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More ‘fiscal cliffs’ to come as population ages

The fiscal cliff that held Americans in suspense over the holidays won’t be the only seismic budget crisis the country faces over the coming decades.

Even if there are no wars and the nation’s infrastructure problems are solved overnight, huge demographic changes will squeeze local, state and federal budgets like never before.

Avoiding it will be next to impossible. Put simply, the country is getting older.

By 2050, analysts predict two-thirds of Ohio’s counties will have an over-60 population that is greater than 30 percent. In urban counties like Montgomery and Clark, where that percentage was around 17 or 18 percent two decades ago, that represents a major shift. But it will be even greater in high-growth counties like Warren, which saw many young families move in during the 1990s, a trend that continued over the first decade of this century.

In 1990, 12.9 percent of Warren County residents were 60 and older. By 2050, 27.4 percent will be in that age category, according to an analysis by the Scripps Gerontology Center at Miami University.

Those demographic changes are occurring in different degrees throughout Ohio and the nation, posing enormous implications on the availability of services older Americans have come to expect from their government.

“If things continue at the present rate, Medicaid would contain the largest part of the state budget, and that’s simply not feasible,” said Suzanne Kunkel, director of the Scripps Gerontology Center. “We should be worried about these demographics. They should be a wake-up call to take action and think differently about the way we do things. Now is the time to look at what does and doesn’t work with the existing system.”

While the projections show the future impact of the Baby Boom generation, they also reflect the migration of Ohio’s young people to other states in search of jobs. Ohio ranks seventh in the nation in the percentage of citizens 60 and older, according to the Scripps center, but Kunkel said the state is comparable to other industrial states such as Illinois, Pennsylvania and Michigan with similar economic struggles.

Kunkel and other experts see signs for optimism in the way Ohioans are approaching the problem. Douglas McGarry, executive director of the Area Agency on Aging, said the state has taken significant steps to reduce the cost of long-term care.

Fifteen years ago, he noted, 90 percent of Medicaid reimbursements for long-term care went toward nursing homes; today that figure has been reduced to 58 percent, with more and more seniors staying in their homes with the help of home health care and other direct services.

“That’s very significant when you compare the cost — $60,000 a year for nursing homes compared with less than $20,000 for home health care,” said McGarry, whose agency serves seniors in Champaign, Clark, Darke, Greene, Logan, Miami, Montgomery, Preble and Shelby Counties. “It’s the seniors’ preference and it’s what taxpayers should want because it is already saving the state $1 billion annually.”

Bonnie Kantor-Burman, director of the Ohio Department of Aging, concurred: “We want to provide for Ohio’s elders the kind of care and caring that they want, and that kind of care is often the most cost-effective.”

Kantor-Burman said she looks at the state’s changing demographics as an opportunity rather than a problem. “Why is the population aging?” she asked. “It’s because we have been extremely successful during the last century in extending our life expectancy through better public health and medical interventions, through better ventilation and better water quality. Why are we seeing our successes as a problem?”

As the population ages, more jobs are created in the health care field, said Kantor-Burman. But more importantly, she said, “It enriches families when we are able to care for our elders, and the family unit is strongest when generations are able to interact with each other. We want our society to think about aging as an exciting, normal part of life where decline is not inevitable.”

Ohio has been selected for two pilot programs looking at innovative ways to serve the elderly. On Dec. 12, Governor John Kasich announced that the Centers for Medicare and Medicaid Services (CMS) had selected Ohio as one of the first three states to take part in a three-year project to better coordinate care for clients eligible for both Medicare and Medicaid.

“This agreement puts Ohio at the cutting edge of care coordination in the country,” Kasich said.

Last year the U.S. Administration on Aging picked Ohio as one of four states receiving $3.2 million in grants to develop integrated systems of care to serve Alzheimer’s patients. The three-year initiative is designed to ensure that patients can remain independent and healthy. “We have been asked to create a model that other states can emulate,” Kantor-Burman said.

Kunkel said that it’s “very significant” that Ohio was chosen for the two pilot programs: “Ohio has been seen as a state moving in the right direction and making significant improvements in these situations.”

Aging experts believe the health-conscious Baby Boomers may reduce Medicaid and Medicare costs by staying active longer and having fewer illnesses and disabilities. “Older individuals are continuing to work longer, Kantor-Burman said. “Think about the skills and wisdom they can be imparting to younger co-workers about what punctuality means and what it means to get a job done well.”

Staffers at the Charles Lathrem Senior Center in Kettering have noticed an interesting trend: the growing number of patrons who have day jobs. Program supervisor Anna Breidenbach said that the center has added more evening classes and activities. Remaining active and social is a key factor, she believes, by increasing longevity and keeping seniors independent. “The biggest thing is socialization,” she said. “Some of our seniors have relocated here to be closer to their families, but they still need their own lives.”

Kettering also offers transportation services for seniors, with a fleet of drivers who will drive clients to the grocery store or shopping center for $2 or $3 each way.

“This is such an exciting time for our field and the buzz word in senior recreation is Baby Boomers,” Breidenbach said.

There’s only one little catch: They don’t care to be called seniors. “They definitely don’t like the ‘s’ word,” Breidenbach said. “Some centers have even dropped the name. But it has to go beyond a name change. People know we have a center that’s vital and vivacious.”

The aging of Ohio leaves plenty of room for concern, Kunkel acknowledged, but she said, “I’m optimistic because of innovations in our state and a dramatic change in what it means to grow old. Baby Boomers want to continue to be an active part of their community. This is the new face of aging.”

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