00:00 - Focus on aging adults is sponsored in part by AARP.

00:06 - Pennsylvania has one of the largest aging populations in the country.

00:10 - Our aging adults are vibrant, active contributors to our society.

00:15 - PCN In partnership with AARP,

00:18 - present focus on aging adults.

00:21 - Welcome to Focus on Aging Adults.

00:23 - I'm Larry Casper.

00:25 - This program is brought to you in partnership between PCN

00:28 - and the AARP of Pennsylvania.

00:32 - Today, we're talking about family caregiving.

00:35 - Our guests are Clay Jacobs, director

00:37 - of the Alzheimer's Association of Greater Pennsylvania.

00:41 - Roy Asla Bok, founder and president of the Author book Group.

00:45 - And Nora Dowd, Eisenhower volunteer State president of the AARP of Pennsylvania.

00:51 - Nora, we're going to start with you.

00:52 - When older Pennsylvanians need help with their day to day life,

00:55 - often family steps up first.

00:58 - So try to describe the typical scenario.

01:02 - Good morning,

01:03 - Larry, and thank you for that introduction.

01:07 - While there is a typical scenario,

01:09 - the most common thing we see is that older people want to age

01:14 - in their communities, in their homes, with family and friends.

01:18 - Family is the first line

01:21 - of helping older adults make that happen.

01:24 - We know that there are over a million caregivers

01:27 - in Pennsylvania, and I'm sure that that number is much higher.

01:31 - I hear from people every day who are confronting the reality

01:35 - of what do I do to help my loved one stay home?

01:39 - So it's an issue that we know

01:41 - many people the longer people are living.

01:44 - That longevity bonus has a cost.

01:47 - And often we see it initially be picked up by family members.

01:52 - And it's it's a heavy burden.

01:54 - And often physical and cognitive challenges complicate the situation.

01:59 - Absolutely.

01:59 - And I think when we think of that one in four caregivers in Pennsylvania

02:02 - as caring for a loved one with a cognitive concern,

02:06 - and that brings a whole other suite of issues,

02:08 - which may be things that you hadn't expected

02:10 - or things that are progressive and change throughout time.

02:13 - And how do we navigate that from finances to day to day living to support services?

02:18 - All of those things.

02:19 - And so we may have our plan and we may have those caregiving issues,

02:23 - but then also when cognitive concerns come in, how does that change

02:27 - and how do we need to adapt along the way?

02:28 - I think is one of those subsets that's a very important

02:31 - and unfortunately has a tremendous impact here in Pennsylvania.

02:34 - Well, and of course, we also really don't know

02:36 - exactly when that cognitive concern is going to occur.

02:40 - Sometimes it's masked, sometimes it isn't masked.

02:42 - But people think that it's occurring because the individual loses sight

02:46 - or they lose hearing or they lose a balance.

02:49 - And people seem to think, well, you know, maybe there's something

02:51 - going on mentally as well, when in many cases that just isn't so.

02:55 - And I know from firsthand

02:57 - because as you know, Larry, I cared for my mother for 25 years.

03:00 - Fortunately, it was relatively easy for me because her

03:03 - her needs were basically related to physical needs.

03:06 - It was only toward the very end that she began to have some cognitive problems.

03:10 - So but even at that earlier on, I thought she was having

03:13 - cognitive problems because she began to have macular degeneration.

03:18 - So she could no longer read any longer.

03:20 - She began to be extremely hard of hearing, and therefore

03:24 - it was difficult to communicate with her.

03:26 - And I wasn't quite sure whether it was

03:27 - because she wasn't understanding until we discovered what the issues were.

03:31 - And then that made a world of difference.

03:33 - But again, there was only so much we could do,

03:34 - especially with macular degeneration and so forth.

03:36 - So it's tough. It's it's tough to figure it out.

03:39 - And then once were you and your mom under the same roof?

03:42 - yes. Yes.

03:42 - I brought my parents back from Florida, where they had retired, too, in 1995.

03:47 - My dad passed away in 2001.

03:49 - He had some issues as well, but mother was pretty much able to care for him.

03:53 - But from that point on then, yes, I took mother with me

03:56 - wherever I moved to from that. Yeah.

03:57 - And the reason

03:58 - I ask about that everybody is that obviously logistics are involved here.

04:02 - So what kind of distance is typically between the family and the person

04:05 - they want to care for?

04:06 - How often do they live under the same roof as Roy just described?

04:10 - We know that many people live in other states.

04:14 - Roy mentioned Florida.

04:15 - We know people in the early retirement years or young older people might move

04:20 - to another state where it's warmer, but often they return when they need care.

04:25 - Often they return for grandchildren.

04:27 - Often they return to be part of that family unit

04:29 - that they that they missed or loved ones or friends or neighbors.

04:33 - But we do know that caring for someone in your home while it's demanding,

04:37 - it can be a crisis situation unexpectedly.

04:41 - It is easier than the long distance caregiving that we see so much of today.

04:46 - And when you're able bodied in your cognition is good.

04:48 - It's easy to take these activities for granted.

04:51 - So try to just educate our viewers

04:53 - on the things that they don't think about every day.

04:55 - But suddenly they're a vital importance when they're dealing with an aging parent.

05:00 - Well, just beginning and get up in the morning.

05:03 - Obviously, getting dressed is an issue.

05:04 - But beyond that, it's how do you get your cup of coffee?

05:08 - You know, can I really trust myself to be able to use that?

05:10 - That stove, whether it's electric or gas, doesn't make any difference, really.

05:13 - Can I really trust myself to use that or do I have to do it in a microwave?

05:17 - And if I have to do it in a microwave, I certainly can't use one that's up

05:19 - above the stove because maybe I can't reach that high.

05:22 - I can't see well enough to be safe getting the cup in and out

05:25 - so you get another smaller microwave and you put it down on the counter

05:28 - where it's easy to operate and then you put

05:29 - little fuzzy things on the buttons so they know which button to push.

05:32 - And as long as the cognition is that right? I have to see.

05:35 - This is the kind of insight I'm very interested in.

05:37 - Roy, go ahead, tell us more. Yeah.

05:39 - And as long as the cognition is there, that works fine because they can remember

05:42 - the first to the left, the second on the right,

05:44 - whatever it might be, to be able to do those buttons.

05:46 - Same thing is true with just basic meals.

05:48 - Now, fortunately, in the grocery stores

05:50 - today, you can buy readily prepared meals that are easily warmed in a microwave.

05:54 - Right.

05:54 - So that works well also.

05:56 - But the nutrition isn't always the best.

05:58 - And so there are some difficulties that one has to overcome with that.

06:01 - But the biggest difficulty

06:02 - is the fear of leaving that individual alone for an extended period of time.

06:06 - And of course, in my line of work, there were many days

06:08 - I had to be overnight.

06:09 - So I always had to make sure I had a caregiver

06:11 - that could at least stop in make sure everything was all right.

06:14 - I always had at least two cell phones available to different rooms

06:18 - so that if mother became sort of stranded in one room or the other,

06:21 - she'd still be able to get to a telephone.

06:23 - And I was definitely using the type that she could also put in her apron

06:27 - and carry around with different phones, with different numbers.

06:29 - It just occurs to me.

06:30 - Well, unfortunately, yes, but but you have call forwarding, you say.

06:34 - So I could make sure everything was call forwarded into one phone.

06:37 - And that was helpful.

06:38 - You know, that's that's a really good example.

06:40 - And while having your morning cup of coffee may sound to someone

06:44 - like it's not that important, it's so significant for your independence

06:48 - and maintaining your lifestyle and doing the things that you want to continue doing

06:52 - for as long as you possibly can.

06:54 - But we've not mentioned medications.

06:56 - This to doctors, a number

06:59 - of other things that require more care can be more of a crisis,

07:04 - can make it very difficult for someone who has a full time job,

07:07 - who's now confronted with caring for a family member

07:10 - that needs a lot more support than they needed a week ago or even a month ago.

07:14 - So these are very significant issues

07:16 - for and a little bit of managing contain there can only go so far.

07:19 - Yeah, there's a lot of limitations in there are so many things like that.

07:22 - Right.

07:22 - We think about the breadth of that from whether it's a cup of coffee

07:25 - or in Congo can be as simple as brushing your teeth.

07:29 - You think of how many your first doctor today has autonomy,

07:31 - and that's important to people,

07:32 - very important to those things that make up your day.

07:35 - But then you look at medication management, transportation,

07:38 - looking at social, all those things that are about quality of life

07:40 - and how we engage with others when people are living at home.

07:44 - And as we see these pieces come up as caregivers,

07:47 - how do we do all of that if somebody is able to drive or not?

07:49 - How do we access the places and people and the things they want to be able to see?

07:54 - Being able to attend church or temple, All of those things come in that often

07:58 - we don't think of, but they are what make us who we are,

08:01 - how we engage, how we interact.

08:03 - And all of those things come along in different ways for a caregiver

08:06 - and the people they're caring for, including the simple act of bathing.

08:11 - I mean, obviously, fortunately I was able to get a property

08:14 - and mother could be in that property and we had a very low step in shower

08:19 - because there was no way in the world

08:21 - and the caregiver could have gotten her in and out of the tub.

08:23 - So oftentimes

08:24 - those adjustments have to be made just with the physical property itself.

08:28 - But, you know, it's

08:29 - and sometimes it can be very expensive.

08:31 - So it's difficult for folks that don't have the wherewithal

08:34 - to be able to do that.

08:35 - It can be expensive to overhaul your bathroom and have an idea or two in step.

08:39 - Absolutely. Yes.

08:40 - And you're often doing it when you absolutely need to.

08:44 - Right. That's part of it, too.

08:45 - As things progress, you're realizing something happens

08:47 - and you need to make an adjustment in emergency

08:49 - and you have to deal with condense time.

08:50 - So it's not only those barriers, but it's also then being able to do it versus

08:54 - what are some of the really important conversations to talk about?

08:57 - What's ahead?

08:58 - What could you plan for?

08:59 - What could you be looking at?

09:00 - All of this kind of comes into play?

09:02 - Well, as far as our discussion is concerned, the plot thickens,

09:05 - you might say, when you consider day to day support.

09:08 - Can be hard for family members

09:10 - because they have their own lives and their own responsibilities, too.

09:14 - So that adds up to pressure and maybe things getting overlooked and not done.

09:19 - Well, that's exactly right.

09:20 - And that's why there are some interventions that can take place.

09:23 - We have the adult day services, for example.

09:25 - If an individual truly cannot be left alone

09:29 - for a number of for any number of hours, really

09:32 - adult day services is available.

09:34 - And in many cases, an individual can qualify under Medicaid

09:38 - through the federal government

09:39 - combination state government funding or if they're not that poor,

09:43 - which is one of the bad requirements of Medicaid, sure,

09:46 - then they can be able to qualify under the state's options program,

09:50 - which is very similar to the types of services that Medicaid would provide.

09:53 - But it's funded by the Pennsylvania lottery and it's on a sliding scale.

09:57 - So depending upon the individual's ability to pay

10:00 - for services, that that options program can help.

10:03 - So there are these kinds of interventions that could take place in addition to home

10:07 - care.

10:07 - That's also which is what I utilized when I was out of town.

10:10 - But there's a lot of home care agencies out there,

10:14 - although they too are suffering since COVID

10:15 - because they're having a tough time

10:17 - getting people who are willing to go in to somebody else's house.

10:20 - One of the things we have to remember is that there's not a one size fits all

10:24 - as we age, just as when we were younger.

10:27 - We want to do our own thing.

10:28 - Our families look differently.

10:31 - Each individual has a support system.

10:34 - Some can adjust quickly and pivot when there's a crisis.

10:38 - Some cannot.

10:39 - Most of the people I talked to again, I talked to people in the supermarket.

10:43 - I talked to people that I run into at events where they are paying with

10:47 - with with Clay and with Roy.

10:49 - We work together. We run into people.

10:51 - Most of the people I talked to do not qualify for Medicaid.

10:55 - It is a low income program, so the cost then falls back on the family

10:59 - or the individual, and that can be very challenging.

11:03 - I will also say, though, that I really want to give a plug for adult day centers.

11:08 - Before the pandemic, we saw adult day centers

11:11 - as an alternative to people who go to work.

11:15 - Someone comes for their loved one who's experienced some cognitive issues

11:19 - and they're in a safe place all day, and then they have them home in the evenings.

11:24 - And how are they?

11:25 - How are they distributed statewide?

11:26 - In other words, everybody,

11:27 - our listeners, our viewers want to know if one is nearby.

11:30 - There may be one nearby. They were more before the pandemic.

11:33 - The pandemic was a big hit for adult day centers.

11:36 - Many of them have come back.

11:38 - Check with your local area agency on aging.

11:40 - We'll give the number at the end of the program, I'm sure.

11:43 - Look in your town.

11:45 - Look in your county.

11:46 - There are adult day centers across Pennsylvania and really across

11:49 - the country.

11:50 - It's a good alternative for some people.

11:53 - Right now,

11:53 - it's about 200 of them in Pennsylvania right now that are up and functioning.

11:57 - There's also the life program, which is essentially adult day

12:01 - centers of its own, or IT contracts with existing adult day centers.

12:04 - So if anyone is involved in the life program, that's one avenue also.

12:09 - But as Nora said, the best thing to do is,

12:10 - is to check with the area agency on Aging.

12:13 - There's 52 of them across the Commonwealth.

12:15 - Every county is represented by one of them and they will have the information

12:19 - to be able to forward

12:20 - for not just adult day but any other number of helpers as well.

12:25 - Now, Medicaid's already been mentioned a couple of times

12:27 - so far, and I'm going to return to that subject along with Medicare.

12:30 - But first I just want to talk about our our general attitudes

12:34 - and how people's attitudes evolve over time.

12:38 - As far as the way we view giving day to day support

12:42 - to older Pennsylvanians and what kind of change or evolution

12:46 - have you seen over the over recent years that it's just helping?

12:51 - Well, first, I'm going to tell you what's not helping guide,

12:54 - and that is the demographic boom in this population.

12:57 - People are living longer.

12:59 - They want to age at home.

13:01 - We need care and services and innovations and supports to help them do that.

13:06 - And by helping that individual do that, we're helping families

13:09 - or helping loved ones. We're helping communities.

13:11 - Everyone benefits when someone can stay at home for as long as possible

13:16 - and enjoy that connectivity with their family and friends.

13:20 - Right?

13:21 - So I think that's a really important thing to note here.

13:24 - We're here today in part because the population is growing

13:27 - every day, and it's a huge, huge issue for many, many families.

13:32 - And what

13:33 - Nora's just described, what we call today, home and community based services.

13:37 - When the lottery was established in 1971, and as you know, Larry,

13:41 - I know this because I helped write the bill,

13:43 - that's an indicator of how long I've been around.

13:45 - But when the lottery was established, it was designed for that very purpose

13:49 - to be able to allow people to remain in their home

13:51 - and live in the community

13:52 - for as long as possible and avoid having to go into an institutional setting.

13:56 - And nowhere in the lottery, however, will you find that

13:59 - there is a statement saying

14:00 - this is for home and community based services

14:02 - because we didn't use that term at that time.

14:04 - So that's one of the things that has clearly changed

14:06 - as people have begun to recognize that there's a whole array of services

14:10 - that are necessary for an individual to be able to access from time to time,

14:14 - if necessary,

14:15 - or perhaps all the time to be able to stay in their home and community.

14:18 - But this government's, both the federal and state government, have moved

14:21 - in the direction of recognizing that as well, and have encouraged

14:25 - all the various players in this to begin

14:28 - to focus upon deinstitutionalization, if you will, before it ever occurs,

14:33 - which is let's keep people at home and in the community

14:35 - because it's a lot less expensive. It's where they want to be.

14:38 - It keeps them, frankly, healthier for a longer period of time

14:42 - than if we just default automatically.

14:44 - And that is the one issue with Medicare.

14:46 - You have an automatic default to a nursing home,

14:48 - but you don't have a default to home and community based services.

14:52 - And you mention reframe the question as we talk about perspective.

14:55 - I think as we think of the Alzheimer's Association and those living

14:58 - with dementia, all of those things are particularly true.

15:01 - But it's not only a perception of its reality

15:03 - when 70% of those living with dementia are living at home.

15:06 - And so they have complex needs and things occurring that family caregivers

15:10 - and home community based services need to be able to address.

15:14 - And yet often those who haven't dealt with it directly

15:16 - think of it as the later stages of the disease.

15:19 - The institutionalized care portion of it.

15:21 - But that is not the reality.

15:22 - And even today, more people are being diagnosed younger and earlier.

15:26 - And so it's not only how are we ready for what's here right now,

15:30 - but the years to come.

15:32 - And so your point on, not only have we come a long way, but I think

15:35 - we're even going to see more as our aging population shifts in the coming decades.

15:39 - That's what I'm looking for,

15:40 - is indications of progress and awareness that these things are happening.

15:45 - Well, I think we're seeing innovations.

15:47 - We talk about smart homes.

15:49 - We talk about homes that are you're able

15:52 - to live in them from birth to death.

15:57 - So the universal design aspects of those homes

16:00 - really enable people of all ages to live together.

16:04 - And that's going to make it easier for family caregivers.

16:06 - Many of us live in older houses where we have steps,

16:10 - steps up, and that that can become a crisis.

16:13 - And the crisis as, as we know, is not predictable.

16:17 - So families might not be ready to deal with that.

16:20 - But as we look at advances, that is making communities more livable,

16:25 - which we see in the aging our way, Pennsylvania plan,

16:28 - I think we're really becoming more sensitive to that and to supporting families

16:33 - as they become family caregivers.

16:36 - Science has done a wonderful job, a medical science done a wonderful job

16:39 - of being able to address physical issues and extend life in that fashion.

16:45 - But they haven't found a way to be able

16:46 - to address mental issues and cognitive issues.

16:49 - And that's where we're getting this strong tension.

16:52 - People are living a lot longer.

16:54 - And as Clay knows, when you get into dementia and so forth

16:57 - and you look at the 80 year old and above bracket, you've got a lot more people

17:01 - affected by dementia and cognitive issues then below that.

17:05 - So what's the fastest growing demographic among those who are aging

17:10 - right up there close to the 100 year mark, which means we've got this tension

17:14 - that we really have to figure out how to deal with.

17:17 - And I think there are some exciting things that are happening.

17:19 - One of the examples is you mentioned that kind of changing need piece

17:23 - that strikes me as actually something.

17:24 - There are about two dozen providers who've just received Pennsylvania federal

17:28 - funding, really looking at

17:29 - something called the guide model, which is dementia care navigation.

17:33 - So things we've talked about around

17:35 - physical therapy, occupational therapy, home assessments,

17:38 - but even social work support and nursing support

17:41 - to navigate the various stages of the disease and progression.

17:44 - We're seeing these things

17:46 - where it's this public private partnership just start to come into play.

17:50 - But they are the ways on how do we solve for

17:52 - how do we allow for these solutions to really empower families to do

17:56 - what they need, how they need to, where, where, where they live.

17:59 - And so those are some of the things that I think are exciting to me

18:02 - that a decade ago would have been, you know, we hope we wish.

18:06 - And now you're seeing some of that come into play.

18:07 - It is how quickly

18:08 - can we bring those things to the families who are asking for them?

18:12 - We started off our program

18:14 - talking about addressing basic needs for older Pennsylvanians,

18:17 - and it just occurred to me the other day,

18:19 - very basic need is access to your own home.

18:22 - If it was built 100 years ago and it has five steps leading up to the front door.

18:26 - I saw a fairly complex ramp system made out of aluminum

18:29 - that made it possible for someone to get in that home

18:32 - that someone had to engineer that built it and someone had to pay for it.

18:35 - I wonder if there are funds available that can help make those modifications?

18:40 - Well, yes, there are actually.

18:41 - And again, much of that comes from the lottery

18:44 - and it runs through the area agencies on aging,

18:47 - they do have authority to do home modifications.

18:50 - Unfortunately, when money gets tight and we'll talk about that later

18:53 - as it has become this year,

18:55 - that is one of the things that has to get onto a waiting list

18:58 - because it's obviously necessary and it's very helpful to individuals,

19:02 - but it's not as critical as having a home health aide or something of that

19:05 - nature that for the very personal care that you would need.

19:09 - So but yes, those monies are available.

19:11 - There's federal monies available for that as well.

19:13 - And in fact, a number of local counties throughout Pennsylvania have begun to look

19:18 - at the possibility of how they can help with home modifications, too.

19:22 - And truthfully, it's one of the things that's the easiest thing

19:25 - to do in some ways and the most difficult and others.

19:29 - The front door of a building is generally large enough

19:31 - for someone with a in a wheelchair to be able to get in.

19:34 - But once you're inside that room, especially the older row homes,

19:38 - the doorways aren't necessarily wide enough,

19:40 - including the doorway to the bathroom, which is integral, obviously.

19:43 - So there's a lot of changes that that would have to be made

19:46 - in some of the older buildings that are frankly very expensive and difficult.

19:50 - But there were some interventions that can be made as well.

19:54 - I'd like to talk about the short program.

19:56 - I work with the Philadelphia Corporation for Aging, one of our area

20:00 - agencies on Aging in the City of Philadelphia.

20:03 - The short program is a federally funded program, Senior Housing Assistance

20:07 - Repair Program.

20:09 - I will tell you there's a waitlist for services,

20:11 - but they can do home repairs up to 20 $500.

20:16 - And that's a program that exists across Pennsylvania

20:18 - run by our area agencies on aging.

20:23 - Getting that support when you needed

20:25 - to get that access ramp to the front door can open a world of possibilities.

20:31 - Now, it's not going to help someone if they're in a wheelchair in their house

20:34 - and they can't get up and down the stairs.

20:35 - But let's take this problem as it occurs.

20:39 - The one of the first things people need is to be able to get into their house,

20:42 - into that front door.

20:43 - And there is a program to help with that if you can't afford it.

20:47 - And it is not a hugely expensive repair compared to others.

20:52 - So I will say let's look at each situation individually.

20:56 - Let's see where the solutions may exist.

20:59 - There's not going to be a solution for everything everywhere,

21:01 - but there are solutions out there right now.

21:04 - And I've seen them work and it's it's amazing what you can do.

21:09 - So let's consider to explore solutions.

21:11 - That's a good word.

21:12 - And we're considering day to day care for older Pennsylvanians.

21:15 - So bearing that in mind, we have to talk about the government entitlements.

21:20 - We've mentioned Medicaid a few times, but I want to take a step back from that.

21:24 - And even just consider Medicare.

21:26 - Medicare, government entitlement.

21:27 - When you turn 65 and brief review on which health care expenses,

21:32 - does that pay for it?

21:33 - How about these day to day

21:35 - services for older Pennsylvanians that we're concentrating on today?

21:39 - Well, I will tell you that Medicare does not pay for institutional care.

21:44 - Medicaid is the program.

21:45 - It's a federally funded health.

21:48 - Well, Medicare, health, healthy.

21:49 - For some, it will it will help you for some of those treatments at home.

21:53 - But if you're talking long term and chronic,

21:55 - you're not going to be able to turn to Medicare for help in that area.

21:59 - You're going to have to find other resources

22:01 - unless you're very low income and you qualify for Medicaid.

22:05 - So we need to have other services available as well.

22:08 - So Medicare

22:09 - is there, but albeit for limited time, Low care's there for a lot of things.

22:13 - Medicare is now for preventative care.

22:15 - Medicare is there for hospital care.

22:17 - Medicare can be there for important patients.

22:19 - They're really important.

22:20 - One of the things we think that is keeping people living longer is

22:23 - the great advances we've made in medications.

22:26 - You know, 100 years ago, we didn't have a pill for high blood pressure.

22:29 - We take it for granted now, and it's keeping people

22:32 - alive longer and having a high quality of life.

22:36 - But Medicare is not going to be a solution when we have low and moderate income

22:40 - looking for help in caregiving,

22:42 - they won't pay for that person to come over to your house. No,

22:46 - it's that simple.

22:47 - Our viewers need to understand that. Certainly.

22:49 - Okay. Well, then why don't we get more into Medicaid?

22:51 - And then there's the economics considered there.

22:54 - And Roy, why don't you take that?

22:55 - Because like you said, sometimes from sometimes frustration results

22:59 - when you're above that threshold, that's Medicaid.

23:02 - Well, that's exactly right.

23:03 - And Medicaid is based on two things.

23:06 - But most importantly, it's based upon the financial assets of the individual.

23:10 - It's designed for those individuals who just simply don't have sufficient

23:14 - financial assets to do any kind of private care

23:16 - or get into it, or they don't have insurance.

23:18 - A private sector insurance, or whatever the case may be.

23:21 - The second thing it looks at, of course, is the acuity of the situation.

23:24 - The does the individual qualify on both counts?

23:28 - Do they?

23:28 - Absolutely need the help

23:29 - and are they so poor that they can't afford it any other way?

23:33 - There are people who are able to qualify for both Medicare and Medicaid

23:36 - because Medicare, as we just mentioned, pays for things like hospital

23:39 - stays, it pays for doctor's visits, it pays for medication,

23:42 - it pays for 100 days of rehabilitation, but not anymore than that.

23:46 - So if you need long term care beyond that, well, now where do we go?

23:49 - And then that's when Medicaid kicks in.

23:51 - If, in fact, you need to have institutional care,

23:55 - whether it's in a nursing home or longer than 100 days in a rehab facility,

23:59 - Medicaid can pick up at that point as well.

24:01 - And here's what oftentimes happens to individuals

24:03 - if they're not sufficiently poor or

24:05 - if they have too much in the way of financial assets to qualify

24:08 - for Medicaid, they have to what is called spend down, in other words,

24:12 - spend their own savings, whatever they may have,

24:15 - until their financial assets reach that point where they qualify for Medicaid.

24:19 - So by not allowing to have the ability to at least buy into Medicaid,

24:24 - if nothing else, which has been proposed from time to time,

24:26 - we're forcing people to become poverty ridden before we're willing to give them

24:31 - the the help they need.

24:32 - And what does that mean along that whole path?

24:34 - You can bet that they're getting sicker, not healthier.

24:37 - So do you think it changes in order then, as far as the eligibility parameters

24:40 - are concerned for Medicaid? And of course, we'd love to see a change.

24:43 - We'd love to see more people eligible for Medicaid.

24:46 - We'd love to see those income limits increased.

24:49 - I think it's a hard sell, though, in these days

24:52 - where we'd have to then call on more federal and state dollars.

24:55 - What I'd like to do also, though, is look at what we have in place.

24:58 - What do we have in place

24:59 - in the community for people that may not be income restricted?

25:04 - Let's think about our senior centers or community centers.

25:07 - Think about the activities that we already have

25:10 - that engage people in their community that can keep them healthier longer.

25:14 - Many of those programs are funded with pen care, with state

25:18 - dollars, with local dollars through our area agencies on aging.

25:22 - They are the ones that run senior centers in our communities, and they serve meals.

25:28 - They they they engage people.

25:31 - And we know that loneliness

25:32 - and a lack of connectivity is almost as bad for you as smoking.

25:36 - So let's just look at that to prevent people

25:39 - from getting to the point where they get very ill and they need more care.

25:45 - Let's see if we can extend that time where people are healthy,

25:48 - where they're actively engaged in the community.

25:50 - And that's really what we're about here today.

25:51 - That's what our area agencies on aging focus on doing.

25:55 - In addition to serving very low income, vulnerable individuals.

25:59 - And that's what the aging our way is about,

26:02 - extending the productive life that we have in our communities

26:06 - so that we don't need these.

26:07 - This would be the governor's agenda for like today.

26:10 - Yes, absolutely.

26:11 - Governor SHAPIRO has has really pushed this agenda.

26:14 - We in the aging everything manifesto lately,

26:17 - I need ten tangible evidence that we're going ahead with that agenda.

26:20 - Who can update?

26:22 - I bet there's an Alzheimer's office being talked about.

26:25 - Right. So there is certainly a subset of that.

26:26 - And I think it is it's an exciting thing, right, to have what was an appropriation

26:31 - of 1.9 million to establish this Office of Alzheimer Disease and Related disorders.

26:35 - It is a space where the governor and legislative champions have stepped in

26:39 - to make that possible, really to bring Pennsylvania up to speed

26:43 - to our counterparts throughout the country on here

26:46 - is dedicated staffing that's looking at policy issues and support services

26:50 - and really coordinating for this incredibly large population

26:54 - with complex issues.

26:55 - As we look at that right now, as we see that

26:58 - move, having moved through the budget, it is then how does that manifest?

27:01 - How does that engage with the area sees on aging, the enabling legislation

27:05 - that includes things like the state plan and the stakeholder group

27:09 - and actually identifying priorities each year is still in process,

27:13 - but it is that initial investment that the governor, the Secretary of Aging

27:17 - and others have stepped in to say this is a space we need to do more for

27:21 - because we know Pennsylvanians need it and deserve it at this point.

27:26 - And so it's certainly exciting to see.

27:27 - Well, Claire, I'd like you to keep the floor

27:29 - for a couple more minutes on the subject of Alzheimer's disease in general.

27:33 - In other words, I'd like to start with what developments have been made

27:36 - in the recent past that help us understand Alzheimer's disease better.

27:41 - So I think it's exciting.

27:42 - And Pennsylvanians

27:43 - in particular should be incredibly proud because so much of what we've learned

27:47 - recently has its foundation in Pennsylvanian institutions.

27:51 - When you think of things like the imaging techniques used to look at the disease,

27:56 - they were initially developed at places

27:57 - like the University of Pittsburgh and the University of Pennsylvania.

28:00 - So now Alzheimer's shows up on a picture and it didn't used to

28:02 - it does so and not only that, but multiple biomarkers.

28:06 - So we're entering a world where in research settings

28:09 - we can look at functional pet imaging, we can look at things

28:12 - like cerebrospinal fluid and diagnose accurately.

28:14 - But we're also on the cusp of things like blood biomarkers,

28:17 - being able to in a blood test, actually be able to diagnose Alzheimer disease

28:21 - and identify even get some symptoms less invasive than others is

28:25 - what I'm getting are and you look at cost and accessibility

28:28 - and all of those other things to think of the difference between

28:31 - a lumbar puncture or a spinal tap to diagnose versus a blood test as a part

28:35 - of a regular panel and identifying before you see symptoms potentially.

28:40 - We also see just in the past few years the first FDA approved

28:43 - treatments ever for.

28:45 - So what's the latest on treatment? This is exciting to hear about.

28:48 - It is so so

28:49 - there are three FDA approved treatments that showed benefit in clinical trials

28:53 - around actually reversing amyloid accumulation, essentially the protein

28:56 - buildup in the brain, not just slowing progression, but reversing it.

29:00 - Really.

29:01 - There are proof for the earliest stages of the disease.

29:04 - And what they showed in those trials is keeping the disease from progressing.

29:07 - So not a reversal, not a cure, but if administered early,

29:11 - the sooner you get that from, which then brings in to things

29:14 - like how are we diagnosis, How are we talking about this?

29:16 - How are we then supporting folks to notice point earlier?

29:21 - It also looks at how medical science

29:23 - has allowed us to live longer and live quality lives longer.

29:27 - I mean, that's the

29:27 - the era of treatment is something rendering to their the first rate.

29:31 - So we will hope to see continued better

29:35 - options, more accessible options across other dementia.

29:38 - But it is something that, again, a decade ago would have been pie in the sky.

29:43 - It would have been a wish.

29:44 - And so much of that work

29:45 - is happening here in Pennsylvania as well across our institutions that really those

29:49 - who are involved in trials are leading globally and have access to things

29:53 - that you wouldn't be able to elsewhere in the country.

29:55 - And I think education is so important here.

29:57 - Building on what Clay said,

30:00 - people historically thought, I don't want to know if we have dementia.

30:03 - Don't tell me it's such a terrible diagnosis

30:06 - that goes to changing attitudes that we were talking about before.

30:09 - There's something and the earlier you get in with some of the medication,

30:13 - the better chance you have at maintaining without.

30:16 - So you should embrace that early diagnosis and not try to avoid it.

30:19 - Well, I think you should.

30:21 - And right now, education is the key.

30:23 - And that's why having an office now within the Department

30:25 - of Aging in Pennsylvania, I think, can make a real difference.

30:27 - And how do we educate the public and the sector

30:30 - as well, physicians and because the systems piece about it.

30:34 - Right.

30:34 - So if you're in a world where you can diagnose

30:37 - that the primary care setting with a blood, there are treatments.

30:40 - But to see a specialist could be a 9 to 12 month wait.

30:43 - You know, all of this complexity comes into play.

30:45 - And then once you do it is to the point earlier, right.

30:48 - We we do the best we can at the moment we can

30:51 - all of this work is how do we reach people early to help them

30:53 - know what to navigate, Being able to access things like the AIDS

30:57 - in aging, to know what resources and services are available.

31:00 - That idea of aging our way.

31:02 - A plan on how we age.

31:05 - Just then, this short conversation,

31:07 - you see the complexity of all of these issues

31:09 - or other disease states or all of these pieces

31:11 - and being intentional about that just has so much benefit to the Commonwealth,

31:15 - but ultimately to the individuals impacted.

31:18 - And our aging population overall.

31:20 - Claire, you said the new Alzheimer's office

31:23 - is still in the stage where they're establishing their priorities.

31:27 - So what's been built up so far?

31:28 - In other words, is there leadership, Is there a clear agenda?

31:31 - And of course, most importantly, the funding.

31:34 - So I think key is the funding.

31:36 - We're seeing those piece.

31:37 - I know

31:39 - they're looking at what those roles would be.

31:41 - How is it

31:42 - because, by the way, our viewers need to know that anybody know

31:44 - the exact name of this Alzheimer's office within government.

31:47 - So I think the closest we've seen it is under the Department of Aging

31:50 - and Office of Alzheimer Disease and Related Disorders. Correct.

31:52 - We're seeing what those we go

31:54 - on that website, we might find mention of the Pennsylvania Department of Aging.

31:57 - You'll see mention of it. Yes.

31:59 - Yeah. Because it's really being built up now.

32:01 - I think one of the pieces and Roy and others have been active in this piece

32:05 - is that there is legislation that is enabling this work

32:09 - setting standards, putting in some additional accountability

32:11 - and kind of where we are in our legislative session.

32:14 - Some of these things are happening at parallel pathways,

32:17 - and that's one of the interesting pieces here.

32:19 - So it is really around how we do some of that and how do we do it

32:23 - that is looking at this is this is not solely an aging issues

32:26 - to public health crisis right across this work.

32:29 - And some diagnoses are coming in earlier than they used to.

32:33 - Certainly certainly in issues like brain health

32:35 - and risk reduction of that is, yes, forces maybe.

32:39 - I think I've seen early onset

32:42 - Alzheimer's as young as in the fifties,

32:45 - but we're also seeing a lot of information coming out about brain health

32:50 - and how to protect your brain in the long run.

32:54 - So sometimes it's diet, sometimes it's exercise it's all the same things

32:58 - everybody says about everything, I think in some ways, but it's keeping active.

33:02 - And again, I'm going to go back to social connectivity.

33:04 - One of the things we see is that people

33:07 - who engage more, who have more friends and it's not just a numbers game,

33:12 - but who are socially engaged more are less likely to have

33:16 - some of the mental health issues that we see and cognitive decline

33:19 - can be connected with it. I think we're seeing a bit of that.

33:21 - Absolutely.

33:22 - In fact,

33:22 - in this November, the Department of Aging is hosting a forum on brain health

33:26 - because we know that things

33:28 - like social activity, mental activity, diet and exercise

33:31 - outside of pharmaceuticals are the greatest things we can do

33:33 - to reduce our impact, to build that kind of neuroplasticity city

33:36 - and capacity Exercise is good for the brain.

33:40 - It is, absolutely.

33:41 - Yes, absolutely. So it's exciting.

33:43 - And that's Pennsylvania.

33:44 - We'll have a forum to do that actually just coming up

33:46 - in a couple of months here, which is exciting as well.

33:49 - Yes. And in addition to as as Nora and Clay have mentioned,

33:52 - the change of attitudes and you, too, Larry, brought this up,

33:55 - the change of attitude is phenomenal because right now, Alzheimer's, brain

33:59 - health, etc., is in a position where cancer was about 40 years ago.

34:03 - No one wanted to talk about it.

34:04 - Everybody was afraid of it. You know, what's early diagnosis?

34:07 - What I can tell you as a cancer survivor, early diagnosis is everything,

34:10 - because that's I've been I was diagnosed in 2001

34:14 - and had the operation and everything has been fine since then.

34:18 - Without that early diagnosis, I may not be around today.

34:21 - We were learning the very same thing is now true about Alzheimer's and dementia

34:25 - that the earlier, as everyone has just said, that you can talk about it,

34:29 - that you're willing to talk about it

34:30 - and get a diagnosis, the better off everybody is.

34:34 - Okay, one more question about Alzheimer's disease in general, and often

34:38 - Alzheimer's disease and dementia, those terms are interchanged.

34:41 - I want to know what is the difference?

34:44 - So it's a great question.

34:45 - I think particularly important because as medical science is improved,

34:49 - those variations are so dementia is a big umbrella term.

34:52 - We see symptoms and facts. It's a syndrome.

34:54 - We see personality changes, memory changes or other components.

34:58 - There are things that may manifest that way, like you mentioned earlier,

35:01 - like hearing difficulties or visual impairment.

35:04 - But then there are also medical issues.

35:06 - But again, dementia is that big umbrella.

35:09 - Alzheimer disease tends to be the most common.

35:10 - But even as we learn more,

35:11 - we we know things like vascular dementia or Lewy body dementia

35:15 - are increasing to ultimately it's we're seeing some of the same symptoms.

35:20 - But what's happening in the brain is different.

35:22 - And as we get to a world of treatment, an accurate diagnosis in those pieces,

35:26 - it would be the same 40 years ago of saying all cancer is the same cancer.

35:29 - That's not the case.

35:30 - How we approach it, what it impacts is different.

35:33 - And so that dementia, umbrella term Alzheimer's disease is the most common.

35:36 - But then even as we talk about Alzheimer's treatments, it is just treatment

35:40 - for a cognitive impairment of Alzheimer disease.

35:42 - So there are all of these other things

35:43 - that we're progressing and trying to approach

35:46 - so that that that personalized medicine approach

35:48 - in a community setting, the care issues are very much the same.

35:51 - And so it is important for us to address those issues holistically.

35:55 - For people who live at home, the symptoms may be different,

35:58 - but the same challenges exist for

35:59 - for the whole population dealing with cognitive issues.

36:03 - I think it's also important to recognize that even though

36:05 - the implementing legislation is still awaiting passage,

36:08 - the legislature has currently bought

36:10 - into this the $1.9 billion appropriation has been made.

36:14 - There is language in the fiscal code which specifically instructs

36:18 - the Department of Aging to establish this office

36:21 - and as soon as possible, there are four departments

36:24 - that are engaged in a cooperative effort to do that.

36:27 - It's the Department of Aging, Department of Human Services.

36:30 - The Department of Labor, interestingly enough, and the Department of Health.

36:34 - So there's a true effort to be able to get behind this already

36:37 - approved by the legislature.

36:38 - The final piece has to be done either Senate Bill 840 or House Bill 2400,

36:43 - to create the ability of having the advisory committee and a

36:46 - few of the other things that are required in order to make this whole thing work.

36:51 - So when those things are finalized, Roy, you think this will really take off?

36:54 - Is that holding it back in any way? Now?

36:56 - Didn't occur to me

36:57 - that you still had to do some legislative dotting of I's and crossing TS.

37:01 - yes, Yes.

37:02 - I don't know that that's holding it back because there's a lot of preparatory work

37:06 - that needs to be done, that can be done with the knowledge that the legislation

37:10 - is going to be passed, which bill it is doesn't really matter in that at all.

37:13 - And we have every indication that when the legislature comes back into session

37:17 - this month and again in October, that one of those two bills will be passed

37:21 - and sent to the governor for a signature.

37:23 - So I don't think it's holding it back at this point, with the exception

37:26 - of being able to organize the advisory committee and appoint those individuals.

37:30 - And by the way, that's quite a large committee.

37:32 - There's at least 28 people just by my rough count earlier this morning.

37:36 - Yeah.

37:37 - And the exciting thing, too, is, is Pennsylvania at a point

37:40 - where you can learn?

37:41 - I think the administration has done a wonderful job looking at other states

37:44 - and other populations who had some of these piece in play.

37:46 - And how do you learn so that you can move this from idea to practice?

37:51 - That's not always the case. We're looking at other states.

37:53 - There's a pathway here.

37:54 - There's a pathway. We've seen places like Georgia.

37:56 - South Carolina is a great example

37:58 - where these dementia care navigators working with their age, they're aging.

38:01 - So right in your backyard you're able to navigate care.

38:04 - But it came out of this type of state plan and learning

38:07 - from other people's experience. I like the sound of that.

38:09 - It's an exciting thing, and I think it's something

38:11 - that really the secretary and the administration

38:13 - have done a great job really looking at those so that we can move this

38:16 - to impact and benefit Pennsylvanians as quickly as possible.

38:20 - I Roy, let's go back to you and just consider your basic background

38:24 - and the kind of work you do now, like under your name.

38:26 - We put the Answer back group.

38:28 - So what is that the answer group is basically basically

38:32 - a consultancy group, although we do some direct lobbying as well.

38:35 - We represent the area agencies on aging for their organization and individual.

38:40 - Some of the area agencies we represent adult day centers, senior centers,

38:44 - the Southwestern Pennsylvania Partnership for Aging, Meals on Wheels,

38:48 - and at the national level, we also represent National Adult Day Services.

38:52 - The the reason we brought all these groups together into this one

38:55 - umbrella is because they all have not just similar interests, but also

38:59 - similar stake in making sure that whatever we do in terms

39:03 - of trying to address aging issues, we do it in the right fashion

39:06 - and we do it as a collaborative, more so than as a competitive business.

39:11 - And believe me, sometimes, you know,

39:12 - I've been involved in turf battles all my life.

39:14 - When I was in the legislature, I chaired the Professional Licensure Committee.

39:17 - And if you want to talk about turf battles, get in there.

39:20 - But the fact is that they don't have to be turf battles

39:23 - because there are cooperative ways in which these groups can work together.

39:26 - And they do, and they do.

39:28 - We've been able to get that done.

39:29 - We were disappointed, very disappointed in the legislature

39:32 - and the governor's office this year with respect to the budget

39:35 - and the fact that a number of things were held flatlined at last year's level

39:40 - despite inflation, despite the fact that the ARPA funds, as

39:44 - they're called the American Rescue Plan Act, are going away,

39:46 - do they directly affect the area agencies on aging?

39:49 - Absolutely.

39:49 - Directly affects area agencies on aging across this commonwealth.

39:53 - Every one of those 52 agencies, which means every one of the 67 counties

39:57 - is going to be

39:58 - trying to operate on less money this year than they did last year, despite

40:02 - the fact that the number of individuals requiring assistance is increasing,

40:06 - the number of applications for assistance is increasing.

40:10 - It's just unfathomable to me how the legislature could ignore that.

40:14 - And it wasn't a great amount of money that the department was seeking,

40:17 - in addition to what they already receive as a 5% increase, $15.2 million

40:21 - to be able to support these programs put out by the area agencies on aging,

40:26 - we are working with legislators now to be able to effectuate a transfer

40:30 - from the lottery funds because remember, these are all lottery

40:33 - funds funding TennCare.

40:34 - The only other funds coming in to Penn Care

40:36 - in the Department of Aging that are not lottery or federal funds.

40:39 - There are no state tax dollars funding either the department,

40:41 - the operation of the department, or any of the programs.

40:44 - So we have the lottery fund.

40:46 - There's enough balance in there.

40:47 - The estimates are most lately

40:49 - received is about a $200 million balance will occur at the end of the year.

40:53 - There's plenty of money

40:54 - there to take 15.2 million and give these Triple A's the ability

40:58 - to carry on above and beyond what they had to live with last year.

41:02 - So that's a matter of moving the money

41:04 - from the lottery to the Department of Aging, correct?

41:06 - That is it.

41:07 - It's as simple as that.

41:08 - Authorizing the governor to make a transfer from the

41:11 - from the lottery fund directly to the Department of Aging pen care line item.

41:14 - And why DeLay doing that?

41:15 - And I bet with your insight as a lawmaker, you can give us a hint.

41:18 - Well, there are a number of things.

41:19 - There are some people that don't want to admit

41:21 - they made a mistake by not putting it in the first place.

41:23 - There are some people who are still concerned

41:25 - that the lottery is going bankrupt, which it never has, never.

41:28 - I wouldn't say never will. That's a long time.

41:30 - But clearly there's no indication that that's going to happen.

41:33 - There are some people who just don't understand the situation.

41:36 - There are and I mean, literally just don't understand the situation,

41:38 - not through any fault of their own because it wasn't explained to them.

41:41 - Think the lawmakers are expected to be experts on everything,

41:45 - but they're not right?

41:45 - That's exactly right.

41:46 - And I especially can't be if the Senate, which is done now for a few years,

41:50 - doesn't hold an appropriations hearing for the Department of Aging.

41:53 - The House does.

41:54 - To their credit, the Senate gave up that idea.

41:57 - I don't know, ten years ago, perhaps on the idea that, well, since

42:00 - it's not state tax money,

42:02 - it's off budget, so to speak, and therefore

42:04 - we don't have to hold a public hearing on it.

42:05 - Well, that's just garbage.

42:07 - And we've been working with Senate leadership to try to get them

42:10 - to understand that and come back to at least an appropriations hearing.

42:14 - But then you also have something which is known as a tracking document.

42:17 - And again, the House and the governor's budget office do this.

42:20 - And that tracking document lists every expenditure

42:23 - that is proposed in the budget by department by line item

42:26 - and how much the governor is proposing for it.

42:29 - Well, guess what?

42:29 - There's no tracking document for the Department of Aging.

42:32 - So when the members go into their various meetings to discuss the budget

42:35 - and so on, see a tracking document for the entire general fund,

42:39 - which is state tax money and federal money,

42:41 - and they see some reference to the federal money

42:43 - that will go to the Department of Aging,

42:45 - but they don't see a tracking document for the Department of Aging

42:48 - and how the money is used within that department.

42:50 - That's got to change as well.

42:51 - So we're we're advocating that in addition to a piece of legislation

42:55 - to authorize the governor for a transfer,

42:57 - if we can get that done in the few session days and there's only 11

43:00 - session days left for the House and Senate combined,

43:03 - if we can get that done in this period of time,

43:07 - the the potential difficulty will be, well, not potential.

43:10 - The absolute difficulty will be abated.

43:12 - But if it's not done until next spring,

43:15 - that's a difficult situation because already the cuts

43:18 - in the waiting lists and so on will have been established.

43:20 - You know, that is such an expert analysis.

43:22 - I don't think I could get anything to it, but I will.

43:25 - And that is waiting lists.

43:27 - What will the agencies on aging do with this shortfall in funding

43:31 - that they expected up until the very last minute?

43:35 - They will waiting lists for services, whether it's Meals on Wheels,

43:38 - whether it's an options program, whether it's senior centers,

43:43 - which we mentioned

43:43 - earlier, is sort of the last bastion of activity in the community.

43:47 - That's not means tested and that exists

43:51 - in almost every community across Pennsylvania.

43:54 - So there are real consequences to this.

43:57 - Simply, some places can get longer.

44:00 - They will get longer as a result of this year's budget and priorities.

44:04 - Well, a Nora, while you're talking, I want to make sure we talk a little bit

44:08 - about AARP of Pennsylvania.

44:10 - And of course, you'll be hoping I get to that.

44:12 - So you're here representing AARP in Pennsylvania.

44:15 - And tell us briefly what your involvement is.

44:18 - My involvement is as a volunteer state president.

44:21 - So those of you who already have a state president.

44:24 - Right. Why they need to volunteer, why they don't have a state present.

44:26 - They have a state director.

44:27 - Thank you.

44:28 - So that state director is a staffer and there is an AARP office

44:32 - in every state across the country.

44:33 - Many in our legislative capitals.

44:36 - My job as a volunteer state director, you know, I'm a lawyer by training.

44:41 - So I really see it as my pro-bono obligation

44:44 - to work in the community, to work on these issues that I've gotten paid

44:48 - for for so many years in various levels of government.

44:51 - And that is focusing on the aging population and making

44:54 - sure as it grows, it has what it needs to flourish.

44:58 - You know, it can be different things for different people.

45:00 - But at AARP, what we're really focused on is education, is engagement

45:05 - is making sure people know how to vote, where

45:08 - to vote, issues that really are bread and butter issues for our population.

45:12 - Aside from the issues we've talked about today

45:14 - and caregiving is a big issue for us right now.

45:17 - We're making sure that we talk to every candidate about their stand on caregiving,

45:23 - where they stand on this issue, how can they help people who are in family

45:27 - caregivers, who are really in a crunch and in a crisis right now?

45:31 - Many, many of them.

45:32 - So those are just some of the issues that we're working on at AARP, Pennsylvania.

45:37 - We have 2.8 million members across the state.

45:40 - Now. Roy gave us a report on legislative progress, pretty comprehensive

45:45 - on funding there and how it's affecting the area agencies on aging.

45:49 - So let's consider then we'll go back to something

45:52 - we talked about before the governor's plan called Aging Our Way.

45:56 - I just so our viewers, we keep them on the tracks here.

46:00 - What's happening with the budget immediately doesn't necessarily

46:02 - have anything to do with his agenda for aging, does it?

46:06 - No, I think it does.

46:08 - I think that aging our way, Pennsylvania is a framework.

46:12 - If you will, that the Department of Aging and others across

46:15 - government and partners across Pennsylvania have been working on.

46:18 - It grows out of a lot of activities related to livable communities,

46:22 - which is something that the World Health Organization talked about 20 years ago.

46:27 - So it looks at your community and gives you ways to evaluate how livable it is.

46:33 - And it's really about living at home, living in your community

46:36 - as long as possible.

46:37 - One of the items to come out of that is the office, the Alzheimer's office.

46:43 - I'm going to call it the shorthand,

46:45 - and that was funded and we're very excited about that.

46:48 - We think it's a huge opportunity for Pennsylvania,

46:50 - but there are other things in aging our way, Pennsylvania,

46:54 - that still need to be funded.

46:55 - But it's a long term plan.

46:57 - It's something that we want to go back to.

46:59 - We want to work with it.

47:00 - We want to tweak it each year.

47:02 - We want to look at the issues that we're facing.

47:04 - Where is there most growth in the population?

47:06 - Where is there more need?

47:08 - How has the dementia

47:10 - played out in our

47:11 - office with these new developments you just heard we're talking about today.

47:14 - So we're keeping our eye on that.

47:16 - And so aging our way.

47:17 - Pennsylvania is really about looking at those issues

47:20 - and looking at the area Agency on Aging network and everything

47:24 - we have in place to keep people at home and in their communities longer

47:28 - and making sure flourishes.

47:30 - And that's the overarching goal that Governor SHAPIRO has stated

47:33 - that our secretary of Aging, Jason Coolidge, has talked about.

47:36 - And that's really why we're here today to talk to you about these issues

47:39 - and aging our way didn't just come out of the

47:42 - think tanks somewhere around the country or what have you.

47:45 - In Pennsylvania.

47:46 - The area agencies on aging came together

47:49 - and held over 200 forums, if you will, for individuals to come in

47:55 - and tell the officials who were sitting there,

47:58 - here's what we mean, here's what we think should be done.

48:00 - They call them public hearings, right? Well, that's right.

48:02 - That's exactly right.

48:03 - And so over 200 of them, there were well, thousands of thousands of comments

48:07 - that came out of those hearings, as well as others

48:09 - that were sent in via email or what have you.

48:11 - So this plan was was really developed and devised out of all these people's

48:15 - thoughts and desires of what they felt were necessary and how it should be done.

48:21 - The governor then, or rather the governor and the Secretary of Aging,

48:24 - asked for an $11.9 million appropriation in the budget

48:28 - to be able to begin implementing all these different sections of the plan.

48:32 - The legislature thought that was too much of a bite at one time,

48:35 - and it would take time to gear up and ramp up and so forth.

48:37 - And so they approved,

48:38 - I believe it was 2.9 million, basically, which is designed for caregiver support.

48:43 - Now, that's clearly helpful and clearly necessary,

48:46 - and it gives the department a starting base from which to begin.

48:50 - And I think they they're in the process of doing that right now.

48:53 - But you can see there was a huge difference

48:55 - between an 11.9 million request and a 2.9 million or 2.5,

48:58 - whatever It was in that range for that just one piece of it.

49:02 - What's going to happen with the rest of it?

49:04 - The new budget

49:05 - that is proposed in February may give us an indication of that.

49:08 - But at this point, as Nora said, it's a long

49:11 - term process and supposed to be a dynamic living process.

49:15 - So hopefully we'll keep working through it.

49:18 - And let's consider

49:19 - a law that's been in place since 1965 called the Older Americans.

49:23 - And so let's try to put our discussion now.

49:26 - Let's dovetail our discussion today with whatever that provides

49:30 - as far as entitling rights and benefits for older Pennsylvanians.

49:34 - It's extremely important because the

49:38 - funding from the Older Americans Act comes directly into the area

49:41 - Agencies on aging.

49:43 - And one of the principal requirements for the older Americans is

49:46 - it sounds like federal funding is for funding.

49:48 - That's exactly right.

49:49 - One of the principal requirements

49:51 - is that there be at least one area agency of aging in every state.

49:55 - Well, a state like Pennsylvania needs more than one

49:58 - in Rhode Island's gotten a well, perfectly gotten well done with only one.

50:01 - But, you know, their their entire land

50:03 - base is less than the county of Allegheny in Pennsylvania.

50:05 - So the states vary in the numbers that they have.

50:08 - But the most important aspect of that is nutrition and meals.

50:13 - It's expanded beyond that for other services.

50:15 - But it was really that which got started with the Older Americans Act back in 1965,

50:20 - I believe, and that became the hallmark of the act,

50:24 - if you will,

50:25 - because the various candidates for president in 1960, in 1964,

50:30 - going around the United States, were just appalled at the amount of people

50:34 - that just simply did not have sufficient meals and sufficient food.

50:38 - So the idea of congregate meals and setting up a senior center, again,

50:41 - a mandatory portion of the act is there for that purpose.

50:45 - Home delivered meals has been added to it.

50:47 - A number of other things as well.

50:49 - We're very concerned right now because the ACT expires

50:53 - this year at the end of this month, actually.

50:55 - And Washington has failed to renew it.

50:57 - How often do you have to renew it?

50:58 - Every five years is what they've been doing.

51:00 - I don't know that there's a requirement that it be every five years,

51:03 - but they've chosen to do it in every five year increments.

51:05 - It expires.

51:06 - As I say, this year, I believe it's September 30th.

51:09 - Congress has been very slow in terms of getting anything together to renew it.

51:13 - The Senate has been moving pretty deliberately to do so.

51:15 - The House hasn't even been talking about it at this point.

51:18 - Any tweaks expected the older Americans act?

51:20 - I mean, since you renew it every five years,

51:22 - it's tempting to take a good look at it and update it.

51:24 - That's right.

51:25 - And I think there will be some tweaks added to it.

51:27 - But the real problem is lies in the House where we have members

51:31 - who absolutely just want to do away with it.

51:32 - They feel that it's outlived its usefulness

51:35 - and they are basically is it maybe redundant with some other funding source?

51:38 - So what's their reason?

51:40 - Well, their reason, I suspect, is they want to cut back on the budget.

51:43 - There really isn't any good reason that's been put forth.

51:45 - But it is what has been holding up consideration

51:48 - in the House of Representatives in Washington that's going to pass

51:51 - once this election is over in November.

51:53 - I am sure that the act will be taken up,

51:55 - probably not until next year, when all the new members of Congress are sworn in.

51:59 - But I don't see it going away by any means.

52:01 - And I do see some tweaks taking place to modernize it, if you will,

52:05 - and to address some issues that have been of a concern for some time.

52:08 - Because, you know, five years ago, we didn't have the type of virtual

52:13 - and electronic communication that we have today.

52:15 - So some of those things have to be updated.

52:18 - But yeah, it's extremely important.

52:19 - ACT We have about 5 minutes left in our program, so let's circle

52:23 - around to daily caregiving here and certainly our viewers are out there

52:27 - and they have questions.

52:28 - So what should they do right now if they encounter some of these problems

52:33 - with older parents who obviously need some help at home,

52:37 - what can they do to tap into available funds out there?

52:41 - That's the key.

52:43 - well, I think they should start with their area agency on aging.

52:45 - And let me just say that in Philadelphia, it's called the Philadelphia Corporation

52:50 - for Aging.

52:50 - In Montgomery County, it may be called something else.

52:53 - And Allegheny County and Pittsburgh, it may be called something else.

52:57 - So I'm going to just suggest Google Area Agency on aging in your life.

53:01 - Sounds good.

53:02 - I mean, we can give you the I think it's P for a P

53:06 - for a Dawg Pennsylvania Association of Area Agencies on Aging.

53:10 - Who's going to remember that it's a lot of age.

53:12 - But if we start somewhere looking for aging services where you live,

53:17 - get to the area agency on aging.

53:19 - They have an information and help line.

53:21 - It is a really important place to start.

53:23 - Now, you may be disappointed if you don't qualify for services,

53:27 - but there are services in the community that you can pay for.

53:31 - And if you can't afford those services, there are some services Senior center,

53:35 - some Meals on Wheels.

53:36 - Do not look at financial eligibility.

53:39 - So you may be able to take advantage

53:41 - of some of those services and to explore all these possibilities.

53:44 - It's challenging. Don't give up.

53:46 - Keep, keep trying.

53:47 - But Google Area Agency on Aging in your location.

53:51 - And if you'll excuse me, please go ahead.

53:53 - Go ahead, please.

53:54 - One of the things it's just an add on to that, because Air Peace

53:57 - and the Alzheimer's Association also have a site community resource finder.

54:01 - That's true.

54:01 - Which not only on your local area,

54:03 - it's an aging, but if there are other questions,

54:05 - you have other resources, support services and other pieces.

54:08 - So we have those.

54:09 - But I think that's a great example of

54:10 - with your zip code, getting that targeted information right in your backyard.

54:14 - Right. It's really local.

54:16 - What you want to find out to stay at home and stay in your community is

54:19 - what does your offer to support you right now?

54:22 - There are many websites you can look at.

54:24 - It's a great idea to mention AARP, of course, and their resources

54:28 - and the Alzheimer's Association

54:30 - and pay for it. So those are just a couple people

54:32 - have to know that these programs are out there.

54:34 - So that's why you can feel isolated.

54:35 - But definitely you got to reach out.

54:37 - And if you don't have access to it for whatever reason,

54:40 - to websites and computers and pick up the telephone, it's a good

54:44 - either you or your neighbor probably has a telephone.

54:45 - Pick up the telephone.

54:46 - I can assure you,

54:47 - if you call any legislators office, whether in the House or the Senate,

54:51 - they will be able to direct you to your local area agency

54:54 - on aging as well, your county commissioners, your county executive,

54:58 - your mayors in many cases in the municipalities,

55:01 - they all have these directories that will be able to say,

55:04 - every agency on aging or aging services to which they can direct you.

55:08 - All right.

55:08 - Our guests have been Clay Jacobs, executive director

55:12 - of the Alzheimer's Association of Greater Pennsylvania,

55:15 - Roy Arthur Bok, founder and president of the Arthur Bach Group.

55:19 - And Nora Dowd, Eisenhower, volunteer state

55:22 - president of the AARP of Pennsylvania.

55:25 - Thanks, everyone.

55:26 - Thank you. Thank you.

55:27 - That's for Focus on Aging Adults.

55:30 - I'm Larry Casper.

55:31 - Thanks for watching.

55:53 - And Focus on aging

56:01 - adults is sponsored in part by AARP.