Perspective Long Term Care Task Force Final Report


Putting Long Term Care into Perspective in Fairfax

A Profile for 2000 and 2010

The Long Term Care Task Force has taken the time to look at the Fairfax area (Fairfax County, and the cities of Fairfax and Falls Church hereafter referred to as "Fairfax" or "Fairfax Community") in relation to the current and future long term care needs of its residents. In so doing, the Task Force has been able to see both how Fairfax differs from other jurisdictions and how it shares the challenges faced by others. The following section provides the reader with a profile.

Potential Population in Need of Long Term Care Services

The task force has identified persons 65 years and over, and adults under 65 with disabilities, as the primary population focus of its efforts. In 2000 there were an estimated 104,818 persons in this group, representing 10.4 percent of the Fairfax Community’s population. In 2010, it is estimated that there will be 187,378 persons in this group, representing 16.8 percent of the Fairfax population, for a 78 percent increase over the 10-year period.

Growth of the Older Population

For the nation as a whole, older persons comprise the fastest growing segment of the population. While this is true of the Fairfax Community as well, older persons in the Community represent a smaller percentage of the population than that of the nation. In 2000, 12.4 percent of the nation’s population is 65 or older, but only 8.1 percent of the Community’s population is 65 or older.

When one looks at the next oldest age group, however, a different picture emerges. Nationally, persons in the 55-64 age group comprise 8.6 percent of the population. In Fairfax, they comprise 9.1 percent of the population.

Together, these facts tells us that, assuming current demographic trends hold, the Community’s short-term challenges may be somewhat less daunting than elsewhere, but long term challenges may be more daunting. A close look at the Community’s demographic shifts demonstrates how dramatically different the future may be.

Chart 1 shows the population forecast estimates for the Community’s age groups (cohorts) for 2000 and 2010.

Fairfax Population


Chart 2 provides a closer look at the forecasted changes by age cohort.

Population change by age

Chart 3 depicts those changes in terms of percentage increase or decrease.

Chart 3 Percent Population Change by age


Together, these charts tell us that the population from age 60 to age 74 is forecasted to grow the most in terms of total persons, while the population age 85 and over is forecasted to experience one of the largest percentage increase. Since the size of the elderly population is a primary indicator of the demand for long term care services these data are compelling. The greatest users of long term care services tend to be the oldest members of the population, those age 85 and over, so the growth in that age cohort is worthy of particular notice.

Change in the Adult Working Age Population

Also significant is the minimal growth, or decrease, in total numbers of persons in much of the working age population – persons age 35 to 54 – who are relied upon to be providers of long term care services. This points to a potential labor supply problem just at the time when it is most needed.

Persons with Disabilities

Nationally, statewide, and locally, age is the main factor affecting the likelihood of having a disability. In Fairfax in 2000, only 3.6 percent of the population 35-64 (21,730 persons) reported a disability, compared to 25.6 percent of the household population 65 and over (20,940 persons). However, in total numbers, the non-elderly population of persons with disabilities is larger than the elderly population with disabilities. Therefore, as the population ages, the total number of people with disabilities will increase.

chart


Overall, nearly 5.7 percent of the Fairfax Community’s household population, or an estimated 56,472 persons, reported a disability in 2000. This rate is lower than rates quoted for the nation as a whole, although comparisons with national data often cannot reliably be made due to differing definitions of disability.

Although the likelihood of having a disability increases with age, a significant national trend is that the prevalence of disability among the elderly declined by 3.6 percent from 1984 to1994. This suggests that elderly persons as a group may be healthier than they were in prior years.

The Need for Assistance with the Activities of Daily Living

Although there are over 100,000 persons in Fairfax who are elderly or have a disability, many elderly persons and many persons with disabilities never require long term care assistance. Therefore, another view of the population is needed.

Activities of daily living (ADL’s) are the basic activities one must perform to care for oneself, such as bathing, eating, dressing, using the toilet, and walking. The size of the population needing assistance with ADL’s is a better measure of the population needing long term care services. As Table 1 demonstrates, the estimated number of persons needing such assistance was 14,500 in 1995 and will grow to an estimated 24,280 in 2010.






Table 1:


Estimates of Number of Persons Needing Assistance


Activities of Daily Living (ADL’s)


Age Cohort Percentage of Age Cohort – 1995 Baseline Persons Needing Assistance with ADL’s – 1995 Persons Needing Assistance 2000
(1998 estimate)
Persons Needing Assistance 2005
(1999 estimate)
Persons Needing Assistance 2010
(1999 estimate)

18 – 34

.9%

2,000

1,840

1,920

2,080

35 – 54

1.1%

3,500

3,660

3,820

3,770

55 – 64

3.1%

2,100

3,100

3,960

4,780

65+

10.3%

6,900

8,750

10,700

13,650

Totals

14,500

17,350

20,400

24,280

Population 18+

673,284

721,383

792,972

860,661

Total Population

879,400

966,137

1,045,417

1,112,943

Baseline data from Fairfax-Falls Church Community Needs Assessment – 1995

 

In 1995, 47 percent of the persons needing assistance with ADL’s were over 65 years of age. Based on the 1999 population forecasts, this percentage will rise to 50 percent in 2000 and 56 percent by 2010.

The trend toward needing increased assistance with advancing age is supported by data from the 1990 U.S. Census, which revealed that nearly 18 percent of Virginians age 60 and over had either mobility or self-care limitations (or both), but 55 percent of the population age 85 and over had these limitations.

Income and Age

The median household income of the Fairfax Community’s older population is three times that of the nation’s older population.

  • The 2000 median household income in Fairfax for persons aged 65 and over was $60,000, which represented 73 percent of the median income for all households.
  • Nationally, the median household income for older persons was $20,761, representing 54 percent of the nation’s median household income.

Within this picture of relative prosperity, however, there are low-income persons with significant needs. Approximately 8 percent, or 6,500 persons age 65 and over in the Community, receive Medicaid assistance.

For the elderly, income data alone can be unreliable as a measure of financial distress or economic need. Many elderly may experience a reduction in real income as they age, but they may have other assets or personal wealth that ensures they are not in financial distress.

It should also be noted that there is not adequate data available to forecast future income levels for the elderly population in Fairfax. The high median income for working households may mean higher retirement incomes for "baby boomers" who are now approaching the last few years of their working lives, but data are currently not available to substantiate this conclusion. The future pattern of out-migration for this generation as they retire is also a major unknown, which could significantly affect future income distribution within age groups, as well as limit the ability to forecast numbers of people for age groupings over 65.

Income and Disability

In the Fairfax Community, persons with disabilities are disproportionately represented among low-income persons (See Table 2). While disability rates increase with age in all income groups, it is lower in all age groups for households with incomes over $41,000.

Table 2:

Population Percentages by Disability Status and Age
Within Income Group

Disability Status

0 – 17

18 – 34

35 – 54

55 – 64

65 up

Households with Incomes below $41,000 (below 50% of 2000 County median income)

With Long Lasting Condition

4%

7%

11%

19%

33%

No Long Lasting Condition

96%

93%

89%

81%

67%

Households with Incomes of $41,000 - $81,999 (50% to 100% of 2000 County median income)

With Long Lasting Condition

2%

3%

5%

9%

25%

No Long Lasting Condition

98%

97%

95%

91%

75%

Households with Incomes of $82,000 and above (100% of 2000 County median income and above)

With Long Lasting Condition

2%

3%

3%

4%

23%

No Long Lasting Condition

98%

97%

97%

96%

77%

Based on data from the 2000 Fairfax Falls Church Community Assessment
  • 33 percent of persons aged 65 and over who live in households with incomes of $41,000 or less have disabilities, compared to less than 25% with disabilities for persons aged 65 and over who live in households with incomes over $41,000.
  • For all persons under 65, the percentage of persons who live in households with income of $41,000 or less and have disabilities is two to four times the percentage of persons in higher income groups in this age range who have disabilities.
  • In addition, the 2000 Household Survey revealed that 21 percent of Fairfax residents with disabilities, age 21-60, are not in the labor force, compared to only 10 percent of residents without disabilities.

Mobility Issues

The need for assistance increases with the loss of mobility and access to transportation, especially automobiles. Nationally, according to the Administration on Aging, the population of disabled persons who do not drive (25 to 30 million) is significantly larger than the population of elderly who do not drive (8 million). Since these numbers are likely to grow, meeting the mobility needs of these persons is likely to present a major challenge.

The percentage of elderly without access to a vehicle in Fairfax is far less than the national rate. Based on the 1998 Household Survey data, less than 0.5 percent of persons age 60 and over do not have access to a vehicle, compared to over 19 percent of elderly nationally. These figures do not indicate whether or not a member of the household can actually drive, but only that a vehicle is available to the household.

The larger mobility issue is one of safety, particularly for a community such as Fairfax which is built around the use of the automobile as the primary mode of travel and an essential means to access almost any element of community life. There is a common perception of older driver safety problems, but a 2000 report from the federal Department of Transportation (DOT) indicated that the fatality rate remained reasonably level up to age 75, then begins to rise, climbing steeply for persons over 80.

Equally, if not more pertinent, is the issue of pedestrian safety. The DOT report also states that "pedestrians aged 70 and over represented over 9 percent of the population, but accounted for 17 percent of all pedestrian fatalities in 2000".

The need for transportation assistance may be greater for younger persons with disabilities than for the elderly, constituting a significant barrier to employment and higher income. The 1998 Household Survey reported that 16 percent of persons with physical or sensory disabilities use public transportation to go to work, compared to only 9 percent of persons without these disabilities. The availability of transportation may be a factor in the lower labor force participation rates among persons with disabilities noted above.

Living Arrangements

Living arrangements, particularly in the case of older persons living alone, are an indicator of the potential need for assistance. According to an analysis of 2000 Census data by the Administration on Aging:

  • Over half (55%) the older noninstitutionalized persons lived with their spouse in 2000. Approximately 10.1 million or 73% of older men, and 7.7 million or 41% of older women, lived with their spouse (Figure 3). The proportion living with their spouse decreased with age, especially for women. Only 28.8% of women 75+ years old lived with a spouse.
  • About 30% (9.7 million) of all noninstitutionalized older persons in 2000 lived alone (7.4 million women, 2.4 million men). They represented 40% of older women and 17% of older men. The proportion living alone increases with advanced age. Among women aged 75 and over, for example, half (49.4%) lived alone.
  • About 633,000 grandparents aged 65 or over maintained households in which grandchildren were present in 1997. In addition, 510,000 grandparents over 65 years lived in parent- maintained households in which their grandchildren were present.
  • While a relatively small number (1.56 million) and percentage (4.5%) of the 65+ population lived in nursing homes in 2000, the percentage increases dramatically with age, ranging from 1.1% for persons 65-74 years to 4.7% for persons 75-84 years and 18.2% for persons 85+.

Family Caregiver Issues

Nearly one in four US households provides care to a relative or friend age 50 or older. Nationally, relatives are estimated to provide 85 percent of the care for persons needing long term care assistance. The importance of family supports for persons needing long term care must not be overlooked. The National Academy on an Aging Society has reported that "50 percent of the persons with long term care needs and no family network are in institutions." But, in contrast, only "7 percent of the persons with long term care needs and access to family caregivers are in institutions." The ramifications of these two statements are profound, both for the recipients of assistance and for the family caregivers.

The American Society on Aging (ASA) reports that nearly three-fourths (72 percent) of caregivers are female, and the average caregiver is 57 years old, with more than one-third age 65 and over. The ASA estimates that nearly three-fourths of caregivers live with the care recipient, and 20-40 percent are in the "sandwich generation," caring for children under 18 in addition to a disabled older relative.

In the Fairfax Community, there are several trends that affect the availability of family members as caregivers.

  • The high percentage of women in the labor force in Fairfax (over 72 percent in 2000, compared to 59 percent nationally) constrains the availability of women as possible caregivers for family members. This situation may also add to the unmet demand for paid caregivers in the community.
  • The overall high labor force participation rate in Fairfax, nearly 79 percent compared to 66 percent nationally, also contributes to the labor supply shortage for home and personal care providers.
  • The continued trend toward smaller household size in Fairfax means that there are likely to be fewer family caregivers in the future. Household size in Fairfax has decreased from 2.75 in 1990 to 2.73 in 2000 to an estimated 2.68 in 2010.

The Paid Caregiver Work Force

The development of in-home medical technologies, substantial cost savings, and patients’ preference for care in the home have helped make this once small segment of the workforce one of the fastest growing in the US economy. The number of elderly persons is projected to rise substantially. In Fairfax, the elderly in 2000 account for 50% of persons needing ADL assistance, and by 2010, the percentage of elderly will increase to 56% due to faster growth in numbers of elderly overall and a higher rate of need with increasing age.

According to a 1998 report from the Bureau of Labor and Statistics, projected rates of employment growth for this industry range from 8% in hospitals, the largest and slowest growing industry segment, to 80% in the much smaller home health care segment. Health service occupations such as nursing and psychiatric aides, medical assistants, home health aides, and personal care attendants for younger disabled persons attract many workers with little or no specialized education or training. In fact, 56% of the workers in nursing and personal care facilities have a high school diploma or less, as do 24% of the workers in hospitals. In Virginia, 75 hours of training for certification of home health care providers is suggested but not required.

The median hourly wage of home health care providers is $8.71 per hour – working an average of 29.6 hours a week. Total annual earnings around $13,000, with monthly incomes around $1,030, no health benefits or reimbursement for travel to and from appointments, result in extremely high turnover for workers in this field. Given the average monthly rent of $1,129 for housing in Fairfax, the probability of an individual choosing home health care as their primary field of work is slim. Home health care occupations have one of the highest turnover rates due to low pay and status, poor benefits, low training requirements and high emotional demands of the work. Most home health aides work part-time on an on-call basis, have a second job, or live in a household where their income is supplemented by other members of that household.

Racial and Ethnic Diversity

As Chart 5 shows, the Fairfax Community’s older population is less diverse than those under 65 years of age, although it is likely that the older population will become more diverse over time if current population trends remain. Nationwide, minority populations are expected to comprise 25 percent of the elderly population in 2030. In Fairfax, that percentage is likely to be reached earlier.

Population Distribution by race

Language and Cultural Diversity

Fairfax is rapidly becoming more linguistically diverse as the percentage of persons speaking a language other than English at home has risen from 11 percent in 1980 to 19 percent in 1990 to 35 percent in 2000. While many of these persons speak English at home as well, the data presents challenges from the perspective of both service providers and service recipients.

Population and the Age of Housing Stock

For the Fairfax Community as a whole, 36 percent of the housing stock is 30 years old or more but in some areas, primarily those inside the Beltway, the percentages are much higher. Several of these areas are also among the highest in Fairfax in the percentage of residents 65 and over. (See Chart 6) Challenges in home maintenance, home repair, and home modification for persons "aging in place" are likely to arise if current trends remain.


Housing Stock chart


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