Alaska Commission on Aging

Presentation to the

Alaska Mental Health Trust Authority

September 6, 2007

Overview

Our Mission, Members, and Activities FY 07 Accomplishments Characteristics of Older Alaskan

Beneficiaries FY 08 Budget Summary and Impacts FY 09 Budget Recommendations FY 09 Policy Recommendations Questions and Closing

Our Mission and Primary Activities

The Alaska Commission on Aging advocates for policies, programs, and services that promote the dignity and independence of Alaska’s seniors and help them maintain a meaningful quality of life.

The ACoA advances this mission by engaging in planning, advocacy, promotion of public awareness, and inter-agency coordination on behalf of all older Alaskans.

Alaska Commission on Aging Members: Banarsi Lal (Fairbanks) – Board Chair for FY 08 Frank Appel (Anchorage) Patricia Branson (Kodiak) – Provider Sharon Howerton-Clark (Homer) Tara Jollie (Anchorage) – DCED Designee – NEW (Aug. ’07) Lillian Boen Kasnick (Sitka) – NEW (Sept. ‘06) Betty Keegan (Wrangell) Iver Malutin (Kodiak) Rod Moline (Anchorage) – DSDS Designee Paula Pawlowski (Anchorage) – NEW (Sept. ’06) Ed Zastrow (Ketchikan) – Pioneers’ Homes Advisory

Board Chair

Staff: Denise Daniello, Executive Director MaryAnn VandeCastle, H&SS Planner II Lesley Bullock, H&SS Planner I (NEW) Administrative Assistant (currently vacant)

FY 2007 ACoA Accomplishments:

Completion of the Alaska State Plan for Senior Services, FY 2008-2011

Publication of “Report on the Economic Well-Being of Alaska Seniors”

Successful Advocacy for Senior Benefits, WWAMI Program Expansion, Flexible Long-Term Care Supports Budget

Over $9 Million in Capital Project Funding for Senior Centers, Pioneer Homes, AHFC Senior Housing, and Other Senior Programs

Successful Legislative Audit of the Commission Creation of the Alaska Aging Advocacy Network

Characteristics of the Alaska Commission

on Aging’s Beneficiaries

Older Alaskans by Age Group, 2001 - 2030

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

2001 2006 2010 2015 2020 2025 2030

60-64 65-74 75-84 85+

Urban and Rural Older Alaskans

67%

33%

Urban Rural

Older Alaskans by Race

76%

14%

2% 6% 2%

White Only Native Only

African-American Only Asian/Pacific Islander Only

Two or More Races

Alaska has the largest net out-flow of seniors of any state.

44.4

19.2

-6.0

-13.0

-23.5

-39.4

-40.0 -30.0 -20.0 -10.0 0.0 10.0 20.0 30.0 40.0 50.0

Mountain States

Southern States

Pacific States

Midwest States

Northeast States

Alaska

Net Interstate Migration per 1,000 Seniors (65+), 1995 to 2000

Older Alaskans have higher mean and median incomes than U.S. seniors – without adjusting for cost of living.

U.S. TotalPopulation U.S. Seniors

AK TotalPopulation AK Seniors

Mean

Median

$17,100

$14,410

$22,000

$17,085

$27,182

$24,519

$30,187$28,717

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

Per Capita Incomes, Alaska and U.S.

Mean Median

The percentage of seniors receiving Senior Care cash benefits varied considerably by region of residence.

48.1 51.9

35.4 64.6

24.6 75.4

17.8 82.2

14.8 85.2

14.4 85.6

13.6 86.4

13.5 86.5

11.8 88.2

11.6 88.4

0 10 20 30 40 50 60 70 80 90 100

Western

Northwest

Southwest

Aleutians

ALASKA AVERAGE

North Slope Borough

Anchorage

Interior

Southcentral

Southeast

Seniors 65+ Receiving SeniorCare Benefits, April 2007

Yes No

Alaskans’ life expectancy is below the median among U.S. states.

1. Hawaii – 79.8 years 2. Minnesota – 79.1 years 3. North Dakota – 78.7 years 29. Alaska – 76.7 years 49. Louisiana – 74.4 years 50. Mississippi – 73.7 years 51. District of Columbia – 72.6 years

Older Alaskans have higher suicide rates than U.S. seniors as a whole.

Ages 55 to 64Ages 65 to 74

Ages 75 to 84

U.S.

Alaska

18.5 19.6

22.3

13.8

12.7

16.4

0

5

10

15

20

25

Senior Suicide Rates Per 100,000

U.S. Alaska

But older Alaskans have lower overall age-adjusted death rates than U.S. seniors.

Ages 55 to 64Ages 65 to 74

Ages 75 to 84Ages 85 and

Over

Alaska

U.S.

940.92,255.0

5,463.1

14,593.3

761.02,117.8

4,935.9

11,565.2

0.0

2,000.0

4,000.0

6,000.0

8,000.0

10,000.0

12,000.0

14,000.0

16,000.0

Age-Adjusted Death Rates (Per 100,000) by Age Group

Alaska U.S.

Top Causes of Non-Fatal Hospitalized Injuries for Alaskans Age 65+

1. Falls 2. Motor Vehicle Accidents – Occupant 3. Suicide Attempts 4. Water Transport Accidents 5. Snow Machine Accidents 6. Motor Vehicle Accidents – Pedestrian 7. Assaults 8. Hypothermia/Frostbite 9. ATV Accidents; Cuts (TIE) 10. Machinery Accidents

Falls Impact Seniors More Than Other Alaskans.

93.9

129.3

184.6

0

20

40

60

80

100

120

140

160

180

200

Alaska All-Age Average Alaska Age 65-74Average

Alaska Age 75+Average

TBI Cases per 100,000 Population

Some 4,919 Alaskans age 65 and older, or 10.8% of that age group, may have Alzheimer’s Disease and Related

Dementias (ADRD), based on national prevalence rates.

Estimated Number of Alaskans Age 65+ with ADRD

553, 11%

1,784, 36%

2,582, 53%

Age 65 to 74 Age 75 to 84 Age 85+

Alaska seniors are more likely to drink heavily and

to smoke than are U.S. seniors as a whole.

2.9 3.3 3.0

5.2

8.8

13.8

0

2

4

6

8

10

12

14

Heavy Drinker Binge Drinker Current Smoker

Percent Alaska & U.S. Seniors with Selected Health Risks (BRFSS)

U.S. Senior Alaska Senior

Seniors with mental illness may be almost invisible. An estimated 18.5% of seniors suffer from depression – that’s as

many as 13,261 Alaskan seniors. Some Canadian research indicates significantly more depression among those living in cold, dark environments.

An estimated 26.2% of all American adults suffer from a diagnosable mental disorder in a given year – that’s 18,769 older Alaskans.

But older persons with a mental illness rarely seek treatment for the disease. They may not recognize the symptoms, or may fear that it indicates a character flaw that could stigmatize them.

Many people (seniors and caregivers) incorrectly assume that depression is a normal part of aging.

Nationally, the number of elderly mentally ill is projected to almost quadruple from

1970 to 2030.

“A national crisis in geriatric mental health care is emerging. The present research infrastructure, health care financing, pool of mental health care personnel with appropriate geriatric training, and the mental health care delivery systems are extremely inadequate to meet the challenges posed by the expected increase in the number of elderly with mental illness.”

-- Archives of General Psychiatry,

September, 1999

FY 08 Budget Summary and

Impacts

FY 08 Budget Summary and Impacts: Senior Benefits Program – new, enhanced program is a major

improvement over previous Senior Care program – provides monthly cash to low-income seniors, including Trust beneficiaries and potential beneficiaries, to help pay costs of food, fuel, medicine, housing, and other basic needs

Flexible Long-Term Care Supports – added $125.0 to budget base for total of $250.0 to support HCBS for seniors with ADRD cared for at home by family and friends

WWAMI Program Enhancement – legislation doubled the number of slots for Alaskans in the WWAMI medical school program from 10 to 20 per year – will increase the number of physicians practicing in Alaska, helping prepare the state to address the health care needs of Alaska’s growing senior population

FY 09 Budget and Policy

Recommendations

FY 09 Budget Recommendations:

1. FACES – Family and Community Elder Supports (Senior HCBS Grants Increment)

2. Senior Crisis Intervention Services 3. SOAR Project (Senior Outreach,

Assessment and Referral) 4. Primary Care Clinics – Alaska Primary

Care Association 5. Healthy Body, Healthy Brain Campaign 6. Senior Fall Prevention

1. FACES (Family and Community Elder Supports) $1,500.0 in GF/MH for HCBS senior grants increment – to

provide additional funding for existing grant services, including home-delivered meals, congregate meals, assisted and unassisted transportation, care coordination, adult day services and education, respite care, chore service, and family caregiver support

Services help seniors remain in their own homes and communities as they prefer, help prevent the development or progression of disease and disability, and prevent the need for much more costly nursing home care

Alaska’s senior population has increased dramatically in the past decade and will continue to do so over the next 25 years – but state funding for services has declined per capita\

Average costs of grant-based services per seniors is less than one percent of the cost of nursing home care

Senior Grant Funds Have Not Kept Pace with an Increasing Population

Grant Funds for Senior Services (in 2006 Dollars)

$0.00

$2,000.00

$4,000.00

$6,000.00

$8,000.00

$10,000.00

$12,000.00

$14,000.00

$16,000.00

$18,000.00

FY 1997 FY 1998 FY 1999 FY 2000 FY 2001 FY 2002 FY 2003 FY 2004 FY 2005 FY 2006

State Grant Funds Total Grant Funds

Alaska Senior (Age 60+) Population

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

FY 1997 FY 1998 FY 1999 FY 2000 FY 2001 FY 2002 FY 2003 FY 2004 FY 2005 FY 2006

Per Capita Expenditures for State Grant-Funded Services, in 2006 Dollars, Have Decreased by Over One-Third in the Past Decade.

Per Capita Expenditures Per Senior (in 2006 Dollars)

0.15

0.14

0.14

0.180.170.170.18

0.220.200.20

0

0.05

0.1

0.15

0.2

0.25

FY 1997 FY 1998 FY 1999 FY 2000 FY 2001 FY 2002 FY 2003 FY 2004 FY 2005 FY 2006

Cost of Providing Grant Services is Minimal Compared with Nursing Home

Costs.

$735

$20,297 $21,592

$121,031

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

Grant Recipient PCA Recipient Waiver Recipient Nursing HomeResident

Average Annual Costs of Long-Term Care Options, FY 06 (DSDS)

A recent senior provider survey paints an alarming picture.

6 %

94 %12 %

88 %

53 %

47 %

18 %82 %

0 10 20 30 40 50 60 70 80 90 100

Had difficulty attracting qualifiedemployees?

Had to cut back on employeewages or benefits?

Had to use emergency funds tocontinue services?

Had to cut or cut back onservices due to lack of funding?

Since FY 2000, Has Your Agency:

NO YES

Unit costs for services are rising significantly.

2006 Average Unit Costs: Congregate Meal -

$14.21/meal Home-Delivered Meal -

$15.73 / meal Assisted Transportation -

$18.61 / ride Unassisted Transportation

- $13.78 / ride Family Caregiver Support

- $34.23 / hour Chore/Homemaker -

$18.40 / hour Adult Day Service -

$115.65 / day15.72

14.43

47.5425.05

23.41

5.64

19.71

0 5 10 15 20 25 30 35 40 45 50

Adult Day Services

Chore/Homemaker

Family Caregiver Support

Unassisted Transportation

Assisted Transportation

Home-Delivered Meals

Congregate Meals

Percent Increase in Unit Cost, 2003 - 2006

EXAMPLE: Grant support for ADRD education and support has remained the same for the past decade.

FY 1998: $115,000 FY 2008: $115,000 Includes outreach, information and referral,

awareness presentations, support groups, education for professionals, etc.

Meanwhile, Alaska’s senior population has grown by approximately 60%

2. Senior Crisis Intervention Services $500.0 in GF/MH for crisis intervention for mentally

ill seniors in Pioneer Homes and assisted living facilities, and training for assisted living home administrators

Providers report increasing cases of severe mental illness (most previously undiagnosed) among residents – dozens in the Pioneer Homes alone; facilities are not properly staffed or licensed to provide adequate care for these individuals; only nine assisted living homes statewide are appropriately licensed to care for mentally ill seniors (all located in the SouthCentral region)

3. SOAR Project (Senior Outreach, Assessment, and Referral) $300.0 for outreach, assessment and referral services targeted to the

unique needs of seniors, coordinated statewide, with special focus on six communities (a mix of regional hubs and urban centers)

Senior centers and other service providers are reporting an increase in aggression and substance abuse among seniors; isolation, depression, and other mental health problems among those who do not attend any programs are also thought to be increasing

70 to 75 percent of seniors who commit suicide saw a primary care provider in the month preceding their deaths

Will work with Division of Behavioral Health to provide a statewide coordinator and community clinicians in six communities; in conjunction with community gatekeepers, they will identify vulnerable seniors and connect with them to provide assessment and referral to treatment resources; they will also do community education and work with primary care providers to increase behavioral health screening opportunities

Project staff will collect data on clients, services provided, individuals trained, and services that are needed but unavailable in their communities

4. Primary Care Clinics $350.0 GF/MH appropriation for the Alaska Primary Care Association for

help in providing primary care to seniors, many of whom cannot find a primary care provider outside the Community Health Center system

The inability of many Alaska seniors on Medicare to find a primary care physician reached epic proportions in the past year, receiving statewide news coverage and triggering a special Congressional hearing in February 2007. Private physicians claim that Medicare’s reimbursement rate is too low.

As the number of seniors in Alaska increases, and the state continues to attract too few physicians, this problem is likely to grow.

CHCs do not turn patients away, regardless of their ability to pay or their coverage by Medicare. CHCs do offer a sliding fee scale and encourage patient responsibility.

In 2005, Alaska’s Community Health Centers served 5,468 seniors age 65 and over – 7 percent of the patients seen. This number was up 12 percent from 2004.

Alaska is one of 14 states that does not currently provide any direct funding for Community Health Centers

With sustainable funding, the CHCs can continue to increase the number of patients and encounters

5. Healthy Body, Healthy Brain Campaign Enhancement $150,000 in GF/MH to expand the Healthy Body, Healthy Brain

Campaign to offer healthy lifestyle programs at fifteen senior centers or community health centers

Received $25,000 in MHTAAR for FY 08/09 for a public awareness campaign to alert baby boomers and seniors to the lifestyle connection to ADRD risk; in process of producing posters, bus signs, bookmarks, and ads to bring this message to the public

Fifteen $10,000 grants to senior centers or community centers would assist them in providing programs that reward physical activity, healthy eating, mental challenges, and socializing with friends.

6. Senior Fall Prevention $200.0 in GF/MH to support fall prevention activities in rural Alaskan

communities with the Alaska Brain Injury Network and Behavioral Health

The highest percentage of brain injury survivors in Alaska are seniors age 75+

Falls are the #1 cause of brain injury in seniors. Reasons for falls may include: medications affecting perception and balance medical conditions that make falls more likely (visual limitations,

orthopedic problems, etc.) and external factors such as lack of exercise, improper footwear, and

hazards in the home Physical changes in older individuals make their brains more

vulnerable to injury and reduce their chances to recover The only “cure” for a brain injury is prevention

Advocacy Strategies Engage the Alaska Aging Advocacy Network – a committed

group of about 130 senior advocates Coordinate with senior providers and assisted living home

administrators to invite legislators to their agencies to directly observe clients, programs, and services

Team up with AARP, AgeNet and the Trust to educate legislators about the need for services through meetings, support letters, and legislative committee presentations

Encourage letters to the editor, op-ed articles, Senior Voice coverage, and highlight issues in the ACoA newsletter

FY 09 Policy Recommendations: A. Support Alaska Commission on Aging “sunrise” legislation and

associated statutory changes B. Begin statewide broad-based strategic long-term care

planning process C. Create a brain-based disorders (ADRD, TBI) Medicaid waiver D. Support equitable Medicaid waiver rates (underway) E. Consider Long-Term Care as a future focus area for the Trust

to benefit all beneficiaries F. Support for the Trust’s advocacy priorities including the

Housing Trust and Workforce Development initiatives

Thank you.

Questions?