Health & Aging Fellow Reflects on Change

Each year the Health and Aging Fellowship brings together alumni, mentors, and Fellows to network at a Leadership Retreat. In addition to this retreat is an intensive orientation to CMS – the Centers for Medicare and Medicaid Services. At 7:00 in the morning eight fellows boarded a bus at the Palomar Hotel in DC and headed to Baltimore. Fellows were given the opportunity to meet with the leaders in Medicare policy including Patrick Conway, MD, Chief Medical Officer, and Shari Ling, MD, Deputy Chief Medical Officer. This is all in preparation for selected projects.

After the orientation Fellows and alumni listened to the previous year’s Fellows who presented on their policy projects. A reactor then commented on the project and the impact the Fellow made to US health policy. Fellow placements were diverse across the federal government including the Senate Special Subcommittee on Aging, the Office of the Surgeon General, Centers for Disease Control and Prevention, Assistance Secretary for Policy and Evaluation, CMS Center for Clinical Standards and Quality, Congressional member offices, and numerous other sites.

The presentations included work on changing access to dental care, making communities more livable for seniors, challenging the payment policies for long-term care, opening communication between providers and CMS, and helping to set standards for quality and measurements in geriatrics. One presentation in particular caught my attention. Tracie Harrison, PhD, RN, Associate Professor of Nursing at The University of Texas at Austin worked with the recently formed Administration on Community Living (ACL). The ACL brings together the Administration on Aging and Administration on Disabilities under one entity led by the Assistant Secretary for Aging, Kathy Greenlee.

This consolidation (or reorganization) was lauded by many as a step in the right direction. Many states already coordinate aging and disability in one entity. Even national organizations such as the National Association of State Units on Aging (NASUA) expanded to become the National Association of State Units on Aging and Disability (NASUAD). In fact, Greater Twin Cities United Way funds 36 partners in 42 programs to maximize the independence of older adults, people with disabilities, and their caregivers.

However, many were critical of the new ACL. Older Americans and Americans with disabilities certainly have commonalities, but are also extremely different. At the most basic level, the philosophies for approaching services and advocacy by each are strikingly different. In addition, older adults often do not associate their age related changes or losses with disability. People with a lifelong disability often experience significant changes in benefits and programs merely because they reached a certain age. Lumping the two together can often cause problems with advocacy organizations and resource allocation.

I remained silent through all presentations, but needed to ask a question that was on my mind since the formation of the ACL. “What do you say to individuals that are not embracing the integrated concept of aging and disabilities?”

Dr. Harrison’s reactor was ACL Administration on Intellectual and Developmental Disabilities Deputy Commissioner Jamie Kendall. She said it best by stating the vision of the ACL: “All Americans – including people with disabilities and seniors – should be able to live at home with the supports they need, participating in communities that value their contributions.” She further recognized the similarities and differences and assured those of us in attendance that the purpose was not to force strategies together, but to inspire synergy where it makes sense and to support difference where it makes sense (my words, not hers).

It was so simple. In my gut I knew the answer and to hear an official so high in the Administration repeat the mantra I silently replay in my mind was affirming. With only one short trip to DC under my belt as a Health and Aging Policy Fellow, I can already tell this will be a life changing experience.

Rajean Moone, Contributor
Independence Consultant
Greater Twin Cities United Way