Trump’s Budget Proposal Comes ‘Dead on Arrival’ to Aging Groups

Published in Woonsocket Call on February 18, 2018

Last Monday, President Donald Trump released his 2019 budget proposal, “An American Budget,” providing guidance to Congress on how to spend hundreds of billions of dollars in new federal spending plan authorized by the Bipartisan Budget Act recently passed into law. Trump’s federal spending wish list clearly shows that many programs and services for older Americans will take a huge hit if any of these proposals are picked up by the Republican-controlled Congress.

The Washington, DC-based National Committee to Preserve Social Security and Medicare (NCPSSM) expresses concern that Trump’s budget proposal contains many of the same harmful proposals that the Administration and Republican-controlled Congress has pushed before, including $1.4 trillion in Medicaid cuts, $490 billion in Medicare cuts, and repeal of the Affordable Care Act.

Social Security on the Chopping Block

According to the NCPSSM’s analysis released this month, the President’s budget blue print calls for deep cuts to Social Security Disability Insurance, breaking his campaign promise not to touch Social Security.

Trump proposes to slash up to $64 billion from Social Security Disability Insurance (SSDI) benefits through eight demonstrations “ostensibly” geared toward helping disability beneficiaries to stay at work or return to work, says NCPSSM, noting that these Social Security Administration’s (SSA) demonstration projects, established in 1980, had only “a modest effect on beneficiaries’ workforce participation.”

NCPSSM’s analysis warns that the President’s proposed budget also calls for other benefit cuts for disabled seniors, including limiting the retroactivity of applications for disability benefits from 12 months to six months. It would also deny unemployment compensation payments to SSDI beneficiaries who work but get laid off. Social Security Income recipients that live together, even with families, would see their benefits reduced, too.

The Trump Administration also proposes $12.393 billion for SSA’s FY 2019 appropriation for administrative funding, says NCPSSM, warning that this $89 million funding cut will result in longer waits for decisions on initial disability claims and time to speak to a representative from SSA’s 800 number. “With 10,000 baby boomers reaching age 65 every day, SSA needs substantial yearly increases just to keep pace with increased workloads, says NCPSSM.

President Trump’s budget plan only funds production and mailing of only 15 million Social Security statements. “This proposal is part of SSA’s overall plan to limit sending statements only to individuals who are 60 or older rather than sending them to all workers every five years,” says the aging advocacy group, urging the Administration “to send these important financial planning documents to all workers, as is required in section 1143 of the Social Security Act.”

Medicare Takes a Blow

President Trump’s draconian budget calls for over $500 billion in cuts to Medicare, many of these savings coming from cuts to Medicare providers and suppliers. This is another campaign promise broken.

NCCPSSM warns that President Trump’s 2019 budget proposal also includes policy changes to the prescription drug benefit that would impact Medicare’s spending and beneficiary costs. It would create an out-of-pocket maximum for Part D. Medicare t beneficiaries with very high drug costs would no longer have cost sharing responsibility once they hit the catastrophic threshold. This would add $7.4 billion in costs over 10 years.

Trump’s budget proposal would also change the way the threshold for moving out of the coverage gap or “donut hole”” is calculated that would make it more costly to seniors to move through it. “Taken together with an out-of-pocket cap, it will mean savings for some seniors with very high drug costs, but costs will climb for a larger number of seniors. This saves $47.0 billion over 10 years,” reports NCPSSM.

Finally, Trump’s 2019 budget proposal saves $210 million over 10 years by eliminating the cost-sharing on generic drugs for low-income beneficiaries.

Hurting Medicaid Recipients

In FY 2015, federal and state governments spent about $158 billion or 30 percent of Medicaid spending on long-term services and supports (LTSS). The federal and state partnership pays for about half of all LTSS for older adults and people with disabilities.

The President’s 2019 budget proposal slashes the program’s funding by changing the structure of the program into either a per capita cap or Medicaid block grant, with a goal of giving states more flexibility of managing their programs. Through 2028, the president’s budget would cut $1.4 trillion from the Medicaid program through repealing the Affordable Care Act, restructuring the program.

NCPSSM expresses concern that if states lose money under per capita caps or block grants, state law makers would have to make up the funding themselves if federal funds do not keep up with their Medicaid population’s needs. This can happen by either by cutting benefits and/or limiting eligibility, requiring family members to pick up more nursing home costs, or scaling back nursing home regulations that ensure quality, service and safety protections.

And That’s Not All

NCPSSM’s analysis says that Trump’s budget proposal also calls for the elimination of the Older Americans Act Title V Senior Community Service Employment Program (SCSEP). The program, funded $ 400 million in FY 2017. provides job training to nearly 70,000 low-income older adults each year.

Community Services Block Grants ($715 million), the Community Development Block Grant ($3 billion) and the Social Services Block Grant ($1.7 billion) programs are also targeted to be eliminated. Some Meals on Wheels programs rely on funding from these federal programs, in addition to OAA funding, to deliver nutritious meals to at-risk seniors.

Trump’s 2019 Budget proposal would also eliminate funding for the Low-Income Home Energy Assistance Program (LIHEAP) This program received $3.39 billion in FY 2017. “Of the 6.8 million households that receive assistance with heating and cooling costs through LIHEAP each year, 2.26 million or one-third are age 60 or older,” says NCPSSM.

Trump’s budget plan also eliminates funding for Senior Corps programs including the Retired and Senior Volunteer Program, Foster Grandparents and Senior Companions. Current Senior Corps funding at the FY 2017 level is $202.1 million. “These programs enable seniors to remain active and engaged in their communities, serving neighbors across the lifespan, and benefitting their own health in the process. In 2016, 245,000 Senior Corps volunteers provided 74.6 million hours of service,” says NCPSSM. .

Finally, research into cancer, Alzheimer’s Parkinson’s and other diseases affecting older persons will be negatively impacted with $ 46 million in funding cuts to National Institute on Aging at the National Institutes of Health.

Aging advocacy groups view Trump’s second budget “flawed,” jam-packed with “damaging policies” for Congress to enact with an aging population. It’s “Dead on Arrival.” If Trump and GOP lawmakers choose not to listen to their older constituents, the results of the upcoming mid-term elections might just get their attention.

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Older Americans to Benefit from Bipartisan Budget Act

Published in the Woonsocket Call on February 11, 2018

While many were sleeping, funding to operate the federal government expired midnight Thursday, though it was restored about eight and a half hours later with action from Congress to end the brief government shutdown, when President Donald Trump signing the 652-page Bipartisan Budget Act of 2018 early Friday morning.

The $400 billion budget agreement funds the federal government through March 23 to give lawmakers time to pull together the details needed to craft full appropriations bills that become the official federal budget.

Lawmakers had expected the massive budget bill to pass before the midnight deadline to avoid a government shutdown but Sen. Rand Paul (R-Ky.), delayed the Senate vote past midnight to protest the additional billions of dollars being added to the federal budget deficit by the legislation.

Ultimately the House approved the bill by 240 votes to 186, almost four hours after the Senate had passed the budget bill by 71 to 28 three hours earlier. The GOP-controlled House needed the help of 73 Democratic lawmakers to pass the budget bill because 67 House Republicans voted against the legislation.

The Nuts and Bolts

The two-year budget deal eliminates strict budget caps that were set in 2011 to reduce the federal deficit and allows Congress to increase military and domestic spending by $300 billion, along with adding another $90 billion for emergency disaster aid for Texas, Florida and Puerto Rico and throws in billions more for infrastructure, the opioid epidemic and health programs. It also suspends the debt limit for one year – until after the upcoming midterm elections.

Specifically, the newly enacted Bipartisan Budget Act of 2018, would allocate $165 billion to the Pentagon and defense spending while $131 billion would be directed to domestic programs. In addition, $20 billion would be spent on infrastructure programs such as surface transportation, rural water and wastewater systems, $ 7 billion in community health centers to provide care to low-income people, $6 billion to fight the opioid crisis, and $4 billion directed to veteran’s health care.

The budget agreement also repeals the controversial Obamacare’s Independent Payment Advisory Board (IPAB), which was designed to limit Medicare costs. It also gives a ten-year extension to the Children’s Health Insurance Program (CHIP), which is four years longer than the previous spending bill passed last month. Finally, the legislation did not address the dilemma of 700,000 “Dreamer immigrants who are in the United States illegally after being brought here as children and who” are enrolled in the Deferred Action for Childhood Arrivals program, set to expire on March 5, nor did it provide funding for President Trump’s proposed southern border wall.

“A Pretty Good Deal for Seniors”

Max Richtman, President and CEO of the Washington, D.C.-based National Committee to Preserve Social Security and Medicare, sees the Bipartisan Budget Bill of 2018 “a pretty good deal for seniors.”

“Seniors will feel these changes in their pocketbooks and even in the way they feel physically,” says Richtman, in a released statement. “We have been fighting for these measures for quite some time and are happy to see Congress take action on a bipartisan basis.”

According to Richtman, the Bipartisan Budget Act of 2018 closes Medicare Part D “donut hole” in 2019. The prescription drug coverage gap embedded in the original law, which the Affordable Care Act has been gradually closing, will be altogether eliminated one year early. This will save seniors thousands of dollars in out-of-pocket prescription drug costs., he says.

Richtman says that the enacted Budget agreement also repeals Medicare therapy caps. The bill scraps arbitrary caps on physical, speech, language and occupational therapies that have cost senior’s money – or delayed care at crucial times. Beneficiaries will now find it easier – and more affordable – to get the therapies they need without undue interruption, he notes.

The Bipartisan Budget Act of 2018 also lifts non-defense domestic spending caps, allowing Congress to appropriate more adequate funding for the Social Security Administration’s (SSA) operating budget, says Richtman, noting that the federal agency has suffered from draconian budget cuts since 2011 which have impinged on customer service, even as 10,000 Baby Boomers retire every day. He notes that “this badly-needed (but yet unspecified) higher level of funding should allow SSA to improve customer service for the program’s 67 million beneficiaries.”

But, on the negative side, says Richtman, the new law increases Medicare premiums for some individuals by further expanding Medicare means-testing. “Congress continues to expand Medicare means-testing, and they will not stop until middle-class seniors are burdened with higher Medicare premiums,” he warns.

“We are particularly pleased that this legislation permanently repeals Medicare’s therapy caps, something that AARP has long supported. Millions of vulnerable patients who need occupational, physical, and speech-language therapy will now be protected from an arbitrary limit on how much Medicare will pay for needed therapy,” said Nancy LeaMond, AARP’s Executive Vice President and Chief Advocacy & Engagement Officer, in a released statement..

“AARP is also pleased that Congress expedited the closing of the Medicare prescription drug coverage gap known as the ‘donut hole,’ which will now close in 2019, one year earlier than currently scheduled. Medicare beneficiaries will soon get permanent relief from higher out-of-pocket costs for prescription drugs. We also applaud the provision that adds biosimilar drugs to the Medicare Part D Coverage Gap Discount Program. This change will lower out-of-pocket costs and encourage the development and use of these drugs,” adds LeaMond.

Pets Can Bring You Health, Happiness

Published in the Woonsocket Call on February 4, 2018

My newly adopted three-month old chocolate lab, Molly, keeps me on my toes. Literally. My daily walks around the block and playing ball in the back yard equal over eight thousand steps calculated by my Fitbit App. Being a pet owner I can certainly vouch for research findings published over the years that indicate that older adults who also are pet owners benefit from the regular exercise and bonds they form with their companion animal.

The Positives of Owning a Pet

According to Dr. William Truesdale, owner of Seekonk, Massachusetts Central Avenue Veterinary Hospital, “having a companion animal can greatly improve your life. Of course you should always choose the right pet based upon your lifestyle and activity levels,” says the veterinarian who has practiced for over 43 years.

“Studies have demonstrated that having a pet in the home can actually lower a child’s likelihood of developing related allergies or asthma. Children exposed early on to animals tend to develop stronger immune systems overall (as published in the Journal of Allergies and Clinical Immunology),” says Truesdale.

“The Centers for Disease Control and Prevention (CDC) have conducted heart related studies on people who have pets. The finding showed that pet owners exhibit decreased blood pressure, cholesterol and triglyceride levels. All of which can ultimately minimize their risk for having a heart attack,” adds Dr. Truesdale, noting that people affected by depression, loneliness or PTSD may find that a companion animal may greatly improve their overall mood.

“As a dog owner myself and knowing so many people who find companionship and just plain fun as a pet owner, I can attest to the many benefits,” said AARP RI State Director Kathleen Connell. “While not for everyone, there is an abundance of evidence supporting this. I have heard so many stories about pets in senior living centers and even service pets that provide furry contact for patients in nursing homes and hospitals I know they can do so much to brighten a day. And when you are on Facebook, you almost expect to see friends’ proud dog and cat pictures.

“When it comes to dogs, they need walking. Anything that gets older people up and out of the house is a good thing, even if it requires carrying a supply of clean-up bags. Bending and stretching is exercise, you know. In addition, there inevitably is increased social interaction as people meet and make new pet-owner on the sidewalks and at dog parks. It’s all good.”

Pet-Friendly Policies Abound in Health Care Settings

Dr. Karl Steinberg, a San Diego-based hospice and nursing home medical director and Chief Medical Officer for Mariner Health Central, has seen the positive impact of pets in patient care settings. For over twenty years the long-term care geriatrician has taken his own dogs with him to nursing homes, assisted living facilities and on house calls to hospice patients almost every day. ”It generates a lot of happiness,” says Steinberg.

Steinberg sees first-hand on a daily basis the joy they bring to the residents, even those with severe dementia. “It slows down the day a little bit, because when you walk past a room and someone shouts, ‘Oh! A dog!’, you can’t just walk on down the hall. You stop and share the unconditional love, and it’s so worth it.,” says the geriatrician and hospice physician

For years, Administrator Hugh Hall has brought Bella, a Labrador Retriever, to visit residents of the West Warwick-based West View Nursing and Rehabilitation. Bella is considered “an important member” of the Rehabilitation staff of the 120 bed skilled nursing facility,” says Hall, noting the 8-year old canine is utilized by therapists to assist and motivate patients in their recovery.

“Residents love the ability to ability to interact and hold or cuddle with Bella and visiting pets,” observes Hall, noting that his dog is the “official greeter” at the facility’s main entrance. “The residents get to pet her and reminisce about their pets of the past and this memory is warm and happy,” he says.

Mike, a 12 -year old Labrador often makes the “rounds” with Geriatrician David A. Smith, MAD, CMD, at facilities in Central Texas. His pet’s impact on residents is very positive and improves the quality of his rapport with residents enabling him to get “better history and better compliance from them” he says.

“In a meta-analysis of non-pharmacologic therapies for behavioral problems in Nursing Home Residents with dementia, pet therapy was one of only a small number of interventions that showed statistical benefit,” says Smith, who is a past president of AMA: The Society for Post-Acute and Long-Term Care Medicine.

Smith warns that there is a downside in owning a pet. Frail adults may trip over a pet. Elders may age out of the ability to care for a pet, placing an additional burden on a caregiver who must care for the pet. Plans need to be in place for the placement of a pet in case of a move to an assisted living facility or if an owner passes away.

Life-Like Pets Can Also Bring Benefits to Older Adults

But, for those who find taking care of a living pet taxing because of deceased mobility or memory loss, Hasbro, Inc., has created a new realistic pet, an animatronic cat with soft fur, soothing purrs, and pleasant meows and a barking dog, especially designed to bring companionship to older adults.

In 2015, the Joy For All Companion Pets brand, featuring the animatronic cat, was Hasbro’s first foray into products designed specifically for older adults. In addition to captivating older adults, Joy For All Companion Pets can help enhance the interaction between caregivers and their loved ones by incorporating lighthearted fun, joy, and laughter into time spent together.

In 2016, Hasbro’s the JOY FOR ALL Companion Pet brand included a lifelike pup that sounds, and feels like a real dog; when the pup’s “owner” speaks, it looks toward him/her and reacts with realistic puppy sounds. That year the Pawtucket-based toy company collaborated with Meals on Wheels America to fight senior isolation and loneliness, which affects one in four seniors across the country. Hasbro donated $100,000 to Meals on Wheels America and provided JOY FOR ALL Companion Pets to local Meals on Wheels programs across the country in order to provide comfort and companionship to the nation’s most vulnerable citizens.

“Aging loved ones and their caregivers have been thrilled with the Companion Pet Cats, and we are inspired by their positive feedback and personal stories,” said Ted Fischer, vice president of business development at Hasbro in a statement announcing the new life-like product. “The Cat delivers a unique way for all generations to connect deeply through interaction and play, but dog lovers continually asked when we planned to add a dog to the line. We are truly excited for the new JOY FOR ALL product – the Companion Pet Pup – to bring even more lighthearted fun and laughter to seniors and their families.”

“We heard from seniors across the country that companionship was important to their happiness. Many live alone, miss having a pet, or are no longer able to care for a pet,” said Fischer. “While it’s not a replacement for a pet, the Joy For All Companion Pet Cat is a life-like alternative that can provide the joy and companionship of owning a real pet, without the often cumbersome responsibilities,” he says.

The Joy For All Companion products are available for purchase on JoyForAll.com.