The Elder Economic Security Standard Index for Connecticut

Transcription

1 The Elder Economic Security Initiative Program: The Elder Economic Security Standard Index for Connecticut 2009 Wider Opportunities for Women

2 Acknowledgements The Permanent Commission on the Status of Women and the Connecticut Commission on Aging would like to acknowledge their staff for their work on this project, Lisa P. Sementilli, Research and Policy Director of PCSW, Deb Polun, Legislative Director for the CoA, and Emma I. Mullen, PCSW s Research Assistant. The Connecticut State Data Center provided consultation on The Five Connecticuts. We are grateful for the innovative approach the Connecticut initiative was able to take due to their research. We would also like to thank all the members of the Connecticut Elder Action Network for their contributions. In particular, this work would not have been possible without Pamela Giannini of the Connecticut Department of Social Services (and her staff at the Unit on Aging), A. Kate McEvoy, Esq., of the Area Agency on Aging of South Central Connecticut, Kevin Brophy from Legal Services of Connecticut, Orlando Rodriguez of the Connecticut State Data Center, Molly Gavin from Connecticut Community Care, Inc., Raphie Podolsky of Connecticut Legal Services, and Ron Schack from the Charter Oak Group. About the Permanent Commission on the Status of Women The Permanent Commission on the Status of Women (PCSW) the State s leading force for women s equality has advanced the discussion on economic security in Connecticut over the last thirty-five years. PCSW was created in 1973 by an act of the Connecticut General Assembly (Public Act ). Under Sections 46a-1 through 46a-6 of the Connecticut General Statutes, a seventeen-member commission, staff, and volunteers work to eliminate sex discrimination in Connecticut. Our work is to inform leaders about the nature and scope of discrimination, to serve as a liaison between government and private interest groups concerned with services for women, to promote consideration of women for governmental positions, and to work with State agencies to access programs and practices as they affect women. Economic security is PCSW s top public policy priority. We see the Elder Economic Security Initiative as an opportunity to advance our focus economic security throughout the lifespan. For more information about PCSW, see About the Connecticut Commission on Aging The Commission on Aging (CoA) is an independent state agency advocating on behalf of Connecticut s present and future generations of older adults. CoA was created in 1993 by an act of the Connecticut General Assembly (Public Act ). Under Section 17b-420 of the Connecticut General Statutes, a thirty-three member commission, staff and volunteers work to improve the lives of older adults of today and tomorrow. The Commission has launched several recent complementary projects, including a Redefining Retirement Years initiative. Additionally, the Commission was instrumental in the completion of the state s first Long-Term Care Needs Assessment in over twenty years, conducted by the University of Connecticut Health Center Center on Aging. The 2007 study collected needed data about the long-term care needs of state residents and made recommendations towards long-term care systems change. The Elder Economic Security Standard Index builds on that long term care needs assessment and takes the dialogue on long term care to the next level. For more information about CoA, see For information about long-term care services and supports in Connecticut, see www. ct.gov/longtermcare. The Gerontology Institute University of Massachusetts Boston The Gerontology Institute, John W. McCormack Graduate School of Policy Studies, University of Massachusetts Boston addresses social and economic issues associated with population aging. The Institute conducts applied research, analyzes policy issues, and engages in public education. It also encourages the participation of older people in aging services and policy development. In its work with local, state, national, and international organizations, the Institute has five priorities: 1) productive aging, that is, opportunities for older people to play useful social roles; 2) health care for the elderly; 3) long-term care for the elderly; 4) economic security for older adults; and 5) social and demographic research on aging. The Institute pays particular attention to the special needs of low-income and minority elderly. For more information about The Gerontology Institute please visit or gerontology@umb.edu. Wider Opportunities for Women (WOW) Wider Opportunities for Women (WOW) works nationally and in its home community of Washington, DC to achieve economic independence and equality of opportunity for women and their families at all stages of life. For over 40 years, WOW has been a leader in the areas of nontraditional employment, job training and education, welfare to work and workforce development policy. Since 1995, WOW has been devoted to the self-sufficiency of women and their families through the national Family Economic Self-Sufficiency (FESS) Project. Through FESS, WOW has reframed the national debate on social policies and programs from one that focuses on poverty to one that focuses on what it takes families to make ends meet. Building on FESS, WOW has expanded to meet its intergenerational mission of economic independence for women at all stages of life with the Elder Economic Security Initiative. For more information about WOW s programs please visit or call WOW at Elder Economic Security Initiative Program: The Elder Economic Security Standard Index for Connecticut 2009, the Gerontology Institute, University of Massachusetts Boston, and Wider Opportunities for Women.

3 Elder Economic Security Initiative Program: The Elder Economic Security Standard Index for Connecticut Gerontology Institute John W. McCormack Graduate School of Policy Studies University of Massachusetts Boston and Wider Opportunities for Women The Atlantic Philanthropies 2009 Copyright, 2009, the Gerontology Institute, University of Massachusetts Boston, and Wider Opportunities for Women.

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5 Preface: The Elder Economic Security Initiative Program and The Elder Economic Security Standard Index The multi-year national Elder Economic Security Initiative (the Initiative) at Wider Opportunities for Women (WOW) offers a conceptual framework and concrete tools to shape public policies and programs to promote the economic well-being of older adults. The Initiative combines coalition building, research, education, and advocacy at the community, state and national levels. With support from the Retirement Research Foundation, WOW partnered with five pilot states, California, Pennsylvania, Massachusetts, Illinois, and Wisconsin, to launch the national Initiative. Support from The Atlantic Philanthropies will expand the project to a total of twenty states, including Minnesota, Connecticut, New Jersey, and Michigan, in an effort that will ultimately result in a national database with information on all 50 states and the District of Columbia. Underpinning the Initiative is the Elder Economic Security Standard Index (the Elder Index), a new tool for use by policy makers, older adults, family caregivers, service providers, aging advocates and the public at large. Developed by the Gerontology Institute at the University of Massachusetts Boston and WOW, the Elder Index is a measure of income that older adults require to maintain their independence in the community and meet their daily costs of living, including affordable and appropriate housing and health care. The development and use of the Elder Index promotes a measure of income that respects the autonomy goals of older adults, rather than a measure of what we all struggle to avoid poverty. The information developed through the Elder Index helps us understand that many older adults who are not poor, as defined by the official poverty level, still do not have enough income to meet their basic needs. The Initiative, through the use of the Elder Index and other policy tools, answers the following questions: How much income or combination of personal income and public programs is needed by older adults living on fixed incomes to cover today s rising living costs? What is the impact of public programs, such as Medicare, Medicaid, or housing assistance, on an elder s evolving income and health needs? How does the need for long-term care services affect economic security? Will income needs make it necessary for able older adults to continue to work for pay, despite preferring to retire? The Initiative is guided by a National Advisory Board that is composed of national experts in the field of aging. The Advisory Board has provided direction in the design of the Initiative and the development of the Elder Index. WOW would like to thank our National Advisory Board members for helping us launch this exciting new Initiative. Members of the Gerontology Institute primarily responsible for this report are Jan E. Mutchler, Alison Gottlieb and Ellen Bruce. Valued assistance was provided by Jillian Knox and Lauren Martin. We acknowledge the contributions of Laura Russell in developing the core methodology used in the Elder Index, and Judith Conahan for her work to develop the long-term care cost component of the Elder Index. The authors, of course, are responsible for the contents of this report and accept responsibility for any errors or omissions. Elder Economic Security Initiative Program: The Elder Economic Security Standard Index for Connecticut iii

6 Foreword Elder Economic Security: Vital for Connecticut, Vital for Women Because Connecticut is graying and the proportion of elderly women in Connecticut is growing, the Connecticut Elder Economic Security Initiative poses an opportunity for Connecticut to respond to demographic changes which are already transforming our economy, our workplaces and our families. The U.S. Census Bureau estimates that Connecticut has the 8th oldest population of all states with a median age of 38.9 as compared to a nationwide median of 36.4 years. There are over 470,000 people over age 65 in Connecticut. Approximately 60% (over 277,000) are women. There are approximately one million baby boomers in Connecticut almost one-third of the state s population. It is estimated that almost 30,000, or 7%, of Connecticut s elderly residents live in poverty. Although Connecticut residents are among those with highest per capita income in the country, the Permanent Commission on the Status of Women s prior research on economic security for families (with members ages 18 64), entitled Where Connecticut Stands, shows that one in five of those Connecticut families cannot meet their basic needs with their current income. Most of these households have at least one working adult. Those living in Connecticut s five major cities, Latinos, households headed by women, households with young children and households with people of color are most likely to live below a basic standard of living. Because of the wage gap, a woman with typical earnings would have to work more than 15 years longer to achieve the same lifetime earnings as a man. (The wage gap is the difference between the wages of women and men. Full-time working women still get paid on average only 77 cents for each dollar full-time working men get paid.) The retirement gap is a direct result of years of wage gaps combined with asset gaps building until retirement age for women, particularly women of color. It is not surprising then, that these two groups may be the most insecure in retirement. In an effort to address these issues, the PCSW along with the Connecticut Commission on Aging, has joined the National Elder Economic Security Initiative launched by Wider Opportunities for Women (WOW) in Washington, DC. Critical to the work is a new measure of income adequacy the Elder Economic Security Standard Index (the Index). The Index, tabulated using national methodology developed by WOW and the University of Massachusetts-Boston Gerontology Institute (GI), measures the living expenses for older adults in today s economy. We expect that the Initiative will result in: A better educated community of younger and mid-life women; Increased awareness among policymakers of the challenges facing older adults; Improved income supports for older adults; Improved planning and expectations for retirement or a redefined retirement; More flexibility for unpaid caregivers in the workplace; Increased healthcare access; and More choices in home and community-based services. iv Wider Opportunities for Women

7 Retirement Challenges for Women and Communities of Color The Index provides a startling picture of what older women face in retirement. Poverty increases with age, especially among older women of color and older women who live alone. Among older women living alone, one out of every two African Americans and two out of five Hispanic Americans live in poverty. 1 Median annual retirement earnings, primarily from Social Security for women in Connecticut, are about $16,600. Those living on Social Security alone average approximately $12,600. For an older woman who lives alone, rents and relies entirely on Social Security, Connecticut s Index shows a gap of approximately $12,000 between her retirement income and the cost of living in Connecticut. More than 70% of all older adults living in poverty are women. Women and people of color are more likely to rely exclusively on Social Security for retirement income. The demise of pensions and employer-sponsored retirement plans, lower rates of homeownership, and fewer assets place greater weight on Social Security as a guaranteed source of income. Women have lower rates of pension coverage and pension income than men. Only about 36% of elderly women have pension coverage, while approximately 48% of elderly men are covered. Of those who have pension income the average annual benefit for women and their spouses was $4,365 compared to $6,604 for men. 2 Fewer elderly women than men are employed, and those who are employed earn lower average wages than men. Without Social Security, more than half of women 65 and older would have been poor in 1998 compared to 39.7% of elderly men. 3 Pension income was received by only 29% of elderly African Americans and their spouses and 22% of elderly Hispanic Americans. According to the national Index, African American women who own their homes obtain only 65% of their basic living expenses from Social Security. 4 Regional and Long-Term Care Challenges The Long-Term Care Needs Assessment 5 found that demand for long-term care services (ages 40+) will increase by nearly 30% by 2030, with far higher percentage increases among older age groups. Limited long-term care capacity and financing complicates the planning burden for the State, caregivers and the elderly. The Index offers vital information on the costs for such services as well as basic living expenses. In Connecticut, as in all states, it is less expensive to provide care to individuals in their own homes than to provide care through nursing homes. Despite this, the vast majority of public funding is for nursing home care Administration on Aging U.S. Department of Health and Human Services Wider Opportunities for Women The Long-Term Care Needs Assessment conducted by the University of Connecticut Health Center, Center on Aging included a comprehensive literature review on Connecticut-specific and national data, a statewide mail, telephone and in-person surveys of both Connecticut residents and providers of longterm care services. Research staff also conducted a full review of Connecticut s existing array of services and long-term care system rebalancing efforts. See Elder Economic Security Initiative Program: The Elder Economic Security Standard Index for Connecticut v

8 Connecticut is beginning to rebalance its services with the goal of allowing more older adults to receive home and community-based services and supports. Connecticut has many programs and benefits to help older adults meet their needs at home, including the Connecticut Home Care Program for Elders, adult day care and the recently implemented Money Follows the Person program. However, these programs are fragmented, complex and difficult to navigate and access. In addition, the public is often uninformed about the availability and funding of long-term care services and supports. For example, many Connecticut residents do not know that Medicare actually pays very little for either long-term nursing home or home and community-based care. Almost half (46%) of those over age 60 think that Medicare will pay for their long-term care needs. In addition, one-quarter of all baby boomers and one-third of all young adults expect to rely on Medicaid to help pay for their long-term care. Differences in health status and related indicators among Connecticut s regions are striking, according to the regional analysis in the Long-Term Care Needs Assessment. For example, compared to respondents from other regions, Willimantic area respondents are in the poorest health. The Willimantic region has the highest percentage of people with any type of disability (34%) and more users of home and community based services than other regions. Willimantic area residents also report a great unmet need for transportation, homemaker, home health care, adult day programs, friendly visitor, care management, home delivered meals, and visiting nurse services. Rural Connecticut will bear a triple burden of demographic changes: lower capacity, higher dependency ratios and higher number of elderly residents. In rural Connecticut, the population 65 and older will more than double an increase of 112% by In contrast, statewide this population is expected to increase by 62%. The University of Connecticut estimates that by 2030, rural Connecticut will have 99 non-working dependents (children age 0 to 19 plus elderly age 65 and over) for each 100 workers (age 20 to 64). This will create a burdensome dependency ratio for rural municipalities. vi Wider Opportunities for Women

9 Table of Contents Executive Summary...ix I. Introduction...1 II. Cost Components of the Elder Economic Security Standard Index...5 III. The Elder Economic Security Standard Index for Connecticut...9 IV. The Impact of Home and Community-Based Long-Term Care Services V. Summary References...24 Appendices Appendix A: Data Sources and Notes regarding the National WOW-GI Elder Economic Security Standard Index Methodology Appendix B: List of Connecticut Metropolitan/Micropolitan Areas and Counties Appendix C: Map of Five Connecticuts...31 Map of Connecticut Counties Appendix D: Elder Economic Security Standard Index for Connecticut Counties and Five Connecticuts, and Two-Person Elder Households Appendix E: Wider Opportunities for Women Appendix F: The Gerontology Institute...47 List of Figures and Tables Table 1: The Statewide Elder Economic Security Standard Index for Connecticut, Figure 1: The Index Compared to Other Benchmarks, 2008, Index for -Person Elder Households in Connecticut...2 Figure 2: The Index Compared to Other Benchmarks, 2008, Index for Two-Person Elder Households in Connecticut...3 Figure 3: Connecticut Median Household Income by Age, Figure 4: Connecticut Elder Household Income Distribution by Age, Figure 5: Comparison of U.S. Poverty Thresholds by Age, Figure 6: Household Spending as a Percentage of Total Budget: Elder vs. All Households in Northeast, Chart 1: Impact of Health Status on Total Estimated Out-of-Pocket Health Care Expenses Assuming Medigap Coverage...6 Figure 7: Owner and Renter Status of Householders Age 65 and Over in Connecticut, Chart 2: Total Estimated Out-of-Pocket Health Care Expenses in Selected Communities...7 Table 2: The Five Connecticuts and Connecticut s Elder Economic Security Standard Index...8 Figure 8: Distribution of Connecticut Population, by Five Connecticuts, Table 3: The Elder Economic Security Standard Index for Wealthy Connecticut (Westport), 2008, Expenses for Selected Household Types Table 4: The Elder Economic Security Standard Index for Suburban Connecticut (Cheshire), 2008, Expenses for Selected Household Types...12 Table 5: The Elder Economic Security Standard Index for Rural Connecticut (Putnam), 2008, Expenses for Selected Household Types...14 Table 6: The Elder Economic Security Standard Index for Urban Periphery Connecticut (Manchester), 2008, Expenses for Selected Household Types...16 Table 7: The Elder Economic Security Standard Index for Urban Core Connecticut (New Haven), 2008, Expenses for Selected Household Types...18 Elder Economic Security Initiative Program: The Elder Economic Security Standard Index for Connecticut vii

10 Table 8: Home and Community-Based Long-Term Care Costs for the Elder Economic Security Standard Index, 2008 At Public Reimbursement and Private Pay Rates in Connecticut Table 9: Connecticut Elder Economic Security Standard Index Home and Community-Based Long-Term Care Services Package Long-Term Care at 6, 16 and 36 Hours/Week...21 Table 10: Connecticut Elder Index Home and Community-Based Long-Term Care Services Public and Private Pay Rates, Table 11: The Elder Economic Security Standard Index for the State of Connecticut, 2008: Addition of Home and Community-Based Long-Term Care Costs Figure 9: Adding Home and Community-Based Long-Term Care Costs to the Elder Economic Security Standard Index for the State of Connecticut, 2008 Example of an Elder Renter Appendix Tables Tables D1 D13: Elder Economic Security Standard Index for the Eight Connecticut Counties and for the Five Connecticuts, 2008: - and Two-Person Elder Households viii Wider Opportunities for Women

11 The Elder Economic Security Standard Index for Connecticut Executive Summary The Permanent Commission on the Status of Women (PCSW) and the Connecticut Commission on Aging (CoA) recognize that many Connecticut adults age 65 and older struggle to make ends meet. Living costs are high, especially for housing and health care. In the face of rising expenses, many older adults receive only a modest cost of living adjustment each year; thus, they are spending down retirement savings, and/or face growing debt. At the same time, older people strain to be prepared for the present, but face a challenging future if their life circumstances change due to illness, loss of a spouse or partner, and/ or growing needs for help with daily tasks. Older women are particularly challenged with income and assets that are typically lower than men s. Their longer lifespan also means that they more often live with chronic illnesses and high health costs. In an effort to address these issues, The Permanent Commission on the Status of Women (PCSW) and CoA joined the National Elder Economic Security Initiative launched by Wider Opportunities for Women in Washington, DC. Critical to the work is a new measure of income adequacy the Elder Economic Security Standard Index (Index). The Index for Connecticut was tabulated using the WOW - University of Massachusetts Boston Gerontology Institute national methodology. The Index measures the living expense costs for older adults in today s economy. The Index helps us answer key questions: What is an adequate income for older adults in Connecticut to age in place? How do financial needs vary according to the life circumstances of older adults - whether they are living alone or with a spouse or partner, rent or own their home, drive a car or use other transportation? How do living expenses change as health status and life circumstances change? What happens if older adults need long-term care to remain at home? The Elder Economic Security Initiative, through the use and development of the Index, provides a framework to help guide public, private and personal decisions that form the foundation for the well being of today s older adults. It provides information critical to aging boomers who encounter issues related to care, living options, and economic realities for their aging parent(s). It can also inform life and retirement planning for baby boomers. The Elder Economic Security Initiative puts into action strategies to meet realistic income needs in today s economy that respect the autonomy of older adults. A Framework for Measuring Economic Security for Older Adults The Elder Economic Security Standard Index (Index) is developed as a measure of the cost of basic expenses of elder households (those with household heads who are age 65 or older) to age in place, continuing to live in the community setting of their choice. The Index defines economic security as the financial status where older adults have sufficient income (from Social Security, pension, retirement savings, and other sources) to cover basic and necessary living expenses. The Index is based on the idea that older adults should be able to meet their expenses without public support, such as food assistance, energy assistance, subsidized housing or property tax help. It also demonstrates the interplay between Connecticut older adults living expenses and actual income. The Index also illustrates how older adults living expenses change when their life circumstances change. This report presents the Index for Connecticut to benchmark basic living expense costs for elder households. It illustrates how expenses vary both by types of Connecticut communities and by the circumstances of elder households, including household size, homeowner or renter status, health status, and the need for long-term care. The expenses are based on market costs and do not assume any public or private supports. Key Findings for Connecticut 1. Connecticut older adults cannot meet their basic living expenses whether they live at the Federal Poverty Level or the level of the average Social Security benefit. This is true of elders statewide, whether they rent or own a home. 6 About 7% of CT s older adults live at or below the federal poverty level. Social Security is the only source of income for one out of five older adults in Connecticut, the majority of whom are women, and virtually the only source of income for 40% of older women in Connecticut. 6 Permanent Commission on the Status of Women. Elder Income Security Analysis. Unpublished research report. November Elder Economic Security Initiative Program: The Elder Economic Security Standard Index for Connecticut ix

12 Expenses vary widely across types of communities. Elder homeowners with no mortgage who live alone in a rural community like Putnam need $19,690 per year to cover basic living expenses. In contrast, elder renters living alone in a wealthy community like Westport need as much as $31,007 to cover expenses. The statewide average for single older adults is $21,000 for an owner with no mortgage and $24,000 for a single renter. Elder couples who own a home with no mortgage and live in a rural community like Putnam need $30,709 per year to cover basic living expenses. In contrast, couples who rent a home in a wealthy community like Westport need as much as $42,130 to meet their basic household budgets. The statewide average for an older couple is $32,000 for an owner with no mortgage and $35,000 for couples who rent. 2. Housing costs (mortgage or rent, taxes, utilities and insurance) put a heavy burden on some elder households, representing as much as half of their total expenses. The Index reflects wide variation in housing costs depending on whether older adults own or rent and by community. Older adults still paying a mortgage or paying fair market rents have higher housing costs. The monthly costs for elder homeowners without a mortgage range from a low of $507 per month in rural communities like Putnam to a high of $1,157 per month in wealthy communities like Westport. The monthly costs for older adults paying fair market rent for a one bedroom apartment range from a low of $681 per month in rural communities like Putnam to a high of $1,314 per month in wealthy communities like Westport. 3. The Index shows the significance of health care costs for Connecticut older adults who must purchase supplemental health and prescription drug coverage to Medicare. 7 The Index includes premium costs of supplemental health and prescription drug coverage to Medicare, which provide critical protection against high medical and prescription drug costs. 8 Older adults in Connecticut who are in good health face combined health care costs (insurance premiums plus co-pays, deductibles, fees, and other out-of-pocket expenses) of $385 per month to have protection against high medical and prescription drug costs. Retired couples are unable to purchase supplemental health insurance through a family plan ; rather, they must each buy coverage as an individual. Thus, combined health care costs are doubled for elder couples, totaling $770 per month. 4. Even older adults who are currently making ends meet face an uncertain future if their life circumstances change, such as loss of a spouse/ partner or a decline in health status. An elder paying market rate rent in Connecticut has expenses reduced by only 30% when a spouse dies yet his or her income mix of Social Security and/or pension income may decrease substantially. Older adults often face a rise in health care expenses when their health declines. While adding supplemental health and prescription drug coverage to Medicare provides protection against unanticipated health care expenses, average out-of-pocket expenses rise by more than $300 a year for an individual in fair to poor health. 5. The need for home and community-based longterm care can more than double an elder s expenses, significantly increasing the income needed to meet basic needs. 9 The need for home and community-based long-term care can double or even triple an elder s expenses. Adding a low level of care for one person adds $7,500 per year to living costs. Requiring a medium level of care adds $20,000 and needing a high level of care adds $39,000 $45,000. As a comparison, national market surveys report an average annual rate $114,000 for skilled nursing facility care (semi-private room) in Connecticut. 10 The Key findings are amplified for older women, as their incomes and assets tend to be lower; poverty increases with age; they live longer than men; and suffer with costly disabilities and chronic conditions. 7 8 There are approximately 36,000 participants in ConnPACE, about 80% of whom are women, almost 50,000 people are eligible. Co-pays, deductibles and fees are included, which vary according to older adults health status. 9 The need for home and community-based long-term care can vary considerably over time. Because this need is not universally incurred, it is included as a separate, potentially catastrophic cost for older adults. 10 Calculated from Genworth Financial (2008) Cost of Care Survey. Richmond, VA: Genworth Financial. genworth_com/web/us/en/products_we_offer/long_term_care_insurance/ long_term_care_overview/what_is_the_cost_of_long_term_care.html. x Wider Opportunities for Women

13 Determining Economic Security For Connecticut Older Adults I. INTRODUCTION This report addresses income adequacy for Connecticut s older adults using the national WOW-GI National Elder Economic Security Standard Index (Elder Index) methodology. The Index benchmarks basic costs of living for elder households and illustrates how costs of living vary geographically and are based on the characteristics of elder households, including household size, home ownership or renter status, and health status. The costs are based on market costs for basic needs of elder households and do not assume any public or private supports. The Index presented in this report will be used to increase public awareness and influence public policies and programs to benefit older adults through the broader Elder Economic Security Initiative. The Elder Economic Security Initiative is designed to: Provide important new information to illustrate the basic expenses that older adults face and how changes in their life circumstances affect their financial security. Common changes include the need for long-term care services, which dramatically increases living expenses, or the death of a spouse, which often greatly reduces income without significantly decreasing living expense costs; Provide a framework for analyzing the effects of public policy and policy proposals in such areas as retirement security, health and long-term care, taxes, and housing; Educate older adults about actual and projected living costs to inform their financial, employment, and life decisions; Provide new tools for older adults to use in advocating for policy changes; Help agencies that serve older adults to set goals, assess needs, and design programs; and Influence community planning efforts to develop strategies to help older adults age in place. According to the U.S. Census Bureau s population estimates for 2007, 13.5% of Connecticut residents were 65 years or older, and 11.4% were between the ages of 55 64, poised to dramatically increase older adults numbers as the baby boomers age. 11 The individual circumstances of Connecticut older adults vary from the most fortunate, who are healthy and economically secure, to the least fortunate, who are low-income, ill and/or living with a disability. Older adults situations vary greatly in terms of 11 Source: Population Estimates program of the U.S. Census Bureau. See family support, neighborhood networks, and community and social connections. Connecticut older adults also differ according to their housing situation, health status, and need for long-term care. Many of these characteristics change over an elder s life span. The Index, with its respective scenarios for older adults living in different circumstances, will show how older adults may be prepared for the present, yet face a precarious future as living expenses rise markedly because of situational changes. Statewide Findings of the Connecticut Elder Economic Security Standard Index 1. For single older adults in good health, the statewide Connecticut Elder Economic Security Standard Index is $21,383 (for homeowners without a mortgage) or $24,408 (for renters). This represents the living expense costs (housing, health care, transportation, food and miscellaneous) for adults age 65 and older in Connecticut. The Connecticut Index is much higher than other commonly used income benchmarks. The federal poverty guideline, which is a formula measuring income inadequacy that is based solely on food costs, is $10,400 per year for an individual. This is only 49% of the statewide Index for homeowners with no mortgage or 43% of the statewide Index for renters. The average Social Security benefit for Connecticut older adults is $14,154 per year for an individual. This represents only 66% of the statewide Index for homeowners with no mortgage or 58% of the statewide Index for renters. 2. For elder couples in good health, the statewide Connecticut Elder Economic Security Standard Index is $32,039 (for homeowners without a mortgage) or $35,064 (for renters). This represents the living expense costs (housing, health care, transportation, food and miscellaneous) for couples including at least one elder age 65 and older in Connecticut. The statewide Elder Index is much higher than other commonly used income benchmarks. Elder Economic Security Initiative Program: The Elder Economic Security Standard Index for Connecticut 1

14 The federal poverty guideline is $14,000 per year for elder couples. This is only 44% of the statewide Elder Index for homeowners with no mortgage or 40% of the statewide Elder Index for renters. The average Social Security benefit for Connecticut couples is estimated to be $23,022 per year. This represents only 72% of the statewide Elder Index for homeowners with no mortgage or 66% of the statewide Elder Index for renters. Comparison to Other Benchmarks of Income The following chart compares the Index to other measures of income adequacy. Figure 1 compares the Index (for Connecticut one-person elder households) with the federal poverty guideline and average Social Security benefits for single elders in Connecticut. The federal poverty guideline (not the federal poverty threshold) is used as the basis for most income eligibility guidelines for public support programs. Figure 2 presents comparisons for elder couple households. -Person Household Federal Poverty Guidelines: As illustrated in Figure 1, the average after-tax income required by an elder living alone in Connecticut is 2.1 to 2.3 times as high as the official poverty guideline. In 2008, under the federal poverty guidelines a single adult household is poor only if he or she has a monthly income of $867 ($10,400 per year) or less. Average Social Security Benefit: The average Social Security benefit in Connecticut in 2008, at $1,180 per month ($14,154 per year), is higher than the poverty FIGURE 1 The Elder Index Compared to Other Benchmarks, 2008, Index for -Person Elder Households in Connecticut $40,000 $35,000 $30,000 $25,000 $20,000 $15,000 $10,000 $5,000 $0 $10,400 Federal Poverty Guideline $14,154 $21,383 Avg. Social Estimated Security Statewide Index Benefit for (owner w/o retired worker, CT mortgage, good health) $24,408 Estimated Statewide Index (renter, good health) guidelines, but well below the Index for owners without a mortgage, and further below the Index for older adults paying market rate rents. Monthly Expenses Table 1 The Statewide Elder Economic Security Standard Index for Connecticut, 2008 Single Elder Renter Elder Couple Renter Housing $657 $909 $1,483 $657 $909 $1,483 Food Transportation Health Care (Good Health) Miscellaneous Total Monthly (Index) Expenses $1,782 $2,034 $2,608 $2,670 $2,922 $3,496 Total Annual (Index) Expenses $21,383 $24,408 $31,296 $32,039 $35,064 $41,952 Source: Gerontology Institute, UMass Boston and Wider Opportunities for Women, The Elder Economic Security Initiative Program: The Elder Economic Security Standard Index for Connecticut. (Washington, DC: Wider Opportunities for Women, 2009). 2 Wider Opportunities for Women

15 FIGURE 2 The Index Compared to Other Benchmarks, 2008 Index for Two-Person Elder Households in Connecticut $40,000 $35,000 $30,000 $32,039 $35,064 FIGURE 3 Connecticut Median Income by Age, (in 2007 inflation-adjusted dollars) $90,000 $80,000 $70,000 $60,000 $71,570 $81,583 $25,000 $23,022 $50,000 $20,000 $15,000 $14,000 $40,000 $30,000 $33,269 $36,156 $10,000 $20,000 $5,000 $10,000 $0 Federal Poverty Guideline Avg. Social Estimated Security Statewide Index Benefit for (owner w/o retired worker, CT mortgage, good health) Estimated Statewide Index (renter, good health) $0 Householder under 25 years Householder years Householder years Householder 65 years+ Source: Estimated from the U.S. Census Bureau, American Community Survey, Table B Two-Person Household Federal Poverty Guidelines: As illustrated in Figure 2, the average after-tax income required by an elder couple in Connecticut is 2.3 to 2.5 times the official poverty guideline. In 2008, under the federal poverty guidelines, a two-adult household is poor if it has a monthly income of $1,167 ($14,000 per year). Average Social Security Benefit: The estimated average Social Security benefit for an elder couple in Connecticut in 2008, at $1,919 per month ($23,022 per year), is below the Index for homeowner couples without a mortgage, and further below the Index for elder couples renting at market rates. Income Trends of Connecticut s Older Adults Household income levels vary by age and life circumstance. Typically, median income levels rise with age until midlife and then decline with advancing age, as indicated in Figure 3. In households headed by those 65 and over, 12 median income was less than half the income for 12 A householder is the person in whose name the home is owned or rented. Household income includes the income of the householder plus all other individuals living in the same home households headed by those in their peak earnings years of According to the federal poverty threshold and American Community Survey data, an estimated 7% of Connecticut s older adults were considered poor in , and even more Connecticut older adults were just above the poverty threshold. A full 16% were estimated to have incomes at or below 150% of the poverty threshold. 14 Poverty rates for older women are much higher than for older men, 8% (women) versus 5% (men). Moreover, poor older households are disproportionately headed by women. In , nearly 70% of older households in Connecticut with incomes below the poverty level were headed by an older widowed or non-married woman. 15 Reasons for higher poverty rates among women include 13 With inflation, $36,156 in 2007 represents $37,972 in Calculated from Tables B17001 and B17024, American Community Survey year estimates. Available online: DatasetMainPageServlet?_program=ACS&_submenuId=&_lang=en&_ts=. In 2007, the poverty threshold for an older individual living alone was $9,944, and $12,533 for an older couple. Older individuals living alone were below 150% of the threshold if they had income of less than $14,816 annually; couples were below 150% of the threshold if they had income of less than $18,800 annually. For 2007 thresholds, see thresh07.html 15 Estimated using Table B17017, American Community Survey 3-Year Estimates; see html?_lang=en&_ts= Elder Economic Security Initiative Program: The Elder Economic Security Standard Index for Connecticut 3

16 lower wages, lower lifetime earnings, and less time in the workforce. Women also have longer life expectancies but more chronic illness, and are more likely than men to experience loss of income when widowed. This report focuses on the challenges of meeting expenses for low- and moderate-income older adults. Figure 4 shows that in , 13% of Connecticut householders aged had incomes under $15,000; 24% had incomes under $25,000. Of those 75 years and older, 22% had incomes under $15,000; 45% had incomes under $25, Households headed by those over 75 have substantially lower incomes due to less employment income, erosion of assets with age; and gender. Single women head a progressively larger share of older households, due to their greater longevity. The Federal Poverty Threshold The poverty thresholds are drawn from the original version of the federal poverty measure. 17 The poverty thresholds were first calculated in the 1960 s by taking the cost of food needed to meet the minimum nutritional needs of adults of different ages, and multiplying this by three. This figure was then used as the reference point for the amount of income needed to live at a basic level. This calculation was based on consumption surveys conducted in the late 1950s showing that U.S. families spent about one-third of their incomes on food. Since that time, the thresholds are updated each year by the change in the consumer price index (CPI). Despite this reliance on an outdated connection to households food costs alone, the poverty thresholds continue to be used as the basis to estimate the number of Americans living in poverty each year. To make matters worse, the U.S. Department of Agriculture calculations assume that older adults have lower caloric requirements than younger adults. As a result, the official U.S. poverty thresholds are lower for adults 65 and older than for younger adults. The federal poverty thresholds do not consider age variability in any other costs e.g., housing, health care, transportation or long-term care. Figure 5 compares the U.S. poverty thresholds by age for one- and two-person households. The poverty cutoff for older adults living alone is $843 per year less than the 16 With inflation, $15,000 in 2007 represents $15,753 in 2008 dollars, and $25,000 in 2007 represents $26,255 in 2008 dollars. 17 The federal poverty thresholds were developed by Mollie Orshansky of the Social Security Administration in and are updated each year by the U.S. Census Bureau. For more information on the federal poverty measures, see 40% 35% 30% 25% 20% 15% 10% 5% 0% FIGURE 4 Connecticut Elder Household Income Distribution by Age, (in 2007 inflation-adjusted dollars) 12.9% 11.3% 17.3% 22.3% years 36.3% 22.2% 22.5% 20.7% 75 and up 17.7% 16.9% Under $15,000 $15,000 $24,999 $25,000 $39,999 $40,000 $64,999 Over $65,000 Source: Calculated by the Gerontology Institute using microdata from the merged 2005, 2006 and 2007 American Community Surveys, downloaded from the U.S. Census Bureau website. cutoff for younger adults, and the poverty cutoff for elder couples is $1,351 less than the cutoff for younger couples. 18 As indicated, the federal poverty measure s methodology is based on outdated spending patterns and assumes households spend a fixed ratio of one-third of their incomes on food. In addition, it does not allow for different rates of inflation for different living expenses; for example, health care and housing costs have risen much more than food costs. Finally, it does not reflect variations in regional living costs The poverty guidelines are a second version of the federal poverty measure. Issued each year in the Federal Register by the Department of Health and Human Services, they are a simplification of the poverty thresholds for administrative uses, such as determining eligibility for certain federal programs. The federal poverty guidelines for 2008 are $10,400 for one-person households and $14,000 for two-person households, and do not differ by age of householder. They are the same in 48 states and adjusted for living costs only in Alaska and Hawaii. 19 For an analysis of problems with the federal poverty measures and information on a proposed alternative measure, see Constance F. Citro and Robert T. Michael, Measuring Poverty: A New Approach (Washington, DC: National Academy of Sciences, 1995). Their proposed measure is based on household spending patterns from the Consumer Expenditure Survey, and adjusts household incomes for transfer payments (subsidies) as well as taxes. The Census Bureau from time to time calculates the number of households that would be in poverty under the alternative poverty measure, but the recommendation to substitute the new measure has not been adopted. 4 Wider Opportunities for Women

17 FIGURE 5 Comparison of U.S. Poverty Thresholds by Age, 2007 $16,000 $14,000 $12,000 $10,000 $8,000 $6,000 $4,000 $2,000 $0 Poverty Thresholds: <65 Poverty Thresholds: >65 $10,787 $9,944 1-Person HHs $13,884 $12,533 2-Person HHs Source: U.S. Census Bureau, threshld/thresh07.html Defining the Elder Index: A Framework for Economic Security for Older Adults In contrast, the Index is a measure of the living expenses for basic needs for elder households to age in place in their homes or the community setting of their choice. The Index is informed by the work of Wider Opportunities for Women and Dr. Diana Pearce, who created the Self- Sufficiency Standard for families in the 1990s. 20 The Index methodology is based on the characteristics and spending patterns of elder households. The Index reflects a realistic measure of income adequacy as opposed to the original intent of the federal poverty measure which was to illustrate income inadequacy. Economic security requires that older adults have sufficient income (from Social Security, pensions, retirement savings, and other income) to cover living costs. Using The Index we can illustrate the basic costs that older adults face, and the interplay between living costs and older adults income adequacy. 20 The methodology embodied in the Self-Sufficiency Standard was developed by WOW s research partner, Dr. Diana Pearce, when she directed the Women and Poverty Project at WOW. As of 2008, she teaches at the School of Social Work, University of Washington. The Self-Sufficiency Standard undergirds the six strategies of the Family Economic Self-Sufficiency (FESS) Project. The FESS Project is led by Wider Opportunities for Women and was created to provide tools to communities to help low income working families make ends meet. II. COST COMPONENTS OF THE ELDER ECONOMIC SECURITY STANDARD INDEX The cost components and methodology for the Elder Economic Security Standard Index have been developed with input and guidance from the Advisory Committee for the Connecticut Elder Index convened by the Permanent Commission on the Status of Women, and from the Advisory Board for the national Elder Economic Security Initiative convened by Wider Opportunities for Women. 21 The Index uses cost data from public federal and state sources that are comparable, geographically specific, easily accessible, and widely accepted. In areas where existing public data sources are not currently available, such as long-term care costs, the Index uses a consistent methodology to derive comparable measures for costs across states. The following represent some of the assumptions that are built into the Elder Index s methodology. The Elder Index: measures basic living expenses for older adults living in the community (i.e., not in nursing homes or assisted living facilities); measures costs for elder households to live independently (vs. living in intergenerational households); measures living expenses for adults ages 65 and over to reflect the age at which Medicare begins; includes Medicare because older adults qualify for and receive it based on age and eligibility for Social Security, without regard to income and assets, making Medicare nearly a universal program; 22 and models costs for retired older adults, who no longer have work-related expenses such as payroll taxes and commuting to work. 21 For more detailed information on the methodology and data sources used in calculating the Elder Index, see the companion report, Laura Henze Russell, Ellen A. Bruce and Judith Conahan and Wider Opportunities for Women, The WOW-GI National Elder Economic Security Standard: A Methodology for Determining Economic Security for Older adults (Washington, DC: Wider Opportunities for Women and Gerontology Institute at the University of Massachusetts Boston, 2006). 22 An individual is eligible for Medicare if he or she (or his/her spouse) worked for at least 10 years in Medicare-covered employment, is 65 years or older, and is a citizen or permanent resident of the United States (see gov/medicareeligibility/home.asp?dest=nav Home GeneralEnrollment#TabTop). Some individuals, such as recent immigrants, may never qualify for Social Security or Medicare. Elder Economic Security Initiative Program: The Elder Economic Security Standard Index for Connecticut 5

18 The Big Picture: Older Adults Spending Compared to All Households Figure 6 compares elder households spending to all households, based on data from the Consumer Expenditure Survey. For the Northeast region as a whole, elder households spend about the same percentage of their budgets on housing, food, and apparel as do all households, slightly less on transportation, but more than twice the percentage on health care. All other expenditures account for 22% of household spending by the average older household, somewhat less than the percentage for all households in the Northeast (26%). Similar spending patterns for older households are reported in the Health and Retirement Survey (HRS). 23 Introduction to Cost Components of the Index The basic cost components developed for the Index are: 24 Housing includes housing (rent or mortgage payment, if any), and related costs (heat, utilities, insurance, and property taxes) for elder renters and elder owners, based 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% FIGURE 6 Household Spending as a Percentage of Total Budget: Elder vs. All Households in Northeast, % 3% 14% 13% 11% 37% 65+ Other Apparel Transport Food Health Housing Source: US Department of Labor, Bureau of Labor Statistics, Consumer Expenditure Survey Barbara Butrica et al. Understanding Expenditure Patterns in Retirement (Washington, DC: Urban Institute, 2005). 24 See Appendix A for source information. All 26% 4% 16% 12% 5% 36% on latest available U.S. Census reported elder owner housing costs, and U.S. Department of Housing and Urban Development (HUD) Fair Market Rents. As illustrated in Figure 7, 53% of Connecticut older householders own their homes without a mortgage, 25% are renters, and 22% are homeowners with a mortgage. Food represents costs of food prepared at home, based on USDA Low-Cost Food Plan for older adults, using the average of June 2008 low cost food plan budgets for women and men. 25 Health Care combines 2008 premium costs for full supplemental coverage to Medicare (Part B, Medigap, and Part D) and out-of-pocket costs (including co-pays, deductibles and fees for uncovered expenses). Calculations are based on data from the Medicare Options Compare website (see DataSection/Questions/SearchOptions.asp). In calculating health care costs, we assume coverage through private Medicare Supplement (Medigap) plans because Connecticut has an enrollment rate in Medicare Advantage plans that is lower than the national average: 13% compared to 21% nationally in Estimated costs are based on individuals age since this is the median age group for people 65 and older. Costs are calculated for people in good, fair/poor, and very good/excellent health. Annual costs assume people purchase a private Medicare Supplement plan as well as Medicare Part D Prescription drug plan. To simplify presentation, the Index is presented for older adults in good health, which is the most common health status self- Chart 1 Impact of Health Status on Total Estimated Out-of-Pocket Health Care Expenses Assuming Medigap Coverage (increase or decrease from estimated expenses for Good Health) Per Person: Fair/ Poor Very Good/ Excellent Change in Cost Per Month +$21 -$20 Change in Cost Per Year +$252 -$240 Source: Calculated by the Gerontology Institute based on data from the Medicare Options Compare Website. See: Welcome.asp 25 For the Five-Connecticuts version of the Index, estimated food costs were adjusted using the Council for Community and Economic Research s Cost of Living Index (COLI) for grocery items for communities that participated in the data collection upon which the COLI index is based. 26 Kaiser Family Foundation, Health Plan Tracker, healthplantracker/topicgeo.jsp?i=8. 6 Wider Opportunities for Women

19 FIGURE 7 Owner and Renter Status of Householders Age 65 and Over in Connecticut, % Renter 25% 53% Source: Calculated by the Gerontology Institute using microdata from the merged 2005, 2006 and 2007 American Community Surveys, downloaded from the Census Bureau website. Note: Renter includes a small number of householders who pay no cash rent. reported by older adults. In Connecticut, the average monthly health care cost for older adults in good health is $385 (or $4,620 per year). 27 The expense cost adjustments for changes in health status are presented below, and show that estimated costs are somewhat higher for those in fair or poor health, but lower for those in very good or excellent health. For purposes of comparison, if we assume coverage through Medicare Advantage including prescription drug coverage rather than through Medigap, monthly health care costs can be substantially lower for people in good or excellent health as seen in Chart 2. However, health care costs for people in fair to poor health are higher when assuming Medicare Advantage as compared with a Medigap plan. Transportation uses automobile owner and operating costs from Internal Revenue Service (IRS) mileage reimbursement rates, and elder auto usage patterns estimated from the most recent National Household Travel Survey (NHTS). 28 Miscellaneous represents all other goods, such as clothing, personal and household needs, and any other expenses not captured elsewhere. Based on an analysis of the detailed elder spending patterns from consumer spending data, the Index estimates miscellaneous expenses at 20% of all other costs (excluding long-term care) in each Cost per Month: Chart 2 Total Estimated Out-of-Pocket Health Care Expenses in Selected Communities Individuals in Good Health Individuals in Fair/Poor Health Individuals in Very Good/ Excellent Health Assuming Medigap coverage (Statewide values): $385 $406 $365 Assuming Medicare Advantage Coverage: Westport $277 $427 $245 Cheshire $279 $429 $247 Putnam $284 $426 $254 Manchester $288 $439 $256 New Haven $279 $429 $247 Source: Calculated by the Gerontology Institute based on data from the Medicare Options Compare Website. Values are the estimated monthly outof-pocket expenditures averaged across all Medicare Advantage plans available in an area. See: 27 Estimated health care costs based on Medigap coverage do not vary within Connecticut. 28 See Appendix A for source information. In communities with public transportation systems having high usage patterns, an additional track is reported assuming public transportation use. Connecticut has no communities with high rates of public transportation use so this option is not presented. Elder Economic Security Initiative Program: The Elder Economic Security Standard Index for Connecticut 7

20 community for owners without a mortgage. 29 This amount is calculated separately for older individuals and older couples, and applied to each of the three housing scenarios. 30 See Appendix A for information on data sources and notes regarding the methodology. See also The WOW-GI National Elder Economic Security Standard: A Methodology to Determine Economic Security for Elders. 31 The Index is presented in Section I. Older adults living expenses in each of the above areas are added to determine household budgets for each of the respective scenarios for elder households. This gives a measure of the Index, the after-tax income required to cover older adults living expenses based on where they live and the characteristics of their households. The Impact of Home and Community- Based Long-Term Care Costs of home and community-based long-term care services, for those who require them to remain in their homes, are presented for three services packages along the continuum of care in Section IV. Because home and community-based long-term care is not a need experienced by all older adults, it is provided as an add-on component to the basic Index. Taxes Local property taxes are included in the housing cost component for homeowners, and Connecticut sales tax (6%) is included in the miscellaneous category. 32 A significant portion of Social Security income is exempt from federal income tax when older adults combined incomes are under certain limits. Income tax treatment and rates vary by source of income; older adults typically rely on a combination of Social Security, pension, and savings. Because most of the Index household basic budgets are below the no-tax limits 33, and because tax rates vary by income source, calculations do not include income taxes in the basic model. Table 2 The Five Connecticuts and Connecticut s Elder Economic Security Standard Index Geographic Designation CtSDC Criteria Municipal Representative for EESI Note Urban Core lowest income highest poverty highest population density* New Haven Almost 20% of Connecticut residents are in this group. Urban Periphery below average income average poverty high population density Manchester 30% of Connecticut residents are in this group. Suburban above average income low poverty moderate population density Cheshire Suburb to both Waterbury and New Haven Wealthy exceptionally high income* low poverty moderate population density Westport All such towns are now concentrated in Fairfield County Rural average income below average poverty lowest population density* Putnam *Primary characteristic 29 See U.S. BLS Consumer Expenditure Survey data by age at cex/2005/share/age.pdf, and Social Security Administration, Expenditures of the Aged Chartbook, May Note that 20% of all other costs equal 16.67% of total expenses. Miscellaneous expenses include all expenditures other than those specified elsewhere in the Elder Index. Within household type (singles, couples), miscellaneous expenses are estimated based on the value of all other expenses for homeowners without a mortgage (the largest single segment of the older householder population). This strategy is used because miscellaneous expenses are not likely to vary dramatically across housing types. 31 Russell et al, op. cit. 32 See 33 For a single elder, Social Security benefits will not be taxable unless modified adjusted gross income, plus one-half of Social Security benefits, exceeds $25,000. For a couple, the no-tax limit is $32,000 ( gov/pubs/10035.html). 8 Wider Opportunities for Women