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Lending a hand: State’s growing senior population requires more services, and is stretching every dollar to meet the needs of its residents

Gene Walsh/Journal Register News Service
Caregiver Gina Bufo, right, supports West Norriton resident Marion Philomeno walk to her kitchen for dinner. Bufo is with Montgomery County’s Department of Aging and Adult Services.

NORRISTOWN - No matter how you look at the statistics for aging Pennsylvanians and the elderly population in Montgomery County, there is a growing need for multi-faceted elder care services, improved medical support systems and targeted funding for the elderly in Montgomery County.

There are about 160,000 residents of Montgomery County who are 60-years-and-older, according to a two-year-old study by the Public Health Management Corp. of Philadelphia. That 160,000 total represents 22 percent of the older people in the five-county (Montgomery, Bucks, Delaware, Chester and Philadelphia counties) area, said Allen Glicksman, the director of research and evaluation for the Philadelphia Corp. for Aging.

By population, Pennsylvania has the third highest number of elderly in the U.S., trailing California and Florida. By median age, Pennsylvania is ranked fifth at 39.5 years, trailing behind Maine (41.1 years). Vermont (40.4 years), West Virginia (40.2 years) and Florida (39.6 years), according to the U.S. Census Bureau.

Starting in 2012, nearly 10,000 Americans will turn 65 each day or 330 per hour. Baby boomers, who ranged in age from 42 to 60 in 2006, represent one-half of the U.S. workforce. The number of workers age 55 and over is growing four times faster than the workforce as a whole.

Because Pennsylvania is facing a $4 billion budget shortfall in 2011, it is difficult to predict whether elder funding for a variety of services will remain in place.

The Montgomery County Aging and Adult Services (MCAAS) department had an annual budget of $25 million this year, said MCAAS Executive Director Joanne Kline. The 107-employee department has four district offices. A $14 million block grant from federal and state funds represents slightly more than half of the annual budget.

A roster of 129 contracted companies with large staffs provide home-delivered meals, senior centers, skilled nurses and a variety of other social services.

The department provides information and referral services, an 'options' program that can assess a senior's living situation, health and in-home services, a family caregiver support program and various in-home services for the elderly.

The department has dramatically increased its Medicaid "waiver" program for the low-income elderly who need in-home services. In 2005, the department had about 50 elderly recipients who got home visits from nurses on a regular basis under the waiver program.

"In 2010, we have 575 client cases in the program, Kline said. "Care can range from two to four hours, once a week of personal care, bathing and dressing up to 7 to eight hours of care, seven days a week."

"There is a waiting list for in-home care because there are not enough lottery dollars," said Kline.

The boost in the amount of in-home elderly services provided by MCAAS came after the federal government pointed out that Pennsylvania was ranked 49th in spending for home care services in 2005.

"The federal government said, 'do a different job. You need to spend more money' for home care," Kline said, "and we have done a much better job."

As a suburban and fairly-rich county demographically, Montgomery County has unique attributes and problems that require customized elderly services. Large older homes located in neighborhoods without sidewalks or bus service make mobility solutions and adaptive construction a priority. The popular, two and three-story 55-and-older communities that attract older persons now require 1st-floor bathroom modifications and transportation to both medical services and routine shopping for the elderly.

Montgomery County does not have a cross-county bus system or connecting service to many of the western townships in Montgomery County.

Personal inertia for both the elderly and their families can prevent them from implementing the necessary advanced directives, living wills and power of attorney documents. Adequate savings for retirement, medical care and emergencies can also be washed away over the years by lay-offs, illnesses and the immediate needs of children.

The 2000 U.S. Census had more bad news for the elderly in Montgomery County. The census said that 33,494 older adults (over 65) in the county, 32.1 percent, had a reported disability. And 26.8 percent of those older adults had an annual income less than $20,000. In 1999, 4.8 percent of those older adults had an income that was less than the federal poverty level. It is not surprising that income assistance was the fourth highest need in surveyed older Montgomery County residents, according to a MCAAS four-year plan (2008-2012). The top three were transportation, health care and affordable housing, in that order.

The MCAAS staff ranked home health care, mental/physical health and home maintenance as some of their top priorities. An advisory council and community meetings both ranked home health care as the top priority.

"I'm very concerned about the pople who are not calling us for help. Sometimes services can be paid through a waiver program, long-term care insurance or a sliding scale fee," Kline said. "The department can do an assessement of the person, the home and the family situation."

Glicksman sees "a complex future in terms of creating services that can benefit all older citizens."

"The biggest change is that seniors are becoming more diverse in income, race, health status and age," Glicksman said. "You will have more people who are frail, who need services, have a low income and with multiple illnesses.

At the same time, there will be a group who are more rich, more healthy and more educated in the county. That puts two kinds of strains on the system."