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The U.S. Department of Health and Human Services (HHS) is committed to serving the needs of these older individuals. Through medical insurance offered by Medicare, public support for long-term care options such as home health care and nursing homes, assistance for family caregivers, nutrition services, grant programs, and research into the causes and effects of aging, HHS agencies are striving to support older Americans and to help them lead healthy, active lives. President Clinton and HHS Secretary Donna E. Shalala are leading this effort with new programs to aid the elderly and with a commitment of nearly $2.6 billion in funding for aging programs in the President's fiscal year fiscal year 2001 budget, an increase of nearly $200 million over fiscal year 2000.

Background: Today, one in every six Americans, or 45 million people, is 60 years of age or older. According to the Administration on Aging, one in every four, over 89 million Americans, will reach that milestone in the next 30 years. Given this longevity revolution, baby boomers, who are now in their late 30s, 40s, and 50s, can expect to live well into their 80s and 90s. While most older adults are active members of their families and communities, others need some type of assistance, ranging from help with transportation or preparing meals, to total care.

Because America's older population is so rapidly growing, planning and caring for the needs of the aging is an HHS priority. In fiscal year 2000, HHS programs to provide services and assistance for the aging - as well as research into the processes and disabilities associated with aging - totaled nearly $2.4 billion. President Clinton's fiscal year 2001 budget increases that funding to almost $2.6 billion.

Major HHS agencies and divisions serving older Americans are:

Agency/Division                                                    FY 2000 Budget                            FY 2001 Budget Request

Administration on Aging    Aging service programs    Operation Restore Trust	$933 million    1.5 million	$1.1 billion   1.7 million
National Institutes of Health    Research on aging, including    projects through the National    Institute on Aging	1.4 billion	1.5 billion
Substance Abuse and Mental Health Services Administration    Mental health and substance    abuse programs	3.8 million	3.8 million
Agency for Healthcare Research   and Quality    Medical Expenditures Panel Surveys    Research on health costs, quality       and outcomes	18 million    2.2 million	20.5 million      24 million
Office of the Secretary    Women's health programs	2.5 million	2.5 million

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Total                                                        $2.4 billion                                              $2.6 billion
 

In addition to spending on HHS programs for services, planning, and research for the elderly, the department administers the Medicare and Medicaid programs, the largest health insurance programs for older Americans.

According to the Health Care Financing Administration (HCFA), the agency that oversees the Medicare and Medicaid programs, 1999 Medicare spending for the health care of the program's 39 million aged and disabled enrollees totaled $181.3 billion. Total federal spending on the aged through the federal-state Medicaid program in 1999 was $27.3 billion, to which states contributed an additional $20.9 billion. Medicaid coverage provides care for low-income aged primarily through nursing homes and through federally-approved state waiver programs that expand the availability of community-based services through health care in the home.

HHS PROGRAMS AND INITIATIVES FOR THE AGING

MEDICARE

Medicare was created in 1965 as a health insurance program for those aged 65 and older to complement the retirement, survivors and disability insurance benefits available under the Social Security Act. By the end of 1966, 3.7 million individuals had received some health care under the Medicare program. Today, more than 39 million people - most of whom are elderly - receive health coverage through Medicare. In 1999, total Medicare spending was $181.3 billion.

Today's Medicare program has more to offer beneficiaries than ever before, including more preventive benefits, new patient protections, and more responsible customer service. Through targeted new programs and a dedication to modernizing Medicare to meet the nation's health needs, the administration and HHS are taking the necessary steps to improve and secure Medicare coverage for older Americans today and in the future. Specific programs and initiatives currently underway include:

• Fighting Fraud and Abuse: Since 1993, the Clinton administration has focused unprecedented attention on the fight against fraud, abuse and waste in both the Medicare and Medicaid programs. Today, the result is a series of investigations, indictments and convictions, as well as new management tools to identify wasteful mispayments to health care providers. In 1999, HHS increased health care fraud convictions over 1998 levels. As a result, the federal government last year recovered nearly $500 million from health care prosecutions.

  In May 1995, President Clinton and Secretary Shalala launched Operation Restore Trust (ORT), a comprehensive anti-fraud initiative in five key states designed to test the success of several innovations in fighting fraud and abuse in the Medicare and Medicaid programs. As partners, HCFA, the HHS Inspector General, and the HHS Administration on Aging put this plan into action. During its two year demonstration, ORT identified $23 in overpayments for every $1 spent looking at suspected trouble spots in Medicare, including home health care, skilled nursing facilities, and providers of durable medical equipment. Since 1996, aggressive enforcement has recovered nearly $1.9 billion. To build on this unprecedented success in fighting health care fraud, waste, and abuse, President Clinton's fiscal year 2001 budget includes further anti-fraud and abuse legislative proposals that would save Medicare some $3 billion over five years.

• Preserving the Medicare Benefit: Due in part to the success of the administration's fraud-fighting efforts, the solvency of the Medicare program has been extended longer than ever thought possible just a few years ago. This spring, the Medicare Trustees reported that the Hospital Insurance trust fund will remain solvent until the year 2025, based on the most probable economic and demographic assumptions. The projected depletion date has been extended by 26 years since 1993, when the fund was projected to become insolvent in 1999. The Trustees credited the combination of the robust economy, as well as restrained expenditures due to HCFA's aggressive management of the system and structural reforms accomplished by the Balanced Budget Act, for extending the life of the trust fund and cutting the projected 75-year actuarial deficit by more than three-fourths.

• Prescription Drug Benefit Proposal: Although a prescription drug benefit was not included in Medicare when the program was created in 1965, the advances in medicine and drug treatments today make a drug benefit essential for the health and well-being of senior citizens. A recent study conducted by HHS revealed, among numerous other findings, that seniors without drug coverage not only lack insurance against high costs, but do not have access to the discounts and rebates that insured people receive. To address these problems, President Clinton has proposed a prescription drug plan that would give elderly and disabled beneficiaries the option to purchase a prescription drug benefit that covers half of all drug costs up to $5,000 when fully phased in and includes a stop-loss provision to protect seniors against catastrophic drug costs. The President's prescription drug benefit is part of a larger plan to strengthen and modernize Medicare. This plan also includes reforms to make Medicare more competitive and efficient and dedicates $432 billion to Medicare to help pay for the prescription drug benefit and to improve the program's financing, helping to extend the life of its trust fund to at least 2030.

• Supporting Preventive Medicine: HHS and the administration understand that the best way to stay healthy is through preventive medicine. To protect the health of older Americans, Medicare has expanded coverage of mammograms, pap smears, colorectal cancer screening, bone mass measurement for beneficiaries at risk for osteoporosis and other bone abnormalities, and diabetes self-management. This emphasis on early detection and management of disease was a result of the President and Congress working together to expand preventive benefits available to all Medicare beneficiaries through passage of the Balanced Budget Act.

• The National Medicare Education Program: To help Medicare beneficiaries make the best use of new benefits and program flexibility, HCFA is conducting its most extensive education program to date to help answer beneficiaries' questions about Medicare. The comprehensive information program, Medicare & You, provides beneficiaries with accurate, easy-to-understand information about their benefits, rights, and health insurance options so they can become more active participants in their health care decisions. It is the largest and most comprehensive educational effort in the history of Medicare.

• The program includes the Medicare & You handbook, mailed to all Medicare beneficiary households every fall (and each month to new beneficiaries), which includes an overview of Medicare, descriptions of the rights and protections of all beneficiaries, listings of new preventative benefits, and descriptions of available health plan options, including Medicare health maintenance organizations and private fee-for-service plans. In addition, the education campaign offers a toll-free Medicare helpline at 1-800-MEDICARE (1-800-633-4227) as well as an alliance of more than 200 national and local organizations committed to educating Medicare beneficiaries about the benefits available to them. Finally, the campaign includes the Medicare beneficiary Internet site, www.medicare.gov. Information on the site includes:

1. The Medicare & You handbook;
   
2. Medicare Compare, a database including detailed comparisons of the benefits, costs, consumer satisfaction survey results and standardized quality measures of available Medicare managed care plans;
   
3. Nursing Home Compare, a database providing detailed information about individual nursing homes across the country, including state survey results; and
   
4. A calendar of Medicare & You activities across the nation;
   
5. Lists of resources for beneficiaries;
   
6. Information about individual Medigap policies.
   

• The Healthy Aging Project: In 1998, HHS launched a $3.7 million five-year project to identify the best ways to promote health and prevent physical decline among older Americans, particularly Medicare beneficiaries. The Healthy Aging Project is designed to identify strategies that have been successful in promoting a healthy aging experience and will find and test ways to reduce behavioral risk factors and encourage the use of preventive medicine. Health care providers will be able to use this information to improve the delivery of preventive services.

LONG-TERM CARE

By 2030, one of every four Americans will be 60 years old or older. As the baby boom population approaches retirement, a comprehensive and reliable system for providing long-term care will be imperative to meet the needs of this aging population.

For those who use the formal long-term care system, such as nursing homes and home health care, Medicaid is the primary public payer, covering 31% of long-term care expenses in 1995. Initially, Medicaid coverage of long-term care was limited to services provided in institutional settings, like nursing homes. However, in an effort to provide the most cost-effective services and in response to clear indications that consumers want a choice to receive services at home, states have now been given substantial flexibility to provide home- and community-based personal care services under waivers in the Medicaid program.

Secretary Shalala and the Clinton administration have set a new national policy direction for long-term care that promotes home- and community-based services, emphasizes choice for consumers, and offers protections to individuals who live in institutional facilities like nursing homes. Current long-term care programs and initiatives include:

• Long-Term Care Initiative: Families are the mainstay underpinning long-term care for older persons in the United States. According to the most recent National Long Term Care Survey (1994), more than 7 million people in America are informal caregivers providing unpaid help to older relatives. These individuals often take on the emotionally and financially straining role of being a caregiver while supporting their own families. To provide the assistance these families need, President Clinton's fiscal year 2001 budget includes a $3,000 tax credit for people with long-term care needs or their caregivers that makes an investment in long-term care of $26.6 billion over 10 years. In addition to the tax credit, the initiative will: provide funding for services that support family caregivers of older persons; improve equity in Medicaid eligibility for people in home- and community-based settings; encourage partnerships between low-income housing for the elderly and Medicaid; and encourage the purchase of quality private long-term care insurance by federal employees.

• Home and Community Based Services Work Group: In September 1997, Secretary Shalala committed HHS to working with the states to make home- and community-based services more accessible to older persons who need them through the creation of the Home and Community Based Services Work Group. The group established and is setting programs in place to meet three overall goals:
  1. Reduce unnecessary nursing home use by providing incentives to states to transition individuals who can and wish to live in the community out of institutions and into home- and community-based settings.

  2. Develop a technical assistance primer to explain to states how they can capitalize on the flexibility of the Medicaid program to implement comprehensive and efficient systems for home- and community-based services.

  3. Develop a state-specific technical assistance program that supports state efforts to provide consumers of long-term care with a greater array of choices for services.

• Nursing Home Quality Initiative: About 1.6 million elderly and disabled Americans receive care in nearly 17,000 nursing homes across the United States. Under the Medicare and Medicaid programs, states have the primary responsibility for conducting on-site inspections and recommending sanctions against nursing homes that violate health and safety requirements. The Clinton administration has made ensuring the health and safety of nursing home residents a top priority. In 1995, HHS issued the toughest nursing home regulations in the history of the Medicare and Medicaid programs. Those reforms led to measurable improvements in quality of care for nursing home residents, and HHS has continued its vigilance to protect nursing home residents through the Nursing Home Quality Initiative. Examples of actions taken under this comprehensive initiative include:

1. HCFA instructed states to impose immediate sanctions, such as fines, against nursing homes in more situations -- including any time that a nursing home is found to have caused harm to a resident in consecutive survey cycles.

2. HCFA gave states expanded authority to notify nursing homes when they would be denied payments for new admissions and other sanctions for failing to meet health and safety requirements.

3. Nursing Home Compare, HCFA's Internet resource for consumers, now includes more data about residents' health status at every Medicare- and Medicaid-certified nursing home.

4. Consumers now can use HCFA's updated "Guide to Choosing a Nursing Home" to take families and friends step-by-step through the process of identifying an appropriate home for a loved one.

5. The administration has added new enforcement tools and strengthened federal oversight of nursing home health and safety standards. For fiscal year 2000, the President requested and secured more than $50 million in new resources to support the nursing-home initiative, including $18.1 million more for states' Medicare survey efforts and another $15.6 million in Medicaid matching funds available to states.

SERVICES

Primarily through the Administration on Aging (AoA), HHS oversees numerous programs to provide essential services such as nutrition, supportive, transportation, and in-home services, to older Americans who need assistance. AoA provides leadership in the federal government for the organization, coordination, and provision of supportive home- and community-based services and for generating new opportunities for meeting the needs of older adults and their caregivers. AoA's fiscal year 2000 budget included $933 million for programs and services for the aging. The president's fiscal year 2001 budget increases that commitment for the nation's growing elderly population to $1.1 billion.

AoA is not only the nation's focal point and advocacy agency for older persons; it also provides funds to support programs and services, and it assists in protecting the rights of vulnerable and at-risk older persons. Working in close partnership with other agencies in HHS and throughout the executive branch of government, AoA leads a national aging network of 57 State Offices on Aging, 655 Area Agencies on Aging, 225 Tribal organizations representing 300 tribes, and thousands of service providers, senior centers, caregivers, and volunteers. AoA initiatives include:

• Fostering independence is a priority in 2000. Some 3 million to 4 million older individuals rely on care from family and close friends to remain at home. The role of the caregiver is difficult; half are over the age of 65, the majority are women, and one-third have full-time jobs. New support for family caregivers is a component of the President's Long-Term Care Initiative and a priority for AoA. The President's fiscal year 2001 budget request for AoA includes $125 million to provide quality respite care and other supportive services to an estimated 225,000.

• The Eldercare Locator, a national toll-free service (1-800-677-1116), helps callers find necessary, convenient services and resources for their older loved ones in their own communities or throughout the country.

• Insurance, Benefits, and Pension Counseling Programs help older Americans access their pensions and make informed insurance and health care choices.

• Long Term Care Ombudsman Programs are elder rights protection programs that investigate and resolve complaints made by or for residents of nursing, board and care, and similar adult care homes. AoA supports the training of thousands of paid and volunteer long term care ombudsmen, insurance counselors, and other professionals who assist with spotting and reporting fraud and abuse in nursing homes and other settings.

• The Elderly Nutrition Program helps older Americans build a foundation for health through improved diets, increased physical activity, and improved lifestyle choices by providing: nutritious, satisfying meals in community settings five days a week; nutritious satisfying home-delivered meals, also known as Meals-on-Wheels, to homebound older adults, five days a week; nutrition and health promotion education to improve health behaviors; nutrition counseling to help manage nutrition-related chronic diseases; and linkages to other supportive and health-related services, such as physical activity or fitness classes and health screenings.

• The Initiative to Eliminate Racial and Ethnic Disparities in Health, an HHS-wide initiative, is also an imperative for AoA. AoA's commitment focuses on three key areas: diabetes, cardiovascular disease, and adult immunizations as they relate to minority elders. AoA seeks to prevent or delay the onset of diabetes, cardiovascular disease, influenza, and pneumococcal diseases through the strategic use of nutrition programs, information outreach programs, the adoption of culturally appropriate strategies, and methods that assure increased access to services for those in greatest economic and social need, particularly low-income minorities.

• Tribal Title VI programs fund services designed to meet the needs of older American Indians, Alaska Natives, and Native Hawaiians. Under Title VI of the Older Americans Act, grant awards are made directly to tribal and native organizations representing Native American Indian, Alaska Natives, and Native Hawaiian organizations to provide supportive and nutrition services, including congregate and home-delivered meals. In 1999, a total of $18,475,000 was awarded to 225 tribal organizations and two Native Hawaiian organizations.

• The Mental Health Initiative, a department-wide program to address the mental health needs of individuals of all ages, includes a commitment to research and treatment for older Americans. Older people commit suicide 50 percent more often than those under the age of 65. According to the Surgeon General's Report on Mental Health issued in 1999, depression is the leading risk factor for suicide in older adults but is neither well recognized or treated. The President's fiscal year 2001 budget includes $5 million as part of this initiative to be used by AoA to detect, refer, and provide supportive services to assist older people with receiving help from professionals in the mental health system.

• Additional mental health and substance abuse programs provide further assistance for older Americans. The Substance Abuse and Mental Health Services Administration (SAMHSA) has supported a collaborative project the with the National Council on Aging to identify ways to engage providers of aging services in substance abuse and mental health education, screening, prevention, treatment referrals and follow-up activities. Working with the Health Resources and Services Administration and other HHS agencies, SAMHSA is evaluating various methods of delivering and financing mental health and substance abuse services for older adults in primary health care settings. In addition, SAMHSA developed the Treatment Improvement Protocol, designed to assist the health care community to better detect and treat alcohol and medication abuse among older patients. The president's fiscal year 2001 budget includes $3.8 million for mental health and substance abuse programs through SAMHSA.

HHS is also committed to investigating the causes and effects of the aging process to improve the lives of older Americans today and for future generations. The National Institute on Aging (NIA), one of the 25 institutes and centers of the National Institutes of Health (NIH), leads a broad scientific effort to understand the nature of aging and to extend the healthy, active years of life. In 1974, Congress granted authority to form the NIA to provide leadership in aging research, training, health information dissemination, and other programs relevant to aging and older people. Subsequent amendments to this legislation designated the NIA as the primary federal agency on Alzheimer's disease research.

Funding for NIA programs in fiscal year 2000 is $686 million. The President's fiscal year 2001 budget increases that investment to $726 million. Total spending for all NIH research related to aging in fiscal year 2001 is proposed at $1.5 billion. Examples of projects to assist the aging currently underway at NIA include:

• The Biology of Aging Program supports research to determine the biochemical, genetic, and physiological mechanisms of aging. This includes investigations of the gradual effects of normal aging, as well as investigations of the changes that are risk factors for age-related disease. The ultimate goal is to reduce and eventually delay age-related ailments.

• The Neuroscience and Neuropsychology of Aging Program supports research and training to improve the understanding of the aging process as it relates to the nervous system. An important component of this program is the Alzheimer's Prevention Initiative to support basic, clinical, and epidemiological studies of Alzheimer's disease and related dementias of aging.

• The Behavioral and Social Research Program supports basic social and behavioral research on aging processes and the place of older people in society. It focuses on how people change with aging, on the interrelationships between older people and social institutions - such as the family and health-care systems - and on the impact that the rapidly growing elderly population will have on American society.

• The Geriatrics Program supports research directed at the diagnosis, treatment, and prevention of age-related diseases, degenerative conditions, and disabilities. An issue of special relevance is physical frailty, for example, studying deficits in strength, mobility, balance, and endurance.

• The Epidemiology, Demography, and Biometry Program studies patterns of diseases in selected populations groups and communities with the goal of understanding more about risk factors related to the aging process. Its research emphasizes three areas: physical function and disability, cognitive function and dementia, and age-associated diseases and conditions.

• The NIA Intramural Research Program has played an important role in research on aging. The long-term goals of the program are: 1) to develop and sustain a broad, basic program relevant to understanding aging processes and age-associated disabilities; and 2) to develop biological, pharmacological, and other interventions to prevent or retard age-associated diseases and disabilities including Alzheimer's disease, cardiovascular disease, frailty, osteoporosis, cancer, incontinence, metabolic disturbances, osteoarthritis, and hypertension.

• The Alzheimer's Disease Education and Referral Center provides information about Alzheimer's disease, its impact on the family and health professionals, and research into the possible causes and cures for the disease. Health information for older Americans is available at 1-800-222-2225.

In addition to research programs conducted through NIA, HHS' Agency for Healthcare Research and Quality (AHRQ) conducts numerous studies on health costs, quality and outcomes. Biomedical and clinical research has made great progress in identifying ways to prevent and treat common conditions associated with aging, thereby improving the health of those who suffer with age-associated chronic illness. Research conducted by AHRQ has provided new and practical information on priority topics for older Americans, such as disease prevention, managing health problems and long-term care.

Finally, the Office of Disability, Aging and Long Term Care Policy (DALTCP), within the Office of the Assistant Secretary of Planning and Evaluation, also engages in aging research. DALTCP is currently sponsoring research on the assisted living industry, focusing on issues such as the supply of assisted living facilities and the degree to which the industry meets the needs of disabled elderly. In addition, DALTCP is supporting research that examines the experience of frail elders in selected Medicare managed health plans to determine the degree to which managed care meets the needs of disabled and chronically ill elders. Finally, DALTCP supports research that examines the issues confronting the key resources used by the elderly - such as health, long-term care and pension and retirement systems - as they struggle under the pressures of the sheer number of aging baby boomers.

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Note: For other HHS Press Releases and Fact Sheets pertaining to the subject of this announcement, please www.os.dhhs.gov/news/press/ .