Senior Services and Support
Being mindful of a growing population with increasing needs
Tracy Bradshaw is shown participating in a Paint Night fundraiser at the Denali Center.
By the year 2034 Alaska’s overall population is expected to grow by nearly 25 percent, and the senior demographic is predicted to more than double in size as the state’s Baby Boomer generation ages, hitting the 65-year-old mark.
As of 2009, according to the Alaska Department of Labor, seniors represented 7.5 percent of the state’s population, but that number will likely hit 14.5 percent by 2034. Currently, according to the US Census Bureau, 10.4 percent of the state’s population is more than 65 years old.
But it’s unlikely today’s range and depth of services for the state’s growing senior population will double in size and keep pace given government funding cutbacks, a declining healthcare workforce, shaky economic tailwinds, and an increasing need for housing and additional support care services.
Denali Center resident Bernadette King is shown dancing with volunteer Tony Karl at Denali Center’s annual prom.
State, Federal Grant Funding in Play
The state of Alaska, at present, services more than 11,000 seniors (age 60 or older) via community based, senior focused grant programs. The grants are extensions of national Title III funding via the Older American’s Act, which is provided to all US states.
The funding pays for a slew of needs, from meals, transportation, case management, respite support, information, and assistance and adult day care to education and training for caregivers regarding Alzheimer’s disease. The state provides a sliding scale fee for some services, but for most clients the lone eligibility requirement is being least 60 years old.
“These programs provide assistance to seniors and their care givers so they can remain independent and in their homes longer,” says Lisa Morley, Grants Unit manager at Senior and Disability Services of the Alaska Department of Health and Social Services.
“Sometimes a senior needs a meal or someone to help them with chores; without this help they might have to move into an assisted living home, which is very expensive and causes them to use up their resources, and eventually they have to go on Medicaid, even if they weren’t before.”
State and federal grants support many local nonprofit agency programs providing care to Alaska seniors who do not meet level of care or income eligibility for the Medicaid Waiver program.
The most commonly supported programs, according to state officials, are nutrition, transportation and support for senior in-home care and family caregivers, and Medicare counseling and outreach, as well as legal assistance, meal delivery, and nutrition education. Thirty-six state grantees are providing all or some of these services, often through senior centers.
Grant funding also supports in-home senior services, ranging from case management to respite, provided by fifteen grantees. In addition, nine grantees are providing family caregiver support services. A dozen grantee funded programs are providing adult day services. Grant funding also supports rural assisted living homes in three communities: Dillingham, Galena, Tanana.
Yet while state and federal funded services are robust, local senior care facility operators, care homes, and medical centers providing senior support programs say the increasing client population and need for services presents a real challenge.
Midnight Sun Home Care Staff plan care with a client.
Community Level Senior Services
The community of Ketchikan is one such example. According to state data, Ketchikan’s population as of mid-July 2016 was 13,746—with 14 percent (1,945) age 65 or older. The senior segment grew to that figure, from a starting point of 10 percent, between 2010 and 2016.
A big trend in play regarding the demand for senior services, according to Mischa Chernick, manager of communication and engagement at PeaceHealth Ketchikan Medical Center, is that more seniors want to remain local than move away or retire south.
“More people are remaining in the community through the end of their lives and more Baby Boomers become seniors each and every day,” says Chernick.
The center provides several direct services for seniors, including a twenty-nine-bed long-term care unit offering skilled-nursing care and home health services and stabilizing or improving a short-term or chronic health condition. It also offers primary, internal medicine, and surgical care as well as a palliative care program for patients diagnosed with life-changing medical issues and a volunteer hospice program.
At critical access hospitals, patient stays are limited to four days or fewer; otherwise patients need to be transferred to an off-island acute care hospital, long-term care, or assisted living facility, explains Chernick.
“If the patient can be released from the hospital, but still needs care that is beyond what the family is able or willing to provide, the patient’s options locally are limited to PeaceHealth Ketchikan’s long-term care unit or the Pioneer Home, both of which are operating at capacity with long waiting lists,” she says.
In many cases home healthcare or additional in-home supportive care from community organizations or volunteers become the only answer for many older local residents.
That scenario, says Chernick, often leaves family caregivers in the position of providing care they do not feel prepared or equipped to provide; they are often worn out and feel unsupported.
“As more seniors decide to stay in Alaska through the end of their lives, our communities must begin thoughtfully and diligently expanding the care and support care services available for both elders and at end-of-life,” she says.
“We must begin having conversations with families in our communities to help them make fully-informed plans of care for elders well in advance of their later years,” she adds. Chernick believes communities need to start inventorying the types and availability of care and ramping up to accommodate these ever-growing needs so seniors receive the level of care they require when they require it.
Another challenge in the senior services equation, Chernick says, is a looming shortage of healthcare workers within the state.
“Our communities need to be actively ‘growing our own’ by preparing young people in our community for careers in healthcare with the hope that they will return home to provide that care.”
Kevin Turkington (left) stands with Sharon Ameline, a caregiver with thirteen years of service, as she is honored for her decade-plus of work at Midnight Sun Home Care.
Senior Healthcare Needs are Diverse
Boosting the workforce, especially within the long-term care facility environment, is one challenge Fran Hradecky puts on her long list of challenges related to providing senior care.
Hradecky is center administrator at the Denali Center, based in Fairbanks, which provides an Eden Alternative skilled nursing facility as well as long- and short-term care for those needing skilled and dementia care. Clients have access to services ranging from nursing to therapy to meals and activities.
The center opened in 1994 as a ninety-bed comprehensive short- and long-term care facility and is located next to Fairbanks Memorial Hospital. Its nursing facility services all ages and typically cares for 70 patients daily. Most recently the oldest was 97 years old and the youngest was 21—and the mean population client age is about 74 years old, explains Hradecky.
“The current trends show the demand for nursing home level of care is shared across the generations,” she says, adding the demand for services for those dealing with dementia is on the rise.
When it comes to listing out the challenges in providing needed senior services, Hradecky’s list is long. In addition to citing a high staff turnover rate for long-term care facilities, obstacles include everything from beds for specific care needs, finding appropriate placement for assisted living versus a nursing facility, and complex funding sources.
There is also expanding the need for options as seniors get well and are eligible for discharge planning, says Hradecky.
Hradecky also cites government funding cuts that are creating shortages in federal and state resources, which is increasing the time for placement and funding approvals.
“There is difficulty finding appropriate placement for residents with challenging conditions that require more specialized care, resources, and equipment, such as those that require one-to-one care, have behavioral health needs, or are morbidly obese,” she notes.
Senior Support Workforce on Decline
Kevin Turkington, founder and CEO of Midnight Sun Home Care in Anchorage, agrees the declining number of healthcare workers and care professionals present a huge challenge when it comes to providing senior services in the next decades.
“I think the biggest challenge to providing services are the increasing lack of a willing and qualified workforce,” he says, citing a declining economy, unscrupulous care providers, and crime as other issues presenting challenges. Anchorage, according to state data, is home to nearly 48,000 seniors over the age of 60.
Midnight Sun Care, founded in 2002, provides a bevy of in-home services from personal and hygienic care to laundry, shopping meal prep, medication management, and post-surgical care.
Its motto is dual focused that clients and loved ones “feel listened to, advocated for, educated about choices, relieved of stress, and served in the most personalized and collaborative way.”
Midnight Sun Care client services are paid either by patients, insurance, or via the US Department of Veterans Affairs and are focused on helping adults remain safe in their home for as long as possible.
The facility, available to residents living in Anchorage, Eagle River, Chugiak, Peters Creek, and the Mat-Su Valley and surrounding area, currently serves about 105 clients and the client list has been on a continual upward trajectory.
“With aging of the Boomers, more seniors moving to Alaska to live with and support or be supported by other family, and the quality of senior services in Alaska, I expect the trend to continue for at least another five to ten years,” says Turkington.
Yet despite all the challenges and hurdles ahead in meeting the needs of the elderly and aging in Alaska, Turkington, a fifty-year Alaskan who may one day need such senior services, isn’t about to move anywhere at any point.
“I think it's best to age in the place of your choosing, and from my experience most choose home. I know I do,” he says.
Judy Mottl writes about important issues country-wide with an affinity for Alaska.