OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH Working

OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH Working Together to Address the Challenges Faced by Aging Racial and Ethnic Minorities Alexis Bakos, Ph. D, MPH, RN Senior Advisor to the Deputy Assistant Secretary for Minority Health Office of Minority Health U. S. Department of Health and Human Services Dean’s Diversity Forum, Widener University Commonwealth Law School Harrisburg, PA – February 22, 2019

Agenda • • • Profile of Older Americans • Q&A Overview: HHS Office of Minority Health (OMH) Other Federal Initiatives and Programs to Improve Health and Health Care Among Older Americans O F F I C E O F T H E ASSISTANT SECRETARY FOR HEALTH 2

Over 65 Population Expected to Nearly Double by 2060 Number of persons Age 65 and Over, 1900 -2060 (in millions) 140 • The age 65+ population increased 33% from 2006 -2016 (37. 2 million to 49. 2 million) • Represented 5. 2% of the population in 2016 and will rise to 21. 7% by 2040 • The 85 and over population, 6. 4 million in 2016, will increase 129% to 14. 6 million by 2040 120 98, 2 100 82, 3 80 60 49, 2 56, 4 35 40 25, 5 20 3, 1 4, 9 9 16, 2 0 1900 1920 1940 1960 1980 2000 2016 2020 2040 2060 US Census Bureau Population Estimates O F F I C E O F T H E ASSISTANT SECRETARY FOR HEALTH 3

Growth in Aging Racial/Ethnic Minority Population RACIAL AND ETHNIC MINORITIES, 65 AND OVER 2020 -2060 (in thousands) 2030 2040 2050 2060 Hispanic African American AANHPI 1195 996 834 657 416 7548 6175 4889 3644 12374 10283 9130 7810 2468 4831 5406 8023 11695 15421 19516 2020 AI/AN An Aging Nation: The Older Population in the United States. U. S. Census Bureau - 2014 O F F I C E O F T H E ASSISTANT SECRETARY FOR HEALTH 4

Percentage of Adults Aged ≥ 65 Years Who Reported Excellent or Very Good Health, by Race/Ethnicity and Poverty Status Morbidity and Mortality Weekly Report May 31, 2013 / 62(21); 431 O F F I C E O F T H E ASSISTANT SECRETARY FOR HEALTH 5

OMH’S HISTORIC BEGINNING THE CASE FOR ELIMINATING HEALTH DISPARITIES Big Six Improvement Areas O F F I C E O F (1) Cancer, (2) Cardiovascular disease and stroke, (3) Chemical dependency, measured by deaths due to cirrhosis, (4) Diabetes, (5) Homicide and accidents (unintentional injuries), (6) Infant mortality (1) Health information and education, (2) Delivering and financing health services, (3) Health professions development, (4) Cooperative efforts with the non-federal sector, (5) Data development, (6) Research agenda T H E ASSISTANT SECRETARY FOR HEALTH 6

NEW DEPUTY ASSISTANT SECRETARY FOR MINORITY HEALTH & DIRECTOR, HHS OFFICE OF MINORITY HEALTH • CAPT Felicia Collins, MD, MPH § Appointed Deputy Assistant Secretary for Minority Health and OMH Director on January 31 § Nearly 20 years at HHS, most recently as senior advisor, Bureau of Primary Health Care, Health Resources and Services Administration (HRSA) § Board-certified pediatrician and captain in the US Public Health Service Commissioned Corps O F F I C E O F T H E ASSISTANT SECRETARY FOR HEALTH 7

The Office of Minority Health (OMH) OMH Mission To improve the health of racial and ethnic minority populations through the development of health policies and programs that will help eliminate health disparities OMH Functions Research, Demonstrations and Evaluation Awareness Policies, Programs and Practices Data Partnerships and Networks O F F I C E O F T H E ASSISTANT SECRETARY FOR HEALTH 8

OMH Elevated by Congressional Statute, March 2010 • Transferred to the Office of the Secretary, administratively supported by the Office of the Assistant Secretary for Health (OASH) • Established the Deputy Assistant Secretary for Minority Health • Authorized six additional offices of minority health and the National Institute on Minority Health and Health Disparities at NIH Office of Minority Health and Health Equity Statutory Authority: Public Health Service Act § 1707 (42 U. S. C. § 300 u-6) O F F I C E O F T H E ASSISTANT SECRETARY FOR HEALTH 9

Examples of OMH Networks/Partners/Collaboration Institutions of Higher Education, including Minority. Serving Institutions (HBCUs, HSIs, TCUs, AANAPISIs) Community-based and faith-based organizations Federal, state, territorial, and local agencies National organizations and associations State and Territorial Offices of Minority Health Tribes and tribal organizations • • Administration for Community Living National Hispanic Council on Aging AARP Pennsylvania Office of Health Equity Federal, state, and territorial legislators O F F I C E O F T H E ASSISTANT SECRETARY FOR HEALTH 10

The Opioid Epidemic: An HHS Priority • OMH is administratively supported by the Office of the Assistant Secretary for Health (OASH), under ADM Brett Giroir, MD § § § Dr. Giroir also serves as senior advisor to the Secretary Alex Azar for the opioids epidemic The epidemic is one of the Administration’s highest priorities The crisis is also a public health emergency for seniors O F F I C E O F T H E ASSISTANT SECRETARY FOR HEALTH 11

The Impact of the Opioid Epidemic on the Elderly • The crisis for seniors goes beyond their own substance use disorders § Parents of adult children who are misusing opioids become targets of financial, physical and emotional abuse § More grandparents are raising grandchildren because the parents have died, are incarcerated, using drugs, in treatment or otherwise unable to care for their children ü The Administration for Children and Families reports that 92, 000 children (34 percent) were removed from their homes in 2016 because of parental substance misuse ü The foster system is increasingly turning to other family members for help O F F I C E O F T H E ASSISTANT SECRETARY FOR HEALTH 12

Opioids and Elders: Medicare Part D, 2017 Data Nearly 1 in 3 Part D beneficiaries received at least one prescription opioid (14. 1 million enrollees) Medicare Part D paid for 76 million opioid prescriptions 1 in 10 Part D beneficiaries received opioids for three or more months Frequent use of opioids was more likely among seniors who were poor or low income, and seniors living in rural areas 36. 1 percent of hospitalizations for opioid poisoning listed Medicare as the primary source 12. 7 percent of ED visits for opioid poisoning listed Medicare as the primary source for payment O F F I C E O F T H E ASSISTANT SECRETARY FOR HEALTH 13

OPIOID MISUSE INCREASES AMONG OLDER ADULTS Opioid-Related Inpatient Stays and Emergency Department Visits Among Patients Aged 65 Years and Older, 2010 and 2015. HCUP September 2018 O F F I C E O F T H E ASSISTANT SECRETARY FOR HEALTH 14

Opioid Use By Race, Age 65 and Older 2015 • • Elderly Adults with any opioid prescriptions fills during the year Elderly Adults with 4 or more opioid prescriptions fills during the year • While the proportion of older adults who misuse opioids is relatively small compared to younger adults, opioid use nearly doubled among seniors from 2004 -2014 Among patients aged 65 years and older, the rate of opioid-related hospitalizations increased more than the rate of non-opioidrelated hospitalizations between 2010 and 2015 In 2015– 2016, whites were more likely than other races to fill an opioid prescription at least once during the year. A similar pattern was observed for frequent use of opioid prescriptions. HCUP Statistical Brief #244 September 2018 O F F I C E O F T H E ASSISTANT SECRETARY FOR HEALTH 15

HHS 5 -POINT STRATEGY TO COMBAT THE OPIOIDS CRISIS https: //www. hhs. gov/opioids O F F I C E O F T H E ASSISTANT SECRETARY FOR HEALTH 16

Guideline for Prescribing Opioids for Chronic Pain • Issued by the Centers for Disease Control and Prevention for prescribing opioid pain medication for patients 18 and older in primary care setting. Three main focus areas: § Determining when to initiate or continue opioids for chronic pain § Opioid selection, dosage, duration, follow-up, and discontinuation § Assessing risk and addressing harms of opioid use O F F I C E O F T H E ASSISTANT SECRETARY FOR HEALTH 17 17

Older Adults in Healthy People 2020 Immunizations and Infectious Diseases IID-12. 12: Annual Flu Vaccination IID-13. 1: Pneumonia Vaccination Injury and Violence Prevention IVP-23. 2: Prevent an Increase in Fall. Related Deaths Disability and Health DH-7: Reduce the Proportion of Older Adults with Disabilities Who Use Inappropriate Medications Access to Health Services • AHS-5: Have a Specific Source of Ongoing Care • AHS-7 (Developmental): Receive Recommended Clinical Preventive Services O F F I C E O F Nutrition and Weight Status NWS-13: Reduce Food Insecurity NWS-14, 15: Increase Fruit and Vegetable Consumption Physical Activity PA-15 (Developmental): Increase Built Environment Policies to Increase Physical Activity Older Adults Topic Area: Health Services, Chronic Illness Prevention and Treatment, Injury Prevention, and Caregivers Social Determinants of Health SDOH-3: Reduce the Proportion of Persons Living in Poverty T H E ASSISTANT SECRETARY FOR HEALTH 18

2018 Healthy Aging Summit and Workshop Healthy Aging Summit • • Focused on healthy aging and maximizing the health of older adults through prevention strategies Goals: (1) Explore the science on healthy aging; (2) Identify knowledge gaps; (3) Promote prevention, (4) Support people aging in place / community Healthy Aging Workshop • • Support from: HHS (ODPHP, OWH, ACL, CDC), National Council on Aging, Trust for America’s Health, and Alzheimer’s Association Key priority areas identified in participant action plans: • Chronic conditions and preventive health care, transportation, surveillance and education, health literacy, injury and falls prevention, workforce and caregiving, age-friendly communities, physical disabilities, physical activity and mobility, and healthy foods. O F F I C E O F T H E ASSISTANT SECRETARY FOR HEALTH 19

What We Learned: Jurisdictional Priorities for Healthy Aging National Topic Areas Chronic Conditions and Preventive Health Care Transportation Surveillance and Education Health Literacy and Cultural Sensitivity Mental Health Injury and Falls Prevention Emergency Preparedness O F F I C E O F • Healthy Aging Topics Identified as Priorities in Action Plans § Identified by state and local health and aging officials in attendance at the Healthy Aging Summit workshop § Officials said these should be important priorities for their state action plans T H E ASSISTANT SECRETARY FOR HEALTH 20

New HHS Investment in Adult Protective Services • • $3 million investment by the Administration for Community Living to support states in building the “Adult Protective Services (APS) of tomorrow” Continues work to develop tools and infrastructure over the next three years: § § § Update the National Voluntary Consensus Guidelines for Adult Protective Services Systems, create a dissemination plan for the guidelines and build a stronger evidence base of APS best practices Establish an APS client outcomes study Develop an inventory of screening and assessment tools https: //acl. gov/news-and-events/announcements/acl-announces-3 -million-investment-strengthen-adult-protective O F F I C E O F T H E ASSISTANT SECRETARY FOR HEALTH 21

• • • Charged with identifying and proposing solutions to challenges involving elder abuse, neglect and financial exploitation Consists of representatives from 12 federal departments and agencies Includes the Elder Justice Working Group, made up of senior staff from the 12 federal departments/agencies. OMH participation: § § • Interagency Partnership on Aging Veterans and Mental Health Data Collection Subgroup The Council is required by Congressional statute to issue a Report to Congress every two years. The next report will be submitted later this year. https: //acl. gov/programs/elder-justice-coordinating-council-ejcc To Submit Public Input on Future Priorities for the Council: https: //acl. gov/about-acl/public-input Public Comment Period Ends: September 30, 2019 O F F I C E O F T H E ASSISTANT SECRETARY FOR HEALTH 22

Rise in Older Incarcerated Individuals State and Federal Prison Population, 55 and Over, 1995 -2030 • Older incarcerated individuals have greater and unique physical and behavior health needs § 450 000 400 000 § § 350 000 30% of the prison population projected to be 55+ by 2030 250 000 200 000 150 000 100 000 50 000 0 1995 2015 2030 O F F I C E O F Older incarcerated are 13 -15 times more likely to report an ambulatory disability, 6 times more likely to report a hearing disability and 4 -5 times to report a vision disability 52 percent report living with a mental condition There is a specific concern about prevalence of dementia among older inmates and challenges association with management Aging, Reentry and Health Coverage: Barriers to Medicare & Medicaid for Older Reentrants, March 2018 Office of the Assistant Secretary for Planning & Evaluation T H E ASSISTANT SECRETARY FOR HEALTH 23

Examining Barriers to Medicare and Medicaid for Aging Reentrants • • • Most of the elder prison population is white, however the largest percentage of older inmates are African American Older reentrants face greater barriers to Medicaid coverage in states that did not expand Medicaid eligibility Distrust of the medical system causes underutilization of health care services by justiceinvolved African American men Details operational, legal and regulatory barriers to enrollment in Medicare and Medicaid Explores promising correctional and community-based strategies for gaining coverage Identifies key gaps in current understanding and ways to help address the gaps and inform future policy Assistant Secretary for Planning and Evaluation (ASPE) Office of Disability, Aging and Long-Term Care Policy O F F I C E O F T H E ASSISTANT SECRETARY FOR HEALTH 24

Older Veteran Behavioral Health Resource Inventory • • Released by the Interagency Partnership on Aging Veterans and Mental Health Collaboration by: § U. S. Department of Veterans Affairs (VA) ü Veterans Health Administration (VHA) ü Veterans Benefits Administration (VBA) § U. S. Department of Health and Human Services (HHS) ü ü § Administration for Community Living (ACL) Center for Medicare & Medicaid Services (CMS) Office of Minority Health Substance Abuse and Mental Health Services Administration (SAMHSA) National Council on Aging (NCOA) https: //www. mentalhealth. va. gov/communityproviders/docs/Older_Veteran_Behavioral_Health_Resource_Inventory_050418. pdf O F F I C E O F T H E ASSISTANT SECRETARY FOR HEALTH 25

PILOT PROJECT TO INCREASE MINORITY NURSING WORKFORCE • Diversifying the Nursing Workforce: Mentoring for Student Retention and NCLEX Success at Historically Black Colleges and Universities (HBCUs) § Pilot program to help faculty at HBCUs increase BSN graduates and passage of board certification § Train-the-trainer program developed in conjunction with the AARP’s Center to Champion Nursing in America, § The first workshop held October 9 -11 in Washington, DC - Pilot includes representatives from HBCUs in Mid. Atlantic - Plans call for expansion to remaining HBCU BSN nursing programs this year O F F I C E O F T H E ASSISTANT SECRETARY FOR HEALTH 26

Update: New NIH Rule on Clinical Research • NIH’s new Inclusion Across the Lifespan policy stipulates that people age 65 and older be included in clinical research § Clinicians don’t know how most treatments affect older people because they are not routinely included in research that informs treatment: ü About 66% of clinical trials exclude elders ü 67% of trials had average patient ages younger than the ages for the diseases being studied ü Even when older Americans were included, the structure of the studies raises questions about the applicability of the results • • The Inclusion Across the Lifespan policy became effective for all NIH grant applications with due dates on or after January 25, 2019. The policy and effective date also apply to solicitations for R & D contracts and intramural studies O F F I C E O F T H E ASSISTANT SECRETARY FOR HEALTH 27

Older Americans Month, May 2019 (OMH Involvement? ) • • Organized every May by the Administration for Community Living 2019 Theme: Connect, Create, Contribute § § § • Connect with friends, family and services that support participation Create by engaging in activities that promote learning, health and personal enrichment Contribute time, talent and life experiences to benefit others Includes web and social media recourses and event/activity ideas § § https: //acl. gov/oam/2019/older-americans-month-2019 Twitter ü $#OAM 19 ü #Connect. Create. Contribute O F F I C E O F T H E ASSISTANT SECRETARY FOR HEALTH 28

April is National Minority Health Month Theme: Active & Healthy § Builds on the new HHS Activity Guidelines § Aligns with the Office of Disease Prevention and Health Promotion’s “Move Your Way Campaign” O F F I C E O F T H E ASSISTANT SECRETARY FOR HEALTH 29

Office of Minority Health Resource Center (OMHRC) • The nation’s largest repository of information on the health of minority populations in the U. S. and its territories • Services available include: § § Literature Services Funding Searches Data/Statistics Capacity Building § § Consumer Materials Technical Assistance E-Newsletters Social Media Phone: 301 -251 -1797 Toll-Free: 800 -444 -6472 info@minorityhealth. hhs. gov O F F I C E O F T H E ASSISTANT SECRETARY FOR HEALTH 30

THANK YOU Potential Opportunities for HHS Funding and Engaging with OMH ü Subscribe to OMH Newsletter through minorityhealth. hhs. gov ü Join our listserv through minorityhealth. hhs. gov ü Sign up for our grants listserv through minorityhealth. hhs. gov Connect with OMH on Social Media Twitter: @Minority. Health (English); @OMH_Espanol (Spanish) Facebook: Office of Minority Health Instagram: @officeofminorityhealth O F F I C E O F T H E ASSISTANT SECRETARY FOR HEALTH 31