Gap Analysis of Home and Community-based Services for an Aging Population in the NWCCOG Region Michelle Kobayashi (michelle@n-r-c.com) National Research Center, Inc. March 23, 2017

Gap Analysis Methods Demographic Analysis Older Resident Survey Colorado Division of Local Government, State Demography Office US Census Demographic Analysis Mailed to 2,300 492 Completed, 23% RR, 4% MOE Older Resident Survey Email invites to 155 47 Completed Key Actor Survey Review of relevant reports/publications from 2011-2016 Secondary Analysis Health and human services directory (2-1-1), 2010 inventory, online searches and key actor report Facility Analysis

Aging In the NWCCOG region

2016 Total Populations 54K+ 30K+ 18K 15K 12K+ 10K 6K+ 1K+ Eagle County Summit County Pitkin County Grand County Steamboat Springs Glenwood Springs Carbondale Jackson County

2016 65+ Populations 9% 12% 17% 16% 23% 3K+ 5K+ 3K+ 2K+ 300 Eagle County Summit County Pitkin County Grand County Steamboat Springs Glenwood Springs Carbondale Jackson County

Population Projections 65+ 14,336 28,231 41,071 2050 2030 2016 The number of adults aged 65 and older in the NWCCOG region is predicted to double by 2030 and triple by 2050. However, not all counties are predicted to experience the same rates of growth. Eagle County is expected to see the most growth while Jackson County may see a decrease in its overall and older adult populations Eagle, Garfield, Grand, Jackson, Lake, Pitkin, and Summit Counties, Colorado Division of Local Government, State Demography Office, https://dola.colorado.gov/demog_webapps/pag_category.jsf 6

Projections NWCCOG 65+ 2016-2050 Eagle County: 274% Garfield County (Glenwood Springs/Carbondale): 217% Summit County: 199% Grand County: 163% Routt County (Steamboat Springs): 99% Pitkin County: 54% Jackson County: -22%

National Trends Impacting the Aging of Residents in NWCCOG Surge of Baby Boomers Increased ethnic and race diversity “Amenity migrants” and portable careers Second home ownership Cost of housing Need for community based services the Denver metro area, for instance, adds more than 1,000 new residents per week 66% second homes in summit county Nationally up 50% in 2014 – baby boomers like them Cost of housing – most of the housing mortgages/rents require 2-3 full time workers to support payment Median aspen 1.5 mil, vail 900K, summi/breck close to 600K, steamboat 500K, glenwood $400 winter park 300K

Community Livability

What parts of your community foster older adult aging in place? What parts most hinder it? Provide mental health counseling/or peer counseling

2 3 9 10 in in NWCCOG as a place to live Place to retire Excellent or good NWCCOG as a place to live Much higher than the nation 2 3 in Excellent or good Place to retire Likely to recommend their community Much lower than the nation

Strengths and Shortfalls Opportunities to volunteer Community safety Recreational opportunities Religious/spiritual opportunities Fitness opportunities Shortfalls Variety of housing options Cost of living Affordable, quality housing Affordable, quality mental health care Employment opportunities Financial and legal planning services We asked about 26 community characteristics Cost of living was not asked in 2010

Community Rating Trends Increases Financial and legal planning services Opportunities to attend social events/activities Opportunities to enroll in skill-building or enrichment Employment opportunities Decreases Affordable, quality housing Variety of housing options Affordable, quality mental health care Information about resources

Key Drivers Fitness opportunities Opportunities to volunteer Overall feeling of safety Opportunities to attend social events/activities Ease of travel by car Availability of preventative health care Availability of affordable food Variety of housing options Cost of living Place to live Place to retire Higher rated Lower rated

Regional Strengths and Challenges (Key Actors) Quality services/programs (67%) Community support/organizations (62%) Healthy community/physical environment (17%) Challenges Housing (37%) In-home care/homemaker services (30%) Physical environment/location (28%) Health care (26%)

Assisted living, community resources, transportation Single Change to Age in Place 37% 24% 10% 5% 2% Housing In home care Assisted living, community resources, transportation Health care Cost of living

Older Adult Needs

What are the biggest struggles for older adults in your community? Provide mental health counseling/or peer counseling

% minor,major or moderate problem Top Needs Not knowing services available Feeling like voice is heard Finding affordable health insurance 5 10 in Doing heavy/intense housework Staying physically fit Your physical health Getting health care needed Maintaining home/yard 4 10 in 44 different needs % minor, moderate or major in past 12 months Dealing with loss of family or friends Having enough money to meet expenses Having interesting social activities Having friends and family to rely on 3 10 in % minor,major or moderate problem

2 5 1 4 in in Finding affordable health insurance At least minor problem Finding affordable health insurance Adequate info for public programs Dealing with financial planning Having enough money to meet daily expenses 1 4 in Affording medications Finding work in retirement Enough money to pay property taxes

Affordable Housing Costs Jackson County Grand County Eagle County Summit County Pitkin County $1,331 $1,233 $1,194 $890 $695 21

NWCCOG Compared to Nation Finding affordable health insurance Getting the health care you need Financial issues Having friends and family to rely on Lower than nation on 31 issues

Health Is An Asset! Higher than the nation on … Ate 5+ Fruits and Vegetables per day Participated in Physical Activity Overall Physical Health Overall Mental Health Only area lower than the nation – days hospitalized

Top Issues Rated by Key Actors Experiencing confusion/forgetfulness Maintaining one’s home Having tooth or mouth problems Maintaining one’s yard Having enough money to pay daily expenses

Older Adult Service Inventory

What services for older adults does your community provide best? What services are absent or need reinforcement? Provide mental health counseling/or peer counseling

6 10 excellent or good in Overall services

Services Offered in NWCCOG Most Offered Services Immunizations Education, socialization, and recreational activities Fitness programs Volunteer opportunities for program participants Medicare, Medicaid and other health insurance counseling Education events (nutrition, crime, accident prevention, etc.) Home delivered meals Least Offered Services Day care for adults Caregiver mental health counseling Memory care/dementia support services Companion services Vocational training/older worker career job placement services Design guidelines to encourage senior friendly housing Temporary, alternative living arrangements LGBT (Lesbian, Gay, Bisexual, and Transgender) services Design guidelines to encourage "visitability" of senior households In terms of county-specific offerings, Garfield, Pitkin and Summit offered the largest variety of services (Table 22). These counties also had county-level senior agencies that serve as major clearinghouses of information, offer case management and conduct more extensive social and education programs. Grand County also provides a significant number of programs given its size. The more rural counties were able to offer fewer services to their aging residents. (See Appendix C: CASOA Results by County for more detailed findings on service delivery.) Garfield, Pitkin and Summit offered the largest variety of services

Secondary Data Analysis Gaps High cost of living, lack of housing options Supply Variety Affordability Undersupply of health care Medical Mental Dental Preventative

45% of Older Adults are Caregivers Caregiving in Region

Conclusions and Recommendations

Gaps Identified in Study

Opportunities Planning Collaborate with government, private sector and other CBOs to identify shared interests

Outreach, Education and Assistance Opportunities Planning Outreach, Education and Assistance Participate in activities aimed at systems change (policy advocacy, public education, networking)

Opportunities Education, Outreach and Assistance Planning Community Collaboration and Partnership Harness power of baby boomers to volunteer and contribute in meaningful ways

Opportunities Planning Outreach, Education and Assistance Community Collaboration and Partnership A Paradigm Shift: Older Adults as Resources Grant-writing

Use of Built Environment Opportunities Use of Built Environment Provide mental health counseling/or peer counseling

Opportunities Use of Built Environment Promotion of Healthy Lifestyles Provide mental health counseling/or peer counseling

Opportunities Promotion of Home and Community Based Services Use of Built Environment Promotion of Healthy Lifestyles Provide mental health counseling/or peer counseling

Recommendations Aging in Place GOVERNMENT PRIVATE SECTOR   COMMUNITY-BASED Organizations Aging in Place PRIVATE SECTOR  

Thank you! Michelle Kobayashi (michelle@n-r-c.com) National Research Center, Inc. March 23, 2017