Prescott 2050

Aging Report

Older Adult Issues Sub-Committee Recommendations

January, 2009

Setting the Stage

Nationally, according to AARP Magazine:

• Currently, 41% of American adults are over 50.  The highest percentage in U.S. History., and according to the 2000 census 40% of Prescott’s population are in
• This category.

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

• Americans 50+ account for 45% of U.S. consumer spending.

• There are more Americans age 65+ than Canadians of any age.

• Fastest growing cohort of American population are those 85+.

• At ages 85 +, 1 out of every 2 people have Alzheimer’s or senior dementia.

Locally, (primarily according to Gray Matters- an Economic Analysis of Yavapai County’s senior industries and senior population.)

• The senior population of Yavpai 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 nation’s as a whole.

• Stunning evidence mounts that America is facing a Perfect Economic Storm that will push the traditional entitlement safety net out of reach of middle class and affluent seniors.  Federal & State programs are disintegrating.  Medicaid is on the brink of financial insolvency, yet most Americans are unaware.  What will happen as Medicaid & Medicare cut back further and quality continues to plummet? 

• Since a large portion 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 the workforce shortages to assure sufficient capacity to serve the needs of an aging population; while, educating adults of all ages about the need for planning ahead in order to have money to spend on services.

Discovery

The Older Issues Sub-Committee found that in order to maintain Prescott as a vibrant, intergenerational community, several critical issues must be addressed, beginning immediately.  (These issues are those that fall within the pervue of the Older Issues Sub-Committee, without duplicating other sub-committees.)

• A “disconnect” frequently exists in Prescott between the general public and the Mayor & City council, because no official “vehicle” exists to assist in prioritizing issues and driving solutions for problems of older adults.

• Most people are not aware of the existing public and private services for seniors and adults of all ages because there is no centralized repository of this information.

• Most area adults may not realize that seniors who maintain their health are more likely to retain a significant portion of their savings, compared to those who suffer from health problems.

• Most area citizens do not realize that they must plan continuously from age 40 onward for their future health, family & fiscal requirements in order to have adequate resources in today’s world.

• There is a shortage of caregivers adequately trained, and workers in senior industries due to the current and increasing population of older adults vs. younger population in Prescott.

Recommendations

• Create a Commission on Aging for Prescott to aide the Mayor and City Council in prioritizing the issues and driving solutions for problems of older adults.

• Develop and execute an ongoing Adult Information Campaign for adults of all ages to encourage planning ahead for future health, family, and fiscal requirements.

• Create a central information and referral system – a one stop repository of information about all the existing public and private adult & senior services available- to promote the general public’s access to these programs.

• Enlarge the workforce of caregivers and other employees of senior industries by appropriately training, paying, and efficiently supporting them with information.

Table of Contents

I.  The Process – Our Approach

II.  Recommendations – Cost and Implementation Plans

III. Appendix – Defining Older Adult Issues within Prescott

I. Approach

A.  Overview
Prescott Mayor, Jack Wilson created the 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 to research and prepare recommendations. 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.
The Older Adults Subcommittee provides this document of recommendations to the overall Visioning Committee.
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 & focus on key needs.

• Research solutions.

• Prepare recommendations, with implementation plans and costs. 

B.  Mission Statement
In order to make Prescott a community for all ages, explore the needs and recommend solutions created by an expanding older population, 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. 

• Do not duplicate efforts of other sub-committees, like housing and transportation.

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 doctors by 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 an Information & Referral Program for Adults
 Establish an Adult Education Campaign to explore the building blocks of a healthy & secure adult lifestyle and retirement.
 Support this with a comprehensive referral database.

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

II. Recommendations & Implementation Plans
Overview – Projected Senior Needs for Prescott Area
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 (see Appendix A).  We came up with the following need categories:

• Commission on Aging
• Information Program for Adults
• Caregiver Workforce
• Senior Housing
• Transportation
• Wellness
• Primary Care
• Care Coordination
• Financial & Legal Planning
• Social Aspects
• Leisure Activities
• Employment & Voluntary Opportunities

After our prioritization process we established that the key recommendations we would focus on were:

• Establish a Prescott Commission on Aging.

• Execute a Personal Responsibility Education Campaign supported by an Information & Referral Database/Service.

• Enlarge & Support the Caregiver Workforce

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, and to identify, improve and develop services and opportunities for the aging population. The Commission will also seek to more fully incorporate and engage these citizens into the community.

Rationale:  Why Does Prescott Need a Commission on Aging?

1. To coordinate and prioritize the community’s older adult issues.

2. To serve as a bridge and resource between the aging population and the City Council.

3. To drive information and possible solutions to the problems of aging in areas such as: 
• Caregiver workforce
• Information programs & resources
• Housing
• Transportation
• Social & Wellness
• Employment opportunities
• Financial planning

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.

Recommended Structure:
• Seven (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 will 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:
• Members of the Committee have met with Mayor Wilson, City Council Member Bob Bell and Bill Arnold to lay the groundwork for driving this recommendation and are currently working with Gary Kidd the City Attorney on drafting the ordinance. 

• The Older Adult Sub-Committee members would initially organize and prioritize the issues for the Commission on Aging.

• City Council will need to pass an ordinance to establish the Commission.  Then a detailed written plan with a projected timelines will be developed.

Preliminary Short Term (6 months) Commission Goals and Actions:

1. Familiarize the commission members about existing community services. 

2. Update the commission members on the Arizona Open Meeting Act and any other legislative issues which may need to be addressed.

3. Prioritize the needs of the aging community & if necessary set up sub- committees to address these needs.

4. Submit a report to the City Council with an annual plan and long-term goals.

Key Long Range Implementation Phases:

• Phase I (2009) – Establish a Prescott Commission on Aging, begin meetings, set goals, and 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 Countywide Commission on Aging.

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

Cost:  None (Use of an office and a voicemail box provided by the City.)

B. Establish an Education & Information Program for Adults: 

Rationale:  Why does Prescott Need an Adult Education Campaign?

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 during their early adult years 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 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 an Adult Education Campaign to encourage Prescott Adults of all ages to become more personally responsible by planning ahead, both for financing their personal expenses through retirement and for creating a healthy lifestyle that will lead to a healthier life.  Include in the campaign, information about healthy living, financial planning, long-term care insurance, reverse mortgages, wills and trusts, financial and health care powers of attorney, estate & tax planning, exercise, and other ideas to encourage planning.  Also include topics that the other Sub-committees want to disseminate information. Support this campaign with an Information & Referral Network to assist seniors in accessing appropriate community resources.

Part 1:  Implementation Steps for the Education Campaign:

1. The Older Issues Sub-Committee of the Visioning 2050 Committee will recruit a Volunteer Facilitator to create the Education Campaign to encourage personal responsibility and planning by adults of all ages.

a. A 12-month schedule of monthly or bi-monthly speakers on a variety of topics relevant to all age groups will be developed.

b. Development will include contacts with
• Chamber of Commerce
• Yavapai College OLI Volunteer Program,
• Various Professional Associations.
• Other 2050 Sub-Committees

2.  The Older Issues Sub-Committee will meet with the City of Prescott Event
Coordinator and the City Manager to request that the Volunteer Facilitator for
this Education Campaign operates as an adjunct to the City Event Department.

3.  The Facilitator will invite volunteers who are experts in their fields to provide the
education programs, monthly or bi-monthly throughout each year.

4.  The Facilitator will promote this campaign by
• Press releases to radio, print, and television media for public service announcements.
• Suggesting each speaker pay for advertisements. 
• Distribution of announcements through City water bills.
• Approaching businesses to fund printing for water bill announcements.
• Requesting Chamber of Commerce to include the Education Campaign schedule on their website.

5.  The Facilitator will develop an on-going volunteer Speaker’s Bureau on topics
relevant to all Prescott Adults.

6.  The City Event Planner will pre-approve the schedule of topics and presenters to
ensure the educational focus on topics of lifestyle planning.

7.  The City Council will arrange with the Prescott Adult Center for meeting space
and a room for child care at no cost for the first year.  (The Facilitator will
arrange for volunteer childcare for each presentation.)

PERSONAL RESPONSIBILITY EDUCATION CAMPAIGN COST:  NONE

BENEFIT:  Attitude change and future personal funds to pay for senior services.
Part 2:  Implementation Steps for the Information & Referral Service:

1. Create an Information & Referral Service database of local, regional, and national non-profit and for-profit resources available to seniors, their families, and caregivers within the Prescott Community.

a. Identify existing Information & Referral databases for referral to, such as
i. NACOG-AREA AGENCY on AGING, Region III.

ii.  Professional, fraternal, and charitable organizations, such as
• Habitat for Humanity
• Shriners
• Salvation Army
• Legal Aide
• Financial Planners Association
• United Way
b.  Require the I & R Coordinator to develop and publish a brief Directory of
Information and Referral Services in brochure format and disseminate at
the Chamber of Commerce, pharmacies and possibly through City Water
Bills (limited costs).

c.  Convince City Council to fund a Coordinator to research and develop the
database, and staff the referral request line after the database is complete.

d.  Require the I & R Coordinator to write grants to fund the maintenance of
the Information and Referral database and brochure dissemination.

INFORMATION & REFERRAL PROGRAM COST:  $50,000

BENEFIT:  Reduces welfare program participation by directing adults to appropriate services and supporting family caregivers.

C. Enlarging the Caregiver Coverage & Workforce:

Rationale:  Why does Prescott require a large pool of caregivers?

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 period. 

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.

Eight-five percent of older adults choose to remain in their homes as long as possible and eventually will 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. 

The key issues surrounding having an adequate caregiver workforce are:

• Prescott needs to increase the caregiver work force in order to keep up with the growing demand.

• Caregivers must receive fair salaries and benefits.

• Caregiver workforce status must be elevated by:

 Establishing consistent criteria (certifications, licensing, etc.) for caregiving in order to maintain consistent quality of service.

 Providing local caregiving education for those getting into the caregiving workforce as well as a support program for family caregivers.

Recommendations and Implementation Steps:

1.  Begin an on-going effort to attract sufficient caregiver workforce by providing
appropriate salaries & benefits.

• Through the citywide Adult Information Campaign (see previous proposal), encourage adults of all ages to plan, save, invest, OR insure for future caregiving costs so that caregivers can be paid adequately.

2.  Support professional caregivers by elevating their status through accessible training
programs and professional certification programs.

• Encourage CEO’s & owners of Home Care Agencies to work with JTED to establish Home Care Aide courses at the high school level.

• Encourage CEO’s & owners of Home Care Agencies to work with Yavapai College to establish Home Care Aide Certification courses.

• Encourage CEO’s & owners of Home Care Agencies to become nationally accredited Agencies through the National Home Care Association.
o Thereby establishing consistent training criteria.
o Thereby establishing consistent supervision of Aides.
o Thereby establishing consistent health-testing criteria.

3.  Support family caregivers by making community services accessible through a
citywide Information & Referral Program.  (See previous proposal.)

4.  Support a Guest Worker Program by working with the Chamber of Commerce and
it’s Lobbyist and the City Council.

5.  Establish a Commission on Aging (see previous proposal) that has as part of its goal
to make individuals, their advisors, city officials, media and non-profit organizations
aware of caregivng issues.

• Do public speaking at Home Care Agency Professional Associations to encourage the CEO’s and owners of agencies to work toward the training, licensing, and certification ideas outlined above.

• Host an annual meeting of all Home Care Agency CEO’s and owners to educate and motivate them to work together to establish training, supervision, and certification programs for their employees.

6. Consider honoring those who serve locally by either asking the Commission on Aging or the Chamber of Commerce to reinforce the idea of family caregiving through a quarterly recognition program celebrating individual caregivers and their stories. 

Cost:  None

Benefit:  Establish a pool of professional caregivers sufficient to community need.
Appendix - Projected Senior Needs for Prescott

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 & Legal Planning B B A A
Social Aspects B B B B
Leisure Activities A A B C
Employment & Voluntary 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 & Legal 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 & Voluntary Opportunities – Provide information about employment opportunities (full time or part time) for seniors. Also, encourage local business to hire seniors. Additionally, 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 & Legal Planning S S L/S
Social Aspects S S S
Leisure Activities S S S
Employment & Voluntary Opportunities S S L