Addressing the needs of seniors requires local, state and federal offices to act as a “team,” which can be complicated when the federal government is an inconsistent funding partner, said U.S. Sen. Ben Cardin (D) in a roundtable discussion of seniors Monday at Winchester Hall.
There were wins at the federal level this year with the on-time passage of a Department of Health and Human Services budget without cuts to Medicare, Medicaid or Social Security, Cardin said. With a budget resolution still to be voted on, however, it’s possible a lame-duck Congress could make cuts to these “bedrock” programs or repeal the Affordable Care Act, also known as “Obamacare,” with a simple majority.
“The midterm election will determine the scope of the [lame-duck Congress] and the agenda next year,” Cardin said in an interview after the roundtable.
He predicted that if the Senate lost its Republican majority, the sitting members would focus on pushing through President Donald Trump’s nominations, and if the House majority flips, Republicans would likely bring the Affordable Care Act up for repeal again during the lame-duck session. The latter is important in Frederick County, as elected officials work to help its senior population age in place.
Dr. Barbara Brookmyer, county health officer, and Kathy Schey, director of the county’s Senior Services Division, led a discussion on Monday of how the county is adapting to shifting senior needs and what gaps have already been identified.
“When we look at what contributes to someone’s overall health and well-being, only about 10 percent of that is clinical care — maybe 20 percent is genetics — but the whole rest of it is the social determinants of health: It’s their economics, it’s their housing, it’s their food, their nutrition, their exercise and all those other things,” Brookmyer said.
What can be difficult is finding reimbursement opportunities for all the layers.
One way the county taps into federal funding is through Adult Evaluation and Review Services, which looks at the medical, social and environmental factors affecting seniors. The program is funded through Medicaid and allows health officials to visit seniors at their homes and make individual care plans.
Geoffrey Littrell is one of the community health nurses who assess seniors through the program. He distributes information on public and private resources and helps connect seniors to doctors, transportation, or even a person to combat loneliness.
But other areas, such as affordable housing, are harder to secure funding for even when federal dollars are available.
Melanie Cox, president of Advocates for the Aging and a participant in Monday’s roundtable, reminded Cardin there is only one U.S. Housing and Urban Development program that funds affordable housing for seniors. It is also a program that struggles to get full funding each year, she said.
Cardin acknowledged that housing is the single greatest area inadequately funded for seniors. One of the challenges of a typical affordable housing project is that the federal government foots 90 percent — while the private sector foots 10 percent — of the bill.
“If we don’t have the funding for the governmental support, the projects can’t get going. There’s just not deep pockets enough in the community to provide affordable housing,” Cardin said.
Frederick County has begun to tackle the shortage of affordable senior housing on its own. In August, the County Council passed an “accessory dwelling unit” ordinance, which allows an additional structure up to 800 square feet to be built on an existing lot, said council President Bud Otis.
County Executive Jan Gardner agreed to waive school impact fees on these “tiny houses,” which makes them a financially viable option for families to move an aging relative close to their home while maintaining the person’s independence.
Yet as more seniors choose independent living, the demand for transportation services has also increased.
TransIT Director Nancy Norris informed Cardin of a troubling gap in services emerging in the county’s paratransit system.
Nearly all of paratransit — which provides rides to senior and disabled residents — is funded by the county to the tune of $500,000 with an additional $159,159 coming from the state. In fiscal 2015, the service did not have to deny any ride requests, but in this month alone, the agency had to deny 750 rides, she said.
The number of denied rides has slowly crept up this fiscal year from 255 in July, to 375 in August, to 513 in September and finally 750 in October. Norris suspects seniors are having to shift their appointments back month-by-month in the hope of eventually getting transportation.
“It’s just starting to get out of control,” Norris said.
Cardin didn’t have an immediate answer to the problem, but he threw out the possibility to trying to attach federal funding for paratransit to Medicare or a federal transportation bill in the future.
In summary, he said the problems with health care, housing and transportation can be tied back to a shifting definition of who a senior is, which the federal support systems have yet to catch up to.
“In some cases, you’re going to have to be very creative with the funding sources because they don’t really fit the services that you’re providing. We’re trying to turn that around at the national level,” Cardin said.
U.S. senators serve six-year terms and are paid a base salary of $174,000 per year. Cardin’s seat is being challenged by Republican Tony Campbell, Libertarian Arvin Vohra, unaffiliated candidate Neal Simon and write-in candidates Michael Puskar, Edward Shlikas and Lih Young.