Author Archives: Nancy Lundebjerg

Why the Older Americans Act is Important

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The Older Americans Act and Me

After they both retired, my parents volunteered with Meals on Wheels, which delivers food to home-bound elders. Programs like Meals on Wheels have been supported through legislation like the Older Americans Act (OAA), a historic bill that was passed in 1965 to help all of us remain independent in our homes and communities as we age, but which has been overdue for reauthorization (the process by which Congress makes changes to laws over time) since 2011.

Independence is something my friends and I think about a lot now that we are in our 50s and 60s, with many of us caring for our own parents, too. We talk about how we can remain independent in our homes for as long as possible—and legislation like the OAA plays an important role in those thought processes.

As CEO of the American Geriatrics Society, I know that two important pillars to remaining independent in our homes as we age are (1) ensuring we have a workforce that is competent to care for us wherever we may reside; and (2) supporting access to home and community-based services. Many of the programs I will likely need when I am older are funded by the OAA. Recently, key legislation has been introduced by U.S. Senators Lamar Alexander (R-TN), Patty Murray (D-WA), Richard Burr (R-NC), and Bernie Sanders (I-VT) to reauthorize the OAA. In so doing, this effort will strengthen support that will address elder abuse, evidence-based disease prevention and health promotion initiatives, effective coordination of services at the federal, state, and local levels, and several other challenges confronting older Americans and their health providers.

What the OAA Supports
In this post, I want to highlight three types of services supported by the OAA that have more than likely impacted you or someone you know: nutritional services, supportive services, and programs to assist family caregivers.

These are services that currently support elders remaining in their communities. They are programs that I—like many of us—will need when I’m older.

  • The nutritional services supported by the OAA—like the Meals on Wheels programs—ensure the health and well-being of older adults by enhancing access to nutritious food at home and in the community. More than 90 percent of older adults receiving home-delivered meals from programs like Meals on Wheels say this support has helped them to remain in their own homes. In fact, Citymeals-on-Wheels, which operates in my native New York, provides 2 million meals to 18,000 older New Yorkers each year. In addition to nutritionally balanced senior meals, staff from Citymeals and volunteers also deliver vital human companionship—an important added benefit for older men and women who get to enjoy regular visits from people they know and can trust.
  • The supportive services authorized by the OAA provide flexible funding to state and local agencies to offer senior transportation programs, information and referral services, case management services, adult day care, chore services, in-home services for frail older adults, and much more. In 2009, for example, this type of support under the OAA helped communities across the country offer nearly 8 million hours of adult day care, some 28 million rides to healthcare professionals’ offices, and upwards of 29 million hours of personal care and homemaker services for older adults in need. It’s especially encouraging to see so many older adults who live alone accessing transportation services: as many of these men and women report, without this important benefit, they might otherwise be homebound.
  • The OAA-funded National Family Caregiver Support Program (NFCSP) helps older adults age in place by promoting family caregiving and reducing reliance on institutionalization. Specifically, the NFCSP provides grants to states and territories, based on their population aged 70 and older, to fund a range of supports that assist family and informal caregivers who help older adults live at home for as long as safely possible. More than 75% of caregivers participating in programs supported by this provision of the OAA say these services have enabled them to provide care longer than would have been possible otherwise, and an astounding 89% of caregivers reported that program services helped them to be better caregivers.

These are but a few of the vital safety net programs supported by the OAA. They’re programs that matter because I’m a caregiver, but also because I know we can all benefit from their sustained support as we grow older. Reauthorizing the OAA is essential to that future reality, and I know that it will take all of us to make that possible moving forward.

So—what can you do?
Well, visiting our Health in Aging Advocacy Center is a great first step. It has lots of easy-to-use resources that can help you get in touch with your Senators and House Representative to make sure that your voice is heard as we look toward a future with an even stronger OAA—one that we helped shape here and now!

 

Celebrating the Medicare #DocFix

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Photo credit: David W. Parke II, MD

Photo credit: David W. Parke II, MD

This week, I made a pilgrimage to Washington DC to attend a reception in the White House Rose Garden at the invitation of President Obama. It was a heady moment for this new CEO of the American Geriatrics Society and the Health in Aging Foundation. My 91-year old mother and her friends were quite impressed–going so far as to ask me to put in a good word for older adults. Got that covered, Mom.

Putting aside the excitement of seeing the Rose Garden and shaking President Obama’s hand (I admit shaking a President’s hand is really exciting), why was this moment so important for geriatrics health professionals and the older adults they serve? Congress, in a rare bi-partisan, bicameral moment, had passed The Medicare Access and CHIP Reauthorization Act and President Obama signed it into law April 16, 2015.

I won’t go into all the details of the bill here—nor will I try to explain the Sustainable Growth Rate (SGR), which may be what you heard a lot about in the news related to this legislation. Suffice it to say, this new legislation finally fixes a huge problem for geriatrics health professionals and the older adults they serve.

Geriatrics health professionals are specially trained to care for older adults (learn more about these professionals here; we can even help you find one here). Having benefited from their expertise as a family caregiver, I know first hand how different it is to partner with someone with this kind of training when caring for my loved ones. They always start the care process by considering what matters to older patients and their families as people, and then work back to how they can help you get there.

Geriatrics healthcare professionals are pretty much wholly paid by Medicare, so a looming cut in payment of more than 20% annually is a big deal when you still have practice expenses to pay (that’s what these health professionals faced under the old SGR system). We don’t often talk about the business of medicine, but if you are in private practice you have expenses just like any other business. These include rent, staff (most geriatrics health professionals work in teams), equipment, supplies; malpractice insurance and your own health insurance. Like any other business, a sharp drop in revenue could endanger your ability to provide services. And that, in a nutshell, was the broader threat of the old SGR formula. With a stroke of the President’s pen, that threat is gone.

President Obama addressing reception attendees.

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Making Healthcare Decisions for Me, Part 2

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Nancy Lundebjerg casualNancy E. Lundebjerg, MPA
Chief Executive Officer
American Geriatrics Society
Health in Aging Foundation

In my last post, I shared some personal reflections on the importance of completing an advance directive—what the process has taught me about my needs, my wishes, and the type of voice and control I want to have should I ever need someone else to make healthcare decisions on my behalf.

That last point is quite important, and—in honor of today being National Healthcare Decisions Day—I thought I’d walk through some of the questions and considerations that helped drive my own search for a healthcare proxy. These are built on discussions I’ve had with this person—one who knows me well—about the questions, answers, and decisions that are important to me. While these points reflect my own thoughts and perspective, maybe you can use them as a guide for considering what’s important to you—and how you’d want those points acted upon should someone else need to make important health decisions on your behalf.

 Who You Are, Mr./Ms. Healthcare Proxy?

  • You are my advocate and you are most definitely the person who has final say in decisions if I’m unable to make them for myself. Collaborative decision-making in tandem with my doctor is OK—but you know what I would want better than most.
  • You will not let anyone rush you through a conversation—you’ll make sure all your questions are answered.
  • You’ll make sure I’m getting the best care possible—you’ll know who my doctors are and where they trained.
  • You are someone I trust to do whatever needs to be done—and that includes letting me go gently if that is the right decision. And by “right”, I mean your right—others can advise you, but the decision is yours to make based on what we’ve talked about and what you know about my wishes, needs, and expectations.

What You Know about Me

  • You know that quality of life is more important to me than length of life.
  • You know that I, personally, don’t have religious or moral beliefs that are relevant to decisions about life-sustaining treatments. You should make those decisions based solely on my medical condition and my long-term prognosis (the likely course of the disease or condition).
  • You know how I feel about artificial nutrition and hydration. I personally think it’s an OK short-term solution if you are “waiting and seeing” if I’ll recover, but please don’t pursue it for me if I’m in a persistent vegetative state or if scans show no activity in a substantial portion of my brain.
  • You know that I would ask for prognosis, weigh all the facts, make a decision, and then stick to that decision.
  • You know that I firmly believe that there are no wrong decisions.
  • You know that I am not afraid of living with disability nor am I afraid of dying.

What You Understand About My Long-Term Prognosis

  • Get the facts and the prognosis from the doctor(s) overseeing my care.
  • Ask about how I will physically function. Ask if I’ll have trouble with my mental capabilities. If I will, ask what that means in terms of my ability to function.
  • Weigh those answers within the context of what you know about me and make your decisions accordingly.
  • Finally, be sure to make time for yourself—being my (or anyone’s) proxy is not an easy task. I know, I’ve been there and done that. Most of all, know that I am going to be A-OK with whatever decisions you make. I trust you—and that’s what this relationship is all about.

 

Making Healthcare Decisions for Me, Part 1

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Nancy E. Lundebjerg, MPA
Chief Executive Officer
American Geriatrics Society
Health in Aging Foundation

Have you ever imagined a time when you are unable to make decisions for yourself? Who knows how you would make decisions? What information would you want? What do you think about life-prolonging treatments? Who knows how you feel about dying? Who knows you?

Have you looked at that moment through the eyes of family who may have no—or every—legal authority to make decisions for you? Have you thought about the range of decisions that might need to be made for you—each decision likely leading to another decision and accompanied by concern that someone might not be doing what you would do if you were making this decision for yourself?

We don’t like thinking about those types of things—at least my family doesn’t, and I wouldn’t be surprised if yours didn’t as well. You might, like me, have an advance directive gathering dust in some corner of your home with another copy in the hands of your proxy and yet another copy stapled into a chart for a doctor you haven’t seen in more than fifteen years because you’ve moved on and so have they. You may have completed an advance directive as a part of writing your will, as someone recently told me they had, so you can mentally check it off your to-do list. Health Care Proxy/Advance Care Directive. Done.

But maybe we should start thinking about this as a conversation as one addressing how we would want to live rather than one focused on how we would want to die. I know how I want to die–without a long decline into disability and dementia. I also know that kind of death can be hard to come by. Simply put, in this day and age, we can live for much longer than we could before.

If you look at Advance Care Directive forms, you’ll see that most ask for some specificity. As an example, my home state of New York allows me to check off that I don’t want blood transfusions—just one of the 11 examples that the New York form provides. It’s enough to make my head spin.

To be honest, I am not sure I could outline every possible scenario in a way that would be a road map for my proxy. The thing I know from being a caregiver is that there will be a lot of decisions and a lot of nuances to those decisions. I know they will start small and build to a crescendo. And, at least for me, it’s been helpful to balance sharing my wishes with remaining flexible—not trying to control everything with a lot of instructions. That’s one of the most helpful parts of selecting a healthy proxy when completing an advance directive—you can identify a person you trust to do whatever is in your best interests.

It’s important to have an Advance Care Directive form completed and a decision-maker identified. No less important is empowering your decision-maker to act on your behalf. More on that in my next post.

 

Central Park: An Age-Friendly Place

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Grantmakers in Aging (GIA) recently announced the winners of its Friendly Faces. Friendly Places photo contest.  They had submissions from all over the world and it’s pretty amazing to see so many different perspectives on aging all in one place.”We launched this contest to gain insight on what people think best illustrates an age-friendly community.  We had hundreds of wonderful submissions that captured different moments among family and friends, and showed how communities can be great places to grow up and grow old,” said John Feather, PhD, Chief Executive Officer of Grantmakers In Aging.  “Our winning photographs tell meaningful stories of how older adults are vitally connected to the life of their cities, towns and villages in many different parts of the world.”

I am honored to be counted among the winning photos for Walking in a Winter Wonderland—a photo I snapped quickly while walking on a beautiful winter day in New York City’s Central Park.

Nancy Friendly Faces Friendly Places Photo

I typically snap photos of people from behind.  I like the mystery—Who is that person?  Where did she come from?  Where is he going?  I also like the way you see someone when not distracted by their faces.  The focus becomes on how a person is moving.  Is she using an assistive device like a walker or a cane?  Is a friend or caregiver supporting him with a gentle hand or the offer of an arm?  Is an older couple walking hand in hand as if they were 22 and just married?

I rarely submit my photos to contests but I was drawn to the idea of the “Friendly Faces, Friendly Places” contest that John Feather so aptly captures in his quote above.  I happen to think that Central Park is one of the most age-friendly parks in the world.  There are plenty of paved walk ways and benches upon which to rest and watch the rest of the world go by at every turn.  New York City has this reputation as being big and burly—a place where young people come to make their way.

The less known side of the city is what an age-friendly place it can be.  Thanks to GIA for hosting this contest and giving professional and amateur photographers alike a chance to show off why we think our communities are age friendly.


About the Author
Nancy Lundebjerg is Chief Operating Officer of the American Geriatrics Society and the Health in Aging Foundation.