The Coming Budget Freeze on Elder Care, and What to Do About It

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Prepare yourself for big new cuts in government support for elder care.  

In his State of the Union address last evening, President Obama called for a five-year freeze on a narrow slice of the federal budget. Unfortunately, programs subject to the freeze would include many that are critically important to the frail elderly and younger people with disabilities--especially those living in the community.

This is only the beginning of what will be a very difficult period. Yet it is an opportunity for communities to pull together to provide services that government may no longer offer.

The freeze would not include Medicare or Medicaid, although Medicaid long-term care benefits are already being cut at the state level. However, it is very likely that programs such as meals-on-wheels, adult day care, transportation, housing, aging and disability resource centers, and Area Agencies on Aging would all be hit by this freeze.

It is not clear exactly how the freeze would work. It could be an across-the-board cut in all so-called domestic discetionary programs. These are programs that are subject to annual congressional review, but exclude entitlements such as Medicare, Medicaid, and Social Security. Alternatively, Congress could pick and choose which programs to cut, as long as the total amount of all domestic non-entitlement spending did not rise from year to year.

Either way, a freeze will inevitably result in fewer services since demand for this assistance is growing as the population ages and the cost of services rises.

Congressional Republicans are already criticizing Obama's plan as too weak and vow to cut even more deeply into these programs. Some would return spending to 2008 levels, others to 2006 funding. However it finally works out, there is little doubt that many of the long-term care supports and services that seniors now rely upon are in line for major cuts.

With a national debt of $14 trillion and annual deficits of more than $1 trillion, there is no doubt that government spending is going to be trimmed--perhaps quite substantially.It is also likely that sooner or later, federal payments for Medicaid services will also be slashed. One can hope that an eventual budget deal will eventually include tax increases as well, which would help soften the spending blow. But in the current political environment, that is not likely--at least until after the next presidential election.

So what do families and advocates do? I believe we need to begin to look for community, non-government solutions. If transportation services are cut, we should pull together to create volunteer ride programs. Senior villages are one way to build such an infrastructure. So are more informal groups organized around neighborhoods, churches, synagogues, or fraternal organizations.

If budgets for government-funded resource centers are slashed, we should support private non-profits that pick up the slack.(Full disclosure: I serve on the board of one of these--the Jewish Council for the Aging of Greater Washington--and as an adviser to another--Caring from a Distance). 

As needs grow and government services shrink, we all face a huge challenge. But it is also an opportunity to rethink our obligations to, not only our own parents, but to our neighbors and friends. I hope we will be creative enough to take up this challenge.    



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"But it is also an opportunity to rethink our obligations to, not only our own parents, but to our neighbors and friends."

What is wrong with thinking of our obligations to all the vulnerable, including the elderly, as something that our government plays a major role in? What is the purpose of "community, non-government organizations"? As someone who has done a great deal of volunteer work (at every level from envelope-stuffer and direction-giver to leader of major projects) and has as a paid staff person had to depend on volunteers for many contributions, I am only too aware of the short-comings of many community-driven organizations. They can be some of the very best--but they can also be absolutely terrible, be insufficient (even when doing their best) to the need, and very much give rise to the free-rider syndrome. While the very wealthy make no contribution to caring for the elderly unless they choose to do so, lower income people shoulder the burden of raising money and/or actually performing the work that needs to be done. Taking care of our elderly should be a societal obligation, with volunteer organizations enhancing their quality, not trying to handle a job that is far beyond the capabilities of most. Historically, even in an era when many women did not work outside the home and were able to provide much larger quantities of time to volunteer organizations, too many people fell through the cracks. Community, non-governmental organizations as the solution to this issue is a feel good suggestion, nothing more.

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This page contains a single entry by Howard Gleckman published on January 26, 2011 10:25 AM.

More Bad News for State Long-Term Care Services was the previous entry in this blog.

New Study: CLASS Insurance Unaffordable for Many is the next entry in this blog.

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