Module 4 Overview
Policy for Older Adults
1. History and Social Construction of U.S. Policy for Older Adults
A. Introduction
• Attitudes towards older adults:
a. In the 1600–1800s, those who were older were treated with respect and
deference.
b. Some evidence that suggests that older adults may have been treated with
disdain and viewed as a burden in agricultural societies.
c. Their social status was affected by their perceived race/ethnicity, immigration
status, land ownership, and wealth.
• No U.S. social policy for older adults.
• Older adults were categorized as “deserving” and received some assistance.
B. Retirement and health as worthy of public investment
• Great Depression led to age being viewed as a separate area of public policy.
• Social Security Act provided retirement benefits that were universal and
substitutive, replacing a portion of income from work. Substitutive benefits:
Benefits that are designed to replace something of equal or similar value.
• The original provisions resulted in racist policies.
• Social Security benefits have risen by Cost-of-Living Adjustments since 1975.
Cost-of-living adjustments: Adjustments that are made to benefit to ensure that
they retain their value.
C. Changing political power among older adults
• The American Association for Retired Persons (AARP).
• Gray Panthers--viewed interdependence as natural part of human condition.
Interdependence: A concept expressing the mutual and reciprocal reliance of
people and communities.
D. Current overall trends and policies
• Life expectancy increasing has caused a shift in the dependency ratio.
a. Dependency ratio: The ratio of those who provide support to those who
receive support.
b. Many programs that are designed to benefit older adults are financed by
younger, working-age populations.
c. Sandwich generation: A term describing the cohort of people who
simultaneously provide care and support to both older and younger family
members, such as parents of young children who also provide care for their
own aging relatives.
• When those in the workforce are outnumbered by nonworking populations, the
social and financial costs of caring for older adults may become burdensome.
E. Disparities and cumulative disadvantage
•
Life expectancy has increased, but there have been sporadic reductions
attributable to public health crises such as AIDS epidemic. Life expectancy: The
median age of death for a particular group.
a. There are educational, socioeconomic, and racial and ethnic disparities.
Disparity: Differences in outcomes between different populations or groups.
b. Cumulative disadvantage: The compounding nature of disadvantage that
accrues across the life course and therefore intensifies with age. Example:
Unsafe housing and poor access to preventative medical care as a child may
lead to chronic health conditions that may impact employment.
F. Changing political power among older adults
2. Current Policies for Older Adults
A. The Older Americans Act and aging in place
• It provides funding to local government for services to people aged 60 and older,
with the primary goal of supporting older adults who live in their own
communities.
• Services provided through the OAANP are universal but coverage is insufficient.
• Priorities must also be derived from what older adults believe to be most
important to them, and therefore must be included in policy-making at all stages.
• The “Village Model” is an example of one U.S. community-based response to fill
public policy gaps for adults who are aging within their own homes and
communities, but they reinforce homophily. Homophily: The tendency for people
to live and associate with people like themselves.
B. Social Security retirement benefits
• Benefits are insufficient to meet most older adults’ basic needs.
• Pensions replace a small percentage of the preretirement income of older adults.
• Reforms in the Social Security funding need to be enacted; please see the Social
Security game for some reform options. https://socialsecuritygame.actuary.org/
C. Medicare
• Medicare is a federal program that has covered people over 65 since 1965, created
as an amendment to the Social Security Act.
a. Covers approximately 59 million Americans.
b. Primary federal health insurance program for older adults regardless of
income.
• Medicaid is the primary public health insurance for people with low incomes.
a. Some low-income older adults may be eligible for benefits from both
programs.
b. Medicaid also helps low-income older adults pay for out-of-pocket expenses
through the Medicare Savings Program.
• Medicare services are covered in four “parts”:
a. Part A covers hospital and nursing facility care, some home health care, and
hospice.
b. Part B includes visits to doctors, outpatient services, preventive care, and
some home health care.
c. Beneficiaries who enroll in Part C, also called Medicare Advantage, are
essentially enrolling in a private health plan like a health maintenance
organization (HMO) or preferred provider organization (PPO) that must
provide all of the benefits that a traditional Medicare plan provides.
d. Created by Medicare Prescription Drug, Improvement, and Modernization Act
of 2003, Part D is the most recent addition, which provides coverage for
outpatient prescription drugs for recipients, either through Medicare
Advantage or stand-alone prescription plans. Coinsurance: The portion of
payment for a service such as a doctor’s visit that the beneficiary must pay.
D. Older adults who are veterans
• Older veterans with disabilities tend to experience anxiety and depression at
increased rates as well as higher rates of poverty.
• The VA provides a range of long-term care geriatric programs for veterans with
complex needs, including home-based and community services.
• Financial assistance is available to VA beneficiaries who are homebound,
bedridden, in need of help performing daily functions, or in a nursing home.
3. Policy Informed by Alternative Lenses
A. Interdependence, including the ability to rely on social safety nets, may foster
individual opportunities and choices.
B. Policies and programs are interconnected.
• Policies that support veterans and social security are built in part to support older
people who have contribute to our well-being as service members and workers,
respectively.
• These policies help people who contributed while they were physically and
developmentally able, and we reward their contributions by providing for them
when they may no longer be able to support themselves or other
4. Opportunities for Advocacy
A. Aging LGBTQ+ older adults.
B. Identify, develop, and implement guidelines to ensure effective practice that is
designed to treat people more equitably.
Work and Employment Policies
1. Introduction
A. Social safety net: The basic set of government programs that mitigated economic
risks.
B. Work and employment policies are characterized by a focus on individual choice over
the well-being and safety of workers.
2. History and Social Construction of U.S. Work and Employment
A. The early years
• The United States was made up of small, family-run farms that provided
sustenance for individual families together with small towns and growing cities
that were home to small businesses.
a. Such workers included apprentices or indentured servants.
b. Indentured servants contracted to work for periods of time generally ranging
from 4 to 7 years in exchange for passage to the United States, room and
board.
c. The work was difficult and the conditions were meagre.
• Trans-Atlantic slave trade fed increasing need for labor as the country grew.
B. Industrialization and the beginnings of workplace protections
• Manufacturing relied on low wage labor in factories and in the building of
infrastructure, such as railroads.
• Capital was concentrated in the hands of a relatively small group of individuals
and companies.
• Most workers were extremely poor, with few options for employment or the
means to otherwise sustain themselves.
a. Individual workers wielded virtually no leverage against employers, who set
the terms of their employment.
b. In company towns, employers might also be landlords and run the company
store.
• Long-term oppression and hardship led to the formation and growth of unions that
allowed workers to join forces.
• Workplace disasters resulting from hazardous conditions also played a role in the
creation of workplace protections.
• Legislation included the first laws prohibiting child labor and laws for protecting
women such as setting maximum working hours.
C. Filling in gaps in the worker safety net
• The period following the stock market crash and the Great Depression of
1929 is often considered a turning point in the history of social welfare.
• New Deal programs created jobs for the huge number of unemployed.
• The Civil Works Administration
a. It operated from 1933 to 1934, employed 4 million workers in low-skill level
works projects such as building roads and grading airport runways.
b. These programs stimulated the economy and provided long-term benefits for
the country.
• WPA and CCC led new projects
a. Hoover Dam, the nation’s highway system, and the National Parks.
b. Programs were considered emergency relief.
• Federal Unemployment Insurance was established during Great Depression.
• New Deal programs were criticized for being discriminatory.
• Fair Labor Standards Act of 1938: Set minimum working-age limits, set a federal
minimum wage, rules around record-keeping, and overtime.
a. Minimum wage: The minimum hourly wage that workers must be paid by
law.
• National Labor Relations Board: The federal agency housed in the Department
of Labor that is charged with protecting workers’ individual and collective rights.
D. A larger mission: Equality in the workplace
•
•
Movement was spurred by activism during the Civil Rights era.
In 1963 by President John F. Kennedy (1963) introduced a proposal for the Civil
Rights Act (CRA) to the American public.
• Title VII set up the Equal Employment Opportunity Commission (EEOC) that
would review complaints about discrimination by employers and labor unions.
Equal Employment Opportunity Commission: The federal agency that can
investigate and help resolve complaints when the agency determines that
discrimination has occurred.
• Workplace protections have not expanded equally for all, such as gender
discrimination.
a. Civil Rights Division: The U.S. Department of Justice arm charged with the
oversight of the Civil Rights Act that has the authority to investigate and bring
forward cases of discrimination.
• Age Discrimination in Employment Act
• OSHA established by Occupational Safety and Health Act in 1970:
a. Occupational Safety and Health Administration (OSHA): The federal
agency housed in the Department of Labor that sets, provides education about,
and enforces regulations regarding workplace safety in government and
private employment.
b. Whistleblower: An employee who alerts OSHA to safety and health
violations under OSHA or other statutes. These individuals are entitled to
certain protections against retaliation.
3. Current Work and Employment Policies
A. The changing employment context
• Expansion of labor rights:
a. From the 1960s to the 1990s, labor rights were expanded through programs
designed to enhance equality and protect workers.
b. Courts, government agencies, workplaces, and employees struggled to
interpret the meaning and scope of these protections.
• The Lilly Ledbetter Fair Pay Act defines every new unequal paycheck as a new
discriminatory act, and therefore increases the likelihood that those who are
discriminated against are able to sue.
• Gig economy: New employment areas that are characterized by temporary
employment and decreasing employer commitment to their employees.
• Shift work: Work that is carried out at atypical and changing hours, often a
feature of low-wage employment.
• Living wage: The hourly wage that is considered sufficient to meet a worker’s
needs.
B. Retirement benefits
• Retirement benefits:
a. Retirement benefits represent approximately two thirds of Social Security
benefit claims.
b. Workers’ contributions pay for current recipients rather than being placed in
savings accounts for their own future use.
• The Social Security Administration (SSA): The federal agency charged with
administering policies and programs under the Social Security Act.
• Social security is an entitlement program. Entitlement program: A benefit that
the government is obligated to provide.
• The solvency of Social Security, or its ability to pay future benefits, has long been
a concern.
• Workplace retirement plans are another type of retirement benefit.
a. Defined benefit plans are those in which the employer guarantees payment of
a specified monthly amount upon retirement.
b. Defined contribution plans only set the amount that the employee will
contribute.
C. Unemployment
• Bureau of Labor Statistics considers people unemployed when they are not
working but are interested in working and have actively looked for a job during
the past four weeks.
• The United States measures employment every month based on a sample from the
Current Population Survey. Current Population Survey: A survey carried out by
the U.S. Census Bureau. The survey’s unemployment measure does not include
underemployed or discouraged workers.
• The Federal Unemployment Tax Act (FUTA) regulates a federal–state partnership
for temporary support for workers when they become unemployed.
a. FUTA pays half of unemployment benefits when these benefits are extended
during periods of high unemployment.
b. Great Recession: An economic downturn in the United States and global
markets, lasting from 2007 through 2009, that especially impacted the real
estate and the banking industry, which originated with a crisis in the mortgage
industry.
• Workers’ compensation insurance programs for workers who are hurt or killed in
work-related incidents exist at the state level. Federal workers’ compensation is
available for some employment sectors or incidences.
D. Creating jobs, education, and training workers
• New Deal was only time that federal and local governments created jobs to raise
employment rates.
• The Employment and Training Administration (ETA) administers job training and
worker dislocation programs.
• Under the Workforce Investment Act (WIA) (1998), reauthorized in 2014 as the
Workforce Innovation and Opportunity Act (WIOA), money is provided to states
to fund workforce development programs.
• Those receiving public welfare benefits may receive job training and supportive
services to enable employment.
4. Policy Informed by Alternative Lenses
A. The European Union’s Working Time Directive
• The European Union’s Working Time Directive (2003/88/EC) sets minimum
standards for member countries’ regulation of labor conditions.
• These standards limit work hours and set standards for leave and breaks on the job
including requirements such as:
a. Work weeks not to exceed 48 hours, including any overtime
b. Eleven consecutive hours of daily rest in every 24-hour period
c. Rest breaks for employees on duty more than 6 hours
d. Uninterrupted rest periods of 24 hours for every 7-day period
e. Four weeks of paid annual leave
• This directive also includes special protections for specific types of workers,
including night workers, doctors in training, and transportation workers.
B. Family leave for the U.S. Armed Forces
• The military provides extended workplace leave for service members and their
families to care for family members or themselves in the event of birth, adoption,
or sickness.
• Result of the 2009 Congressional expansion of the Family Medical Leave Act for
service members as part of the National Defense Authorization Act.
5. Opportunities for Advocacy
A. Who are minimum wage workers?
• The minimum wage directly affects a small portion of the workforce.
• Majority of minimum and near-minimum wage earners work in the
restaurant/food industry.
• Employers may also be allowed to pay some categories of workers, such as youth
or people with disabilities, subminimum wage in order to encourage their
employment.
B. Living wage and the “Fight for 15”
• Minimum wage is often far lower than the living wage
a. The minimum income necessary to satisfy basic expenses for food, housing,
and other essential needs.
b. Living wage advocates also note that the cost of living varies by location and
family size.
• “The Fight for 15” has mobilized thousands of service workers across the nation,
particularly in the fast food industry, resulting in significant victories.