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By Thomas Goldsmith

One hour every other week.

That’s the average break that a North Carolinian looking after someone with dementia gets under Project CARE, a state-funded respite program found in 94 counties.

Using a Project CARE voucher for a fill-in by another person, an adult day care, a home care agency or other program, the caregiver can get out of the house for shopping, errands, banking or even a little alone time. More than 80 percent of people using the service receive one $500 voucher annually, paying for professional services at about $20 an hour, or a friend or family member at $10 or so.

Rep. Josh Dobson (R-Nebo) Photo courtesy NCGA

“A $500 voucher doesn’t provide too much respite,” Dawn Oakey Gartman, director of Project Care, told members of the General Assembly‘s Subcommittee on Aging on Tuesday.

Chairs Rep. Josh Dobson, a Nebo Republican, and Sen. Joyce Krawiec, a Kernersville Republican, also heard from representatives of home and hospice care, nursing homes, assisted living communities, adult day care and Catawba County aging services.

The subcommittee, charged with forging a plan to present to the General Assembly on legislative means to support the state’s older people, voted to postpone creation of a planned draft report, citing weather-related delays and the wealth of material to be considered.

Sen. Joyce Krawiec (R-Kernersville)

The panel will continue to work on a report to the legislature about what improvements are needed, and what those changes would cost. Advocates for older people are pushing for a $7 million increase in the federal Home and Community Care Block Grant dollars that pay for services such as Meals on Wheels, in-home personal care, congregate meals and others.

This week’s presentations, mostly from Medicaid-funded operations, tended to echo one another except in scale — those from the multi-billion dollar nursing home industry had points in common with the word from Project CARE, with a budget of a little more than $1 million.

“As was repeatedly said today, the cost of care is increasing,” said Gartman, the last presenter.

Upward curve of older folks

Based on raw numbers and share of population, older people represent so many North Carolinians that lawmakers can’t ignore the needs that will require paying for services at even a minimal level.

For example, by next year’s July 4, celebrants 60 and older at a typical North Carolina holiday picnic will outnumber kids 17 and younger. And by 2030, only 12 years away, one of five North Carolinians will be older than 65.

More than half of the state’s counties are already experiencing population aging – a demographic shift in which the median age of the population increases significantly due to improved life expectancy and a drastic decline in birth rate. Map progression shows the changing number of people over 65 in each county. Data: NC Office of State Budget and Management

Those figures, supplied by state demographer Michael Cline in a separate interview, illustrate a syndrome that people who study aging have long foreseen. That’s the time when people largely past wage-earning years will outnumber children, with some members of both groups likely requiring some form of support, whether from family, public agencies or private resources.

The projection that by 2025, 90 of North Carolina’s counties will have more people older than 60 than younger than 17, is one of the several drivers to the formation of the North Carolina General Assembly’s subcommittee on aging.

A subgroup of the legislature oversight committee on the Department of Health and Human Services, the panel is a revival of sorts of the former Study Commission on Aging. Formed as the House Aging Committee in 1977, that body was disbanded in 2011 after more than three decades of examining the situation of older North Carolinians and proposing fixes for problems in the form of legislative initiatives.

The newer subcommittee, established by legislators in 2016, has heard from nearly two dozen groups that are part of the network of care used by many older Tar Heels. Dobson acknowledged the increasing cost of looking after older people in an economy that’s creating lots of better-paying jobs.

Costco snagged best workers

“What are some of the other things the General Assembly could look at?” Dobson said. “How do we get and keep our most talented people?”

Tracy Colvard, representing the Association for Home and Hospice Care, said the industry has a hard time finding qualified workers at the going rates of $8 or $9 an hour. Companies are facing shortages of frontline workers in both rural and urban areas, based on competition from the fast-food and warehouse industries.

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“At Christmas time, Costco snagged 15 of their best workers, offered them $15 an hour and a health-care package,” Colvard said of a provider he didn’t identify.

Krawiec asked speaker Adam Sholar, a lobbyist from the North Carolina Health Care Facilities Association, about the 88 percent occupancy rates for the state’s skilled nursing facilities.

“We hear stories all the time of waiting lists,” she said. “Do you have availability in some places and not in others?”

Sholar said the presence of residential nursing centers that are tied to large hospitals means that some areas are more richly supplied with beds than others.

“Greensboro generally would have adequate access,” he said.

Far below average

Throughout the presentations, people representing public, private and nonprofit agencies stressed recent increases in both the cost of services and the number of people served.

Jeff Holden, executive director of the North Carolina Senior Living Association, said his group appreciated a hike passed by the General Assembly in fees for personal care services.

“However, this reimbursement rate remains significantly lower than the national average,” Holden said. “Low reimbursement rates present significant challenges for providers in aide recruitment and retention, potentially compromising the quality of care and services provided to residents.

“We concur with the recommendation of N.C. Coalition on Aging that North Carolina needs to increase the rate over the next two years to the national average of $18.82 an hour.”

Mark Bumgarner, of Hickory, representing adult day care programs, said only 50 N.C. counties have the service, which allows older people, often with dementia to spend days in a compassionate, stimulating environment.

“We are operating at a loss,” Bumgarner said. “Centers are closing because they can’t afford to stay open.”

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Thomas Goldsmith

Thomas Goldsmith worked in daily newspapers for 33 years before joining North Carolina Health News. Goldsmith is a native Tar Heel who attended the UNC-Chapel Hill, and worked at newspapers in Tennessee...