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.

A new poll found the Maryland's U.S. Senate race is a dead heat and Marylanders 50 and older are highly motivated to vote.

The bipartisan poll conducted on behalf of AARP Maryland surveyed more than 1,200 likely voters. It found the Senate race between former Gov. Larry Hogan, a Republican, and Prince George's County Executive Angela Alsobrooks, a Democrat, is tied at 46% each, with 7% of voters undecided.

Jeff Liszt, partner at Impact Research, said at this point in the race, name recognition is big.

"There are a lot of voters in Maryland who still don't know Alsobrooks," Liszt pointed out. "Part of the reason that Larry Hogan is right now doing as well as he is with a lot of Democratic-leaning constituencies is that younger voters know Larry Hogan a lot better than they know Alsobrooks."

The poll found Kamala Harris leading Donald Trump in the state by a wide margin. With Hogan polling much better than Trump, Liszt said 33% of voters over 50 are currently splitting their tickets between the presidential race and the Senate contest.

Top issues resonating with Maryland voters 50 and older include the economy and jobs, threats to democracy, immigration and border security along with inflation and rising prices. The poll found more than 80% of voters 50 and older support funding the state grant program for family caregivers to cover some out-of-pocket expenses.

Hank Greenberg, state director for AARP Maryland, said there are several hundred thousand family caregivers in the state.

"There are over 770,000 self-identified family caregivers," Greenberg reported. "Their out-of-pocket expenses are about $7,200 a year and in fact, nearly a third of them, according to the survey that was just done, they're spending over 21 hours a week doing family caregiving and they could really use some assistance in that regard."

The new Caregiver Expense Grant Program took effect July 1 and offers up to $2,500 a year to help cover care-related expenses.

When pollsters asked voters 50 and older about specific issues, Greenberg noted they found Social Security was the top concern.

"Fifty-two percent of older voters say that Social Security is going to be a major source of their income, or is a major source of their income," Greenberg explained. "And that 79% of older voters say that candidate's position on Social Security is extremely or very important. "

Older voters also reported they are very motivated to vote, with 87% rating their motivation as 10 out of 10.

New York State is developing a Master Plan for Aging. It will act as a framework to help older adults age in place while ensuring their quality of life remains high.

The project stems from a 2022 executive order signed by Gov. Kathy Hochul after yearslong discussions with state partners and community stakeholders.

Beth Finkel, state director of AARP New York, said the plan takes a multipronged approach to addressing older adults' needs as they age.

"That can be from affordable housing to available transportation to remedies that would fight isolation and depression," Finkel outlined. "And mental health to make sure that if people want to work there are jobs available so there's no ageism."

While the plan is still being developed after numerous stakeholder meetings, Finkel noted addressing the needs of unpaid family caregivers is critical. More than 2 million unpaid family caregivers provided more than 2 billion hours of care in New York in 2021. They spent $8,000 of their own money to provide at-home care. A final draft of the plan is slated to be released early next year.

Feedback and comments on the plan have been mostly positive. While it is a collaborative effort among state agencies, Finkel found other work can be tackled now by state lawmakers. Some issues to address include road safety and inclusive design for homes and public spaces. She emphasized they can start by addressing long-term care workforce issues.

"They can be looking at strengthening the long-term care workforce," Finkel urged. "It is very hard to maintain home care workers and also nursing home workers cause their salaries have just not been kept up with other salaries."

Finkel supports increasing funding for the state's Long-Term Care Ombudsman program, which conducts oversight visits at nursing homes, assisted living and adult care facilities. The pandemic increased service demands for local Offices for the Aging but now federal stimulus dollars are not around to bolster the programs. Reports show a shortage of funds has kept the program from being able to fulfill its duties.


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Congress faces increasing pressure to adopt changes to keep Social Security on firm financial ground in the years to come.

North Dakota retirees are sharing their thoughts about key challenges facing the program. It is not losing money as fast as once thought but a recent federal report predicted Social Security will be unable to pay full benefits a decade from now if moves are not made ahead of time.

Eddie Johs, a retiree from Fargo and an AARP volunteer, receives Social Security benefits in addition to a pension. He feels he is one of the lucky ones who does not rely solely on monthly payments from the safety net.

"I realize many people don't have a pension," Johs noted. "Social Security is just a lifeline for those people."

He said some self-employed individuals and those receiving lower wages face barriers in securing larger nest eggs. Johs will attend a Social Security Summit hosted by AARP next Tuesday at the Fargodome from 10 a.m. to 2 p.m. He hopes fellow retirees listen in to what elected officials and others have to say about potential solutions and the program's impact.

Congress has long been at odds over how to address the solvency issue. Democrats often push for higher earners to be taxed on more of their income, while some Republicans have floated raising the retirement age. Johs suggested a variety of changes are likely needed but he is skeptical about asking people to work longer for the benefits they've earned.

"People that work construction or work outside, city employees, that'd be tough to work at age 65 and up when you do outdoor physical work," Johs stressed.

Currently, the full benefit retirement age is 66 for those born in 1955, and it will gradually rise to 67 for those born in later years. In the U.S. House, the Republican Study Committee has called for what it describes as "modest adjustments" to the retirement age to account for increases in life expectancy.