The Graying of Montana

As the aging population explodes statewide and in the Flathead Valley, Montana policymakers are bracing for a dramatic demographic shift

By Tristan Scott
Kenneth Soward and his daughter Patricia diStefano, pictured at Prestige Assisted Living in Kalispell on May 11, 2016. Greg Lindstrom | Flathead Beacon

Montana is growing long in the tooth.

State projections show that its population is graying at an unprecedented rate, outpacing the rest of the country and placing added pressure on state and local governments, as well as stressing community services.

More than a quarter of the state’s population will be seniors by 2030, a full two decades before the demographic shift sweeps the rest of the nation, according to projections. In Flathead County, which stands among Montana’s grayest communities, seniors will make up a quarter of the population by 2020.

The so-called “aging tsunami” is a bellwether of social and economic change that Montana policymakers have been bracing for, and which will impact local systems of health care, retirement, housing, employment, and more.

Analysts across the nation have warned that local governments should prepare for the coming tide of senior citizens as the post-World War II Baby Boomer generation hits retirement age. With a sudden influx of elderly residents comes a growing demand for medical and city services, such as public transportation and walk-able streets for a segment of the populace that tends to drive less frequently.

“The aging population is exploding nationally, across Montana and in Flathead County,” according to the Flathead County Agency on Aging’s most recent plan, which covers a period between Oct. 1, 2015 and Sept. 30, 2019. “This demographic shift is unprecedented and will require sustained innovation and investment at all levels to ensure quality of life, health and well-being for all.”

Providing care for Montana’s seniors is further complicated by the state’s rural environment, which is characterized by long travel distances, poor secondary roads, long winters, inclement weather, and limited community-based services.

Montana currently ranks first in the nation for having the largest share of Medicare beneficiaries living in rural areas – 77 percent, compared to a nationwide average of only 24 percent, according to a study by the Montana State University, called Health Enhancement for Rural Elderly.

“The very frontier nature of service delivery in our state creates huge issues,” said Kelly Williams, administrator of the Montana Department of Public Health and Human Services’ Senior and Long-Term Care Division. “In some cases, the elderly person or their caregivers may have to travel up to 100 miles or more to get services or the service provider may have to travel to provide the service in the individual’s home.”

Flathead County’s future will also be grayer as the local segment of aging retirees grows more rapidly than younger workers and newborns, according to a 2013 population study, which was commissioned by the Census and Economic Information Center of the Montana Department of Commerce.

In 2010, the U.S. Census reported that 21.2 percent of Flathead County residents were age 60 or older, the eligibility age for services under the Older Americans Act. New census statistics for 2013 estimate that 24.2 percent of the Flathead County residents are now age 60 or older, a 3 percent increase, and 14.5 percent are age 65 or older.

According to the Montana Department of Health and Human Services’ State Plan on Aging, the population is predicted to jump to 25.7 percent in 2020 and to 26.8 percent in 2025.

“Although many do not need assistance, others have challenges that make life difficult to manage without help,” the plan notes.

Providing that help through local services designed to minimize the number of seniors who require high-cost, medically complex care is a challenging task.

In the face of those challenges, Williams said the state agency is asking: “How do we best provide services to them?”

For decades now, Montana has been searching for ways to keep care accessible. It was one of the first states to create a Medicaid waiver program in the 1980s, allowing residents who need long-term care to use Medicaid funds for care in their community, often by family or friends, rather than in an institution.

It was also among the first to implement the model of small, limited-service rural hospitals, now known as Critical Access Hospitals. These have also begun to provide long-term care in areas that have a shortage of nursing home beds.

The number of nursing home beds in the state dropped from nearly 1,850 in 2005 to fewer than 1,400 in 2009 because of regulations that made it harder to keep these homes as part of a hospital. Home health care has also dwindled, falling from 76 agencies in 2000 to just 42 in 2009 because of payment methods that require a minimum volume to remain viable, which Montana couldn’t meet.

This development comes even as the state’s Plan On Aging identified home care and community-based services as some of the key areas the state should grow in order to meet the needs of the “aging tsunami.”

“We have done a tremendous amount of work at the department level to focus on providing care, in-home services and support to seniors at the local level,” Williams said.

But as always, the demand for services outweighs the available resources, particularly as federal funds have declined.

“Our data shows we are experiencing an increase in demand for services across the board,” according to Flathead County Agency on Aging Director Lisa Sheppard. “We have been fortunate to have enough resources to meet the growing needs in the short term but are concerned about our ability to do so in the medium and long terms given the increased costs of doing business and the rapid demographic changes.”

Among older adults in Flathead County, 34 percent have a disabling condition, while almost 10 percent live alone and 7 percent live below the poverty level.

Sheppard reported a sharp increase in the demand for in-home services like Meals on Wheels, and said the agency is clearly serving the population with the greatest need. However, of the older adults receiving in-home assistance services, 85 percent are at moderate to high risk of institutionalization, a costly burden on local and state resources.

According to a survey by the American Association of Retired Persons, 80 percent of older people want to “age in place,” meaning most want to live out their days in the community where they spent their lives.

Providing low-level in-home services helps facilitate that, Williams said, while it also postpones the need for high-cost, medically complex services.

The changing demographics will also alter the demand for government services.

For instance, money spent on K-12 education is projected to fall, while the state’s share of Medicaid spending would go up. Overall, researchers predict that the impacts of more elderly residents on Medicaid spending and income tax revenues will be offset by the impacts of fewer young people on education and corrections expenditures, and on residential property tax revenues.

However, several factors could change the projections. If medical costs continue to increase rapidly, the Medicaid costs and overall cost of the aging population could go up substantially.

With the number of seniors living with Alzheimer’s Disease projected to rise exponentially in the next decade, Medicaid costs of caring for people with Alzheimer’s will increase dramatically. In 2016, the projected cost of Alzheimer’s care was $150 million.

An interim committee of the Montana Legislature is taking an in-depth look at caring for patients with Alzheimer’s, which currently affects 19,000 Montana seniors age 65 and older.

According to statistics compiled by the Alzheimer’s Association, Alzheimer’s is currently the sixth leading cause of death in Montana. The average per-person Medicaid spending for seniors with Alzheimer’s is 19 times more than for seniors without the disease. By 2025, an estimated 27,000 Montanans will be living with Alzheimer’s.

“We are in the first stage of making Montana a dementia-ready state,” Williams said.

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