State Report Calls for Tax Incentives, Better Insurance, Greater Flexibility to Improve Care for Rapidly Growing Older Population

A new report by the state legislature’s Commission on Aging, examining state funding and support for home and community-based care for older adults and individuals with Alzheimer’s Disease, has issued more than a dozen recommendations, including establishment of a Dependent Care Tax Credit, release of funds to support home modifications, and extension of paid sick leave to cover care of elderly relatives.  Incentives for employers to offer long-term care insurance coverage are also suggested. The Commission on Aging is a nonpartisan public policy and research office of the Connecticut General Assembly.  A law passed by the legislature last year charged the Commission with studying private sources of funding available to elderly persons and persons with Alzheimer's disease in need of home or community-based care, including the cost effectiveness of such programs funded by the state with recommendations on which state programs should be expanded.aging report

Connecticut is the 7th oldest state in the nation.  Over 70,000 people age 65 and older live with Alzheimer’s Disease or another dementia, and disabilities affect 10.4 percent of all Connecticut residents – nearly 400,000 people. Due to factors including aging demographics and consumer choice, demand for home-care based services is expected to “increase exponentially in coming decades,” according to the report. Between 2010 and 2040, Connecticut’s population of people age 65 and older is projected to grow by 57 percent, with less than 2 percent growth for people age 20 to 64 during the same period.seniors 2

The 23-page report noted that “informal caregivers are the backbone of the long-term service and support system. It is estimated that the economic value of the care provided by unpaid caregivers is $5.8 billion in Connecticut. Supporting caregivers is a cost effective means of reducing the reliance on costly formal care system.”  The report went on to caution that “without support, caregivers are likely to become emotionally and physically ‘burnt-out’ and find few options” short of turning to institutional care.

The report recommends amending the state tax code to include a Dependent Care Credit where the tax filer can receive a credit for care expenses incurred while a caregiver is working. Home care and adult day care costs are cited as examples of work‐related expenses that may be eligible.

To provide further support to informal caregivers, the report calls on the legislature to extend paid sick leave for those caring for an aging parent or other relative.  Connecticut’s law currently allows paid sick leave to be used for a worker’s own illness or injury, or to care for the worker’s child or spouse.  It does not extend to cover workers who care for a parent or other relative. aging population

Policies that “allow for flexibility” in work schedules are also urged, cited studies have shown such schedules not only are “an import way to support a caregiver but also… positively affect recruitment and retention efforts.”

The report urges the authorization of $6 million in bond money for home modifications and adaptive technology, which was allocated by last year’s legislature, and development of a list of “vetted home repair and home modification contractors and programs” to improve the likelihood that individuals would be able to “age in place.”

The goal, the report indicated, would be to “enable them to function with greater independence in the home, remain in the community and reduce the need for human assistance. Simple modifications include adding nonslip strips to bathroom floors or other smooth surfaces, improving lighting, providing telephones with large numbers and letters, and installing grab bars. More complex (and expensive) modifications include installing ramps, chair lifts, stair glides, widened doorways, roll-in showers, and lowered countertops.”

Among the other recommendations, the report urges professional development for those whose job it is to care for individuals with Alzheimer’s and dementia, to align with changing demographics in the state’s population.

seniorsThe report also suggests that policy makers “explore the possibility of incenting employer-based long-term care insurance coverage.”  In 2009 almost 25,000 employers in the U.S. offered long-term care insurance to their employees – just 35 percent of the 7.5 million insurance policies in effect.  In addition, the report encourages the Connecticut Congressional delegation to support a federal tax deduction for long-term care insurance, and urges policy makers to consider making reverse mortgages “a more viable option.”

Additionally, the report also considers advances in technology in the care of older residents.  It describes “telehealth” as a mode of delivering health care, public health and certain non-clinical services using electronic communications technology, stating that it “represents an opportunity for Connecticut to improve access to care, coordination, quality and outcomes for individuals, all while reducing cost, promoting local economic health, and offering a patient-centered approach.”  The Commission on Aging calls on Connecticut to join at least 21 other states that have telehealth parity laws for private insurance, meaning that providers can collect reimbursement for telehealth services.RdN-XMIb_400x400

The report, “Study of Funding and Support for Home and Community-Based Care for Older Adults and Persons with Alzheimer's Disease,” also recommends that the state “address service challenges specific to housing, transportation and behavioral health,” including conducting “walkability audits” to assess sidewalks, crosswalks, and pedestrian access to essential services.  It also suggests that the state “explore the use of taxi vouchers, public and private paratransit services, paid and volunteer driver services, on-demand car rental services and other forms of transportation in the growing “shared mobility” economy.



Task Force Report on State Response to Alzheimer’s Nears Completion

Thirty-one states have published a plan to respond to what advocates describe as the “escalating crisis” of Alzheimer’s Disease. Connecticut may be next, and is one of 13 states currently in the midst of developing plans.

The Connecticut Chapter of the Alzheimer’s Association was among the leaders in crafting and shepherding legislation in the 2013 General Assembly session to create a task force to study the care provided to persons diagnosed with Alzheimer's disease and dementia in the state.  That Task Falzheimers-wordsorce has been up and running throughout the fall, and is poised to announce its recommendations next month, just ahead of the start of the 2014 legislative session in February.

The 23-member task force of key agencies and community stakeholders convened in September, under the auspices of the Legislative Commission on Aging, to prepare findings and recommendations on ways to improve early detection, better coordinate health care services, set training requirements for health care providers and other professionals, services for early-stage and younger onset, and support to family caregialz mapvers.

The Task Force was co-chaired by State Commissioner on Aging Edith Prague and Rep. Joseph Serra of Middletown.  Members included Laurie Julian of the Alzheimer’s Association in Connecticut and other diverse community stakeholders appointed by legislative leadership and representatives from state agencies including the Department of Public Health, Department of Emergency Services, Department of Banking, Department of Labor and Department of Social Services, as well as six current legislators.

Over 5 million Americans are living with Alzheimer’s, and as many as 16 million will have the disease in 2050. Nearly one in every three seniors who dies each year has Alzheimer’s or another dementia. The cost of caring for those with Alzheimer’s and other dementias is estimated to total $203 billion in 2013, increasing to $1.2 trillion (in today’s dollars) by mid-century. Between 2000 and 2010, nationally, the number of people who died as a result of breast cancer, prostate cancer, heart disease, stroke and HIV all declined, while the number of people who died with Alzheimer’s increased by 68 percent.

In Connecticut, there were 820 deaths due to Alzheimer’s Disease in 2010, there are more than 63,000 individuals with Alzheimer’s in nursing homes in the state and it is estimated that 68% of nursing home residents have a cognitive impairment. As of 2010, there were an estimated 2,800 people between age 65-74 with Alzheimer’s in Connecticut, 30,000 between 75 and 84, and 37,000 age 85 or older.

The task force, in accordance with the legislation, will make recommendations in areas including:alz stats

  • services provided to persons diagnosed with Alzheimer's disease and dementia; including persons with early-state and early-onset of Alzheimer's disease, and such persons' family members and caregivers
  • legislative policy changes to better serve such persons, family members and caregivers;
  • coordination between state agencies and private community-based health care providers to serve such persons, family members and caregivers;
  • case management services for such persons, family members and caregivers;
  • the transition of such persons from one health care facility to another; and
  • the placement of such persons in community-based settings or health care facilities other than nursing home facilities, when feasible.

The state legislature acknowledged the growing numbers of residents impacted by the disease, passing the bill unanimously earlier this year, with 67 co-sponsors. It was signed into law in June by Gov. Malloy.  The Alzheimer’s Association has been actively involved in the effort. The organization’s   Connecticut chapter is based in Rocky Hill, with regional offices in Hamden, Norwalk, Norwich and New Milford.

In accordance with the legislation, the task force report is due to be published early next month, according to officials at the State Legislative Commission on Aging.