Services for Older Adults in Massachusetts with Elissa Sherman, PhD

Disclaimer: Unedited AI Transcript

Larry (00:07):

You are listening to specifically for Seniors, a podcast designed for a vibrant and diverse senior community. I'm your host, Dr. Larry Barsh. Join me in a lineup of experts as we discuss a wide variety of topics that will empower, inform, entertain, and inspire as we celebrate the richness and wisdom of this incredible stage of life. There is an organization in Massachusetts that is focused on caring for an aging population that develop services that meet older adults needs and preferences and advocates for us. I had not heard of this organization before, so we invited Alyssa Sherman, the president of Leading age Massachusetts, to explain it to us. Dr. Sherman has worked in aging policy for more than 30 years, beginning her career in state government as an analyst for the Massachusetts State Legislatures Joint Committee on Human Services and Elder Affairs, and later working at the Commonwealth Executive Office of Elder Affairs, where she was involved in the development and implementation of regulations governing assisted living. She joined leading age Massachusetts in 1998 as director of public policy and has overseen the association's public policy and government relations work since that time. During her tenure at leading age Massachusetts, Dr. Sherman has brought the voice of not-for-profit aging service providers to the development of state policy through her work leading the association's advocacy activities, and through her involvement on numerous state advisory boards, Dr. Sherman completed her PhD in social policy at the Heller School at Brandeis University and received her bachelor's degree from the University of Vermont. Welcome to specifically for seniors Alyssa.

Elissa Sherman (02:42):

Yeah, thank you so much, Larry. It's wonderful to be with you.

Larry (02:46):

Aging is a confusing time for both the older adult and for those caregivers trying to help, adjusting to challenges can be daunting. Do you find that a pretty universal occurrence? So what is leading age and what can it do for us?

Elissa Sherman (04:37):

Sure. <laugh> so leading age, and we are leading age Massachusetts. We're a community of nonprofit aging services providers. We're really working collectively to better meet the needs of our, of our aging population and our aging society. So we have about 200 member organizations in Massachusetts really across the commonwealth, all not-for-profit organizations that serve older adults in a range of different settings. Really there to meet the needs of those as as as they have changing needs in, in their older age. And we are there to really collectively advocate to make sure that all older adults can get access to the services that they need when they need them in the place they call home. And so you know, that may be the home that somebody's been living in for the past 50 years and want to be able to stay there. It might be a senior housing community that, that someone chooses to move into. It might be a nursing home that somebody needs as, as their needs increase. And and they find that they have, you know, additional care needs that really require them to be in a, in a more specialized setting. So we wanna make sure, and we're really advocating to ensure that, that there are these options for older adults and high quality options really across, across this entire continuum.

Larry (06:04):

I think it might be a good idea to clarify exactly what a nonprofit organization is. I think there's some confusion there.

Elissa Sherman (06:14):

Sure, sure. Yeah, I don't think a lot of people really understand what, what it means to be nonprofit. But essentially nonprofit organizations are really first and foremost established to meet a community need. So they are, in general, they're governed by volunteer boards of directors. Many of them have very deep roots in their community. The nonprofit organizations here in Massachusetts that, that are part of the leading age Massachusetts membership, many of them have been around for over a hundred years. They may have been founded by a religious, fraternal, philanthropic organization to say, how do we really take care of the older adults in in our community? And again, they have a, a volunteer board of directors that, that really oversee the direction of, of that organization. And really for a nonprofit, any of the revenues, the additional margin or profit goes back and is redirected to enhance the services that are provided.

Elissa Sherman (07:16):

So it's not going to any sort of outside owner or shareholder. It's really going to enhance the services of of the organization. And, and that's why sometimes when you take a look at a nonprofit nursing home, for example in general, they tend to have higher staffing ratios. They may have some more services that that might not be available in, in, in other organizations because they are able to invest those resources really back into the organization to make sure that they're enhancing the quality of care and quality of lives for people who are, who are receiving those services.

Larry (07:57):

And you do have some priorities in public policy?

Elissa Sherman (08:02):

Yeah, we do. And, and as I said, you know, our, our vision is that all older adults should be able to receive the services that they need when they need them in the place they call home. And so we wanna make sure that there are options that, that folks have access to housing affordable and, and, and decent housing, which has services embedded within them. We wanna make sure that people can remain in their communities to be able to you know, continue to participate in the community that's important to them. You know, be able to continue to be with family and friends and, and attend the services if they're, you know, part of a, a church or a synagogue, to be able to continue to be able to participate in, in those things that are most important to them. And so we wanna make sure that there are services that they have, regardless of if they have a disability or how it any sort of functional impairment that they can still continue to participate in those parts of life that are really most meaningful to them.

Larry (09:10):

So it seems though that there's a disparity according to income. The people with sufficient finances can, can usually find housing and services, the very poor have Medicaid and other services, but those in the middle are the ones who were having big problems as they age. Yeah.

Elissa Sherman (09:38):

That, that's absolutely correct. And it is one of the biggest growing issues that we're starting to see is, and, and it's really no different than we see and for, for other aspects of life. You know but for, for those that you described it perfectly for who have sufficient means to be able to pay for services that they need they're okay. And for those who are you know, low enough to qualify for subsidy programs you know, they also can get covered. But it's, it's that growing middle income population that really don't have sufficient income and resources to, to cover the care. And the, and the reality is, is that care needs are very high,

Larry (10:23):

Even though leading age, Massachusetts is a trade organization. It has some consumer services and they're featured on the website as well. Let me show a brief video for a minute.

Video Announcer (10:38):

From our very first days, how we keep up with life's changes and meet the moment on our terms is what life's all about. And as we age, it's only natural that most of us will need some support from a little extra help around the house to communities offering specialized services. You've got more quality choices than you may realize. Learn about your options and keep contributing and leading life your way.

Larry (11:09):

So let's talk briefly about some of these consumer services. At the website. You have a consumer guide?

Elissa Sherman (11:19):

Yes, we, we do. And you know, one of the things that we're really trying to do is provide as much information and education to consumers. You know, as I mentioned a a lot of people don't really understand what options are available and, and ultimately, you know, end up making decisions with, with little information. So so we do have a website available that both lists all of the, not-for-profit providers within our membership by different levels of care. So we can talk a little bit about kind of what the different levels of care are that are available, as well as information to explain what those different levels of care are. As well as providing information about, you know, what's available in terms of paying for care, how do you pay for care, how do you find some of these services.

Elissa Sherman (12:08):

So that's, you know, information that we provide. And we also really, a lot of our members organizations hold information sessions and, and are really there to be able to support information in the community to help them understand issues that older adults in the community may be facing and, and to help them really understand what their options are that are, that are available. So that's, that's information that's available both on our website as well as our national that video actually came from our national organization leading age, that's our national partner. That's really again about trying to help educate consumers about the options that are available and help them to really better plan for their needs over time.

Larry (12:56):

What type of nonprofit organizations are associated with leading age?

Elissa Sherman (13:03):

Sure. Well, we really have members that provide services across what we call the entire continuum of care. So we, you know, to just talk about some of the services that are available and, and you know, a lot of people obviously wanna try to stay home and, and receive services in their home if they, if they can. I think you, you hear studies that say about 80% of population says that they would like to be able to stay home as long as possible and receive services in the, in the home. So, so there's a whole range of of home care services that are available to people you know, for those who might need assistance with personal care. So they may need assistance, helping to get up in the morning, go to bed at night, bathe, shower so there's, there's home health aide services that are available.

Elissa Sherman (14:00):

Some folks might need assistance with meal preparation. So these are, these are both what we call activities of daily living and, and instrumental activities of daily living, the types of services that people might need over time because of chronic conditions that that lead them to need some assistance. And there's, there's also, in addition to the, what we call long-term services and supports the, the types of services that people might need over a longer period of time to remain home and, and independent. There's also some short-term services that you might need in, in the home. So a lot of, in, in many cases, somebody who might have had a hospitalization you know, an illness, and they're only gonna need some short-term care, sometimes they're coming home and they might need some rehab services and that they're able to get at home physical therapy, some nursing services, which is only gonna have take place over a short period of time.

Elissa Sherman (15:00):

In, in many cases Medicare is gonna pay for that. And, and sometimes when they leave the hospital, the hospital will help arrange for those types of in-home supports. But as I said, there's also the, the care that people would need maybe over a longer period of time due to chronic conditions that they might have, and they, they need assistance. So, so there are those in-Home Services, in addition to receiving those home care home health aid services in the home. There are services, there are types of organizations that individuals can receive support while they're still living at home, but maybe they're going out during the day. There's programs that are called Adult Day Health Programs, and these are wonderful programs for people who are able to go and they have some structure during the day. In many cases, some people who, who can't be, if they're living with a spouse or a family member who, who maybe is not home during the day and they, they may have cognitive impairment, needs some support or, and they can go and also get home health.

Elissa Sherman (16:07):

They have nursing services as well at, at the, the Adult Day Health Program. So these are really great programs for for many folks to be able to continue to live, who wanna continue to live at their homes but receive those supports. As well, there are a number of organizations that have started around the around the country and around the state that are called Villages. And these are grassroots organizations that have been established within cities and towns to they're, they're essentially kind of a membership. So an older adult in their city or town can join this village. And they get access to usually a range of social recreational programs, but also in some cases these villages have recommended providers to really be able to support the individual. You know, it might be a home care or home health provider.

Elissa Sherman (17:06):

It might be things like you know, vendors for tech support or you know, somebody who can come and help clear snow or yard work. But these villages are really developed in communities to support older adults to be able to, again, to stay in their homes and communities for as long as as possible. So those are some of the, the in-home home and community-based supports that are available. In Massachusetts, we're very fortunate to have a network of what are called aging service access points. They're actually funded by both the state and they also receive some federal dollars to be able to provide supports to individuals living in their own homes. So we're fortunate to have that series of, of providers around the state that are intended to support individuals living in their community.

Larry (18:05):

I was going to ask, how does someone go about finding these services and evaluating which one is the best choice for them?

Elissa Sherman (18:17):

Yeah. Well, the asaps in Massachusetts are a great place to start for many people because they do have case management, they have the ability to do those kinds of assessments. Their programs are generally available to folks who are, are within a certain income because it is a state funded subsidized program. But they're always a great source to to, to start. There are also a lot of private agencies that are available for in-Home Care. And you know, in general those are paid as paid for privately, so they're not covered by either Medicare or Medicaid. People usually do pay privately for those, for those services. And a lot of times those are recommendations, you know, from somebody who might be leaving the hospital. They might have recommendations. They are, in general, the private agencies are not regulated at, you know, by the state in any way right now in Massachusetts. But, and we also leading age Massachusetts on our website, you know, we do have a list of, so-called Home, you know, what we call home and community-based service providers who do offer in many cases, some of these services in the home. So, you know, we encourage people to take a look at, on our website and look at the list of home and community-based services.

Larry (19:36):

You said asap,

Elissa Sherman (19:39):

Asap, which stands for Aging Service Access Points. And there, I think there's, I think there's about 24 of them right now around the state. They have contracts with the Commonwealth of Massachusetts Executive Office of Elder Affairs, and they receive funding to be able to do assessments, case management and contract for home care services. So that's always a great place to start. 'cause The asaps and I'm pretty sure we have a, we have a link to them as well on our website because they cover different regions of the state. So so individuals can, can reach out to the ASAP within their region in order to, to get more information and start the process.

Larry (20:22):

And then the other services are senior housing options for those who feel like they need more services than can be provided in the home.

Elissa Sherman (20:35):

Yeah. So and in, and in some cases, you know, people are decide they want to move for not just because they need services, but you know, it's, it's they no longer wanna, in some cases, no longer wanna take care of their home and they no longer wanna have to worry about the maintenance and, you know, again, snow removal and, and, and upkeep. And so they may decide that they want to move into a community that provides lots of different services, supports c and, and community. And we also have for those who are income eligible, a lower income, we, there is subsidized senior housing. Because for, for some folks, you know, the, the cost of, of housing, especially if they're in a rental situation, may continue to be, you know, really prohibitive. So so there is everything from kind of more independent senior housing, which is you know provides for, for that community.

Elissa Sherman (21:36):

And, and in, in cases where it's subsidized, affordable folks who have meet certain income requirements income limitations sorry, income restrictions will qualify may qualify to be able to receive the subsidized senior housing. Unfortunately, many of them, they're very long waiting lists to, to access. But you know, these communities are, are, again, it's a independent apartment, but in they, in many cases, they have activities, they have supports that are attached with that. And, and again, it's the creation of community. There are on, on kind of the other side of the income spectrum are what we call life plan communities or continuing care retirement communities which in many cases include really a, a whole continuum. So it includes independent apartments. Most people will move in when they are independent and be able to take advantage of a whole range of activities and, and programming that that is, that the community offers.

Elissa Sherman (22:45):

But they also have access to either higher levels of care, some, some cases home health assisted living or nursing home care that they would have access to if their needs do change over time. And so most of those, what we call, again, life plan communities or continuing care retirement communities require a, a buy-in or an entrance fee that that people put down. And then in addition to a monthly fee. So they need to be able to have those resources to, to access that kind of, that kind of community. But a lot of people move in really to take advantage of the lifestyle and, and everything that, that the community has to offer in addition to being able to really plan for, for their needs over time. And then of course, you know, there are housing senior housing options that are really what I like to say, more kind of need driven.

Elissa Sherman (23:46):

So we have assisted living and, and then of course, nursing home care. And, you know, most people ch will move to assisted living as their needs are really increasing, and they, and they get to a point where it's very difficult to continue to remain at home safely because of either, again, increasing physical needs increasing potentially cognitive impairment that really requires them to be in a more structured setting where they can have 24 or seven access to, to support and and, and staffing. So you know, within assisted living, assisted living provides, as I said, 24 hour care you know, your meals, it has, you know, staff who are available to provide assistance with that personal care activities of daily living, help with medication reminders you know, in addition to a whole sense a, a set of, you know, structured activities. And then nursing home care, obviously for folks who really have that 24 7 need more skilled care needs or, or much, much greater personal care needs that, that really make it difficult for them to do any of those things independently. And so those are, those are, you know, additional housing options that we, you know facility options for people who may need them.

Larry (25:20):

And with the growing population size of older adults, this whole situation gets more and more challenging.

Elissa Sherman (25:33):

Yes. you know, right now our, when you look at our population 65 65 and older, it's about 17% of our, of our population both actually in Massachusetts and in the United States, about 17%. And that percentage is expected to grow. The 65 and older population is expected to grow to about 22% by, by the year 2040. So that population is growing, which is, you know, a, a great thing, but it also puts challenges on our system because we really don't have the infrastructure to be able to meet that growing need. And one of the biggest challenges that we have is the available workforce because as that our, our older adult population is growing, the, the population that is really in the age range to be able to provide care has been shrinking. And as it is today, we already have a number of, of shortages, workforce shortages, that's, that's has made it difficult for people to access the care that they need.

Elissa Sherman (26:40):

Unfortunately the, you know, the, the Covid pandemic really took a toll on the workforce and seen a number of, of folks that kind of left the field. We have seen, unfortunately, a real big shortage in nurses. And this is really across, you know healthcare. So, you know, hospitals have had a hard time hiring nursing homes, home health agencies, and and, and unfortunately we're not training and developing enough new nurses to replace the nurses that we've, that we've lost in the, in the field. So we are going to need not just, you know, for, to, to meet the needs of our growing aging population, we're gonna need about 3.5 million workers and long-term services and supports by the year 2030 to keep up with our, with our, with our population. So it really, the, it's, this is a major priority for leading age to, to look, to develop our workforce, to grow our, the pipeline of people who can come into the field and work in aging services, because there really are some great opportunities for people who, who like to make a difference and like to work with people.

Elissa Sherman (27:59):

So this is a priority for us to, to look at really encouraging more people to come into the, into the field. But we also know we need some investments public investments in order to make sure that we can to, to pay the workers in this field, you know, living wages. Unfortunately, certainly in, at least in the nursing home environment our, our nursing homes are heavily dependent upon Medicaid to pay for the care of older adults and, and the Medicaid program doesn't pay well enough to really make sure that we're able to pay all of our workers living wages. So that is certainly, you know, a, a, a major priority that we need to look at in terms of investing in, in our aging services workforce. Both, you know, really in, in, in nursing homes and really across the entire continuum.

Larry (28:58):

And the federal government has been really lax in, in even beginning to approach the problem of old, older adults in the United States.

Elissa Sherman (29:13):

Yeah, it's, it's always a little shocking going back to what we talked about, that this is really a universal experience, and and everyone has you know, either had the experience of, of an older family member who needs, who needs care or you know, a a spouse or them, they themselves one day will need, will need care. So this really is a universal experience, but we haven't been able to get any traction on you know, making sure that we really have a strong system in place to, to meet the needs of our, our growing aging population.

Larry (29:50):

E even in the field of elder abuse and elder services. It's just been it's been a disgrace at the federal level.

Elissa Sherman (30:04):

Yeah, I, and I think it's something why a lot of states are really looking to see, you know, what can we make sure that we're at least doing on the state level. There had been some efforts in years past to look at the creation of a better system to pay for long-term services and supports. It was actually part of the Affordable Care Act. There was a program within the Affordable Care Act called Class. The Class Act of the, the late Senator Kennedy was actually from Massachusetts, was, was the lead sponsor of the Class Act. And, and it was a program that would have paid for made funds available for long-term care and long-term services and supports after individuals paid into the system and would have access to, to funds after a certain number of years.

Elissa Sherman (31:00):

And if they developed needs that they would qualify for, for for payments. And unfortunately because of the way it was designed, it, it was, it, it was ultimately repealed. But there haven't been Congress really hasn't been able to, to make any strides in, in, in solving this problem. So there are a number of states that are looking at creating state-based social insurance programs to be able to cover long-term services and supports. You know, we were talking before about the problem of the middle income. Again, if you have enough resources to pay privately, you know, you're generally set, if you are low income enough to be able to qualify for Medicaid Medicaid will, will cover your care at least in a nursing home. But it's really that middle income, those that just don't have, have the resources and are really dependent upon, you know, family having to pay everything out of pocket and ultimately paying until they impoverish themselves and become eligible for Medicaid.

Elissa Sherman (32:12):

That's ultimately how, you know you know, Medicaid was really designed as a program for the poor. Why it has become the default program for long-term care in nursing homes is because many people become poor paying for care in a nursing home, or, you know, paying down until they, they really don't have any income and assets left. And, and so ultimately they, they don't have sufficient resources and Medicaid will, will pick up the you know, will then pay at that point. We need a better system. This, you know, we really do need a, a, some sort of insurance system. Long-Term care insurance is not something that unfortunately you know, less than 10%, I think it's like 8% of the population actually has purchased long-term care insurance. It's, it's too prohibitively expensive for people who you know, who wait long enough to, to purchase it or they may not qualify. So we really need a, a, a state-based solution. It ideally a federal based solution, but again, it's something that a lot of states are, are looking at in, in, including Massachusetts

Larry (33:25):

On a federal level, the congress and the politicians have not stopped calling Social Security a benefit yet. So and a lot of these problems are even more, more severe with minority groups.

Elissa Sherman (33:49):

Yeah, it's, I mean, there is, we certainly have an issue with, with equitable access. We know to, to healthcare and to, to housing. And it is, it's, it's something that I know a lot of our members are really working on to make sure that they are able to serve populations that are really reflective of who's living in their community. And working to create environments also where, you know, individuals of all backgrounds, you know, can, can belong and, and feel like their, their needs can be met also, not just, not just living there, but also working there. We wanna make sure that, you know, as I was talking about the workforce challenges that we have you know, we, we wanna create, make sure we're creating opportunities for folks from kind of all different backgrounds to be able to come and and, and work and, and feel like it's a, it's a great place to work, and that they can truly be themselves at work.

Larry (34:58):

Alyssa, thank you so much. You cleared up a, a lot of confusion in what is a confusing time of life. Making the transition from working life to retirement to needing help is a, is a problem for a lot of people. Thanks for clarifying.

Elissa Sherman (35:25):

My pleasure. Thanks for having me.