Growing Older in North Carolina: Helping Seniors Navigate Transitions
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The aging population in North Carolina is growing rapidly, with the number of those aged 65 and older expected to double over the next 20 years. This demographic shift presents challenges around ensuring seniors have access to necessary support services. Effective care transitions between medical settings and the community are important to support senior well-being and reduce healthcare costs. Many communities in the state are working to develop coordinated systems and partnerships to help seniors navigate these transitions.
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Growing Older in North Carolina: Helping Seniors Navigate Transitions
- 1. GROWING OLDER IN NORTH CAROLINA: Helping Seniors Navigate Transitions North Carolina Association of County Commissioners Annual Conference August 17, 2012
- 2. The Silver Tsunami Every day for the next five years, 2
- 3. Percent of Population 65 and Over in NC 2010 Pasquotank Currituck Camden Alleghany Ashe Surry Stokes Warren Northampton Rockingham Caswell Person Gates Vance Watauga Wilkes Halifax Hertford Granville Perquimans Yadkin Forsyth Mitchell Avery Guilford Franklin Chowan AlamanceOrange Bertie Caldwell Alexander Davie Durham Nash Yancey Madison Edgecombe Iredell Davidson Wake Martin Washington Burke Randolph Chatham Catawba Wilson Tyrrell Dare Buncombe McDowell Rowan Haywood Pitt Beaufort Johnston Swain Rutherford Lincoln Lee Greene Hyde Graham Henderson Cabarrus Harnett Moore Wayne Jackson Polk Cleveland Gaston Stanly Montgomery Mecklenburg Lenoir Cherokee Macon Transylvania Craven Clay Cumberland Pamlico Richmond Hoke Jones Union Sampson Anson Duplin Scotland Onslow Carteret Robeson Bladen Pender Columbus New Hanover Brunswick 10% or less 11% to 20% 21% to 30% North Carolina – 13% Source: US Census 2010
- 4. Percent of Population 65 and Over in NC 2030 Pasquotank Currituck Camden Alleghany Ashe Surry Stokes Warren Northampton Rockingham Caswell Person Gates Vance Watauga Wilkes Halifax Hertford Granville Perquimans Yadkin Forsyth Mitchell Avery Guilford Franklin Chowan AlamanceOrange Bertie Caldwell Alexander Davie Durham Nash Yancey Madison Edgecombe Iredell Davidson Wake Martin Washington Burke Randolph Chatham Catawba Wilson Tyrrell Dare Buncombe McDowell Rowan Haywood Pitt Beaufort Johnston Swain Rutherford Lincoln Lee Greene Hyde Graham Henderson Cabarrus Harnett Moore Wayne Jackson Polk Cleveland Gaston Stanly Montgomery Mecklenburg Lenoir Cherokee Macon Transylvania Craven Clay Cumberland Pamlico Richmond Hoke Jones Union Sampson Anson Duplin Scotland Onslow Carteret Robeson Bladen Pender Columbus New Hanover Brunswick 10% or less 11% to 20% North Carolina – 19% 21% to 30% 31% or more Source: NC State Data Center, April 2012
- 5. The Graying of North Carolina • NC in the midst of significant demographic change • The state’s 2.4 million baby boomers are entering retirement age • NC has the highest percentage of older adults living in rural areas among Pasquotank Currituck the most populous states Camden Alleghany Ashe Surry Stokes Warren Northampton Rockingham Caswell Person Gates Vance Watauga Wilkes Halifax Hertford Granville Perquimans Yadkin Forsyth Mitchell Avery Guilford Franklin Chowan AlamanceOrange Bertie Caldwell Alexander Davie Durham Nash Yancey Madison Edgecombe Iredell Davidson Wake Martin Washington Burke Randolph Chatham Catawba Wilson Tyrrell Dare Buncombe McDowell Rowan Haywood Pitt Beaufort Johnston Swain Rutherford Lincoln Lee Greene Hyde Graham Henderson Cabarrus Harnett Moore Wayne Jackson Polk Cleveland Gaston Stanly Montgomery Mecklenburg Lenoir Cherokee Macon Transylvania Craven Clay Cumberland Pamlico Richmond Hoke Jones Union Sampson Anson Duplin Scotland Onslow Carteret Robeson Bladen Pender Columbus New Hanover 2010 Brunswick Counties with more 60+ than 0-17 (43) Counties with more 0-17 than 60+ (57) Source: US Census 2010
- 6. • Our 65 and older population will double in the next 20 years from 1.2 to 2.4 million. • While NC is 10th nationally in size of total population, we are 9th in those 60 +. • By 2025, 85 of NC 100 counties are projected to have more people over age 60 than under age 17 and one in four NC citizens will be 60 and older. Pasquotank Currituck Camden Alleghany Ashe Surry Stokes Warren Northampton Rockingham Caswell Person Gates Vance Watauga Wilkes Halifax Hertford Granville Perquimans Yadkin Forsyth Mitchell Avery Guilford Franklin Chowan AlamanceOrange Bertie Caldwell Alexander Davie Durham Nash Yancey Madison Edgecombe Iredell Davidson Wake Martin Washington Burke Randolph Chatham Catawba Wilson Tyrrell Dare Buncombe McDowell Rowan Haywood Pitt Beaufort Johnston Swain Rutherford Lincoln Lee Greene Hyde Graham Henderson Cabarrus Harnett Moore Wayne Jackson Polk Cleveland Gaston Stanly Montgomery Mecklenburg Lenoir Cherokee Macon Transylvania Craven Clay Cumberland Pamlico Richmond Hoke Jones Union Sampson Anson Duplin Scotland Onslow Carteret Robeson Bladen Pender 2025 Columbus New Hanover Brunswick Counties with more 60+ than 0-17 (85) Counties with more 0-17 than 60+ (15) Source: NC State Data Center
- 7. The Long-Term Services and Supports Landscape In North Carolina long-term services and supports are funded by numerous sources, administered by multiple agencies, and have complex, fragmented, and often duplicative intake, assessment, and eligibility functions. 7
- 8. Determining how to obtain services is difficult both for persons who qualify for publicly funded support and for those who can pay privately. A uniform, coordinated system of information and access for all persons seeking long-term support will minimize confusion, enhance individual choice, be cost efficient, and support informed decision- making. 8
- 9. Recent Milestones For American Health Care • Medicare Modernization Act (2003) • Deficit Reduction Act (2005) • Medicare Improvement for Patients and Providers Act (2008) • Affordable Care Act (2010)
- 10. http://www.kff.org/medicare 10
- 11. 11
- 12. • In 2003, the US Administration on Aging (AoA) launched the federal Aging and Disability Resource Center (ADRC) initiative, which began with three core functions – Awareness, Assistance, and Access • The set of core expectations has grown over time – Information, referral, and awareness – Options counseling, advice, and assistance – Streamlined eligibility determinations for public programs – Person-centered transitions – Quality assurance and continuous improvement • Since 2009 AoA and CMS are viewing ADRCs as the platform to: – Intervene during care transitions – Promote consumer direction – Implement new initiatives (e.g., Veteran Directed Home and Community Based Services) – Catalyze broader systems change 12
- 13. North Carolina Community Resource Connections (CRCs) Alleghany Northampton Cu Gates Pa rrituck Vance Warren sq Granville Stokes Surry Rockingham Caswell uo Ashe Person Pe Ca t an Hertford rq m k de ui n Watauga Halifax m an Ch Wilkes Alamance s Orange o Durham Avery Yadkin Forsyth wa Guilford Bertie Franklin n Edg r Caldwell de Nash e Yancey an Davie co m ex Iredell n Madison Al Martin hin gto be Davidson Wake Was Tyrrell Chatham Wilson Dare Burke Randolph McDowell Ha Buncombe Catawba Rowan yw Pitt Beaufort oo d Lincoln Johnston Hyde Swain Greene Lee Rutherford Cabarrus Clev Mecklenbu Harnett Graham Henderson Jack Stanly Moore elan s on Gaston Wayne Lenoir ia Polk Montgomery Craven van d Pa Cherokee Macon n syl rg ml T ra Cumber ic o Clay Richmond Hoke -land Jones Union Anson Sampson Duplin Scot- land Onslow Carteret Robeson Cabarrus CRC (Cabarrus ) Bladen Chatham-Orange CRC [Chatham and Orange] Pender Eastern Carolina CRC -Developing [Carteret, Craven, Duplin, Greene, Jones, New Hanove r Lenoir, Onslow, Pamlico, Wayne] Columbus Forsyth CRC [Forsyth] Brunswick Great Smokies CRC [Haywood, Jackson, Macon] High Country CRC [Ashe, Alleghany, Avery, Watauga, Wilkes] Isothermal CRC - Developing [Cleveland, McDowell, Polk, Rutherford] Land of Sky CRC [Buncombe, Henderson, Madison, Transylvania] Lumber River CRC - Developing [Bladen, Hoke, Richmond, Robeson, Scotland] Mecklenburg CRC [Mecklenburg] Northwest Piedmont CRC [Davie, Stokes, Surry, Yadkin] Piedmont Triad CRC [Alamance, Caswell, Davidson, Guilford, Montgomery, Randolph, Rockingham] Pitt-Beaufort CRC [Pitt, Beaufort] Wake CRC [Wake] Western CRC [Cherokee, Clay, Graham, Swain] March 2012
- 14. In 2009 NC was one of 9 states to be awarded a CMS Person- Centered Hospital Discharge Model Grant (PCHDM) • The over arching goal for this grant was to provide states the opportunity to develop effective care transitions models that integrated community-based services with hospital discharge planning as a means for preventing avoidable hospital re-admissions. • Projected Outcomes- • Improve quality of care for Medicare beneficiaries through a comprehensive community effort • Reduce preventable hospital re-admissions • Increase discharge from Hospital to Home for target populations
- 15. Resources and Milestones • CRC Care Transition Projects – Forsyth County – Chatham-Orange Counties – Rockingham County – Land of Sky • PASSPORT • Area Agencies on Aging • NC Alliance for Care Transition (NC ACT) – NC Hospital Association Quality Center – Community Care of NC – Carolinas Center for Medical Excellence
- 16. Transitions of Care • Definition: The movement of persons from one health care practitioner or setting to another as their condition and care needs change • Poor Transitions… – Compromise clients safety & quality of care – Burden clients and their families – Increase costs to clients, payers, providers & employers
- 17. Readmissions: By the Numbers 20% Medicare Beneficiaries readmitted within 30 Days 33% readmitted within 90 Days Hospitalizations account for 33% of total Medicare $ Readmissions result in $17.4 Billion annually 76% of Medicare readmissions potentially avoidable Estimated $12 Billion Preventable Expenditures
- 18. The Challenge “If re-hospitalizations are frequent, costly, and able to be reduced, why haven’t they been?” Hospital-level barriers Community-level barriers State-level barriers
- 19. New Models of Care There are a number of proven & promising models to improve outcomes during transitions: Common Elements: Interdisciplinary Communication/Collaboration Transitional Care Staff Patient Activation Enhanced Follow-up (by phone / home visit) For more resources: www.cfmc.org/integratingcare
- 20. NCMJ: Care Transitions www.ncmedicaljournal.com
- 21. How does our community navigate this transition? Area Agency on County Aging Social Home Services Assisted Living Cooperative Extension Nursing ? Home Mental Health Home Health Provider Care Continuing Care Rehabilitation Retirement Community Community Resource Connection Faith Adult Day Services Community Senior County Council/ Center Department on Aging
- 22. Community Engagement Event • Plan WITH Not FOR Community • Power of Consumers • Map Current Reality • Assess Beliefs • Build Common Vision • Set Priorities • Define Action Steps
- 23. Local Core Collaborators Consumers Aging Services Agencies Disability Services Agencies In-Home services Senior Centers Community Organizations Dept. of Social Services Area Agencies on Aging Community Health Centers Hospitals
- 24. Community-Based Approach “Communities across the US are beginning to consider transitions of care as a community–based challenge that requires shared ownership and close collaboration across settings.” (Institute for Healthcare Improvement)
- 25. Local Level Planning • How to get started? • What has been done?
- 26. Orange County Is Now In It’s Third Master Aging Plan (MAP) •Objectives for Developing MAP •Input •Process •Plan
- 27. Objectives For Developing MAP • Citizen Engagement • A plan for the whole county • Sustainability • Accountability
- 28. Citizen Engagement • Focus Groups • Community Forums • Work Groups – Housing – Navigation and Transportation – Health and Wellness – Community Engagement – Aging in Place
- 29. Integrated Countywide Plan • Government Readiness Survey • Personal Interviews with County Dept. Heads.
- 30. • Steering Committee – Key County Department Heads, citizen representation, community organizations, BOCC Representatives – Increased buy-in and commitment agencies across the county – Personal interviews
- 31. Sustainability and Accountability • Economic context requires creativity • Public Private Partnerships • Built-in indicators of success • MAP Evaluation Committee
- 32. How Can You Begin In Your Community? • Contact your local Dept. or Council on Aging • Find out if they have a strategic plan • Is it time to update the plan and you like what you have heard today visit us at www.orangecountync.gov/aging • We have created an on-line MAP toolkit
- 33. Most Important Role For You • Get involved and stay involved! • If your community does not have an Aging Plan, advocate that they get started planning. • The Silver Tsunami is going to have a dramatic impact on you and your community.
- 34. Our Contact Information Bernadette Pelissier Orange County Board of Commissioners bpelissier@orangecountync.gov Heather Altman Carol Woods Retirement Community haltman@carolwoods.org Sabrena Lea North Carolina Division of Aging & Adult Services Sabrena.Lea@dhhs.nc.gov Janice Tyler Orange County Department on Aging jtyler@orangecountync.gov