“We’re the Taptations with white hair / We’d rather dance than rock in a rockin’ chair!”
Today, 20 percent of our population in North Carolina is 60 years old or older, with the number expected to rise by 58.3 percent by the year 2033. Even more significant is the 102 percent increase in individuals between the ages of 75 and 84 expected during the same period.1
Policymakers and state administrators have been focused on the unique challenges related to North Carolina’s growing senior population for some time. While the methods used to address these challenges have changed, one of the most targeted efforts has been the creation of four-year Aging Services Plans.
In February 2011, the N.C. Division of Aging and Adult Services (a part of the N.C. Department of Health and Human Services) released the 2011–15 North Carolina Aging Services Plan. Based on input from approximately 1,200 citizens and community leaders, and seven separate conferences and roundtables, this plan outlined eight separate strategic goals to guide the work of state and local agencies and organizations as it related to the aging population.
The close of 2014 offers a perfect opportunity to examine how well those most involved in directing local services believe we are meeting the goals laid out in the plan, as well as provide input on the statewide primary area of focus for 2015. To that end, the Center surveyed 151 aging and adult services professionals from across the state. Of those contacted, 31 replied, a response rate of 20.5 percent. We include the results of the survey responses here. In each category, an answer of “0” represented the “worst possible” performance, while “5” suggested the “best possible” performance.
Respondents were not asked to give specific examples or their rationale. Rather, the focus was on a general sense of the respective county and overall state performance under each aging services plan goal. In general, respondents tended to answer that both the state and local governments were performing in the mid-range, with 52.8 percent of the survey questions receiving a score of two or three, out of the zero- to five- point scale. However, on the outer ends of the scale, respondents were far more likely to indicate that the state and county were performing very well, with 39.2 percent of responses falling in the four- or five range. By contrast, only 8 percent of responses fell in the bottom (zero- or one-point) categories. (See Figure 1.)
From the Mountains to the Coast: Responses by Region
Some interesting patterns develop when the data is dissected by region. As indicated in Figure 2, there are no responses from the mountain region that answered goal performance in any category is the “worst possible.” Overall, respondents in the mountain region tended to trend more positively in reply to goals at both the state and local level, with an average response of 3.24 on the 0–5 scale. However, the piedmont region actually generated the greatest proportion of “best possible” responses, with 13.3 percent of those who answered the survey indicating a “best possible” perception.
Interestingly, there was not a substantial difference between the general perception of statewide and local performance. When considering total responses, the statewide performance received an average score of 3.05, while the average local score was 3.11. Reflecting the overall trend, the respondents from the mountains again saw things as more positive at both the statewide and local level.
Rural or Urban Community?
When asked to identify the level of urbanization in their community, most respondents in this survey selected “rural” out of the five options: very rural; rural; suburban; urban; very urban.
One of the more interesting findings relates to urbanization and performance. Respondents who indicated they are in a “rural” area generally indicated the greatest satisfaction, with an average response of 3.26. Self-identified “suburban” respondents showed the least satisfaction, with an average score of 2.85. “Very rural” and “urban” respondents both generated average performance scores of 3.0. When asked to identify the level of urbanization in their community, most respondents in this survey selected “rural” out of the five options: very rural; rural; suburban; urban; very urban.
So what does this all mean?
- First, it means that aging services leaders who responded to the survey believe that on both a statewide and local level we are performing in the mid-range in terms of meeting the goals laid out in the 2011–15 Aging Services plan. In addition, while responses about the county level performance tended to be more positive, they are not substantially different than the perception of how we are doing as a state as a whole.
- Second, it means that the mountain representatives who responded, on average, have a more positive view of progress in these areas than their counterparts. (Interestingly, this seems to apply for all mountain respondents, including those from both rural and urban areas).
- Third, it may mean that more work needs to be done in suburban areas, as respondents seemed less satisfied with performance at all levels.
What Should Be the Focus in 2015?
Before we examine responses to each individual goal, it’s important to look ahead.
“The capacity to serve an increasing population of economically vulnerable older adults is seriously in jeopardy.”
Respondents were very thoughtful as they opined on what our focus as a state should be going into 2015. The most frequently cited concerns relate to limited funding for services for the aging population. As one respondent noted, “The capacity to serve an increasing population of economically vulnerable older adults is seriously in jeopardy.” Both federal and state funding reductions are noted in the answers, with particular attention to the cost of transportation currently and the potential future cost as the number of seniors grows significantly in proportion to the overall population.
However, the concerns are not limited to budget issues. Many respondents focused on the need to allow seniors to age in place, while providing the transportation, medication, and food support necessary to maintain a high quality of life.
The non-budgetary policy implications are two-fold. First, several respondents cited a growing concern about the ability of the state to have enough workers to support the services needed by our aging citizens. As one respondent noted, “the senior population is currently on course to surpass the forty to sixty age group, leaving nobody to care for our seniors.” Others noted a different but related problem. They indicated a growing trend for working family members to drop out of the workforce at a younger age so they can care for their aging parents. This decreases the overall income of the home and potentially increases financial instability while increasing demands for supportive services. Second, a call for citizen (and legislative) education and understanding as to the financial implications of aging is evident in the survey. To quote one reply,
“many citizens continue to believe that Medicare will take care of them in a health crisis and don’t understand the burden that many families face with regard to financial costs and caregiver burden.”
Of course, some respondents shared a few creative ideas to address aging needs. One suggested a meal card that would allow home bound seniors to order from nutritious menus at local restaurants. Another suggested changes to local building codes that could facilitate the development of more adult day health facilities. And, others indicated that additional community education about existing services would be helpful.
The N.C. Division of Aging and Adult Services is on schedule to publish a new aging services plan in March of 2015. That plan will, we understand, reflect the need to continue to move forward in some of these important areas of support and education. It will also reflect the needs of a different period of time and a new administration.
As explained by the Division, the plan was developed “In collaboration with the Governor’s Advisory Committee on Aging (GACOA) and the 16 regional Area Agencies on Aging who support older adults and their caregivers. The 2015–2019 State Aging Services Plan bears the title ‘Booming Forward: Working Together to Improve Lives.’ It is a title that acknowledges North Carolina’s baby boomers have begun to reach retirement age and that a collective response is required to foster and support creative ideas, leverage resources, and build both public and private partnerships to ensure positive outcomes for the diverse needs of our citizens. The Plan has six goals that take into account the multi-faceted nature of what is required to work together to improve lives. The next four years will see increased efforts on the part of state agencies that serve these older adults and their families to enhance collaboration, streamline service administration, target available resources, and emphasize accountability for improved person-centered outcomes.”
The Division also explains that while the Plan is their responsibility, “It is a collective effort of many partners and organizations to help shape our priorities and set an aging agenda for the state. The implementation of the Plan will require the work of many, including individuals, local organizations, advocates, policy makers and government. Together we can improve the lives of North Carolina’s older adults and caregivers.”
Current and previous aging services plans are available on the N.C. Department of Health and Human Services website at http://www.ncdhhs.gov/aging/plan.htm.
Here’s a look at responses related to each of the eight major goals outlined in the 2011–15 aging services plan. As you will note from the goals, the plan is expansive and addresses a broad array of issues as they relate to North Carolina’s aging population. Each chart that follows displays ratings of state performance and the respondent’s county performance. Largely, the most positive responses appear in the areas of public steward- ship (Goal 8) and volunteerism (Goal 5). County services tended to garner the most positive scores in the areas of empowering seniors for optimal health (Goal 3), senior safety (Goal 4), and volunteerism (Goal 5). And, reflective of the overall findings, the average response to each goal was more likely to be middle of the road progress.
Goal 1: Empower older adults, their families, and other consumers to make informed decisions and to easily access existing health and long-term care options. Specific goal objectives in the 2011–15 plan focused on educating the public, streamlining and strengthening access to service and support, and ensuring the inclusion of diverse cultures and abilities. Much of the effort suggested by the plan was often tied to better use of technology, partnerships, and training opportunities. In this survey, respondents often had a slightly more positive view of local efforts as compared to statewide performance, although the greatest number of respondents hovered around the middle of the spectrum.
Goal 2: Enable older adults to age in their place of choice with appropriate services and supports. Objectives in this area included greater fl in publicly funded supports, expanding community-based services, and transforming the existing long-term care system to reflect greater collaboration, linkages, and a person-centered philosophy of care. The the right assistance, at the right time, in the way the consumer prefers to receive it.” For this goal, the county responses were more distributed, with some respondents putting their county’s performance in the “worst possible” category, while others placed their community in the “best possible” grouping.
Goal 3: Empower older adults to enjoy optimal health status and to have a healthy lifestyle. This goal is centered around the issues of health and healthy living, with a particular focus on encouraging seniors to take responsibility for their health and behaviors. Most objectives and strategies under this goal targeted both creating infrastructure and opportunities, as well as encouraging participation in health promotion and disease prevention programs. Individual elements of the plan addressed such varied needs as dental care access, fall prevention, and mental health.
Goal 4: Ensure the safety and rights of older and vulnerable adults and prevent their abuse, neglect, and exploitation. Much of the work suggested in this area revolves around better use and expansion of existing programs to fit different types of elder abuse and exploitation. However, the strategy also moves farther into the public policy realm, encouraging the appointment of a legislative study commission, passage of legislation to prevent fraud against the elderly (discussed elsewhere in this issue of Insight), and new partnerships with the business community to fight fraud against seniors and the disabled.
Goal 5: Empower older adults to engage in the community through volunteerism, lifelong learning, and civic activities. Personal growth, social engagement, and volunteerism are the focal points for this goal — one of the areas where those surveyed believed there has been the greatest success. Again, more progress is seen at the local level, although the view of statewide advancement is not quite as positive. Specific policy-related strategies in this area relate to the continuation of the Senior Tar Heel Legislature and the Senior Leadership program offered through the University of North Carolina Institute on Aging, although more local strategies are also included to harness older volunteer experience.
Goal 6: Prepare North Carolina for an aging population. While the stated, overarching goal is rather broad, the strategies associated with it are specifically targeted to the state and local governments and the use of their resources to inform and educate. The survey results suggest local governments are doing a little better in this regard. However, unlike the previous goals, the responses are more dispersed, with respondents indicating very positive and very poor performance at both the state and local level.
Goal 7: Ensure an adequate direct care workforce for an aging population and opportunities for older workers. The strategies associated with this goal fall into two distinct categories. The first strategy is a focus on the need to ensure the presence of an adequate and appropriately trained workforce to support our aging population in their later years. The second strategy is an emphasis on making sure seniors have access to and the ability to maintain gainful employment. In this goal, respondents tended to rate both the state and local governments in the middle, with some indications of high satisfaction and high dissatisfaction in some areas.
Goal 8: Maintain good stewardship of publicly funded services. In particular, strategies were centered on increasing efficiency and effectiveness through use of better management and performance-based practices. Overall, the respondents gave both the state and local governments high marks in this area.
Dr. Linda S. Millsaps served as the executive director of the North Carolina Center for Public Policy Research.