Advance Long and Productive Lives

2021 Blueprint of Federal Social Policy Priorities: Recommendations to the Biden-Harris Administration and Congress

Grand challenges for social work

The rapid aging of the U.S. population presents opportunities for all generations. The experiences and contributions of older adults benefit all of us and strengthen our communities. At the same time, as much of the U.S. population lives longer, healthier lives, many of us are affected by physical illness and disability and lack the economic security to meet our basic needs. Health and economic disparities related to race, ethnicity, gender, gender identity, and sexual orientation often have a cumulative effect in later life. Ageism impedes full participation within the paid workforce, volunteer workforce, and other aspects of community life.

All of us should have universal, equitable access to affordable, comprehensive, high-quality health care (including for mental health and substance use) and long-term services and supports (LTSS, which include accessible housing and transportation) as we age. Federal leadership and investment in enhancing and creating such systems will help all of us to maximize our dignity, health, and independence as we age. Such leadership will not only enable us to remain engaged in our communities—thereby reducing the occurrence or severity of elder abuse, neglect, and exploitation and of mental health and substance use disorders—but will also foster economic security in later life.

The social work profession is an integral component of the support structure for older adults and families. At the micro level, gerontological social workers support the goals and strengths of older adults and families through various modalities, such as care coordination, options counseling, caregiver support, health education, and psychotherapy. Furthermore, social workers serve older adults and families in the public, nonprofit, and for-profit sectors and throughout all levels of the Aging Network (local, state, national, and Tribal Nations), including in Area Agencies on Aging and other community-based social service organizations as well as numerous health, behavioral health and other settings. By working together, the social work profession, NASW, and the federal government can create a society in which older adults and people of all ages thrive.

NASW calls on national leaders to:

  • Support reauthorization of the Elder Justice Act (EJA), full funding for all programs authorized by the EJA (including the creation of a multi-stakeholder Advisory Board on Elder Abuse, Neglect, and Exploitation), and increased funding for Adult Protective Services, the State Long-Term Care Ombudsman Program, and the Social Services Block Grant.
  • Preserve the integrity of original Medicare and reject proposals to change Medicare from a defined benefit program to a defined contribution program, to privatize the program further, to raise the age of Medicare eligibility, or to shift additional costs to beneficiaries.
  • Strengthen Medicare outreach and enrollment by equalizing promotion, enrollment, coverage, payment, and regulation between original Medicare and Medicare Advantage and by providing sufficient, sustainable funding to Medicare State Health Insurance Assistance Programs.
  • Enforce Medicare beneficiary access to the full scope of Medicare home health services, including medical social services.
  • Make permanent Money Follows the Person and protections against spousal impoverishment for individuals who use Medicaid-funded home and community-based services and increase the income threshold and eliminate the asset eligibility test for Medicare Savings Programs and the Part D Low-Income Subsidy program.
  • Pass the Improving Access to Mental Health Act (S.782/H.R. 1533 in the 116th Congress) which enables Medicare beneficiaries to access two types of services from independent clinical social workers under Medicare Part B: (a) Health and Behavior Assessment and Intervention services, which help beneficiaries with emotional and psychosocial concerns that arise because of a physical condition and (b) discretionary mental health services while simultaneously using skilled nursing facility benefits under Part A.
  • Within long-term care facilities, improve the ratio of residents to social services staff and strengthen the personnel qualifications of social services staff to a minimum of a baccalaureate degree in social work (without substitutions).
  • Support development of an equitable, universal social insurance financing system that provides comprehensive, affordable, high-quality long-term services and supports that enable people with disabilities and older adults to maintain maximal quality of life in their setting of choice.