear and Stereotyping: Reclaiming Common Purpose in a Time of Division.” On current political realities: “We can all be proud of how we have responded to that urgent need [to help older adults], but I’m very concerned with the atmosphere of acrimony that circum- scribes our own creativity and work, and obscures and devalues what we share. In a country that enacted Social Security, the GI Bill, Medicare, Medicaid, Food Stamps and the EPA, we are now enmeshed in disagreement.” On how to fix it: “We need to bring empathy into the light, to claim a shared purpose and strike down stereotyping, not by demonizing those who come from different place. Let’s resist those who pit generations against each other, let’s resist those who blame people for choices that are rational, given the hands they were dealt.” On ageism and discrimination and their downstream effects: “The stubborn persistence of age dis- crimination makes it much harder for old- er adults to be hired and to keep working. If you are tossed out of a full-time job at age 50 and live to age 90, that’s a recipe for long-term deprivation.” On discrimination of diverse elders: “The fight against discrimination must also encompass the LGBT community, and must acknowledge the prejudice

against LGBT elders—a bias that often re- sults in re-closeting and fuels isolation, 50 years post-Stonewall.” Onfighting the goodfight for equity: “Now the fight is for equity: we de- mand to live in a country where health and well-being should not be dependent upon one’s zip code. The fight for equity is a fight where ASA can really make a dif- ference … the fight for equity means ob- jecting against cutting Social Security, it means addressing financial security on the front end. We know people are 15 times more likely to save money if they are able to do so at work. We need to pro- mote financial security by rooting out age discrimination.” In a General Session sponsored by GSK Consumer Healthcare, a panel of dental experts laid out the landscape of oral health among elders in the United States, discussed advocacy efforts directed at im- proving that landscape and detailed findings in a new “A State of Decay, Vol. IV” report from Oral Health America. Moderated by Stephen Shuman, asso- ciate professor and director, Health Ser- vices for Older Adults Program at Univer- sity of Minnesota School of Dentistry, panelists included Beth Truett, principal, BJT Solutions; Karen Tracy, vice presi- dent of Strategic Alliances and Integrated Communications, The Gerontological So- ciety of America; and Caswell Evans, as- sociate dean for Prevention and Public Health Sciences, University of Illinois at Chicago, College of Dentistry. On advocacy for dental healthcare: “We hope you will understand the im- portance of an inter-professional ap- proach to address the needs of older adults, we hope to provide the ammuni- tion with compelling evidence of why we need to change the dental healthcare sys- tem we have and mobilize older adults to General Session 2: Advocacy to Improve Oral Health

The 2019 AiA General Sessions: moments of inspiration, wisdom AARP Public Policy Institute’s Jean Accius (also ASA Board of Directors Secretary) and AARP Foundation’s Marc McDonald converse prior to a General Session.

and rousing advocacy O n April 15, Aging in America (AiA) 2019 kicked off with a brand-new event—a Public Policy Town Hall Meeting, which included live polling of ASAmembership on public policy issues in aging. Afirst for ASA, the event, sponsored by Abbott, represented ASA’s continual commitment to ensuring its members’ voices are heard by Congress and in state legislatures. Moderated by ASA Immediate Past Board Chair Bob Blancato, the panel fea- tured ASA Public Policy Co-Chairs Paul Downey and Bill Benson and incoming ASA Public Policy Committee Chair Amy Herr, who all addressed questions submit- ted by ASAmembers on issues such as oral health, U.S. veteran homelessness and So- cial Security. Live polling covered the topics of Medi- care and Medicaid, affordable housing for elders, elder homelessness and the com- plexities of elder justice policy and advo- cacy. Using live polling data, ASA mem- bers voted in real time to show their support for expandingMedicare eligibility to people ages 50−64 (72 percent). Of those who responded to the poll, 76 percent said they have seen an increase in older adult homelessness in their communities and 69 percent of those polled at the Town Hall said they have noticed an increase in elder abuse, neglect and exploitation inci- dents. Ninety percent of respondents said

they wanted to see increases in elder jus- tice programs funding. On elder homelessness: “We have a Section 8waiting list in San Diego of about 11 years. And we have a 150-unit housing complex, with 300 peo- ple plus on the waiting list; 85 percent will never get into the housing,” said Downey, adding that policymakers need to create more resources to support older adults, while building a system that helps identify those at risk of losing their homes before they are in financial trouble. “Homeless seniors are a forgotten part of the care continuum,” he said. On elder justice and legislation: Benson updated members on elder jus- tice programs and legislation, including an Older Americans Act reauthorization effort recently confirmed by Sen. Chuck Grassley. “There’s a consensus package moving forward,” Benson said, although he acknowledged that advocates are un- sure where the reauthorization legislation could be headed, as far as changes in the law-making process. “We have no clue how it’ll turn out. Requirements for new money are in the crosshairs,” he said. On elder advocacy: Amy Herr made a stringent call to ac- tion, asking members to contact their lawmakers to make themselves heard. “We want to harness our energy and bring it together,” she said, outlining her

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Aging Today July–August 2019

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AGING WITH OPTIONS

Choosing the right community—a quality of life issue By Rodney Harrell E ditor’s Note: This column, “Aging with Options,” is sponsored by the AARP Public Policy Institute. Col- physical ability, as the concept of livability takes the entire community into account. One of the trickier aspects of defining a livable community is that the elements can be overwhelming—it is difficult for in- dividuals to think of all of the factors that a community must have to support them as they age. Complicating this fact is that residents may not know the benefits that other neighborhoods have, whether those neighborhoods are on the other side of town or the other side of the country.

‘How socially connected is this community?’ umn content will focus on innovative solu- tions to change systems and empower individuals and their families to thrive at home and in community. Many Americans do little research when buying or renting a home. They tend to find a pretty house, calculate the driv- ing time to work and drive by the house a few times. If they are more experienced with home search, they might look up the area’s school system, but many merely trust their eyes and gut. This approach, however, can cause problems later on. There are many factors that influence people as they choose neighborhoods— how many grocery stores are nearby? How good is the access to healthcare? How socially connected is this communi- ty? Are there choices on the other side of town that may be better in the long run? As conversations around the social deter- minants of health demonstrate, places with features such as social connectivity and easy access to food, healthcare and public transportation can improve the quality of life for all. These questions may not seem impor- tant to consider whenmoving in, but many people live in communities longer than ex- pected. Conditions change in ways that can create challenges: during retirement, income drops, kids move out, parents get sick and move in or a fall can limit mobili- ty. Life happens, and a housing location that seemed perfect at age 50 may now be more of a liability. All of a sudden, better access to public transportation or having a more affordable housing option can rise in importance. A home and neighborhood choice that was perfect for raising chil- dren can be disabling in older adulthood. Assessing a Community’s Livability, Weighing Options Top ten city lists and other such guides are popular and can be helpful for learning about communities, but by design, they skim the surface—most take averages or composite figures for a few characteristics across the entire city or metropolitan area. Neighborhoods are different. It is impor- tant to look beneath the city level to know how livable a city’s distinct neighborhoods truly are, and how the options in that com- munity can benefit (or limit) its residents. Communities should seek to have the options that people want and need to stay and thrive in the neighborhood and set- ting of their choice—to be able to reach their best outcomes, regardless of age, in- come, physical ability or other factors. The ideal is that every community should strive to meet a goal of being livable for all residents, whatever their age. So-called livable communities include options for people of all ages, incomes and levels of

If Community “A” has all of the ameni- ties clustered in one neighborhood, then

livability index. The Index, and similar tools, can help to address the lack of infor- mation about neighborhood livability, and help shape policies that can improve neighborhoods and communities. Since its inception, the Livability Index has engaged users in all 50 states and bol- stered efforts tomake livable communities in the 363 communities and four states that aremembers of the AARPNetwork of Age-Friendly States and Communities. From Colorado Springs, Colo., to Sheboy- gan, Wisc., citizens and community lead- ers use the Index to drive local change efforts and create better places to live. Whether one is looking for a new place to live or is focusing on improving a com- munity, neighborhood-based tools like

Montbello is rife with economic and racial disparities and the built-in suburban challenge of limited transportation. adults felt it was the first time anyone had ever listened to their concerns about aging in Montbello. That initial session developed into a monthly meeting, which continues to this day. Now the Conectores de Montbello project has four Conectores , a title chosen to more accurately depict their roles as connectors between older adults and needed resources. Current Co- nectores are Aurelio Avalos, Angela Tzul, Maria Coronado and Rosario Mendoza. From its inception, Latino Age Wave | Conectores de Montbello has been listen- ing to its community, trying to meet their needs in whatever ways possible. Says Young, “Initially, we had this big fancy the- ory of change, the purpose outlined was to establish an active and effective system of community resources and related policies that [would] meet the needs of families car- ing for older adults in Latino communities. “But this big, beautiful plan was made without community involvement,” she adds. Quickly, Latino Age Wave let its funders know that yes, they would still ful- fill the original purpose and plan of their grants, but might have to go about it in another way, within the existing budget. “While we had an agenda, we were flexible enough to put that agenda aside and follow what older adults and families wanted. We had no idea we’d have a monthly meeting, a bingo game, coffee talks, a craft group or a connection to a the Livability Index can be used to exam- ine the differences within communities. People should use these tools in combina- tion with any local information they can collect in order to help decide where to live and to find out how well their com- munity can serve them if their needs change—and, in using these resources, cities can find a starting point for more ef- fective community-change efforts. n Rodney Harrell, Ph.D., is interim vice president of Livable Communities and Long Term Services and Supports and director of Livability Thought Leadership with the AARP Public Policy Institute, in Washing- ton, D.C. For a collection of resources on improving community livability, please visit www.aarp.org/livable .

It is hard to imagine all the factors a community must have to support aging well.

residents on the other side of town in Community “B” cannot benefit from those resources. If access to transporta- tion options, healthy food, parks or hous- ing options are limited, then that entire town faces livability challenges, as resi- dents must adapt and do without. Enter the AARP Livability Index The AARP Livability Index ( www.aarp. org/livabilityinde x), launched in 2015, was the first nationwide, neighborhood-based

The 2019 NOMA Award winner: Latino Age Wave Colorado T he 2019 Award for Excellence in Multicultural Aging (NOMA Award) goes to Latino Age Wave

Colorado | Conectores de Montbello, a place-based, community-driven project in one of Denver’s neighborhoods serving a majority Latino population. The NOMA Award recognizes organizations that have demonstrated high-quality, innovative pro- grams enhancing the lives of people in mul- ticultural aging populations. Latino Age Wave Colorado’s Program Manager Daniela Young, who has been with the nonprofit since 2016, compares the challenges that her work sometimes presents to the game ofWhac-A-Mole: “As soon as we address one need or resource or connection, three other challenges pop up.” But Young responds with grace and flexibility, which is how Latino Age Wave Colorado, specifically its Conectores de Montbello project (a program of the Lati- no Community Foundation of Colorado), has thrived and evolved to consistently meet its constituents’ needs. Program funding comes from the Rose Community Foundation, The Colorado Health Foun- dation and NextFifty Initiative. The Value of Being Heard Young describes Montbello as an “under- resourced” suburb of northeast Denver— an area rife with economic and racial disparities and the built-in suburban chal- lenge of limited transportation for its old- er adults. Prior to Young’s start at Latino Age Wave, a Promotora (a community leader) had been talking to older adults on

the street, generally familiarizing herself with Montbello and its issues. She invited the older adults she met to a “listening- back” session in which she revealed the community’s most commonly mentioned difficulties: childcare, food access, health, programs and services, transportation, caregiving for older adults and housing. Sixmonths later, the group would identify access to medical services, dental and vi- sion services and social opportunities as their top three priorities. The big takeaway from this meeting was that participants asked Latino Age Wave to keep coming back. These older Victoria Gomez Betancourt and her mother Doña Teo attend the annual picnic in Montbello.

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Aging Today July–August 2019

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Aging Today July–August 2019

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When disasters strike communities, how do older adults survive? In November 2018, the California town of Paradise was destroyed in the devastating Camp Fire—one of the worst fires in the state’s histo- ry. Eight-five people perished, and among them, the average age was 71. This tragedy left the state’s lawmakers and populace wondering what more could have been done to help these elders, many of them infirm. This In Focus starts off with Alonzo Plough’s Page 1 overview story, which discusses how prepared we are, as a society (and espe- cially elders) when it comes to facing disasters; Kathleen Votava touts the all-hazards preparedness approach; Helen McSweeney-Feld and Sandi Lane outline lessons learned in building a culture of readi- ness; April Naturale addresses the critical role of social workers in Dealing with disasters: an all-hazards preparedness approach helps build resilient communities

disaster response; and Sara Jahnke writes about why it’s important to not just depend upon first responders—and how disasters affect these frontline heroes. With fire and hurricane seasons nearly upon us, preparing well for the next incidents could mean much better out- comes—and fewer lives lost.

people living with dementia, their family members and caregivers on how to pre- pare for and understand what to expect in the event of a disaster. The toolkit fea- tures tip sheets and checklists for people living with dementia, their families and others who interact with them. Topics in- clude tips for people with dementia who live alone, strategies for communicating with people with dementia during disas- ters, how to respond to dementia symp- toms and planning for what to do after a disaster. Preparedness Help People who depend upon electricity to live and maintain their independence at home also present a unique challenge. The CDC Morbidity and Mortality Weekly Report , in analyzing mortality data after Hurricane Irma, found two unique sub- categories of heat-related and oxygen de- pendent–related deaths in which power outages contributed to worsening of ex- isting medical conditions ( tinyurl.com/ y6zn5leq ). Without sufficient planning and mitigation, many older adults may seek help at hospitals when these facilities are already overwhelmed. When a disas- ter hits, it is long past the time for agen- cies and community-based organizations (CBO) to be handing out business cards. An effective response requires an entire community and an all-hazards approach ponents of the healthcare system. Hos- pitals, nursing homes and community clinics must coordinate their roles in emergency response. However the na- tion’s lowest score on the Index is in Healthcare Delivery—a 4.9 out of 10. Performance in this domain re- mained flat from 2013 to 2015, but has trended up moderately by 6.5 percent. Public officials should have plans that provide guidance and training via exer- cises to improve coordination during an emergency or disaster. Community or- ganizations should be part of this plan- ning and development so that vulnerable populations’ needs are well understood and incorporated into planning. The Community Resilience Toolkit ( tinyurl. com/y4sm6sls ) is a tested approach for community-level engagement in pre- paredness planning.

Older people become at risk if one component of their complex system of supports falls apart. mal supports and healthcare to keep them as independent as possible in their own homes. People can become at risk if one or more of these supports falls apart. Emer- gency planners need to identify and meet the needs of those vulnerable older adults and people with disabilities who live in their own homes if and when any of these supports become interrupted. Available resources and tools to help with planning processes are described below. People who live with dementia, or who are caring for someone with cogni- tive issues, are especially challenged dur- ing a disaster. The National Alzheimer’s and Dementia Resource Center (NADRC; nadrc.acl.gov/), with funding from the Ad- ministration for Community Living (ACL), developed the Disaster Planning Toolkit for People Living with Dementia ( tinyurl. com/yxfnt5pg ). This toolkit helps to guide supportive relationships among govern- ment agencies, community organizations and residents to create shared plans for responding to emergencies. Health secu- rity in this area improved 17.8 percent be- tween 2013 and 2017—demonstrating that states can improve preparedness; howev- er, performance in this domain declined moderately in 2018 to a score of 5.2. An important part of community pre- paredness happens at the neighborhood level. In many emergencies, such as se- vere floods, tornadoes or earthquakes, traditional first responders might not be able to reach a community for many days. Having neighborhood-level plans in place and encouraging neighbors to get to know neighbors are key. Neighbors be- ing familiar with one another’s strengths and vulnerabilities can influence survival outcomes, as very often, neighbors will be first responders in an emergency. Current levels of health security re- main less than optimal. One area that needs improvement and that is particu- larly important for older Americans is coordination between the different com-

By Kathleen Votava D isasters can happen anytime, anywhere. Recent years have brought many disaster events, including hurricanes Harvey, Irma, Ma- ria and Michael, as well as wildfires and major flooding. Older adults and people with disabilities who have access needs and functional needs are particularly af- fected. Recently, the Center for Disaster Philanthropy noted that the majority of victims in California’s 2018 Camp Fire were older than age 60, and half of Hur- ricane Sandy’s victims in 2012 were older adults ( tinyurl.com/y5t2mw8f ). We build resilient individuals and communities when we adopt a “whole community” and “all- hazards” prepared- ness approach. This planning includes preparing for natural, manmade and pub- lic health emergencies. AMultifaceted System of Supports Today’s older adults and people with dis- abilities rely on an interdependent, often- times complex systemof formal and infor- state level, but also in communities, about the importance of health security and how it influences social inequality and healthcare delivery, and how to ensure that any vulnerable population, including many older Americans, has the knowl- edge and protections they need amid emergencies and disasters. According to the Index, U.S. prepared- ness increased by 3.1 percent over the last year, scoring 6.7 on a 10-point scale for pre- paredness—an improvement of 11.7 per­ cent since the Index began in 2013 and a 3.1 percent improvement over the last year. One area of improvement especially im- portant for older Americans is the area of community engagement and planning strategies that incorporate specific strate- gies for vulnerable populations. Areas for Improvement But gains in community planning and en- gagement demonstrate that we can still improve in one metric we have historical- ly struggled with, which is developing Health security preparedness › continued from page 1

A culture of health supports health equity. America is experiencing multiple threats to health and safety that extend be- yond what we typically think of as health. In recent years, we have seen extreme weather events, natural disasters and out- breaks of vaccine-preventable infectious diseases, in addition to the overall aging of our nation’s infrastructure. Strong health security preparedness is a crucial compo- nent to help our populations to live longer, healthier lives—regardless of their home state; we call this a culture of health that supports health equity. The Index fosters collaboration between government, com- munities and across sectors to make the places where Americans live, work and play as healthy as they can be. n Alonzo L. Plough, Ph.D., M.P.H., is chief science officer and vice president at the Robert Wood Johnson Foundation, in Princeton, N.J. communications (such as broadband) all affect health. to planning. Help with this approach also is available through the federal govern- ment and state and county agencies. The U.S. Department of Health and Human Services, Assistant Secretary for Preparedness and Response (ASPR) developed an interactive map called em- POWER ( empowermap.hhs.gov/ ) that displays the total number of Medicare beneficiaries at state, county and ZIP Code levels ( tinyurl.com/y4qohn6d ). Users can use it for their own geographic information system applications, too. State and county governments have ac- cessed emPOWER to reach out to at-risk individuals, including older adults. They › continued on page 8

Preparedness Supports a Culture of Health

Health extends far beyond traditional healthcare services: clean air, safe com- munities and access to 21st century tele-

Aging Today July–August 2019

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Lessons from the frontlines of trauma: social workers’ roles in emergency response

throughout time, despite many individual and community-wide traumatic events. Social workers also are called upon to conduct needs-assessment processes, gathering input from disaster-affected community leaders, survivors, family members, service providers and other re- sponders to inform the response program operations plan. Working with local gov- ernment and representatives from the affected community, social workers sup- port resilience-building and community capacity-building. This is managed by training people in the affected locale—from mental health and crisis intervention providers to stu- dents, interns, school staff, parents and other caregivers—to provide psycho-edu- cation(whichtells survivorswhat toexpect in terms of emotional distress responses), to launch support services and to integrate practices that can enhance treatment and the natural resilience of the human spirit. These practices include mindfulness, ar- tistic expression, narrative, body move- ment and social integration. We have learned many lessons, espe- cially from the large scale and scope of di- sasters that have occurred in the past 20 years, including the 9/11 and San Bernardi- no terrorist attacks, the Boston Marathon bombing, hurricanes Katrina, Rita, Ike, Sandy, Maria and Harvey and internation- al events such as the July 7 London bomb- ing, the Indonesian tsunami and more. Lessons Learned About Older Adults, Trauma and Resilience One lesson is extremely important to note—prior to 9/11, older adults were considered to be a high-risk population; everyone in the older adult age category was seen as potentially in need of behav- ioral health services due to their age. When working with representative groups of older adults in several affected communities, we learned that even with- in this population we need to break down the identification of individual needs to more accurately determine who might be at higher risk versus who could be more resilient, and even participate in re- sponse activities. For example, many older adults de- scribed having experienced one or more and beneficial partners for local public health and emergency management agen- cies. They are subject matter experts about the populations and communities they serve. CBOs should work together with local public health and emergency management agencies to ensure that older adults and people with disabilities are in- cluded in planning for disasters. The Capacity Building Toolkit for Older Adults and People with Disasters ( tinyurl. com/y2k8qoje ) was developed to guide the aging and disability networks to increase their ability to plan for and respond to emergencies. The toolkit can also help emergency managers and public health officials to understand the capabilities and expertise of these organizations. This toolkit was developed by ASPR, in collab-

By April Naturale I t is quite evident that planet Earth is experiencing an increase in the fre- quency and intensity of natural disas- ters such as hurricanes, earthquakes, tor- nados, fires and floods. Additionally, fundamentalist ideologies, expanding so- cial and economic problems and the easy availability of weapons merge to support acts of mass violence and terrorism throughout developing and stable societ- ies. What is less evident is how varied population groups and cultures cope with and recover from these traumatic events, although we (disaster and emergency re- sponse professionals) are building an evi- dence base to better inform us in address- ing this concern. Social workers play critical roles in pre- paring for, planning around and respond- ing to disasters and emergencies, as well as contributing to research in this segment of the social work discipline. In the United States, social workers typically make up about half of the responder community, providing crisis intervention, Psychologi- cal First Aid, Skills for Psychological Re- covery and more formal traumatic stress ‘Social workers typically make up about half of the responder community, providing crisis intervention.’ Social Workers as Emergency Responders: ANatural Fit treatments, such as Cognitive Behavioral Therapy for Post Disaster Distress, Expo- sure Therapy, Eye Movement Desensitiza- tion and Reprocessing and others. Social work and emergency response is a natural fit, as the social work discipline historically has used an ecological per- spective that takes into account how each aspect of a person’s life influences his or her trauma responses (which is a key com- ponent of trauma-informed therapy). This perspective also puts forth a strengths- based, client-centered and culturally in- formed approach that encourages build- ing upon the experiences and coping skills that have allowed humans to flourish have identified gaps in resources and made informed decisions about the loca- tions of emergency shelters. For example, the Florida Department of Health used the map to conduct critical outreach to more than 40,000 at-risk individuals dur- ing Hurricane Matthew. Nevada used emPOWER in partnershipwith the state’s Aging and Disability Services Division, a Tribal emergencymanager, durablemedi- cal equipment suppliers and others to conduct outreach during flood events. Dealing with disasters › continued from page 7

traumatic events in their lives, thus learn- ing good coping skills, which they had since retained. This skills development helped them tomove through the negative aspects of trauma and bounce back (exhib- iting resilience) more rapidly than other Many older adults have learned good coping skills through their experiences with past traumatic events. cohorts with limited experience in posi- tive coping. Modeling good coping for oth- ers is invaluable in a post-disaster setting: it shows people that recovery and hope, so vital to the human spirit, are possible. Another advantage many older adults possess is that theymay havemore time to volunteer for or donate to a response ef- fort, especially if they are retired from full-time employment. Often, these elders bring valuable skills from their lifelong activities: perhaps they have business ex- pertise and excellent organizational and project management skills; or they have finance expertise; or they have experi- ence in working with children, providing care and supervision, and teaching chil- dren how to experience joy, even in the midst of a disaster. Older adults with medical concerns, those who require oxygen, lifesaving medications and food supplies (and espe- cially those who live alone, but depend upon others to assist them with activities oration with the National Association of County & City Health Officials and the Association of State and Territorial Health Officials. The ACL, in partnership with the Aging and Disability Network, also collaborated on the toolkit. CBOs should work with public entities to include older adults in disaster planning. Older adults and people with disabili- ties have an important role to play in di- saster preparedness. They should be aware of any potential hazards in their communities; is there a history of flood- ing, tornadoes, hurricanes or wildfires? The website www.ready.gov provides

of daily living), are a sub-specialty popu- lation needing behavioral health identifi- cation and outreach. After Hurricane Sandy, we learned that people in the older adult and general adult populations who have functional and access needs may be at higher risk for traumatic stress responses if they are not mobile enough to evacuate during life- threatening weather events. During Hur- ricane Sandy, a lack of electricity trapped many people in their homes and high-rise apartments for days, as they were physi- cally unable to get out on their own. Thus, the lesson is to look, even within certain age groups and larger cultures, at what strengths and weaknesses may con- tribute to individuals’ needs, as well as to the community’s overall recovery and resilience. Traumatic stress cannot be assumed in all of the affected population. Social workers must consider individual strengths and even post-traumatic growth in those who show an ability to cope well and to support others in the re- covery process. n April Naturale, Ph.D., is a Disaster Re- covery and Community Resilience senior manager at ICF, a management consulting company, and works as an operations direc- tor and a clinician specializing in response to traumatic events out of Orleans, Mass. After 9/11, Naturale directed Project Liber- ty, the New York State Office of Mental Health’s Federal Emergency Management Agency–funded mental health response to the World Trade Center disaster. many resources, including guidance on building disaster kits specifically for older adults and people with disabilities. The site also provides information on plan- ning for pets’ welfare and how to be finan- cially prepared in an emergency. People responsible for disaster pre- paredness must adapt planning to meet the needs of those who rely on critical support services. Planners who are proac- tive and address changing environments can better serve older adults and people with disabilities to continue to live inde- pendently in their communities. n Kathleen Votava is an Aging Program Services Specialist in the Office of Regional Operations, Administration for Communi- ty Living, U.S. Department of Health and Human Services, in Washington, D.C.

CBOs—and Older Adults—Are Key in Disaster Planning

CBOs that workwith older adults and peo- ple with disabilities are valuable resources

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