in fiscal year 2013 and a high of $2.13 billion in fiscal year 2021. Advocates would like to see funding rise to nearly $2.5 billion per year, if not more, to keep up with the need. “Over the past 20 years, the OAA has lost ground due to our rapidly increasing frail, older population, and federal funding that has not kept pace with either inflation or growth in the older population,” the National Committee to Preserve Social Security & Medicare wrote last year in a position paper. “Eligible seniors face waiting periods for many OAA services in most states.” More Than Money Funding is not the only challenge to ensuring that services keep up with the needs of older Americans. Another issue stems from the kinds of services that can be covered. The Older Americans Act focuses on social services that help people live at home. Medicare and Medicaid cover medical-related services, such as assistance with bathing and going to the bathroom. They are known as activities of daily living, or ADLs. Among the biggest gaps is coverage for addressing what are known as instrumental activities of daily living, or IADLs, says Letha McDowell, president of the National Academy of Elder Law Attorneys. IADLs include things such as shopping for food, managing medications and paying bills. Help with IADLs can be crucial to a person’s ability to live independently. But the help can be expensive, says McDowell, a certified elder law attorney with Hook Law Center, a law firm with offices in southern Virginia and North Carolina. “In some areas, there are companies that you can pay to help with these things. But for some seniors, I would say it’s probably the largest hole in the system.” A reverse mortgage can help older homeowners by eliminating debt and freeing up income, McDowell notes. They might be able to afford a housekeeper, for example, while still qualifying for programs, such as Meals on Wheels. Income from a HECM, however, can affect a senior’s ability to qualify for Medicaid coverage for ADL assistance, she notes. If a spouse or partner develops Alzheimer’s, it can get more complicated. The partner may be able to handle ADLs but might still need a sitter when left alone, McDowell says. That service would not qualify for coverage as a medical need. “It’s a big problem and there really is no good solution for people who don’t have infinite amounts of money,” she says. Older Americans Act continued from page 21 Letha McDowell 22 REVERSE MORTGAGE / MAY- JUNE 2022
RkJQdWJsaXNoZXIy MjQ1MzY1