Perceived in the local community . Also for dr. Frieden, a group of staffers like myself were at the cdc headquarters and were able to meet with your team combatting and organizing the response. One of the things we heard was when it comes to Public Infrastructure the Health Ministers dont get as much attention as other ministers. How is this outbreak changing that environment . Are we able to leverage that situation to get them to pay more attention for longterm growth . It is generally our experience in Public Health that people pay most attention to us in the middle of an outbreak or epidemic. Within countries you will find that Health Ministries are generally weak compared to other ministries and that the Public Health aspect of that is particularly weak. Congressional initiative from senator harkin and others to establish Public Health institutes that would be able to run Laboratory Networks and train and host Operation Centers are very important. And it would be tragic if we didnt ensure that as we respond to ebola we also put in place the kind of systems that would prevent the next outbreak like this from getting out of hand as this has. And the first question was the role of Health Care Workers in the front line . Well, you know, they face enormous challenges and enormous risks. One of the overlooked there is a lot of focus on ebola treatment units but those most at risk are in the normal health system. When someone presents with ebola symptoms if that facility does not have the equipment needs and the staff person does not have the training that they need then they are extremely at risk. These are countries with extremely weak health systems. So there is traditionally not fantastic Infection Prevention within the health system. The Community Care program that the president announced is intended in part to address that. It will be at Priority Health facilities providing training and equipment so that Health Workers can better protect themselves and will also help to set up ebola care centers which will be already popping up. Communities are self organizing to set up care centers. They are just not getting support. This will provide support, a degree of training and Equipment Support to the centers so Health Facilities will have a place to go with people infected with ebola rather than have to keep that in the Health Center where they may not be equipped to handle it. I will give a minute to dr. Tapero from cdc who was just in liberia and has very valuable final comments about ebola. Thank you for the opportunity. Im more than happy to talk with people afterwards. I know we are about ready to close. I would like to reiterate that the Health Care Workers on the front lines have been largely liberia Health Care Workers. They have taken a tremendous toll in the early days of the epidemic. We need to turn it off quickly. We can do that. We know how to do that. We have been working in this space for four decades. So the support that we can give to communities as they try and provide Community Care centers while these ebola treatment units are built is critical. The most critical element is that when a Family Member takes care of their loved one in these facilities that we give those Family Members and those caregivers who leave the hospitals to work in these Community Care centers the best opportunities for good Infection Control practices to bridge the gap to when we actually have the ebola treatment units fully functional and set up with the support of dod and others. There are tragic stories but the most compelling reason for moving in this direction is that the Health Care Workers that remain on the front lines, they are there and they want to come to work. They just want to be trained. They want the physical facilities and the personal protective equipment and the training that allows them to do the job effectively. The Infection Control training practices that were doing the training will have long term benefits well after the epidemic is put under control and will decrease all kinds of hospital acquired infections as well as protecting Health Care Workers who see people when they come for care. I would be happy to take questions. I will stick around and talk about my personal experience and other things. Thank you. Thank you for being here and being part of this. Just one more word on the Health Care Workers experience. I think many of us in this room have friends or colleagues that are working on the front line in west africa and struck us at our center that there isnt an easy way for people to be sharing real time information and learning. That is being built into the system. So we are trying an experiment in our center which is called sharing exchange ebola Knowledge Forum to put first impressions, anecdotes and stories they are learning that can make their way into formal guidance. So i think its now two minutes past time. And i want to thank all of our very distinguished panelists for their time today and for their service for this country and west africa. A special thank you for those who really worked in the last few weeks to put this together. I want to thank our panelists all together for their work. [ applause ] and keep up the good work on the hill. Thank you. Here is a look at tonights primetime network. Bill gates discusses the Ebola Outbreak in west africa and his foundations pledge to donate 50 million to fight the virus. On cspan 2 the communicators with maureen ohlhausen. She discusses net neutrality, privacy and data security. And a series of discussions on mars and Science Education including discussion on the difficulties nasa would face sending humans to mars. That is all tonight beginning at 8 00 p. M. Eastern on the cspan networks. Live tomorrow the House Oversight committee holds a hearing looking at the secret security protocols looking at an incident in which an armed intruder entered the white house. You can watch it live at 10 00 a. M. Eastern on cspan. Next a look at the Housing Needs of seniors. A report by the Harvard Joint Center for housing studies examine the consequences of housing cost burdens and what is needed to meet the needs of the increasing aging. The groups managing director talked about the findings at this event cohosted by the Harvard Joint Center. Good morning. Its nice to see so many people here today, the day after labor day weekend. When we set the date, we heard grumbling back that no one would come. I think this is a testament both to the importance of the issue and the fact that people are ready to get back to work after a good summer and a good labor day weekend. Let me first start by sending my thanks to the hartfords for funding and to the aarp foundation. Thank you. This is an issue that the joint center identified for a number of years as one to spend more time on and the grant gave us the opportunity to do it and build the infrastructure and capacity. I also want to thank the folks we work with closely at the foundation. Vivian and tyler who have been instrumental in helping marshall this through the process and have been certainly not funders but collaborators. They have been instrumental in helping us put together an Advisory Committee to shape the report and review drafts. I will not go through the process of naming them now but they are named on the website. Their input was critical in terms of informing us and pointing us many the right direction. I would have to thank the joint center staff. A number of whom are here today. I wont call them out. I think the effort that goes into the report, our state of the nation report and the American Housing report is phenomenal. I think we under estimated to some extent the amount of effort that goes into learning the issues that intersect with senior and older American Housing. So the amount of work that our staff did to get up to speed on that literature, all the data sets we analyzed was really quite amazing and been working very hard this summer, i should add. I have to give a special thank you to jennifer molisnski, sitting here in the front, who was the manager of this project and who is incredibly passionate about this issue and really put blood, sweat and tears into getting this report to be what it is today. So to the extent that the report, if it passes, i think the credit goes to jen. Let me turn to the report itself. Obviously the motivation for the study begins with the fact that we are at a time of unprecedented growth in the older population. Its growing not just because of longevity which is increasing. Because the baby boom generation has been crossing important thresholds. We have seen it growing for years. Since 2011. Beginning to accelerate and ten years from now, the oldest old population beginning to grow. Ten years from now we see the oldest old population beginning to grow. It is a tremendous need to meet the needs of an aging society. The needs are great. There are challenges we face as we age. Challenges to maintain our health and physical security. To remain connected to our communities. And to remain productive members of society. As lisa said in her remarks, i think if you look at it, housing is critical to so many of the elements of maintaining wellbeing, and we use the phrase lynchpin. We have discussion if anyone would know what it is. Im really grateful that you defined it. As we say in the report, housing is a lynchpin of well being. Because it intersects with so many key issues. One is the Financial Security of households. Housing is typically the largest item in a household budget. Whether your housing is affordable or not will have a lot to say about whether or not your overall financial picture is in good shape. Its also the principal source of wealth. If you are a homeowner whether you have the nest egg or not is an important asset people can tap potentially as they age. In terms of physical security, whether the home is suitable to your needs as the inevitable challenges arise. Does the house provide a safe and secure environment. As we learned more and more the ways if which the house is also related to Health Issues in terms of both the interior environment of the home and how it connects to communities. In terms of social connections, where you live, what your housing situation is. Does it facilitate you interacting with the community. Do you have access to Transportation Options to engage with the community. The housing is central to that. Finally in terms of links to long term supports and services, as we age when we needer more supports in the home, those are helping in situations facilitating getting the services so we can age in our communities and avoid the high costs of institutionalized care. In each of these areas we face significant challenges. In terms of Financial Security, older households are already facing high housing cost burdens. And given the situation of those approaching retirement, they may well worsen. More people are entering retirement with mortgage debt. In terms of physical security, there is a shortage of housing with accessibility features. There are important trade offs between spending on food and therefore hunger and health care and therefore health. In terms of social connections there are deficiencies in terms of the house ing thats well connected to city centers and town centers and transit. There are deficiencies in pedestrian infrastructure that make it difficult to make those. In terms of linking to Long Term Services and supports there are ways in which the housing and health care cysystems dont wor well together and threaten the ability to get services you need. Housing play as Critical Role in making the connections. We certainly are facing a number of challenges today as the list makes clear. Well face more challenges in the future. This is a problem already but going to become a bigger problem. The issue or the good news is there is still time to prepare. Most of the challenges will really accelerate when the population begins to grow. That will happen a decade from now. As lisa said there were a number of promising models and ways we know to address these things. If we are going to build infrastructure in terms of housing and systems to deliver the services we have to start now. The goal is to raise awareness and understanding of the issues. To provide the data thats needed to document it and highlight areas where action is needed and can take place at all levels of government by the private and nonprofit sectors. Most importantly at the individual and family level. There is a need for individuals to take stock of whats going to be the demands on them as they age. And begin to take steps now to prepare for that. Also to provide the support needed for the policies and programs that are going to be needed to support an aging society. With that, let me now turn to the details of the report. As we say, these reports are always chock a block full of information. Every paragraph is carefully honed. So i will be able to touch upon only a part of it. So i really do encourage you to read all of the report. Let me turn to the highlights. So the first portion of the this shows the population in 50 year increments. Which so this chart shows the population in 15year increments. Those are the categories youll see. A preretirement group, 50 to 60. Retirement into the first years post retirement. 6579. And then the oldest old, 80 and over. You can see that we have already experienced a huge runup in the 50plus population. When the baby boom turned 50 in the 90s, that group started to grow. From 1990 to 2010 we saw that population double from 30 million to 60 million. Now were at a point that the baby boom as of 2011 started to turn 65. We are just beginning to see the population grow rapidly. So between 2010 and 2030 well see that grow from 27 million to 43 million. And then up to 53 million by 2030. So by 2030, one in five americans will be 65 and older. A really astounding share of the overall population. The oldest old have been growing with longevity. And that group will start to rapid up again in 2026. That beginning at the 2020s and 2030s well see the oldest old population grow. And as well see, thats the group that really has tremendous needs for supports. While its growing now, it will be growing much more rapidly a decade from now. So this chart illustrates the challenges that grow when you age, in terms of an increased risk of disability, isolation and Financial Stress. So we show here different categories of disabilities from cognitive issues with memory and decisionmaking, selfcare in terms of bathing and dressing. Independent living in terms of running errands and taking care of finances and mobility. As you can see, there is an increase as people from go from their 50s and 60s to their 60s and 70s and a huge increase as they hit 80 plus. By then one in three have issues with independent living. One in five have issues with selfcare. Likewise with People Living alone as people become widowers and widows, more than a third are living alone, increasing the risk of isolation. When we look at housing cost burdens we have less of an increase. This is more of a democratic problem with more than a third of people facing housing cost burdens in their 50s, 60s and 70s. And then it does rise in the 80s as incomes become more constrained. As we see people age, issues around disability issues, issues around isolation and issues around Financial Stress will grow. In terms of disabilities, age in many respects is a great equalizer. So what these charts show is again looking now at incidents of disability. Combining the likelihood of having the issue of hearing, vision, selfcare, mobility and the likelihood of having an issue rises sharply with age. These panels show issues by race and ethnicity, income and housing tenure. And among younger people, we see higher income households are less likely to be disabled. But age over time takes a toll on all. So by the time you get to your 80s 70 of households of all demographic stripes are dealing with disabilities. So this is not an issue for some demographic slice. Its an issue for all of us as we age. In terms of income, the financial pressures also tend to converge. So this chart shows the Median Household Income with different age bands for different groups. Thats the Median Income of people 60 to 64 and by race, tenure and family type. At that point its a wide disparity in meeting incomes. Much higher for whites and asians. Much higher for homeowners. If you look at the red bars, those differences really largely dissipate. So most household types, regardless again of what your demographic stripe is have Median Income household between 20,000 and 25,000. The longer we live t fewer sources of income we have to rely on. So again, more Financial Stress across the spectrum. Now turning to housing and Financial Security. One of the main issues we look at is housing cost burdens. This is the shared households spending at least 30 of income for housing, which is a typical measure of affordability. We refer to severe burdens as people spending more than 50 of their income on housing. We always get a question when we do a report. What do you find surprising . This part of the analysis though it is one we may spend the most time on is one that really gave me pause. If we look at renter households, among older households, the differences arent that significant from the overall population. People in their 50s and early 60s, about half have housing cost burdens, true of all renters and a little more than a quarter have severe housing cost burdens. They do rise with age. Theyre already pretty high. By the time theyre in the 80s, almost 60 of renters have housing cost burdens. Its not a slice of data we often look at. If you look at it that way, you find people who have a mortgage who live later in life, are much more likely to face housing cost burdens. Among those 50 to 64, a third have housing cost burdens but by the time they age into retirement ages, it rises to 45 and then 60 of those over 80. And so really this issue about managing your mortgage debt while youre still working and trying to get to a situation where youre not facing those costs in retirement is really significant. As a 53yearold mortgage holder of a 28year mortgage this certainly gave me pause thinking about what i may need to do in the next ten years. If you look at homeowners who own their home free and clear it really provides a dividend in terms of avoiding housing cost burdens. Only 13 to 14 of homeowners under the age of 80 have housing cost burdens. It rises after 80 because incomes drop and property taxes and insurance can become more of a burden. But again, owning your home free and clear is really an important dividend homeowners get and one that well see in a minute is becoming less likely the to be realized. Another issue we look at is what are the implications of housing cost burdens . The way the joint center looks is to use the Consumer Expenditure survey and look at how typical households spend on a monthly basis. What we do is compare those who are facing either moderate cost burdens, between 30 and 50 of their income or severe burdens, spending more than 50 . This is just for households in the bottom expenditure quartile. That is basically a proxy for bottom income. And if you look, the green bars are able to find Affordable Housing. The yellow are moderate burden. The red are severe burden. And you can see across all the age group, the spending categories that takes the biggest hit are the other items that make up a portion. And food is always a significant one. Across a spectrum. The household facing cost burdens. Severe cost burdens spend between 41 and 47 less each month on food. Showing a clear link between spending on housing and whether or not you can get adequate nutrition. The next biggest is transportation. A clear trade off between how high your housing costs are and how much you spend on transportation. Here, the differences are between twothirds and threequarters lower spending on transportation. The link between high housing costs and isolation. In terms of health care, we see there is a lower spending of about a half to twothirds for those who face severe cost burdens. Among those 80 plus its 67 less on health care. The other area of spending that cuts back is retirement savings. It will be reflected in your situation when you retire. Clear links between whether you can get Affordable Housing and spending on all other categories. Back to the mortgage issue, this chart shows the share of households who are homeowners with mortgage debt and the average amount of debt over time. Just looking at the yellow bars for 65 plus going back to 1992, about 19 of people who are 65 and owned a home had a mortgage. By 2010 that share had risen to 40 . So much more likely to be entering your retirement years with a mortgage. If you look at the righthand size, the average for the loans, its gone from 28 to 45 . So not only are you more likely to enter retirement with mortgage, youre much more likely to have more debt. And if you think back to that cost burden chart, what does that imply about how well people are going to be able to manage their housing finances in retirement, and then what the implications of that are for the other spending. So i think this issue about how were managing mortgage debt Going Forward is really going to be important for the next generation of older households. The other issue for 50 to 64yearolds is the toll that the housing crash has had on the Home Ownership rates. This compares rates in 2005 and 14 for different age segments. Homeowner ship races have held homeownership rates have held up well. A slight decline in 55 to 79yearolds and 80 plus has gone up a little bit. The 50 to 64yearold group has seen the homeowner ship rate fail fall by five percentage points. And for that age, its not likely to be made up in the remaining years before they hit retirement. So that group is going to go into retirement less likely to own their home. If we look at the overall net wealth picture between 2007 and 2010 the 50 to 64yearold group saw their net wealth fall 32 . So one other common theme in this report is that group of 50 to 64yearolds and how much theyve been suffering from the recession and other Financial Issues that weve been having, less likely to find benefit pension plans. As much as we look at todays older households, trying to extrapolate from the 50 to 64yearold Group Forward its not a pretty picture. In terms of wealth, theres a lot of figures in terms of the distributeution of wealth. The bottom line is homeowners have about a quarter Million Dollars of net wealth with a typical median homeowner compared to 6,000 for renters. We think, too, about the situation for homeowners and renters as they retire. Very different situation. You can see housing wealth is sizable. That will be an important issue Going Forward. Being able to get rental Housing Assistance is important to manage their finances. What this chart is showing is on the lefthand side using data from the hud the number of older 62 plus who are very low income which is a standard determination of eligibility for Housing Assistance programs. For older renters being able to get rental Housing Assistance is incredibly important to be able to manage their finances. So with this chart is showing is on the left hand side, using data from hud, the number of elderly households for housing we have done a simple exercise to try to give some sense of where the issue is going. Remember that the baby boom has started recently turning 65. So that age Eligible Group is over the next decade going to grow by leaps and bounds. So what we did is we said based on joint centers own estimates of what we project to be the number of elderly renters over the next decade or so. We do this by holing holding homeownership rates constant. What does that imply about the numbers of elderly households who are eligible for rental assistance. There is a lot of switches in there. I think that in some sense you can say that homeownership rate or rentership rate may be too low. The income assumption may be too generous giving the fact that that group is suffering financially. It could go the other way. Based on that we project that by 2030 there will be 6. 4 million very low income renters eligible for rental assistance. To put that in perspective just to keep the same onethird share assisted we would have to have 900,000 more assisted units for that population. We have 1. 4 million. We havent added that many in a long time. If we dont have ability to keep pace with that we will have many more elderly rental households. We already see that results in 60 having worst case Housing Needs. I think the issue about rental Housing Assistance and how much support is provided will really become a salient one over the next few years. Turning to the issues of accessibility needs in the Housing Stock one of the key issues is as we talked about is how well suited housing is to meeting the needs of an aging population in terms of accessibility. As a starting point it is helpful to look at what types of older households you are looking at already. This is as of 2011 in terms of types of structures that households are living in. 71 are living in detached housing most of which is owner occupied. They do probably have greater ability to modify the home to suit their needs. Single Family Housing may present more challenges in terms of multi floor living and the like to be able to adapt to meet their needs. If you look at the share living to the extent that buildings with elevators may have greater accessibility it is a small share of the older population, only 9 of older households living in large multi family building. When you think about adapting housing to meet accessibility needs we are largely talking about single housing. We are talking about that because this is the population that does not move very frequently. As people age the likelihood of moving becomes much lower. In the 50s about 4 moves every year. As you get to 60s and 70s it is 3 . As a result we are looking at where the older houses are living now is probably where they are likely to be living as they age. This chart shows the share of households of different age groups who have been in their home for different periods of time. The dark green bars show the share living in their home for 20 years or more. So if you look at that righthand panel those 80 and over, 60 have been in their homes for at least 20 years. If you look at the 65 to 79 year olds, 47 have been in it for 20 years, another 23 have been in there for ten years or more. Basically people are making decisions about the housing they are going to occupy later into life when they are mostly in their 50s or early 60s. By that time they are locked in. The issue is how to get people to be aware of the choices that they should make now for the housing they are going to need when they are 75 and 80. It is not easy because we dont like to picture ourselves in that situation and we dont think it will happen to us. I was talking to my brotherinlaw yesterday who remodelled his house and didnt do anything to make his house accessible. He said my parents are 90 and they are fine. I said they are lucky. May you be as lucky, as well. No one in the process, not the architect or builder pointed out this was an issue to be aware of. This is one issue that we need to penetrate peoples consciousness. You are making decisions now that you will live with for a long time if you want to age in place and think about that now. I think we need to have it built in along the supply chain. In terms of accessibility features we looked at using American Housing survey, characteristics of the stock mung main dimensions used in terms of universal design features including extra wide hallways and doors to accommodate wheel chairs, lever style doors on faucets. No step entry, accessible Electrical Controls and single floor living. If you look at those dimensions, single floor living is most common followed by accessible electrical control. Levers and extra wide hallways and doors are least common. If you look at the bundle the share that has more than one of these things it becomes quite limited. So only 57 of the Housing Stock has more than one of these features and only 21 has at least three. Only 1 has all five. We are talking about the existing Housing Stock how accessible it is. There are significant deficiencies. They vary by region. The northeast tends to have more Single Family homes that lack single floor living or no step entry. And this chart shows they vary by age. Newer housing is more likely to have accessibility features. Even though the slope is upwards it is probably not as deep as it needs to be to make sure the new housing we are adding is adding greatly to the accessible stock. We have an issue in terms of how well suited the current stock is to meeting the needs of an aging population. And this chart compares the likelihood of living in a home with a least three accessibility features versus the likelihood of having a disabled Family Member. You can see for younger households about one in five are likely to have a disability, a person with disabilities in the home and about one in five are likely to live in a home with accessibility features. These are kind of the odds. It goes up a bit for 65 to 79. By the time you hit 80 the incident of disabilities goes up to 60 and the likelihood of living in a house goes up to 30 . There is some indication that you will move to more accessible housing. Moves are rare and not enough to offset the rise in disability. A big mismatch between needs for accessibility and what the stock offers. So what is it going to take to try to make this more accessible . Met life has done a couple of studies where they estimate what the expense would be for a variety of the most commonly needed investments in the home. Some of them are simple and not too expensive. They get more complex and costly as we go up. Adding grab bars, grips in the bathrooms, hand rails can be done for less than 1,000. Each door widening 800. Wheelchair ramp. Chair lifts 3,000 to 12,000. When you Start Talking about remodeling a bathroom, adding a bathroom, adding a bedroom the costs become more substantial. While some things can be done easily other things take much more expense. Just to give you an example of the potential scale of this consider the fact that as of 2011 there were 10. 3 million households 50 and over who reported having some serious difficulty walking or climbing stairs. Of that group 5. 5 million report living in a house that requires that they climb stairs to enter or exit the house. Then you say of that 5. 5 million lets say even a half a million need to put in a ramp to be able to get into the house. The estimate of 2,400 adds up to 1 1. 3 billion. Either way you slice it that is a big market. And either it is a big opportunity or also a big need for subsidy. When you multiply the millions of households facing the issues even by modest costs you can add up to a big number. How are we going to increase the stock . There are a number of policies and programs that are being used. One of them is visibility ordinances. There has been a growing adoption of these over the last couple of decades. Mostly focused on housing that is being built with public funds that are having mandates that have visibility features that were talked about in the earlier slide. More and more there is an interest in expanding that beyond just the publicy funded housing to more housing. And certainly having mandates or inceptives to have those kinds of features which start to add to the stock over time. There is also examples of tax incentives offered to homeowners or Home Builders who undertake housing that has visibility features or accessibility features that provide that kind of subsidy mechanism to encourage people to undertake those improvements. There are grants or low interest loans from federal, state or local sources. There are ways in which, a program used for that, a program under funding constrands in recent years but has played a big role in providing small grants and loans to homeowners. Other options include potential for medicaid through home and Community Based waivers to be able to Fund Improvements to the home so that people can age in place either through changes in the bathroom or the alike. There are a variety of ways to tap different types of grants and low interest loans to make homeowners make the vainvestmen. And then volunteer assistance. I think an interesting example is rebuilding america which has a model sort of like habitat for humanity where they rely on volunteer assistance and donations and resources to go into homes of the elderly, veterans and disabled households to make the homes accessible. In 2013 they modified 4,200 homes. So it is small scale but the kind of Community Level grass roots effort brought to scale might go a long way towards helping. Social connection and community support. The ability of people to remain connected with their communities is important not just for their own Mental Health and peace of mind but also for the community to be able to take advantage of the expertise and volunteer energy and the like that those households bring. Certainly a number of ways in which the current layout of housing will become a challenge to maintain that social connection as households age. If we look at the distribution of where the 50 plus households currently live this is based on American Housing survey it estimates that about 25 are in central cities, 50 are in suburban areas and another 25 are in nonmetro areas. We have about three quarters of older households living in areas that are not dense by definition and may be constrained in terms of the transit options available to them. If we look at the distribution of households by their this is looking at the share that have no access to cars and do not have transit within a quarter mile of where they live, based on this measure you can see that people in the 50s, 60s, 70s have good access to transit. They either drive or live near transit. By the time they get to be in the 80s the share of households at that level have some deficiencies in their ability to connect with transportation opportunities becomes much more limited in particularly in suburban and rural areas. And in many respects they struggle with how to present this information. Living within a quarter mile of transit is not necessarily a good measure of whether the transit is useful for you. A quarter mile is a long way if you are walking with your walker. You may have to cross streets that dont have good crossings and good sidewalks. When you get to the transit can you get into the station . If you get into the station does the transit take you where you want to go . There arent Good Measures of how much transit serves the needs of people who have issues with mobility. The other issues in terms of having a car and the question of whether or not you have broad use of that car as peoples vision is diminished and reflexes are diminished there is a survey showing if you drive a share of people that say i missed out on activities because it was too late at night and raining and ways in which it overestimates the ability to connect with transit. As much as we struggle to capture this i think as people age in particularly into their 80s they become much more isolated in suburban and Rural Communities in particular. So what are the approaches to enhance connectivity . Certainly one way is in terms of services that can help people remain tied to their communities. Senior centers are valuable resource to provide recreational opportunities, social activities and other avenues for engaging with your community. Area agencies on aging are incredible resource for host of Services Including meal delivery, home care, adult daycare. There is a whole Service Infrastructure that needs to be there once people get into their communities so they have places to gather and interact and to deliver services to them in their home. Part of that is this Service System that needs to help plug that gap. Beyond that there is a need to encourage broader Housing Options. People need to have options within their communities that are close to the centers, close to transit and may mean having more multi Family Housing in places that have been averse to that and may mean allowing dwelling units and allowing for other forms of housing, other groups living together that may not be allowed by zoning. We need to think about in the communities that may not have had the options that there will be a growing need for them. Improving Transportation Options. There are many ways in which existing Mass Transit System can have improvements to make it more accessible to people and a whole range of para transit, taxi discounts and other options for making more Transportation Options that will take people from point to point that they need on an affordable basis. In terms of pedestrian experience certainly need to think about increasing accessibility of sidewalks, adding lighting and buffers in traffic, making street crossings safer. All of these things are helpful to make sure that even if destinations are reached that they can be safely traversed. Put these things together and we are talking about making an age friendly community. What that means is not just for older households but for all households. Many things we are talking about work as well for young people and young families as they do for older people and having safe pedestrian networks. In many respects these are not investments needed just for older folks but needed for overall. Finally in terms of linking housing and long term supports and services as i pointed out at the beginning the incidents of disabilities rise sharply with age. Ultimately many people are wrestling with the need for services and support to maintain res dependenidence in their hom folks clearly express a preference for that because of the importance of the social networks and connections. It is important because maintaining residence in your home saves society a lot of money from delaying institutionalization before it is needed. This chart shows living arrangements of households or population with disabilities by age. The slice that is pulled out is the share living in Group Quarters which is some sort of institutional setting not in the community. You can see that share is 5 of those under the age of 80. It rises to 13 of those 80 and over. The majority of people with disabilities are living in the community. This is a trend that has been increasing over time. The nursing home population has been declining. There has been more options like assisted living and more ways of providing support in the home which has all been for the good. One way in which people are able to get probably the most important way people are able to get support in the home is from Family Members from spouses or children. Twothirds of people getting longterm care in their home are getting it solely from Family Members. That is important means of keeping people in their homes. Only 9 get care from nonfamily sources. We are a society of demographic shifts. Theyre going to make that sort of support challenging. Baby boomers got married later, had fewer kids, smaller families. So if you look at the share of people by age who do not have any children, people in their 50s, 15 do not have any children compared with 60 in their 70s. There are going to be fewer family care givers to rely on. Aarp has an estimate that as of today, theres a ratio of seven potential family care givers for every person 80 and over. By 2030 that ratio will be 41, im one of five, thankfully, my mom is aging, the five of us were able to pool together our time and our money to two that. You look at our children, we have two, you look at them and say we are in big trouble. They certainly have to mature and they better get a better job. But that family care giver ratio is going the wrong direction, its going to put more pressure on other sources of care. This chart estimates the cost providing weekly assistance of different types. So youll see adult daycare to a homemaker service, home health aid, both of those are assumed at 30 hours a week for a month. The monthly cost goes from 1,400 to 25 ,5 2,500 for thoser types of assistance, nursing home care is about 6,500. The costs really get quite high. Again going back to the renter homeowner issue, in terms of homeowners, if you look at their wealth, how long can they support themselves drawing down that wealth, in each of those situations, it can go on for years even if they dont tap their homing witty, renters, given that median wealth of 16,000, they can last about four months, but by the time you get to those other issues, they dont have the resources to last more than a month or two. While they have these growing options for care, their cost is very high and while some people have the wherewithal to support it, many dont. I think again, the retro population is one that we really need to spend a lot of time thinking about and how we support them. Just briefly in terms of policies and programs to expand Affordable Housing with longterm Affordable Housing, hud had section 2. 2. There are efforts to revamp that by making it more productive. By removing capital grants and looking to other sources of development for the costs. Its partly passing the buck to other sources of development funding, so as long as we have a tax credit as a principal source of it, which itself has been mentioned for cut backs and has also been relied on for a whole host of rental housing. Given the fact that we havent had a lot of this housing over time, the 202 Housing Units are very old, this is really a critical year of support. There are a number of successful nonprofit models, taking existing assisted housing and bringing in resources from the Health Care System to help support them. We do have to take advantage of the fact that we have a number of existing developments that have a concentration of older households and help to support those models as an important resource. And finally ways in which we can look for ways to enhance the reentry of renters coming back into if youre a renter and youre institutionalized by a couple of months, youre coming out and trying to establish yourself into an apartment, whether its accessible or not, using other resources to secure that unit and making sure that its accessible to you and getting reestablished. In some cases the money follows the purpose that may be used for this purpose, theyre small scale, but i think we need to be thinking about how do we facilitate access to private housing as well. All right, so thats kind of the run through the issues. You know, i think the joint senators often referred to as the joint senator for gloom and doom. We get up here and we cite a litany of statistics about how awful the situation is, and makes you want to throw up your hands and say abandon hope all ye who enter here. Thats not the message i want to leave you with. The report does point to a number of promising approaches, theres issues of scale, theres issues of funding. The other issue we have to take comfort in, is that while wrestling with serious issues today, those issues are going to grow more profound over time so we do have time to prepare. We do have to build more of a housing infrastructure, we do have to build more of an infrastructure for the support structures that are needed. But we have to start now to do that. As lisa said in the introduction, its going to require efforts at all levels of government. Certainly we need to expand funding for that. Its going to require efforts from the nonprofit sector, who have been so important in trying to break down silos and finding different funding to their clients and people they care about. And also in terms of their advocacy role. Its going to take the private sector, in the it private sector, theres tremendous opportunities here. I do think one of the issues is breaking through the consumer, to make them aware of the issues, so when they market their products, designed for accessibility and the like, they find a more willing clientele. Again, its going to come back to the individual, its going to come back to individuals and their families, recognizing these issues, taking steps now to prepare themselves thes and recognizing the importance of what their communities have to do to be prepared and being supportive of those steps. But ultimately, i think the rubber meets the road at the Community Level. Its at the Community Level where the Housing Options have to be expanded, where the service infrasfur needs to be expanded, where we need to see better transportation infrastructures. Theres a lot of pressure on local governments, their awareness and appreciation for this is important as well. The final message is this is not an isolated problem, but a problem thats going to face most communities across the country. If you look at, getting back to the power point, so this is a map showing counties, and the share in the population of 50plus in 1990. And so the red areas are places that had 40 of the population that were 50plus. And you can see, theres places in florida, theres places in arizona, theres a few places in the midwest, pockets here or there where the population was over 50. Many areas that are green where the population over 50 was less than 25 . If we fast forward 20 years, those red areas are growing. So certainly florida still has those areas, but theyre all across the north, theyre in appalachia, theyre in the northeast. Some of these places are gone. To the effect that these people age in place, theyre going to age in that community, where they are now. So this is an issue that communities across the country have to face. I hope with this report we have raised awareness, we have pointed to solutions and we have helped that process of whats going to happen to us as a country over the next 100 years. Thank you very much. Here are just a few of the comments we have recently received from our viewers. I just finished watching q a, jenny beth martin, i suppose the most offensive thing about that whole hour was the facts that it was the daughter, the methodist minister. I was a methodist for years, many years. And you just got to wonder, what in the heck is the Methodist Church in the south like, you know . And how did i wonder what her parents positions are . And how did she, you know, i heard the whole hour, how she got to where she is. All right, i just want to first start off by allowing cspan to know that i do not watch any other channel on my cable selection besides this, and cspan 1, 2 and 3, and so i really want to show my appreciation for this, for your services there, and your ability to really keep it mixed up and really keep it lively, and around international viewpoints. I just watched your what do you think of Global Warming show. And i would like to say, it would be nice if cspan would hold people at least accountable for the nonfacts that they spew out and you could have put everybodys mind at ease about trying to explain this if you had put the picture of the huge trash swirl thats in the Pacific Ocean right now. That is the size of texas. You know, cspan, put the information out there. You know, when you do your reading, make sure you put pictures up also, because that would have confronted anybodys denial. We have a big trash swirl the size of texas and i heard its 90 miles deep. I dont know how wide it is, but you need to put that on. And continue to let us know what you think about the programs youre watching, call us at 2 026263400. Email us comments at cspan. Org. Swroin the cspan conversation, like us on facebook, follow us on twitter. Tonight, on cspan 3, portions from a mars explore rag summit hosted by George Washington university a Nonprofit Organization explore mars, thats followed by a hearing on efforts to improve education on science, technology, engineerg
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