Page 16 - Flathead Beacon // 5.18.16

COVER
GRAYING MONTANA
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 OF THE BEACON
Montana is growing long in the tooth.
State projections show that its popula- tion 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 com- munity services.
More than a quarter of the state’s pop- ulation 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 commu- nities, seniors will make up a quarter of the population by 2020.
The so-called “aging tsunami” is a bell- wether of social and economic change that Montana policymakers have been bracing for, and which will impact local systems of health care, retirement, hous- ing, 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 gener- ation hits retirement age. With a sudden in ux of elderly residents comes a grow- ing 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 Flat- head 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 demo- graphic shift is unprecedented and will require sustained innovation and invest- ment 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 rst in the nation for having the largest share of Medicare bene ciaries living in rural areas – 77 percent, compared to a nation- wide average of only 24 percent, accord- ing to a study by the Montana State Uni- versity, 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.”
Centenarian Kenneth Soward and his daughter Patricia diStefano. GREG LINDSTROM | FLATHEAD BEACON
long terms given the increased costs of doing business and the rapid demo- graphic changes.”
Among older adults in Flathead County, 34 percent have a disabling con- dition, 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 ser- vices, 85 percent are at moderate to high risk of institutionalization, a costly bur- den on local and state resources.
According to a survey by the Ameri- can 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 reve- nues will be o set by the impacts of fewer young people on education and correc- tions 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, Med- icaid costs of caring for people with Alz- heimer’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 a ects 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-per- son 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 liv- ing with Alzheimer’s.
“We are in the rst stage of making Montana a dementia-ready state,” Wil-
liams said.
Flathead County’s future will also be grayer as the local segment of aging retir- ees grows more rapidly than younger workers and newborns, according to a 2013 population study, which was com- missioned 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 per- cent 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 assis- tance, others have challenges that make life di cult to manage without help,” the plan notes.
Providing that help through local ser- vices designed to minimize the number of seniors who require high-cost, medically complex care is a challenging task.
In the face of those challenges, Wil- liams 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 accessi- ble. It was one of the rst states to cre- ate 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 rst to imple- ment 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 identi ed 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,” Wil- liams said.
But as always, the demand for services outweighs the available resources, par- ticularly 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
tscott@ atheadbeacon.com
16
MAY 18, 2016 // FLATHEADBEACON.COM