By Thomas Goldsmith

North Carolina is making plans to address some of the alarming changes predicted for the state’s rapidly growing population of older people.

Those who work in the field of aging describe long waiting lists for services chronically short of funds, retirees seeking scarce accessible housing to replace family homes with too many steps, and people living longer, but not necessarily better.

People in the state’s three regions will have chances to express their views on what’s needed for older people through June 27 at aging-policy listening sessions set up by the state Division of Aging and Adult Services.

“I’ve been hearing a lot of issues around adequate housing and affordable housing,” said Mary Warren, director of the Triangle J Area Agency on Aging, a regional government agency. “A lot of the boomers are in the same housing they’ve been in. Is the housing even adequate for their needs, as they get into that frail category?”

Projections by the state Division of Aging and Adult Services display the need for federally mandated planning for the years 2019-2023: North Carolina’s overall population will undergo major changes in just a few years’ time:

• The number of state residents with Alzheimer’s disease, estimated at 160,000 in 2017, will likely rise to 210,000 by 2025, an increase of nearly a third. Care for this group — in both residential and community settings — is already in short supply.
• The number of people 65 or older will likely grow by more than one million by 2036, making up about 80 percent of overall state growth during that stretch, to 12.4 million.
• People older than 85, sometimes called the “old old” by those who study aging, will more than double by 2034 to 365,000 or more.

Grow old along with boomers

A number of demographic shifts have already happened. Remember 2011, when the first baby boomers were turning 65? Now the generation that first came to light in 1946 is at, or near, 72.

That means that all those Beatles, Stones, James Brown and Supremes fans are moving through what gerontologists call the stages of aging, based on the reality that people older than 65 don’t all function alike. Terms vary, but a 2009 study in the Journals of Gerontology dubbed three ranges “young-old” or 65–74, “middle-old,” 75–84, and “oldest-old,” 85 or older.

“I don’t think we as a society have seen this many frail elder people,” Warren said. “It’s going to be different when they are all in their 80s and 90s and there’ll be a real strain on our society to take care of them.”

In one example, advocates for older people frequently learn of food insecurity among these generations. Said Warren, “Despite all the abundance, there are still a lot of people who don’t have enough to eat.”

At the Triangle J Area Agency and 15 equivalent regional governmental agencies across the state, officials work with a network of government, nonprofit and business entities to plan for an aging society. The goal is to help target services for older people, those with disabilities and family caregivers.

Similarly, members of the nonprofit North Carolina Coalition on Aging represent diverse entities on aging issues. They want to make sure people know they have a chance to make a mark on the state’s in-process plan.

“It is important that aging consumers, providers, and advocates come out in full force at these listening sessions to make their voices heard,” Coalition on Aging president Mary Bethel told members recently via email. “Even if you do not make remarks, please attend a session near you and bring others with you. We want to make sure every room is packed.”

A plethora of needs

A recent meeting of coalition leadership brought forth a long list of suggestions for ways to focus state resources on older people’s needs. Some points of emphasis are perennial: For years, advocates and providers have been pushing for an increase in the state-federal Home and Community Care Block Grant.

Each county receives a pot of money from this fund to pay for services identified as locally crucial not paid for by either Medicaid or Medicare. The services include Meals on Wheels, respite care, in-home aides, senior center operations, home upfits and adult day care, all designed to keep clients out of costly long-term care.

Adult day care industry representative Mark Bumgarner, of Hickory, told legislators in February that only half of N.C. counties have adult day services, which allows vulnerable clients a place to spend the day with supervision, enrichment and companionship, so some family caregivers can continue working.

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

Figures supplied by the Coalition on Aging show that nearly 11,000 older people are on waiting lists for this kind of block grant-funded help. The group is advocating for a $7 million increase in state funding in this sector, an increase that would cut the waiting list by an estimated third.

However, demand for many of these services has been so great that many of the overloaded providers no longer add to waiting lists. Otherwise, sign-ups would contain the names of many more older friends and relations.

“We’re going to see a lot more people living longer, especially the generation over 80,” Warren said. “We’re trying to keep people healthy as long as we can.”

A number of additional areas of public, nonprofit and private endeavor require help, according to advocates. Those seen as needing additional support include Community Alternatives Program for Disabled Adults, or (CAP/DA); the entire field of professional and direct-care workers, whose pay continues to lag; underfunded county adult protective services departments; and the 1.28 million family caregivers for their loved ones who have limitations in performing activities of daily life.

In addition, help for older people with substance abuse problems is lagging, as is the supply of the frequently cited top need for seniors: transportation.

A previous version of this story incorrectly identified Mary Warren, director of the Triangle J Area Agency on Aging, as Mary Edwards.

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