White Paper Report:
A CALL FOR ACTION ON THE GROWTH OF MONTGOMERY COUNTY'S AGING POPULATION

SUMMARY

GROWS' Call for Action for addressing the growth of Montgomery County's aging population is based on the projections that over the next 20 years there will be tremendous growth in Montgomery County's senior citizen population. The Grass Roots Organization for the Well-being of Seniors (GROWS) believes it is imperative that, collectively, Montgomery County government, seniors, their families, the business community, and service and faith-based organizations be proactive in preparing for the multitude of issues accompanying the coming "tsunami" in the senior population. As this paper reflects, some of the issues are straightforward while many are complex. Inaction or "business as usual" is not acceptable.

GROWS believes it is necessary for Montgomery County to develop a community-wide model for addressing the issues of our aging community. The model needs to:

• Promote the civic and social engagement of older adults in the community
• and also Support the health, well being, and independence of all elders including those who are at risk for disease or disability and those who are frail, sick, or disabled. Prevention strategies appear to be important intervention approaches.

GROWS calls on County government to serve as a community leader in studying and formulating responses to the Tsunami of Senior Citizen Service Needs. Further, GROWS recommends using an investment strategy that prepares for the longer-range needs by incrementally investing over the coming years in such elements as manpower development, training, legal/regulatory framework, land use policies, resource development, and community education.

GROWS sees three critical areas that especially require the County's leadership:

1. Development of a comprehensive strategic plan for maintaining and expanding the full continuum of private and public resources necessary to preserve maximum independence, personal dignity, freedom of choice, and quality of life for older county residents.
2. Service system reform and expansion using an integrated approach that involves all elements of both the public and private community (e.g. business, faith, service, policy and political, citizen, and consumer sectors)
3. Development of an integrated and strategic communications plan that is comprehensive, multifaceted, repetitive, and long-term so that identifying and accessing services is made easier.

It is vital that the County, through leadership and support, address senior issues today so that Montgomery County will be a place where all persons, including seniors, can lead meaningful and fulfilling lives.

BACKGROUND

There is an Approaching Tsunami of Senior Needs

Numerous demographic reports, including those from the U.S. Census Bureau, State of Maryland, and research conducted by the County, project major growth in our senior population both in the near term and over at least the next two generations. These changing demographics will affect all citizens of Montgomery County. Below are some of the facts about our senior population today and in the future:

• Between 2000 and 2020, there will be a staggering 74% increase in the number of county residents aged 60 and older. The senior population in Montgomery County is projected to reach 227,000 by 2020.
• Within this group of growing seniors, there will be a 45% increase in the "85 plus" category.
• The increase in chronic health problems that will accompany this senior population growth will challenge public and private health systems as well as place tremendous stress on the human service system and families.[1] For example, the number of County residents with Alzheimer's disease will almost double by 2020 - growing from 14,700 in 2000 to 28,000 in the year 2020.[2]
• The baby-boomer generation is close to becoming a senior population. Many new baby-boomer seniors will face not only their own age-related challenges but will also be responsible for their frail family members. Both generations' financial, psychological, and family pressures will burden caregivers, governments, non-government organizations, and local businesses.
• While a significant portion of the expanding senior population will be healthy, independent seniors seeking and deserving a meaningful, vital lifestyle, many also will be coping with care giving responsibilities for frail elderly family members.

The Issue is Extremely Complex

Ensuring the lifelong involvement of seniors in meaningful community life and providing comprehensive services to meet the needs of seniors are complex challenges. Following are some of the factors that make this so complex.

• As aging progresses, many individuals become frail and impaired by injury, general decline, and/or disease. For each person, these changes occur at different rates and each person brings to the transition a range of coping abilities and attitudes (often referred to as resiliency).
• An individual's ability to manage disability is further impacted by the extent of family and informal community supports and by the person's income and other resources. The resiliency and resources of the family can make a considerable difference in the outcome a person experiences.
• The service system, regulations, and laws are complex and often contradictory. Both citizens and professionals report that it is difficult to navigate the system. In addition, many seniors are not users of the types of technology that might make the search easier; they are often engaging in this search for services at a time when personal energy and stamina are declining.
• Multicultural issues impact service delivery on both the consumer and provider side of service.
• Seeking reasonable and safe solutions for older adults is legally complicated because they are "adults". As such, they have the right to choose risk over safety, a right that challenges families and professionals.

Addressing Senior Population Growth is Also Complex

The above demographics and issues will require ever more integrated policy-making in housing, transportation, health and social services, community supports, private services, and other vital living components. The community must address service questions such as: which supports and services will be needed; what level and quality will be appropriate, who will provide and pay for the services and supports? Each of these questions involves political, philosophical, fiscal, technical, and administrative issues.

In seeking solutions, many community models have been developed and implemented across the United States. One such model, The AdvantAge Initiative of the Center for Home Care Policy and Research of the Visiting Nurses Service of New York, proposes two objectives supported by GROWS:

• Promote the civic and social engagement of older adults in the community
• Support the health, well being, and independence of all elders including those who are at risk for disease or disability and those who are frail, sick, or disabled.

The County's decisions on how to make these objectives a reality should be informed by the understanding of how well seniors are prepared to meet the economic burden of their Montgomery County lifetime basic living (LBL) costs. The LBL costs are the combination of needs of daily living as described in the County's Minimum Standard of Need and the variety of long-term care, drug, medical, and insurance costs likely to be incurred by individuals. "The Lost Retirement Dream for Baby Boomers", an article in the Washington Post, December 7, 2003, reported that in the aggregate, retirees in this country in the year 2030 will be at least $45 billion short of the income they need to cover basic living expenses plus expenses associated with nursing- home or even home health care. Information available to GROWS indicates that very few Montgomery County seniors have enough funds to support their retirement needs and that this shortage may be more than $1 billion currently.

The bar chart at the right is a model depicting the sources of support to meet the basic living needs for the typical person at three different stages in life. The chart shows that the "gap" in resources (red) is small for our young population (through 20 years of age), miniscule for the 21 through 64-year-old population, but is estimated to be more than 30% for those 65 and older. Assumptions used to develop this chart are based on budget and demographic information available from the County or from sources that reflect current Lifetime Basic Living cost in Montgomery County.

The cost of not planning is very high for the entire community but especially for government, which has the burden of providing services for those unable to do so for themselves.

Long-range planning, cost/investment analysis, and program impacts are particularly difficult to assess because outcomes cannot easily be measured by periodic testing, as with children, or by short-range statistics. No one can foresee non-County actions such as changes in Federal/State policies and laws, new directions in business and medical breakthroughs, debates over data credibility, and analysis of the interdependency of all these factors. These challenges will require critical thinking about services and outcomes and a community-wide vision.

The Role of Montgomery County Government

The primary responsibility of Montgomery County government is to provide for the health and welfare of all of its citizens. To this end, the County government provides basic services (e.g., water, sewer, roads, emergency services), ensures that we have professionals and volunteers (physicians, police, teachers, firefighters, health and social services specialists, librarians, recreation specialists, etc.) staffs a plethora of institutions and community services, and puts policies and supports in place (e.g., master planning), to make it possible for citizens to achieve a high quality of living. The average adult voluntarily chooses from available public and private services and products to meet his/her basic living needs (housing, employment, education, recreation, etc.). The county has received state and national recognition for its forward thinking in many areas.

With respect to children ages 5-18, Montgomery County government articulates its responsibility by investing more than half its budget in a comprehensive educational program, ensuring basic schooling, and providing for those youngsters with special needs. Our citizens are proud of our excellent educational system.

The County's focus on meeting the needs of its senior citizens is, for historical reasons, less comprehensive and less well articulated. On November 22, 1999, Chuck Short, then County Health and Human Services Director, said, "We have worked hard to forge a consensus within the children's community to work together toward common outcomes for children. We now need to do the same thing for our aging senior community." The steering committee for Vital Living - Montgomery was established with the goal of forging such a shared vision for vital, optimal aging in Montgomery County. The challenging work of this group continues.

Montgomery County has tried to be responsive to specific aging needs as they arise. This includes implementing a Medicaid Waiver Program, providing assessment services, mental health services through the SORT team, and contracting for community programs to name a few. But there is an important difference between reacting to immediate needs versus anticipating and preparing for future senior needs. At present, many of the Lifetime Basic Living needs of senior citizens are not being met. Most programs and services have waiting lists, are not adequately publicized and are difficult to access. In addition, the County is not positioning itself to meet these in the future when even more of its citizens will fall into the "senior" demographic category, the "Coming Tsunami".

Montgomery County needs an investment strategy that offers our current and future seniors hope and confidence that Montgomery County is committed to meeting Lifetime Basic Living needs while recognizing that seniors are a tremendously valuable community resource.

CALL TO ACTION

Senior Supports: Developing a New Vision. Providing Public Policy Leadership.

GROWS calls on the Montgomery County Executive and County Council to provide the political leadership for addressing the coming Tsunami. The Montgomery County government and the community's response to the Tsunami will be daunting unless a comprehensive and cohesive plan is developed soon. The current complex structure of human services programs has evolved over time in response to perceived needs in the community. In addition, Federal and State mandates, local decisions, and competitive interests have forced shifting priorities and pressures on the system making a holistic approach a difficult task.

Now is the critical time to develop a proactive, comprehensive plan to meet the needs of seniors in the future. The operational complexity makes it even more important that the County and the community together develop a response that uses an investment strategy over time and is based on a continuum of community support and care. The needs of the at-risk and frail elderly should be a special focus since they are often the most in need yet least able to publicly articulate their issues.

Despite the need to meet short-term critical problems, the new effort must look at the broader issues of policy and priorities (i.e. the "forest" of senior issues) rather than falling victim to the mutually harmful battles over particular budgets and services (i.e. the "trees"). The effort must involve all levels of government and all elements of the community, public and private. These local elements include the political, social service, economic, community, faith, and family systems. Operating within these systems are a variety of actors including seniors, other citizens, elected officials, government and non-profit professionals, business and private sector services professionals, non-government organizations, volunteers, and family members.

GROWS sees three critical areas requiring the County's leadership:

1. Development of a Comprehensive Strategic Plan

   The County should involve all elements of the community, public, nonprofit, and corporate, in developing a comprehensive strategic plan to build the community's capacity and services infrastructure in order to be prepared for the Tsunami. The plan should use a "senior resources investment logic" for 2005 and beyond based on establishing the necessary "continuum of services" with special emphasis on the home-based needs of seniors including at-risk and frail seniors. A long-term strategic plan will create opportunities and a rationale for long-term partnerships among levels of government, community organizations, business, and families. It is not only right for the County to help seniors remain active members of their families and community, it is essential if we are to derive the most benefit from public and private resources spent on long-term care services.

   A systematic needs analysis is an essential first step to better define the challenges facing seniors today and in the next 15-20 years. This analysis should start by reexamining existing data to determine the gaps existing and for a better understanding of senior trends. There is also a need to analyze data and assumptions to determine the growing social services and social engagement needs of seniors and how well the Montgomery County community is responding to them. In addition, research on the impacts of taxation and service fees should be included.

2. Service System Reform and Expansion (Integrated Services)

   For an investment strategy to succeed, the complexity of the provision of support must be documented so that both short-and long- term approaches can be embraced. The County should involve all elements of the direct public and private services community to identify policy issues, gaps in service, short- and long-term solutions, reforms and new approaches for ensuring the provision of needed senior supports. Teams consisting of representatives of local and state governments as well as the nonprofit and private sectors providers should thoroughly examine the current services policies and delivery systems. This will be especially important for services such as transportation, housing, community development, health care, and other "continuum of services" areas.

3. Development of an Integrated and Strategic Communications Plan

   It is well known that identifying and accessing information on senior supports can be a daunting task for seniors, families, and others in the provider community. There are many reasons for this including general lack of awareness of services, organizational and personal barriers to acquiring information, the nature of the messages, complexity of the delivery systems, and so on. An integrated, strategic communications plan should be developed that is comprehensive, targeted, repetitive, and long-term that will extend benefits to the entire community.

   Montgomery County has some of the best well-known public education and public relations organizations in the country. A task force of these organizations should be called upon to identify the information challenges for seniors and to craft a long-term, comprehensive, targeted, and cohesive, public and private sector information and awareness program.

Footnotes

1. Currently available data are showing that disease and disability in the senior population is not increasing at as high a rate as the aging population. Disease and disability prevention appear to be an important intervention approach.
2. The estimated prevalence of Alzheimer's disease is based on research by Denis A. Evans, Harvard Medical School, applied to population projections by the Maryland Office of Planning, based on the 2000 U.S. Census.