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    Middle Income Older Adults Need New Policies and Programs That Will Work for Them

    By Dr. Marcy Adelman–

    Joan and Lucy are members of an increasing population of older adults in their 70s and 80s who will need some type of assistance to support them to age in place. Joan is a retired teacher and her partner Lucy is a retired social worker.

    Joan told me for the San Francisco Bay Times: “We always planned on traveling after retirement. There are so many places we haven’t been, and we wanted to visit all of them. But then Lucy developed Alzheimer’s, and everything changed. We took some great trips at the beginning of the disease. We enjoyed every minute of our time together. It was just grand really. Over time the trips got shorter and then they stopped.”

    She continued, “At first, I could take care of Lucy by myself. Then we had lots of help from our closest friends. Then we needed to hire help and then more help. We can’t afford to move to one of those senior housing places that have dementia services. That just isn’t an option at all, even if we had the money. I’m not sure if they would be respectful of our relationship.”

    “We didn’t think about long term care insurance,” Joan added. “It just wasn’t on our radar. But oh my god, the cost of working with these home care agencies is staggering … and then there is getting comfortable with strangers in our home. It feels like we’re caught between a rock and a hard place.”

    Challenges in Managing Later Life Care

    A recent study in the journal Health Affairs ( https://bit.ly/2UMTrB6 ) projects that, in just ten years, 54% of the 14.4 million middle-income American seniors will lack the financial resources to pay for senior housing and supportive care. Medicare does not pay for long-term assisted living or nursing home care and covers very limited in-home care. Middle income older adults do not qualify for Medicaid. Without assistance of some kind, even the best of financial planning will only go so far for most middle-income seniors.

    The study looked at older adults age 75 to 84 and defined middle income as those who would have incomes in 2029 of $25,001 to $74,298 and incomes of $24,450 to $95,051 for seniors 85 years or more. These incomes are too high to be eligible for public assistance, but not high enough to cover the cost of long-term care for a sustained period of time.

    Joan and Lucy, unlike many LGBTQ elders who are single or widowed, have each other to navigate the journey they are on. But like most LGBTQ elders, they do not have adult children to help support them by providing informal direct care or emotional and/or financial support. LGBTQ older adults are more likely than heterosexual seniors to live alone and to be childless. These differences between LGBTQ and heterosexual older adults leave LGBTQ older adults with fewer resources and options for managing later life care. 

    Clearly, there is need for more affordable LGBTQ welcoming senior housing with services for low- and middle-income older adults. One new Northern California affordable LGBTQ welcoming senior housing project is now open and another project in Southern California has just been approved for development. Openhouse’s (a San Francisco LGBTQ senior housing and senior service nonprofit) new campus of 79 apartments and community activity center is slated to open July of this year. This will complement their adjacent 40-unit building for a total of 119 apartments. In Southern California, the Palm Springs City Council recently approved plans for a three story, 95-unit LGBTQ friendly retirement complex.  

    Need for Affordable Senior Housing with Supportive Services

    The general housing crisis now has the attention of California’s Governor Newsom and leaders of local municipalities, such as Mayor London Breed in San Francisco. State and local funding are being made available to build more affordable housing for low- and middle-income people and working families, and to build shelters for the homeless. But building alone is not enough. There needs to be a commitment, at the highest levels of government, to supportive services that helps people age in their homes and in their communities. In response to the need for more affordable long term care services welcoming to frail LGBTQ seniors, Openhouse, in partnership with OnLok, a community based nonprofit that pioneered PACE (Program of All-inclusive Care for the Elderly), is developing on their new site a Senior Social Adult Day Program for low- and middle-income adults who require a high level of support. Social day programs help participants to maintain their physical health, and provide empowering and engaging client-centered community programs. For the caregivers of participants, the programs provide them with rest from caregiving activities and offer them the comfort of knowing their loved one is in a safe and engaging environment. Social Adult Day Programs help frail older adults to remain in community and in their homes for as long as possible. 

    California Bills Attempting to Address Senior Care Necessities

    Many middle-income seniors, regardless of sexual orientation, will need financial assistance to help care for themselves or their loved one at home or in a long-term care facility. There are several California bills attempting to address issues of affordability and protection for consumers of long-term care insurance.  

    SB512, authored by Sen. Richard Pan and co-sponsored by the California Commission on Aging, creates the organizational structure to manage the Long-Term Services and Supports (LTSS) benefit fund. The fund would provide middle-class and working families with a managed care benefit to spend on services, such as help with bathing, dressing and medication assistance, as well as help with housekeeping and transportation. The bill has passed through the Senate and is now in the Assembly.

    AB567, authored by Assembly member Ian Calderon and co-sponsored by the California Commission on Aging, would create a task force in the Insurance Commissioner’s office to study ways to create a new LTSS product accessible for middle-income and working-class families in California.

    Bill AB1209, authored by Assembly member Adrian Nazarian, would provide consumer protection by giving consumers the right to access any loan and withdrawal features while receiving long-term care benefits. The bill further protects consumers by prohibiting rate increases based on the insured’s age as well as mandates disclosures to help consumers make more informed decisions.

    The authors of the Health Affaires study present several ideas for making housing with supportive services and in-home care more affordable. They suggest new tax incentives for increasing affordability of long-term care insurance and expanding tax credits to encourage developers to build senior housing with supportive services for middle-income older adults. They also advocate for the expanded use of housing subsidies and voucher programs for middle income seniors. 

    All these policy changes and programmatic efforts to find a solution are important and will help, in the short term, to provide more affordable senior housing and supportive services, but at the end of the day, they will not fix a broken system. We need a federal policy that benefits all seniors regardless of age, income, race, ethnicity, sexual orientation or gender identity. We need a benefit expanded Medicare that works closely with a reinvigorated and expanded Department of Housing and Urban Development. Until then, it is important to keep improving affordability and access wherever and whenever we can.

    Dr. Marcy Adelman, Co-founder of the nonprofit Openhouse, oversees the Aging in Community column. She is a psychologist and LGBTQI longevity advocate and policy advisor. She serves on the California Commission on Aging, the Board of the Alzheimer’s Association of Northern California and Northern Nevada and the San Francisco Dignity Fund Oversight and Advisory Committee.