BRACING FOR

THE SILVER TSUNAMI

May 2013

James H. Johnson, Jr. Frank Hawkins Kenan Institute of Private Enterprise

Kenan-Flagler Business School University of North Carolina at Chapel Hill

OVERVIEW

• Disruptive Demographics

• The Greying of America

• Challenges & Opportunities

• A Social Purpose Venture

6 DISRUPTIVE TRENDS

• The South Rises – Again

• The Browning of America

• Marrying Out is “In”

• The Silver Tsunami is About Hit

• The End of Men?

• Cooling Water from Grandma’s Well… and Grandpa’s Too!

May 2013 3

THE GREYING OF AMERICA

Key Drivers

• Changes in Longevity

• Declining Fertility

• Aging of Boomer Cohort

LIFE EXPECTANCY AT BIRTH

YEAR AGE

1900 47.3

1930 59.7

1960 69.7

1997 76.5

2007 77.9

2010 78.3

2030 101.0

Centenarians in the U.S.

Year Number

1950 2,300

2010 79,000

2050 601,000

COMPLETED FERTILITY FOR WOMEN 40 - 44 YEARS OLD

YearPercent

Childless

Avg. Number of

Children

Percent Higher Order

Births*

2006 20 1.9 28

1976 10 3.1 59

*Three or more Children

TOTAL FERTILITY RATES OF U.S. WOMEN BY RACE/ETHNICITY, 2007

Race/Ethnicity Total Fertility Rate

Hispanic 3.0

Non-Hispanic White 1.9

Blacks 2.1

Asian 2.0

Native American 1.9

THE SILVER TSUNAMI

U.S. POPULATION CHANGE BY AGE, 2000-2009

Age 2009

Absolute

Change

2000 - 2009

Percentage

Change

2000 - 2009

<25 104,960,250 5,258,492 5.3

25-44 84,096,278 -1,898,345 -2.2

45-64 79,379,439 16,977,567 27.2

65+ 39,570,590 4,496,886 12.8

TOTAL 307,006,550 24,834,593 8.8

U.S. POPULATION TURNING 50, 55, 62, AND 65 YEARS OF AGE, (2007-2015)

Age

50

Age

55

Age

62

Age

65

Average Number/Day 12,344 11,541 9,221 8,032

Average Number/Minute 8.6 8.0 6.4 5.6

ABSOLUTE AND PERCENT CHANGE IN U.S. POPULATION BY AGE

Age 2005 2050 % Change

Total 296 438 50.0

0-17 73 102 39.7

18-64 186 255 37.1

65+ 37 81 118.9

POPULATION CHANGE BY AGE IN THE SOUTH, 2000-2010

Age

2010

Population

Absolute

Change

2000-2010

Percent

Change

2000-2010

Total 114,555,744 14,318,924 14.3

<10 (Gen Z) 15,346,300 1,284,900 9.1

10-29 (Gen Y) 31,624,788 3,247,518 11.4

30-44 (Gen X) 22,820,248 -401,156 -1.7

45-64

(Boomers)29,870,423 7,731,944 34.9

65+ (Pre-

Boomers)14,893,985 2,455,718 19.7

NC ABSOLUTE POPULATION CHANGE BY AGE, 2000-2010

Age All Counties

Tier 3

Counties

Tier 2

Counties

Tier 1

Counties

All Ages 1,486,170 1,088,946 327,859 69,365

<25 449,385 369,818 85,481 - 5,914

25-44 73,209 159,248 - 36,139 -49,900

45-64 698,545 410,705 199,101 88,739

65+ 265,031 149,175 79,416 36,440

THE BIG CHALLENGE

And The Big Opportunity

Total and Elderly Population Change, 2000-2010

TotalPopulation

Percent Change

Absolute Change

U.S. 9.5 26,884.972

South 14.3 14,318,924

The Carolinas

17.4 2,099,702

NorthCarolina

18.5 1,486,170

South Carolina

15.3 613,532

ElderlyPopulation

PercentChange

Absolute Change

U.S. 10.7 3,787,660

South 19.7 2,455,718

The Carolinas

28.2 411,572

North Carolina

27.3 265,031

South Carolina

30.2 146,541

Elderly Share of Net Population Change, 2000-2010

Area Total PopulationChange

ElderlyPopulation Change

Elderly Share of Net Change

United States 26,884,972 3,737,660 13.9%

South Region 14,318,924 2,455,718 17.2%

The Carolinas 2,099,702 411,572 19.6%

North Carolina 1,486,170 265,031 17.8%

South Carolina 613,532 146,541 23.9%

GROWING DEPENDENCY

A Train Wreck in the Making

DEPENDENCY RATIOS IN THE AMERICAN SOUTH

Source: Census 2010

NC COUNTIES WITH THE LARGEST ABSOLUTE POPULATION GAINS, 2000-2010

NC COUNTIES EXPERIENCING POPULATION DECLINE, 2000-2010

Counties with Biologically Declining Populations, 2009

Legend

Deaths > Births

Deaths < Births

40 75 15037.5

Miles

Pitt

Wake

Bladen

Duplin

Hyde

BertieWilkes

Pender

Moore

Union

Nash

Robeson

Surry

Onslow

Columbus

Burke

Ashe

Anson

Guilford

Harnett

Brunswick

Chatham

Macon

Rowan

Stokes Gates

ForsythYadkinHalifax

Sampson

Iredell

Swain Johnston

Randolph

Wayne

Jones

Martin

Hoke

Lee

LenoirStanly

Craven

WarrenGranville

Tyrrell

Franklin

Buncombe

Davidson

Haywood

Person

Jackson

Dare

Carteret

Caswell

Beaufort

Caldwell

Cumberland

Wilson

Madison

Orange

RutherfordPolk Gaston

Cherokee

Rockingham

Davie

Catawba

Richmond

Hertford

McDowell

Cleveland

NorthamptonVance

Clay

Avery

Mecklenburg

Alamance

Lincoln

EdgecombeYancey

Montgomery

Pamlico

Cabarrus

Durham

GrahamGreene

Watauga

Scotland

Henderson

Washington

Transylvania

Mitchell

Camden

Alexander

Currituck

Alleghany

ChowanPerquimans

Pasquotank

New Hanover

Age-Related Challenges

• Mobility Limitations

• Hearing Loss

• Vision Impairments

• Mental Disorders

• Substance Abuse Issues

• Chronic Disabilities

• Economic Constraints

The Triple Whammy

• Aging Boomers Face Mortality

• Elder Care Responsibilities

• Raising Grandchildren

The Elder Care Economy Innovations Hub

27

Research and Demonstration

Projects

Mobilizing Collective Ambition

Leveraging Intellectual Capital

New Venture Creation Lab

Social Innovation Fund

Digital Health Entrepreneurs

Digital Literacy

Succession Planning

Research Fellows Initiative for

Emerging Scholars and Practitioners

Aging in Place Clearinghouse• White Papers• Policy Briefs• Business Plans• Workshops• Conferences

Scholar & Practitioner

Network

• Noel Greis

• Monica Nogueira

• Sharon Williams

• Mary Altpeter

• Ellen Roberts

Evaluation

Assessing Progress and Building the Research

& Evidence Base

Fostering & Facilitating Success

Aging in Place Ventures

• Person- Centered

• Built-Environment Centered

KenanInstitute

of Private Enterprise

Institute on Aging

Center for Aging & Health

R.L. Mace Universal

Design Institute

AARPAIP

Ventures

Leadership Team

JohnsonDilworth-Anderson

Carter-Edwards

Busby-Whitehead

Duncan Galloway McCoy

AGING IN PLACE RESEARCH FRAMEWORK

Senior

Population

Person-Centered Activities

Seniors

Caregivers

Service

Providers

Assistive

Technologies

Digital

Literacy

•Remote Care Systems

•Online Health Promotion

•Sympathetic Devices

•ICT

•AAL

Successful

Aging in

Place

Built

Environment

Centered

Activities

•Dwellings

•Neighborhoods

•Communities

•Cities/Regions

•Nation-states

SAFE: Secure Audits for the Elderly Anatomy of an Intervention

Falls Among Older Adults

• One out of three adults age 65 or older falls each year.

• Among seniors, falls are the leading cause of injury-related death.

• 2.3 million nonfatal fall injuries treated in ERs and more than 662,000 of these falls victims were hospitalized in 2010.

• Direct medical costs of falls was $30b in 2010, projected to rise to $55b by 2020.

Joint Venture Partners

• Kenan Institute, Managing Director

• UNC Center for Aging and Health

• Universal Design Institute

• Athletic Concepts, LLC

• AT&T & Other Private Sector Firms

Program Goals

• Reduce Falls & Falls-Related Injuries & Deaths Among Seniors

• Create Jobs and Nurture Small Business Growth and Expansion

Program Components

• Falls Prevention Education

• Home Audits and Modifications

• Senior Fitness Parks and Wellness Centers

• Formative and Summative Evaluations

SMART SLIPPERS

GLOWCAPS

SENIOR PLAYGROUNDS

SENIOR PLAYGROUNDS

Senior Wellness Center Integrated Health Modules

CardiorespiratoryFitness

Strength/Endurance Balance & Proprioception

Prevention Education

Low impact aerobics

Circuit training Tai Chi Healthy Back

Dance Weight equipment Yoga Disease processes: BP, Diabetes, COPD, CHF*, OA, RA

Treadmill, Cycling, etc.

Resistance tubing, bands

Balance exercises Nutrition

Aquatics Proprioception exercises

Suggestions from Seniors

Human Resource Demand

• Lay Health Professionals

• Wellness Advisors & Fitness Instructors

• Home modification experts

• Architects

• Landscape Architects

Target Markets

Gender Composition of Elderly Population by Age, 2010

Age The Carolinas North Carolina South Carolina

All Elderly (65+) 1,865,953 1,234,079 631,874

% Female 57.3 57.5 56.7

Young Old (65-74) 1,066,610 697,567 369,043

% Female 53.8 54.0 53.4

Middle Old (75-84) 581,165 389,051 192,114

% Female 59.0 59.2 58.4

Oldest Old (85+) 218,178 147,461 70,717

% Female 69.9 70.0 69.7

Distribution of Widowed Elderly Women by County, The Carolinas, 2010

Legend

51% or more

41% - 50%

36% - 40%

25%-35%

40 75 15037.5

Miles

Horry

Pitt

Aiken

York

Wake

Berkeley

Bladen

Duplin

Colleton

Hyde

BertieWilkes

Pender

Moore

Union

Lee

Nash

Robeson

Surry

Onslow

Columbus

Laurens

Burke

Fairfield

Ashe

Union

Anson

Guilford

Harnett

Brunswick

Chatham

Macon

Rowan

Chester

Stokes Gates

ForsythYadkinHalifax

Sampson

Iredell

Jasper

Orangeburg

SumterFlorence

Swain Johnston

Richland

Oconee

Kershaw

Randolph

Greenville

Wayne

Jones

Anderson

Lexington

Martin

Hoke

Dillon

Williamsburg

Marion

Lee

Spartanburg

Chesterfield

Georgetown

Newberry

Clarendon

Saluda

LenoirStanly

Craven

Pickens

Warren

Barnwell

Granville

Tyrrell

Franklin

Buncombe

Davidson

Haywood

Person

Hampton

Jackson

Dare

Carteret

Caswell

Beaufort

Caldwell

Abbeville

Marlboro

Lancaster

Charleston

Cumberland

Wilson

Darlington

Madison

Orange

RutherfordPolk

Dorchester

Edgefield

Gaston

Cherokee

Rockingham

Davie

Catawba

Richmond

Hertford

McDowell

Cleveland

Northampton

Calhoun

Vance

Clay

Allendale

Avery

Mecklenburg

Alamance

Beaufort

Lincoln

EdgecombeYancey

Bamberg

Cherokee

Montgomery

Pamlico

Greenwood

Cabarrus

Durham

GrahamGreene

Watauga

McCormick

Scotland

Henderson

Washington

Transylvania

Mitchell

Camden

Alexander

Currituck

Alleghany

ChowanPerquimans

Pasquotank

New Hanover

North Carolina Elderly Population Living Alone, 2010

Gender Total Population

Number Living Alone

Percent Living Alone

Both Sexes 1,234,079 326,252 26.4

Male 523,956 83,408 15.9

Female 710,123 242,844 34.2

Distribution of Elderly Female Householders, No Husband Present, The Carolinas, 2010

Legend

15% or more

10% - 14%

5% - 9%

Less than 5%

40 75 15037.5

Miles

Horry

Pitt

Aiken

York

Wake

Berkeley

Bladen

Duplin

Colleton

Hyde

BertieWilkes

Pender

Moore

Union

Lee

Nash

Robeson

Surry

Onslow

Columbus

Laurens

Burke

Fairfield

Ashe

Union

Anson

Guilford

Harnett

Brunswick

Chatham

Macon

Rowan

Chester

Stokes Gates

ForsythYadkinHalifax

Sampson

Iredell

Jasper

Orangeburg

SumterFlorence

Swain Johnston

Richland

Oconee

Kershaw

Randolph

Greenville

Wayne

Jones

Anderson

Lexington

Martin

Hoke

Dillon

Williamsburg

Marion

Lee

Spartanburg

Chesterfield

Georgetown

Newberry

Clarendon

Saluda

LenoirStanly

Craven

Pickens

Warren

Barnwell

Granville

Tyrrell

Franklin

Buncombe

Davidson

Haywood

Person

Hampton

Jackson

Dare

Carteret

Caswell

Beaufort

Caldwell

Abbeville

Marlboro

Lancaster

Charleston

Cumberland

Wilson

Darlington

Madison

Orange

RutherfordPolk

Dorchester

Edgefield

Gaston

Cherokee

Rockingham

Davie

Catawba

Richmond

Hertford

McDowell

Cleveland

Northampton

Calhoun

Vance

Clay

Allendale

Avery

Mecklenburg

Alamance

Beaufort

Lincoln

EdgecombeYancey

Bamberg

Cherokee

Montgomery

Pamlico

Greenwood

Cabarrus

Durham

GrahamGreene

Watauga

McCormick

Scotland

Henderson

Washington

Transylvania

Mitchell

Camden

Alexander

Currituck

Alleghany

ChowanPerquimans

Pasquotank

New Hanover

Demonstration Sites

• Bertie County

• Guilford County

• Henderson County

Indicators of Social Wellbeing in Demonstration Site Counties

Indicator North Carolina

Henderson County

GuilfordCounty

Bertie County

Total Population,2009

9,543,537 106,740 488,406 21,282

Unemployment Rate, 2011

10.4% 8.0% 11.1% 12.8%

Per capita income, 2008

$38,534 $35,901 $35,294 $28,888

Percent Uninsured, 2008-09

19.7% 19.7% 19.5% 20.4%

Percent Medicaid Eligible , 2010

17.0% 14.0% 15.0% 27.0%

Percent Dually Enrolled in Medicare, 2010

14.5% 16.4% 13.2% 24.1%

Strategic Alliance

Partners Fall Prevention campaign will involve wide-ranging partners

May 2013 47

Anticipated Outcomes

• Fewer Falls

• Reduced hospitalizations

• Extended independent living

• Reduced unemployment

• Sustainable model of falls prevention

IMPACT

• Reduced Medicaid Burden

• Lowered Caregiver Stress

• Greater Health Equity

• Healthier Communities

THE END