Perspectives in Aging Final

Threelegged Stool

Represent 3 major retirement income sources:

1) Retirement benefits from Social Security

2) Pensions

3) Personal savings/assets

having all 3 legs = financial secuirty

If one leg is unstable, the stool can’t stand

Social Security

• Started around the Great Depression

  • 1935

• Varies in amount and length of benefits

• Funded through taxes

• Retirees, disabled individuals, dependents, widows, widowers

Employer Pensions

• Organized by employers

• Based on: number of years worked, education you have, gender, part of a union, how frequently you change jobs

Social Security (equity)

How fairly Social Security treats different groups

• High vs. low earners

• Men vs. women

Social Security Trust Fund

The trust fund reserves funds that help pay beneftis when payroll tax revenue is insufficient

The retirement of baby boomers will start to rise and run out of money around 2033

• Social Security won’t be able to pay the full amount of benefits promised to retirees

What can be done?

• Increase the age for retirement

• Privitization

• Increase contributions through higher payroll

Payroll Taxes

Taxes taken from workers paychecks to fund social security and medicare

Economic lifestyle hypothesis

A totally adapted economic life cycle would have adequate finances throughout life and end up with absolutely no resources at the time of death

FICA

Federal Insurnace Contributions Act: The law that authorizes Social Secuirty and Medicare Payroll Taxes

Medicare

Federal insurance program for people over the age of 65 or those with certain disabilities

Medicaid

A joint federal and state program for people of low income

CCRC

Continuing Care Retiriment Community: Offers a full range of care in one location

Hospice

End of life comfort care for people with less then 6 months to live

Palliative care

Comfort focused care for serious illness at any stage

Home health/HCBS

Services delivered at home to support independence

Assisted living

Residential setting with support for daily tasks but less medical care than nursing homes

Functional ability (ADLs/IADLs)

ADLs: basic tasks like bathing, dressing, eating

IADLs: more complex tasks like shopping, managing money, using transportation

Out of pocket payment

Health expenses paid directly by the individual

Welfare

Safety net programs for citizens who need public support with income, food, or healthcare for whatever reason

Welfare state

Government programs for citizens who require asssistance with meeting their basic needs

• public pensions

• sick benefits

• maternity/paternity benefits

• unemployement compensation

Welfare State Convergence

The concept in which as countries ages and modernizes, the welfare states programs would beging to mirror each other

• dominating western perspective

• the United States is an exception, lacks universal healthcare

Comparitive perspective on global aging

Comparing nations shows how demography, culture, politics, and economy interact

Demographic divide

• more developed = low fertility, high life expectancy, older populations

• less developed = higher fetility, younger populations, but aging rapidly

Social Determinants of Health

Certain factors that have a huge impact on health inequities

Economic stability as a social determinant

• 10% of the US lives at or below the poverty line

• Poverty is fueled by systemic discrimination

• Lower life expectancy, increased chronic disease, substance abuse

Domino Effect of Education Access

Low income family → lack of education → less job opportunities

• Strong correlation between more education and living longer

Healthcare Access and Quality Barriers

• 1 in 10 Americans do not have health insurance

• Lack of access to prescription medicine and routine check ins

• Long wait times

Neighborhood and Environment Connection to Aging

• Neighborhood environment becomes increasingly influential as people age

• A safe, supportive neighborhood promotes healthy aging

Social and Community Connection to Aging

How connected someone is in their community and how supported they are by their relationships

Impact on Social and Community Connection to Aging

• Loneliness and Isolation

• Emotional support

• Functional health

• Purpose and well being

How can SDOH be incorporated into healthcare?

• Collaboration between the community and government

• Maintaining public health programs and health clinics

  • Medicare (65+)

  • Medicaid (low income, elderly, disabled)

• Food programs

  • SNAP

  • Food programs for students

Old-age Welfare State

Arose as a concept of elderly as a social group emerged

Older Americans Act 1965

• Administration of Aging: department providing services for 60+, a dependent view

• More local agencies established

Age Entitlement

Qualifying for certain social programs based soley on age

Need entitilement

A system of qualifying for benefits or services based on criteria such as low income, poor health, or inadequate housing

• Politically vulnerable

• Lacks bipartisan support due to social stigma and negative public opinion

Which state has the greatest proportion of elderly living there?

Florida

Which state has the greatest elderly population?

California

Subjective Age

The age that one associates themself with based on one or multiple characteristics

Ascribed Status

Status markers that are assigned to an individual based on permanent or difficult to change characteristics

• age

• sex

• race

• gender

• sexuality

Achieved Status

Status markers that are aquired throughout the life span through experience and hard work

• skills in a job

• activity level

Employee Retiriment Income Secuirty Act of 1974 (ERISA)

• dictates how employer pensions work

• pension benefit guarentee corporation

Defined Benefit Systems

• More in control of the employer

• Formula to calculate amount

• Moving out of style

Defined contribution pensions

• 401K

• more in the hands of the employee

• employers still contribute in some way

Longevity Economy

Economic activity driven by the needs and spending of the aging population

Age stratification theory

Theory that explains how age organizes society and shapes peoples roles, opportunities, and experiences across the life course

Demographic dividend

Economic boost when a country has a high proportion of working age adults

Poverty vs. Near poverty

Poverty: Below the federal poverty line, basic needs cannot be met

Near Poverty: Just above the federal poverty line (100-124% of the federal poverty line), slightly better off but still financially insecure and vulnerable

Fee for Service

Providers paid per service

Consumer Direction

Long term care models where older adults have control over how their care is delivered

“Graying” of the budget

Growing share of deferal spending going to programs for older adults

Social Security (Adequacy)

How well Social Secuirty benefits meet retirees basic needs

Net worth

Total assets minus total debts

COLA

Cost of Living Adjustment: Yearly increase in Social Security benefits based on inflation

PBGC

Pension Benefit Guaranty Corporation: insures private-sector defined benefit pensions

In-kind Income

Non-cash assistance like SNAP, housing subsidies, or Medicare benefits

Medicare A/B/D

A: Hospital insurance

B: Outpatient/medical insurance

D: Prescription drug coverage

Medicare Advantage

Private medicare plans that bundle A and B with added benefits

Medigap

Supplemental private insurance that covers Medicare out of pocket costs

Medicaid & Waiver/HCBS

Medicaid programs that fund home and community based services instead of institutions

Affordable Care Act

Expanded coverage and protections

Prospective Payment System (PPS)

Fixed payments based on diagnosis

Nursing homes

24/7 licensed medical care facilities

Biopsychosocial model

Health shaped by biological, psychological, and social factors

Medical Model

Focus on diagnosing and treating disease

• less attention to social context

Medicalization

Treating normal aging or social issues as medical problems

Social Constructions of old age

How society views older adults:

Dependent → seen as needing help

Advantaged → respected, politically powerful

Contender→ powerful but viewed with suspicion

Older Americans Act

Federal law funding community aging services, like senior centers, Meals on Wheels

1983 Social Security Reform

Reforms that gradually raised retirement age and taxed Social Security benefits for higher income recipients

AARP & Age Based Advocacy

AARP (American Association of Retired Persons) advocates for older adults on issues like Social Security, Medicare, and long-term care

Generational Equity/Independence

Debate between fairness across age groups vs. mutual support between generations

Healthy People 2030

US health goals emphasizing SDOH

5 domains of SDOH:

1. Economic stability

2. Education access and quality

3. Healthcare Access and Quality

4. Neighborhood and Built environment

5. Social and community context

Healthy People 2030 Overarching Goal

Create conditions so everyone can reach full health potential