Policy Overview

In many ways, gerontology represents the future of health care. The U.S. population is aging rapidly. By 2030, 71 million Americans (about 20% of the U.S. population) will be 65 and older. These individuals are at high risk for complex health problems, chronic illness, and disability, and they are, and will continue to be, the heaviest users of health care.

Although estimates vary, today, older adults account for a substantial proportion of hospital days, ambulatory adult primary care visits, home care visits, and nursing home residents. Over the next 30 years, as the number of older Americans doubles, almost every medical specialty will have an increasingly older patient base. As a result, society is facing critical challenges regarding health and social services.

Our nation’s decision makers are currently confronting an enormous range of specific challenges in health care for the aging. These include:

• Contributions to the Affordable Care Act
• Medicare payment reform
• Restructuring health care delivery systems (e.g., the medical home concept)
• Regulation of nursing homes and long-term care facilities
• Improving quality through financial incentives (e.g., Medicare’s Value-Based Purchasing Initiative)
• The role of States in health policy
• Reauthorizing the Older Americans Act
• Strategies for chronic care coordination
• Mental health and preventive healthcare benefits in Medicare
• Health information technology
• Engaging consumers in health care quality
• Funding for health professionals training
• Setting priorities for biomedical and behavioral research in aging
• Providing care for the aging cohorts of U.S. veterans
• Strategies for individuals dually eligible for Medicare and Medicaid

At the same time, the substantial disparities that already exist within the older population promise to become even more pronounced in the future. Single, divorced, or widowed women as well as members of racial minorities and immigrant groups, whose numbers will increase substantially, are especially vulnerable to debilitating chronic health problems, poverty, and unmet health and social needs as they age. Many of these individuals have incomes below 200 percent of the poverty level, less than a high school education, and poor health status and limitations in daily activities. As the older population grows, so will the size of this vulnerable fraction of older adults who need more assistance than those who are fortunate to have good health, strong social connections, and adequate resources.

The Health and Aging Policy Fellows Program views health in a broad context which extends beyond just health care. We define health and aging policies as policies that aim to improve the whole well-being of older adults. This can include issues of income security and civic engagement. Policy areas we consider priority include:

• Policies affecting older adults with multiple, serious chronic conditions – costs of care; differential impact of health care costs and access by race, ethnicity, gender, socio-economic status; improvements in the health care system including models of care coordination, integrated mental health and preventive care
• Policies affecting the economic and physical security of vulnerable and disadvantaged older adults – access to low income benefits (Medicare, Medicaid, LIHEAP, food stamps, etc.), pensions and retirement income; employment and transitions to work; consumer protections (predatory lending, telemarketing fraud); financial literacy; nutrition and “food deserts”; environmental and transportation issues affecting older Americans
• Policies that promote civic engagement (volunteerism and community engagement) by older adults and caregivers to improve the healthcare system and the well being of older Americans (especially individuals with low incomes and people of color)