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HomeMy WebLinkAboutAgenda - 06-26-2003-5AORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: June 26, 2003 Action Agenda Item No. ~-A SUBJECT: Resolution In Support of a "Senior Wellness Campus" Concept Plan for the Southern Human Services -Carolina North Site DEPARTMENT: Aging Advisory Board on Aging ATTACHMENT(S): Resolution Endorsing the Southern Human Services -Horace Williams Site - November 4, 1998 Report -Campus on Senior Wellness and Longevity: APublic-Private Partnership -August 9, 2002 Resolution in Support of a "Senior Wellness Campus" Concept Plan for the Southern Human Services Center - Carolina North Site PUBLIC HEARING: (Y/N) No INFORMATION CONTACT: Florence Soltys, Chair, Advisory Board on Aging Jack Chestnut, Vice-Chair, Advisory Board on Aging Jerry Passmore, ext. 2009 TELEPHONE NUMBERS: Hillsborough Chapel Hill Durham Mebane 732-8181 968-4501 688-7331 336-227-2031 PURPOSE: To adopt a resolution in support of pursuing the concept of a "Senior Wellness Campus" on the Southern Human Services -Carolina North site to include the new Southern Orange Senior Center. BACKGROUND: In 1998, a group named the Aging Resources Collaborative Planning Group was formed. This group included representatives from the University of North Carolina at Chapel Hill, Orange County Government, UNC Hospitals, UNC Institute on Aging, UNC Medical School -Program on Aging, the Town of Chapel Hill, the Town of Carrboro, Triangle J Council of Governments, Carol Woods, Friends of the Chapel Hill Senior Center and other seniors from Southern Orange. It was agreed at that time that senior services for the future should go beyond what was traditionally offered at a senior center and should encompass research, education, training and direct service. This prompted a spirit of collaboration and strong interest in developing a campus environment that encompassed not only a future senior center, but also the possibility of a senior wellness center and/or clinic and research facilities geared toward seniors. On November 4, 1998, the BOCC approved a recommendation to endorse the use of a footprint on the Southern Human Services Center property for a future County senior center adjoining the University's Horace Williams property, now referred to as Carolina North, and passed a resolution to pursue the campus concept with the University at this location (see attachment). In August 2002, the Orange County Advisory Board on Aging approved a detailed report prepared by the Department on Aging staff that re-affirms the campus concept originally supported by resolution in November1998 (see attachment). In November 2001, a County bond passed approving $4 million for construction of two new multipurpose senior centers: a Southern Orange Senior Center to replace the Chapel Hill Senior Center currently located in leased space on Elliott Road in Chapel Hill, and the Central Orange Senior Center, also leasing space in Hillsborough. As the Board is aware, the lease of the Chapel Hill Senior Center is due to expire on June 30, 2006. During May-June, the Orange County Advisory Board on Aging along with the Friends of the Senior Centers have sponsored local community input forums on planning for the two new senior centers. All input received will be shared in a report to the County Commissioners in September in preparation for the formal senior center planning process. The Department on Aging and the Advisory Board on Aging are asking that the attached resolution be adopted by the BOCC as a demonstration of support that can be shared with the University as it continues its deliberations with the community throughout the summer on various development options and opportunities for Carolina North. Copies of the resolution will be forwarded to representatives and officials of the University and UNC Hospital who attended the April 8, 2003 informational meeting hosted by the County and the Advisory Board on Aging. FINANCIAL IMPACT: None RECOMMENDATION(S): The County Manager recommends that the Board of County Commissioners adopt the resolution that supports a "Senor Wellness Campus" Concept Plan for the Southern Human Services -Carolina North site. 3 ORANGE COUNTY BOARD OF COMMISSIONERS Action Agenda Item No. ,~,_ ACTION AGENDA ITEM ABSTRACT Meeting Date: November 4,1998 . SUBJECT: Senior Center Update DEPARTMENT: Courrty Manager -Public Hearing: No Budget Amendment No ATTACHMENT(S): INFORMATION CONTACT: John Link, ext. 2300 Resolution Pam Jones. ext. 2850 Rent proposal comparison Mop (Under separate cover) . ~ Telephone Number- Hillsborough 732-8181 Chapel Hi8 967-9251 Mebane ~ 227-2031 Durham 668-7331 PURPOSE: To discuss options nrgarding future plans to develop a senior center in southern Orange County. BACKGROUND: As the Board is aware, the lease on the Chapel Hill Senior Center is due to expire on June 30, 2fl01. Since the failure of the 1997 bond issue that included a new senior center, County staff and others have discussed how the facility needs for senior activities quid best be served. In order to ensure that a full range of development options was explored, a group named the Aging Resources Cbpaborative Planning Group was formed. The group included representatives from the University of North CaroNrta at Chapel Hsi, Orange County Government, UNC Hospitals, UNC's institute on Aging, UNC's Modica! School- Program on Aging, the Town of Chapel Hill, the Town of Can-boro, Triangle J Council of Governments, Carol Woods and the seniors of southern Orange. After significant discussion about. a number of locations, the group unanimously endorsed the site at the Southern Human Services Cerrter as berg the most feasible and the most desirable. The attached resolution reflec#s the recommendation from the Planning Group. It is interesting to note that the discussions focused not only on faalities, but also on the programming to be offered by the various groups. Wrthout exception, the group agreed that senior services for the future would go beyond what was traditionally offered at a senior center. This .lead to a spirit of collaboration in which the University of North Carolina at Chape! HiQ and UNC Hospitals expressed a strong interest in the development of a campus environment that encompassed not only a senior enter, but 4 also the possibility of a wellness :center and/or clinic and research facilities geared toward seniors. The Commissioners had earlier expressed the need to preserve the County's options to build faa7ities on the thn:e future development footprints at the Southern Human Senrices Center. Wrth these comments in mind, County staff developed an alternative layout. The alfemative layout as reflected on the attached map (attachment #3), re- orients the future building footprint and places the po#ential tocatiori far the senior center in the southwest comer of the property. Tile University has expressed approval in allowing property to be used from the Horace Williams tract to join with the County property and allow sufficient space to develop the campus plan referenced earlier in this abstract. They will proceed with their in#emal approval process. Further, it is our understanding that they will develop a proposed scope of work for the facility in the near future. This information will be submitted to the appropriate paities to request advance planning funds. Construction, funds would then be requested at the appropriate milestone within the planning process. The Southern Human Services-Horace Williams site will serve the County and the University's tong-term purposes to develop the needed facilities. However, given the funding process for University buildings, it is not likely that a building wilt be 'constructed in the immedia#e future. Parallel to this process has been on going discussions with the Galleria of NC, LLC, the Chaps! HiN Senior Center landlord. The landlord was requested to reconsider the proposal presented to the County in 1997. We .are pleased to report that the negotiations have been successful and the landlord has responded favorably to our request to lower the County's cos#s. The proposed terms and condii~rs are included as attachment # 1. Given the fad that the lease is more favorable to the County, particularly when viewed in the terms of present value dollars that would be needed for raw corrstn~ction, and given that the University and the County would find it difficult to respond with new faalities by June 30, 2001. we therefore believe the lease renewal through June 30, 2006 to be a prudent option for the Board to consider. RECOMMENDATION: The Manager recommends that the Board take the following action: • Endorse the use of the footprint on the Southern Human Services Center property as identified on the attached map for future development of a senior center. Approximately 1.25 acres of County property would be combined with additional University property io accommodate a campus for aging services, including the senior center and other aging related University facilities; and • Authorize the Manager to continue working toward an agreement with the University to solidify a land-sharing anan~ment to accommodate the proposed facilities; and • Authorize the Manager to develop a tease extension with the Gatleria of NC, LLC for the Chapel Hill Senior Center, consistent with terms identified on attachment 2 and contingent upon Attorney and staff review; and ' Author¢e the Chair to sign the lease on behalf of the Board. 5 RESOLUTION Endorsing the Southern i~uman Services Center-Horace Williams site Por the Southr*m Orange Senior Center WHEREAS, the senior population (60+) in Orange County is currently estimated to be 93,700 and is expected is double by the year 2015; !and • WHEREAS, Orange County is desirous',to provide quality services m Orange Courrty seniors through it's Dep~bnent on Aging; and ', WHEREAS, there is a cognizant belief that effective service deCroery for senior; extends beyond the confines of a tradiiwnat senior cartel; and WHEREAS, the University of North Carolina through it's institute on Aging and UNC Hospitals have also expressed arr interest in partnering with the County to provide services to seniors; and WHEREAS, the Aging Resouroes Col~borative Planning group was forn~d to represent the various interests of stakeholders; and WHEREAS; the planning group, which included representativesfrorn the Universrty of North Carolina at Chapel Hill,_ Orange County Govemmerrt, UNC Hospr~als, UNC's Institute on Aging, UNC's Medk~l School- Program on Aging. the Town of Chapel Hiii, the Town of Carrboro, Triangle J Council of Governments, Carol Woods and the Seniors of southern Orange has met to explore the hest possible options for provkling senior servk~s in southern Orange County; and WHEREAS, the group has worked diligently over a song period of time to explore various options of progranxning and physical facilities for senior activities; and WHEREAS, the group has agreed that programming of the individual entities should complement the overall services offered•th seniors; and• ~. WHEREAS, the group has agreed that the programs can be~offered most effectively if the faalities are ~ be co-togted in a campWS environments acrd WHEREAS, after detailed review of over seven sites, the Planning Group has determined the Southern Horror Services-Horace Vlfil~ams site on Homestead Road to be the mast feasible and the most des~able site tiiiscrused; BE IT THEREFORE RESOLVED THAT. the Aging Resources Collaborative Planning Group has unanimously endorsed the Southern Human Services Garner-Horace Wt~iarr~ site on Homestead Road to pursue the campus eoncept~of senior programs in southern Orange County. This, the twenti~h day of October, 9998. . Ned Brooks, Chair Aging Resourr~s Coilalrorative Planning Group ., ~. ~ t~v ~ q ~ tl~ ~ ~i oo~ w ~ ~ ~ ~ ~ ~ ~ ~ f ~ ~ ~ ~ ~ ~ ~ ~ ~~ ~ ~ ' ' ~ ~ r M r Mi N r N ~ r N ~ r N ~ ~. N h r N fD r M ~ r N c ~ ~} r M ~7 r N ~ r N r W r Ml r ~A r N ~~yy iR N• M ~ r: N $ F W ti f ~ n n ~ tf~ ~ ~ ~i ~ h f m~ ~ ~ ~i ~ ~ N ~ ~ N N g N ~ N ~ ~ ~ ~ p~ M p~ Vl ~ ~j M ~ t~ ~l ~ ~ ~ r - w ~ + ~ ii ~ tV ~ ~ t~i ~ g• ~~ ~ ~ ~ Ci i~d~ ~ ~ O ~ g ~ 0 ~ 1~ ~ o ~ a~ ~ W ~ ~ ~ ~ ~ ~ ~ ~ ~ ~gi ~~ ~ ~ ~ ~ ~i ~+ N r W ~ N t~l r N r N ~~ ~ ~ p ~ t s r iI~ e~ N r N r N ~- N r N e~ N e- M { -~ ~r N ~N ... • v: ~ ~ ~ ~• M ~ M ~ r~ M ~ ~ N t+rS !~'i ~Il r ~ ~ ~ t~ ~ ~ ~ S ti l r ~ ~ ~ ~ ~j M' ~lt ~ ~ g 11- ~ ~ ~ ~ ~ ~ ~ ~ ` ~G ~~ ti t'-f ~ ~ ili ~ a O ~ ~ _ ~ ~ ~ r ...~ ... ~ ~ ~ ~ R~f R ~ ~ ~ @ F. p G ~ 1~ {~-j' O ~,. ~ 1 {~.. O W i~ N ~~ ~ S N '" r e r ~ ~ ~ ~ ~ r ~ ~ . . , d TOTAL P.01 7 A Campus on Senior Wellness and Longevity "Preparing for the Future Age Wave" A Public-Private Partnership Proposal Prepared By Jerry M. Passmore, Director Orange County Department on Aging For The Orange County Advisory Board on Aging Florence Soltys, Chair Approved August 9, 2002 8 Introduction Over the centuries both society and individuals have continued to raise the same age old, but fascinating questions - Why do I grow old? How can I stop, slow down or reverse the aging process? What impact do environment, lifestyle and genes play in successful aging? How can I live a longer life? Perhaps the most important question to us is: How can 1 stay healthy, well and functionally independent as long as possible up to the time of death? Simply stated -How can I improve both the quality and quantity of my life to the very end? As we enter the 21St Century, we as a society will be forced to consider this ancient question as never before. We are living at a critical point in history in which five demographic conditions never before seen will force us to make critical decisions concerning massive societal changes. 1. Never before in history have we lived chronologically longer lives. The U.S. Administration on -Aging states, "Globally, we are witnessing one of society's greatest achievements-an extension of human longevity more dramatic than in the preceding 4,500 years. Advancements in medicine, public health and technology will make it even more commonplace for people to live 80, 90, or 100 or more years." (AoA, Ref #1) According to the U.S. Census, the number of people aged 100 or above, "centenarians," increased dramatically from 37,306 in 1990 to 50,545 in 2000, a 35% increase over the last decade. (AoA, Ref #2) In Orange County the projected growth between the year 2000 and 2020 is most dramatic for the 95+ population with an increase of 234%. Life expectancy in the United States in 1900 was only 49 years as compared to 76.9 years in 2000. In 2000, a person who was 65 had an average life expectancy of 17.9 years (19.2 years for females and 16.3 years for males). In North Carolina the life expectancy is 75.6 years and a person who was 65 had an average life expectancy of 17.1 years, a little less than the national figure. 2. Never before in history have we seen such an explosion in the sheer numbers of older persons. The older population is the fastest growing segment in the United States today and in the foreseeable future. According to the United Nations Population Division, "The number of persons age 60 or older (world wide) is estimated to be nearly 600 million in 1999, and is projected to grow to almost 2 billion by 2050, at which time the population of older persons will be larger than the population of children (0-14) for the first time in human history." (UN,1999, Ref #15) This population shift will have an impact on the caregiving of tomorrow, especially on women who have been the primary caregivers. Women today and in the future can count on caring for older 9 family members for longer period of time than they will care for their own children (under 18 years of age)! This will be exacerbated as the Baby Boomers age to due fewer family caregivers with responsibility for more elderly adults. In the United States, comparing the turn of the century year 1900 to 2000: • The 65+ age group is 3 times larger. • The 65-74 age group (18.4 million) is eight times larger, • The 75-84 age group (12.4 million) is 16 times larger, and • The 85+ age group is 34 times larger. (AoA, Ref #2) As illustrated in Table 1, in the year 2000 the older population (65+) now numbers 35 million. By the year 2030, the older population will more than double to about 70 million. The 85+ population will see an even more dramatic increase from 4.2 million in 2000 to 8.9 million in 2030. (AoA, Ref #3) Table 1 also demonstrates how the "age wave" will be at high tide in the year 2030 when all Baby Boomers (born between 1946 and 1964) will reach 65 years of age. The 65+ population in 2030 will represent 20% of the U.S. population compared to 12.4% in 2000. The ratio of older adults to the rest of the population will increase from 1 to 8 to 1 to 5. (AoA, Ref #4) By 2030 the state of North Carolina will have nearly 18% of its population over age 65, which is a higher percentage than the state of Florida's current 17.6% 65+ population. (AoA, Ref #4) In 2000 the state of North Carolina had almost one million (969,048) older persons 65+, representing 12% of the total population. The state's 65+ population showed a dramatic increase of 20.5% between 1990 and the 2000 Census (Table 1). Thirteen other states also had increases of 20% or more for the decade. (AoA, Ref #5) The growth in numbers of older adults in Orange County is expected to outpace similar growth for the nation as a whole, as well as that of North Carolina. Orange County's 65+ population is expected to grow from 10,744 persons in the year 2000 to 23,840 by 2020 (Table 1). This is an increase of 122% over the 2000 total, versus an anticipated total county population increase of only 40.5% for the same period. 10 Table 1: Percent of Persons Age 65 Years and Older Year Orange County North Carolina United States 1990 8,136 (8.7%) 804,341 (12.1 %) 31,241,831 (12.6%) 2000 9,931 (8.4%) (22.1 % change from 1990) 969,048 (12.0%) (20.5% change from 1990) 34,991,753 (12.4%) (12.0% change from 1990) 2010 14,825 (10.4%) 1,306,942 (13.8%) 39,715,000 (13.5%) 2020 23,840 (14.2%) 1,831,699 (16.8%) 53,733,000 (16.5%) 2030 30,757 (17.0%) 2,221,470 (17.8%) 70,319,000 (20.1 %) Source: U.S. Census Bureau, NC State Demographics 3. Never before in history have we seen so many people living more of their advanced years in declining health and limited function before death. As we age we have more illnesses, disabilities and chronic conditions that limit our independence and ability to perform ordinary tasks. In the United States, most older Americans (65+) have at least one or more chronic conditions. In 1996 (AoA, Ref #6) the "most frequently occurring conditions per 100 elderly were: arthritis (49), hypertension (36), hearing impairments (30), heart disease (27), cataracts (17), orthopedic impairments (18), sinusitis (12), and diabetes (10)." According to a U.S. Administration on Aging (AoA, Ref #7) Report, "With a current life expectancy of 75 years, newborns today (2000) can expect to experience an average of 13 years with an activity limitation. Because the 85 plus group is the fastest growing segment of the population, many Americans may live with activity limitations for 20 years or more." In North Carolina the average years of healthy life remaining at birth (based on perceived health status) is 63.0. "This means that 12.6 of the 75.6 years of life expectancy will be spent in a state where health status is perceived to be fair or poor." (N.C. Center for Health Statistics, Jan. 2002, Ref #13) The fact that the 85+ population (the" Oldest-Old") is the fastest growing population segment and has the highest per capita disability rate creates social and economic implications for our society now and dramatically more so in the future. Two social situations that best illustrate this are: (1) Increase in Nursing Home Placements with Age. In 2000, only 4.5% of the nation's 65+ population (1.56 million) lived in a nursing home. 11 However, as illustrated in Figure 1, that percentage increased dramatically as age increased, with a low of 1.1 % for the 65-74 age group, 4.7% for the 75-84 age group and a staggering 18.2% for the 85+ age group. (AoA, Ref #8) Figure 1: Nursing Home Occupancy by Age Group, 2000 20 15 10 5 0 O Percent in 2000 (2) Increase in Alzheimer's Disease with Age. Alzheimer's Disease (AD) affects 6-8% of all people over age 65, but the prevalence of the disease doubles every 5 years after age 60. Therefore, estimates suggest that almost 30% of the 85+ population has AD. When you look at dementia in the 85+ category (Figure 2), the numbers are estimated to be over 40%. From diagnosis to death, the range of care needed for those with AD is from 3 to 20 years. The financial and emotional impact on caregivers can be devastating, especially since many AD patients do not qualify for skilled care. (Many AD patients have few medical problems, thus making them eligible for assisted living level of care.) Figure 2: Percent with AD or Dementia by Age Group 50 40 30 20 10 0 65-74 75-84 85 and older 65+ with AD 85+ with AD 85+ with dementia 12 Medical advances have enabled us to live longer, but have not improved the delivery of chronic care services. According to Chronic Care in America: A 21St Century Challenge, a report from the Robert Wood Johnson Foundation: "There is no effective system to care for those with chronic conditions in the United States. As a result, much of the care that is available is fragmented, inappropriate, and difficult to obtain." Furthermore, the report states, "In 1995, one in six Americans-41 million people - had a chronic condition that inhibited their lives to some degree." Some of the chronic conditions listed were arthritis, cancer, heart disease, diabetes, emphysema, Alzheimer's disease, blindness, hearing impairments, mental retardation and mental illness. (AoA, Ref #7) In 1998, 28.8 % of those in the 65-74 age group reported limitations in their daily activities because of a chronic condition. This percentage increased with age to over half (50.6%) for those in the 75+ age group. The U.S. Administration on Aging's A Profile of OlderAmericans: 2001 (AoA. Ref #6), reported a 1997 study indicated that more than half (54.5%) of the older Americans (65+) had a least one disability of some type (physical or nonphysical). Furthermore, 37.7% of Older Americans had at least one severe disability, 14.2% (4.5 million) had difficulty in carrying out activities of daily living (ADCs), and 21.6% (6.9 million) had difficulty with instrumental activities of daily living (IADLs) (Figure 3). ADCs are defined as basis self- care activities such as bathing, dressing, eating, toileting and hygiene. IADLs include tasks related to independent living, such as telephoning, shopping, preparing meals, doing housework, taking medication properly and handling money or managing finances. Figure 3: Percent 65 Years and Older with Disabilities, 1997 60 50 40 30 20 10 0 At least one At least one Difficulty with Difficulty with disability severe disability ADCs IADLs 13 As the older population grows in age and magnitude, the percentage of disabilities and chronic conditions will increase sharply for both the United States and North Carolina. For the 80+ age group In the United States, almost three-fourths (73.6%) reported at least one disability, over half (57.6%) indicated one or more severe disabilities, and over one-third (34.9%) needed assistance as a result of disability (Figure 4). (AoA, Ref #6) Figure 4: Percent 80 years and Older with Disabilities ~s ro. disability disabilities due to disability The economic costs and social impact of this phenomenon on the health care system and society will be catastrophic unless society focuses on chronic diseases through prevention, home health and rehabilitative services rather than merely reimbursing short-term acute care needs. While most older people only see their doctor for a chronic condition, doctors are limited in what they can prescribe for the chronically ill. In 1999, the Administration on Aging reported older Americans (65+) as compared to the under age 65 group, had four times the number of days of hospitalization (1.6 days vs. 0.4 days) and averaged more doctor contacts (6.8 contacts vs. 3.5 contacts). Out~f-pocket health care expenses for older Americans increased to an average of $3,019 in 1999, a rise of more than one third since 1990. As illustrated in Figure 5, these health care costs add up to an average of $1554 (51 %) for insurance, $706 (23%) for medications, $601 (20%) for medical services, and $158 (6%) for medical supplies. Older Americans spend twice as much on total health care (11 % vs 5%) as the rest of the population. (AoA, Ref #6) At least one One or more severe Assistance needed 14 Figure 5: Out of Pocket Expenses for Older Adults, 1999 ~ Insurance-51% Medications-23% ^ Medical Services-20% Medical Supplies-6% 4. Never before in history have we seen so many multiple generations living at one time, and scattered throughout the United States. Thus, we are seeing more "Long Distance" caregiving of older persons by relatives, as well as older persons having to rely more on community resources and government assistance in later years. While over half (55%) of older Americans (65+) lived with their spouse in 2000, a large and growing segment of older adults are "Older Persons Living Alone" or (OLA). In 2000 about 30% (9.7 million) of all Older Americans (65+) lived alone. Nearly 17% of older men (65+) lived alone while as many as 40% of older women (65+) lived alone. For women in the 75+ age group, almost half (49.4%) lived alone. In 2000, 28% of old North Carolinians lived alone and 25 % lived alone in Orange County. The percentage living alone increases with advanced age, again, especially for women. For the period 1990 to 2020, the Older persons 85+ living alone group is projected to double in size. (AOA, Ref #9) The negative societal implications for older adults increase as more and more seniors live alone in advanced years: (1) Little or no assistance with ADLs or IADLs within a household thereby allowing a person to live independently. (2) Higher rates of depression -especially among older men who live alone and are more prone to suicidal behavior. (3) Emergencies left undetected for long periods of time, such as falls, myocardial infarctions, cerebral vascular accidents. Personal emergency response systems (PERS) have developed to respond to this issue. (4) Little or no socialization can lead to cognitive decline. (5) No consistent person to assess changes in memory, mood, or behaviors. (6) No consistent person to coordinate care, even if funds are available to purchase this assistance. 15 The older person living alone (OLA) is more likely to need home and community-based services. Compared to the older population in general, research has shown that OLAs are more likely to: (1) have inadequate diets and poor nutrition, (2) rely on formal paid services for assistance, (3) be more socially isolated and at greater risk of mental health problems, (4) be functionally disabled, (5) be at greater risk for nursing home admission, and (6) be more reliant on public support for nursing home care, particularly from the Medicaid program. (AOA, Ref #9) 5. Never before in history have we seen such a large and growing number of retirees who are a major human resource. The future Baby Boomers will likely place more demands on the health and retirement systems between 2010 and 2030 when they have passed age 65. They will also be a major human resource with skills and talents that can be utilized by society. In 2030, approximately 1.5 million Boomers will be living in North Carolina. Compared to North Carolina's older persons today, aging N.C. Baby Boomers are predicted to: • Be a larger and more diverse population; • Be better-educated; • Have had higher incomes, • Be the largest group of consumers, • Be less likely to exercise vigorously and regularly, • Experience lower rates of illness and impairment in their later years, • Be likely to do volunteer work and give to charities, • Remain in the work force for a longer period of time. (NCDOA, 1997, Ref #12) Issues and problem areas that will become exacerbated with the future Baby Boomers are listed below: 1. Inadequate health care work force to meet today's and tomorrow's demands, even thou4h older adults may have the resources to pay for them. • Turnover rates for Certified Nurses Aides (CNA) in Adult Care Homes & Nursing Homes in N.C. (Currently,140% average annual turnover rate in Adult Care Homes and 100% average annual turnover rate in Nursing Homes.) • Staffing problems for home care agencies. • Low numbers of nursing students. 16 • Low numbers of Masters in Social Work students with specialization in aging. • Few board certified geriatricians. 2. Continued Geographic relocation of older persons that lead to the further creation of age-segregated societies in the form of Continuing Care Retirement Communities (CCRCs), Assisted Living, and other retirement communities. This trend creates artificial boundaries between the generations and between socio-economic classes of seniors who have resources. Some have referred to this situation as the development of "golden ghettos" for the old, rich and talented. 3. Continued overuse of the medical system occurs because older adults do not know where to turn for help especially when treatments and medications are non-reimbursable. This situation is driven, in part, by the media and mass advertisement. 4. Growing trend among older adults toward alternative or holistic medicine, natural healing remedies or therapies such as massage, acupuncture, reflexology, meditation, hydrotherapy, herbs, vitamins, diet and exercise, to name a few. Many of these approaches require out-of pocket expenditures and lack scientific research on their effectiveness. 17 Proposal The unprecedented number of older persons with longer life spans, but with more years with disabilities or poor health, will create challenges never before seen in public policy that will impact every institution in society. More demands will likely be placed on the health and retirement systems and other community resources. Therefore, society and especially its governmental and educational institutions, must find new and better ways to support, as well as utilize, the skills of a growing older population. While it seems that health problems and increased costs are inevitable in later life due to disability, mounting evidence (AoA, Ref #10) indicates that one can improve health and delay disability by at least seven years if he/she stops smoking, stays physically active and maintains weight appropriate to height. A 1996 U.S. Surgeon General report found that many diseases and chronic conditions in later life could be prevented, controlled or forestalled by adopting a healthy active lifestyle, specifically moderate exercise done on a regular basis. Yet, it is difficult to convince older persons of the importance of physical activity or get their participation in fitness programs. (AoA, Ref #11) It is imperative that we now begin "Longevity Planning" that focuses on prevention (research, education and services), rather than reaction to these demographic conditions with increases in our current services. How should we respond to these historic age-related trends in our society? How do we prepare for a society of Longevity? First, citizens must receive encouragement and assistance to plan now for a long life. They must begin "Personal Longevity Planning" (Passmore, 2002, Ref #14) or what others refer to as "life course planning." The time is now to begin developing programs and services for future older persons that promote personal responsibility for their health and well-being utilizing their skills and talents. The so-called "retirement planning" concept of the past is no longer appropriate for the future, since many older persons will not choose or be able to retire from work. The opportunity to live a long life carries with it the new responsibility to make healthy lifestyle choices. Society must assist in implementing Personal Longevity Planning that includes health promotion, senior employment and community volunteer options. Collectively, this generation and future ones have the power to increase their own longevity and improve their quality of life until the end of life. Second, the State of North Carolina has an obligation and a responsibility to begin "Societal or Community Longevity Planning" (Passmore, 2002). We must take the lead both locally and statewide through governmental entities and educational systems to identify, promote and offer healthy active life choices for older North Carolinians. Innovative partnerships between academic and community 18 programs can create models that address the quality of life issues faced by older persons with chronic disabilities. In response to this challenge, we propose the establishment of a Campus on Senior Wellness and Longevity at the University of North Carolina at Chapel Hill that brings together research, education, training and service from an interdisciplinary perspective. (See Chart: Campus on Senior Wellness and Longevity, page 12) The Campus's mission would be "to improve the independence, functionality, quality of life and well-being of older persons as long as possible through research, education and service." In addition, the Campus's mission should address positive interdependence between diverse generations such as the roles of seniors as mentors and contributors, rather than merely as those who require assistance. The Campus must include the following key characteristics: 1. A public and private partnership. All sectors including government, private non-profit and private enterprise have a part to play in the campus's mission. 2. Interdisciplinary in scope. The campus should include all schools, departments and institutes. UNC-Chapel Hill is especially blessed by being one of only 16 universities in the U.S. with all Health Sciences and its School of Social Work on campus. 3. Involve the business community including pharmacies, housing providers and health care providers who already market goods and services to seniors. 4. A centrally located and easily accessible campus for senior citizens, students, faculty, employees and public transportation services. The University's Horace Williams Property, adjoining the County's Homestead property, would be an ideal location if appropriate access can be achieved. 5. A Enough acreage to accommodate research, education and training facilities, a central Senior Wellness-Longevity Service Center, and several research models for senior living and service delivery such as housing, health care (nursing) center, an adult day and rehabilitation program and a geriatric assessment center. 6. Easy access to other campus facilities. 7. Adequate parking and drop-off design features to accommodate disabled persons and public transit/private bus service. rn 'G ~~ ~ ~ ~ .. = O ~ O = U a~ J p C ~~ O ~a~ _ ~z ~w ^~ ~ ^- 3 L •~ ~ ~ ._ ~ L 0 ~ _ ~ .. ~ = C o ~,~~ ~~~ ~o ~ ca a~ ~ ~ V fl. 0 L a ~V C R ._ ._ L ~" O ^~ W V L W ~. ._ L a .~ L a ~V a .. .~ a 0 U a~ .. ~ ~ S L T i }~ /~~ / ii AA i - ~ ^~ ~- u ~ ~+ L ~ ~ I W • t = ~ 3 ~ j~ W }' > = {A .~ Z ~ cn ~ a ~ ~ • ~ • i~ ., i 0 'r^"., a ~~ ~ V ^- ~. O a~ ~ a ~~ /~~ Y/ .L ~ O= a =a ~ .- ~ _ ~~ i N ~ ~~ _Q lJ V a` ~ n V w a' ~a Va Z '~ L d ~ _ ~ J V ~3~ •~~ = = H'~ ~ ~ a O ~ OQ ~ .. _ _ c c G~~~V 3 V L = .~ ,ooh J ~ ^ 'Q ~ L ~- a C V C ~ ~~ ~ ~ V a V a~ioG`-' li V ~ ~E ~a a~.+ L a o+ __ a c O a O U R .~ L .C GL o~ =3 o~ L d p n. a °- u a~ c ~~ ~ U C 0 0 GT. L ~ ~ .. ~ ~ ~ ~ V ~ . ~ ~ ~ V '~ pG a t a p ~ Z *, ~ Vu ~ ~ L ~ ~ ~ ~ 3 _ ~ 19 N ~' O a N ~ t~N ~ L H a o+ ~ ~ Qa~ .-~ c ~ c a ~ ~ ~ r.. ~ ~(~ ~ 0 ~ ~ o pV~a V ~ V}+vyi°o Z•La{~A ~ d7 ~ !~ L 20 Local Resources and Aging Initiatives Several nationally recognized local resources have been established over the years, and many current initiatives are taking place that make Chapel Hill an excellent location to establish a Campus on Senior Wellness and Longevity. Local Resources: • The Orange County/Chapel Hill community has one of the highest concentrations of older persons in the state, and has been a creative force for change. • More than 20 years ago, Orange County established one of the first public departments on aging and community advisory boards on aging to help plan, advocate and offer services in cooperation with other organizations. • More than 10 years ago, the Friends of the Chapel Hill Senor Center organization was formed to provide leadership, funding and community involvement in the operation of the Chapel Hill Senior Center. • More than 25 years ago, the Town of Chapel Hill established the Council on Aging and the Retired Senior Volunteer Program. These programs eventually merged with the County Department on Aging, but the Town still supports senior services. • Carol Woods Retirement Community, a continuing care retirement community, has provided funds and staff for community aging projects and serves as a training center for UNC students. Current Aging Initiatives: Orange County has supported and practiced the development of community partnerships, both public and private, over the years. Several initiatives exist on the University of North Carolina-Chapel Hill campus, in the community and within Orange County government that would support a Campus on Senior Wellness and Longevity. 1. Interdisciplinary Aging activities on UNC campus: A. Program on Aging -Geriatric Assessment Clinic that works with Gero-psychiatry, Nursing, Physical Therapy, Occupational Therapy, Social Work and Pharmacy as a training center that sees frail elderly with multiple health problems and their families. The Departments of Speech and Language Pathology and Nutrition are called upon when needed. B. Institute on Aging -providing research opportunities and educational opportunities for students from social work and allied health with a Certificate in Aging. C. School of Social Work- Geriatric Specialization offering interdisciplinary classes on aging that involve students in clinical services or in community planning such as the Master Aging Plan, and specific services such as Adult Day Care and Eldercare Programs. D. Hubbard Project- An interdisciplinary program consisting of senior residents in Medicine, Pharmacy, Allied Health and Social Work who make home visits to frail seniors. Referrals are made from the Dept. 21 on Aging, Geriatric Evaluation Clinic and community providers. Care Plans are sent to the care provider. The students learn to look holistically at the patient and family and appreciate the contribution of each discipline. Appropriate patients are then referred to the new home visiting of Student Health Action Center (SHAG) who will visit monthly to monitor. E. The Pharmacy School -Under the direction of faculty, doctoral students make home visits to assist with medication monitoring. Referrals are made from the County Dept. on Aging and Geriatric Evaluation Clinic. 2. University and Community Partnership on Aging: A. In Praise of Age Weekly. The television show is produced by seniors for seniors on topics of aging, and features University faculty and programs. Co-sponsored by the Orange County Department on Aging, Carol Woods Retirement Community and the Friends of the Senior Centers in Chapel Hill and Central Orange. B. Coalition on Continuity of Care. University faculty and community agencies have come together to inform each other on community needs and to advocate legislative and community change. C. Senior Wellness Program. UNC Health Care co-sponsors and assists in funding this Orange County program. It provides direct services such as immunizations, foot care, blood pressure checks and community education. Students and faculty from various disciplines have been involved with these services and serve on the Wellness Advisory Board. D. Elder Mistreatment Coalition. Along with community agencies, the Coalition educates the community on abuse, neglect and mistreatment of older persons. E. UNC and Department on Aging. Over the years the Department on Aging has been a training and research center for University students from the schools of: nursing, pharmacy, public health, social work, and rehabilitation counseling. The Department on Aging (DOA) has offered internships in its various divisions such as Eldercare, Senior Centers, Wellness, Transportation, Administration, and Volunteerism, as well as special planning projects. Currently, the School of pharmacy and Eldercare are partnering on a grant to provide Pharmacy services/education in the homes of DoA community clients. Interdisciplinary students from the Health Service Schools and Social Work have worked in teams on the development of the new Day Health Care Program initiative in central Orange. 3. Orange County Government Initiatives in Aging: A. Orange County has developed, adopted and begun the implementation over a five year period (2001-2005) of one of the state's first comprehensive Master Aging Plans (MAP) that focuses on older adults over their life span. Sensitive to the functional diversity within the senior population, the MAP addresses the needs of the well elderly, the moderately impaired elderly living in the community, and the frail elderly both at home and in institutions. The emphasis on prevention, 22 maximizing functionality, and enhancing quality of life, is in some cases directly related to quality of care. B. The Orange County Board of Commissioners placed on the ballot a Senior Centers Bond that was approved by the voters in November, 2001. The Bond will help construct two large multipurpose Senior Centers -one in southern Orange and the other in central Orange. The Senior Centers are hubs for healthy living and exercise, disease prevention, socialization, recreation, information, counseling, and services for seniors and their families. C. The Chapel Hill Senior Center, operated by the Department on Aging, is recognized as a state-wide model for the coordination of and access to, community services and opportunities. It has a proven track record for consistently providing high quality services to all segments of the older adult population. Over the past 20 years the Department on Aging has been awarded seven Achievement Awards by the National Association of Counties (NACo). Most of the awards were associated with senior center operations such as Coordinated Leisure Programming, Saturday School for Seniors, Volunteer Income Tax Assistance, Coordinated Agency Transportation, and the Senior Times Newspaper: APublic-Private Partnership to promote aging services. D. For over 20 years, Orange County Nursing Home and Adult Care Home Advisory Committees have been grassroots ombudsmen that visit local long-term care facilities quarterly and act as advocates for residents. They are appointed by the County Commissioners, staffed by the Department on Aging and receive training and technical assistance from the Regional Ombudsman Program through Triangle J Area Agency on Aging. 23 Impact and Benefits The impact and benefits from the research, training and service generated by a Campus for Senior Wellness and Longevity will be enormous. Here is a brief listing: 1. Improve the quality of life and longevity for older persons in Orange County, North Carolina. 2. Improve the quality of education and training of professionals in gerontology within a community setting. The gerontological education and training would focus on the older person and the aging process holistically- from a "mind, body and spiritual perspective." This would include partnerships with the faith community. 3. Reduce the workforce shortage of health professionals needed in geriatrics. 4. Establish UNC as a national and international leader in geriatrics and gerontology. 5. Attract research and development funds from federal sources, private foundations and the business community. 6. Develop effective and efficient service delivery models that can be replicated in North Carolina, as well as nationally and internationally. 7. Develop research, education and training models that can be replicated on other UNC campuses. 8. Develop a university and community partnership to reduce fragmentation of service delivery, which can be replicated across NC on a university campus with allied health programs. 9. Expand the traditional medical model to reflect an inter-disciplinary approach, which addresses the unmet needs of chronically ill patients, resulting in lower Medicare/Medicaid costs and greater patient satisfaction. Such a program could be a pilot project to replace the state Community Alternatives Program (CAP). 10. Research, evaluate and develop holistic medical models that use natural healing remedies and therapies to which older adults and the general population are turning for relief of chronic conditions. 24 11. Develop innovative, intergenerational housing models that meet the needs for affordable housing of seniors, students, paraprofessionals in the aging workforce and lower income UNC employees both active and retired. This addresses the issue of geographically distant nuclear families in many communities, and creates a setting within which multiple generations can teach each other and help each other. 12. Develop a training partnership between the UNC system, the state Division of Aging and the Area Agencies on Aging which would enable local front line workers in the field of aging to develop their knowledge base and enhance their skills in working with individual seniors and in developing successful programming. 13. Identify and address cultural, political, policy and socio-economic norms that undermine wellness among certain groups of older adults (rural, minorities) or impede their access to information, services and resources that facilitate wellness and longevity. 14. Develop nursing home, adult day care and rehabilitation service models that can address the chronic conditions of older adults from amulti-dimensional wellness perspective. This is an opportune time to establish a Campus for Senior Wellness and Longevity that provides leadership and meets the age-related challenges now facing our county, state, nation, and world. 25 References (1) Administration on Aging (AoA), Fact Sheet: Life Course Planning, May, 2000 (2) Administration on Aging (AoA), A Profile of Older Americans: 2001, The Older Population, December, 2001 (3) Administration on Aging (AoA), A Profile of Older Americans:2001, Highlights, December, 2001 (4) Administration on Aging (AoA), A Profile of Older Americans:2001, Future Growth, December, 2001 (5) Administration on Aging (AoA), A Profile of Older Americans:2001,eeographic Distribution, December, 2001 (6) Administration on Aging (AoA), A Profile of Older Americans:2001, Health, Health Care and Disability, December, 2001 (7) Administration on Aging (AoA), Fact Sheet: Older and Younger People with Disabilities: Improving Chronic Care Throughout the Life Span, May, 2000 (8 Administration on Aging (AoA), A Profile of Older Americans:2001, Living Arrangements, December, 2001 (9) Administration on Aging (AoA), Fact Sheet: The Many Faces of Aging, Older People Living Alone, May, 2001 (10) Administration on Aging (AoA), Fact Sheet: The Future is Aging, Good Nutrition !Essential for Health, May, 2000. (11) Administration on Aging (AoA), Fact Sheet: Older Americans Month, Health Promotion Programs for Older Americans, November, 1998. (12) N.C. Division on Aging (NCDOA), The Future of Aging in North Carolina, July, 1997. (13) N.C. Center for Health Statistics, January, 2002. (14) N.C. State Demographics, Population Projections, retrieved from http://demog.state.nc.us! on June 6, 2002. (15) Passmore, Jerry M., A Campus on Senior Wellness and Longevity, May, 2002. (16) United Nations (UN), Population Division, Dept. of Economic and Social Affairs, 1999 (17) United States Census Bureau. Population Projections. January 13, 2001. FN:H/Proposals/Proposal Senior Wellness Campus020809-approved 26 Orange County Board of Commissioners RESOLUTION In Support of a "Campus on Senior Wellness and Longevity" Concept Plan for the Southern Orange Senior Center WHEREAS, According to the latest population figures, there are more than 16,200 persons over 60 years of age in Orange County, a number which may more than double by the year 2020; and WHEREAS, the Board of County Commissioners approved, on March 6, 2001, a Master Aging Plan (M.A.P.), the purpose of which was to anticipate and begin to prepare a response to the service needs of this growing older population over the life span; and WHEREAS, the Board of County Commissioners through its Department on Aging is now initiating planning phases for developing two new multipurpose Senior Centers for the 21St Century -one in Chapel :Kill (Southern Orange) and one in Northern-Central Orange County; and WHEREAS, the University of North Carolina, UNC Hospitals, Carol Woods and other groups have expressed an interest in identifying unique and mutually beneficial ways to partner with the County to provide services to seniors; and WHEREAS, the Board of County Commissioners concurs with the concept that senior programs can be offered most effectively if facilities can be co-located in a campus environment as envisioned for the Southern Human Services- Carolina North site and expressed in "Report on Senior Wellness and Longevity"; z~ NOW, THEREFORE, BE IT RESOLVED that the ORANGE COUNTY BOARD OF COUNTY COMMISSIONERS encourages the establishment of a Campus on Senior Wellness and Longevity with the University of North Carolina at Chapel Hill that would together foster research, education and direct services through the planned Senior Center for Southern Orange and other University facilities, and encourage the University in its current deliberations on the development of Carolina North, to grant favorable consideration to this objective. This the 26th day of June, 2003. Margaret Brown, Chair Orange County Board of Commissioners