By 2030, about 72 million Americans will be 65 or older -- roughly twice the number in 2000, according to estimates by the National Institute on Aging.
While there has been plenty of attention to how this coming tidal wave of seniors will strain Medicaid, aging specialists and health care advocates are also beginning to address the "forgotten population" -- those who may have enough assets to pay for some health care services but not the cost of a long-term nursing home.
It can be a difficult population to care for. Typically, people 80 or older have one chronic disease; those 85 or older have two chronic diseases. Many of these seniors also have problems doing everyday tasks such as cooking meals, washing their clothes or tying their shoes.
On average, 24-hour care in a nursing home runs about $60,000 a year.
Building a safety net for these elderly Americans is one of the focal points of the 35th Annual National Association of Area Agencies on Aging Conference & Tradeshow, which kicked off over the weekend at the Hyatt Regency Hotel in St. Louis.
"We need to build a strong home-based and community-based system for those who can pay for it and those who can't," said Sandy Markwood, chief executive of N4A, a nonprofit national association that sponsors the annual conference. "The cost of long-term care systems and supports would impoverish anyone."
Area Agencies on Aging were established under the Older Americans Act in 1973 to respond to the needs of senior citizens in every local community. These nonprofit, quasi-governmental agencies provide a range of options to allow the elderly to remain in their homes and communities as long as possible.
In Missouri, the Mid-East Area Agency on Aging helps serve the needs of St. Louis, St. Charles, Franklin and Jefferson counties.
The conference, which has drawn hundreds of professionals who specialize in health care and social services for the aging, continues through Wednesday.
Today, author Gail Sheehy will appear as the conference's keynote speaker. U.S. Assistant Secretary for Aging Kathy Greenlee will present the conference Tuesday with the latest findings, policies and prescriptions to address the needs of the elderly.
One panel on Sunday highlighted the efforts of a novel program in Knoxville, Tenn., called the One Call Club, which received a grant from the Robert Wood Johnson Foundation.
For an annual membership fee of $100, the club offers a telephone referral service to help the elderly locate everything from jobs, in-home meals and transportation to plumbers and other contractors -- as well as a "do not call list" for those service providers determined to be incompetent or scam artists.
Members can also, if needed, take advantage of a revolving loan fund to borrow for certain services and pay on a monthly basis.
"We're spending a lot of time looking at the boomers -- how to market to them and (determining) what their needs are," said Kathy Sergeant, the club's director.
"We're reaching an audience that the Office of Aging would never have reached," said Barbara Monty, director of the Knoxville Knox-County Office of Aging, an independent nonprofit supported by local government that founded the One Call Club. "We would've reached them eventually, but unfortunately, when their downward spiral had begun."
It is still too early to tell how successful the program has been in helping to keep people out of nursing homes, she said.
Some participants Sunday spoke of how senior citizens and their families can be overwhelmed by the number of choices in skilled nursing care and alternatives.
Some seniors are frightened, and others become victims of fraud.
"Our strategy: Let's catch people before they go into long-term care," said Joe Ruby, who heads an Area Agency on Aging in Ohio. His representatives talk to patients and their family members at Ohio hospitals and larger physician practices to discuss in-home alternatives.
Laura Trejo, general manager of the Los Angeles Department of Aging, spoke of how her agency has focused on healthful lifestyle choices for the elderly, who may suffer from arthritis, diabetes, osteoporosis or dementia.
She said that a sedentary lifestyle is linked to 23 percent of deaths from chronic disease; falls account for 37 percent of accidental deaths among those 65 or older.
Richard McGhee, director of an Area Agency for Aging in central Texas, said his colleagues rely on "transitional coaching" to help seniors develop confidence and manage their lives. The program, he said, identifies people who may need assistance in hospital care settings and has helped to reduce hospital re-admissions.
That's good news for federal and state officials, who are desperately trying to contain the cost of Medicaid, which provides health care services for those with limited resources.
Mimi Toomey, director of policy, analysis and development of the federal Administration on Aging, said about 14 percent of seniors have chronic conditions and functional limitations -- yet this group represents 46 percent of U.S. health care spending.
"It's about collaboration, partnership and cooperation -- all of us working together with seniors," said Cindy Padilla, principal deputy assistant secretary for the Administration on Aging. "We want to keep them safe, keep them healthy, and keep them in their homes and communities for as long as possible."
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