GROWING OLDER IN NORTH CAROLINA: 

Helping Seniors Navigate Transitions

North Carolina Association of County Commissioners Annual Conference

August 17, 2012

The Silver Tsunami

Every day for the next five years, 8000 people are turning 65

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New

Alexander

AlleghanyAshe

Avery

BuncombeBurke

Cabarrus

Caldwell

Catawba

CherokeeCleveland

Davie

GastonGraham

Haywood

Henderson

Iredell

Jackson

McDowell

Macon

Madison

Mecklenburg

Mitchell

Polk

Rowan

Rutherford

Surry

Swain

Union

Watauga WilkesYadkin

Yancey

ClayTransylvania

Lincoln

Granville

NashAlamance

Anson

Bladen

Caswell

Chatham

Columbus

Cumberland

Davidson

Durham

Forsyth FranklinGuilford

Harnett

Hoke

JohnstonLee

Montgomery Moore

Orange

Person

Randolph

Richmond

Robeson

Rockingham

Sampson

Scotland

Stanly

StokesVance

Wake

Warren

Beaufort

Bertie

Carteret

Chowan

Craven

Dare

Duplin

Edgecombe

Gates

Greene

Halifax Hertford

Hyde

Jones

Lenoir

Martin

Hanover

Northampton

Onslow

Pamlico

Pasquotank

Pender

Perquimans

Pitt

Tyrrell

Brunswick

Washington

Wayne

Wilson

CamdenCurrituck

Percent of Population 65 and Over in NC 2010

11% to 20%

21% to 30%

Source: US Census 2010

10% or less

North Carolina – 13%

New

Alexander

AlleghanyAshe

Avery

BuncombeBurke

Cabarrus

Caldwell

Catawba

CherokeeCleveland

Davie

GastonGraham

Haywood

Henderson

Iredell

Jackson

McDowell

Macon

Madison

Mecklenburg

Mitchell

Polk

Rowan

Rutherford

Surry

Swain

Union

Watauga WilkesYadkin

Yancey

ClayTransylvania

Lincoln

Granville

NashAlamance

Anson

Bladen

Caswell

Chatham

Columbus

Cumberland

Davidson

Durham

Forsyth FranklinGuilford

Harnett

Hoke

JohnstonLee

Montgomery Moore

Orange

Person

Randolph

Richmond

Robeson

Rockingham

Sampson

Scotland

Stanly

StokesVance

Wake

Warren

Beaufort

Bertie

Carteret

Chowan

Craven

Dare

Duplin

Edgecombe

Gates

Greene

Halifax Hertford

Hyde

Jones

Lenoir

Martin

Hanover

Northampton

Onslow

Pamlico

Pasquotank

Pender

Perquimans

Pitt

Tyrrell

Brunswick

Washington

Wayne

Wilson

CamdenCurrituck

Percent of Population 65 and Over in NC2030

11% to 20%

21% to 30%

Source: NC State Data Center, April 2012

10% or less

31% or more

North Carolina – 19%

New

Alexander

AlleghanyAshe

Avery

BuncombeBurke

Cabarrus

Caldwell

Catawba

CherokeeCleveland

Davie

GastonGraham

Haywood

Henderson

Iredell

Jackson

McDowell

Macon

Madison

Mecklenburg

Mitchell

Polk

Rowan

Rutherford

Surry

Swain

Union

Watauga WilkesYadkin

Yancey

ClayTransylvania

Lincoln

Granville

NashAlamance

Anson

Bladen

Caswell

Chatham

Columbus

Cumberland

Davidson

Durham

Forsyth FranklinGuilford

Harnett

Hoke

JohnstonLee

Montgomery Moore

Orange

Person

Randolph

Richmond

Robeson

Rockingham

Sampson

Scotland

Stanly

StokesVance

Wake

Warren

Beaufort

Bertie

Carteret

Chowan

Craven

Dare

Duplin

Edgecombe

Gates

Greene

Halifax Hertford

Hyde

Jones

Lenoir

Martin

Hanover

Northampton

Onslow

Pamlico

Pasquotank

Pender

Perquimans

Pitt

Tyrrell

Brunswick

Washington

Wayne

Wilson

CamdenCurrituck

The Graying of North Carolina

Counties with more 60+ than 0-17 (43)

Counties with more 0-17 than 60+ (57)

Source: US Census 2010

• NC in the midst of significant demographic change• The state’s 2.4 million baby boomers are entering retirement age

• NC has the highest percentage of older adults living in rural areas among

the most populous states

2010

New

Alexander

AlleghanyAshe

Avery

BuncombeBurke

Cabarrus

Caldwell

Catawba

CherokeeCleveland

Davie

GastonGraham

Haywood

Henderson

Iredell

Jackson

McDowell

Macon

Madison

Mecklenburg

Mitchell

Polk

Rowan

Rutherford

Surry

Swain

Union

Watauga WilkesYadkin

Yancey

ClayTransylvania

Lincoln

Granville

NashAlamance

Anson

Bladen

Caswell

Chatham

Columbus

Cumberland

Davidson

Durham

Forsyth FranklinGuilford

Harnett

Hoke

JohnstonLee

Montgomery Moore

Orange

Person

Randolph

Richmond

Robeson

Rockingham

Sampson

Scotland

Stanly

StokesVance

Wake

Warren

Beaufort

Bertie

Carteret

Chowan

Craven

Dare

Duplin

Edgecombe

Gates

Greene

Halifax Hertford

Hyde

Jones

Lenoir

Martin

Hanover

Northampton

Onslow

Pamlico

Pasquotank

Pender

Perquimans

Pitt

Tyrrell

Brunswick

Washington

Wayne

Wilson

CamdenCurrituck

2025

Counties with more 60+ than 0-17

Counties with more 0-17 than 60+

(85)

(15)

Source: NC State Data Center

• Our 65 and older population will double in the next 20 years from 1.2 to 2.4 million.

• While NC is 10th nationally in size of total population, we are 9th in those 60 +.• By 2025, 85 of NC 100 counties are projected to have more people over age 60 than under age 17 and one in four NC citizens will be 60 and older.

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The Long-Term Services and Supports LandscapeIn North Carolina long-term services and supports are funded by numerous sources, administered by multiple agencies, and have complex, fragmented, and often duplicative intake, assessment, and eligibility functions.

7

8

Determining how to obtain services is difficult both for persons who qualify for publicly funded support and for those who can pay privately.

A uniform, coordinated system of information and access for all persons seeking long-term support will minimize confusion, enhance individual choice, be cost efficient, and support informed decision-making.

Recent Milestones For American Health Care

• Medicare Modernization Act (2003)

• Deficit Reduction Act (2005)• Medicare Improvement for

Patients and Providers Act (2008)

• Affordable Care Act (2010)

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http://www.kff.org/medicare

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• In 2003, the US Administration on Aging (AoA) launched the federal Aging and Disability Resource Center (ADRC) initiative, which began with three core functions– Awareness, Assistance, and Access

• The set of core expectations has grown over time– Information, referral, and awareness– Options counseling, advice, and assistance– Streamlined eligibility determinations for public programs– Person-centered transitions– Quality assurance and continuous improvement

• Since 2009 AoA and CMS are viewing ADRCs as the platform to:– Intervene during care transitions– Promote consumer direction– Implement new initiatives (e.g., Veteran Directed Home and Community Based

Services)– Catalyze broader systems change

12

Anson

Beaufort

Bertie

Brunswick

Camden

Carteret

Columbus

Craven

Currituck

Duplin

Edgecombe

Gaston

Gates

Halifax

Harnett

Hertford

Hoke

HydeJohnston

Jones

Lee

Lenoir

Lincoln

Martin

Moore

Nash

Northampton

Onslow

Pamlico

Pasquotank

Pender

Perquimans

Pitt

Richmond

Robeson

Sampson

Scot-land

Tyrrell

Union

Washington

Wayne

Wilson

Alam

ance

Alexander

Alleghany

Ashe

Caldwell

Caswell

Catawba

ChathamDavidson

Davie

ForsythFranklinGuilford

Gra

nvil l

e

Iredell

Person

Randolph

RockinghamStokes

Surry

Vanc

e

Warren

WataugaWilkes

Yadkin

Wake

Avery

Cherokee

Clay

Graham Henderson

BuncombeMcDowell

MaconPolk

RutherfordSwain

Madison

HaywoodN

ew

Hanover

Chowan

Cumber-land

MontgomeryStanly

Mecklenbu rg

Cabarrus

Rowan

Cleveland

Burke

Orange

Durham

Jackson

Bladen

Dare

Transylvania

Yancey

Greene

Cabarrus CRC (Cabarrus )Chatham-Orange CRC [Chatham and Orange]Eastern Carolina CRC -Developing [Carteret, Craven, Duplin, Greene, Jones, Lenoir, Onslow, Pamlico, Wayne]Forsyth CRC [Forsyth]Great Smokies CRC [Haywood, Jackson, Macon]High Country CRC [Ashe, Alleghany, Avery, Watauga, Wilkes]Isothermal CRC - Developing [Cleveland, McDowell, Polk, Rutherford]Land of Sky CRC [Buncombe, Henderson, Madison, Transylvania]Lumber River CRC - Developing [Bladen, Hoke, Richmond, Robeson, Scotland]Mecklenburg CRC [Mecklenburg]Northwest Piedmont CRC [Davie, Stokes, Surry, Yadkin]Piedmont Triad CRC [Alamance, Caswell, Davidson, Guilford, Montgomery, Randolph, Rockingham]Pitt-Beaufort CRC [Pitt, Beaufort]Wake CRC [Wake]Western CRC [Cherokee, Clay, Graham, Swain]

March 2012

North Carolina Community Resource Connections (CRCs)

In 2009 NC was one of 9 states to be awarded a CMS Person-

Centered Hospital Discharge Model Grant (PCHDM)

• The over arching goal for this grant was to provide states the opportunity to develop effective care transitions models that integrated community-based services with hospital discharge planning as a means for preventing avoidable hospital re-admissions.

• Projected Outcomes-• Improve quality of care for Medicare beneficiaries through a

comprehensive community effort• Reduce preventable hospital re-admissions • Increase discharge from Hospital to Home for target populations

Resources and Milestones

• CRC Care Transition Projects– Forsyth County– Chatham-Orange Counties– Rockingham County– Land of Sky

• PASSPORT• Area Agencies on Aging• NC Alliance for Care Transition (NC ACT)

– NC Hospital Association Quality Center– Community Care of NC– Carolinas Center for Medical Excellence

Transitions of Care

• Definition: The movement of persons from one health care practitioner or setting to another as their condition and care needs change

• Poor Transitions… – Compromise clients safety & quality of care– Burden clients and their families– Increase costs to clients, payers, providers & employers

20% Medicare Beneficiaries readmitted within 30 Days

33% readmitted within 90 Days

Hospitalizations account for 33% of total Medicare $

Readmissions result in $17.4 Billion annually

76% of Medicare readmissions potentially avoidable

Estimated $12 Billion Preventable Expenditures

Readmissions: By the Numbers

The Challenge

“If re-hospitalizations are frequent, costly, and able to be reduced,

why haven’t they been?”

Hospital-level barriersCommunity-level barriers

State-level barriers

New Models of Care

There are a number of proven & promising models to improve outcomes during transitions:

Common Elements:Interdisciplinary Communication/Collaboration Transitional Care Staff Patient Activation Enhanced Follow-up (by phone / home visit)

For more resources: www.cfmc.org/integratingcare

NCMJ: Care Transitions

www.ncmedicaljournal.com

How does our community navigate this transition?

Nursing Home

Assisted Living

RehabilitationContinuing Care

Retirement Community

Home

County Council/Department on

Aging

Area Agency on

Aging

Cooperative Extension

Mental Health

Provider

Community Resource Connection

Home Health Care

Senior Center

Adult Day ServicesFaith Community

County Social

Services

?

Community Engagement Event

• Plan WITH Not FOR Community• Power of Consumers• Map Current Reality• Assess Beliefs• Build Common Vision • Set Priorities• Define Action Steps

Local Core Collaborators

Consumers Aging Services Agencies Disability Services Agencies In-Home services Senior Centers Community Organizations Dept. of Social Services Area Agencies on Aging Community Health Centers Hospitals

Community-Based Approach

“Communities across the US are beginning to consider transitions of care as a community–based challenge that requires shared ownership and close collaboration across settings.”

(Institute for Healthcare Improvement)

Local Level Planning

• How to get started?• What has been done?

Orange County Is Now In It’s Third Master Aging Plan (MAP)

•Objectives for Developing MAP

•Input

•Process

•Plan

Objectives For Developing MAP

• Citizen Engagement

• A plan for the whole county

• Sustainability

• Accountability

Citizen Engagement

• Focus Groups• Community Forums• Work Groups

– Housing– Navigation and Transportation– Health and Wellness– Community Engagement– Aging in Place

Integrated Countywide Plan

• Government Readiness Survey• Personal Interviews with County Dept. Heads.

• Steering Committee– Key County Department Heads, citizen

representation, community organizations, BOCC Representatives

– Increased buy-in and commitment agencies across the county – Personal interviews

Sustainability and Accountability

• Economic context requires creativity

• Public Private Partnerships

• Built-in indicators of success

• MAP Evaluation Committee

How Can You Begin In Your Community?

• Contact your local Dept. or Council on Aging• Find out if they have a strategic plan• Is it time to update the plan and you like what

you have heard today visit us at www.orangecountync.gov/aging

• We have created an on-line MAP toolkit

Most Important Role For You

• Get involved and stay involved!

• If your community does not have an Aging Plan, advocate that they get started planning.

• The Silver Tsunami is going to have a dramatic impact on you and your community.

Our Contact Information

Bernadette PelissierOrange County Board of Commissionersbpelissier@orangecountync.gov

Heather AltmanCarol Woods Retirement Communityhaltman@carolwoods.org

Sabrena LeaNorth Carolina Division of Aging & Adult ServicesSabrena.Lea@dhhs.nc.gov

Janice Tyler Orange County Department on Agingjtyler@orangecountync.gov