By Thomas Goldsmith
Advocates for older North Carolinians should prepare to reach legislators in 2017 by telling the human and economic stories of the state’s fast-growing population of people over 65, Rick Brajer, secretary of the state Department of Health and Human Services, said Friday.
A former business executive, Brajer has headed the department since August 2015, when he was picked by Gov. Pat McCrory to replace Aldona Wos, a physician and political fundraiser who had a controversial two-and-a-half year tenure as secretary. Brajer spoke last week to the state Coalition on Aging, a group of stakeholders from the government, public and private sectors who have interests in aging issues.
Success in promoting increased funding and new legislative initiatives will come if advocates bring both positive and negative messages about aging to the General Assembly, Brajer said in a meeting at the Dorothea Dix campus headquarters of the Division of Aging and Adult Services.
“You need a couple of really simple messages,” he said.
Here’s one message: The aging population is increasing so rapidly that in 2018 more North Carolinians will be older than 60 than those from birth to age 17.
Legislators need to get the word, for instance, that caring for vulnerable older people by providing them help at home is generally less expensive than placement in residential long-term care, Brajer said.
Brajer: Calculate your ROI
“You can speak to conservatives in terms of return on investment — the cost of caring at home versus institutions,” he said. “In more outcomes-driven language [that] you can use as an example — you can reduce the number of hospital readmissions.
“That’s an outcome that can be very positive.”
Meeting participants heard of changes to come in the Medicaid program on the federal and state levels. President-elect Donald Trump’s proposal to send Medicaid funds in the form of block grants to the states might serve older North Carolinians better because of the flexibility it would mean, Brajer said.
Trump’s opponent, former Secretary of State Hillary Clinton, likely would have devoted resources to expanding Medicaid to more working-class families, he said.
The NC General Assembly in 2015 passed Medicaid legislation that would put private insurers in charge of health care for low-income people in regions across the state. Linda Shaw, state director of PACE, or Programs of All-Inclusive Care for the Elderly, told Brajer that advocates for older people have not had a sufficient voice in the discussion on the state’s Medicaid reform plan, which still requires approval from the federal Center on Medicare and Medicaid Services.
“The focus around Medicaid reform seems not to be the elderly,” Shaw said. “Increasingly it seems as though the elderly are stuck out there.”
AARP: Hard financial times ahead
Charmaine Fuller Cooper, a lobbyist for the state AARP, said the organization and its membership would like to see a legislative focus on the financial security of older people. Given the lessened role of defined benefit pensions and a declining savings rate, the future looks grim for many older people, she said.
“A lot of physical abuse is related to financial abuse,” Fuller Cooper said. “We are really looking at a financial tsunami with regard to retirement that’s going to hit us in the next 10 years.”
Brajer advised coalition members to make sure that specific legislators know about elder abuse and exploitation, just as other organizations have recently educated lawmakers on problems with children’s foster care.
“It’s wrong when bad things happen — well, what do we do about it?” Brajer said.
As director of the High Country Area Agency on Aging, coalition member Julie Wiggins coordinates efforts to serve older people in seven northwestern counties of North Carolina.
The state’s home and community care block grants are funded annually by the legislature. Their use is determined by groups in each county. Among the many services funded by the grants are transportation, in-home aides, Meals on Wheels and adult day care.
“What we are finding is that we have increased wait lists and are struggling to meet the needs of older adults in our regions,” Wiggins told Brajer.