Policy for Aging Well: Insights with Georgia Lane

This is a conversation on a podcast about the intersection of policy and social work. The guest, Georgia Lane, works with the Arrowhead Area Agency on Aging and discusses her journey in the field of social work and aging. She explains how federal policy, such as the Older Americans Act, provides funding for agencies like hers to support older adults in their communities. She also mentions state policies, like the Elderly Waiver program in Minnesota, which helps seniors on Medicare and Medicaid access services to delay nursing home placements. Georgia emphasizes the challenge of limited funding and the need to make difficult decisions on how to allocate resources. Overall, the conversation highlights the impact of policy on the work of social workers in the field of aging. Welcome to the Policy Podcast with Krista and Tracy, the spot where we chat about how policies play out in everyday social work. It's your go-to place for easygoing talks about the nitty-gritty of policy and action. So grab a seat, relax, and let's dive into the world where policy meets real life. All right. Thank you, Tracy. And today we have Georgia Lane. Yay! Yay. I know, right? We've been looking forward to spending some time with you, Georgia, because you're doing such amazing work on behalf of elders and older adults, not only in our community but with a wider casting net, especially looking at that kind of measure and macro level of social work. And so, Georgia, thank you so much for being here today. Georgia and Tracy, it's kind of like old home week. We, I think, first met a long time ago kind of on just a call. Yes. I don't even know if it was a Zoom. And you were talking about Juniper, which is an evidence-based health promotion program. And Tracy and I were like, ooh, what Georgia's saying resonates with us. What she's doing totally resonates with us. And it hasn't changed. We're still kind of in the same sphere, and we just are very honored to have you here today. So, Georgia, I'll let you go ahead and kind of explain what your work is and how policy affects your life and your work life and kind of go from there. Thank you so much. Awesome. Well, thanks, Tracy and Krista. I'm super happy to be here. As Krista said, my name is Georgia Lane. I work for the Arrowhead Area Agency on Aging. I've been with the organization for almost eight years, eight and a half years now. So really excited to be here today. This, Georgia, this is my very first podcast. Well, we're happy that we're your first podcast. Yeah. I'm envisioning, like, is this what it looks like when, like, we can do hard things, Glennon Doyle is talking to other people? Like, I'm envisioning myself in that podcast world. Thank you. But really happy to be here talking to social work students today. You guys are all awesome. I am also a social worker. I actually did my undergrad at the College of St. Benedict, graduated from there, but I got that in sociology in 2002 and then graduated with my MSW from the University of Minnesota in 2007. I went into social work. Well, I initially went into social work because both my mom and my sisters worked in education and had their summers off, and in my 20s I thought it would be really fun to also have my summers off, so I thought, well, I'll be a school social worker because I didn't want to be a teacher. I love that. And so my first year MSW internship was at Central High School in St. Paul, and it really was not a good fit for me. So I switched from a micro, you know, direct practice youth to macro practice older adults simply because I happened upon a research assistantship to work in aging services and in assisted living. So that was kind of my journey to get into kind of social work and aging. Oh, fascinating. Georgia, can I just stop you and just ask you a little bit more about that? So that opportunity just came up at your school. They advertised it, and it just sparked your interest? It did. I'm going to ask you this through a mentor of mine, Helen Kivnik. She has since passed, but she is probably one of the main reasons I got into aging and adult services. She did a lot of great work in a field of work called vital involvement in old age. Okay. And so Helen was my mentor, and I had her for my first HBSE class, human behavior and social environment class. And she, you know, I didn't – the research assistantship paid half of my tuition and gave me health insurance. Excellent. That helps. But sure, I'll do this with you, and I really like Helen. And from there, that's what kind of got me interested in aging. I really loved it and started liking more of my policy classes. Fascinating. Yeah, and so my second year internship was with the Metropolitan Area Agency on Aging, working in an early dementia identification project. So I guess however many years later – is it 15 years later? Here I am in Duluth at the Arrowhead Area Agency on Aging. I worked for about eight years right out of grad school. I did some private paid geriatric care management and then worked for about eight or nine years with Presbyterian Homes and Services, more on a management level, doing macro practice program development and grants management with Presbyterian Homes to expand home and community-based services. Wow. All of that, just from saying yes to a potential opportunity. Exactly. And if I ever have to give somebody advice in your career path, it's just try different things. You know, you never know where your road's going to lead. Do what you like. You know, you can never absorb all the different topics and areas, but when I work with interns, you know, it's like do your best and try different things and try to keep a sense of humor about you. Great advice. Yeah. So from there, I guess, can you point me back to my question, Kristen? Yeah, yeah. You bet. I think you were talking a little bit about just your path to the work that you're doing now and maybe with that ultimate end point of, like, how policy, you know, evolves your work and kind of guides what you do and maybe your role in making policy changes and things like that. Right, right. So I work for the Arrowhead Area Agency on Aging. I'll start there. And the reason we exist is because of federal policy called the Older Americans Act. That was written in probably, gosh, you guys, that'd be a good research question for someone to look up. In the 50s or 60s, federal dollars to support older adults to live at home and in the community. And so that is a significant, obviously, policy implication because we, the Area Agencies on Aging, operate under the Minnesota Board on Aging, which is the designated state unit on aging. So federal dollars come down through this Older Americans Act policy to every state, and every state has to have a designated unit on aging. So every state is a little bit different, but in Minnesota, we have the Minnesota Board on Aging. And then under the Minnesota Board on Aging are seven Area Agencies on Aging. So if you're throughout the state, I encourage you to look up who your Area Agency on Aging is and kind of see the breadth of things that we do because it really is really wide. Through Older Americans Act, I think one of our major things is to do grants administration. So in our region, we are in the seven-county Arrowhead region. We allocate those federal funds and sometimes state funds down to home and community-based service providers. So while Older Americans Act dollars are a very small piece of the pie, so I think how policy affects me and my work on a day-to-day is there's simply not enough dollars to go around for Older Americans Act dollars. On a positive note, with COVID, we did experience a boost in federal and state dollars through COVID relief. And so right now, we were able to allocate out additional dollars to our home and community-based service providers through the ARPA funds, which is American Recovery ARPA. But they're additional COVID dollars. And so a lot of what we do in our division or in our development team is try to help get those limited dollars to where they're needed the most. So we provide things through Older Americans Act dollars. It's through services like transportation, home-delivered meals, congregate dining, caregiver support, chore services, homemaker services, legal services, evidence-based health promotion programs can be covered under that. And so there's a whole bunch of categories that can fall under Older Americans Act dollars. So we are tasked with the job of trying to make the hard decisions of where to invest those dollars. Now, we do try to target those who are in greatest need, but our services are really open to anyone. So anybody could go find a congregate dining site if you're 60 and older and be able to utilize those services. So I think that is, you know, in kind of a very high-level overview of kind of the policy that affects kind of who we are and what we do. And additionally, what we try to do is leverage. I'm going to go into – that was a federal policy. Now I want to talk about a state policy because – are your students familiar with something called Elderly Waiver or other waiver programs? Probably not yet. Okay. Yeah. Challenge number two. Somebody can Google Minnesota State Waiver Program. So it's kind of – I love these challenges. Perfect. Yeah. And then email me if you learn something. I'll give you my email later. Perfect. So in Minnesota, we have something that – it's called Waivered Services. And if somebody is on Medicare or Medicaid – so Medicaid means low income. Medicare means you're 65 and older. If you are on both Medicare and Medicaid, so low-income seniors, you can qualify for something called a waiver, which there's a couple different waivers, but the most common one is Elderly Waiver. And so what that is meant to do is to delay people from moving into nursing home placements. So it is state money that comes under essentially your insurance. So if it's Medicare or Medicaid and you're on a waiver, it would pay for things like transportation, like having somebody come in and help you make a meal or do your laundry and things like that. So I think the state determines – obviously the state budget and determines what funding goes into each one of those pots. And waiver reimbursements, there's also things like disability waivers. So if somebody has a traumatic brain injury or has developmental disabilities, they qualify for services. And it's very interesting – I'll actually add another personal note here. So I have some experience with disability services as well because I am a caregiver for my brother-in-law who has autism, and he is on an MRRD waiver, which is archaic and stands for Mental Retardation and Related Disability. So that kind of speaks a little bit to when that waiver was put into place. So those types of waivers will pay for things like group homes and pay for transportation and things like that, similar to like elderly waivers, so somebody who is an older adult. Waiver reimbursement rates for disability services are much higher if you compare them to the elderly waiver. Or there's another waiver called the CADI waiver, which some older adults are on as well. This is really geeking out about waiver services. This is great information. I love it. All this to say is that in aging services, if there's a provider who's doing transportation, they don't get paid as much under their reimbursement as somebody who would be providing transportation for somebody with a disability. So we see that our aging service providers struggle. And oftentimes when I worked in assisted livings through Presbyterian Homes and Services, what the state paid that assisted living in a waiver was lower than what it cost them to provide care. So there's not as many what we call waiver beds because those assisted livings take a hit on it because the waiver reimbursement rates for elderly waiver aren't sufficient to meet the needs or what the cost is. And so in terms of a policy, right, that there's an ethical issue in terms of social work. It's a gap in services that you don't get enough service providers because they simply can't make ends meet. Now, the ways that some people do it, if you are providing, let's say, adult-based services under waiver and transportation, you might be able to make a little bit more on one and a little bit less on another and make it work to make ends meet. It's a lot more complicated than that, but I'm trying to keep it simple because there's variability in waiver services. And then our nonprofits depend on writing a lot of grants and things like that to be able to keep them afloat. But I think in terms of like a policy, like how that affects our world and my work life is that we see providers not providing services because it's difficult for them to be sustainable in doing that. Oh, go ahead. And I would just imagine it's going to be even more difficult in the future with the aging population. Are you? Yes, absolutely. So we are in the midst of a longevity revolution. People are living longer and healthier lives. There is also a portion of those people who are living longer who do need increased supports and services. And so absolutely, there is a lot of work that needs to be done to build an infrastructure, to build a policy infrastructure that will allow for older adults to live throughout their life in their community. And there's not, I mean, just with the growth of the aging population, there's not enough assisted living or nursing home beds or even, you know, that you couldn't move everyone to a facility like that, nor do people want to. You know, there's research from AARP shows that people want to stay living at their homes in their communities, things like that. Yeah. Yeah. And it impacts everybody. It impacts if you're caring for an older loved one, an older parent. Just that shift, you know, I worked in healthcare, and we didn't see that, you know, 15, 20 years ago. It was like we would just call around to see where there was an open spot for somebody who had a knee replacement, and now it's you barely get a bed unless you absolutely need it. They are relying on people in the community, caregivers and friends and family, to do that because there's not enough space. Yeah. It can get to be a pretty dark reality pretty quickly, and that it is very difficult to live in this environment. I'll also note that for the facilities that are staying open, the workforce issue is what, you know, prohibits them, even if they have rooms and beds, they don't have the staffing to be able to provide them. So they might only be operating, you know, a third of their units or, you know, rooms are not open just because they can't staff it. So we're definitely seeing that as a big issue as well. There are, you know, closures that happen, and so what ends up happening is either A, people are, it falls solely on the responsibility of the family. So we're talking so much about, like, if you want to age in a rural environment, you better have family there to take care of you. Otherwise, you won't, you know, folks are moving to the metro or moving to more populated areas. And so kind of on a policy piece there, too, I mean, this could talk from state policy to even, like, employer policy is what is the support for working caregivers? You know, do caregivers have the tools and the information, the flexibility that they need in their work lives to be able to do those caregiving duties? Do we have an awareness about what it actually takes? Like, what is the toll on caregivers after, you know, for caring for folks? So there's, you know, a lot of research done in that field as well. But, you know, you could talk about everything from additional sort of FMLA time, kind of qualifying for that. What are the other tax benefits that could be a potential policy for people who are fit under a caregiver category to be able to, you know, sort of monetize, I guess, some of the work that they're doing? There's research done. I'm not going to be able to pull it off the top of my head. But the amount of dollars that caregivers, quote, unquote, save or, you know, spend, what that would cost if you were actually paying the caregivers what they're being, the work that they're actually doing. So I think the caregiver policy is a big, important one to look at as well. That would be a great one, you know, looking at what policies are out there to analyze for those of you who are interested, you know, the listeners who might be interested in that realm. And, Georgia, I think I just thank you for creating a really holistic picture of how, you know, we might have students in the class thinking, I'm working micro, right? Like, I'm working on a one-to-one basis. But what's going to happen is you're going to see, on a micro level, gaps and needs. And you're going to get probably angry because we're passionate as social workers. And we're going to say, nope, we need to move upstream a little bit and make some policy change. Because it feels like it's, you know, kind of upstream and trickling down, and that happens. But I think where the real work is, is those working at the micro level and the mezzo level putting on their advocacy hat and saying, I'm still doing this work, but I need to go further up and we need to appropriate some dollars, some more dollars for this because we're drowning. Absolutely. And so I think even though, you know, this is where I'm challenging students to get excited about kind of policy work is that even if you are doing micro work, you're doing macro work. Absolutely. Eventually. Yeah. Right. I mean, that's the systems approach for social work, right? Absolutely. Like, we have our micro, mezzo, macro, and they're constantly interacting with each other. And just because, quote, unquote, just because you're working in one area doesn't mean that you aren't having an impact on another area. And so it's important to really approach this work from that lens. Mm-hmm. Mm-hmm. And really have, yeah, exactly, that systems approach and that kind of widespread awareness, right? You may not be doing it in your everyday work, but having it, tucking it away in the back of your mind of, like, this is a need. This is a gap. We're not seeing that kind of thing. So nice. So federal Older Americans Act, you know, the Minnesota Board on Aging, those are all great services. Other, you know, great legislation is the Waivered Programs. Anything else you can think of? Yeah, I have two more things that I want to touch on. I'd be remiss if I didn't talk about the Age-Friendly Minnesota work that's happening. Perfect. Yes, great. Because that's actually what I'm spending most of my time on right now. So let's see where to start on this. In 2019, Governor Walz started or appointed Governor's Council on an Age-Friendly Minnesota. So part of that was to help a variety of state departments and community representatives look at what would Minnesota need to do in order to prepare for our changing demographics and aging, seeing that this is coming and that communities aren't prepared. One of those results of what happened was that Minnesota entered into the AARP network. It's a global network of age-friendly states and communities. It's a five-year process where you – it's not – the age-friendly designation doesn't mean that you've achieved something. It's a commitment to working towards becoming more age-friendly. And so there's a lot of information on the AARP backslash livable communities website if anybody wants to check that out. But Minnesota entered into that as a state. And there are folks from a variety of state departments like, you know, Minnesota Housing and Finance, the Veterans Affairs, Transportation. You know, currently we have the Minnesota Board on Aging, which is one state department. But we want to have – you know, aging is everyone's business. Aging affects everyone. All roads lead to aging. And so this council then came back with a set of recommendations in 2021. And following that, the Minnesota State Legislature allocated $2.9 million to go out to communities for age-friendly community grants. The majority of that did go out in grants. Some of it was retained to continue with that age-friendly council and have some staffing there, some state staffing. But we, that has a direct – that actually is what my time is spent under right now. There were about 10 to 12 entities that received technical assistance grants. So to really kind of be gurus on anything age-friendly Minnesota. And then to help communities apply for these age-friendly grants. So currently I work with about 15 different grantees throughout the seven-county Arrowhead region doing really fun stuff. So things like looking at how to make the Superior Hiking Trail more age-friendly, to establishing something called a Returnship Toolkit for Employers. So it's something like internships, but for older adults and people who have been out of the workforce for a while. It's super cool. North Stand is working on that. So they are – you know, we're looking to launch that, hopefully, within the coming months. So a lot of different really fun age-friendly projects. Some communities are looking at entering into the age-friendly network, which is, you know, we have Duluth and Lake County who are currently in the network. Throughout Minnesota I think there's about 15 to 16, could be more, communities who have entered into this network and really saying, you know, how do we look at this age-friendly lens. And they can choose – it's structured under eight domains, which are things like housing, transportation, outdoor spaces, social inclusion, civic engagement. So Age-Friendly Minnesota, because of that policy, I'll bring back to policy, has created a buzz, right, and it's helping communities, it's helping organizations think about how do I apply an age-friendly lens. It could be like, okay, we're going to put together, you know, I'll use an example, a pickleball court in Aurora, right. They're really great infrastructure projects where it's promoting inclusion and social engagement. So that first round of funding was allocated, and then because of the success and support behind it, an additional $2.9 million was allocated. So the second round of grants is going on. And it's really making, you know, it's making a name for age-friendly. We're talking to folks like city planners and economic developers and things like that, to folks who haven't necessarily thought about aging, because we typically frame aging in the supports and services provided for, quote-unquote, old people. Well, guess what? We're all aging, right. So we're reframing this as kind of how do we capitalize on the assets of older adults and see them as integral members of our community versus you turn 65 and then you're done. I always use the analogy, we play the game of life, the board game with my kids at home. I love that game. It's a super fun game. But it ends at retirement. It's a very ageist game. If you play the game, life ends at retirement. And now my 9-year-old. Oh, my. Yeah, right? I know. My 9-year-old is like, Mom, we need to create, like, what do you do? You know, like, we're living longer. We've got an extra, you know, 30 years or so to live. And so a lot of the age-friendly work is trying to shift our perspectives about aging. And, you know, we needed, A, first, that policy to happen. And now when we're out doing this work, we need to be able to communicate back to our policymakers, to our elected officials, kind of like what's the good work that's happening, but where do we need more? And it's not always dollars allocated. I mean, that's a big thing, too. But it's sort of just like, you know, getting people to think differently. Like, we're all aging, right? Even if you're in your, well, at any age of life, right? We're all aging from the moment we're born. So wanting to reshift that. So age-friendly Minnesota was the one policy that I kind of wanted to, you know, translate to how that translated into daily life. And then the second piece is there's a legislative task force on aging. So the first one is under the Governor's Council. This one's under the state legislature, where they are currently, there's a task force that's just taking public testimony and getting a lot of information from a whole bunch of stakeholders to sort of look at what legislatively do we need to do. And it's a great opportunity for advocacy. So I can send, if anybody's interested, or I can send it to Kristen, Tracy. We're looking for stories. So if you or your parents or your grandparents are aging, particularly in rural Minnesota, it doesn't have to be, you don't have to be an expert. You just have to say what's helping me age well, what doesn't help. We want the stories of rural Minnesotans and out-of-state Minnesotans to be able to show up on the radar for this legislative task force. So these are the type of policy, you know, it's, the task force isn't necessarily a policy yet, but it's informing our elected officials on what are the issues, what are the stories. That's really important. So even if you are at a micro level, like telling your story, advocacy doesn't have to be this big scary thing. You really can just send your story. Thank you for saying that. That's so key. I mean, for anything, like our representatives are there to hear from us, and it's, you know, click on, look on the state website or on the federal website, you can find your elected official. It could even be county commissioners. I had coffee with our county commissioners, it was probably a couple months, one of our county commissioners about a month ago, and it was really, you know, they're people like we are. And so they are doing their best in their job, and I think it's really, we have such a disconnect and such a, I mean, I'm guilty of it myself, just a really bad taste in our mouth about politics and elected officials in general because we're living in such divisive times. But it doesn't, you know, I guess my social work empowerment is change can start with one person. We're all here in this life, and it can be, it doesn't have to be big, it can be small. We have a, I was telling Krista and Tracy earlier, we have a group, we're calling ourselves the Arrowhead Changemakers, and it's a group right now, about 15 active, some are retired, some semi-retired, older adults, and some people actually are even older adults, they're in their 40s. But we're just looking at making changes around aging advocacy in big ways and in small ways. So we've gone and talked to city councils and mayors. It could be anything from keeping the sidewalk shoveled to joining the Age-Friendly Coalition. So I think, you know, we often think of policy as just like this very nebulous out there thing. But policies happen everywhere. They happen in your city or in your township. They're happening in your social work department. They're happening in your family, right? We don't call them policies, we just call them rules in my family. So I think, like, you know, when I approach policy, you can really break it down, and everybody has a voice. And I think that's what I would kind of encourage folks to just remember. And as you're kind of going about whatever path you choose in social work, that policy and advocacy can be very approachable and very doable for everyone. Georgia, you covered so many great things. Like, we didn't even have to ask questions because you answered them before we even asked. And so I thank you for that because, yeah, Tracy, comments. Yeah, I love that. I was going to ask you a few more questions, and then you just kind of naturally went right into answering them. And one thing that really stood out that you just said a little bit ago is all roads lead to aging. And I feel that everything you've said is so relatable. And I was going to also then just ask how could students get involved because I'm feeling inspired and excited, and so I'm sure students are that are listening. You mentioned a lot of things that students could do, just one step, one smaller thing, but that can lead to big changes. So I thank you for that. And is there anything else that you can think of you would want students to know of how if they want to just know where to start, where to make a change, make a difference? Yeah, I mean, I think, I mean, this sounds cliche, but change always starts with ourselves. So true, so true. You know, personally from like an aging advocacy thing, we have to examine our own thoughts and feelings about how we feel about aging. And so I would, if I had to point people to a couple of websites, I'd point them to the Minnesota Leadership Council on Aging. I think they're pretty much a big statewide thought leader for, you know, all aging services, including home and community-based service providers. And they've got some aging advocacy 101 trainings coming up. They're doing something on the, like, how do you reach out to your legislatures, and they're doing a training for elected officials on aging advocacy and why they should care. So that's kind of cool, and I think that's coming up in February. They're also launching a statewide reframing aging initiative. So there's a national center on reframing aging called, I think that's called National Center on Reframing Aging, CARAVAN. But so they're taking some of that national work and offering some trainings and some intensives in Minnesota. So that's exciting. Wonderful. Thank you. And I would like to encourage the two other spots I would encourage folks to look at are the Age-Friendly Minnesota, checking out things there, as well as the AARP Age-Friendly Network, livable communities. And Krista and Tracy, I'm happy to send you guys links if you want to forward those on. Yeah. Thank you, Georgia, because what I'm thinking is in each of the modules for our students, we have these optional things because it's so expansive, policy is, right? And so trying to whittle down what we really want students as required readings, but then for those students who may be choosing a social problem or a topic in an area such as aging, we have a resource guide, kind of like just optional resources for you. And so if you don't mind sending me those, I'll make sure that those get in our Brightspace shell. And I was frantically jotting down some notes, too, so I'll do that as well. Same. Great. And I'm in here as a resource, too, so feel free, or your local area is in San Adrian. That's what we are here for. If you're not in our area, I'm not the only person working in the shop. There's people who are smarter and know more about certain things than I do. So we work as a team, and we're happy to connect with students or anyone out in the community. Such good work. Thank you. You guys, too. Thank you so much for having me. I really appreciate this opportunity. It has been really fun. And that's a wrap on this episode of the Policy Podcast. Thanks for tuning in to our Policy Pack discussion. Remember, policies may be complex, but our conversations don't have to be. Until next time, stay informed, stay engaged, and keep making a difference in your community. This is the Policy Podcast signing off. ♪♪♪