THE FUTURE OF OUR NURSING HOMES

For home healthcare nurses in particular, the next 10 years are going to result in drastic changes in practice and operations in home healthcare nursing practice. Most of these changes are going to be positive from the home healthcare nurse's perspective. However, I am concerned that home healthcare nurses are not ready for the extent of these drastic changes, and I present several scenarios that could occur, based on the IOM report and existing research.

?international year of the nurse-healthcare reform may make that recognition ongoing and permanent, from a home healthcare policy perspective!

The question is whether healthcare reform will extend to the care of older adults, especially in the face of complex needs in the last years of their lives. This examining the demographics of the older adult population, the eldercare workforce, and the current inadequate patchwork of financing. Some aging issues, such as chronic care, are being addressed in the broad context of healthcare reform, whereas health information technology and others remain marginal. The window of opportunity for a clear and coherent voice in a reformed/reshaped healthcare system is narrow. Now is the time for the "trusted" profession to advocate for meaningful change that will meet the current and future needs of older adults.

>>> Cover Story: The Future of Social Security <<<

SLOW RESPONSES, WRONG ANSWERS More people are complaining about customer service from Social Security. How the agency intends to respond by michelle andrews

When Jim Sauer read the letter from the Social Security Administration (SSA) in October 2021, he was puzzled. Because he was claiming benefits a year after his full retirement age, he was expecting bigger payments than what the SSA said he would receive. So Sauer called the Social Security office near his home in Fairfield Township, Ohio, to address the problem. But after 12 conversations with local SSA customer service representatives and two calls to the agency's national call center, Sauer remained not only puzzled but also frustrated.

"It's not just the issues themselves," says Sauer, a former career employee at a Fortune 500 company who worked in international finance. "It's when you call, you wait on hold forever. And then when you finally get ahold of someone, they seemingly just don't care about helping you and are highly unqualified to answer your questions or to lead you to where you could get answers."

While there's no hard data on complaints about SSA service, the SSA does release data on wait times for callers. In fiscal year 2011, someone trying to reach Social Security by phone had to wait three minutes to be connected with a representative; in fiscal 2020, the average wait was 16 minutes. The delays were worse in 2018, when a caller would wait an average of 24 minutes to speak with someone.

As to complaints, the anecdotal evidence is plentiful. Nationally syndicated columnists Tom Margenau, former director of the Social Security Administration's public information office, wrote on the topic last August, noting "Almost every day I hear from readers who have been misled by an SSA representative." Another popular money columnist, Liz Weston, also recently reported about older Americans' frustrations with service from the SSA. And AARP routinely hears complaints from members about their difficulties getting help from the agency.

COVID-19, which led the SSA to temporarily shutter its 1,200 field offices, isn't helping matters. The pandemic has exacerbated previously existing customer service challenges, including conflicting advice and long wait times, says Joel Eskovitz, director of Social Security and saving at the AARP Public Policy Institiute. "You have [28,000] people working remotely," adds Mary Beth Franklin, a certified financial planner and the author of Maximizing Social Security Retirement Benefits. "You have to ask: How good are their computer systems and how good are the connections?" (The 1,200 field offices my reopen this spring. "We anticipate that the field offices will restore increased in - person service to the public, without an appointment, in early April," an SSA press officer told the AARP Bulletin in January.)

According to the SSA, shortening phone wait times since 2018 point to an improvement in service. But with roughly 10,000 boomers reaching retirement age every day, the workload for customer service staff will only increase. Is the agency equipped to handle it?

>> LESS MONEY, LESS STAFF As with most things, customer service issues are tied in large part to money. Since 2010, the SSA's operating budget -set each year by Congress - has declined by 13 percent and its staff by 12 percent, while the number of Social Security beneficiaries has increased 22 percent, according to an analysis by the Center on Budget and Policy Priorities.

"It's a customer service agency, and you need money for that," says Kathleen Romig, a CBPP senior policy analyst who authored the analysis (and who worked at the SSA for eight years). "The more people you have to take claims and answer questions, the more quickly and accurately it gets done. Staffing has declined precisely as much as the funding because that's where the money goes."

In 2010, the SSA had over 67,000 full-time employees. By 2021, there were fewer than 59,000. An SSA spokesperson, replying by email to questions from the AARP Bulletin, noted that the agency "experienced many years where we received less than the annual President's Budget request." The SSA has authorized about 6,000 hires in fiscal year 2021 for its "front line components," but having enough warm bodies is only part of the solution. Staff need extensive training to decipher the agency's highly complex rules and regulations, and to coax accurate results from its antiquated computer systems, which in some cases are more than 35 years old.

New employees typically get four to six months of training, including peer mentoring that "mitigates the loss of institutional knowledge" as experienced employees leave, according to the SSA spokesperson. But loss of institutional knowledge could still be a looming problem. The agency anticipates that about a third of SSA employees - more than 21,000 people - will retire by 2025.

"They're doing the best they can," says Franklin. "[But] it's a mess."

>>> WHOM SHOULD YOU TRUST? <<

After her ex-husband died in 2016, 62 - year - old Ewa Gorzela tried to collect survivor benefits. At her first visit to the local office near her Carrollton, Texas, home in 2019, an SSA representative told her that yes, she would receive survivor benefits, but that she needed to bring in another document.

She brought the document to her second meeting but was assigned to a different SSA representative. This one asked if she was still working. She said yes - and he said she earned too much money to receive survivor benefits.

"Two people and two different answers," Gorzela says. "I don't know what to do."

As Gorzela knows, right answer - and wrong answers - can impact people's lives. According to a 2018 report from the SSA Office of the Inspector General, some of those eligible to receive widow and widower benefits weren't adequately informed that waiting to claim until age 70 could have increased their payments. A 2016 U.S. Government Accountability Office report found that some recipients who visited SSA field offices did not consistently receive critical information to help make well-informed decisions. The report cited studies and surveys showing "widespread misunderstanding about whether spousal benefits are available, how monthly benefits are determined, and how the retirement earnings test works.

As for Jim Sauer, the Ohio retiree who was expecting bigger benefits, the SSA said it would recalculate his benefit amount, issue him a "makeup" payment in 2022 and pay him the new, higher amount going forward. "It appears that it all may be working out," he says of the three-month process. "I'm not totally convinced. But for the first time in 14 calls, I've gotten the same response from two different individuals."

by Michelle Andrews

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