As region ages, service demands expected to rise

BLUEFIELD, W.Va. (AP) — By 2030, more than 70 million Americans, one in every five, will be 65 years old and older, twice the number in 2000, according to the National Association of Area Agencies on Aging.

That will create a more taxing demand for services, the organization says, a demand agencies are already struggling to meet.

For much of Southern West Virginia and Southwest Virginia, that 20 percent of the population milestone has already been reached, creating problems in several areas of need.

All counties in the region have a higher percentage of the population 65 and older than in 2010, most seeing a 2 to almost 5 percent jump, according to the U.S. Census Bureau.

For example, Mercer County’s 65 and over population in 2010 was 18 percent of the total population. The 2016 estimate was 20.6 percent.

The highest jump was in Bland County, from 17.4 percent to 22 percent. Buchanan County saw a large rise too, from 16.1 percent to 20.7 percent from 2010 to 2016.

In McDowell County, the increase was from 16.5 percent to 19.8 percent and in Monroe County the percentage jumped from 19.6 to 23.6. That 23.6 percent, almost one out of every four people 65 and over, was the highest of any county in the region and near the top in the state.

Raleigh County saw a jump from 16.1 percent in 2010 to 19.4 percent in 2016.

As a comparison, West Virginia’s overall percentage of those 65 and over was 18.8 in 2016 while Virginia’s stood at 14.6 percent and nationwide it was 15.6 percent.

Only Florida, which has a huge number of retirees, and Maine have higher percentages of that age range population than West Virginia.

Robert E. Roswell, commissioner of the West Virginia Bureau of Senior Services, said an associated problem with the aging population is the rising ages of people actually seeking services.

People are generally considered “senior” and can receive services at age 60, but he said aging agencies are not seeing many in that age range, and that in itself creates difficulties providing services.

“They are still working and they are not necessarily going to a senior center,” he said of those in their 60s.

“The demand is for much older groups,” he said. What is taxing services for the aging is the 70-80 year-old, or older, range.

“Our average client is a female at age 75,” he said, referring to statewide statistics. “Sixty-six percent are over the age of 75 and more than 50 percent are female.”

People in that age range tend to need services more, he said, and that creates a strain on the agencies.

“Transportation is the big one,” he said, adding that medical transport is not so much a problem because carriers are paid. “But to get to the grocery store and pharmacy, it’s door-to-door service.”

Providing that service is difficult, and the same is true for in-home care.

“We have a waiting list in every home care program,” he said. “We are only serving about 50 percent of those who need it.”

The waiting list to care for Alzheimer’s patients who remain at home is shorter, he said, because “there is a tendency in West Virginia not to give up the responsibility to take care of your parents. There is still a demand for services, but less demand.”

Waiting lists are also the norm for in-home meals, he said, with few exceptions, and it’s difficult to say how many are actually in need because they quit asking for help.

Funding, of course, is an issue, and the bureau is now facing a 1 percent cut in federal funding for nutrition programs.

“We have not had an increase in federal funds for 11 years,” he said. “And now we will lose $151,000 a year starting Oct. 1.”

The cut was based on a change in a complicated federal formula for determining how much money states receive.

Needs are exacerbated too, he said, because people are living longer.

“It’s difficult, and there’s not an easy solution for us,” he said. “It’s time for us to ask for more money whether the state has it or not.”

Roswall said volunteers could be a huge help with agencies, but not enough interest is shown.

“Volunteers are needed all over the state,” he said. “We don’t get enough volunteers.”

Sandy Graham is the director of CASE West Virginia Commission on Aging based Princeton, an agency that covers the counties in the southeastern part of the state, including Mercer and Monroe.

She sees many of the same issues that Roswall does.

“Our people age in place here,” she said. “People live their whole lives here.”

That helps create those high percentages, she said.

Another issue is more cultural and generational.

“For many people at that age we have a lot of widows,” she said. “Widowers tend to remarry right away, widows don’t.”

Many of those widows have been homemakers and may need help with things their husbands took care of, including Medicare sign-ups, she said. They also need socialization and transportation.

Graham also agrees that when people turn 60 they don’t automatically seek services, and are now working longer.

“Many baby boomers are working,” she said of the people born from 1946 to 1964, when about 75 million babies were born in the United States.

CASE offers many services that cover a wide variety of growing needs, she added.

“We provide a multitude of services for seniors, including congregate meals in Princeton and Bluefield,” she said. “Our main site in Princeton serves lunch every weekday.”

Educational programs are also offered, including health related classes and bringing in attorneys to help with decision making and explaining legal issues.

Counselors are on staff as well.

Graham said there has been an increase in demand for homebound meals, transportation, in-home care and respite services.

She also made the point that services offered are for everyone and not based on income.

Monroe County continues to see a rise in the need for services, and waiting lists are common.

Burl Smith, director of the Monroe County Council on Aging, said the county has more than 2,500 residents 65 and over with 820 being served “on our books.”

“We only have funding to serve less than 300,” he said. “The bottom line is, we have waiting lists. We are underserving our community.”

Transportation is a problem, he said, because the county is rural with many places difficult to reach, and many needed medical services are located in other counties.

Although the agency does receive federal funding (funneled through the state) for buses, there is not enough money to run full time or to run everyone to their particular appointments.

“You have got people going in every different direction (for appointments), all at different times,” he said. “People seem to forget that we serve seniors but also serve those with disabilities.”

Those appointments often are in hospitals or clinics in surrounding counties, which presents logistical problems. “We have no hospitals or major clinics (in the county) that can do anything other than check-ups.”

The county is too small for it to be cost-effective to have regular bus routes, like those in Mercer County, he added.

“We have a limited fleet with a limited number of drivers,” he said. “And we have been trying to do more of other runs (like grocery store and pharmacy).”

Smith said home-delivered meals (Meals on Wheels) is part of the program, serving 60 or so throughout the county. “We are underserving there as well. Many are too far for anyone to get to. There are people who want to get into the program but can’t.”

Congregate meals are served in six different places around the county every weekday, he added.

Four senior centers are located in the county offering many activities, and the agency also provides in-home respite for Alzheimer’s caregivers.

“We do it to allow them to stay home as long as possible,” he said, adding that putting patients in nursing homes or assisted living facilities is far more costly.

More of those in-home services are needed as well.

“The bottom line is, we don’t really have any new funding,” he said. “Our funding has been capped. There is no room to expand to provide the services. Somebody is actually going to have to pass away to add on another person.”

Smith said the recent legislative session did not produce any more funding, but a loss of funding was avoided.

“If (proposed) cuts had been made … federal matching funding would have been lost,” he said. “They ended up not cutting at all.”

Recruiting volunteers is also a problem.

“We used to have a lot of volunteers,” he said, adding that many of those have gotten older and replacements have not stepped up.

“We have been trying really hard to bring in younger groups,” he said, especially those trained in field such as certified practical nursing (CNA). “CNAs are needed. It’s important to get younger people involved because the volunteers are not coming like they use to.”

Regulations are also hurting, he said, because as they increase they mean more and more compliance, which takes time and money.

“It’s not necessarily a bad thing (new regulations),” he said. “But you don’t see the increase in funding to allow money for compliance.”

In Virginia, the Appalachian Agency for Senior Citizens (AASC) serves Buchanan, Dickenson, Russell and Tazewell counties.

The agency’s executive director, Regina Sayers, said the region is already at or above the 20 percent mark for seniors age 65 and over.

“The population is growing older and it is decreasing among younger people,” she said. “They are living longer and women live longer. We have a lot of people in their 70s and we have people in the 90s and even in their 100s.”

Sayers said many clients are women and they often have the lowest income.

“A lot of them were housewives and were not out in the workforce,” she said.

Sayers agreed that transportation, especially for non-medical reasons, is one of the greatest needs, with many seniors not being able to drive anymore and can’t afford the insurance anyway.

“Our agency operates the Four-County Transit so we do have a large population of seniors using those major routes, and that is our largest age group,” she said.

Although meals are offered at AASC’s senior centers and some are taken to homes, as in Monroe County the geography presents difficulties.

“The distance in some places is too great,” she said of the more isolated homes. “We just can’t get to them. We try to reach out to them but it takes too much time to get to them.”

The number of people needing in-home services has increased, she said, but the funding has been level and “there isn’t enough money to go around.”

Like CASE, the AASC offers many services, from meals to educational programs to social activities.

As age advances, so do health issues, putting a strain on more resources.

Sayers said the AASC participates in the Program of All-inclusive Care for the Elderly (PACE), which is a long-term care solution for individuals who need help taking care of themselves at home. PACE programs provide health care and social services for older adults who need nursing home services but want to continue living in their homes and communities.

Agencies also offer health education services, including how to better monitor chronic diseases.

Sayers said funding has also been secured for an adult day care/multipurpose senior services facility in the Falls Mills area.

Volunteers are needed badly, she said.

“We would love to have more volunteers, but it’s very difficult to find them,” she said. “We used to have more retiree volunteers but they have become older and they now need our services.”

Volunteers could help in many areas, she said, including assisting seniors in navigating health plans, outreach, chronic disease health management and delivery of meals to shut-ins.

“There is a great need for volunteers,” she said.

With that predicted dramatic increase in those 65 and older because of the aging baby boomer population, the National Association of Area Agencies on Aging says it’s obvious the change will put a strain on entitlement programs such as Social Security, Medicare and Medicaid.

“But there is less awareness that this shift will also significantly increase demand for home and community-based services (HCBS), like those offered by Area Agencies on Aging (AAAs),” the association says. “Because HCBS costs a fraction of the cost of institutional care options like nursing homes and skilled care facilities, bringing services to people where they live helps them save their own and government dollars, making this a more sensible approach from a fiscal and human perspective.”

As Roswall said, West Virginia as a state will cross that one in five threshold (20 percent) of the population aged 65 and over in the near future, and more funding will be needed to meet the growing demands for services.

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