Growing senior population will challenge government benefits, health care
Published on -6/12/2014, 4:55 PM
By Ken Stephens
The Hutchinson News
Nationwide, baby boomers are turning 65 at the rate of 10,000 a day.
In Kansas, Wichita State University's Center for Economic Development and Business Research projects that the number of people 65 or older, about 376,000 in the 2010 Census, will grow to more than 611,000 by 2030. Reno County's older population is projected to grow by 38 percent, from just under 11,000 in 2010 to 15,168 in 2030. By then, one out of every four Reno County residents will be 65 or older.
The surge in the elderly population presents serious questions for the future: How are we going to care for the rapidly growing number of people 65 and older? Who's going to pay for it? And how are they going to pay for it?
Those questions are perplexing Congress, state and local departments of aging, retirement communities, nursing homes, hospitals, hospices, home health care agencies, the older people themselves and their families.
"This was all knowable 25 years ago," said Lowell Peachey, CEO of Mennonite Friendship Communities in South Hutchinson. "But we haven't dealt with it. But we're going to have to deal with it. That's going to be the challenge for all of us in this business."
Of today's 65 and older population in Reno County, 93 percent live in their homes or apartments rather than nursing homes or other group quarters. Hutchinson's Housing Program Manager, Irene Hart, who formerly oversaw the Department of Aging in Sedgwick County, said that's not likely to change because no community will be able to build enough affordable nursing homes or assisted living centers for the aging baby boomers.
Interviews with Peachey and Mark Mains of Wesley Towers, another continuing care retirement community, indicate that they're looking for alternatives to more brick and mortar because of the uncertainty about how much and how their organizations will be paid by Medicare and private insurance companies.
Most elderly people would prefer to live in their homes anyway. But there also are an unknown number of elderly people who stay in their homes because that's all they can afford.
According to the Census Bureau's American Community Survey, 7.1 percent of all Kansans 65 and older, and 8.1 percent of Reno County's older people, have income less than that of the Federal Poverty Level, or $11,700 a year. Statewide, 29.1 percent are trying to get by on less than 200 percent of FPL, or $22,340. In Reno County, that figure is 31.4 percent. Six percent of Reno County's elderly are on food stamps.
"In the past, a lot of our clients who come to us only have Social Security," said John Scott, president and CEO of Interfaith Housing Services, which has repaired hundreds of homes for poor and elderly people over more than 20 years. "They've worked in service industry jobs most of their life. Their wages were not real high, and their Social Security is not that much. By the time they pay out for their medicines, taxes, food, there's not much left."
That may mean they can't afford to maintain their homes.
"Where it's real bad is after a disaster like the hail storm, where people one, have no insurance because they couldn't afford it, or two, they have insurance, but they can't afford the deductible (to have the roof replaced)," Scott said.
Police officers, firefighters and city inspectors have seen homes in which elderly people were squeezed into living in one dry room because the roof leaked so badly that Sheetrock had fallen from walls and ceilings throughout the rest of the house. In one instance, an elderly couple had hung plastic from the ceiling in an upstairs room to funnel water into a bucket which they would empty out a window. Heating and air conditioning also are frequently in need of repairs costing more than those who are both elderly and poor can afford.
A few years ago, Interfaith Housing got a grant from Reno County's Department of Aging and dug up and replaced a collapsed sewer line outside an elderly man's simple house. Without the repair, which he couldn't afford, he would have had to leave his home.
"As a community, as a society, what are we going to do?" Scott asked. "I don't know. We try to help one family, one situation at a time. But we don't have the funding to keep up with demand."
Interfaith Housing Services used to build a lot of wheelchair ramps to get in and out of houses, but state money specifically earmarked for accessibility modifications dried up. Other funding from the Department of Aging for home repairs has dropped from $20,000 to about $12,000 this year.
Many older people, Scott said, are too proud or too ashamed to ask for help. When they finally do, he said, often he can hear the raw emotion in their voices. "They don't know what to do," he said.
"At Interfaith Housing, our focus is always to help individuals with needs when they come to us for help," Scott said. "While we know there's a larger solution that needs to be found, it's going to take a community rather than one individual or one organization. It's a bigger problem than that."
Barbara Lillyhorn, director of the Reno County Department of Aging, agreed that housing is a problem. In many older homes, doorways into bathrooms or bedrooms aren't wide enough for wheel chairs. They may need grab bars installed next to toilets and bathtubs to help sick and elderly people get up and down safely.
"Our goal is to keep people in their home as long as safely possible," Lillyhorn said. "But for that to happen, you need a home designed for that."
Even those whose homes have been modified for better accessibility may still need other help to remain in their homes, Lillyhorn said.
"We see many people who are capable of staying in their home, but they need a little help," she said. "They may need help with transportation, and some use Rcat. Also, there's a segment that needs someone to go grocery shop for them. They can cook, but the problem is going out to get food.
"They may need light housekeeping assistance. It's available. But can you private pay for it or are you eligible for assistance? People fall in between. They don't have the income to private pay comfortably. That's the segment we have to figure out how to help."
A year ago, Lillyhorn said, an older couple that lived in a rural part of Reno County had their septic system fail. "They were otherwise capable of living on their own, but they couldn't afford to fix the septic system," Lillyhorn said. "We found a partner in a natural resource conservation district. We helped them fill out the paper work to get the money to get the problem solved."
The Department of Aging spends a lot of time helping elderly people or their children visiting from out of town sort through a smorgasbord of services and screening them for their eligibility for assistance under the Older Americans Act. They will refer them to Meals on Wheels or Friendship Meals. They'll help them understand confusing letters, sometimes just determining whether letters purporting to be from Medicare are legitimate.
Each fall the Department of Aging partners with RSVP (the Retired Senior Volunteer Program) to help scores of people about to turn 65 during open enrollment for Medicare Part D prescription drug benefits.
Sometimes elderly people living at home just need the security of someone to check on them regularly, Lillyhorn said. That can be a relative or a caregiver or a volunteer delivering meals. A postal letter carrier can sound an alert if the mailbox isn't emptied. A newspaper carrier or a neighbor can notice that the daily paper hasn't been picked up. Lillyhorn, who also heads Rcat, said her bus drivers know their regular riders.
Last year, Lillyhorn said, an Rcat driver noticed that a regular rider didn't show up. The driver alerted the Department of Aging. "So we went to check on her," Lillyhorn said. "The heat was terrible, and they didn't have food or water. We got them into a facility later that day."
In 2010, the Kansas Department of Labor projected that home health aide was going to be the fastest growing job over the next 10 years, with 58 percent growth from about 8,300 home health aides in 2010 to more than 13,200 in 2020.
In sheer numbers, there is going to be a need for more personal and home care aides and registered nurses than any other occupations. In 2010, there were about 17,900 personal and home care aides. By 2020, the Department of Labor estimated, there will be a need for 9,500 more. In 2010, there were about 29,500 registered nurses, who work in hospitals, clinics, doctors' offices, skilled nursing homes and visit patients in their homes. By 2020, there will be a need for nearly 7,500 more.
Today, Hospice and Home Care of Reno County, just one organization providing home health care, has 10 full-time nurses and five home health aides, according to Executive Director Darla Wilson. They'll spend about an hour in the patient's home on each visit. On a good day, she said, each nurse can see six to eight patients. Some days it's only four or five. The rest of the day is spent filling in records, documenting observations, coordinating care with family members or other professionals and driving between appointments, commonly called "windshield time."
Census bureau statistics show that nearly 4,000 of Reno County's residents age 65 and older live outside Hutchinson and more than 900 of them are living alone, miles from the nearest medical facility.
Taking care of them will be especially challenging, given the "windshield time" involved.
"The living alone point gets to the fact of accessibility and the need for us to find other ways for that person to receive health care in a non-traditional manner," said Kevin Miller, president and CEO of the Hutchinson Regional Medical Health System, which includes the Hutchinson Regional Medical Center and Hospice and Home Care of Reno County. "If they are living alone, how do we know that they are taking their medications, that the diabetic is taking their insulin? How do we know that they are eating properly?"
Miller, Peachey, Wilson and others all think the answer may be greater use of in-home medical technology, or telehealth, as it's being called.
Phillips Medical System, for example, makes a telehealth product that sends a variety of data from the patient's home to nurse or doctor who monitors the patient's condition remotely.
The patient can test their blood pressure, blood sugar, blood oxygen and pulse and weigh themselves. Each peripheral device connects wirelessly with what Phillips calls its Telestation, which transmits the vital signs to the patient's doctor or nurse. Patients who have had a heart procedure or have a history of atrial fibrillation can put an elastic strip around their chest and send their electrocardiogram data through the Telestation. The Telestation also has simple one-touch buttons the patient can use to reply to questions such as whether the patient is feeling better or worse that day, and alert a nurse or doctor to do a follow-up.
Health care organizations are looking to telehealth technology not just because it will allow them to serve more patients or because it will be easier for the patients but also because it may be more cost-efficient in an era in which Medicare, Medicaid and private insurance companies are demanding it.
Slowing the rate at which Medicare and health care spending grows is a priority for the federal government as well as private insurers. But Lowell Peachey of Mennonite Friendship Communities thinks "there's a real disconnect between the politics of this and the reality of it" if you think Medicare costs can be contained enough to accommodate the growing number of Medicare beneficiaries, which is projected to increase by 38 percent through 2030 in Reno County.
"Do you think there's 38 percent waste in the Medicare program now, for fraud?" he asked. "No way. Sure, there's some. But no way. Either people aren't good with math or you have to believe that there's 38 percent inefficiency in there if you're going to go over the next 15 years and save money to do it."
But in the government, there are those who contend that Social Security and Medicare are on a course that cannot be sustained. While the number of beneficiaries grows, the ratio of younger, healthier people who pay the taxes to support the system is shrinking.
In 1940, for instance, there were 159.4 covered workers for every one Social Security beneficiary. In 2010, that ratio was 2.9 workers per beneficiary. By 2030 it will be 2.2 workers per beneficiary. In 1940, you could take full retirement under Social Security at age 65. But a 65-year-old man was only expected to live another 11.9 years then, and a woman was only expected to live another 13.4 years.
Today, the full retirement age is 66 for those born from 1943 to 1954 and it gradually increases to 67 for those born in 1960 or later. But retirees are living longer now. Men who reach full retirement at age 66 are now expected to live another 16.9 years, and women are expected to live another 19.4 years.
That means Social Security and Medicare will have to pay benefits to more people and over a longer time.
Many older people will be dependent on Social Security and Medicare or Medicaid. But some also have accumulated wealth during their lifetime and have pension plans or IRAs to help support them in retirement.
That leads inevitably to discussion of whether Social Security and Medicare could achieve financial stability by applying a means test to those benefits. But the political implications of moving from an entitlement system to a means-based system leave few office holders willing to talk about that, at least not very loudly.
"I don't think you can talk about what's happening in our market and what we're going to try to do to address it without talking about some of those financial implications," Peachey said. "The next decade is going to be a real challenge."
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