Dec 7, 2023 - News

Axios investigates: Solutions to Iowa's "gray tsunami" care crisis

Illustration of a pattern of rocking chairs, with one emanating a bright color.

Illustration: Aïda Amer/Axios

A "gray tsunami" is heading our way.

Driving the news: By 2034, adults over 65 years old are expected to outnumber children for the first time in U.S. history, according to the U.S. Census Bureau.

Why it matters: Iowa is already suffering from a nursing home crisis as staffing shortages and facility closures persist.

  • But the state's rural parts are already making changes to meet these demographics needs, and could help lead the nation as a positive example for aging care.

By the numbers: Older Iowans will make up more than 20% of the population in the majority of the state's counties by 2030, according to the nonprofit LeadingAge Iowa.

  • Our state's 85+ population is expected to grow by over 90% by 2040.

What they're saying: Caring for the next generation of seniors will need to go beyond just adding nursing homes, Iowa State sociology professor David Peters tells Axios.

  • It will require towns to think holistically about their senior services and consider how to help people live in their homes for longer.
  • It will also require upgrading homes and technology to meet seniors' needs.

Iowa, federal government, work to ease financial burden of home assistance

Illustration of an elderly hand touching a puzzle of a hundred dollar bill
Illustration: Sarah Grillo/Axios

Breaking financial barriers that commonly block in-home assistance or care at small nursing home facilities are among the elderly care crisis solutions advocated by AARP.

Why it matters: The organization, one of the nation's largest and most influential interest groups, works for the dignity and rights of seniors.

  • Its members are calling for lawmakers and elderly care regulators to rethink how long-term care services are provided, AARP Iowa director Brad Anderson tells Axios.

Zoom in: Nursing home facilities that operate more like a home with a small number of residents are frequently more efficient and provide better quality of care than large-scale facilities, according to AARP.

  • Yet most are paid for out-of-pocket and not covered by Medicaid, keeping them out of reach for most people.

Meanwhile, non-medical in-home services that can allow elderly people to live in their homes longer also frequently require a special waiver or are not covered by Medicaid.

  • Hundreds of thousands of older or disabled people who qualify for Medicaid are annually on waiting lists for home care, according to a five-year analysis published last year by KFF, an independent health policy research organization.

Of note: State Medicaid officials are currently working with the federal government to improve procedures and expand home services, a spokesperson for the Iowa Department of Health and Human Services tells Axios.

How a small town can help its aging population

An Iowa town of 2,000 people is setting the standard for how cities across America can help support their aging populations.

Driving the news: Sac City in northwest Iowa was designated as a "smart" senior town by Iowa State professor David Peters and visiting scholar Ilona Matysiak.

  • The two co-authored a paper examining Iowa rural towns with older demographics. Their research showed how amenities like nearby healthcare, groceries and even child care resulted in seniors reporting a higher quality of life — and subsequently for younger people as well.

State of play: Despite Sac City's shrinking population, government and community efforts to keep a certain level of amenities helped residents overall.

Zoom in: The research paper, published in 2023, examined communities' initiatives to improve seniors' quality of life.

In 2016, for example, Sac City launched an initiative to help residents obtain care from medical specialists — a struggle since the closest major hospital is hours away.

  • Community members contacted a Sioux City hospital, convincing some doctors that if they came to Sac City one day a month, they would get booked from 8am to 8pm and be assured of a full paycheck.
  • Working with the hospital, volunteers drove seniors to their appointments and made sure they saw all their specialists in one day.

What they're saying: "It's a smart way to think about a problem with a solution that's really innovative and it relies on people's willingness to invest in their community and each other," Peters says.

Since then city officials have kept responding to seniors' requests — for instance, converting most of the basketball courts to pickleball courts.

  • Local volunteers have helped build amenities like ramps to doors and rails in bathrooms.

The bottom line: "The more that seniors are active in their mind and their body and are connecting with other people in the community ... the better health outcomes," Peters says.

How Google Nest or Amazon Echo can help with at-home care

iowa state students at a seniors nursing home
Students from Iowa State University work on a pilot project helping renovate seniors' homes for more comfortable living. Photo: Courtesy of AARP Iowa

The Amazon Echo may do more than make your life more convenient — it can also help with fall detection or remotely check in with a loved one.

Why it matters: 83% of older Iowans say they want to age in place, according to an AARP survey.

Zoom in: Solutions can be as simple as changing door knobs to levers for easier grip, carpeting staircases or installing grab bars for showers.

  • They can also involve more technology to help with monitoring or voice control.
  • AARP launched a "smart home pilot project" in Charles City last year, installing Apple Home Kits in 13 houses. Beyond being able to answer questions through voice command, the kits can alert family members and detect unusual movements.

What they're saying: Economic costs are the biggest barriers for Iowans wanting to add amenities to their homes, Brad Anderson, executive director of AARP Iowa, tells Axios.

  • Modifying a home for an aging person can cost $3,000 to $15,000 on average.

What we're watching: The state's Medicaid funding for seniors primarily goes towards funding traditional care like nursing homes (70%), followed by home and community services (30%).

  • Anderson says he believes it should be a 50-50 split, which will ultimately save the state money by keeping more Iowans out of nursing homes.
  • There's also local and federal programs that can provide grant money, including a Des Moines' initiative that opens January 4 and a USDA loan for low-income and rural households.

Quote du jour: Until it affects you

A photo of Iowa Long-Term Care Ombudsman Angela Van Pelt.
Iowa Long-Term Care Ombudsman Angela Van Pelt. Photo: Courtesy of Van Pelt's office
"This is unfortunately one of those issues where it doesn't seem to bother people until they actually do find themselves in that situation."
— Angela Van Pelt, Iowa's long-term care ombudsman, responding to Iowa Public Radio's question in August about whether there is political will to substantially reform nursing home care and oversight

Of note: Van Pelt concluded that change must be driven by citizens.

Editor's note: This is part of a two-part series that first appeared in Axios Des Moines.


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