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.

Indiana's busy holiday roads can put older drivers to the test.

With 2.8 million Hoosiers traveling this season, the AAA Hoosier Motor Club encouraged families to help senior drivers stay safe.

Christina Griffiths, manager of public affairs and communications for the club, highlighted the importance of preparation for older drivers.

"It really isn't about age necessarily," Griffiths explained. "It truly is a case-by-case basis of what am I dealing with physically, mentally, emotionally, and what can I do better to be as safe as possible?"

Griffiths recommended older drivers take simple steps to prepare for challenging conditions. She suggested checking car tires, brakes and visibility aids like wiper blades. For all drivers, she also stressed the value of adjusting travel times to avoid peak traffic and bad weather.

Winter weather raises the stakes for older drivers. Snow and ice create extra challenges, increasing stress and risk on the road. Griffiths pointed out AAA offers free online assessments and refresher courses to help seniors adjust to physical or emotional changes affecting driving.

"It asks a bunch of questions that you can evaluate: Am I checking behind me when I change lanes? Do I have difficulty with merging, or do I just feel that anxiety, I think is a big one too!" Griffiths outlined. "Maybe you have specific things you need to brush up with on your own skills."

Griffiths urged families to talk openly about driving habits. Small adjustments, like shorter trips or avoiding peak travel times, help seniors stay safe without giving up their independence. She added preparation and support help protect everyone on the road.


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Dementia, a disease with profound effects on families, loved ones and caregivers, affects more than 55 million people globally, including 6 million in the U.S.

New research shows people can reduce their risks by making even small changes in their daily routines, for example, through exercise and eating more vegetables.

Sarah Lock, senior vice president for policy at AARP, said there are also important steps policymakers can take to make it easier for people to maintain healthy behaviors.

"When we do that, we can disrupt dementia," Lock asserted. "That's a really exciting possibility, given that so many of us -- as our nation is aging -- are facing that risk."

Dementia is the third-largest cause of death in the nation for people age 70 and older, and two-thirds of Americans have at least one major potential risk factor. People who smoke five cigarettes per day have a 16% higher dementia risk than nonsmokers. People with prediabetes face a 25% increased risk, which rises to 50% with full-blown diabetes. Prolonged exposure to air pollution is also a major dementia risk factor.

Other risk factors include alcohol use, depression, high body mass index, hearing loss, hypertension, low education, physical inactivity, social isolation and traumatic brain injury. Lock pointed out policies to reduce these risks can vary by state. For example, in Colorado, physical inactivity may not be as big of a
problem as in other states, but hearing loss is relatively high.

"We can suggest to policymakers that they focus on ways to help people screen and correct for hearing loss," Lock noted. "In Colorado, that might be a wiser use of public dollars, to go after the problem that seems to be biggest in your state."

Lock added the goal of the research is to offer people pathways to better brain health and to give older Americans more quality time with their loved ones. The findings were released by the new Dementia Risk Reduction Project, a collaboration between AARP, the Alzheimer's Disease Data Initiative and the University of Washington.

Changes coming to Medicare in 2025 could be beneficial for Oregon residents who are eligible for the program.

Oregonians who qualify for Medicare are now in the open enrollment period through Dec. 7, which allows them to search for health coverage plans to best suit their needs.

Ryan Kibby, Oregon Senior Health Insurance Benefits Assistance project director for the Oregon Department of Human Services, said there will be expanded care options for dementia patients with the Guiding and Improved Dementia Experience or GUIDE program.

"Some of the resources available through GUIDE would include a 24-hour support line, caregiver training and up to $2,500 a year for respite services," Kibby outlined. "That's really just going to help benefit the people who are providing these family caregiver services."

There will also be expanded mental health benefits for people with Medicare in 2025. In 2023, nearly 920,000 Oregonians were enrolled in Medicare. People can get free help to find coverage through Oregon's SHIBA program, either on its website or at 800-722-4134.

Kibby pointed out another major improvement in 2025 is prescription drug costs will be capped.

"There will be a lower maximum to pay for covered drugs, under both Medicare Part D policies and Medicare Advantage drug coverage," Kibby explained. "The maximum amount that people will pay in 2025 is $2,000, and they won't have to pay anything for covered drugs once they reach that amount."

Prescription payment plans will be an option for people who cannot pay in full up-front. The out-of-pocket cost cap also eliminates a gap in coverage, known as the "donut hole," which some have experienced in the past. While Medicare cannot cover prescriptions specifically for weight loss, people can access these drugs for treatment of conditions like Type 2 diabetes.


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