By 2041, it is predicted that adults ages 65 and older will comprise one-quarter of Buncombe County’s population, according to a Community Engagement Needs Assessment report conducted by the Deerfield Charitable Foundation this year.
And Buncombe County is just one drop in the bucket: It is estimated that 2.8 million North Carolina residents will be age 65 or older by 2042, according to the N.C. Department of Health and Human Services’ All Ages, All Stages NC report published earlier this month.
The mounting needs of the state’s aging population are acknowledged at the highest levels: Last year, Gov. Roy Cooper issued an executive order to commit North Carolina to becoming an age-friendly state.
More recently, on May 23, the Age-Friendly Summit, a conference dedicated to the needs of the older population in Buncombe County, relaunched following a five-year hiatus due to the COVID-19 pandemic.
“I felt like it was time to highlight all the work being done across the county and in North Carolina,” says Billie Breeden, age-friendly coordinator for the Buncombe County Department of Health and Human Services’ Adult and Aging Services. “People need to know all the wonderful things that aging services providers do on a daily basis to support older adults.”
And come this summer a working group will present 100 recommendations to achieve an age-friendly state.
Yet despite awareness that a “silver tsunami” is coming, experts say there’s still much work to be done.
“We’ve got this increasingly growing population, and we’re not ready,” says Michelle Wooley, Deerfield Episcopal Retirement Community director of philanthropy, whose foundation financed the CENA study. “Buncombe County is not ready, North Carolina is not ready, the world is not ready.”
Buncombe’s top aging issues
In the keynote address of the summit, representatives from Deerfield Charitable Foundation shared findings from the CENA report about the most pertinent health and social issues facing adults over 65 in Buncombe County. Holleran Consulting conducted the study between November 2023 and March 2024. (The report is available at avl.mx/dqf.)
The top four issues cited by the CENA report are aging in place and age-friendly community; affordable housing and income; navigation of services and access to care; and chronic disease management and prevention.
“None of these findings surprised anybody — they were all things that we were really aware of,” Wooley says. She says aging services organizations will be able to use the data to gain support for the areas of focus.
Older adults face similar issues statewide: In 2023, the N.C. Institute of Medicine published a report about efforts to age well in North Carolina. A Place to Thrive, available at avl.mx/dqe, made a number of recommendations, which include: ensuring safe and affordable housing for older adults; developing community programs that support aging in place; improving the ability of community health workers to address the needs of older adults; and supporting caregivers.
Aging in place
Much of the focus on affordable housing centers on young people in the workforce. However, housing affordability is also a difficulty faced by older adults: Fifty-seven percent of older adult renters in Buncombe County reported spending more than 30% of their income on housing, according to the study.
The CENA report found aging in place was the third-most pressing issue among respondents. Wooley notes older adults who age at home may do so because it’s more affordable than assisted living. But it presents its own raft of expenses regarding maintenance and safety.
“Aging in place, for a lot of older adults, is incredibly challenging because they’re living on fixed incomes [and therefore] they’re deferring maintenance,” she explains. “They have likely let things go to the point where repairs are really expensive and then they don’t have the money.” For example, an older adult may need safety upgrades such as grab bars attached to the bathtub or alongside the toilet; outdoor stairs may need to be reconfigured into ramps.
Aging in place also involves community concerns, such as sidewalks and proximity to basic services like a grocery store and pharmacy. Transportation can be difficult or nonexistent for older adults in rural areas who cannot afford to maintain a car or who can no longer safely drive, Wooley says.
Experiencing a disability can impact an older adult’s ability to age at home. Thirty-two percent of older adults in the study reported having a disability, mainly affecting hearing and walking.
Addressing isolation
In Buncombe County, a larger number of older adults (44.9%) live alone than elsewhere in the state (42.8%), the CENA report found.
Many older adults have vibrant social lives, says Wooley. But plenty do not. For example, she describes how Deerfield residents volunteer with Meals on Wheels of Asheville and Buncombe County and bring meals to housebound adults over age 60. “That’s very likely the only interaction the client receives every day,” she says.
CENA survey respondents listed social isolation as a top health concern — and it’s a serious health risk affecting older adults, according to the national Centers for Disease Control and Prevention. In addition to the increase in depression and anxiety that can stem from loneliness, a 2020 report by the National Academies of Sciences, Engineering and Medicine found that social isolation is associated with a 50% increased risk of dementia.
Services like adult day care centers can enable an older adult to live at home while socializing and receiving professional care during the daytime. However, nearly 70% of CENA respondents reported that these services are lacking in Buncombe County.
Support for caregivers
Breeden says she was drawn to aging services after providing care to both her parents and her spouse’s parent. She found caregiving to be a “privilege,” she says, and went on to earn a master’s degree in social gerontology. But even she acknowledges that caregiving is “hard work” and “stressful.”
The Age-Friendly Summit intentionally provided a track for caregivers as well as one for aging services professionals. A session on caregiver stress addressed ways to deal with the overwhelm that can accompany caring for a loved one. The session also addressed support for kinship caregivers available through the Land of Sky Family Caregiver Support Program. The program provides information about services, as well as limited financial assistance for caregiver respite.
Sixty percent of respondents in the CENA study said support for caregivers is lacking in the community.
‘Funding is flat’
Aging services were established in 1965 with the passage of the Older Americans Act. The majority of federal funding for health and health-related aging services programs comes through North Carolina’s Home and Community Care Block Grant for older adults, which is administered by the N.C. Division on Aging.
“Our whole population, across Buncombe County and across the United States, is aging, and funding is flat,” says Breeden. While funding does increase each year, she says, “it’s just slight increases.”
Buncombe County receives around $1.7 million each year from the state and federal government for aging services. (Services are eligible for funding from the block grant if they are among 20 categories, including adult day care, mental health counseling and home repair.) Buncombe County’s government contributes another $500,000 in funding that is available for service providers who aren’t among the 20 categories for the block grant.
This $2.3 million in funding has to stretch, Breeden says, once again emphasizing that the county’s aging population is expanding.
The Older Americans Act is up for reauthorization by Congress this year. In March Sen. Bernie Sanders, D-Vermont, advocated for increasing its $2 billion in funding to $4.6 billion to address the upswing in transportation, nutrition services and other needs older adults will have in the coming decades.
“We really need this funding because our whole population is aging,” Breeden says.
Well, they seem to be addressing it by raising property taxes every year. Nothing drives out long-term, elderly residents like making their homes unaffordable. But, at least they have bike lanes to assist in moving out.
It appears that the solution to the aging population is to continually raise their property taxes until they cannot live here anymore.