A younger woman pushes an elderly white-haired woman in a wheelchair into a grassy sunlit field that is surrounded by a small fence and a tall tree

Photo by Dominik Lange on Unsplash

Older adults are the fastest-growing population, both nationally and locally. By 2025, one in five people living in the Rochester-Finger Lakes region will be age 65 or older. How will essential services such as health care, housing, transportation and caregiver support meet the emerging needs of this population?

Preparing now for this demographic shift is critical. That is why Common Ground Health convened the Sage II Commission, which is identifying collaborative solutions for improving and coordinating essential older-adult services.

Sage II brings together regional leaders, residents and subject matters experts from skilled nursing facilities, hospitals, insurers, community-based organizations, housing, transportation, workforce and government.

Launched in 2020, Sage II is updating the long-range plan put forth by the original Sage Commission in 2011. Common Ground convened the first Sage Commission to develop a comprehensive plan for aging health services in the nine-county Finger Lakes region of Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne and Yates counties. Central to this plan was a series of objectives aimed at creating a person-centered health system that accommodates the 65 and older population’s preference to live in the least-restrictive settings, delays institutional care and allows older adults to remain in the community for as long as possible.

Successes following the Sage Commission’s plan include the New York State Department of Health accepting and endorsing it as a model in the establishment of Certificates of Need; creation of a new neurobehavioral unit for long-term care residents; and neighborhoods being designed to emulate Naturally Occurring Retirement Communities. Other developments, such as the expansion of Programs of All-Inclusive Care for the Elderly (PACE) aligning with Sage recommendations and expansion of home- and community-based services for older adults have been difficult to scale to meet ongoing needs for services.

The Sage Commission projected that five overarching issues would dramatically affect health-care services for older adults: 1) an aging population boom; 2) a decline in family caregivers’ availability; 3) fragmented and unsustainable care-payment methods; 4) a workforce shortage; and 5) health-care disparities.

What happened in the 10 years since the commission issued its report and made its projections? “With the first Sage Commission, while we correctly identified the key issues impacting older adult long-term health care, we actually underestimated the severity of their impact,” said Ann Marie Cook, Lifespan president and CEO and Sage II co-chair.

Population boom
Projecting a burgeoning older-adult population was on target; however, the projection was not high enough. Using U.S. Census Bureau statistics, the Sage Commission expected a 38% increase in the older-adult population from 2007 to 2025 – comprising 21% of the region’s population. The latest older-adult population forecasts from 2019 are significantly higher than population projections from the original study: 10% higher for 65 to 84-year-olds and 15% higher for those 85 and older.

Caregiver decline
With more women entering the work force, families having fewer children, and the needs for dual responsibility to care for aging parents and children contributing to the stress of caregivers, the region’s informal caregiver ratio was expected to decline by 15.2%.  As the 85 and older population has grown at almost 3 times the rate of females 45-64 — the population most frequently identified as family caregivers — the caregiver ratio has declined further.

Financial uncertainty
Persistent underfunding illuminated and exacerbated systemic shortfalls during the COVID-19 pandemic. Long-term-care institutions are overwhelmed with regulations and reimbursement cuts as Medicaid and managed long-term-care plan enrollment status impact resident return to nursing homes after hospitalization while having to bear tremendous costs of PPE and COVID testing. There is not adequate Medicaid funding to support pay raises in home care and nursing homes, the two most costly Medicaid long-term-care services, and funding uncertainty continues to negatively impact the current long-term-care system.

Workforce shortage
Heightened demands from the growing proportion of older adults in the region is outpacing homecare employment trends. Challenges facing the long-term-care workforce continue to exist. Rates have not kept pace with cost of living increases, resulting in people working full-time in direct care positions only to live in poverty. This is physically demanding work with high burnout rates and difficult working conditions, which were exacerbated during the COVID-19 pandemic. Older adults are staying in their homes longer, delaying institutional care and increasingly relying on home and community services.

Health-care disparities
The number and percentage of people of color in the older population is increasing dramatically. Despite the growth, serious health-care disparities continue to exist among older people of color throughout our region. Forty six percent of  Rochester’s U.S.-born older adults are non-white, the most diverse U.S.-born older adult population in the state, in addition to having the highest poverty rate (31 percent) of any city or county in New York state. Older adults were impacted disproportionately by COVID, with increased death rates, risk for infection and severity. The number of older adults living in poverty in Rochester increased by 38 percent in the past 10 years, prior to COVID-19.

A new vision for the future
To address the ongoing issues affecting long-term health care, the Sage II Commission reviewed projections from 10 years ago to gauge where the region is today and what steps should be taken to improve the system.

The Commission is considering new ways of redirecting dollars for adequate, affordable, home-based services and creating sustainable funding mechanisms that support the continuum of care needed for our aging population. This begins with care that is designed for services prior to older adults having more acute and medically complex needs that require institutional care.

The Commission will further explore solutions that align with local, state and federal funding opportunities, including:

·        Increased Medicaid funding for home and community based services including home health care, personal care services, case management, self-directed personal care, rehabilitative services, and private-duty nursing.

·        Funding for Older Americans Act (OAA) programs for case management, services to address isolation, health promotion and disease prevention, caregiver support, public transit systems to improve access for older adults, the Long Term Care Ombudsman program and technical assistance center for kinship families

·        State and local fiscal recovery funds which are separate from dollars available through Medicaid, including the provision for premium pay for essential workers which could apply to those employed in Long Term Care.

“Sage II is building on the first Sage Commission’s success to re-imagine a system for older adults that meets their health-care needs and supports their desire to remain independent and to live in the community for as long as possible,” said Brian Heppard, M.D., of St. Ann's Community and Sage II co-chair.

Heppard noted that local leaders are working together to enact AARP’s livable communities recommendations. Communities that are livable for people of all ages are communities that do not require a car to get around, are places where people can spend time outdoors enjoying public places, have access to healthy food and needed services, enjoy activities and live safely. Following a commitment to develop livable communities, New York state was named the nation’s first age-friendly state by AARP and the World Health Organization in 2017.

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