Older Worker Demonstration Grants

The U.S. Department of Labor (DOL), Employment and Training Administration (ETA) announced December 19th the availability of approximately $10 million in funds for Older Worker Demonstration Grants. The grants will be awarded though a competitive process as a part of the High Growth Job Training Initiative (HGJTI).

The grants are intended to address the workforce challenges facing older individuals by developing models for talent development in regional economies that recognize older workers as a valuable labor pool and include employment and training strategies to retain and/or connect older workers to jobs in high growth, high demand industries critical to the regional economy. Grants awarded under the Older Worker Demonstration should focus on providing training and related services for individuals age 55 and older that result in employment and advancement opportunities in high growth industries and economic sectors. The proposed strategies must take place in the context of regional talent development efforts designed to contribute to a strong regional economy, and must be developed and implemented by a strategic regional partnership.

The preferred eligible applicants for this solicitation are entities that represent the local workforce investment system, but other entities may apply. It is anticipated that the number of awards will range from 10 to 13, with award amounts ranging from $750,000 to $1,000,000.

Issue Date: December 19, 2008 Closing Date: February 19, 2009
For full announcement visit: http://www.doleta.gov/grants/pdf/SGA-DFA-PY-08-06.pdf

Call for National Day of Service Events

The Leadership Council of Aging Organizations convened a conference call December 22nd with members of the Presidential Inaugural Committee (PIC) to learn about a special opportunity for a day of volunteer service tied to the inauguration of our new president. State Units on Aging, local Area Agencies on Aging and other aging network members may wish to participate. Below is an excerpt from the message from a PIC representative about how to use the PIC website to publicize your event and link volunteers with your project. Please distribute this information to those in the aging network in your state as you determine appropriate.

The Presidential Inaugural Committee (PIC) encourages organizations of all sizes and focus to get involved in planning, organizing and staging non-partisan volunteer community service events all across the country to be held on January 19, 2009 -- Martin Luther King Day.

The PIC is currently conducting outreach to national, regional and local organizations to encourage participation and to begin organizing volunteer events. These initial events will populate a new website dedicated to promoting and organizing this day of service.

Americans in every state will be able to go to the website, enter their zip code, and signup for events in their community.

The website is scheduled to launch after the New Year. Once the website launches, additional national, regional and local groups – as well as individual volunteers – will be able to sign on and help grow the list of service opportunities by creating more ways for every American to get involved.

Here is how your organization can begin getting active right away, and be a part of the initial website launch:

1) Pledge Your Organization’s Involvement Today: PIC is seeking national
participants to plan volunteer service events in multiple states, which will serve as a starting point for the launch of the new interactive website.

2) Schedule and Begin Organizing Events Right Away: Organizations committed to being a part of this national day of service, should immediately begin compiling a list of:
a. Sponsored events;
b. Location of these events;
c. Local contact on the ground for each event (a PIC field representative
will follow-up with them directly);
d. Description of the community service opportunity;
e. How many volunteers each event has the capacity to support.

3) Upload Scheduled Events: Beginning December 17, 2008, participating
organizations will be able to upload their planned events to the new website
before it launches. All events which are to be included in the initial launch of the website must be posted by December 31, 2008. To post an event before the
website launches, please go to http://www.pic2009.org/page/s/DS2.

4) Join with PIC to Help Promote Volunteer Opportunities in the Press: In
addition to direct outreach to potential volunteers, the PIC wants to work with
participating organizations to promote events across the country in the media.
Once the website is launched, PIC will work with participating organizations to
raise awareness around these events and drive additional volunteers to the
web.

From the Senate Special Committee on Aging

12-18-08 Excerpts from Statement by Special Committee on Aging Chairman Herb Kohl (D-WI)

“When it comes to nursing home quality and transparency, I firmly believe two things. First, that Americans should have access to as much information about a nursing home as possible. This information should include the results of independent safety inspections; the health status of residents, which is closely tied to the quality of services provided; the number of direct care staff responsible for providing hands-on care; and basic information about a home’s management and ownership. Second, I believe that the federal government has a responsibility to ensure that consumers can readily obtain this information in a clear manner, so that it can be used to help in making the best possible decision about which home is right for their loved one.

“CMS meets the first obligation fairly well, posting much of this data on the government’s website Nursing Home Compare. And with the implementation today of their five-star rating system for nursing homes, they are getting closer to meeting the second.

“Finally, I agree with (CMS) Administrator Weems that it is critical that families understand that the very best way to choose a nursing home is to visit it – more than once, with and without an appointment. Invaluable information can be gleaned by simply speaking with residents, their family members, administrators, and the state long-term care ombudsman’s office.

To view the 5 star rating systems visit www.medicare.gov/NHCompare

Related Legislation

If you are interested in the rating system for nursing homes, you may also be interested in three bills introduced in the 110th Congress regarding nursing home transparency.

The bill introduced in the Senate is S. 2641 sponsored by Sen. Charles Grassley (R-IA)

Highlights of the Nursing Home Transparency and Improvement Act of 2008

Increases Transparency of Nursing Home Ownership and Operations
Enables the residents and the government to know who actually owns the nursing home
Strengthens accountability requirements for individual facilities and nursing home chains including annual independent audits for nursing home chains
Improves Nursing Home Compare by including a nursing home’s ownership information, the identity of homes in the Special Focus Facility program, and links to inspection reports
Provides more transparency on a nursing home’s expenditures by requiring more detail about staffing expenditures in cost reporting
Brings uniformity and structure to the nursing home complaint process by requiring a standardized complaint form and complaint resolution processes that includes complainant notification and response deadlines
Provides for improved reporting of payroll-based nurse staffing information so that apples-to-apples comparisons can be made across nursing homes

Strengthens Enforcement
Equips the Secretary with tools to address corporate-level quality problems in nursing home chains by giving the authority to develop a national independent monitor program specific to multistate and large intrastate nursing home chains
Provides greater protection to residents of nursing homes that close by requiring advance notice of the closure as well as the development of a transfer and relocation plan of residents
Requires a study on the role that financial issues play in poor-performing homes
Requires a study on best practices for the appointment of temporary management for nursing homes
Authorizes demonstration projects for nursing home “culture change” and for improving resident care through health information technology

Improves Staff Training
Improves staff training to include dementia management and abuse prevention training as part of pre-employment training
Requires a study on increased training requirements either in content or hours for nurse aides and supervisory staff

Similar bills were also introduced in the House including H.R.5799 Sponsored by Rep. Eddie Bernice Johnson (D-TX) and H.R. 7128 sponsored by Rep. Pete Stark (D-CA). To view the bills visit http://www.thomas.loc.gov/

Kaiser Family Foundation offers ideas for Medicaid assistance for states

The Kaiser Family Foundation has published a policy brief discussing several short-term options for strengthening Medicaid during these difficult economic times. Rising demand for program services is straining state budgets as state revenues are declining. The policy brief's suggestions include increasing federal funding, easing enrollment barriers and temporarily expanding coverage. As the 111th Congress and the new administration consider options, some of these recommendations may be included. View the policy brief at http://www.kff.org/medicaid.upload/7843.pdf

Rx Risks for Older Adults

The Leadership Council of Aging Organizations subcommittee on Long-Term Services and Supports met December 8, 2008 for a presentation about medication related problems and older adults. Jeffrey C. Delafuente, Director of Geriatric Programs at Virginia Commonwealth University recounted that seniors in the US account for 37.2% of total prescription expenditures and 40% of over the counter purchases. He advised that medication related problems (MRPs) are due to improper drug selection by the physician, under dosing as well as over dosing, failure of the patient to fill the prescription, adverse drug reactions that go unrecognized, drug interactions and continuing to prescribe a drug that is no longer needed.

Striking figures he cited include the cost of MRPs in 2000 were $13.8B in doctor's visits, $121.5B in hospitalizations, $5.8B in emergency room visits, $32.8B in nursing home care and $3.5B in new prescriptions amounting to $177.4B in direct medical costs. MRPs for 2006 were $217B. These costs do not account for indirect costs such as lost work time when a caregiver must miss work to care for an elderly loved one.

Older adults are at higher risk for MRPs because of age-related physiological changes, high incidence of multiple chronic diseases, visual and cognitive impairments that interfere with proper use, poverty, literacy, language and cultural barriers. Moreover, older adults may be non-compliant with their prescriptions because of lack of understanding of the use of the medication, complex drug regimen, differing doses, inconvenient scheduling, lack of perceived need, cost and social isolation.

One option for reducing MRPs is Medication Therapy Management (MTM) which provides a face to face patient assessment and intervention, as appropriate, by a pharmacist. MTM is not just dispensing but includes counseling that is patient centered not product centered. Examples of MTM services include patient assessment, monitoring drug therapies outcomes, comprehensive medication review and providing patient education to enhance compliance. Some settings for delivering these services include community pharmacies, hospitals, skilled nursing facilities, office practice and home visits. States with Medicaid MTM programs include Florida, Maryland, Mississippi, Ohio, Virginia and Vermont.

An impressive private sector demonstration in Minnesota resulted in a 19.7% increase in drug expenditures but a decrease in total health expenditures from $11,965 to $8,197 per person. The reported return on investment was 12:1.

Prevention should be a priority

Senator Tom Harkin (D-IA) convened a meeting of the Senate Health, Education, Labor and Pensions committee, to learn more about prevention and public health. Dr. Don Wright from the Department of Health and Human Services testified that the US needs a comprehensive system to promote and protect those who are well. He said that emphasizing prevention will help to keep healthy people healthy and will help to keep communities healthy. Further, he urged that we must build a culture of wellness and that prevention is value added.

Senator Harkin asked why the Office of Prevention is not visible on the HHS organization chart and notes that it should be a top priority. He noted that prevention touchesmany other topics including agriculture, transportation, education and nutrition. Senator Harkin mentioned that states are doing good things locally regarding prevention.

Senator Tom Coburn (R-OK) mentioned his concern that federal funding is allocated to the Centers for Disease Control and Prevention, for chronic disease research and to the Administration on Aging for prevention but that no comprehensive plan exists to determine what people need to know and how to get the message to them. He suggested that the federal government needs a plan to compete with the private sector … we need to be advertising about like McDonald’s.

Senator Jack Reed (D-RI) asked about the effectiveness of immunizations. Dr. Wright said that the number of recommended immunizations has increase over the years, but he did not have specific data with him. Senator Reed recommended hat we prioritize prevention activities to promote those with the greatest impact. He suggested information about nutrition, physical activity, medical screenings and avoiding risky behaviors including tobacco use prevention and cessation. He advised that money spent on prevention will not result in immediate savings. However, preventing chronic diseases saves money, improves quality of life and increases productivity he said.

To learn more about prevention and health care costs visit the Trust for America’s Health report available at http://healthyamericans.org/report/prevention08/

Elder Justice Coalition assesses options

Members of the Elder Justice Coalition met December 2 with legislative aides for Senators Orrin Hatch (R-UT) and Blanche Lincoln (D-AR) and Congressman Peter King (R-NY) to discuss strategies for introducing the Elder Justice Act again in the 111th Congress. Coalition members agreed to educate new members of Congress early on to capitalize on momentum from the 110th Congress. Also discussed was timing introduction so that the legislation will not get lost amid the looming issues that will likely get immediate attention including the economy, energy and health care reform.

Several barriers identified in the 110th Congress that the coalition must consider include: identifying the offsets needed for the $777 million cost to fully fund the bill, a perception that the initiatives in the bill are duplicative of existing programs, and objections on Constitutional grounds related to how reports are to be made to the president and Congress. Moreover, more than one committee in the House has jurisdiction including Judiciary, Ways and Means and Energy and Commerce. Another option mentioned was combining Elder Justice with Senator Herbert Kohl's (D-WI) Criminal Background Check bill that passed the Senate Finance Committee at the same time that the Elder Justice Act also passed the committee. These ideas were raised but no decision was reached at this meeting concerning changes to the bill.

The coalition will meet again to further discuss modifications to the legislation, timing of introduction, briefing House and Senate staffs, preparing and sending letters of support from coalition members and generating grass roots support.

NGA and NCSL economic request

The National Governor's Association (NGA) and the National Conference of State Legislatures (NCSL) held a press conference December 1 to explain the economic assistance they will be seeking from the federal government to help to stimulate state economies. Pennsylvania Governor Rendell, Chairman of NGA, noted that states are taking actions to be fiscally responsible. Forty-three of 50 states are expecting to make cuts to balance their budgets.

States have identified $136 billion worth of major infrastructure projects that could be let within 180 days if federal funds are made available. More than 70% of the planned projects are transportation related including constructing roads and repairing 73,000 structurally deficient bridges. Other projects include port expansions, levee construction, as well as water, sewer and broadband projects. Infrastructure spending is expected to stimulate local economies through wages for workers, orders for steel, asphalt and paint and more.

In addition, states are seeking a two year temporary increase in the federal medical assistance program (FMAP) to meet expected increased demands on the Medicaid program. States believe they can infuse these federal funds into the economy immediately.

Waxman to Chair House Energy and Commerce

Representative Henry Waxman (D-CA) prevailed in a 137-122 vote of House Democratic Caucus members to become the Chairman of the House Energy and Commerce Committee. He replaces Representative John Dingell (D-MI) who had been chairman of the committee that oversees many of the issues important to the aging network including health care reform. Environmental issues are also within the committee's jurisdiction. Congressman Dingell was named chairman emeritus allowing him to retain his office in the capitol and he is expected to become chairman of one of the committee's subcommittees - possibly Energy and Air Quality or Health.

As Chairman Waxman takes over Energy and Commerce, he relinquishes chairmanship of House Oversight and Government Reform. The ranking Democratic member of the committee is Representative Edolphus Towns (D-NY) who has declared his intention to seek the chairmanship. The Committee on Oversight and Government Reform is the main investigative committee in the U.S. House of Representatives. This committee is important to the aging network because of its jurisdiction to investigate any federal program and any matter with federal policy implications. The Oversight Committee has conducted numerous investigations and hearings into a wide range of topics from the economy to Medicare. As one example of the investigations, in July of this year Medicare Part D plans were found to be unable to obtain significant price reductions for prescription drugs, resulting in billions of dollars in excess taxpayer costs.

Healthy Body Healthy Brain

The Centers for Disease Control and Prevention convened the Promoting Cognitive Health Partners Meeting to share new research on ways to reach out to older adults and caregivers to maintain a healthy body and a healthy brain. The research builds on The Healthy Brain Initiative: A National Public Health Road Map to Maintaining Cognitive Health published in 2007. The full report is available at www.cdc.gov/aging/

Researchers shared preliminary information about how diverse groups of older adults view cognitive health and impairment. The results of the inquiry will assist in the crafting of a message intended to inspire older adults to take action to maintain their health – brain and body. Researchers conducted 75 focus groups in 9 locations around the country. The same scripts were used in each setting to provide some uniformity. The presenters noted that different cultures use different terms to describe cognitive health. Common themes emerged including social involvement - being around people, mental attitude - maintain a good outlook, alertness - clear minded, physical activity - staying busy,and spirituality- being active in a faith community.

Findings from the research and implications for the future will be published in the Gerontologist in the spring 2009 edition. Partners at the meeting discussed gaps in efforts to promote good cognitive health including lack of assessment tools, no one trusted source for information, brain health is often not considered when discussing overall health and stigma of a diagnosis of cognitive impairment. Participants discussed options for distributing the findings and taking other appropriate actions. AARP and the Alzheimer's Association are currently aiming messages at baby boomers to take care of one's cognitive health. Participants highlighted that health care professionals, policy makers and aging services providers must also be pursued with the message to include brain health when discussing overall health.

DTV Apply, Buy, Try

At a meeting of the Federal Communications Commission (FCC) Digital Television (DTV) Consumer Advisory Committee November 14, 2008, consumers were urged to "apply, buy and try" the converter boxes that will be needed after February 17 when all broadcasts will be digital. Representatives of the broadcast industry and consumer groups are part of the committee that has been meeting to develop plans to make the conversion to digital a smooth one.

The campaign has three goals - 1) to make consumers aware of the change, 2) help them to understand what they must do to stay connected, and 3) convince these consumers to take action. Government officials noted that 34.5 million coupons have been mailed to consumers and 14 million have been redeemed. Everyone who qualifies is permitted to obtain two coupons. The data shows that most requests have been for two coupons.

In response to several questions, it was reiterated that:

If a household requests two coupons and does not redeem them before they expire, no replacement coupons are available

Individuals may share their coupons - if they request two and only need one they may share the extra with a neighbor

Hooking up the box properly and scanning the channels has been a complicated process for a significant number of consumers

The FCC has materials for trouble shooting available for consumers who have trouble getting the set up to work

Rule changes now allow 1) residents of institutions licensed by the state including nursing homes to obtain a coupon and 2) consumers with a Post Office Box may now also receive the coupons

Time is running out to get the coupons in time to obtain the equipment. The coupons are sent by standard mail not first class mail (except in Hawaii where the conversion takes place January 15). Standard mail takes 3-14 days.

For those who do not get the coupon in time, the equipment is available for purchase at retail stores; a coupon is not required. It was initially expected that some individuals would buy new digital televisions forgoing the need for the equipment.

The FCC will have staff in each of the six Designated Market Areas (DMA) to meet with local officials and volunteers to reach more consumers to help consumers stay connected. Town hall meetings and other outreach events are planned for each DMA in the days ahead. A speakers bureau is also available through the FCC to talk with groups to reach as many consumers as possible.

House Energy and Commerce Committee Chairmanship Challenged

Henry Waxman (D-CA) current Chairman of House Oversight and Government Reform Committee has announced his interest in becoming the Energy and Commerce Chairman. John Dingell (D-MI), current chairman of Energy and Commerce, is not willing to give up the position. The committee has jurisdiction for many of the issues about which the aging network is concerned. Project 2020, health reform, Social Security, Medicare, Medicaid and more are within the purview of this committee. Other committee chairmanships may change as the House and Senate members prepare for the 111th Congress.

Health Care Reform Proposal

On Wednesday, November 12, Senator Max Baucus, (D-MT), Chairman of the Senate Finance Committee, unveiled a white paper entitled Call to Action Health Reform 2009 proposing reforms to the national health care system. While public policy makers are concerned about economic problems across the country, the paper notes that national economists concur that health care reform is necessary to sustain our economy, to compete internationally and to address the long-term fiscal challenges we face.

Emphasis is placed on covering all Americans; promoting wellness and prevention; strengthening the role of primary care and chronic disease management; creating payment incentives to improve quality of care; encouraging collaborations among providers to deliver patient centered care; shifting the long-term care focus from institutional care to home and community based care; and exploring tax reforms.

To promote insurance coverage a Health Insurance Exchange would be developed to connect individuals and employers to insurance providers. The plan would prohibit insurers from denying coverage of preexisting conditions, and would offer government subsidies to low-income families to afford coverage. Until the Health Insurance Exchange is operational, temporary options will be available through Medicare and Medicaid. The State Children's Health Insurance Program will continue as an option for covering children.

The paper explains that eliminating waste and fraud, focusing on prevention, and using sophisticated data to identify the most cost-effective therapies will save money in the future. However, the ideas suggested in the document are not cost neutral in the short term. An added benefit to the plan is a healthier nation overall.

Senate Finance Committee staff briefed advocates about the plan, encouraging stakeholders to meet with staff members to help the committtee as it takes the proposal from ideas to reality.

The document is available on the web at http://finance.senate.gov/

Engaging individuals in shaping public policies

Many groups are meeting to assess the opportunities to shape policies in the final days of this Congress and in planning for the 111th Congress and a new administration.

Some examples of engaging advocates
At a meeting today presenters explained their tactics for reaching advocates. One example was a major airline that put considerable energy in a non-partisan "Get Out the Vote" campaign to engage employees in the federal process. The benefit to the airline is that such a campaign helps to build momentum for a federal advocacy effort to implement a new air traffic control system that will be pushed next year.

The Partnership to Fight Chronic Disease created a health care awareness campaign that began airing ten days before the election. Again the purpose was not to push one political candidate, rather to raise awareness among voters to ask candidates about their health care positions. You may have seen the add on the Internet, YouTube or on television. It featured Lauren Bacall as well as other actresses. The campaign highlights the differing ways we communicate to get a message across.

Representatives of a public relations firm described how the firm is able to capture data in the public domain and use it to help clients target messages to those who are likely to respond. The firm looks for patterns to predict interest or behavior.

From this meeting, one could see that nurturing constituents in one aspect of public policy shaping (for example in electing public officials) will prepare these constituents for participation throughout the process. In addition, many messaging options are now available to reach those who are willing to help- even options that seem unconventional. Lastly, data may be helpful to the aging network in new and different ways to help us develop the message and carry it forward.

News from DC, October 17, 2008

Researchers from the University of Michigan presented their findings concerning the impact of Medicare Part D on drug utilization and out of pocket spending at an event in Washington this week. At the same event researchers from the University of Maryland and Yale University presented information about the effect of Medicare Part D on presecription drug prices and utilization. To view the materials presented go to www.aei.org/event1814

Next Wednesday, October 22, the Advisory Panel on Medicare Education will meet in Washington, DC. To learn more about their activities visit http://www.cms.hhs.gov/FACA/04_APME.asp


While Congress was not in session this week, some Congressional committees are meeting, not only in DC but in other parts of the country, particularly to consider the nation's economic situation. If you are in these areas, you may want to attend.

House Education and Labor Committee (Chairman Miller, D-Calif.) will hold a field hearing titled "The Impact of the Financial Crisis on Worker's Retirement Security." Wednesday, Oct. 22, 10 a.m. at 1 Dr. Carlton B Goodlett Place, Room 250, San Francisco, Calif.; Witnesses Scheduled: Shlomo Benartzi - professor, Anderson School of Management, University of California at Los Angeles; Mark Davis - partner, Kravitz Davis Sansone, Encino, Calif.; Jacob S. Hacker - professor, University of California at Berkeley



Senate Finance Committee (Chairman Baucus, D-Mont.) will hold a hearing titled "High Health Care Costs: The Cost Going Forward." Tuesday, Oct. 21, 11 a.m. at St. Patrick's Hospital and Health Sciences Center 500 West Broadway, Conference Room 1 Missoula, Mont.
Witnesses Scheduled: Sara R. Collins - assistant vice president, Program on the Future of Health Insurance, The Commonwealth Fund; Fred Olson - chief medical officer, Blue Cross Blue Shield of Montana; Leif Bjelland - owner, Le Petit Outre, Missoula, Mont.; Julie Foster - Missoula, Mont.