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March 16, 1999

Aging in the Present

by Julie McGee

Year of Older Persons
"Comfort Women"
Baby Boomer's Influence

The "graying of America" has been recognized and often written about over the last 25 years. This growing awareness is reflected in many health, housing, and educational institutions, including undergraduate and graduate programs in the nation's college which now offer specialties in gerontology. Estimates about the size of the over-60 population vary, but there is much factual evidence that both the numbers of older adults and their needs are changing.

The elderly population in the U.S. has been growing for a long time and has doubled three times since 1900. Since 1960 it has increased by more than 100 percent while the overall population has grown only 50 percent. It is estimated that 90,000 persons age sixty and over live in the greater Mobile, Baldwin and Escambia county area. Within the next fifty years the elderly population is expected to double again. The greatest proportional increase in this population is in the eighty-and-over age group, which is expected to increase by 225 percent over the next fifty years. This would increase the age-eighty-plus population from the current estimate of 185 to 1,800 in our region. In approximately ten years the wave of baby boomers will hit retirement age. This new generation of older adults will likely demand changes in policies, programs and funding for services for the aging.

What are the issues facing today's older adults and persons reaching old age in the next five to ten years? The recent boom in construction of assisted-living facilities, the planned construction of two new adult day-care centers in Mobile, Medicare's cut-back in funding of home health services, the development and growth of long-term-care insurance, the establishment of wellness centers, elderhostel programs and master games, the boom in the cruise industry, changes in retirement programs from traditional pensions to IRA's and 401K plans, new Medicare Plus Choice plans, seniors taking bus trips to Canada to buy cheaper prescription drugs, and the national debate on the future of Medicare and Social Security all give us insight into current issues and trends in aging.

While the poverty rate for elderly Americans has declined compared to previous generations, the elderly are not rich. In 1997 in the U.S. approximately forty percent of the elderly had incomes below 200 percent of the poverty level. Nearly two-thirds of elderly households have incomes below $20,000 annually. These persons are particularly vulnerable to increase in housing or out-of-pocket health-care costs or other unexpected expenses.

Today's elderly are also less likely to live with relatives and are more likely to live alone than previously. The proportion of elderly living with other relatives is down from 25 percent in 1960 to only about thirteen percent in 1990. Likewise, the proportion of elderly living alone increased substantially, from less than nineteen percent to 31 percent during the same period. This comes at a time when the pool of potential caregivers grows smaller due to increased mobility of families, more women in the workplace, and smaller family sizes, making it more likely that assistance outside the family will be necessary.

In addition to increasing needs for in-home supportive services, long term care poses a significant financial burden for many elderly. The current average nursing home stay costs about $3,300 a month. Home health care costs vary from $1,000 a month to over $3,000 depending on the level of disability. In 1996, median monthly income among elderly families nationally was $1,324. Elders who need long-term care are clearly financially strapped.

The increasing needs and demand for services come at a time when aging issues are not a top priority on local, state or national levels. At all community levels, resources and debate have largely focused on issues such as education, crime, children and youth. The impact has been flat funding from federal, state and often local sources, resulting in an erosion in existing services for seniors and an inability to fund both current needs and new services. This lack of priority for aging issues is seen at all levels of community planning, from local United Ways, to community foundations, to city and county government, to state and federal government. It is incumbent on us to wake up our communities to the very real needs that our seniors have, and advocate for resources and policies that will ensure that our parents, grandparents, and neighbors have the basic services they require to ensure their dignity and independence.

The Envision Mobile-Baldwin process has provided a vehicle to address aging issues. The stated mission of Envision is to organize the community toward a common vision of the future: to define what the citizens want Mobile and Baldwin Counties to become in the years ahead and then to help organize efforts in the region toward the achievements of an improved quality of life. There are approximately 350 Envision partners with various levels of participation, working on six major focus areas: education, quality of life, economic development, community leadership, infrastructure, and government. Not surprising given the current climate where aging issues are not the "topic of the day," very little attention was paid to senior issues in the initial Envision process. To help correct this oversight and to begin the road of advocacy and to move senior issues to the forefront, a group of interested agencies and citizens joined together as Envision partners and expanded this concept. The result was the formation of "Partners in Aging," a coalition of interested persons in the Mobile, Baldwin and Escambia Counties through coordination, collaboration, and advocacy, and by supporting community efforts which promote cost-effective, efficient, and consumer-directed services. Partners in Aging will achieve its mission through networking and sharing information, identifying gaps in services and developing strategies to address these gaps, and by providing an avenue for advocacy for aging issues at local, state and federal levels. Partners in Aging will hold quarterly county-level meetings and an annual regional meeting. The Mobile County meeting is scheduled for March 19, 1999 at 10 a.m. at the Mary Abbie Berg Senior Center at 1717 Dauphin Street, and is open to the public.

In addition to Partners in Aging, several other initiatives are underway to improve services to area seniors. The Mobile Housing Board was recently successful in obtaining a HUD HOPE VI grant to renovate Central Plaza Towers in Mobile, to include 40 units of affordable assisted living units, a first in the state. The Mobile Infirmary received a grant to construct an Alzheimer's day care center in Mobile for persons with dementia, and the Area Agency on Aging of the South Alabama Regional Planning Commission, in conjunction with the Alabama Commission on Aging, is developing a powerful new computerized information and referral system. This system will provide detailed information on aging services throughout the state. The Area Agency on Aging will also offer a new computerized health insurance counseling services for older adults in April, 1999 to help consumers make informed choices under the Medicare Plus Choice program.

In November 1998 the Ozanam Charitable Pharmacy opened in downtown Mobile, and the Alabama Dental Association began a new donated dental services program through their Montgomery office. Both of these programs are heavily utilized by senior citizens. Other initiatives include services for healthy and active seniors, such as the Masters Games, Ms. Senior Pageant, Senior Spelling Bees, Wellness Centers, and others.

New directions over the next few years are likely to focus on programs that assist with the high costs of prescription medications, and address the continuum of care-delivery system. This system begins when older adults first start needing some in-home services, such as home- delivered meals, homemaker services, transportation, personal care, respite or sitter services, and involves more intense levels of care such as assisted-living facilities. These services are currently unaffordable to many older adults. It is likely that eventually more state Medicaid dollars will be shifted to waivers that fund community based service that are both less expensive that nursing home care, and are overwhelmingly preferred by older adults and their families.

A major advocacy issue for the 1999 Alabama legislative session is to establish an Alabama Senior Service Trust Fund. This trust would receive $10 million annually from the State of Alabama Tobacco Settlement and utilize the earnings to fund local services for senior citizens. Today's senior citizens had one of the highest smoking rates among any U.S. generation, and older adults are the primary victims of smoking-related deaths. They should be able to benefit from the Tobacco Settlement, with these new funds providing a resource to address both current needs, and the doubling of Alabama's senior citizen population within the next 50 years.

Julie McGee is the Director of Area Agency on Aging of the South Alabama Regional Planning Commission in Mobile. Persons interested in the Alabama Senior Service Trust Fund legislation, Partners in Aging, or other advocacy opportunities should contact her at 433-6541.

The Harbinger, P.O. Box U-980, Mobile, AL 36688-0001