US Assistant Secretary of Aging Kathy Greenlee Delivers Public Policy Lecture at the 2010 AGS Annual Scientific Meeting

Before she was appointed U.S. Assistant Secretary for Aging last year, Kathy Greenlee spent three and one half years as Kansas' Secretary of Aging. In that capacity she oversaw the state's Older Americans Act programs, Medicaid long-term care payments, and the regulation of nursing homes, Ms. Greenlee explained at AGS' recent Annual Scientific Meeting, where she delivered the annual Public Policy Lecture.

Among other things, her job entailed visiting nursing homes throughout Kansas, Ms. Greenlee continued. It was during a visit to a nursing home in Abilene that she had a revelation about community-based care and healthcare. At the Abilene home, she met several residents who were planning to redecorate one of the facility's bathrooms -- including one resident who was desperate to have the bathroom redecorated to her specifications.

"I realized that she really wanted and deserved to be at home decorating her own bathroom, not a bathroom in a nursing home," Ms. Greenlee told the 1,500 geriatrics healthcare professionals attending the lecture. "Even though it was one of the best nursing homes in our state, it still wasn't home. And I realized that every person in a nursing home is there for the same reason - they lost their health. My experience that day now frames and motivates everything I do."

"We must do everything we can to support older Americans and their health as they age; it all starts there," she said, emphatically. "We must do everything we can to support people living in the community as long as possible, and expand and provide services in the community."

There will always be a need for long-term care facilities, and ensuring that these facilities are resident-centered will always be essential, she added. But long-term facilities should be only "one step" in a continuum of care that emphasizes both community-based care and community-based healthcare, said Ms. Greenlee, whose lecture focused on how the new healthcare reform law will expand and improve medical care for seniors, and why and how community-based medical and social services should and can be integrated.

The new healthcare reform law - the Patient Protection and Affordable Care Act - will improve medical care for older adults in many ways, she noted. Provisions in the legislation will help seniors stay healthier by making preventive care free for most Medicare beneficiaries. The law will also gradually shrink the Medicare drug plan's notorious "donut hole" coverage gap, closing it entirely by 2020. In addition, the law, which prohibits underwriting based on prior health status, will help adults aged 50 to 64 get health insurance and the care they need to stay as healthy as possible as they approach their later years.

The Patent Protection and Affordable Care Act will also help address shortages of geriatrics healthcare professionals by, among other things, funding the expansion of geriatrics training for physicians, nurses, allied health professionals, and direct care workers. "This is a critical issue - the workforce issue," Ms. Greenlee noted. Other provisions in the healthcare reform law call for the evaluation of loan forgiveness and other programs aimed at increasing recruitment into the field, and provide additional funds for states to expand home- and community-based long-term healthcare services.

The Administration on Aging (AoA), which Ms. Greenlee heads, works with state and tribal organizations and their area agencies on aging to meet older adults' social needs in their communities. AoA programs include not only the extremely popular Meals on Wheels, but also a wide range of other social services that help seniors with everything from activities of daily living to transportation. "We're delivering person-centered services to support independence with the singular goal of helping people stay in the community as long as possible," she said.

To further support the independence of older and disabled people, the AoA and the Centers for Medicare and Medicaid Services (CMS) have, in a collaborative effort, begun establishing state Aging and Disability Resource Centers, Ms. Greenlee noted. Supported by Health and Human Services Department grants, the centers provide the aging, those with disabilities, and their caregivers with information about and assistance accessing the full range of available local services that they need to live independently and grow old in the community.

"The Aging and Disability Resource Centers are our future," said Ms. Greenlee, who plans to use some of the additional funding the new health reform law allocates for the AoA to build on its work with CMS in increasingly innovative ways. "There are some new opportunities -- things we're working on now to move forward together," she said. "And it's exciting."

Though the reform law makes some additional federal funding available to the AoA, Ms. Greenlee said she worries about financing. In the current economic climate, federal and state governments face serious financial challenges -- challenges that have, among other things, contributed to ongoing difficulties finding financing for the newly ratified Elder Justice Act, she pointed out. The act, designed to better protect seniors and other vulnerable people from abuse, neglect and exploitation, has yet to be funded. "I will do everything I can as Assistant Secretary for Aging to address this; we can't overlook the protection (of these vulnerable adults)," Ms. Greenlee said.

Because older adults often need both medical and social services, like Meals on Wheels, community transportation, and protective services, a holistic approach to meeting these needs makes sense, she argued. Another section of the act, based on provisions in the late Senator Ted Kennedy's Community Living Assistance Services and Support (CLASS) Act, she noted, takes an important step toward such an approach to meeting older adults' needs. The act will establish a voluntary, public long-term care insurance program. The program will help enrollees who have functional impairment or disability, who need assistance with multiple activities of daily living, or who have significant cognitive impairment cover the cost of both health-related and social services in their communities. The program won't replace long-term care insurance. But it will supplement it.

"This new voluntary insurance program can revolutionize what we're doing," said Ms. Greenlee. "We need to consider both what medical supports and what social supports older and disabled people need. We have to see the whole person and the whole family, including the caregiver."

"The Medical Home, care coordination, transitions in of care - these are all about the same thing: How do we put the pieces together - the medical and social?" Ms. Greenlee concluded. "I'm looking for opportunities to work with you."