Should we retire the White House Conference on Aging?

In December 2005, Washington hosted the fifth White House Conference on Aging. Many media accounts made this session appear similar to the previous four. As in 1961, 1971, 1981, and 1995, several thousand delegates attended the meeting. The White House Conferences on Aging are, in fact, rare occasions in which advocacy groups for the elderly meet on an equal footing with gerontologists and other researchers who study the issues facing older Americans.

Previous White House Conferences on Aging have had a dramatic impact on a wide range of policies affecting the elderly. The 1961 conference included an appearance by the departing President Eisenhower and provided the impetus for the rise of various interest groups advocating for older persons, including the National Council of Senior Citizens and the AARP. In addition, the 1961 conference launched major changes in Social Security, the creation of Medicare and Medicaid, and amendments to the federal Housing Act of 1961 to make special provisions for the aged. Discussions at the White House Conference also led to passage of the Older Americans Act of 1965, the establishment of the federal Administration on Aging, and the creation of Area Agencies on Aging and State Commissions on Aging.

The 1971 White House Conference influenced the creation of the National Caucus on Black Aged and the Asociacion Nacional pro Personas Mayores (National Association for Hispanic Elderly). President Richard Nixon's policy advisers hoped to use the conference to urge the transfer of several public sector programs to nonprofit organizations, but the effort failed. Instead, delegates drafted and passed 193 recommendations that basically continued the policy direction of the first conference, including the creation of a national nutrition program for older persons and the establishment of a federal Council on Aging. Four years later, a congressional study found that the federal government had implemented most recommendations of the 1971 White House Conference on Aging.

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The 2005 White House Conference won't leave a legacy nearly as impressive as those earlier meetings. Many delegates left angry or disappointed. The resolutions presented at the session received far less press attention than President George W. Bush's decision to skip his own White House Conference and, instead, travel to a nearby Virginia retirement community to talk up Medicare Part D.

To get an informed insider's perspective on the event (or nonevent), Nursing Homes/Long Term Care Management spoke with Terrie Wetle, PhD, associate dean of medicine at Brown University and former deputy director of the National Institute on Aging. In addition to her credentials as past president of The Gerontological Society of America and former director of Yale University's program in long-term care administration, Dr. Wetle was a policy analyst for the Administration on Aging and director of an Area Agency on Aging in Portland, Oregon. Most significant for this article, however, Dr. Wetle is one of a handful of individuals who can offer firsthand comparisons of most of the White House Conferences on Aging. Recruited as a "youth representative" to the 1971 conference, Dr. Wetle has attended every subsequent conference.

Dr. Wetle explained that some aspects of the 2005 session were very impressive. The extensive preparatory miniconferences were well attended and productive (and for a report on long-term care's first effort at this, see "Warning Signs for the White House," Nursing Homes/Long Term Care Management, October 2005, p. 26). Conference events, often sponsored by corporate interests, were lavish, and some of the commercial presentations were interesting because they recognized the economic benefits of addressing the needs of the elderly. Delegates were particularly impressed with Intel and other high-tech firms for adapting their technologies to meet the specialized needs of long-term care.

However, Dr. Wetle and many of last year's attendees agree that the 2005 session was choreographed to deny a meaningful experience for most attendees. Attendees were presented no opportunities to introduce or modify policy resolutions presented to the conference. Although delegates resoundingly rejected Bush administration-backed resolutions supporting the privatization of Medicare and Social Security, they weren't permitted by conference leadership to offer alternatives. In one dramatic incident, a session chairperson ignored conference procedures by refusing to recognize petitions with sufficient delegate signatures to require discussion of a motion. The ultimately deadlocked conference produced no clear road map for future policy.

This is not the first time that the White House Conference on Aging has been relatively unproductive in terms of a legislative agenda. The 1995 White House Conference concentrated on reaffirming support for existing programs, especially those constituting the social safety net for older Americans, but proposed few initiatives. The conference asked Congress to quickly renew the Older Americans Act and adopt reforms to strengthen Medicare and Medicaid but, as Dr. Wetle points out, reauthorization of the Older Americans Act didn't occur until five years later.

One explanation for the apparently devolving value of the White House Conferences on Aging lies in some basic social change since the 1961 and 1971 sessions. Elderly Americans at the time of the first conference constituted a relatively small population segment with no effective economic or political clout. In 1961, for example, although less than 1% of the U.S. population was over 85 years old, the census reported that the elderly, as a group, were more likely to be impoverished than other Americans. In fact, in 1961, the likelihood of falling into poverty increased rapidly after age 65. The 1961 conference was able to highlight an intense area of need. Today, the elderly are far more numerous and generally more prosperous. Nearly 5% of Americans are over 85 years old and are deemed less likely than younger Americans to have incomes below the poverty line. Both private sector and government organizations devoted to the interests of the elderly now are highly influential, in part because of the strong send-offs they received from the first two White House Conferences on Aging.

Delegates from the most recent conference recognized, however, that meeting the needs of America's elderly is far from complete. Older Americans face significant problems of discrimination in housing and employment, and (as our readers are painfully aware) official Washington still turns a deaf ear to the needs of long-term care providers who represent the only source of care with dignity for many people over 85 years old. It also remains true that most older Native Americans and African-Americans do not experience the quality of life attained over the years by the elder majority.

Dr. Wetle recognizes that "all White House Conferences have been, to some extent, political showcases" for the occupant of the Oval Office. However, she believes that these conferences can continue to perform a valuable purpose if they focus on productive discussion among delegates. At the very least, a fair and open forum can contribute to awareness and development of consensus on the needs of older Americans. But, she says, she'll gladly pass on another "trade show" like the 2005 White House Conference on Aging.

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