Pittsburgh Post-Gazette - Ahead of the Aging Boom

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Missing a great opportunity (cont.)

Cracks in the system

Still, officials point to some cracks in the system, which will only worsen as the 85-plus population grows rapidly in the near future and the baby boomer population turns 65 starting after 2010.

Among the problems:

Not enough help is available to the group of older people who have too much income to qualify for Medical Assistance but not enough to afford costly home repairs, personal care services and other expenses.

Waiting lists for government-sponsored assistance, such as someone to come into a frail person’s home to do laundry and housekeeping, have been getting longer and are likely to keep doing so because the growth in that population has outpaced funding increases. Lottery revenues have been relatively flat during the 1990s. The result: More than 8,700 elderly individuals statewide, including 1,000 in Allegheny County, are waiting for services.

Traditional senior centers are losing their relevance because younger, more active seniors are uninterested in bingo and congregate meals, which strike them as musty anachronisms. Many aging officials believe too many of these small neighborhood centers exist, and that they need to be consolidated into bigger facilities that can provide more enrichment classes, health services and valuable information.

Government health care funding has been too focused on nursing home care, hospitalization and the neediest senior citizens instead of promoting community and home care that prolong people’s independence.

The hottest new elder-care trend of the 1990s – development of homelike assisted-living facilities in the suburbs – is out of the price range of the majority of seniors who could benefit from it.

Officials say all these issues are being discussed in Pennsylvania, and new programs are beginning to address some of them.

The state Department of Public Welfare has gradually been shifting Medical Assistance dollars into home care in recent years. The United Way hopes early next year to expand small programs that send volunteers into senior citizens’ homes to make maintenance and safety improvements. Various health programs have sprouted that are aimed at preventive care and delaying institutionalization.

None of that guarantees that there won’t be a crisis of too many elderly people needing too much care sometime in the future, but officials believe that planning is headed in the right direction.

"I don’t want to give a rosy picture. We’re going to have to work hard. There’s going to have to be real creative things done," said Sharon Stevick, director of Allegheny County’s Area Agency on Aging, who said senior centers might expect less funding, and older people themselves might have to help pay for formerly free government services in the future.

"Demand for services is going to go up, but we can shave on the growth in costs," Pennsylvania Aging Secretary Richard Browdie suggested, by emphasizing community care over institutionalization, exploring new ways for elderly people to help pay for services, and benefiting from society’s advances in preserving physical and mental health.

"The shift toward a heavier reliance on home- and community-based services and some kind of matchup between those enhanced services and assisted living is absolutely in the cards," said Browdie, who is also president of the American Society on Aging. "At least Pennsylvania has a history of worrying about what it’s going to do about its population of older people in the future."

Why people stay here

The intangibles of life in Southwestern Pennsylvania – perhaps more than any formal government program or agency service – could be the best asset available to its more than 400,000 elderly residents.

Alice "Toddy" Hilliard, executive director for 25 years of Eastern Area Adult Services, regularly surveys the agency’s older clients, and finds they don’t want to stray from their roots despite any hardships they’re facing.

"The most important things to older people? Neighbors, church, friends. Not transportation, not nearby health services, not someone to shovel the sidewalk," she said.

"One of the strengths here is the communities themselves," agreed Mary Hart, executive director of the multi-service Center in the Woods senior center in California, Pa. "Neighbors really do take care of each other. I see that every day in these little towns where there are few services. … Many times it’s old neighbors taking care of old neighbors."


		Growth of the oldest-old Pennsylvania expects little or no population growth through 2010 and population decline is projected for most of the Pittsburgh region, but the neediest population -- those 85 and over -- is supposed to increase dramatically. The overall elderly population will shrink in numbers.

Among that dependent population are individuals who left Pennsylvania after retirement, only to return to be near relatives and friends. Demographers say Pennsylvania is a state that loses more people in their 60s than it gains, but after that age, relatively few people leave, and just as many in the older group return, although they often have diminished health and resources.

Still, most older people don’t move away at all. Browdie and others are worried about the potential for a downward spiral in some older communities, where elderly residents find it hard to maintain homes, and then move into institutions or die, leaving inheritors who are unable to fix up and sell the properties.

"You have all those [old] people in rowhouses who just don’t seem likely to go anywhere," Browdie said. "You have blocks that will have a lot of vacant properties, because it doesn’t seem likely that anyone will move in."

Local officials such as McKeesport Mayor Joe Bendel and Homestead Mayor Betty Esper, both with elderly populations of 23 percent in the last census, say that some of their older residents may have trouble keeping up their properties, but they haven’t seen entire blocks decline because of aging homeowners.

And even though many of their seniors have limited resources, Bendel and Esper see them as being beneficial in other ways.

"Many of our elderly seniors are contributors, not of money, but to churches, to participation in organizations. They bring a sage experience to the table with our youth," said Bendel, who is 67 himself.