Aging in Rural Missouri

@ma4voice

A Voice For Seniors

• ma4 provides a voice for seniors across Missouri

• We work everyday to speak for those who cannot

• There is a true need to keep our voice strong and to chart new directions

• The need will only grow

The Area Agencies on Aging

Board= Director from Each

AAA

A Committed Board – They Meet Monthly

Staff

• We are a lean operation - efficient

• Staff = The Executive Director

 

 

 

  

…..and the mouse in my pocket

 

 

 

  

So What Do We Do?

MA4 is dedicated to providing service, information and advocacy to improve the lives of older Missourians.

The Challenge: Funding Trends

 Missouri Funding Trend Chart

2008- 2015

Missouri’s Rural Counties101 rural counties

Population density over 150 people per square mile orContains part of the central city of a census-defined Metropolitan Statistical Area (MSA)

14 urban countiesBoone, Buchanan, Cass, Clay, Cole, Greene, Jackson, Jasper, Jefferson, Newton, Platte, St. Charles, St. Louis, and St. Louis City

37% of Missouri population50% of Missouri seniors

Services to Rural Seniors

Statewide

•No 37.4% 48547

•Unk 2.9% 3,767

•Yes 59.7% 77,556

No 37.4%Unk 2.9%Yes 59.7%

Total: 100.0%

DistinctCount of NapisID / Rural

Health Care in Rural Missouri

• 98 of 101 rural counties are primary medical care Health Professional Shortage Areas

• 98 of 101 rural counties are primary care mental Health Professional Shortage Areas with ratios of licensed psychiatrists of at least 20,000 to 1

• 99 counties are dental Health Professional Shortage Areas

• Five rural counties in 2014 have no dental licensees, and 11 counties have no hygienist licensees

Missouri Seniors – Overall Comparison

• In 2013 Missouri ranked 33rd for the health of its seniors.

• In 2013 Missouri ranked 47th for the percentage of seniors who saw a dentist in the last year.

• In 2009 45% of Missouri seniors lived alone.

• In 2009 over 1 in 5 Missouri seniors lived at or below 150% of the poverty line of $21,855 for a 2-person household.

Missouri’s Seniors (2011)

Rural Seniors Urban Seniors66% 66% Live with family members

Some Differences:

11% 20% Graduated from college

11% 7%Have household income below poverty level

$20,668 $31,286 Average annual earnings

5.3% 4.5% Receiving SNAP benefits

Chronic Disease Among Missouri’s Seniors

Rural Seniors Urban Seniors54% 56% High cholesterol (2011)

29% 25% Obese (2011)

21% 22% Diabetes (2011)

124 113Deaths per 10,000 population for diabetes (2012)

ER Usage/Mortality Among Missouri’s Seniors

Rural Seniors Urban Seniors

4.3 2.9ER Visits per 1,000 population for diabetes (2012)

5.6 2.9ER visits per 1,000 for cerebrovascular disease (stroke) (2012)

295 287Deaths per 10,000 from cerebrovascular disease (stroke) (2012)

7.5 6.6ER visits per 1,000 for hypertension (2012)

55 50Deaths per 10,000 from hypertension (2012)

35 25 ER visits per 1,000 for heart disease

31 24 Deaths per 10,000 from heart disease

Mental/Neurological Health in Rural Missouri

Rural Seniors Urban Seniors

171 161Reports of senior abuse per 10,000 (2011)

17.1 14.7Suicide rate per 100,000 for age 65+ (2001-2011)

25.8 10.3Deaths per 100,000 from Alzheimer’s Disease

Health Care Access in Rural Missouri

Rural Counties

Urban Counties

76 90 Licensed hospitals

2.5 4.8 Hospital beds per 1,000 residents

23 86 Licensed ambulatory surgical centers

4.6 13.1Primary care physicians per 1,000 seniors

2,969 1,503 Residents per licensed dentist

Health Care Costs in Rural Missouri

• Medicaid long-term care costs averaging $237 per 1,000 - 200% of costs for urban seniors

• Average Medicaid costs of $1,365 per senior – over 140% of the average for urban seniors

• 58,309 ER visits for dental complaints in 2012 at a cost of ~$17.5 million

• 82,000 ER visits for mental disorders in 2012

Profile of a Senior in Rural Missouri• Has household income of $20,668

• Lives in a medical, mental health, and dental care shortage area

• Is 2.5 times as likely to die of Alzheimer’s Disease as urban counterparts

• Is more likely to visit an ER for a chronic disease

• Is 50% more likely to visit an ER overall

• Is more likely to commit suicide or to be abused

• Generates twice the Medicaid long-term care costs

• Generates 40% more Medicaid costs overall

Older Americans Act

• It was for seniors like these----that the Older Americans Act was passed 50 years ago

• Established basic nutrition programs

• Created planning and service areas

• Created network of AAA’s

So What Can AAAs Do

Nutrition is Still Key…..But

• From 2008 to 2014, State funding for AAAs dropped 19%.

• The cost of home-delivered meals increased 51% from 2008 to 2014.

• Malnutrition is associated with chronic health conditions and the need for (and cost of) long-term care.

• A need for increased funding.

Specific Needs - Transportation

• Transportation

• Medical appointments

• Extensive trips to Dialysis clinics

• Difficult to find and get to some addresses

• Roads in very poor condition

Specific Needs – Health Care

• The availability of physicians and primary care

• The availability of Rehab facilities

Specific Needs - Housing

• Adequate housing

• Alternative housing

• Affordable housing

• Property tax

• How to pay for needed repairs and modifications

Specific Needs – In Home Assistance• Access to meal delivery

• Not able to deliver daily

• Availability of in home care and long-term care

Specific Needs – Health Conditions

• Blindness and Visual impairment

• Alzheimer’s, dementia, mental health issues

• Depression

• Dental needs

Specific Needs - Financial• Elderly poverty

• Cost of healthcare and medications

• Energy costs

• Social Security remaining intact

• Food costs

• Financial abuse

Solutions to Barriers

• Transportation Opportunities

• Access to Information Services - allows for the design of the least restrictive (and often less expensive) care plan

• Medicare Boot Camps – Benefits Counseling – ACA Navigator Services

• Access to on-line health information

• Mental Wellness Partnerships

• Health and Wellness programs

• Distance Dining – Frozen meal programs

Finding a New Road

Finding a New Road

Additional Sources of Revenue