Profiles in Social Work

Shaping Public Policy to Benefit Older Adults

Robyn Golden, ACSW, LCSW, MA


The John Heinz Senate Fellowship Program, founded in 1992 to honor the late senator, provides the opportunity for an aging services professional to spend a year working in a senator's office to learn how public policy is shaped by our national legislature. The fellowship's 2003-2004 recipient, Robyn Golden, ACSW, LCSW, MA, took a year's sabbatical from her position as Director of Program Development and Provider Relations with the Council of Jewish Elderly, a nonprofit service agency in Chicago, to take advantage of the program. She also took a leave of absence from her position as adjunct professor at the University of Chicago, where she teaches courses on mental health and aging.

Golden, who was responsible for researching and developing new programs as well as communicating with community and health care professionals in her role at the Council of Jewish Elderly, applied for the fellowship because she was eager to experience firsthand how Washington worked. "I wanted to learn more about policy and government, to have an opportunity to affect the big picture," she says.

Since joining the staff of New York Senator Hillary Clinton in September 2003, Golden has received a crash course in how public policy is created. In addition to working on legislative issues key to seniors, such as long-term care, caregiving, and health care services, Golden also regularly meets with New Yorkers so she can communicate their concerns to Senator Clinton. "I was pleased to discover how much legislators listen to their constituents," she says.

Golden's stint in Washington comes at a time when issues affecting older adults are making headlines; namely, the Medicare bill passed by Congress on December 8, 2003. Critics charge that the bill's highly touted drug benefit is too minimal, and decry the bill's growing price tag and the perks it provides to pharmaceutical companies and private insurers. Many legislators, including Senator Clinton, continue to press for further Medicare reforms.

Aside from drug benefits, says Golden, one of the hottest debates on Capitol Hill is how to address growing problems with access to and affordability of long-term care. "We are going to have to figure out who is going to pay for what in terms of long-term care," warns Golden.

Of course, many seniors hope to avoid nursing homes altogether, preferring instead to receive treatment while continuing to live at home. Golden highlights the 1999 Supreme Court decision in Olmstead vs. LC, which ruled that placing disabled persons in an institution when they could be--and would prefer to be--served in the community discriminates against them under the Americans with Disabilities Act of 1990. "The goal," says Golden, "is to keep older people in the community, in the least restrictive environment, and out of institutions."

Currently, Medicaid requires only that states provide long-term care for eligible persons, making home-care programs optional. Two bills currently under review by the finance committees in the House and Senate could potentially help rebalance Medicaid dollars between long-term and community care: the Medicaid Community Attendant Services and Supports Act (MCASSA), most recently introduced in May 2003, and "The Money Follows the Person Act," introduced in July 2003. The bills would require states to provide community-based home health services to disabled and older Americans and allow Medicaid funds paying for a person's institutional care to be applied to community-based care for that person upon discharge. Although the bills have bipartisan support, their future remains uncertain.

Other issues that Golden is currently working on include the upcoming reauthorizations of two bills crucial to older adults' care and social support: the Older Americans Act and the Substance Abuse and Mental Health Service Administration (SAMHSA). The former, dating back to 1965 and periodically renewed since that time, created the Administration on Aging. "The bill provides key services to help older adults age in place, such as transportation, home delivery, housekeeping, and caregiver support," explains Golden. SAMHSA provides mental health services for older adults, an important area of interest for Golden, who spent years working as a psychotherapist and counselor for older adults and their families. "Anything related to dementia is also a key topic," adds Golden, including diagnosis and patient care for Alzheimer's disease as well as caregiver support.

Golden believes that her experience in Washington will serve her well when she returns to the Council of Jewish Elderly in the fall. "Now we'll have a better sense when we see a seemingly insurmountable issue of how we might deal with it by influencing public policy," she explains. Although Golden acknowledges that government can move slowly at times, the John Heinz Fellowship has taught her that the system can still serve its citizens' needs. "I believe that if people can frame their issues clearly and advocate for them before Congress, they can really make a difference," she says.

Updated November 18, 2010

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