Family Caregiver Alliance
Volume XIII, Number 7, August 20th, 2013

Drumming Up Local Dollars for Senior Services    


In spite of budget cuts and gridlock in Washington, many states, counties and local communities are finding ways to raise revenue to support services for older and disabled adults. One example: In California's Santa Clara County (the home of Silicon Valley), Measure A passed in November of last year, which raised the local sales tax by 1/8 cent over a 10-year period to provide revenues designated for the county hospital, public health and welfare programs.   


In this issue, our lead article focuses on local government efforts to lower the percentage approval required for passage of local special taxes in California from 66% to 55%. Currently there are 6 bills moving through the California Legislature that, if successful, will amend the California Constitution allowing for the return to enactment by simple majority required before Proposition 13 (property tax limitation), passed in 1978.  



We have also included a report from Miami University on national survey findings detailing special funding measures passed across the statesand highlighting Ohio for raising more money annually for senior services than any other state. It is worth noting this trend in funding services and the need for family caregiver advocates to be at the table when these efforts take shape in local communities and priorities are set for the use of additional revenues. 



Kathleen Kelly, Executive Director

Family Caregiver Alliance, National Center on Caregiving

(San Francisco, CA)



State Legislation, Policy & Reports
Articles of interest on pending and proposed legislation as well as current policies and new reports surrounding caregiving and healthcare at the state level.

1. CA: California Senators Seek Constitutional Ammendments to Lower Number of Voters Required to Approve Special Local Taxes.
2. OH: Local Tax Levels in Ohio Raise More Money Annually for Senior Services than any other state  
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Federal Legislation, Policy & Reports 

Articles of interest on pending and proposed legislation as well as current policies and new reports surrounding caregiving and healthcare across the United States.

1. Commission on LTC Nearing Deadline to Submit Report to Congress and President
2. Learn More About the LTC Commission
3. Maxine Waters Introduces 2 Bills: Alzheimer's Caregiver Support Act, and 'Missing Alzheimer's Disease Patient Alert Program Reauthorization Act of 2013' [HB 2975, HB 2976]
4. NYT Report: Suicide Rates Are High Among the Elderly
5. Sequester in Place, Congress Goes on 5-Week Break for Summer; Budget Unfinished, Hurting the Most Vulnerable
International News

Articles on pending/proposed caregiving legislation, or current policies and reports on caregiving, healthcare around the world.   
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Research Reports & Journal Articles

Organizational reports and professional journal articles of interest surrounding caregiving and healthcare nationally and world-wide.

Conferences & Trainings

Upcoming trainings, educational conferences and speaker series on caregiving and related healthcare topics

1. Alzheimer's Disease Summit: The Path to 2025

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Funding, Media & Miscellaneous 

Information and links related to funding and media and more...

STATE . . .

CA: California Senators Seek Constitutional Amendments to Lower Number of Voters Required to Approve Special Local Taxes 
Since 1978 when Proposition 13 passed in California, fiscal bills that once required a simple majority for enactment have required approval by 2/3 of the legislature for state bills, and 2/3 of local voters for local special taxes.  Due to these restrictions and increasing partisan gridlock at the state and federal level, many local governments are seeking to reduce the threshold for passing local special project taxes to a simple majority. Currently there are six bills moving through the California Legislature that would amend the California Constitution by lowering the current voter approval for local taxes from 66% to 55%. Some bills target schools, libraries and transportation- while others are for general economic development projects. 


OH: Local Tax Levels in Ohio Raise More Money Annually for Senior Services than Any Other State      

A recent Miami University report noted that 69 of the 88 counties in Ohio had at least one county-wide senior service tax levy. In addition, property tax levies ear-marked for senior services existed in 14 other states, while 6 states had additional income taxes ear-marked for senior services, and 6 states have a sales taxes levy for such purposes. Six other states use various other local funding such as casino and lottery proceeds, bonds and a bingo card tax to provide additional funding for senior services. In 2009 Ohio raised more than $166 million in property tax funds to help seniors to continue to live in their home and community.  While these funds provided a variety of services, the most frequent were; home-delivered meals, non-medical transportation, homemaker and personal care services.

  • Download Report PDF: (Locally Funded Services for the Older Population: A Description of Senior-Service Property-Tax Levies in Ohio)


MN: Some Family Caregivers Able to Use Accrued Sick Days to Provide Care  

On August 1, Minnesota adopted a law which allows accrued "sick days" provided by an employer of 20 or more employees to be used for caring for the medical needs for a child of any age, a spouse, sibling, parent, grandparent or stepparent. Although it took four years to get the bill passed, after former Governor Tim Pawlenty vetoed a similar bill in 2009, this time around it again passed with majority support in both the house and senate and was signed by current Governor Mark Dayton.
Senator Hansen, the author of the bill, acknowledges it will only affect the 1/3 of employers that make a distinction between sick leave, vacations and holidays.  The remaining 2/3 of employers don't make these distinctions and offer combined paid time off, which cannot be used for medical needs of family members under this law.   


IL: Governor Signs Bill Requiring Screening and Counseling Before Nursing Home Placement      

The Department on Aging, the Department of Human Services and other appropriate agencies shall implement a nursing home prescreening program to determine whether persons who are in need of long-term care and are living with Alzheimer's disease/Dementia, blindness, or a disability as defined by the Social Security Act, may be satisfactorily cared for in their homes with the use of home and community based services (HCBS). Prescreening will be done by a case coordination unit, and will occur when a person meeting the above description is due to be discharged from a hospital, or if living in the community seems unable to care for themselves and is at risk of nursing home placement.    


An evaluation will be done regardless of ability to pay, although the Department of Aging may charge a fee to cover its costs, and will present the individual with options such as nursing home and home and community-based services. The need to submit financial documentation to access services and spousal impoverishment requirements for government aid must be addressed.     


Commission on Long-Term Care Nearing Deadline to Submit Report to Congress and President  

On January 2, 2013 the Commission on Long-Term Care was established as part of the American Taxpayer Relief Act of 2012.  The 15 member Commission (appointed by the President, the House of Representatives, and the Senate) is charged with developing a plan for financing of long-term services and supports (LTSS) and must issue a report by September 12, 2013. The report must contain recommendations for Congressional or administrative actions that detail how LTSS interact with private long-term care insurance, Medicaid and Medicare, strengthen and ensure access to healthcare programs essential to LTSS, address issues related to the LTSS workforce such as ensuring the quality and capacity to deliver high-quality services, and resolve gaps in the LTSS infrastructure that prevent delivery of high-quality services. This report includes a history of previous attempts to address various LTSS issues.

  • Download PDF Report: The Commission on Long-Term Care:
    Background AUGUST 7, 2013 Behind the Mission  


Learn More About the LTC Commission   

The link below is the official website of the Commission created to develop a plan for creating an improved system of LTC in the US. Video and transcripts of the testimony related to the three hearings held so far are available at this website. The last hearing will be held August 20, 2013. There is also a 'Contact Commission' section where the public, advocates and professionals can submit comments and proposals on how to improve LTC in the U.S. The Commission issues its final report on September 12, 2013.

Maxine Waters Introduces 2 Bills: HB 2975 Alzheimer's Caregiver Support Act &  HB 2976 'Missing Alzheimer's Disease Patient Alert Program Reauthorization Act of 2013'


HB 2975 will amend the Public Health Service Act by providing grants to public and non-profit private healthcare providers for increased training and support services to families and caregivers of people with Alzheimer's. The grants would be available from 2014-2019, and recipients must provide outreach, culturally competent services in the appropriate language of the patient, and integration of treatment while providing support to patient's family and caregivers.  HB 2976 amends the Violent Control and Law Enforcement Act of 1994 to provide grants to nonprofit organizations to design and operate programs to protect and locate missing patients with Alzheimer's and dementia. Preference will be given to national nonprofit organizations that have experience working with patients and families of persons with Alzheimer's and dementia. The bill authorizes $5,000,000 a year from 2014 through 2018.  



NYT Report: Suicide Rates Are High Among the Elderly


Most people report increased psychological well-being later in life, yet ironically, suicide rates among seniors also rise sharply----especially among white men. Suicide among older Americans has declined in recent decades due primarily to improved screening and treatment for depression, but the rate for older men is alarmingly high. The CDC reports suicide amongst all ages is 12.4 per 100,000 while elderly white men have the highest rate at 29 per 100,000 (for white men over 85 the rate is 47 per 100,000). For women over 60 the rate continues to decline. Families, caregivers and professionals should be aware of signs and risk factors for suicide and encourage various forms of treatment such as counseling, support groups and others.  



Congress Goes on Five Week Summer Break with Sequester in Place, Budget Unfinished, Hurting the Most Vulnerable

When the sequester went into effect in March, it was with the idea that all Americans would be adversely affected, forcing a bi-partisan Congress to put its differences aside and agree upon a  budget. Instead, Congress left for a 5-week summer vacation even though no fiscal progress has been made, and in fact, conservatives in the House are taking a harder stance by refusing to support fiscal legislation they favored just three months ago. While lawmakers are on vacation, the budget and all appropriations bills are being held hostage, and unfortunately the House and Senate budget proposals are still $91 billion apart. When Congress reconvenes on September 9 the House will have 9 days and the Senate 16 business days, respectively, before the end of the fiscal year on September 30.  In the 5 months since the sequester was enacted the adverse effects have impacted the poor, elderly and disabled particularly hard.   

Related articles on the effects of Sequestration: 




SINGAPORE:  Study Finds That Family Caregivers of Singapore Elderly Who Rely on Foreign Domestic Workers Fare Better

A recent Duke University study found that 50% of the disabled elderly in Singapore receive some caregiving services from live-in domestic workers from countries such as Indonesia, the Philippines and other low-income countries. Family caregivers who are aided by foreign domestic workers report better health and finances, more control over their schedule and more family support, but also state they have lower self-esteem compared to families without foreign caregivers. Singapore has a rapidly aging population combined with a low use of institutional long term care facilities, which may lead to an influx of foreign care providers. The study notes the need for better health and safety training for workers, and immigration policies that make it easier for foreign caregivers to work in Singapore. 

Cost-Efficiency in Medicaid long-term support services: the role of home and community based services  
A variety of advanced analytical techniques are employed to evaluate the cost efficacy  of long-term support services (LTSS) provided by state Medicaid agencies.  Primary Medicaid data from 49 states and the District of Columbia were analyzed (Arizona was excluded because all LTSS services are exclusively managed care). The efficiency of state funded HCBS programs was compared to federal waiver programs. Findings showed great variation between states, with all showing improvement over time, related to HCBS use. Recommendations to policymakers included liberalizing waiver programs for nursing-home-eligible persons, increasing home- and community-based services by targeting "high need" populations, the developmentally disabled, and mentally retarded beneficiaries. This study provides a new tool for comparing cost efficacy of various long-term care services, while encouraging state Medicaid agencies to promote development of improved data sources and estimation methods which will lead to improved outcomes and lower cost.    


University of Washington Study: Addressing the Needs of LGBT Older Adults
In a report prepared for the LGBT Aging Policy Task Force of San Francisco, researchers from the Institute for Multigenerational Health at the University of Washington surveyed 616 LGBT City residents, aged 60 to 92 years old.  A majority (60%) live alone, and 40% did not have enough income to meet basic needs.  Only 15% have children, but 60% of those with children state they are not available to help them if needed. Health services, housing and food were the areas respondents most needed assistance, followed by transportation, caregiver support and other services. The report also details LGBT respondent's fears, strengths and vulnerabilities, and risks. Ten suggestions are made to address the unmet needs of LGBT residents of San Francisco over the age of 60.
Pew Research Study Highlights Racial, Ethnic, and Gender Differences in Treatments to Dramatically Extend Life

This survey explored the public's attitudes about using medical treatments to slow the aging process and allow people to live to be 100 or 120. While 38% answered they would be in favor of such treatments, 56% stated they would be opposed.  Men (43%) were more likely to favor life extension than women (34%), with younger adults (age 18-49) favoring extension more often than adults aged 50 and older (42% vs. 34%). Hispanics and non-Hispanic blacks are more likely than non-Hispanic whites to say they personally want life-extension treatments, and to see such treatments as beneficial to society. Various opinions regarding the differences are offered. Only 9% of all adults surveyed said they would like to live be 100 years old.  


Alzheimer's Disease Summit: The Path to 2025   

Presented by The New York Academy of Sciences, National Institute on Aging/NIH and the Global CEO Initiative on Alzheimer's Disease

       Date:   6-7 November 2013   
Location:   The New York Academy of Sciences, New York, NY, U.S.A.   

Description:   Alzheimer's disease (AD) is a large and growing global health, fiscal and economic challenge, one whose current trajectory promises to destabilize health care systems and economies in both developed and developing nations. Governments in Europe, Asia and North America have committed to making Alzheimer's a global priority, and they have urged industry engagement in their efforts. Action must be taken now to avert this crisis by accelerating the development of new AD diagnostics and therapeutics through action-oriented programs. This conference will convene leading industry, academic, and government stakeholders to discuss how to prevent and effectively treat Alzheimer's by 2025. Efforts will be made to coordinate with governmental activities to build research resources, reengineer current drug development and evaluation systems, and identify innovative technologies and financing models. The outcome of this meeting will comprise a research agenda that will delineate the pathways needed to effectively treat and prevent Alzheimer's disease by 2025.  


Walk for Alzheimer's - 2013 

The Alzheimer's Association Walk to End Alzheimer's� is the nation's largest event to raise awareness and funds for Alzheimer's care, support and research. Held annually in more than 600 communities nationwide, this inspiring event calls on participants of all ages and abilities to reclaim the future for millions. Together, we can end Alzheimer's disease, the nation's sixth-leading cause of death.  

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