Aging in Alaska: In-Home Support Options and Elder Care Gaps

The Aging Population Swells

The population aged 65 years and older was projected to increase from 35 million in 2000 to roughly 71 million in 2030 (Goulding & Rodgers, 2003; Gelfand, 2003; Gillespie & Sloan, 1990). Those aged 80 and over were expected to increase from 9.3 million in 2000 to 19.5 million in 2030. During those years, the older population among racial minority groups would increase from 11.3% to 16.5%. These minority groups include Blacks, Indian/Alaska Natives, and Asian/Pacific Islanders. The growth of the aging American population aligns with global trends. The global decline in fertility, a 20-year increase in average life span during the second half of the 20th century, and the post-World War II baby boom collectively account for the massive population increase projected from 2010 to 2030. The resulting average life span is likely to extend by another 10 years by 2050 (Goulding & Rodgers; Gelfand; Gillespie & Sloan).

Profile of Aging Alaskans

Up to 1995, Florida had the largest share of the aging population at 19% (Goulding & Rodgers, 2003). That population in Florida was projected to increase to 26% by 2025. Up to 1995, it also accounted for 15% of the aging population across 48 states, excluding Alaska and California. But the trends changed. From 1995 to 2000, Alaska had the largest net outflow of seniors among all states at -39.4 (HSS, 2007). Recent statistics show that 76% of Alaska's senior population is White and 67% live in rural areas. Their life expectancy is below the national median at 76.7 years. Suicide rates are also comparatively higher among older Alaskans than among seniors elsewhere in the United States (HSS; Goulding & Rodgers).

Recent health statistics reveal that about 80% of all persons aged 65 and older have at least one chronic condition, with half having at least two (Goulding & Rodgers, 2003). One such condition is diabetes, which affects one in five seniors, or 18%. The incidence of diabetes is expected to worsen as the population ages, with studies showing it is highest among those aged 75 and older. As American adults live longer, their likelihood of developing Alzheimer's disease doubles every five years after age 65. About 10% of those aged 65–84 and 47% of those aged 85 and older suffer from Alzheimer's disease. These chronic diseases lead to disability, reduce quality of life, and generate increased healthcare costs. Improved public health measures have increased life expectancy and prolonged life, but these gains also demand that public health programs be intensified to respond to greater challenges — including chronic illnesses, injuries, disabilities, and the growing costs of caregiving and healthcare (Goulding & Rodgers).

In-Home State Programs Poorly Managed

The situation became so serious that Alaska was placed under a moratorium by the Federal Centers for Medicare and Medicaid Services until improvements could be made (Demer, 2009). The five-to-six-month moratorium affected approximately 1,000 older Alaskans, some of whom were dying. About 227 died while waiting for a nurse to reassess their needs, and another 27 died while waiting to learn whether they qualified for assistance. These programs were designed to provide in-home help to thousands of aging Alaskans in all forms — from medications to meals — with the goal of keeping older Alaskans at home rather than placing them in nursing homes or other institutions. Medicaid paid for services rendered to the poor and disabled, and the state Division of Senior and Disabilities Services supervised the programs. Eligibility was based on income and need. The average cost of the programs was $250 million, with 61% covered by the federal government. The programs fell under two broad categories: the first covered personal care only, and the second covered a broader range of services including home health care. The first served approximately 3,200 individuals at any one time, and the second served about 3,800. Some seniors were able to access both types (Demer).

Division officials admitted having serious administrative problems (Demer, 2009). A backlog of as many as 2,000 cases awaiting assessment was among the most pressing issues. In response, the division temporarily stopped admitting new participants into the programs to relieve the backlog. Private agencies capable of providing similar services through grant funding were reported to have limited capacity. The State Division also faced eight class-action lawsuits filed by the Northern Justice Project, apparently in response to the incompetent administration of the programs. The complaints alleged that seniors and disabled Alaskans were not receiving the services they needed and to which they were legally entitled. The chief of programs for seniors and disabilities services attributed the backlog largely to approximately 40% vacancy in nurse positions. The State responded by allowing other types of professionals to perform assessments. Officials stated that a new project manager had been appointed to oversee improvements and update the data collection system (Demer).

Despite claims of improvement from state officials, physicians and other healthcare professionals wrote to the Centers for Medicare and Medicaid Services about the lack of meaningful response. Officials never investigated the causes of the deaths and chronic health crises. In response, the State began conducting "focused reviews" of fatalities and cases of serious illness (Demer, 2009).