This chapter discusses the history of the Medicare in the United States; specific components of Medicare Parts A, B, C, and D; and how Medicare provides healthcare resources to older adults and people with disabilities. Medicare, a healthcare program perceived to be a universal program rather than one based upon a needs test, currently provides healthcare to people who reach the age of 64. Comprised of four parts, it can provide hospital care, general healthcare, hospice care, home healthcare, and prescription drug coverage. The chapter provides an overview of the Medicare program, its various components, and aspects of healthcare that are covered through its component parts. Although there are currently no needs tests or limitations as to who qualifies for services, the chapter concludes with some dilemmas for the future of healthcare coverage, including “an empty pot at the end of the rainbow” and rationing of healthcare services and procedures.

This chapter highlights some of the current health programs and policies in place and changes in demographic trends for older adults living within American society. In addition, substantial changes within the social, political, and cultural expectations of communities over the past century pose challenges for policies and programs serving older adults. The chapter presents several issues emerge as realities within the context of policy development and program planning for older adults. These issues include changes in living arrangements, education levels, economic well-being, and rural population settings; trends in morbidity and mortality; and changes within the social, political, and cultural expectations of communities. Despite the availability of programs and services resulting from health policies, many programs have focused upon “medically necessary” services and have lacked a health promotion, health education, or community-based focus.

This chapter briefly discusses the history of the Caregiver Support Act and its specific components and explains how the Caregiver Support Act provides resources to older adults and people with disabilities. It provides an overview of the current status of family members serving as caregivers, with special attention to grandparents raising grandchildren. It then discusses a current profile of relative caregivers raising children in the United States; reasons for the increase in relative caregiving; and issues facing grandparents raising grandchildren. It also provides some background into the literature and promotes an awareness of issues that grandparents face as primary caregivers. A literature review examines some of the current issues and services needed. The chapter discusses resources and services designed to meet the needs of grandparents raising grandchildren, and reviews programmatic responses through the national resources. Finally, the chapter outlines some best practice interventions for review in the text.

This chapter presents a brief overview of some legislative efforts within the mental health (MH) arena and examined their limitations and application with respect to older adults and people living with mental illness. The chapter also takes us through a journey to examine the current status of MH and older adults, with a particular emphasis on depression, anxiety, and schizophrenia. It discusses and reviews the programs, services and issues still outstanding within the MH arena. The chapter helps the reader to understand specific components of the Community Mental Health Act and other MH-related legislation. Many of the community day hospital programs and community MH programs administered through the Community Mental Health Act are based on the deinstitutionalization paradigm since the goal is to treat people outside the institution and within community settings. It concludes with laying out some challenges for the future in the area of MH and older adults.

This chapter helps the reader to be familiar with the demographic and social factors that influence and shape aging and disability policy over time and to be aware of policy changes over the past century within disability and aging public policy. It explains the contrast between advances in science and technology and public policy related to people growing older and people with disabilities. Landmarks serve as essential tools to help us recall specific historical events in time. Historical landmarks, science, and technology have played significant roles in the evolution of social policies; however, aging and disability policies may not have made as many strides as other areas throughout history. The chapter briefly discusses: the role of historical landmarks in shaping social trends and public policies; the relationship between historical landmarks and aging and disability-related policies; and trends in policy, social, and political influences and landmarks in the United States.