New and more services will be needed as the elderly population continues to grow

By Aaron Gifford

In the decades to come, more elderly residents will be increasingly likely to live on their own or in small group homes that promote independent living skills, Central New York health care representatives say. With that shift, there will be more doctor visits by seniors and a greater demand for home health aides. There will be a need for more senior housing and transportation services. Improvements may be needed in community-based long-term care, with an emphasis on outreach services, wellness/healthy aging programs and adult day care services.

Part of this change, said Tim Bobo, executive director of Central New York Health Systems Agency, can also be attributed to the fact that today’s seniors are typically wealthier than their predecessors and can afford better options than nursing homes for living out their twilight years.

“The long-term care service delivery system is increasingly being driven by consumer expectations for greater choices and services which are provided at home or in home-like environments. Changing expectations among the elderly are due, in a large part, to life style change and greater wealth resulting from the growth of contribution based retirement plans and changes in inheritance taxation,” Bobo wrote in his agency’s concept proposal for new or expanded services in the region. “It is uncertain what the future will bring, but it is almost certain that the percent of the elderly who will live in institutional settings and the traditional nursing home or adult home bed (currently 7 percent) is likely to decline as more alternatives become available.”

That’s not to say Central New York’s population is graying rapidly, or that drastic changes are needed immediately. Executives in the region’s health care sector will be well-aware of what’s in store for them long before the 2010 Census figures are released.

For Onondaga County, the largest county in the region, the population of those between the ages of 65 and 74 is on track to increase from 30,860 this year to 36,256 in 2014, or 17.5 percent, according to a study commission by Loretto, a Syracuse agency that provides health, housing and rehabilitation services to older adults. The population of those between 75 and 84, however, is expected to decrease by 6.4 percent in the same five-year period, from 21,298 to 19,922. Moreover, the number of those 85 and over is expected to decrease from 10,235 to 9,016, or 11.9 percent.

“There’s a lot of attention given to the aging of the Baby Boom population, since boomers are in better relative health in comparison to previous generations,” said Sally Berry, Loretto’s senior vice president of policy and programs. “Their impact is certainly felt sociologically, but doesn’t really hit long-term care services until 2020 and later.”

Still, physicians should plan on busy times ahead. The average person 65 and over visits a doctor’s office or medical facility seven times a year, roughly twice as much as adults between the ages of 25 and 64, according to the Central New York Health Systems Agency. In Onondaga County, 36 percent of hospital admissions are by persons 65 and older.

“People are living longer and living independently, but they’re utilizing health care services to do that,” Bobo said. “It’s a changing scenario and a relevant topic today. In general, we’ll have a healthier elderly population, but there’s going to be a need for more support services.”

Sandra H. Martin, president of Home Aides of Central New York, said her agency is already experiencing a greater demand for services. Their average number of clients increased from 436 in 2002 to 649 last year — a 49 percent hike.

“At the same time that there has been an increase in the number of people who need supportive services to remain at home,” she said, “there has also been a decrease in the number of workers available to help them.

This is commonly called a care gap, and it is happening right here in our community.”

Martin said serving seniors in rural areas is an additional challenge. In 2002, her agency launched a mobile recruitment office that traveled to outlying areas. Seven years later, the search for enough home health care aids to serve rural residents continues.

“For instance, if someone calls for service in Elbridge at seven in the morning, that may be difficult to service, because of the distance first, and the time second,” Martin said. “The closest aide that we might have to travel to that area might be from a western suburb, but if it for only one client then the cost of providing that service might be restrictive.  It is a complex situation that will become even more pronounced in the next 10 years.”

Meanwhile, the demand for nursing home beds is decreasing. Loretto, one of the largest providers of senior care services in the region, is in the midst of a $40 million overhaul of its housing options. Under its “Green Community” initiative, more than 100 nursing home beds will be replaced by 13 small homes that house 12 elders each. These assisted living facilities are a residential alternative to nursing home care.

With the decrease of nursing homes and the deinstitutionalization of elder care, said Janet Dauley Altwarg, director of the Long-Term Care Executive Council, it will be crucial in the years to come to assure there are options for seniors who rely entirely on Medicaid, which many non-institutional settings don’t accept.

“There will always be a need for skilled nursing home care because many people have care needs that are too significant to care for in the home or community,” Altwarg said.  “However, there is a definite need to support patient-centered care and a transition plan toward home and community-based care.

Unfortunately, there is currently a gap in resources to care for people in the community.  Many people in skilled nursing facilities do not need skilled nursing services, but there are limited options available to them.”