University of Pittsburgh psychiatry professor Richard Schulz has been one of the nation’s foremost researchers on caregiving stress for
U.S. Sen. Bob Casey, 56, is in his second term representing Pennsylvania in the Senate. He demonstrated interest in issues affecting seniors, such as nursing home quality, during his prior tenure as state auditor general.
He is now positioned to become ranking Democrat on the Senate’s Special Committee on Aging in the new session. It is an unusual committee, in that it does not vote on pending legislation, but it conducts hearings, issues recommendations and can address a broad range of issues affecting older adults.
The future of federal programs of interest to seniors is uncertain under President Donald Trump and a Congress controlled completely by Republicans for the first time in years, so Aging Edge sought out Mr. Casey’s views on key issues he and the aging committee may confront. (Note: The interview has been edited for purposes of length and continuity.)
Aging Edge: First of all, explain what you would hope a panel like the Special Committee on Aging can accomplish, considering it doesn’t move legislation.
Casey: We can continue some of the good work that has been done in the recent past. We can continue to work on senior scams, making sure we’re providing as much information to seniors as we can about these scams and recommending ways to crack down on them. But I think we also have to look for new ways to raise issues that don’t get nearly enough attention sometimes. Part of the reason seniors are held back from living a full life is they become victims of scam artists or they’ve got a health care need or a pension issue that gets in the way, and we have to keep a spotlight on those kinds of issues.
Aging Edge: What do you see happening to Medicare under the new political alignment in Washington?
Casey: It’s like guesswork. Will a President Trump, upon assuming office, be consistent with what he said on the campaign trail (that he did not envision major cuts or changes in Medicare) or will he allow his Health and Human Services Secretary (Mr. Trump has nominated U.S. Rep. Tom Price) to turn Medicare into a voucher program, as he has described? I’d fight that like hell, as I think it’s the wrong policy, especially in a state like ours where we’ve got such a high senior population and Medicare is a good, strong program we’ve got to protect.
Aging Edge: Is there anything you’d like to see changed about Medicare yourself?
Casey: My number one job when it comes to Medicare is stopping them from taking away guaranteed benefits and turning it into a voucher program. Number two is achieving better outcomes for seniors and reducing waste or fraud. I think, long term, we have to consider making sure that when we do tax reform or enact tax reform, we make sure the wealthy are paying their fair share so we can pay Medicare’s bills.
Aging Edge: How about Social Security, which has its own long-term solvency issues? What do you see Republicans doing in the new session and what, if anything, do you believe should be done about the program?
Casey: I don’t have a good sense of that. It’s been awhile since they really pursued converting Social Security to private accounts in a determined way, and we have to see whether they want to deal with that or focus instead on something like repealing Obamacare.
Aging Edge: Any tweaks to Social Security that you think are at least worth considering to assist its solvency?
Casey: In the short term, some people talk about raising the cap [on how much income is subject to Social Security taxes]. There’s a question of whether to draw the line on that. I know of no proposal I embrace, but that’s an area I could see examining.
Aging Edge: As you’ve been active on long-term care issues in the past, do you want the federal government to do anything different in terms of financing it? There’s a big dilemma now for many families that have to spend down assets and become Medicaid-eligible as a way of covering nursing home costs.
Casey: This is one area where even if Republicans say they don’t want to do anything substantial in terms of Social Security or Medicare, they may want to change Medicaid through something like the block grants that House Speaker [Paul] Ryan has proposed, and that’s maybe an area President Trump would favor. I worry about that as the wrong approach. We’ve got to do everything we can to shore up Medicaid and make sure there are resources there for it, as much as for Medicare and Social Security.
Aging Edge: What could or should the federal government do in the area of nursing home quality?
Casey: Part of that is lifting up and highlighting best practices. In so many long-term care settings across the country in the last generation, you’re seeing some high quality long-term care facilities where you see a new culture approach, making them less like an institution, more like a home, referring to the people there as residents instead of patients and treating them that way.
Aging Edge: In what way can the federal government further that progress?
Casey: We can invest in that or incentivize it more by better supporting the workforce and treating them like the professionals they are. We can look at the federal level for more ways to create that and to incentivize facilities investing in that way.
Aging Edge: Those in the nursing home industry contend the federal government doesn’t do much with funding to help them operate better — that Medicaid reimbursement rates don’t even cover the true cost of the care they’re required to provide.
Casey: They make a good point — we should try to pursue policies where we can invest more resources in Medicaid. I just think it’s fundamental to who we are. If we have a program that pays for something like 60 percent of nursing home placements and 45 percent of births in this country, and we claim to be a nation that supports the very old and very young, we should sure as heck find the resources.
Aging Edge: There’s been increasing talk of the needs of family caregivers in modern American and a lack of help for them in the way of federal policy or programs. Do you see that as likely to change?
Casey: I wouldn’t expect a lot of change, although that should not deter us from keeping it on the radar screen of the American people. Some of the numbers [in terms of caregivers providing uncompensated care to relatives] are astounding. This is one area where we could probably get more bipartisanship, in that everyone on both sides of the aisle is either going to become a caregiver, or hire someone for that, or be in a family where the family members are doing caregiving.
Aging Edge: You seem to have a lot of concern about the nation backsliding on a number of issues affecting the elderly under a Republican administration and Congress, but how fair is that? Couldn’t it be that they care just as much about these issues as Democrats but just have a different approach to dealing with them?
Casey: I certainly can’t judge someone’s heart on these issues. I do think there are sharp disagreements, but without knowing someone’s motivations I can’t judge that.
Aging Edge: It’s a difficult fiscal climate in Washington in which to anticipate increased funding, but is there any one program or policy affecting the elderly that you’d say is most in need of additional support, if it were possible to make it a new budget priority?
Casey: It’s hard to be that precise. We’re seeing more and more families take out long-term care [insurance] policies, and we should not only encourage that but help them plan and prepare for these burdens, especially with the numbers in the population going up. Not only is the population over 85 seeing the biggest increase of any age group, but there’s a corresponding increase in folks who will suffer from dementia of one kind or another. That’s not only an insurance issue, but an area in which to spend more time looking at ways we can offer encouragement and support.
Gary Rotstein: firstname.lastname@example.org or 412-263-1255.