First Review and Appraisal of the Madrid International Plan of Action on
Ageing

United States of America

June 2007

Table of Contents

Section I: Introduction Page 3

Section II: Background Page 3

Section III: Advancing Health and Well Being into Old Age Page 6

Section IV: Older Persons and Development Page 10

Ensuring Enabling and Supportive Environments

Section V: Advancing International Collaboration Page 16

Section VI: Role of Civil Society in Implementing Page 17

the MIPAA

**Section I: Introduction**

This report is in response to the United Nations (UN) request for
information on progress UN Member States have made in implementing the
Madrid International Plan of Action on Ageing (MIPAA) 2002. Member
States will have the opportunity to present this information at the
February 7-16, 2007, meeting of the UN Commission for Social
Development. Following the UN Secretariat suggestion to Member States,
this report will:

1.  Indicate the priority area for review; and

2.  Identify laws, regulations, institutions, policies, and programs
    that have been introduced or altered in response to the MIPAA.

**Section II: Background**

The United States (U.S.) of America affirms its commitment to the themes
the MIPAA addresses. In her address to the Second World Assembly on
Ageing in 2002, the U.S. Department of Health and Human Services (HHS)
Assistant Secretary for Aging, Josefina G. Carbonell, stated:

"For the United States Government, the continued improvement in the
lives of older Americans and their families is a priority...We are
committed to strengthening and modernizing our health insurance program
for the elderly, improving access to health care, expanding prescription
drug benefits, and preventing diseases."

The body of this report (Section III) highlights major initiatives being
advanced that address Priority Area 2 of the MIPAA -- Advancing Health
and Well Being into Old Age. Initiatives in Priority Area 2 include:

-   Empowering our citizens by giving them more choices and greater
    control over their own health--- and their health care--- including
    more control over the types of benefits and services they receive
    and the manner in which those providers deliver those benefits and
    services.

-   Moving towards a more balanced system of long-term care that
    respects the wishes of the individual and that dismantles the bias
    toward institutional care in favor of home and community-based
    services.

-   Changing our reimbursement policies to make prevention benefits more
    widely available, and promoting the rapid translation of research
    into practice.

-   Encouraging more competition in health and long-term care and
    greater involvement by the private commercial sector in offering new
    products and services to a growing private-pay market.

[Section IV]{.underline} provides highlights of progress made in
Priority Areas 1 -- Older Persons and Development- and Priority Area 3
-- Ensuring Enabling and Supportive Environments. [Section
V]{.underline} highlights the Administration's international aging
cooperation efforts. [Section VI]{.underline} highlights major
initiatives of civil society, particularly of AARP, the largest NGO for
the elderly in the U.S.

The U.S. is experiencing unprecedented growth and diversity in its aging
population. By 2030, almost 20 percent (approximately 71.5 million) of
all Americans will be 65 or older. Those aged 85 and older are the most
rapidly growing segment of our population. As our post-Second World War
"baby boom" generation ages, this number is expected to increase even
more. At the same time that these demographic changes are occurring, we
are also witnessing sweeping and fundamental transformations in the way
we think about and deliver health and long-term care.

Our system of long-term care is supported by a variety of public and
private sources, with the largest share coming from the personal
contributions and efforts of family caregivers. Families account for
nearly 80 percent of all the long-term care provided in the U.S. Today
nearly 21 percent of all American households have taken on some form of
caregiving responsibility. Many Americans, mostly women, are caring for
both children and aging parents.

The economic value of this informal care is significant. The HHS has
estimated that replacing informal long-term care services for seniors
with professional care would cost as much as \$306 billion a year.

When it comes to public financing for long-term care, our largest source
of funding comes from Medicaid -- a joint federal/state program that
provides health care to people who have limited incomes and assets or
who are disabled.

When Medicaid was enacted in 1965, it was designed as a program for poor
families. Because it was the only public source of financing for nursing
home coverage, it quickly became our nation's long-term care program and
it helped to create a system of care for our seniors that is dominated
by expensive nursing homes. Nationally, institutionally based care
accounts for as much as 70 percent of long-term care spending in
Medicaid and some states are spending over 90 percent of their long-term
care budgets on nursing home care. This approach to long-term care does
not reflect the overwhelming preference of older people to receive care
at home, and it is also a financially unsustainable policy.

**Bottom-Up Approach**

Providing the elderly, their families and organizations representing the
interests of older persons an opportunity for input is at the core of
our approach to programs and services for adults as they age. In
addition to the elderly, their families, and persons with disabilities,
our stakeholders include federal, state, and local governments, business
and industry, national and local organizations and coalitions,
non-profit organizations, health and social welfare organizations and
academic institutions. This "Bottom-Up" approach is described below.

*Local and National Planning Activities: The Older Americans Act*

In the U.S., our foundation for addressing the issues of aging is the
Older Americans Act (OAA), further described in Section III. The OAA
relies on a philosophy of planning from bottom to top. Our programs are
created through the priorities set at the national level together with
the needs expressed in states and local communities.

Our state and local planning agencies are required to submit plans of
action showing the types of services they plan to create and provide,
based upon citizen input, advisory committees, and public hearings. The
state and local advisory committees consist of representatives of
communities, the public and private sector and consumer groups. In
addition, federal officials hold "listening sessions" around the country
to receive input on the needs of older persons. This "bottom up" model
has proven successful for over 40 years and has resulted in continuous
policy improvement and in community-based services reflective of the
input of local citizens. This approach is consistent with the methods
outlined for the follow-up to the MIPAA.

*Local and National Planning Activities: White House Conferences on
Aging*

A future-oriented planning process used in the U.S., and outlined in the
OAA, is the White House Conference on Aging (WHCoA). These conferences
are held approximately every ten years and are designed to provide input
and recommendations to the President and Congress. They are models of
citizen participation to develop and evaluate policies and programs.
Stakeholders include local communities, academic institutions, business
and industry, national and local organizations, non-profit
organizations, and federal, state and local governments.

The first official conference was held in 1961, and the most recent
conference in December 2005. These conferences have outlined the
foundation for key legislation and programs, such as the enactment of
Medicare, Medicaid and the OAA.

The input process for the 2005 WHCoA included more than 400 events
convened around the country and involved more than 130,000 citizens.
Over 3,000 people participated in the conference, including 1200
delegates representing every sector of society. Forty-two International
Observers also attended from twenty-three countries.

Delegates discussed, debated and agreed upon 50 resolutions to send to
the President and Congress to help guide national aging policies for the
next ten years and beyond. In addition, thousands of Implementation
Strategies were developed. A description of this bottom up input process
and a listing of the resolutions are contained in the final report which
can be found at: [http://www.whcoa.gov](http://www.whcoa.gov/).

Evaluations have shown that the OAA has created flexible policies,
programs and services that respond to the needs identified by consumers
through our "bottom up" process.

Section III provides further details on how the U.S. is realigning its
health and long-term care systems to give consumers more choice and
control.

**Section III**

**Advancing Health and Well Being into Old Age:**

**Progress Made Since 2002**

This section will provide more details on how the Federal government is
leading the way in responding to many of the actions recommended by the
MIPAA pertaining to advancing health and well being into old age. As
mentioned in Section II, we are in the process of transforming and
rebalancing our health and long-term care systems. We have made
impressive strides to empower individuals to make informed choices,
target our resources to high-risk individuals, and build prevention into
community-living. Some of our significant activities to date include:

*President Bush's New Freedom Initiative*

One of the first official acts President Bush took when he came into
office was to create the New Freedom Initiative. This initiative
outlined his vision for maximizing the independence and dignity of
people with disabilities of all ages in the U.S. Central to that vision
is a fundamental rebalancing of our system of long-term care and
supports to emphasize providing care in the least restrictive setting
and on giving people more choices and control over their care options.
Our system has been biased toward more expensive institutional care --
the opposite of what older people and their families want. The
fundamental goal of this initiative is to remove barriers that prevent
people with disabilities of all ages from living independently at home
and fully integrated in their communities. Since 2001, the HHS, with the
support of Congress, has provided states and communities with a variety
of new tools to help them advance the goals and values embedded in the
New Freedom Initiative.

*The Older Americans Act*

The OAA is national legislation created in 1965 as part of a
comprehensive package of social welfare legislation designed to combat
poverty. The OAA complemented Medicare, which provides insurance
coverage for healthcare, and Medicaid, which provides health, long-term
care and nursing home care for low-income individuals and persons with
disabilities.

The overall goal of the OAA is to enable older individuals to maintain
their dignity and to live independently in their own homes and
communities. The OAA established a national infrastructure of home and
community-based services and established the Administration on Aging
(AoA) within the HHS to serve as a "Federal Focal Point" on issues
related to aging.

The OAA provides leadership and support through the HHS to a nationwide
network of organizations and individuals -- the Aging Services Network
\-- whose mission is to enable older citizens to remain in their own
homes and communities as long as possible. In the last few years, the
Aging Services Network has taken on a central role in the transformation
of health, and most importantly long-term care services in the U.S.

The OAA provides about \$1.5 billion in funding each year to the states,
and leverages at least twice that amount, to support a wide range of
home and community-based social and supportive services, such as
congregate and home-delivered meals, adult day care, senior centers,
specialized transportation services, health promotion-disease
prevention, and supports for caregivers.

The recently reauthorized OAA (2006), which governs the work of the AoA,
advances the President's New Freedom Initiative and also affirms the
commitment to health promotion and disease prevention, value and
ownership. The OAA embeds the principles of the Administration's Choices
for Independence initiative. The legislation modernizes community based
long-term care systems to further empower consumers to manage their own
care and make choices that will allow them to avoid unnecessary
institutional care and live healthy lives in the community.

One of our major initiatives builds on the fact that the Aging Services
Network is viewed by older people and their families as a "trusted
source of information". In 2003, AoA partnered with the Centers for
Medicare and Medicaid Services (CMS) to launch the Aging and Disability
Resource Center program. Under this program, over \$40 million in
funding has been provided to the states to establish "single points of
entry" to long-term care at the community level to make it easier for
consumers and their families to learn about the options that are
available in their communities.

These Centers also provide consumers with streamlined access to publicly
supported long-term care programs by consolidating multiple
client-intake, assessment and care planning procedures into single,
integrated systems of access.

Together with federal science agencies, AoA is enlisting the Aging
Services Network in the nationwide deployment of low-cost evidence-based
prevention programs that have proven effective in reducing the risk of
disease, disability and injury among the elderly.

This translation of research into practice promotes strategies involving
better nutrition and exercise, fall prevention and the self-management
of chronic conditions that can empower seniors to take more control of
their own health and to reduce healthcare costs.

Finally, OAA programs are assisting the President's initiatives to help
seniors who are at high-risk of nursing home placement -- but not
eligible for Medicaid -- to remain at home. This will give consumers the
option of directing their own care and will become the OAA nursing home
diversion program.

*Presidential Executive Order -- Community-Based Alternatives for
Individuals with Disabilities*

As a complement to the New Freedom Initiative, President Bush issued an
Executive Order directing federal agencies to evaluate and recommend
ways to expand community-based services for individuals with
disabilities.

In response, we have provided our states with more flexibility under the
Medicaid program, and have encouraged them to implement a new model of
self-directed care - Cash and Counseling. This self-directed model gives
clients control over individualized budgets to manage the types of
services and supports they receive, and the manner in which they are
provided, including the option of paying family members, as well as
friends and neighbors, to help them stay at home.

*Federal Agencies -- Real Choice Systems Change*

As part of the New Freedom Initiative, the President authorized funds
for Real Choice System Change Grants to help design and implement
improved ways of providing community supports and services to enable
children and adults of any age who have a disability or long term
illness to live and participate in their communities. Over the last five
years, CMS has provided over \$300 million in funding to help states
realize essential changes to their systems of care to make them more
consumer-directed and more supportive of community-living.

*Congressional Action -- Deficit Reduction Act*

The Money Follows the Person initiative, included as part of the Deficit
Reduction Act (DRA) of 2005 is an essential part of our comprehensive,
coordinated strategy to assist states, in collaboration with
stakeholders, to make widespread changes to their long-term care support
systems. Seventeen states are being assisted in their efforts to further
reduce their reliance on institutional care while developing
community-based long-term care opportunities, enabling the elderly and
people with disabilities to fully participate in their communities. This
initiative will provide \$1.75 billion in new funding over five years to
support states' efforts to transition people out of nursing homes and
back into the community.

The "Own Your Future Campaign" \-- a federal/state partnership of the
HHS and the National Governors Association -- is designed to increase
awareness about the importance of planning ahead for one's long-term
care. To date, we have supported campaigns in 14 states, and we plan to
reach all states within the next four years.

*The National Clearinghouse for Long-Term Care Information.* This is the
first federal web site designed to specifically help consumers plan
ahead for their long-term care. It is designed as a resource focused on
the importance of planning ahead and includes information on services
and financing options -- both public and private \-- that can be helpful
to all individuals. It was developed by the HHS and is found at:
[http://www.longtermcare.gov](http://www.longtermcare.gov/).

*Leveraging Public Funding with Private Financing Approaches.* The
looming retirement of the baby boom generation presents a number of
challenges to our current financing system for long-term care. Its
current reliance on public funds will be tested to the limit as more
than 70 million Americans enter retirement. One of the strategies we are
using to prepare is the development of private/public financing options.
The goal of these options is to encourage Americans to make planning for
long-term care a part of their overall retirement planning. Currently,
only about 4 percent of Americans age 45 and older with incomes of
\$20,000 or more have long-term care insurance coverage. The DRA enables
all states to offer such an incentive through a program entitled the
Partnership for Long-Term Care. This program encourages the use of
private long-term care insurance by offering Medicaid as a form of
re-insurance. The program is designed to make private coverage more
affordable and, therefore, expands the number of people able to purchase
coverage.

A second financing approach is the use of reverse mortgages. This
permits people 62 years of age and older to use the equity in their
homes to help with their expenses, including those related to health and
long-term care.

*Prevention and Healthy Aging*

Just as Medicaid and the OAA have undergone significant changes in the
past five years to better reflect the needs and preferences of consumers
and to improve sustainability, Medicare, too, has undergone a
transformation.

The Medicare Modernization Act resulted in the largest changes in this
public health insurance program in its forty-year history. Medicare now
covers a variety of preventive benefits, including a complete physical
examination when people first join, screening for a variety of diseases
such as cancer so they can be detected and treated early, and of
greatest note, prescription drug coverage.

Additionally, Medicare recipients can now choose from a variety of
competitive private plans to find the one that best serves them. As a
result, seniors are saving money and getting the coverage they want.
Initial results are:

-   Over 90 percent of people with Medicare (39 million) now have drug
    coverage;

-   They are receiving this coverage at a cost that is at least 25
    percent less than what was initially estimated; and

-   Consumer satisfaction rates in excess of 80 percent.

The Aging Services Network, a highly visible and trusted community
source of information for older people, partnered with CMS to
successfully implement the new prescription drug benefit under Medicare.
Affiliates of the Aging Services Network provided the vast majority of
the education, outreach and individualized counseling to the 39 million
seniors who have accessed the benefit.

Building on the success of the prescription drug program, the HHS is now
engaged in a national educational campaign to inform seniors about the
other preventive benefits available through Medicare.

**Section IV**

**Older Persons and Development and Ensuring Enabling and Supportive
Environments:**

**Progress Made Since 2002**

**Introduction**

While the AoA has the primary Federal responsibility for advocating for
the elderly and for providing home and community-based services, a
number of other Federal departments and agencies have programs targeting
or serving the elderly. The following discussion summarizes many of the
Federal initiatives taken since the 2002 MIPAA in the areas of housing,
employment, transportation, and civic engagement.

**Work and Aging**

The American workforce is projected to grow more slowly as a result of
the aging and retirement of the baby boom generation, in combination
with other demographic trends.

At the same time, Americans are living longer and healthier, and could
work later in life.

Surveys indicate that a majority of the baby boom population plans to
continue working past the traditional retirement age. Many of these
older workers will need to continue working in view of the fact that
retirement saving patterns remain extremely low, and financial literacy
in terms of planning for and managing personal economic security over a
20-30 year horizon is generally lacking.

At a time when it is becoming more critical that every available worker
join the workforce, older workers face challenges to full participation
in the labor market. Employment barriers, perceived or real, can
obstruct the normal dynamic of supply and demand for older workers and
their potential employers, and affect the continuing participation of
older workers in the workforce. These barriers range from attributes of
older workers themselves, to misperceptions of employers about the
abilities of older workers, to lack of flexible workplace arrangements,
and elements of the public and private retirement systems in the U.S.

These demographic trends are significant and have received increasing
attention among policymakers, academics, the press, and the general
public. The federal government has a number of efforts underway to
address the aging of the American workforce, several of which are
described below. In addition, employers in the U.S. are taking steps to
address the impact of the aging population on their businesses.

[Work and Retirement Incentives]{.underline}. Many aspects of American
laws and government regulations related to pensions, social security,
health care, and age discrimination complicate the ability of older
individuals to continue working into their later years. Policy
discussions regarding these issues are underway in various forms in the
U.S. recognizing that legislative or regulatory features posing
impediments to work at older ages need to be addressed.

[Taskforce on the Aging of the American Workforce.]{.underline} The
Taskforce on the Aging of the American Workforce, chaired by the DoL,
brings together agencies from across the federal government to work
collectively to address workforce challenges and opportunities of an
aging population. The Taskforce is identifying strategies to help older
Americans remain in or re-enter the labor market and pursue
self-employment opportunities and to enable businesses to take full
advantage of this skilled labor pool.

The Departments of Commerce, Education, Health and Human Services,
Labor, Transportation, and Treasury, as well as the Equal Employment
Opportunity Commission, Small Business Administration and Social
Security Administration participate on the Taskforce.

The Taskforce is focusing on three main areas:

-   [Employer Response to the Aging Workforce]{.underline} -
    opportunities and needs of employers when recruiting, hiring,
    training, and retaining older workers.

-   [Individual Opportunities for Employment]{.underline} - challenges
    posed by older Americans who want to continue to work, such as
    outdated skills, physical limitations, lack of flexible work
    arrangements.

-   [Legal and Regulatory Issues Regarding Work and
    Retirement.]{.underline} - approaches to reform laws and regulations
    pertaining to pension plans, Social Security benefits, tax policy
    with respect to retirement savings, unemployment programs, and
    others.

A report of findings and a blueprint for strategies for government
agencies, business, aging, and workforce communities is due in summer
2007.

[The Workforce Investment System]{.underline}. This system created local
One-Stop Career Centers which provide access to numerous employment and
training programs administered by a variety of federal agencies. Through
partnerships with local employers, community colleges, and training
organizations, the One-Stop system connects jobseekers of all ages,
including older workers, with opportunities for employment or skills
enhancement.

In 2005, DoL issued the *Protocol for Serving Older Workers* -- a guide
to serving older individuals in One-Stop Career Centers. The goal is to
enhance the services provided to older workers, and to infuse the
One-Stop Career Centers with innovative strategies for tapping into this
underutilized labor pool.

[Senior Community Service and Employment Program]{.underline}. As part
of the Workforce Investment System, the Senior Community Service
Employment Program (SCSEP) provides job training and placement services
for low-income individuals aged 55 or older. Program participants are
placed at community and government agencies and paid the higher of the
federal, state or local minimum wage, and they also receive assistance
with moving into unsubsidized employment. Approximately 100,000 older
workers participate in SCSEP each year.

The National Employ Older Workers Week showcases the SCSEP efforts. It
increases awareness and focuses on development of innovative strategies
for tapping into this underutilized labor pool.

[A Study Addressing the Retention of an Aging Nursing and Allied Health
Workforce]{.underline}. The critical shortage of healthcare workers is
due in part to a significant segment of the healthcare workforce nearing
retirement age. The DoL is working with state and private entities in
the labor and healthcare fields to find ways to improve the workforce
needs of the healthcare industry, including improved retention of nurses
and allied health workers.

[Employer Strategies]{.underline}. Efforts to address the impact of an
aging workforce are occurring within the Federal government and in the
private sector as well. While wide-spread recognition of the impacts of
the aging population has not occurred among businesses, many American
employers are taking steps to increase the hiring and retention of older
employees in order to meet their skill and labor force needs now and in
the future. Some of these efforts include: offering phased retirement
programs, in which employees can reduce their hours or level of
responsibility; restructuring the workplace to make the work less
physically demanding; offering flexible work arrangements, such as job
sharing, part-time work, or compressed work schedules; providing
assistance with planning for retirement; offering support for caring for
dependents; and creating an "on call" pool of retired workers who are
re-hired to work on temporary projects.

[Pensions]{.underline}. The Employee Retirement Income Security Act
(ERISA) 1974 governs private, employer-sponsored pensions and health and
welfare plans. The DoL oversees the integrity of ERISA-covered plans.

Congress and the President are concerned about weaknesses in the
security of traditional private pensions, as well as the adequacy of
private savings to compliment retirees' income from pensions and Social
Security. In 2006, Congress enacted the Pension Protection Act (PPA) to
amend ERISA. The PPA ensures fuller funding for defined benefit pension
plans and encourages greater participation in employment-based
retirement savings plans. It allows for a form of phased retirement in
which a pension plan may make retirement distributions to employees age
62 and over without the employees having to separate from employment.
The DoL is working to put the PPA into action through new regulations
and guidance for voluntary employer programs.

Although the U.S. is preparing for demographic change in the country,
the aging of the American workforce poses challenges that will require
further action. By seeking ways to enable greater workforce
participation by older Americans, the country can increase opportunities
for older individuals who want to or need to remain in the workforce;
ease the strain caused by an aging population on the American
government's ability to pay for or guarantee retirement programs and
other public services; help businesses meet their workforce needs; and
help America ensure a skilled workforce.

**Transportation and Aging**

The U.S. Department of Transportation (DoT) is committed to ensuring
transportation safety and security for older Americans. Among the
highlights since 2002:

In 2003, the DoT released ***Safe Mobility for a Maturing Society:
Challenges and Opportunities*,** a set of transportation strategies to
address the needs of the older population. Strategies include:

1.  Building safer, easier-to-use roadways and walkways;

2.  Improving systems for assessing competency of older drivers and
    pedestrians;

3.  Creating better, easier-to-use public transportation services; and,

4.  Targeting state and local action plans.

The DoT has been actively implementing these strategies through
demonstration programs, policies, and other tactics that are designed to
meet the requirements of the Americans with Disabilities Act (ADA) and
to ensure safe mobility of older people.

**Executive Order on Human Services Transportation Coordination.**

In 2004, President Bush signed this Executive Order creating the Federal
Interagency Council on Access and Mobility (CCAM). Under this order,
eleven Federal departments and agencies joined together with the
leadership of the Federal Transit Administration (FTA) to improve
transportation service delivery for older adults, people with
disabilities, and individuals with lower incomes.

This effort launched the ***United We Ride*** (UWR) initiative to
enhance human service transportation coordination, creating a "One Call"
simplified access systems for older adults and other human service
program customers.  Currently a major demonstration initiative is
underway in eight U.S. sites. Policy statements on coordinated
transportation planning at the local level and encouraging sharing
transportation vehicle resources have also been developed.  A widely
accessible web site provides one-stop information on federal programs,
useful practices and transportation tools to better meet the
transportation needs of older adults and other target populations.

 

To implement these activities, FTA and AoA are working together to
address transportation issues unique to older adults. They have
established a ***National Center on Senior Transportation*** and are
cooperating on a number of activities to support improved public
transportation and specialized transportation services, including a new
senior transportation resources tool kit for communities.

In 2006, the National Highway Traffic Safety Administration (NHTSA)
released its ***Older Driver Plan*** that responds to many specific
components of the MIPAA. It covers research, outreach, and other program
activities. Key areas include improving screening and assessment,
improving licensing, educating medical providers, conducting better
education and outreach activities, and conducting other research to
address older driver safety.

NHTSA has a long-standing effort to improve the availability of
screening and assessment of older drivers through medical providers and
other key groups such as licensing and aging services providers. The
Agency has educational materials available regarding vehicle adaptations
for persons with disabilities; materials regarding vehicle adaptations
for older people will be released in 2007.

NHTSA works in partnership with other agencies within the Department,
including FTA and the Federal Highway Administration to promote safer
roads and the availability of transportation options.

The FTA continues to promote formula based funding to States for capital
grants to non-profit and public transportation organizations for public
transportation projects that will meet the special needs of older
persons or persons with disabilities. The FTA legislative policies and
requirements help to coordinate transportation services for older people
and provide reduced fares of older adults. Recent legislation authorized
funding of mobility managers to assist older adults find rides,
coordinate transportation providers and funding sources and aid
individuals with trip planning.

**Housing and Aging**

The U.S. Department of Housing and Urban Development (HUD) faces two
unique senior housing challenges: housing seniors of limited means and
housing those with some level of accumulated assets. HUD's programs,
where appropriate, promote community-based living opportunities for the
elderly and persons with disabilities, and make supportive services
available to residents of rental housing, enabling them to live as
independently as possible in the most integrated setting.

HUD operates a number of programs either targeted specifically to the
elderly or in which the elderly can participate. HUD's ***Section 202
and Section 811*** programs for elderly households and persons with
disabilities are unique among HUD programs in providing the only
construction financing program for affordable supportive housing for the
target population. HUD is strengthening the programs by working
collaboratively with HHS to increase the availability of assisted living
facilities for low-income seniors, especially through coordination with
states that have Medicaid waivers.

The overall aging of the population, and the commensurate need for
senior housing, has prompted HUD to make some changes in a variety of
its programs, including Section 202 which provides affordable housing
units, many with supportive services.

Since 2002, HUD continues to add new units of Section 202 housing.
Funding will provide: construction of new units, congregate services,
service coordinators, funding to convert projects to assisted living,
and funds to renew and amend existing contracts.

In the FY 2008 budget, the Department proposes an innovative
demonstration program aimed at increasing the production of Section 202
units. HUD\'s FY 2008 budget also includes a demonstration project to
utilize housing tax credits and other housing resources (tax-exempt bond
financing, HOME Program, private grants, etc.) to expand production
under the Section 202 program.

HUD, through the Federal Housing Administration (FHA), has a reverse
mortgage insurance program targeting senior homeowners. The ***Home
Equity Conversion Mortgage*** (HECM) enables senior homeowners to
convert the equity in their homes into tax-free income. FHA-insured
mortgages account for over 90 percent of the reverse mortgage market.

This program once served primarily single women, presumably widows, who
had very little or no income and nowhere to turn for help. The program
continues to grow in size and has slowly shifted over the past decade to
attract more couples with higher incomes and more expensive homes. The
HECM program has a statutory limit of 275,000 loans that FHA can insure.
HUD is working to permanently eliminate this cap.

HUD is also proposing a legislative change that would permit HECMs for
home purchase. One of the best ways to serve seniors well is to permit
them to move to alternative housing, whether it\'s a senior community
that offers appropriate amenities and services or simply a smaller,
easier-to-maintain home. A legislative change would permit FHA to offer
a HECM product that would enable seniors to purchase a home and tap into
the equity in their old one in a single transaction.

**Volunteerism for and by the Elderly**

Volunteers of all ages have traditionally been the backbone of community
services in the non-profit sector. Hundreds of thousands of volunteers,
including the elderly, support the services provided under the OAA.

The Corporation for National and Community Service (the Corporation), a
Federal agency, oversees three national programs under the umbrella of
Senior Corps:  Foster Grandparent; Senior Companion; and RSVP. They were
specifically developed to engage adults aged 55 and over in volunteer
activities that help support critical community needs.  Foster
Grandparents tutor and mentor children at risk of failing in schools;
Senior Companions help frail and elderly citizens remain independent in
their homes; and RSVP volunteers support an array of activities that
support the missions of numerous social organizations in local
communities.  Older adults also serve in AmeriCorps and Learn and Serve
America, two other CNCS programs.  

 

America\'s aging adult population includes a generation of healthier,
more active and well-educated Baby Boomers (individuals born between the
years of 1946 and 1964) which prompted the Corporation to include the
recruitment of Baby Boomers as one of the initiatives in its five year
strategic plan.  The talents and skills of individuals from this
generation will be used in volunteer service activities that meets
critical local and national needs, including engaging 250,000 more
adults in activities that support independent living services for the
frail elderly. 

To support this effort, the Corporation developed a national public
service recruitment campaign titled \"Get Involved.\"   The campaign,
which features bilingual newspaper, magazine, radio and
television announcements, is supported by numerous American nonprofit
organizations, private-sector organizations and media organizations.

Individuals are directed to a
website, [www.getinvolved.gov](http://www.getinvolved.gov/) to find
volunteer and community service opportunities that best meet their
interest, needs, experience and lifestyles.

The campaign will also be used to stimulate a public dialogue about the
meaning and purpose of life as one reaches the traditional age of
retirement.  It also encourages all sectors --- nonprofit, business, and
government --- to take actions to support greater involvement of Baby
Boomers in volunteering.

Over the next five years, the Corporation will also build on its
experience to focus on 1) how nonprofit organizations might assess how
the skills of this group can be tapped in unique and creative ways;
2) supporting and strengthening its own programs through the engagement
of Baby Boomers especially in AmeriCorps and Senior Corps where older
adults serve to a lesser degree; and 3) exploring strategies to support
nonprofit organizations in using the unique skills of Baby Boomers.

**Section V:**

**Advancing International Collaboration**

The U.S. government recognizes that aging is a global issue impacting
global economy, labor force, trade, migration, international relations,
and national security. To catalyze greater international dialogue on
these challenges, the U.S. Department of State hosted a *Summit on
Global Aging* in March, 2007, inviting members of the international
community.

Secretary of State, Condoleeza Rice, stated that "The impact of global
aging is enormous and complex. One of the key goals of this summit is to
begin a conversation that will stimulate dialogue, encourage,
collaboration, and promote national and international research."

*Why Population Aging Matters: A Global Perspective* was released at the
Summit. This report, co-published by the National Institute on Aging and
the State Department, used data from the United Nations, U.S. Census
Bureau, and Statistical Office of the European Communities as well as
regional surveys and scientific journals, the U.S. National Institute on
Aging (NIA), with input from demographers, economists, and experts on
aging, identified nine emerging trends in global aging. Together, these
trends present a snapshot of challenges and opportunities that clearly
show why population aging matters.

The Administration's concern for global aging goes beyond research. It
also involves translating research into practice, and exchange of
information and best practices. In the Western Hemisphere in particular,
the U.S. is actively involved in improving health care for all ages,
including the elderly.

The President's Health Diplomacy for the Americas includes the direct
involvement of personnel from HHS and the U.S. Department of Defense in
medical care for poor and rural populations in the region.

In addition to treating some 85,000 patients and conducting 1,500
surgeries on a U.S. Navy ship, dentists will provide basic treatments
and offer preventive education on oral health and hygiene to children
and their parents and grandparents.

The Assistant Secretary for Aging joined Secretary Leavitt in the
Central American part of the President's Health Diplomacy Initiative.
She visited El Salvador, visiting elderly facilities and meeting with
the country's Minister of Health and National Secretary of the Family.

**Section VI:**

**Role of Civil Society in Implementing the MIPAA**

**Introduction**

As described in Section II, Bottom Up Approach, civil society is
intrinsically involved in planning of programs under the OAA. The AoA
works closely with the Aging Network, comprised of 56 State Units on
Aging; 655 Area Agencies on Aging; 236 Tribal and Native organizations
representing 300 American Indian and Alaska Native Tribal organizations;
and two organizations serving Native Hawaiians, plus thousands of
service providers, caregivers, and volunteers.

Many of these organizations have national organizations which are
members of the Leadership Council of Aging Organizations (LCAO), a
coalition of 53 national nonprofit associations dedicated to preserving
and strengthening the well-being of America's older population and
committed to representing their interests in the policy-making arena.

Activities of these organizations fall within the purview of the MIPAA.
As AARP is the largest NGO, representing the interests of 35 million
people age 50 and over, the summary below concentrates on some of their
accomplishments in the three MIPAA priority areas.

**Priority I: Older Persons and Development**

Through a grant from the DoL, the AARP operates the Senior Community
Service Employment Program (SCSEP) to help low-income seniors improve
their skills, obtain training, and find a job. Today, AARP SCSEP has
nearly 80 project sites in 22 states and Puerto Rico. About 10,000 job
seekers are enrolled at any one time.

AARP continues to honor and highlight employers through the Best
Employers for Workers over 50 award that draws significant attention to
the importance of older workers in the changing workforce.

AARP's supports a number of intergenerational activities. AARP is
working with public schools to provide school supplies for needy
students. It is also partnering with a number of other faith based and
national organizations, such as Big Brothers Big Sisters, to promote
intergenerational activities.

**Priority II: Advancing Health and Well Being into Old Age**

Along with a host of NGOs from the LCAO, AARP has actively helped
implement the Prescription Drug Benefit under the Medicare program. AARP
developed a major campaign to inform and educate its members and others,
especially low-income elderly, about the drug discount cards and the
importance of enrolling in the benefits under Medicare.

AARP has done extensive work on a drug-affordability campaign and is
working to reduce prices so prescription drugs are more affordable. The
AARP Rx Watchdog Reports and research forums were instrumental in
keeping the spotlight on rising drug prices.

AARP made progress, especially in the states, on home- and
community-based services, improving quality in nursing homes, and a
multi-state walking campaign to promote physical activity.

**Priority III: Ensuring Enabling and Supportive Environments**

AARP created a framework for future progress on livable communities. It
developed a mobility blueprint to guide thinking on transportation
issues and supported an extension of the Transportation Equity Act for
the 21st Century.

The Reverse Mortgage Project increased its outreach and continued to be
the nation\'s leading source of information on reverse mortgages.

AARP developed a 5-year partnership with Fannie Mae, a private company
operating under a congressional charter to increase the availability and
affordability of homeownership for low, moderate, and middle-income
Americans. The goals of this 5-year partnership are to: a) produce and
preserve rental housing; b) work for policies supporting aging in place
communities; and c) provide outreach for mortgage products. Fannie Mae
is also working with its 55 partnership offices around the country to
customize local strategies that will meet senior housing needs.

**[Advancing International Collaboration]{.underline}**

AARP's Global Aging Program focuses on bringing international
experiences to the United States. Through international exchanges,
conferences and publications, AARP looks abroad to learn from experience
of other countries in delivering programs to older people. AARP plays an
active consulting role to the EU, the UN, other countries and NGOs.

**Summary**

The United States has made significant progress since the Second World
Assembly on Ageing in advancing the priorities of the MIPAA. Future
reports will indicate additional progress made in these priority areas.