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.

Pennsylvanians over age 50 are voicing concerns about the Department of Government Efficiency plans to cut 7,000 jobs from the U.S. Social Security Administration as part of its efforts to shrink the federal government and curb what it describes as waste and fraud.

More than one in five Pennsylvanians get monthly Social Security payments, according to AARP, almost 3 million people.

Nora Dowd Eisenhower, volunteer state president of AARP Pennsylvania, said all the changes have left many beneficiaries confused and worried about potential office closures, employee layoffs and reduced services.

"We are working to make sure that Americans receive the Social Security they have worked hard for and paid for over their entire working lives," Dowd Eisenhower emphasized.

Social Security benefits contribute almost $63 billion a year to Pennsylvania's economy through retirement, survivors and disability payments, according to AARP, all of which boost consumer spending, business sales, and job creation across the state.

Dowd Eisenhower pointed out the Social Security Administration had planned big changes to its phone services in March that would have caused delays and hassles but the decision was reversed this month after intense pushback. She noted AARP members have long been vocal about the need for better customer service from the Social Security Administration.

"Last year, four out of five older Americans, across party lines, supported increased funding for the Social Security Administration as a way to improve customer service," Dowd Eisenhower reported.

President Donald Trump's senior adviser Elon Musk claims Social Security could be cut by $500 billion to $700 billion without reducing benefits.

Dowd Eisenhower added AARP is urging Congress to make sure the Social Security Administration makes payments on time, as it has for nearly 90 years, and provides quality customer service by phone, online and in person.

Back-and-forth decisions on Social Security policies have created confusion, which may leave some Virginians more vulnerable to scams.

Last month, the Social Security Administration announced in-person or online appointments would be required to sign up for benefits, instead of customer support by phone. The decision has now been reversed.

Jim Dau, state director of AARP Virginia, said the changes give con artists room to come up with new scams. He noted they often start with a phone call, text or email about something "urgent." If you receive such communication saying it is from the Social Security Administration, Dau warns, it is a scam.

"This is the perfect kind of recipe for financial predators to step in and escalate Social Security scams to defraud beneficiaries of their money," Dau stressed. "Social Security scams are effective in this kind of environment -- where people are getting information from here, and bits of information from here -- where we are going to see more and more Social Security scams."

Trump's billionaire adviser Elon Musk has said Social Security has "massive" amounts of fraud, but a review by the Social Security Administration's Inspector General has found the agency has made improper payments less than 1% of the time.

More than 1.6 million Virginians receive Social Security benefits. Dau emphasized the monthly income is a lifeline to people across the Commonwealth. He added the administration's initial changes which would have required people to sign up for benefits in person would have negatively affected seniors.

"The prospect of having to go to an in-person meeting at your local Social Security office, hopefully get there on time at a point where the line isn't too long and you have a reasonable chance of actually seeing somebody that day," Dau outlined. "And of course, hopefully your Social Security office is open that day - or at all anymore."

The administration has announced lease terminations of nearly 4% of Social Security field offices. An analysis by the Center on Budget and Policy Priorities finds nine percent of Virginia seniors already live more than 45 miles from the nearest office.

The Department of Government Efficiency, or DOGE, plans to cut 7,000 jobs from the U.S. Social Security Administration as it works to reduce the size of the federal government by eliminating waste and fraud. Nearly one in six Coloradans relies on Social Security payments, according to AARP.

Economist Monique Morrissey with the Economic Policy Institute calls the planned cuts a form of sabotage, and says Social Security is already very efficient.

"Less than 1% of what they are paying out goes to administrative costs. That's including not just the staffing, but the office space and everything else," she said. "So, almost all the money that's going out of Social Security is going directly into beneficiaries' pockets."

Morrissey added the agency is challenged by staffing, which has recently fallen to a 50-year low. She said wait times for phone and in-person appointments have already skyrocketed, and half of all callers now hang up before anyone answers.

President Donald Trump's Senior Advisor Elon Musk claims Social Security could be cut by $500 billion without reducing benefits, but Morrissey said layoffs can only save that kind of money by making it harder for people to access their benefits.

"And they claim that they can do this through looking for waste, fraud and abuse. But when you consider that less than 1% goes to anything that's improper payments - which is mostly not fraud, but just mistakes, and that usually get recouped - you can't get half a trillion dollars out of it and not be cutting benefits," she continued.

The Congressional Budget Office projects that Social Security will run out of money in less than ten years unless Congress acts. Morrissey noted the majority of Americans would rather increase revenues than cut benefits, and added that one easy fix would be to remove the cap on payroll taxes.

"Everybody should pay the same share of their income into Social Security, and right now that is not happening. If you make more than $176,100, you don't pay taxes above that amount," she explained.

The Social Security office in Grand Junction is on a DOGE list of possible closures in June, although the agency said last month it "had not announced the permanent closure of any local field office."


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