National Association of Social Workers
750 First Street, NE, Suite 700
Washington , DC 20002  

Comments for the White House Conference on Aging Listening Session

The National Association of Social Workers (NASW) would like to thank Chairman Hardy and the members of the Policy Committee of the White House Conference on Aging for convening this listening session.

This new century is going to experience an aging revolution that will have a powerful impact on all aspects of society. As the baby boom generation approaches retirement age, it is essential that we implement policies that not only ensure their health, safety, and economic well-being, but also encourage their continued, vital, and active participation in our society.

As this White House Conference on Aging unfolds, key areas to consider are those that address personal choice, economic security, and access to comprehensive health and long-term care services. Underlying these concerns, however, is a larger issue of ensuring that a trained and qualified workforce is available to meet the anticipated increased needs of our nation's older population.

NASW recognizes the mandate of this committee to limit the outcomes of the conference to no more than 50 recommendations. As the committee develops policy recommendations, we urge you to consider the following key issues:

Marketplace/Workforce

The U.S. Administration on Aging has predicted that by 2030, roughly 70 million people in the U.S. will be over age 65—more than double the number of people over 65 in 2000. Given the rapid increase of our aging population, we can expect that there will be an accompanying rise in the need for health care and support services and providers to render those services.

The Center for Health Workforce Studies, applying U.S. Bureau of Labor Statistics (BLS) data, projected that the need for health care workers will be significant over the next ten years, increasing from a level of 10.9 million workers in 2000 to over 14 million in 2010 at a rate more than twice that for non-health related occupations. A similar trend is predicted for social workers in health care. In 2000, the BLS reported that of roughly 601,000 self-identified social workers, 187,000 were employed in the health care arena. The projected need in 2010 is estimated to be 252,000—an increase of 65,000 or 35 percent.

• As Americans age, they face a multitude of physiological, psychological, economic, and social changes. This combination of changes can have momentous, permanent effects on the quality of life for Americans of all ages and often results in the need for supportive services. Consider the following:
• Older adults are far more likely to develop one or more chronic illnesses than individuals under age 65. The more chronic illnesses that individuals develop, the more likely they will need an array of services to address cognitive, physical, or functional limitations.
• Late-life depression affects 6 million Americans, most of them women, but only 10 percent receive treatment. Depressive symptoms occur in approximately 15 percent of community residents over age 65, and rates of depression in nursing homes are up to 25 percent in some areas. Older adults are considered the group most at risk for suicide.
• Older adults are subject to economic disparity, with 19 percent of older adults living in poverty or near poverty. Older adult minorities are disproportionately affected by poverty, with 54 percent of African American women who live alone falling below the poverty index.
• The older American population will be more diverse in the future than it is today. The populations of aging Hispanics, African Americans, and Asian Americans are projected to grow faster than that of older whites. This suggests that services will need to reflect the diversity of those served, and that agencies and organizations will need resources and training to respond to the cultural background of future clients.
• The number of U.S. children in grandparent-headed households has increased 30 percent since 1990. According to the U.S. Census, more than 2.4 million grandparents are primarily responsible for meeting the basic needs of their grandchildren.
• The complexity of negotiating with multiple systems (medical, mental health, home care services, income support, etc.) to access services that are essential to daily living, suggests that the demand for services often associated with the social work profession will increase significantly in the future.
• Family members of older adults need support in negotiating a variety of daily living issues for their aging loved ones. Their needs can range from identifying long-term care living arrangements to substance abuse and depression.

Due to the expanding mature marketplace, it is imperative that a qualified labor force is available to provide services to older adults and their families to protect the health of older adults and to maximize opportunities for independence and personal well-being. NASW recommends that policy proposals developed by this committee include a strong focus on the geriatric workforce including the vital role that social work professionals perform in advancing the quality of care for older Americans.

Health Care and Long-term Living

Health care and long-term living encompass a large but fragmented system of acute and chronic-care services. The current model of care presents challenges and opportunities for policy development, specifically in the areas of access to care, availability of services, and the provision of quality care. The growing number of people who currently need, or will need, long-term care, coupled with an increased consumer demand for more home and community based services, require an expansion of current services as well as the development of a coordinated, seamless system that provides quality care and facilitates access.

Eligibility criteria for health and long-term care services should not be based solely on medical necessity. Comprehensive care services should address cultural and psychosocial-behavioral health needs as well as medical needs. The availability of services should also address the needs of the informal caregiver so that both the caregiver and the receiver of care enjoy the highest possible quality of life.

The increasing societal need for long-term care must be a catalyst for the health care system to re-examine its emphasis on prevention, quality of life, consumer satisfaction, and cost effectiveness of services. Quality in health and long-term care can be promoted through mechanisms that involve participation of consumers and families and that ensure a choice of services and providers. These mechanisms should foster self-determination for the consumer, the family, and informal caregivers.

Economic Security

A nation's economic policies have direct implications for the well-being of all people in this country and for the availability and provision of health and human services. The protection of older persons and other vulnerable individuals from economic insecurity and associated social and health problems must be a priority. Our country's economic system, institutions, and practices influence how well older adults as individuals and as a group can meet their needs and contribute to society. In light of the significant impact of the economy on older adults, priority should be given to the relationship between social and economic policy, including a safety net for those who are unable to provide for themselves.

Conclusion

As we move further into the new millennium, there is no doubt that Americans of all ages will feel the impact of the aging of our population. Now, more than ever, is the time for thoughtful consideration and careful analysis about how public policy will impact the lives of our nation's older population as well as family and professionals who are contributing to their care and well-being.