Prescott 2050

Aging Interim report

Prescott 2050 Visioning

Older Adult Issues Sub-Committee
Recommendations
September 24, 2008

Table of Contents

I. Executive Summary

II. Defining Older Adult Issues within Prescott

III. Recommendations & Implementation Plans

IV. Appendix

I. Executive Summary

A. Approach Overview

Prescott Mayor, Jack Wilson initiated the creation of a 2050 Visionary Advisory committee comprised of local participants to determine what Prescott should look like in the future. This 2050 Visioning Committee created multiple subcommittees which would meet and prepare recommendations. The Older Adults Subcommittee is providing this document of our recommendations to the overall Visioning Committee.
The Mayor’s Prescott 2050 vision is about preserving, maintaining, and enhancing the many attributes of our “Everybody’s Hometown” brand because it is our “reputation capital,” while creating a vibrant, intergenerational community.
In line with these thoughts, the Older Adult Sub-Committee has taken the following approach to develop our recommendations:
• Develop a Mission Statement.

• Brainstorm senior needs.

• Prioritize these needs.

• Research solutions.

• Prepare recommendations and develop preliminary Implementation Plan.

B.  Mission Statement
Explore the needs and recommend solutions created by an expanding older population in order to make Prescott a community for all ages, while promoting the goals of healthy, active, and independent living, to encourage full and productive lives. 

Our guiding principals are these: 

• Building a community based on respect, mutuality, interdependence, and coexistence of all generations. 

• Making an ongoing commitment to addressing the needs of our aging community.

• Providing choice and quality options.

• Recognizing and embracing diversity.

• Respecting aging as a life-long process.

C. Older Adult Sub-Committee Goals

• Grow Prescott into a model senior community and a community for all ages.

• Maintain its reputation as one of the best places to retire within the United States.

• Build on existing studies; do not duplicate.

• Coordinate with other senior activities and organizations citywide, countywide, statewide, and nationally, as applicable. 

D.  Our Sub-Committee Scope Limitations
We recognize that the Older Adult Sub-Committee’s recommendations are not independent and need to be coordinated with other sub-committee recommendations, as well as other city and regional activities. We also understand that many infrastructure issues affect both seniors as well as the overall population of Prescott and are already part of the City Council’s planning process. Therefore to avoid duplication, our Sub-Committee recognizes the importance to seniors of other key topics, but did not focus on areas such as these: 

• Zoning Changes, like changing certain areas to multi-use facilities in order to accommodate senior assisted living communities.

• Attracting and retaining medical resources, like encouraging enough family practice and gerontology physicians who accept Medicare to practice in the community.

• Transportation, both reliable, community-wide mass transit and specialty transportation.

E. Our Key Recommendations
After discussing many areas of senior needs, we identified three priority areas of focus:

• Develop a Prescott Commission on Aging.

• Establish a Personal Responsibility Information Campaign on the building blocks to a Secure Adult Lifestyle, Retirement, & Healthy Aging.  Support this with a comprehensive referral database.

• Enlarge Prescott’s pool of professional and family caregivers.

II. Projected Senior Needs for Prescott
A. General Background

Nationally, according to AARP Magazine:
• 41% of American Adults are over 50, the highest percentage in U.S history.  (Currently, 20% of Prescott residents are over 65.)

• 80% of Congress is over 50.

• Half of the Americans who voted in the 2006 elections were 50+.

• People over 55 own 77% of all financial assets in the United States.

• 50+ adults account for 45% of U.S. consumer spending, or 2.1 trillion per year.

• By 2011 the American 50+ population will surpass the 100 million mark.

Locally, according to Gray Matters – An Economic Analysis of Yavapai Counties Senior Industries study completed in 2002, regarding the senior population of Yavapai County:

• The senior population of Yavapai County is disproportionately large due to the net in-migration of middle-aged or older individuals who then age in place, making Prescott’s population almost a decade older than the nations’ as a whole.

• Seniors spend more than their share on specific industries including medical services, long-term care services, construction, retail, and real estate.

• Since 20% of the Prescott population is over 65, the Yavapai employment base is relatively small compared to the total population.

• The economic future of senior industries hinges on resolving workforce shortages to assure sufficient capacity to serve the needs of an aging population in the area.

B. Projected Senior Needs for Prescott
The Older Adult Sub-Committee identified the key needs of 50+ Prescott citizens and then prioritized these in order to come up with our key recommendations.  To do this, we utilized age categories for seniors that related to lifestyle events and behaviors.  We looked at combinations of physical/biological and social/psychological changes that are the natural correlates of the aging process. By placing seniors into these segments, we predicted behaviors and needs. Baby Boomers are very different than their elders, but seem to trend similarly as they age.

The following is a matrix of general senior needs that we identified and prioritized in order to arrive at our key recommendations:

• Priority needs are indicated with *
• The Level of Importance within the senior category

A = Very Important
B = Important
C = Moderately Important
D = Not Important

Senior Needs Senior Categories
Pre Seniors
(ages 50 – 64) Young Seniors
(ages 65 – 74) Seniors
(ages 75 – 84) Older Seniors
(ages 85+)
* Information Program for Adults A A A A
* Commission on Aging A A A A
* Caregiver Workforce B A A A
Senior Housing C B B A
Transportation C B A A
Wellness B B A A
Primary Care B A A A
Care Coordination C B A A
Financial Planning B B A A
Social Aspects B B B B
Leisure Activities A A B C
Employment Opportunities B B C C

Category Definitions
Information Program for Adults – Establish an ongoing Information Dissemination Program to educate adults of all ages about personal responsibility and the building blocks for a Secure Lifestyle, Retirement, & Healthy Aging, supported by a central repository of information and resources available for older adults. 

Commission on Aging – Establish a Commission on Aging to promote, support and enhance the lives of Prescott’s senior citizens, by working with the City infrastructure to address and deliver optimum level of services and safety to it’s citizens, and to more fully incorporate and engage these citizens into the community.

Caregiver Workforce – A caregiver provides assistance to an older person who has at least one limitation in his or her activities of daily living or has cognitive impairment.  By age 85, 1 out of 2 people have Alzheimer’s or senior dementia.  With the current “age wave” of Baby Boomers, the need for caregivers is great and will continue to grow exponentially.  This makes it critical to enlarge the pool of professional and family caregivers in the Prescott area, by attracting more people to this field and supporting them financially and with information and services. 

Senior Housing – Most seniors pay more than 30% of their income for shelters and half of the senior renters pay more than 50% of their income to a landlord. Therefore, it is crucial to provide affordable housing which promotes “aging in place” by being located geographically near activities, retail outlets, and medical and other services. 

Transportation – Encourage alternatives for seniors requiring transportation. While mass transit solutions are helpful, they are not always effective because seniors often do not have any way to get to mass transit locations. 

Wellness Planning – Provide ongoing education programs which encourage good nutrition, exercise, healthy lifestyle, and safe living environments in order to promote longevity through prevention of chronic conditions and falls.

Primary Care – Primary care physicians provide the patient with a broad spectrum of care and coordinates patient care with other providers in order to provide continuity of care.  It is currently difficult in the Prescott area to find a primary care physician who will accept Medicare, private insurance, or Medicaid.  Therefore, Prescott must attract more primary care physicians, while encouraging age 50+ adults to save and plan for medical expenses and long-term care expenses.

Care Coordination – Provide on-going education programs for adults about case management, geriatric care management, and efficient access to the aging network.

Financial Planning – Affording retirement is more challenging today than ever.  A couple who is 65 and married will need $283,000 by age 79 just for medical costs not covered by insurance and not counting long-term care costs.  Therefore, it is vital for Prescott to provide an ongoing monthly education program that encourages adults of all ages to plan ahead and to save for their retirement and long-term care.  This program should provide information, encouragement, and access to referrals for social security, financial planning, long-term care planning, reverse mortgages, tax planning, and estate planning, will & trusts, and health care & financial powers of attorney.

Social Aspects of Aging – As we age, numerous life-events, like retirement, relocation, health issues, death, divorce, etc.  cause significant changes to our lives and our relationships.  These are changes that may cause anxiety, loneliness, substance abuse, depression, or grief. To enhance the normal aging process and promote “successful aging,” we should provide an on-going education program that emphasizes planning, high mental and physical function to improve quality of life, volunteer opportunities, education opportunities, travel, and social services.

Leisure Activities – Provide information regarding leisure activities and special senior rates.

Employment Opportunities – Provide information about employment opportunities (full time or part time) for seniors. Also, encourage local business to hire seniors.

Life-Long Learning/Education Opportunities – Promote access to information about educational opportunities, such as Yavapai Colleges OLLI program.

C. Senior Needs Development Organizational Matrix
Our Older Adult Sub-Committee understands that it is not an on-going committee.  However, we feel that if our recommendations are accepted by the City Council,, we could be the initial driving force for moving forward and implementing our key recommendations.  We would do so by focusing on establishing the Commission on Aging, and using it as a vehicle to help support the other senior needs identified.  The following matrix demonstrates how our initiatives can be achieved through teamwork.

L = Lead role
S = Support role

Senior Needs & Initiatives Roles by Driving Group
2050 Older Adult Sub-Committee, that evolves into the Commission on Aging City Council Prescott Chamber of Commerce
* Information for Older Adults L S S
* Commission on Aging L L S
* Caregiver Workforce S S S
Senior Housing S L/S S
Transportation S L S
Wellness S S S
Primary Care S S L/S
Care Coordination S S S
Financial Planning S S L/S
Social Aspects S S S
Leisure Activities S S S
Employment Opportunities S S L

III. Recommendations & Implementation Steps
The main senior priorities for Prescott are to establish a Commission on Aging; to create a Personal Responsibility Information Education Campaign & database; and to enlarge our caregiver workforce.  The Commission on Aging is required to ensure that City Government addresses senior issues in a timely way.  The Personal Responsibility Information Campaign is to encourage adults to plan ahead for how they will finance their retirement needs, so that welfare assistance and community programs are available for the truly needy.  (The Information Network supplements this goal).  Enlarging the caregiver workforce is required in order for seniors to continue to retire and “age in place” in Prescott. 

A. Commission on Aging

Establish a Commission on Aging to advise and assist the City governing bodies in implementation of programs and activities which enhance the lives of Prescott’s 50+ adults to address and deliver optimum level of services and safety for its citizens, and to more fully incorporate and engage these citizens into the community. The Prescott Commission on Aging would serve as a model for a regional Commission on Aging.

Recommended Commission on Aging Duties:
• Advise the City Council, Chamber of Commerce, and other City agencies on senior issues and on intergenerational programs of benefit to the community.
• Identify, improve, and develop services and opportunities for the senior population. 
• Create implementation plans for programs, utilizing available community resources including volunteers.
• Establish the Commission on Aging’s long-range goals.
• Advocate on behalf of older individuals, including legislative actions.

Structure:
• The commission should consist of 7 members appointed by the City Council from interested and qualified applicants with at least 4 being over age 60.
• A member of the City Council should also serve in an advisory non-voting capacity.
• Commission members will also chair working sub-committees to achieve specific goals, as needed.
• Meetings will be conducted monthly.

Implementation Steps:
• The Older Adult Sub-Committee members would act as a temporary Commission on Aging, during the implementation process.
• They will meet with Bill Arnold and amenable City Councilpersons to lay the groundwork for driving this recommendation.
• City Council will pass an ordinance to establish the Commission.  (See Appendix A).
• Develop a detailed written plan with a projected timelines.
Key Long Range Implementation Phases:

• Phase I (2009) – establish a Prescott Commission on Aging, begin meetings, set goals, establish working sub-committees.

• Phase II (2010 – 2011) – introduce locally televised meetings.

• Phase III (2011-2015) - refine citywide goals and long-range plan.

• Phase IV (2016 – 2020) – set up County round table meetings.

• Phase V (2021 – 2025) – establish a County-wide Commission on Aging.

• Phase VI (2025 + timeframe) – secure grants or funding for special projects that benefit seniors.

B. Personal Responsibility Information Campaign: 

Rationale:

The Prescott area already offers a great many services for senior citizens.  Many new services will become available in future years as this sector of the population increases. The Older Adult Sub-Committee has identified a disconnect between the availability of services and knowledge by seniors of the availability of and access to these services.

More importantly, the Sub-Committee also recognizes that it is imperative for Prescott Adults of all ages to recognize the realities of aging and plan ahead in order to finance their senior years.  In the past, federal, state, and local programs could provide free and low-cost services to the poor and the middle-class because there were more workers paying taxes than there were seniors.  Today, with the “age wave” of Baby Boomers, most middle class and affluent seniors must be able to pay much of their own way in order to attract enough caregivers, housing, medical care, and other community services for a growing senior population. 

If most Prescott residents can pay privately for their requirements such as primary care, long-term caregivers, housing, transportation, etc. the money will be available to attract sufficient primary care physicians, in-home & in-facility caregivers, and provide solutions to other senior issues.  By paying privately, we mean paying from savings & investments, from health and long-term care insurance, or paying from reverse mortgage proceeds. 

If most of us continue to rely solely on Medicare, Medicaid or other government funded programs to pay for our requirements, the limited amount of financial resources will continue to be spread over a greater number of people, and the system will collapse.  An excellent example of this is the primary care doctor issue:  Because Medicare reimbursement is being cut in 2008, 14% of primary care physicians are no longer accepting Medicare as payment. 
Recommendations:

Create a Personal Responsibility Education Campaign to encourage Prescott Adults of all ages to plan ahead for financing their personal expenses through retirement and to live a lifestyle that will lead to a healthier life.  Include in the campaign, information about financial planning, long-term care insurance, reverse mortgages, wills and trusts, financial and health care powers of attorney, estate & tax planning, healthy living, exercise and other ideas to encourage planning.  Support this campaign with an Information & Referral Network to assist seniors in accessing appropriate community resources. 

Implementation Steps: 

1. Ask the Chamber of Commerce to work with the Commission on Aging to create a Personal Responsibility Education Campaign.  Invite volunteers who are experts in their field to provide the education programs, monthly, throughout the year, each year, on a variety of topics.  Ask the City Council to fund advertisements about this campaign, which would include print, TV, and radio advertisements. 

2. Create an Information & Referral Service by understanding and having available in database format the local, regional, and national non-profit AND for-profit resources available for seniors within the Prescott community.  Some of these resources would include”

• NACOG-Area Agency on Aging, Region III (including the Uniform Information Assessment Tool currently being developed, and GITA-State Government Information Technology Agency). The Area Agency on Aging will significantly contribute to the community’s need for Older Adult Information dissemination.

• Telephone Number 211- a nationwide system for information & referral in development, which brings all community databases together in a call center manned by certified & trained employees.

• Project 20, which is being developed by the National Council on Aging with 3 other agencies.  It will provide person-centered access to information; health promotion & evidence-based disease prevention; and enhanced nursing home diversion (non-Medicaid).

3.  Commission on Aging will write a grant to fund the maintenance of the Information
and Referral Database for 50+ Adults under its prevue to ensure that it includes for-
profit as well as non-profit resources.

C. Enlarging the Caregiver Coverage & Workforce:

Rationale:

Caregivers play a critical role in any community with a senior population.  A caregiver is someone providing assistance to a person who has at least one limitation in his or her activities of daily living or is cognitively impaired.  Caregiving exists on a continuum.  At one end there are few, occasional needs.  At the opposite end there are extensive, on-demand needs that require help over a 24-hour time frame. 

Eight-five percent of older adults are choosing to remain in their homes as long as possible and eventually require support from both family and professional caregivers to maintain a safe living environment and to meet personal needs.  Since the fastest and largest cohort of American adults is already 50+, and since demographics demonstrate that most families have 1.5 children, who do not live nearby, with both spouses working, it is imperative to attract and retain professional caregivers as well as to assist and support family caregivers. 

Most adults age 65 are already dealing with at least one chronic illness, such as arthritis, diabetes, or coronary artery disease.  By the time seniors are 75, they often must deal with at least two chronic health issues.  At age 85, one-half of seniors have senior dementia or Alzheimer’s and may also be coping with 3-4 chronic illnesses.

The key issues surrounding having an adequate caregiver workforce are these:
• To care for the number of seniors wishing care, Prescott needs enough professional caregivers living in or near the community.
• To attract and maintain an adequate number of caregivers in our community, seniors need to be able to afford the cost of care which currently ranges from $17- $29 hourly. 
• To support family caregivers, we need to facilitate their access to community-wide information and program referral.
• To support low-income families, welfare and other government programs need to be saved for the indigent.
• To save the welfare programs for the indigent, middle-class & affluent families need to be encouraged to plan ahead to design and fund their own future care.

Recommendations:

Create a Personal Responsibility Education Program for adults of all ages to teach them how to plan for the future.  Have a Commission on Aging that has as part of its goal to make individuals, their advisors, city officials, media, and non-profit organizations aware that we can no longer plan while looking through the rear-view mirror.  Adults must plan to pay for as much of their future needs as possible in order for our community to have the senior resources we will require.  Lobby at the state and national level for an immigrant guest worker program for caregivers.

Implementation Steps: 

1.  Ask the Prescott Chamber of Commerce to lobby at the state level for the creation of a Guest Worker program that would allow immigrants to legally come to the United State in order to be caregivers.  We need legal immigrants in order to create a viable workforce pool.

2.  Ask the Prescott Chamber of Commerce to request the U.S. Chamber of Commerce to lobby at the national level for a guest worker program to allow immigrants to come to the United States to work as caregivers, after being tested for health concerns (TB, HIV, hepatitis, etc.).

3.  Request the City Council to fund the on-going Information & Education Campaign to improve personal responsibility for financial planning for retirement needs, so that most middle class and affluent seniors have the finances to privately pay the going rates for caregiver and care facilities.  Providing reasonable wages, vacation pay, and health insurance will increase the number of available caregivers.

4. Given that it is intrinsic to a person’s well-being to be involved with their community, information about peer-to-peer caregiving should incorporated into the Personal Responsibility Education Campaign.  This will encourage neighbors to assist each other, while reinforcing that personal responsibility includes being collectively responsible.

5.  Honor those who serve locally by asking the Commission on Aging to reinforce the idea of family caregiving and peer-to-peer caregiving through a quarterly recognition program celebrating individual caregivers and their stories. 

D. Recommendation Summary Timeline

Key Recommendations

A. Establish a Prescott Commission on Aging
B. Execute a Personal Responsibility Education Campaign
C. Enlarge & Support the Caregiver Workforce

Time Line Prescott Population
Projection Recommendations – To Be Accomplished Tied In With Other Committees (Y/N) List Financial Funding From COP (Y/N) Private / Public Funding (Y/N) (Approx Amt) Tied In With Other Towns / Cities

2009
45,813
2010
47,169
2015
53,484
2020
60,645
2025
68,754
2030
77,959
2035
88,397
2040
100,231
2045
113,645
2050
128,815

Appendix A – Commission on Aging Sample Ordinance

PLEASANT HILL, CA
COMMISSION ON AGING

3.15.010 Established – Composition.
A city commission on aging is established. The commission shall consist of nine members. No fewer than six members shall reside in the city. All members shall serve without compensation. (1991 code § 2-38.1)
3.15.020 Appointment.
The members of the commission shall be appointed by the mayor with the approval of the city council, and shall be representative of the economic, cultural, ethnic and racial groups which comprise the population of the city. Two-thirds of the members shall be 55 or older. (1991 code § 2-38.2)
3.15.030 Terms of office.
The term of office of each member shall be four years. (Ord. 497 § 1, 1982; 1991 code § 2-38.3)
3.15.040 Leave of absence.
A member of the commission may be granted a leave of absence by the council, and a temporary vacancy shall thereupon exist for the period of such leave of absence. (1991 code § 2-38.4)
3.15.050 Removal or vacancy of members.
Vacancies on the commission, from whatever cause, except temporary vacancies as provided in PHMC § 3.15.040, shall be filled by the council for the unexpired term. Any member of the commission may be removed from the commission prior to the expiration of his or her term by a three-fifths vote of the council. (1991 code § 2-38.5)
3.15.060 Officers.
A. The commission shall elect one of its members chairman and one of its members vice chairman who shall hold office for one year until their successors are elected unless their terms as members of the commission expire sooner. Nomination and election shall be held at the May meeting. The new officers shall assume their positions at the June meeting.
B. An officer or employee of the city designated by the city manager shall serve as secretary of the commission. (Ord. 497 § 1, 1982; 1991 code § 2-38.6)
3.15.070 Function.
A. The function of the commission shall be to:
1. Identify the needs of the aging in the community and create a citizen awareness of these needs;
2. Encourage improved standards of services and the establishment of needed new services for the aging, both public and private, and in so doing, encourage coordination among organizations providing services to the aging in the community and provide advice and assistance thereto;
3. In cooperation with other agencies collect, maintain and interpret information and statistics on the aging for the use of citizens and organizations in the city;
4. Encourage preparation of publication and results of study and research pertaining to the aging;
5. Advise the council on all matters affecting the aging in the community;
6. Render advice and assistance to other city boards and commissions, to city departments and to private agencies on matters affecting the aging;
7. Perform such other functions and duties as may be directed by the council.
B. In prescribing the above duties and functions of the commission, it is not the intent of this council to duplicate or overlap the functions, duties, or responsibilities heretofore or hereafter assigned to any other city board, commission or department. As to such functions or responsibilities set forth in this section which are partially or wholly the responsibilities of another board or commission or of a department of the city, the commission will render assistance and advice to such board, commission or department as may be requested. (1991 code § 2-38.7)
3.15.080 Meetings.
The commission shall establish a regular time and place of meeting and shall hold at least 10 meetings annually. Special meetings may be called by the chairman, or by any members of the commission, upon written notice being delivered personally or by mail to each member at least 24 hours prior to such meeting. (Ord. 497 § 1, 1982; 1991 code § 2-38.8)
3.15.090 Quorum and record keeping.
Five members shall constitute a quorum; a majority of the quorum is required to take any action. The commission shall keep an accurate record of its proceedings and transactions and shall submit an annual report to the council with a copy to the city manager. (Ord. 497 § 1, 1982; 1991 code § 2-38.9)
3.15.100 Absence from meetings.
A. Any member who, without obtaining a leave of absence, is absent from three consecutive meetings shall be subject to termination by majority vote.
B. The commission chairman shall advise the city clerk of such termination.
C. The city clerk shall notify the member and report to the council that a vacancy exists on the commission, and that an appointment should be made for the unexpired term. (Ord. 497 § 1, 1982; 1991 code § 2-38.10)
3.15.110 Liaison representatives.
Subject to the approval of the council in each case, the commission may designate one of its members to act as a liaison representative to any other board, commission, or committee of the city. The function of such liaison representatives are to attend meetings of such other board, commission, or committee; to advise this commission of the background, attitudes and reasons behind the actions of such other board, commission or committee; and on request of any member of such other board, commission or committee to advise such board, commission or committee of policy, procedures and decisions of this commission that may bear upon matters under discussion by such other board, commission, or committee. Such liaison representatives shall have no power to vote. (1991 code § 2-38.11)
3.15.120 Rules.
The commission may make and alter rules governing its organization and procedures which are not inconsistent with this chapter or any other applicable ordinance of the city. (1991 code § 2-38.12)