Understanding the Many Intersections Between Health & Wealth
What It’s Worth Philadelphia: Financial Health Is Public Health
At last month’s What It’s Worth event in Philadelphia, expert panelists discussed the many ways health and wealth are intimately linked. The event, co-hosted by the Federal Reserve Bank of Philadelphia, the Center for Public Health Initiatives at the University of Pennsylvania and CFED, brought together public health and business experts alongside practitioners from housing and financial well-being organizations. Featured speakers from the Center for Financial Services Innovation, Children’s Hospital of Philadelphia, Philadelphia’s Local Initiatives Support Corporation and Robert Wood Johnson Foundation presented emerging research and led a lively discussion on the need to bolster physical and financial health by bringing these two communities together. Here are some of the insights we gleaned about how to build physical and public health and well-being in Philadelphia.
We Need to Prepare for More Seniors
When it comes to both financial and physical health, seniors are vulnerable. With 10,000 Americans turning 65 everyday, we need to prepare for their future at an individual and systems level. Low-wage jobs, pension system failure, improper or incomplete financial planning, and unexpected health challenges contribute to a difficult “retirement”. One of the presentations in Philadelphia featured the findings from the creator of Community Aging in Place: Advancing Better Living for Elders’ (CAPABLE). Dr. Szanton’s (Associate Professor, Department of Community-Public Health, Johns Hopkins University School of Nursing) research project is examining strategies to enhance patients’ independence that leverage holistic care delivered in the home with collaborative support from partner organizations.
SNAP and LIHEAP Can Decrease Medical Visits
Annually, over 20 million seniors receive emergency care. We need creative ways to limit the cost and resource burden and improve quality of life. Let’s start with food and heat. Dr. Sarah Szanton suggested we zero in on strategies to increase older Americans’ participation in income support programs like Medicaid, LIHEAP and SNAP. She’s seeing signs of lower emergency room and hospital visits and lower nursing home among seniors who use SNAP.
We Must Reduce the Burden on Seniors Seeking Nutrition Assistance
Ted Beck, President and CEO of the National Endowment for Financial Education, explores the impact of aging on cognitive function in a What It’s Worth essay titled “The Upside of Aging.” Beck’s essay explores the concept of crystallized intelligence — the ability to use skills, knowledge and experience accessed from long-term memory — to explain how a person’s life experiences expand their cognitive function.
By understanding that crystallized intelligence peaks and then falls off later in life, Beck argues that we can identify solutions for seniors that set up “smart defaults.” Beck writes, “One of the best ways we can help aging adults is to anticipate what they want to do and help them do it.” He suggests concrete opportunities; for example, automating monthly bill payments could limit errors and ensure seniors pay bills “on time, in the proper amounts, to the right creditors.” This thinking raises a question that participants at the Philadelphia event grappled with: How can we use Beck’s insights to make it easier to set up smarter systems for people in need of assistance, such as nutrition assistance?
SNAP Can Better Help Low-Income Seniors Keep their Benefits
Several states are redesigning public assistance programs to make it easier for seniors to participate and relieve the burden on our health care system. Federal regulations stipulate all households with seniors and disabled members without earned income need to recertify every 24 months in order to receive SNAP benefits, regardless of their age or ability to work. We can certainly improve this system — here’s how:
- Remove asset limits. In “Ending ‘Welfare As We Know It,’” Reggie Bicha & Keri Batchelder of the Colorado Department of Human Services recommend updates and improvements to public assistance programs. They write that “asset tests discourage saving and asset accumulation, the very actions that lead to financial health and well-being.” For instance, while almost 40 states no longer limit assets for seniors on SNAP, they stress that federal law still has asset limitations. Following the model applied in the states, we should remove these asset limits from public policy at all levels to reduce confusion, streamline messaging and boost enrollment.
- Follow New York’s lead. New York State’s Nutrition Improvement Project (NYSNIP) automatically enrolls all SSI “live alone” seniors and people with disabilities into the SNAP program. If enrolled in NYSNIP, participants recertify every 48 months. New York State also waives in-person appointment requirements for recertification for seniors and people with disabilities with no earned income and no changes to report. Interactive Voice Response (IVR) systems leverage automated, computerized telephone scripting systems that create efficiencies for program staff and those who need to recertify.
- Leverage existing data. USDA is experimenting with demonstration waivers to states that could leverage third-party data from the Social Security Administration (such as place of residence data) to support automated eligibility determination and recertification.
Data-Sharing Improves Systems
The government collects and stores data from each of its many programs. How can data already collected through the determination of entitlement eligibility (e.g., health, housing, nutrition) and through the tax system (e.g., education, work incentives in the tax code, residential property valuations) be used to increase seniors’ enrollment in benefit programs?
Let’s imagine a world where the IRS, USDA, Department of Education and Social Security Administration each shared with one another what they knew about where people live, how much they earn, and other pertinent application and recertification information, perhaps through the creation of a national data exchange. Then, in-person appointments with social workers, doctors and case managers could further authenticate a client’s identity and verify their eligibility for all programs through a common application, rather than having separate applications for each program. Such a system could save households, states and the federal government an untold number of hours — and dollars — by improving efficiency. It could also help ensure that more low- and moderate-income seniors participate in programs that improve their quality of life, reduce the number of hours working children spend caring for their elderly relatives, and reduce cost and frequency of health care emergencies.
The conversation in Philadelphia — made possible thanks to What It’s Worth and the many solutions for financial and physical health and well-being it includes — was a good reminder that if we take a “whole-person” approach to the way we administer benefits, people would live longer, healthier, happier lives in their homes and communities. We just need the political will to turn big data and collaborative systems into forces for good.
We will continue to share highlights of important What It’s Worth discussions on Twitter @StrongFinFuture. Follow us, then lead the way!
 “A Model CAPABLE of Creating Lasting Change” http://www.jhartfound.org/blog/a-model-capable-of-creating-lasting-change/
 In 2009–2010, a total of 19.6 million emergency department (ED) visits in the United States were made by persons aged 65 and over. http://www.cdc.gov/nchs/data/databriefs/db130.htm
 Fact Sheet: USDA Support for Older Americans, http://www.fns.usda.gov/pressrelease/2015/020215.