11 “…to raise new ideas and improve policy debates through quality information and analysis on issues shaping New Hampshire’s future.” Board of Directors Todd I. Selig, Chair David Alukonis Michael Buckley William H. Dunlap Sheila T. Francoeur Stephen Reno Stuart V. Smith, Jr. Donna Sytek Brian F. Walsh Kimon S. Zachos Martin L. Gross, Chair Emeritus John D. Crosier, Sr., Emeritus Mapping the Aging Maze AGING IN COMMUNITY: What ’ s Being Done to Prepare? Thursday, August 25, 2011 Steve Norton, Executive Director NH Center for Public Policy Studies

2 The Past

333 Here’s a basic overview of New Hampshire’s population according to the Census data from Not many surprises here. The most densely populated areas are in the state’s southern areas, particularly Rockingham, Hillsborough and Merrimack counties. The highest population centers are in and around Manchester and Nashua, with pockets of density scattered in the cities. The North Country remains sparsely populated. Total state population increased 6.5 percent since 2000, with 1.3 million people now calling New Hampshire home. But let’s look at how that population has shifted over the past decade…..

44 This map details where the growth and loss in population, town by town, occurred since Some obvious points: the biggest increases came in Hillsborough and Rockingham counties. We can also see the influence that Interstate 93 has on population growth over the past decade. Other pockets of large increase: the Conway and Plymouth regions, the Lakes Region and the Upper Valley. We’ll return to those later. And while nearly every region saw some increase in population, the declines were focused largely on the North Country.

55 But while the overall state population increased, the number of school-aged children fell: a loss of more than 22,000 students, or a 7 percent decline since As this map shows, that drop was spread across the state, with a few towns gaining in school-age population. But flip back to the previous map. You’ll see that many of the areas that had the biggest gains in total population saw a decline in their school-aged numbers: portions Hillsborough County and the Rochester area, for instance. How might that trend shape discussions about education spending, both at the state and local level? More broadly, policymakers will have to consider what steps to take to build the education system in a state where the student population is declining.

66 Numbers released earlier this year offered an overview of the state’s population, but the recent figures provide a more detailed portrait. For instance, this map plots the median age of New Hampshire’s cities and towns. The darker the shade of the community, the older the median age of its residents. (The statewide median age was 41.1 in 2010, up from 39.3 in 2000.) New Hampshire can essentially be divided into two regions when it comes to age: an older half north of the Lakes Region, and a younger half below. But even in the “younger” half, there is a further subdivision, with the region between Interstate 93 and the Seacoast significantly younger than the western portion. How might those divisions shape future policy discussions related to health care, education and public spending? (White areas of the map are unincorporated areas for which the Census Bureau did not release information.)

7 This map plots the oldest segment of the population – those aged 85 and older – town by town. (Statewide, 1.9 percent of New Hampshire’s population was 85 or older in 2010.) The darker communities, those whose populations included a higher share of elderly residents, will face additional challenges in the coming years to care for that population. The pressures will be felt in healthcare expenditures, in municipal budgets, and in familial and community ties. As New Hampshire ages faster than the national average, these communities will pave the way for much of the rest of the state in coming years.

8 Here come the baby boomers ….

9 Why is it Difficult to Predict What’s Going to Happen in the Future? Patterns (Migratory) Change

10 Myth #1 We are a state of natives who have been living here for 100s of years? Source: 2000 Census

11 Migration

12 We’re still growing – but slower Percent Change in NH Population 8.5% 13.8% 21.5% 24.8% 20.5% 11.4% 6.9% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% U.S. Census figures released in December show that the 2000s saw the slowest rate of population growth in New Hampshire in six decades. Later this year, the Census Bureau will release specific population figures for counties and communities. What will those numbers tell us about the state’s demographic patterns over the past decade? And what will they mean for the redrawing of electoral districts in the New Hampshire Legislature later this year? Source: New Hampshire Center for Public Policy Studies, analysis of U.S. Census data

13 Myth #2 We are OLD? Median Age Oldest? Maine = 42 Youngest? Utah = 29 Average of US = 37 New Hampshire = 40 NH Rank = 42 Percent Over 65 Oldest? Florida = 17% Youngest? Alaska = 7% Average of US = 13% New Hampshire = 13% NH Rank = American Community Survey 3-Year Estimates 2008 Census Population Estimates

14 Are we old? Not yet, but getting there …

15 Significant variation from community to community in the share of the population over the age of 65

16 The new 60? Significant growth of the population

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18 Elderly Poverty Rates are Higher in the North

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21 What do the baby boomers want? World War II cohort (born from 1928 to 1945)World War II –Key characteristics: conformity, conservatism, traditional family valuesconservatism Baby Boomer cohort #1 (born from 1946 to 1954)Baby Boomer –Key characteristics: experimental, individualism, free spirited, social cause oriented Generation Jones or Boomer cohort #2 (born from 1955 to 1964) –Key characteristics: less optimistic, pragmatic, general cynicism Generation X cohort (born from 1965 to 1980)Generation X –Key characteristics: quest for emotional security, independent, informality, entrepreneurial Millennial Generation cohort also called Generation Y (born from 1981 to 2001)Millennial Generation –Key characteristics: quest for physical security and safety, heightened fears, acceptance of change, technically savvy, environmental issues Source: William Strauss and Neal Turning “Fourth Turning”

22 Aging and the Healthcare System - Simulations

23 Health Care Market Impacts?

24 Medicare will play a growing role in driving the healthcare system

25 Workforce Issues

26 The Caregiver Crunch

27 … varies by community

28 The Workforce Is Aging As Well!

29 Capacity Questions Home Health Home and Community Based Care slots Geriatric hospital services Assisted Living Facilities Alzheimers Support (Hospital, Nursing Homes) Prisons Inpatient versus Outpatient services

30 With all this pressure, the system structure will have to change, right?

31 What’s the Care Continuum? Physician (general) Physician (spec) Outpatient (ASC, Other) InpatientLTC Community Institution

32 And the LTC system?

33 Home Health Providers Hospitals Nursing Homes Hospice Physicians

34 Acute Medical Chronic Medical Community Based LTC Assisted Living Nursing Home FFS PCCM P4P Capitation Care Continuum, Care Management and Reimbursement Hospitals Home Health Care Nursing Homes

35 Acute Medical Chronic Medical Community Based LTC Assisted Living Nursing Home FFS PCCM P4P Capitation Care Continuum, Care Management and Reimbursement What does an LTC ACO look like?

36 Want to learn more? Online: nhpolicy.org Facebook: facebook.com/nhpolicy Our blog: policyblognh.org (603) “…to raise new ideas and improve policy debates through quality information and analysis on issues shaping New Hampshire’s future.”