This is no country for old people.
And that's a problem, because there are lots and lots of them, with more coming.
One person who is looking at the consequences of these demographics is Roger Allbee, the former Vermont Secretary of Agriculture and former chief executive officer of Grace Cottage Hospital in Townshend. He is one of the founders of Windham Aging, a collaboration of people concerned with the challenges of aging in Windham County.
Windham Aging was begun in 2020 by Allbee, Dr. Carolyn Taylor-Olson, and Dr. David Neumeister. The collaboration of 10 health agencies plans to identify Windham County's existing resources, future needs, and best strategies, and then inform legislators and state and local officials - the people who can figure out how to effect these changes. Windham Aging will then track their progress.
"Windham County has one of the older growing populations in the state," Allbee said. "And we said, 'What's this going to mean for all the things that affect the aging population in terms of health care? In terms of housing?'"
He sees it "even in the small town I grew up in, in Brookline, where there's a wonderful couple I know."
"They're money-poor but land-rich," Allbee said. "They both are in a position where they can't really get around anymore. One is in a nursing home now. The other one is still living alone, but can hardly walk. And they couldn't find a room together, because they didn't qualify for a Medicaid room that was a double room. So they're living separately."
Once, aging was different in rural America, Allbee said.
"Back when I was growing up in Brookline, the party line on the telephone was important," Allbee said. "People knew what was going on. People aged together. Today, it doesn't work that way. It's totally disconnected in many ways."
Allbee says that housing and transportation are issues.
"I remember when I was running Grace Cottage Hospital, we created a very robust community health team," he said. "We even set up a transportation system so that people who needed to get to the hospital had a way to get there."
Allbee acknowledged that Southeast Vermont Transit's MOOver does provide door-to-door transportation, for "riders age 60 or over and for persons with ADA-defined disabilities," according to its website.
"But transportation is a critical issue," he said. "Socialization is a critical issue. Food and nutrition are critical."
Allbee tells the story of someone who regularly delivers Meals on Wheels.
"He's probably in his 60s," Allbee said. "And he said, 'The greatest enjoyment I get out of it is meeting people and talking to them.' They're really looking for the socialization that comes with the meal. And that's a way for people to find out what's going on in the home or if somebody's in a dire situation."
The state's policy is that people should age in place, Allbee said. "Many people want to age in place. Even my late mother wanted to age in place. But there's a certain time when that's not possible."
And when that time comes, families find that the state lacks assisted living facilities.
"And then what do you do?" he said.
As part of a group of people trying to create West River Senior Housing, Allbee, a member of the board of Valley Cares, the nonprofit that runs the facility, said that the state balked at the premise of the senior housing and assisted living facility in Townshend.
"The state [initially] said, 'You can't do it. We want people to age in place,'" he said.
Furthermore, "the whole issue becomes Medicare, Medicaid, and private pay," said Allbee, who also serves on the board of Thompson House, a nursing home and rehabilitation center in Brattleboro.
"And the situation you encounter is that if you have too many Medicaid patients, because the rate doesn't cover the cost, the facility can't survive," he explained.
"Yet the demographics of our population is that we have many more Medicaid people because of their income level than we have Medicare and private pay," Allbee continued.
"All these issues are creeping up on us," he said.
The big question, in light of needed services, is how to pay for them.
"The working population needed to support the tax revenue that can support these services is declining," Allbee said. "It creates a dilemma that nobody really is prepared to address yet."
That dilemma? "It's going to take more resources, it's going to take more funding, it's going to take more collaboration," he said.
State steps up with a strategy
The country as a whole has an aging population, led by the age cohort called the baby boomers which covers the generation defined as people born from 1946 - when the soldiers came home from World War II - up to 1964, plus the folks who were born a bit earlier but are still alive.
Old age may not be for sissies, as the old saying goes, but aging in a rural environment adds even more challenges.
According to the Vermont Department of Health, rural Vermont has the fourth-oldest population in the nation. One in four Vermonters is over 60. As of 2020, the percentage of Vermonters age 65 and older exceeds the percentage of those younger than 20. By 2030, one in three Vermonters will be over the age of 60.
Clearly, in a population already full of people competing for scarce services - homeless people and those struggling with mental health issues or substance abuse disorders - the needs of the elderly have long been ignored.
Awareness, followed by planning, has now begun, though it might be too late to help people who are older right now. But the Health Department has just released "Age Strong Vermont: Our roadmap for an Age-Friendly State."
The first premise of the draft report is that "older Vermonters should be able to direct their own lives as they age, and be granted dignity, respect and autonomy when it comes to decisions affecting their lives."
When the state surveyed the population, it first asked, "How important is it for our elected officials to prioritize and invest in a Multisector Plan on Aging?" Of of those responding, 81% said "very or somewhat important."
When asked if the state currently has the resources to address the needs of its older population, 64% said no.
"The proportion of older adults living alone increases with age," according to the state in a summary of statistics for Windham County.
"Older adults who live alone are at higher risk for loneliness, injury from falls, and cognitive decline. The prevalence of adults who do not receive the social and emotional support they need also increases with age," the introduction continues.
The Department of Health also notes that about a third of all older adults fell in the past year and warns that cognitive decline increases among adults 80 years and older. It also points out that those aged 60 to 69 are most prone to not seeing a health care provider, and those in that age bracket are most likely to engage in risky drinking of alcohol.
Windham County has the second-oldest population in the state, the statistics say.
"One in three Windham County residents are over the age of 60 (34 percent or 15,480 adults)," it says. "Since 2001, Windham County has experienced a decreasing youth and an increasing older adult population. An increasing older adult population creates new challenges and emerging health risks."
Obstacles to graceful aging
Just think about rural aging.
So many Vermonters live down dirt roads in single-family homes. Rural living fosters what Vermonters value most - independence.
But aging can clash with independence.
Most people are reluctant to stop driving, for example. While they continue, they can make unsafe driving conditions for everyone else on the road. And when the car keys finally get retired, independence goes by the wayside; older people can never leave home again without support. It's a brutal choice.
Loneliness is a huge issue. Many older Vermonters have raised children who have since left home, and left the state, leaving them without family nearby to call on for help.
In most towns, seniors can rely on volunteers to drive them to their medical appointments, but what if an older person wants to attend a concert or a lecture at the library? Or have tea and a gossip with a friend?
The for-profit health care system has grown increasingly difficult to use. In Vermont, doctors are almost impossible to find. Waiting lists are growing. And costs for patients remain high, even with the help of some form of Medicare.
Leaving an isolated home and moving into town requires housing that, at the moment, does not exist. And the competition for whatever affordable housing does exist is fierce.
Social Security does not cover the costs of living; as a supplemental source of income it is fine, but it can leave a person who does not have other means dependent on dog food for nutrition.
With a restricted budget, it is hard to pay for heat during the winter months. In 2010, a longtime resident of West Townshend was found frozen in his kitchen in February, three months after he was last seen alive. The state medical examiner determined he died "due to cold environmental temperatures."
Nursing homes around the state are folding. And if a person can even find a bed, it can wipe out a lifetime of savings in just a few years.
To add insult to injury, many young people, with the dismissive phrase "OK, boomer" at the ready, collectively blame seniors for the diminished state of the world they're inheriting - wars, income inequity, famine, drought, wildfires, climate change, etc. - and want nothing more than to see them vanish from the Earth.
And yet, people are living longer.
Backing from BMH
The new CEO of Brattleboro Memorial Hospital, Christopher Dougherty, is an enthusiastic member of Windham Aging.
"Every part of living impacts health, and vice versa," Dougherty said. "Everything that people do with their lives are impacted by their health, whether that be good or bad."
He believes that one particular success of the collaborative comes in how it has integrated "community work with what our health systems and health care entities need to do to be a major part of that."
"The challenges are just enormous," he said. "But they are really things that are not insurmountable."
As part of this community work, BMH is participating in a six-month certification program, the Age-Friendly Health System, a national program established by the Institute for Healthcare Improvement and the American Hospital Association.
"We're in a cohort right now to take a stepwise approach towards implementing and becoming an age-friendly health system," Dougherty said. "It's based on evidence-based practices that show these are the best ways to help the elderly."
This system focuses on four key areas it calls "the Four Ms."
"The first 'M' is what matters," Dougherty said. "What matters to the elderly population? What is it that they're looking for? What are their outcome goals? Their care preferences? [...] It is the starting point."
The second "M" is medication.
"It's how we can help with medication planning," Dougherty said. "How can we prevent people from being overly medicated."
The third "M" is mentation, or the use of one's mind. Specifically, this area seeks to prevent, identify, and treat mental health issues like dementia and depression.
"The fourth and final 'M' is mobility," Dougherty said. "Making sure that older adults can move safely every day in order to maintain function, and to do what matters."
As BMH works its way through the Age-Friendly Health System process, it will begin to implement changes.
"I'd say we'll start to see changes within the next six months and continue on an ongoing basis," Dougherty said. "The goal established by Windham Aging is to shoot for a timeframe of 2040 for having all of the older populations thriving in Windham County."
Windham Aging acknowledges aging Americans have been virtually ignored for years.
"We see our greatest mission is to educate people to understand what we're dealing with today," said Neumeister. "Like a shortage of primary care. Not enough nursing homes. We need more nurses. Hospitals are holding patients because there's no place to send them, and they can't send them home."
And no answers to those problems are coming soon. "We're not looking to the short term, to be honest," he said.
"But the problem is going to be worse and worse. It doesn't turn around until 2037. So we've got two decades. It's a little like global warming; it's happening around us. We are experiencing it in slow motion, like the frog in the boiling water."
According to Neumeister, Windham Aging sees the next 17 to 20 years as critical.
"We have a 20-year opportunity to create change," Neumeister said. "We're not limited by what state agencies do. We're not limited by other funding sources. We're not limited by policies that exist right now. We're going to change them because we have to."
We don't have a choice, he said.
"If we don't do something about the aging population and its cost curve, there won't be housing and transportation for people over 60," Neumeister said. "We need to start educating people. More people need to understand, and in a big way."
Windham Aging will hold a listening session to hear community concerns and ideas about housing as it relates to aging on Wednesday, Dec. 13 at 4:30 p.m., at the Winston Prouty Campus on the fourth floor of Holton Hall, 130 Austine Drive, Brattleboro. Registration is requested for this event; to contact Windham Aging, visit windhamaging.com/consultations.
This News item by Joyce Marcel was written for The Commons.