Theyre available for home assessments and modification. But we did reauthorize the Older Americans act earlier this year to support the aging network. In with the low income seniors but the property tax credits and those other paid out of pocket to make funding available for these modifications. In my home state of minnesota and the Congressional District that i represent we have a disproportionate increasing share of seniors in about 15 in nine metropolitan reason regions often lack the support network you get in an urban area. And is an important source of funds for home modifications but the program is a little outdated so we suggest a number of ways to make it more effective to streamline the application process with greater flexibility and let me conclude by saying that but it is our hope his boat, barca National Focus and it is my belief when we face a problem of this magnitude and eventually there will be a response it is Important Research planning an effective and systematic well thought out response rather than dealing with that as a crisis. [applause] i am pleased to be here this afternoon as well to participate in this task force in my first time to work with a Bipartisan Policy Center and a good way to do this we have a lot of discussion that we cant come too important recommendations thank you for the opportunity to do this and want to share a quick comment before start my remarks this report has a great deal of information the numbers are very real film matter in each and every Community Across the country but it does point out solutions that are open to other ideas as well and it is a call to all blast with Public Policy to understand the interaction between health and the communities that we live in and a great opportunity exist if we understand that. There is conversation going in the Health Care Space to understand how important those factors and reconsider a nontraditional and certainly seniors but the health care that contributes into a premature mortality the physical environment and makes a great deal of impact on your individual health the greater importance for greater americans to spend a great portion of their time in their home increasingly seen as care those that have health and Wellness Services for those with chronic conditions with the rapid expansion more and more americans are living with multiple chronic conditions and limitations of daily living. 68 of Medicare Beneficiaries have multiple chronic conditions and as a result 93 percent of medicare spending is spent on these people some understand of multiple chronic conditions to provide care for seniors has the potential to improve outcomes to reduce that in significant ways one is there is evidence that this works and it is growing attention across the country. The at home model that housing when combined with support and services can slow the rate of growth of medicare spending and Johns Hopkins shows how taylor, interventionist can help to avoid hospitalization and. In the innovative ways in to build on the Strong Foundation to read so great housing and learning from all of these different elevations bidders alien to much bigger numbers. The task force including key actors in the National Health care system of course, medicaid and medicare with Medicare Advantage plans to tackle some of these issues headon and Health Care Professionals quite simply the report is a call to action to the entire Health Care Community and to go through a few of the opportunities that we think that can make a difference first for the most of vulnerable seniors with the enhanced care coordination and there are 1. Three ranchers who live in subsidized housing the vast majority is duly eligible for medicare and medicaid. They recommend the centers for Medicaid Services or cms has innovation in coordinating health care and longterm Care Services for Medicare Beneficiaries living in public housing. Health care providers have partnership would implement evidence based care models to be accountable for the al comes in reducing cost eligible applicants would receive payments of the beneficiary on a monthly basis to make investment of care coordination and infrastructure including supporting housing services. Second had an opportunity to help poor outcomes in seniors to be very specific is one out of three older adults paul each year but sometimes quite dramatically resulting in 2. 5 Million Emergency Department visits with 700,000 hospitalizations and 34 billion of the annual Health Care Cost it is very disruptive and difficult and sometimes a life ending experience for them and tragic many are preventable but yet most occur in the home. That is why we strongly recommend that medicare reducing false a top priority opportunity exists to incentivize and provide Technical Assistance cdc has that steady as a great resource and also looking at the system the providers to be held accountable and there are opportunities for false based prevention programs with an effort to modify homes as they talk about the upside is enormous with fitness and movement as that turns out to be real issue. So some very simple examples if you have an older adults and your family the third example the task force spent examining the role of technology in the home setting of Healthy Aging with an Online Survey of house and stakeholders to ask the question which are effective and scalable . Interesting results about this they are included there but they can benefit considerably that patient monitoring to improve health outcomes. There are numerous barriers and costs that need to be reduced the prevent the adoption of a new technology in these barriers should be removed. So i will close by saying that this is an enormous opportunity as we know and we care deeply seniors over 65 so look out for each other and in a way to improve that reduces cost and and and it enables those senior stage successfully over many years. Thank you. [applause] thanks to the cochairs for your remarks and if you could please join us on stage. I am hoping we will have time for question and answer but i wanted to ask a couple of questions on the minds of many of you watching so maybe we should jump right in the first talk about the cost implications of the recommendations and there are some items with respect to cost of Health Care System specs i am happy to say a few words but thank u. S. The leader of the task force of any other team of researchers and writers if we could take a moment to recognize those who are involved. [applause] a good part of the indigenous for this report is in fact, the fact that we are increasingly aware of the role of the cost curve of increasing Budget Expenditures costs related to Medicare MedicaidSocial Security are three of the most important drivers of deficits is a function dramatically as it is a mention 78 billion baby boomers that causes the number of people over 65 years of age to double in 85 triple with increasing medical cost and the most expensive years where they find themselves in lowes expensing housing ever have a nursing home in the medicare law dash medical care needs so anything we can do as a country by enabling people to stay home longer to have care and home peace of mind as rawl positive aspects it does cost some to extend Home Services to create the support system but the expectation is that those costs are less than what can be saved for the most expensive form of care. There are numerous studies done over the years this spoke about trying to create a plateau by what they call compression of the years of morbidity the standard expectations that there is a steady decline and a cost increase over a steady period. That if you can find ways there is a shorter period in which we all concede to the frailties of life and those concepts are all implicit in this report to mention the personal experience two summers ago mother lives in the home that she and my dad bought when they were married and raised five children 69 years and cannot be talked about leaving the house even after i bother died it would have taken dynamite she knew the birds and was her garden and her house. And she fell down of 2014 and it went downhill from there. In the lost her by november so there is a four month period that was very difficult the she had been at her home perfectly happy in functional at 90 until that moment so i lived through the implications of sustained in a place where they can be happy with an inevitable difficulty but if we could create those circumstances for more americans they would be better off in the country as a whole would be better off as well. Talk about the role of the private sector we know about the low Income Housing tax credit in leveraging the private sector investments and their other recommendations engaged in an Affordable Housing and modification had we get the private sector more involved . They strike a great balance with the potential of savings as well as in gauging the private sector of what would be considered of a low income tax credit i had the pleasure to work with senator mitchell he prides itself as being at the birth of the tax credit and one of the successes is there is a tremendous desire for investment for the benefit they received so some of these recommendations psycho modification if you make it more suitable for someone to live in the home and 90 but so often that is not the case because of the constraints and there is so many things to be a tremendous opportunity with the role of technology. Still looking at those areas of opportunity remember the notforprofit sector and the private sector will be engaged in a way that i think can create a much more sustainable program. When we have the experience of local government had to look to another program in a better and smarter way with that tax credit with the recommendation we made a couple of years ago has been picked up by senator hatch who is chairman of finance so its a bipartisan opportunity for something good to happen where over the years people say i would invest thousands or millions more if i could have the extension so we need to keep that in mind Going Forward as we try to think of solutions for the long haul to make it more sustainable and also realize that it will require all of the above not just notforprofit in order to get it done in a way that is sustainable with tremendous challenges. Focusing on health care the task force makes a number of recommendations from the medicare vantage plan nonprofit hospitals with the recommendations that you outlined as removed from volume to value and then realizes outcomes is this the time to become a top priority . There is a great deal of conversation about all the social and environmental and situational factors that relate to health care that people simply cannot get to the hospital they cant fill the prescription because they cannot make it there or as if they had cataract surgery be he knew he had space to take care of him when he got home and was afraid to get it done but the fact is that someone went to his home to talk to him to say we will help you with the eye drops to make sure you know, what is being done to make sure you have a successful outcome that can have been over and over also referring to a Community Partners who can provide these services as the invite the caretakers into their homes or for the families that may not be functioning but they also say this is a stress on the system to provide all this care so we have to think about Health Care Dollars being spent with critical visits in the home it is wonderfully successful with Nurse Practitioners and independent Health Care Providers and bringing health care and house calls back again and not requiring them to come to the hospital so its an interesting time and time for innovation. To make sure the financing model is extremely important and obviously with managedcare because it was just continue to grow with the dramatic impact on families with successful and Healthy Aging they can stay healthy longer and those who are newly 65 and happens every day hopes that is the case that they are relying on policy makers to talk about the Community Partnership to allow payment for services and look at what is happening in medicaid or a variety of states to look at the best practices. That is great. Were living in interesting political tide in the final six months of when congress and administration of a powerful president ial election. [laughter] so how feasible is it for the next congress to take on the recommendation called for today . We have of a couple of reasons people may be negative about that one is general dysfunction and the other is the inability of congress to come up with big ideas with budgetary problems because we cant talk about this for a long time that both of those will get better from our standpoint that may not be true for every policy area but some and you remember the famous economist. With the unsustainable trend is not unsustainable. There is a lot of truth to that. The truth is most members of congress will tell you they dont like the fact that if you talk to them individually or small groups there really want to accomplish things i dont know what exactly precipitates that that will be possible but to do what we talk about today was a basic fact politics drives policy making in the average age is going up that is the other side of the clean the political potency of senior lawyers and their kids to have to deal with these problems so there is a constituency and i really believe with the things that we talk about with the broader war arabia of policies the biggest problem as i mentioned it is not that we wont do anything but we will do a little later than may shed in the of thoughtful way and in the way of other expenditures adult think we will go one time responding to the problems to expand the constituency. We could do wrong and in a way that is too expensive that and said subordinating every of their priority so it is a great value of the task force to encourage thoughtful action before it becomes a tidal wave. Those that demand action is a bipartisan consensus so theres almost no words to describe of how potent this is for the country and even has nationalsecurity dimensions the very character of the country itself it she leaves them with not decent housing so that is truly a global problem we see japan european nations, and that will confront issues with the yen under manpower for Social Security help system so this is our whole peer group of the industrialized nations and besides that watching people who live their whole lives to for a variety of reasons have not ended up with enough money at the end of the day minorities or marginalized when theyre the most frail or most dependent it just isnt fair or right to plan so badly so this is truly a powerful need. So with experts of housing in the Health Care Policy so there will be discussion of medicare and medicaid would is interesting about those proposals Health Care System of self and of those factors around that individuals. But it does bring together zero word does about communities. They want to stay in their home or in their community. Of that Bipartisan Policy Center but those Older Americans with quite a bit of overlap so are there a whole variety of more affordable levels of housing . And that works for you to. And then in the communities as well and i appreciate that. With housing in the home and the place for seniors live. We do want to open that up. As a clinical psychologist in addition to medical care and shelter that is critical for a healthy life. I wonder when people stay in their own home there is that Village Movement so the home as the site of Clinical Care and with the fitness to walk to the park to the Senior Center for the ymca it isnt only about getting their or the exercise. And that is extremely helpful. And with that social interaction is difficult. In that is bring you that as well. That they need to assess the situation so with that beneficiary. Were not mandating that people have to stay in place that perhaps the social interaction and the other of walking distance as the Energy Policy those who have gone to the hill to come to washington to do nothing. A but other than that i should have left before i intervened sovietera is to find one way to make the country better because it thought his comments were so are appropriate but this is something that id think we can move forward. And there is a number of ideas and i am also an optimist. So now i will have to excuse myself. [applause] one or two more then we have to wrap up. End with age ended come in the existing resources with those single homes and that is the modification is hard. And that is very important but there are those in the middle income areas that have resources to make those middleclass deletions to make good use of dollars her troy and in several forms with the recognition of more appropriately scaled and excessive rise steep new units those who leave the mansion in the suburbs to find something more suitable size wives for the widow after husband has passed or engaging cou