Kathy Greenlee views the aging of America as a national benefit, even as she acknowledges caring for senior boomers eventually will cost the government millions of dollars.
The question is: How to make the cost of that care economical and beneficial? Better put: How to give the best value to the aging senior and the taxpayer?
We will see a "great wave of social capital," she says, as younger, active seniors take a greater role in volunteering, philanthropy and maintaining their positions in the workforce.
"These seniors will change the definition of everything," says the new U.S. assistant secretary for aging at the Department of Health and Human Services.
Greenlee, confirmed at the end of June, revealed her aspirations for aging Americans last week at the Minneapolis-based conference of the National Association of Area Agencies on Aging.
It is time, she told me by phone after her speech, "to rewrite the concept" of age and retirement as the oldest of 76 million boomers reaches age 63.
The goal is to keep seniors - they are people 60-plus, she tells me - active and productive. That means taking care of themselves and not expecting government aid.
But even as she spoke, California's legislature battled budget constraints that forced cutbacks in senior services, particularly home health care, used primarily by frail seniors - usually defined as folks older than 80.
Without state-supported home health care, a larger percentage of these frail seniors end up in nursing homes, where their care is paid by Medicaid, a combination of state and federal dollars. Nursing home care on average costs three times the amount of home-based care, according to AARP.
"As secretary of aging in Kansas, I did a study on Medicaid support,"
Greenlee said. "Most seniors have some form of financial support but need to find help in extending it longer. For example, 20 percent of all seniors in Kansas nursing homes spent down $40,000 to $70,000 of their money to pay for the nursing home and then went on Medicaid, which pays the entire bill. If their money could have been supplemented with government-sponsored home care, they could have stayed home longer and actually used fewer government dollars overall.
"There has to be a way to create policy to allow people to stay at home and age in a place that's more manageable," Greenlee said shortly after her appointment. "The services people want are often the least expensive to deliver if we can figure out how to do it - how to shape that program so it works and sustains the increasing number of seniors who ask for those services."
She describes the necessary core services - meals on wheels, home health aide, exercises, transportation.
"We need to find balance and connection," she said. "We need a blurring of the lines between what we consider nursing home care and health care."
Keeping seniors at home also requires attention to socialization, she says. "We have to help them with isolation, boredom, depression. We need a new kind of intergenerational program, one with a new lingo."
Greenlee would connect more seniors to the middle-aged population, people in their 40s and 50s. Seniors, she emphasizes, "need to know they have a reason to live."
"I think the greatest pressure will be to throw the spotlight on the local senior networks, to bring to conversation at the federal level what these organizations are and how we can create partnerships," she said. "People are doing terrific work for seniors, and we need to celebrate what we do collectively."
Bringing senior service groups to the federal table to share collectively would be a positive solution, agrees Marilyn Ditty, head of the Orange County (Calif.) South County Senior Services. "We all share the same goals of keeping people in their homes - healthy, secure and part of our communities."
Everyone agrees on goals, but the support dollars are most often lost in translation.
"What we have now is specific," Greenlee said. "We need to come to the table and network, share information and get systems in line."
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