November is National Family Caregivers Month, which focuses attention on the unpaid care work of family members.

The care provided by families often is enabled and supported by state-funded wrap-around services.

Over the last few decades, Missouri and other state governments around the nation have funded Home and Community Based Services - or HCBS - as a cheaper alternative to nursing-home care.

The turn towards HCBSs has meant that aging Americans are more often able to stay in their homes.

The kind of support they provide is broad, and includes visiting and live-in nursing care, in addition to other services such as transportation, home repair, and remodeling to ensure accessibility.

Recent state budget cuts to these programs threaten the availability of in-home care. Jay Hardenbrook, advocacy director with AARP Missouri, said funding HCBS sufficiently benefits all involved.

"It winds up saving the state a lot of money," said Hardenbrook. "It makes families stronger, especially if it's an unpaid family caregiver who's doing that, and it keeps that person receiving the services in the place that they want to be."

Hardenbrook said in Missouri alone, unpaid family caregivers are providing more than $8 billion worth of care. He called them an essential part of the system that doesn't get enough attention.

Funding for HCBSs in the state has declined over the last decade, with the nonprofit Missouri Budget Project reporting a 40% cut in community-based programs in 2018.

Last year the General Assembly injected $200 million from the American Rescue Plan into the system as a one-time payment to support care workers' wages.

Hardenbrook said the state needs to fully fund these programs.

"The state decides how much money goes into these programs," said Hardenbrook. "And if we let them stagnate for a long time as we did until last year, then fewer and fewer people will provide those services. Now that we've done this increase, if we can just keep it up, really we'll have a larger workforce and we'll have more people who are able to stay in their homes because they're able to get the services they need."

Hardenbrook said when aging seniors can't get the care services or home repairs they need, the state often ends up paying more for them to live in a nursing home.

He said while some people utilizing HCBS programs are doing so daily, others may only need occasional help.

"One of the things that has been very helpful, especially among our dementia enrollees, is that a family caregiver can get a day off," said Hardenbrook. "One day of respite is what we call it. But really, 'Can I just have a day where I don't have to be a caregiver all day long?' "

The Missouri Budget Project reports that on average HCBS support costs less than one third of institutional care.

Civic organizations with ideas for improving their communities have a new opportunity to turn their
ideas into reality, thanks to recently awarded grant funding.

Through Community Challenge grants, AARP's Livable Communities initiative has awarded more than $65,000 across four Mississippi nonprofits and government entities.

Kimberly Campbell, state director for AARP Mississippi, said the grants aim to support quick-action projects to improve public spaces, transportation, housing and digital access. She pointed out a local library is using the funds to expand its extensive print book collection to 50+ patrons.

"The Harrison County Library System was awarded $7,628," Campbell explained. "This project will provide wheeled walkers at three librarian branches, enabling older visitors to pursue the shelves independently."

Campbell noted this year, AARP has awarded $3.8 million to 343 organizations nationwide. AARP Community Challenge grants will be implemented nationwide, with a quick turnaround for project completion by Dec. 15.

The Jackson Heart Foundation provides state-of-the-art cardiovascular care to its patients and received an $18,000 Community Challenge grant.

"That project will create hydration stations and rest areas along the walking and biking trail frequented by older adults," Campbell emphasized. "Planned amenities include new water bottle filling stations, benches, bike racks, trash cans and shade trees."

Campbell added a Mississippi educational institution received funding to improve recreational activities.

"Mississippi Gulf Coast Community College, they've been awarded $20,000," Campbell stated. "Their project will install outdoor fitness stations along the Walking Track popular with older adults. Several stations feature ADA compliant designs."

A $20,000 grant was awarded to the Laurel-Jones County Library System, to convert a donated trolley into a mobile library serving older adults in rural areas. The mobile library will provide residents with laptops, printers, Wi-Fi access and technology classes.

Correcting hearing loss by using hearing aids is a simple and effective way to reduce the risk of cognitive decline and dementia during aging, according to a new Global Council on Brain Health report.

Sarah Lock, executive director of the council, said the report should be a wakeup call for everyone, especially older Americans. She urges people not to let the stigma sometimes associated with hearing loss get in the way of prioritizing hearing health.

"Hearing promotes emotional well being, mental well being and your cognitive health. It's just too important not to take care of," she said. "And when you can do something as simple as getting a hearing aid to correct hearing loss, why wouldn't you want to do that?"

Researchers say if left untreated, hearing loss also increases risks associated with social isolation, loneliness, anxiety and depression.

Lock added the report underscores warnings by the U.S. Surgeon General that the nation is experiencing a loneliness and social isolation epidemic, with health impacts equal to smoking up to 15 cigarettes a day.

Age-related hearing decline is not curable, but it can be treated with hearing aids that achieve the crucial goal of helping people hear better. While hearing loss is often associated with aging, Lock says it's important for people of all ages to protect their hearing.

"Pop those little foam plugs in your ears so that you're not having your ears assaulted at work or at noisy concerts. So there are simple things that you can do to protect your hearing, no matter what age you are," she explained.

An AARP survey found that nearly six in ten Americans age 50 and older have not had a hearing test in the past five years, as recommended. And only 38% said their hearing was excellent. But Lock pointed out nearly 8 in 10 say they would address hearing loss if they knew it could impact brain health.

"AARP offers free screenings for members. If you go to AARP.org/hearing, you can find the hearing center, and you can take a free hearing test over the phone," she continued.


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AARP Iowa is on a road trip, taking knowledge to family caregivers wherever they are and helping them learn more about the resources that may be available to them. It is part of the association's larger effort to educate people about caregiving in Iowa.

AARP Iowa data show the state's 330,000 unpaid family caregivers provide 310 million hours of care every year in the state, which is valued at more than $5 billion.

Brad Anderson, state director for AARP Iowa, said caregivers are busy and often do not know what to expect or where to get information.

"For example, they need to know, 'How do I get in touch with the Area Agency on Aging?' They need to know, 'How does Medicare work?' They need to know, 'Is my loved one on the right prescription drug program?'" Anderson outlined.

AARP is traveling the state from the Mississippi River to the Missouri River in a big red RV to distribute information. Anderson noted they are making stops at grocery stores, hospitals, clinics and pharmacies; the most likely places to run across people who have just inherited caregiving duties.

There are other, more 'hands-on' things caregivers need to know but Anderson added since most people fall into the role, there is no real formal training and they have to learn their new role on the fly.

"How do I feed my loved one? How do I care for a wound? Maybe how do I even lift this person up and help them into bed?" Anderson explained. "These are all things that sometimes happen, literally, overnight."

The informational tour is scheduled to last into August.