Home-based care advocates say they are confident measures outlined in President Joe Biden's now-stalled Build Back Better Act will move forward in some form.

The legislation aims to expand access to services to older adults and people with disabilities, as well as boosting pay for workers who provide home-based care. Currently, more than 3.5 million people rely on Medicaid's Home and Community Based Services (HCBS).

Connie Garner, national policy director for Easterseals, explained demand for home care has outpaced resources, and as a result, more older adults end up in nurse homes.

"That costs more money, that causes more isolation, and that's not what we should have in this country," Garner asserted. "We should have the ability to have people be able to be taken care of correctly at home. And we have to be able to pay and support the providers of that care. They become an essential member of that family."

According to the research firm Paraprofessional Healthcare Institute, more than two million home care workers earn around $16,000 per year, and one in six live below the federal poverty line.

A report by the ICA group found West Virginia is facing a troubling home-caregiver shortage with one caregiver available for roughly every 11 clients.

In Washington, lawmakers say portions of the Build Back Better Act will likely pass this year, but it remains unclear whether the $150 billion earmarked for Medicaid HCBS will remain intact.

According to the Kaiser Family Foundation, in 2020 more than 2.5 million people nationwide received Home and Community Based Services, with hundreds of thousands more on wait lists.

Amber Christ, director of health policy and advocacy for Justice in Aging, said families are forced to make tough choices.

"From an older adult perspective, this lack of investment in home and community-based services in effect pushes older adult into nursing facilities unnecessarily," Christ contended.

A survey by AARP found 76% of Americans age 50 and older say they prefer to remain in their current residence as long as possible, but just 46% anticipate they will be able to stay in their current home.

Alzheimer's disease is one of the leading causes of death in North Dakota, prompting state officials to launch an online dashboard, where the public can learn more about the numbers and resources.

Data compiled from state vital records showed in 2020, more than 500 North Dakotans died from Alzheimer's, up about 100 from 2016.

Melissa Kainz, community clinical coordinator for the North Dakota Department of Health, said it is not surprising to see those numbers gradually increase with an aging population.

"People are living longer," Kainz pointed out. "With that longer life span, these rates are consistently found in the older population, and we just would like to have that awareness piece out there."

With the dashboard, she explained loved ones can sort through links to find out information ranging from getting a diagnosis to becoming a caregiver. The site also includes projections on future cases, giving policymakers a tool in decision-making surrounding public health.

Emerging research has probed methods of detecting the disease before symptoms start to show. In the meantime, Kainz noted they know quickly following up after the signs first appear is key.

"Research shows that the earlier people are diagnosed with Alzheimer's disease or dementia, the greater chance they have or the greater quality of life or living they have for a longer period of time," Kainz stressed.

Some common symptoms include increased memory loss and confusion, as well as an inability to learn new things. As for projections, the dashboard showed annual Medicare claims for the disease should rise from their current average of around 750 to nearly 1,000 by the year 2035.

May is Wildfire Awareness Month, and state officials are encouraging Coloradans to get up to speed on prevention and emergency-exit strategies if evacuation notices are issued.

Rocco Snart, the planning branch chief with the Colorado Division of Fire Prevention and Control, said it's never too early to prepare.

Make a list of all the things you need to take with you, including a week's worth of prescription medicines. Next, find a place you can go, and make plans to get there.

He said you don't want to be in a rush when you leave your house.

"You want to try to make that on your own terms, so that you can make sure that you've collected everything that you need," said Snart. "If you need a walker, and you need to get it in a vehicle, or if you need to arrange to get a ride to come and pick you up, the earlier you can work on those things, the better."

Snart said make sure your insurance policies and personal identification documents are up to date, and make copies for your emergency travel kit - which should also include N95 masks to protect yourself from smoke inhalation.

A complete checklist for disaster preparedness is available at Ready.gov.

The group Wildfire Partners works with Mile High Youth Corps in Denver to provide wildfire-mitigation services at no cost to older residents.

Snart said even small steps can help. Make sure trees and plants are well hydrated, and if you live near open spaces, reduce vegetation to create a buffer around your house.

"Make sure that any deck materials are taken care of and not splintered," said Snart. "I mean, a deck with splintered wood and wood that's breaking down looks like a campfire for embers, right?"

Climate change is projected to create longer wildfire seasons in years ahead, with fires becoming more frequent and intense. Snart said this new reality can lead to a sense of denial, but he encourages everyone to take time to be prepared.

"That's not going to happen in my neighborhood, that's not going to happen in my subdivision," said Snart. "And the reality of it is, it can happen anywhere. In the Front Range, in the mountains, wherever there is fuel and homes next to one another."

An official plan to expand broadband in Texas is due out June 15, after state officials traveled near and far to collect public comments on internet access and affordability.

Tim Morstad, associate state director for AARP Texas, said the pandemic highlighted equal access to high-speed internet is critical and no longer a "nice-to-have" luxury.

"We've got to get access to high-speed internet, and we've got to make sure it's affordable, and we've got to make sure people have the skills to utilize it," Morstad outlined. "I picture it as a three-legged stool to make sure that we can really unlock the potential for older Texans."

Texas lawmakers passed legislation last year to create the Texas Broadband Development Office. Currently, the state has access to $500 million in federal money through COVID-19-related grants with more money promised through the federal infrastructure law House Bill 3684 11/15/2021.

The geographic size of Texas is a challenge for connecting people to reliable internet, especially in rural areas, but Morstad expects Texans will appreciate the benefits when the work is finished.

"For older Texans, it has the ability to unlock things like telehealth," Morstad explained. "It will also allow older Texans to stay connected, whether that's with friends or families or caregivers."

Morstad added half of those who belong to AARP Texas are between the ages of 50 and 64 and still very active in the workplace. It means if they are looking for a job, they need affordable, high-speed internet to find out what's out there and how to apply.

"And some of them, you can work from home, but only if you're connected," Morstad pointed out. "So we really want to see high-speed internet pushed out there further across our state, so these opportunities are available to older Texans."

Later this year, the Texas broadband office expects to issue a map of the state, property by property, to show where expansion is needed.