By Thomas Goldsmith 

Gov. Roy Cooper has state agencies, nonprofits and businesses working on a new aging plan, “All Ages, All Stages NC,” that, if adopted, could result in positive change for many of the 1.8 million North Carolinans who are 65 and older. That would be markedly different from the slow progress that Democrat Cooper and the Republican leadership of the General Assembly have made in proposing, establishing and paying for some of the broad range of services benefiting this population over the past decade.

North Carolinians 65 or older make up 17 percent of the state population, and by 2031 they will represent one in five. However, recent state leaders facing multibillion-dollar issues such as tax cuts, teacher’s salaries and Medicaid expansion have not put top priority on older people’s state-funded needs, according to legislative budgets, state and local officials and older people in several counties. 

People involved in local efforts to help older people tend to see the situation differently. 

“I just like to get out there and fight for the older folks who put in their hours and their years and deserve to be treated with respect and with dignity and allowed to stay at home as long as possible,” said Diedra Evans, 61, director of the Hertford County Center for Aging in Winton, population 625. 

Cooper has in recent years faced limits in getting proposals into law because of Republicans’ veto-proof majority. But his bully pulpit shouldn’t be disregarded as a tool to effect change, said Gary Pearce, a writer/blogger and retired Democratic political consultant who counts himself as a friend and longtime fan of Cooper. 

“The Governor may not have the veto, but he has the biggest microphone in the state,” Pearce wrote. “He has the unique power to elevate and focus on an issue. He can set a policy agenda. That shouldn’t be underestimated.” 

Drawing blanks

Advocates for older North Carolinians, such as speaker Norma Duncan of the Senior Tar Heel Legislature, have been reluctant to make waves on the political scene. But Duncan, 86, a retired state employee from Western North Carolina, spoke forthrightly when asked if Cooper had been an effective advocate for older North Carolinians. 

“He has not,” she said. “I really think that he tries, but the effectiveness hasn’t really been there. We aren’t getting enough funds; we’re seeing the needs not being met.” 

Carter Wrenn, a veteran political operative and Pearce’s Republican blogging counterpart, said he was not aware of Cooper’s new, gradually released plan. Aging issues have not typically had a large presence in state legislative discussions, he said. 

According to Duncan, the Senior Tar Heel Legislature, established by the General Assembly in 1993, has mostly come up short of their goals when seeking help on its top goals such as state funding increases for: 

  • NC Adult Protective Services, in which strapped county offices face a state mandate to prevent neglect and abuse of vulnerable adults. 
  • Home and Community Care Block Grants that pay for senior centers, congregate and home-delivered meals, adult day care, respite care and a host of other public-facing services. 
  • Additional NC long-term care ombudsmen, who advocate for residents in long-term care, fielding and investigating complaints from vulnerable older people and their family members.
  • Establishing for the first time minimum staffing standards for certified nursing assistants (CNAs) in long-term care. The organization says low staffing creates situations in which frail old people can receive insufficient care. 

Long-term care inspections lag 

In another aging-related state sector, people in North Carolina long-term care homes are getting much less frequent inspections and investigations of complaints because of a shortage of Department of Health and Human Services staffers to carry out the work, NC Health News has reported. 

Most of the funding for that program comes from federal coffers, but it can be boosted by state dollars. Right now, a nurse inspector makes about $68,000 — less than what that same nurse could make in a hospital or other agencies. 

Those stymied administrative responses mean long delays or reductions in fines even when inspectors find serious deficiencies, said Duncan, who’s monitored facilities as a DHHS inspector and as a county volunteer. 

“We are seeing it, we are putting it in writing, but it’s being deleted,” she said of long-term deficiencies. 

Aging issues often eclipsed 

Functions of state government that serve older people can seem invisible to younger people or those without aging relatives. Looming billion-dollar priorities have tended to overwhelm attention even to persistent North Carolina shortfalls in vital — and popular — senior-oriented services like congregate meals, senior centers and transportation to medical visits.

“There are things that government can do to make people’s lives easier, to make things more equitable, to reduce the ageism we have baked into some of the things going on around us that we don’t always acknowledge in society,” said Heather Burkhardt, director of the nonprofit North Carolina Coalition on Aging

The “All Ages, All Stages NC” plan sets a February deadline for cross-department funding estimates to be presented to the General Assembly. That body has allowed spending for the state Division of Aging and Adult Services, or DAAS, to trail growth in the senior population since Gov. Pat McCrory took over the post from Gov. Beverly Perdue in 2012. 

“I think in my position as governor, I am positioned to try to make sure that we are more responsive to those communities so that they can continue to be active and purposeful in the things that they do,” Cooper told NC Health News after a May event, during which he talked about the overall plan but didn’t mention the required funding. 

In the same interview, Cooper said that there’s no question that “significant resources” will be needed to meet an announced goal of North Carolina’s being designated as an “Age Friendly” state under a national AARP program

Asked whether he has acted as a leader in aging issues since taking office in 2017, he referred in part to his role as North Carolina’s state attorney general from 2006 to 2017. 

“I would say that in my position as attorney general, that was more consumer protection and law enforcement,” he said. “We did a lot with AARP and seniors on consumer protection. As governor, I’ve got a broader opportunity to help in more ways.” 

Much of Cooper’s time in office has been dominated by his attention to topics such as effective management of the local effects of a catastrophic worldwide pandemic, expanding NC Medicaid and improving the state’s mental health network.

Bill Lamb, a Raleigh activist with long experience in state government and in speaking up for older people at the legislature, said  Cooper had not previously made a comprehensive push such as “All Ages, All Stages” in connection with aging issues. 

The “All Ages, All Stages” effort to develop a comprehensive plan has roots in past and ongoing work by DAAS and state AARP supporters, Lamb said. 

DAAS’ job: Meeting the needs of NC’s older adults

Tax money to pay for aging services In North Carolina comes from federal, state and county sources. Federal and state backing for Medicaid-eligible people to stay in long-term care reaches more than $105 million annually, about twice one year’s funding for DAAS. 

Part of the state Department of Health and Human Services, DAAS is the state agency with the duty “to promote the independence and enhance the dignity of North Carolina’s older adults, persons with disabilities and their families through a community based system of opportunities, services, benefits and protections.” 

In some cases, older North Carolinians can receive their preferred choice by staying at home, and receive less expensive care from aides. In-home care arranged through DHHS is provided for a person who can stay at home under specific conditions. These include receiving help with one or more of the tasks considered “essential to the activities of daily living,” such as walking or using a toilet, or with activities such as doing laundry or grocery shopping.

Many of the state’s public-facing means of helping older people come through federal-, state- and county-supported Home and Community Care Block Grants administered by DAAS and the Division of Social Services

Several advocates for North Carolina’s older population brought up Cooper’s long list of large-scale issues in conversations about the “All Ages, All Stages” initiative. 

Shows a woman speaking into a handheld microphone. She's standing in front of a slide projector screen, where the words" "State Aging Plan" and "Healthy Aging Task Force" and "Multi-Sector Plan on Aging and Disabilities" are projected.
Joyce-Massey Smith, director of the North Carolina Division of Aging and Adult Services, talks on March 14 about state aging-issues plans to attendees of the North Carolina Association of Aging conference in Charlotte. Credit: Thomas Goldsmith

“In terms of all of the policy things that the governor has had to handle, aging hasn’t been on the top of the list before,” Burkhardt said.“I think that this is a good opportunity.” 

Joyce Massey-Smith, director of DAAS, also noted the variety of state functions that compete for tax dollars. Cooper has given “steady attention and focus” to supporting DAAS and making funding recommendations to support its work, she said.In several cases, the governor has made use of funds that don’t require legislative buy-in. Projects include an estimated $43 million from the federal American Rescue Plan for COVID-19 relief that’s going for housing and home improvement, as well as for people who lost nutrition benefits when the federal Public Health Emergency was lifted in May. 

“I feel very supported and encouraged about what we’re doing in state government right now for older people,” Massey-Smith said. 

DAAS funding first dipped under McCrory 

State records since 2017, when Cooper’s terms of office began, show that state support for the DAAS, as passed by the General Assembly, has remained stagnant or increased only slightly. During McCrory’s term, legislators lowered the $54 million level of Aging and Adult Services funding passed under Perdue to $42 million annually, or by 22 percent.

Perdue had ordered each state department to designate an employee as an aging liaison to coordinate planning for more seniors across state government. Those efforts ended when McCrory took office. 

In the long term, state bodies created to assess the situations of older residents have been eliminated by the General Assembly. These have included the legislature’s Study Commission on Aging, a standalone House committee on aging and the Penalty Review Committee. Dating back to 1989, the Penalty Review Committee was eliminated in 2016 after bringing broad public attention to complaints about long-term care facilities, often to the displeasure of the powerful industry. 

An attempt in 2029 by Rep. Donna White (R-Clayton) to establish a 17-member task force on adult caregiving, with no dedicated cost to taxpayers, failed despite a final push to have it included in budget language. 

This year, the governor’s recommendations for the budget that has yet to be resolved included spending $34.8 million to support NC Rural Aging in Place, funded by a Medicaid expansion bonus that remains on hold until the budget passes the legislature. Another $25 million from federal sources is recommended to increase the supply of affordable housing for older people. 

More than 11,000 on wait list

Since Cooper’s first year in office, when he faced down a Republican supermajority in the legislature, state appropriations for the block-grant services have risen and fallen. 

By 2021, the state DAAS budget had fallen to $30.5 million, while the number of residents 65 and older had increased by 170,000 statewide during the same period. 

State allocations for DAAS have increased by about 12 percent since 2017, or at half the rate of increase of the overall state-funded budget. During the same period, positions at DAAS have risen by two, from 77 to 79, or 2.5 percent. 

Between 2017 and 2022, raw numbers of North Carolinians age 65 or older increased by about 14 percent, compared with overall state population growth of 3.9 percent, according to the U.S. Census. 

“You can intuitively tell that it’s not a good reflection because the growth in the population would indicate a growth in need, especially in our 85-plus population,” Massey-Smith said. 

Two women interact at an adult day care canter in Raleigh
Carole Grady chats with her mother, Rachael Mann, at the Total Life Center on Departure Drive. Credit: Thomas Goldsmith

A variety of issues may cause older people to miss out on opportunities for programs like the respite care services, which allow caregivers a break from 24-7 care responsibilities for a spouse, or another relative or a friend. 

“They have heard that services are not available, and they don’t ask,” Massey-Smith said. “And then some people just feel like, as older adults, they need to be responsible and look out for themselves and not ask for help.”

Some appropriations and some pork 

In several aging issues, Republican legislators took the lead, as in the 2021 lifting of a cap on fees for NC adult day-care services, a change that required no additional funding, via a bill sponsored by Rep. Donna White (R-Clayton).

“If we don’t do something, we’re not going to serve any clients,” White said.

Even with the latest funding increase, at least 11,000 older North Carolinians remain on state-tabulated waiting lists for the block-grant services, according to recent DHHS figures, up from estimates that have hovered around 10,000 for years. 

And those numbers likely dip below actual levels of need, according to results based on the use of more sophisticated estimation methods, Massey-Smith said. 

Even as overall state funding has remained largely stagnant, individual lawmakers have sought pork-barrel spending for their local aging needs in the state budget. This type of spending in this year’s budget proposal and prior years’ approved budgets include:

  • $1.5 million in a grant to construct a new Duplin Department of Aging Senior and Veterans’ Services building, a county represented by Republicans in the House and the Senate.
  • In 2021, a $50,000 grant to Brunswick Senior Services for programs and services, in a county represented by Republicans in both chambers.
  • In the 2021 budget, a $10,000 grant to The Pastor’s Pantry in Davidson County, which provides groceries to low income seniors, in a county represented by Republicans in both the House and Senate.
  • Also in the 2021 budget, a $20,000 grant to Lincoln County Senior Services, a county represented by Republicans, including House Finance Committee chair Jason Saine.

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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...