Anne Montgomery, National Academy of Social Insurance and the Altarum Institute
There’s a reason why the nation has convened a White House Conference on Aging (WHCOA) once a decade, and it’s this: Historically, these seminal events – which involve thousands of people feeding in ideas from communities across the country – have spurred creative consensus at a national level about how apparently intractable current challenges can be practically approached, even as strategies for making promising opportunities a reality over time are also mapped out.
The United States is now in Year 3 of its “Age Wave,” and it’s become clear to policymakers and stakeholders alike that much work remains to be done to build sufficient capacity for delivering the comprehensive array of services that our aging society demands, in the form of policy frameworks that align financial incentives and position a broad array of mostly non-coordinated providers to be accountable for delivery of consistently good-quality services. So how can we get from where we are today to meeting these goals? What policies and strategies will get us there?
This is where the WHCOA comes in.
The first Conference was held in January 1961 at the directive of Congress, which established it in legislation that was enacted in 1958 (Public Law 85-908). In addition, in 1959, a Senate Subcommittee on Problems of the Aged and Aging was established, and three years later, this panel was elevated to become the Special Committee on Aging. In the words of then-Aging Committee chair Sen. Pat McNamara, the convening Conference was dedicated to “bringing to national attention the problems, potentials – and challenges – of an aging population.”
For perspective on what McNamara and other framers had in mind for the WHCOA, here is how the aspirations of an aging society were framed in the Aging Committee’s foreword, which accompanied the first Conference’s final report:
“Today the life expectancy is around 70 years. In 1900, it was less than 50 years. In the lifetime of today’s younger generation, without any further progress in medical science, an average life expectancy of 80-85 will be typical….Our traditional approaches to the ‘aged’ require reappraisal in the light of hard facts. For one thing, past approaches were characterized by a tendency to look at the problem involved – if indeed, problems were recognized – in a fragmented way. A systematic, coordinated outlook and action policy[emphasis added] are increasingly called for as we become more and more conscious of the impact of the aging trend in our society upon the lives of the total population and even upon the policies relating to matters not otherwise considered as directly affected by the emergence of the ‘problems of the aged.’”
More than 50 years later, these prognostications have turned out to be remarkably accurate. According to the Social Security Administration, a man reaching the age of 65 today can expect to live, on average, until 83. A woman turning 65 today can expect to live on, average, until the age of 85. Equally or perhaps more important, one out of four 65-year olds will live to be 90 years of age or older, and one out of 10 will live beyond age 95.
The WHCOA framers could not know which, if any, of the many ideas and recommendations that were suggested and debated in 1959, 1960 and 1961 – the first Conference was held after 2 ½ years of public meetings and deliberations–would be adopted. Many focused on health care and income. Today, looking back with the benefit of hindsight, we know that in 1965, Congress enacted legislation establishing Medicare, Medicaid and the Older Americans Act. These statutes and programs have grown in scope and importance over the years, and they are widely acknowledged to be essential for meeting the challenges of our nation’s quickly accelerating “age wave.” The issues being debated at present are whether these and other public programs, along with private-sector options, have adapted sufficiently to meet the challenges of the 21st century. Many are arguing that further reforms are warranted.
Yet looking ahead, the policy picture is far from clear. The current state of discussion about Medicare and Medicaid is vigorous – but divided. No firm consensus has emerged on the specific nature of what changes are essential. Moreover, the Older Americans Act, which is overdue for reauthorization, has been overshadowed by a range of other issues that are deemed to be more pressing. At the same time, the number of Americans turning 65 each day grows by about 10,000.
This situation suggests that a national conversation in the form of a WHCOA, to be held in 2015, and accompanied by a process of meetings and conversations – both in-person and online – to solicit input and ideas from thousands of citizens across the country would be a sound civic investment – just as it was more than five decades ago.
All WHCOAs have resulted in subsequent adoption of signature initiatives. For example, the 1971 WHCOA is given credit for creation of the Supplemental Social Insurance program and establishing the National Institute on Aging within the federal government’s biomedical research establishment, the National Institutes of Health. In 1995, the WHCOA called for establishing a program to recognize and assist the nation’s millions of family caregivers – which led to enactment of the National Family Caregiver Support Program. This WHCOA also highlighted a pressing need to develop strategies for detecting, addressing and preventing elder abuse, along with improved opportunities for retraining and assisting older workers. Notably, it rejected the notion of pitting programs for older adults against those that serve cohorts of younger adults, adolescents and children.
Most recently, the 2005 Conference provided momentum for reauthorizing the Older Americans Act in 2006, which strengthened the role of Aging Disability Resource Centers (ADRCs). Discussions of elder abuse generated widespread attention and interest, and were transformed into a discussion on elder justice, which in turn helped to prompt Congress to enact the Elder Justice Act in 2010. Significantly, the 2005 Conference flagged the issue of coverage and support for long-term care as a critical and emerging issue—one that is awaiting further action.
To forecast what the next WHCOA might be able to help develop in one key area, it is useful to review some of what the delegates considered when they assembled more than 2,500 delegates in Washington, D.C. in 1961. The four-day meeting resulted in a report that covered 20 areas of emphasis. Among these was a section titled “Local Community Organization,” which declared, in part:
“To put total emphasis on the care of the aged, as opposed to developing a community in which one can age with dignity and independence, would poorly serve the coming generations of Americans. We must not create the continual crisis of ‘problems.’ A total program of local community awareness and individual responsibility can develop the great opportunity which we presently have in the lengthened lifespan of Americans….To create this activity in the local community, where the individual must live and function, it is recommended that local communities immediately create a Committee on Aging through which planning may be done for the good life that can be achieved by and for its elder citizens.”
With the subsequent establishment of 50 State Units on Aging as part of the Older Americans Act, and more than 600 local Area Agencies on Aging and their close cousins, ADRCs – which aim to be potential portals for long-term care services and supports – the concept of building stronger networks of cohesive, locally-rooted initiatives that can support frail elders and individuals with disabilities in their own communities is one that has the potential to create a series of lively and productive discussions at the next WHCOA.
In this and many other areas, there is a lot left to do – so if you or your organization would like to lend support to the idea of convening a WHCOA in 2015, please take a moment to read the “Letter to the President” (supported by more than 40 organizations including AARP and the National Council on Aging) and then send in your own request.
Anne Montgomery is a Visiting Scholar at the National Academy of Social Insurance and a Senior Policy Analyst at the Altarum Institute. She worked for the Senate Special Committee on Aging from 2007 until early 2013.