It used to be that life expectancy in the U.S. was well under 50. In just 100 years, we’ve moved from a life expectancy of 47 to a life expectancy of nearly 79. In fact, this year, for the first time in world history, there are more people on earth who are over 65 than there are under the age of five. As life expectancy extends thanks to advances in safety and medicine, and as “Baby Boomers” born after World War II move into the later part of life, more than 10,000 people turn 65 in the United States every day.
Kerstin Gerst Emerson, PhD, Assistant Professor, Department of Health Policy & Management, College of Public Health at the University of Georgia, presented at the November 2017 meeting of Greenville Partnership for Philanthropy, held at Senior Action. She pointed out that some refer to the growing tide of older adults as a “silver tsunami,” but she feels the term suggests the older population is an oncoming disaster that will swallow us alive. Instead, Emerson recommended that local communities, states, and the nation consider what policies, programs, environmental changes, and systems are needed to make an asset out of our aging population.
Nationally, older adults as a cohort differ from the younger population in several key ways. More are white (by 2030, the majority of Americans under 25 will be people of color), fewer have a college degree, and they are slightly less likely to be poor than working age adults (although older African American women experience poverty at higher rates). Most men over 65 live with their spouses, but because of their longer life expectancy, most older women live alone or with relatives. Only 5% of older adults live in nursing homes.
South Carolina is experiencing growth in its older adult population because of the aging of current residents as well as an influx of newcomers choosing to retire in the state. South Carolina ranks 14th in the U.S. for expected growth in older adult population from 2000 – 2030. Are we prepared?
America’s Health Rankings shows several strengths in programs and services for people over 65 in South Carolina. Relative to other states, older South Carolinians are more likely to access hospice services and to receive diabetes care management. SC ranks high for appropriate use of hospitalization and for having a low percentage of low-care nursing home residents.
But the challenges in our state are many. Older South Carolinians have a high prevalence of food insecurity, mental distress, and disability, and low prevalence of dental visits, home delivered meals, and availability of personal care and home health aides. The low prevalence of home delivered meals and aides is especially concerning, because these are resources that can help keep older adults living at home rather than in far more costly assisted living facilities or nursing homes (more on that below).
South Carolina is also ranked 48th for expenditures by Administration on Aging per adult 65+ living in poverty (tied with Nevada), meaning funds provided by the federal government for older adult services – things such as in home care, congregate meals, and transportation – are matched with state funds at among the lowest levels in the nation in our state. Only the state of Mississippi is providing fewer dollars to services that keep poor older adults in their homes.
Family caregivers to older adults, whether a spouse, child, or other relative, face tremendous stress and isolation along with the older person. A recent study found that Medicare spends far more on adults who are socially isolated – as much as $6.7 billion per year. Physicians report how often older adults seem to call the office for the nurse or to schedule a visit that seems to be prompted more for social purposes than medical ones.
Should an older South Carolinian need care or residence in an assisted living or skilled nursing facility, the situation is financially challenging to say the least. Many people don’t realize that assisted living and nursing home care and residence is NOT covered by Medicare (except for time-limited rehabilitation in a skilled nursing facility after a three-day hospital stay). The only public funding source for care and living outside of the home is Medicaid and only for skilled nursing facilities. However, South Carolina’s funding for Medicaid days is so limited that many nursing homes expect a resident to pay out of pocket for a year before converting them to a Medicaid-paid resident – and a year’s out of pocket costs for nursing home care is around $72,000, according to service providers in Greenville County, far more than most older adults have in savings.
What can funders do to address these challenges?
Local funders can invest in nonprofit organizations that support successful aging, such as Senior Action and Meals on Wheels. Senior Action, for instance, has a wide array of activities that provide social and recreational opportunities as well as social work and home care programs, and these can help older adults live at home successfully and for much less than other services might cost.
But it appears that few local funders grant to organizations and programs for older adults. Some present at the membership meeting wondered if there’s a bias to fund services for children or people in the workforce because of the perception of “return on investment.” But older adults are family members, too, and when support for them is needed, it’s usually provided at a cost to their adult children, who are also parents of these young children and who are taken out of the workplace or even out of the workforce to provide care.
Local funders can also advocate for better services and public investment in older adults. Our position at 48th in the nation in investment in community supports for older adults in poverty means that our spending is most likely to occur when these older adults are hospitalized or when their adult children lose their jobs because of providing care to their parents.
Funders can also support a culture of successful aging in our community, including engaging older residents in decision making and in the life of the community, building the community in a way that’s accessible to aging bodies (e.g. exceeding the Americans with Disabilities Act requirements), and considering families as a whole when planning programs and services – grandparents, children, and grandchildren.
We also need to look at the world in a different way as we assume a different population composition is experiencing it. One GPP member who is a “Baby Boomer” recalled how there weren’t enough schools constructed to accommodate the swelling numbers of children entering the K-12 system, which required schools to have morning and afternoon sessions of students. What accommodations will be needed as these Baby Boomers enter the next phase of life?
A population wave of older adults is indeed coming. Let’s work together to consider the “new normal” in our community, state, and nation and how to make our population’s aging successful for all of us.
Visit America’s Health Rankings 2017 Senior Report to view the national rankings and information on seniors’ well-being.
