In caring for the elderly, more want to stay home

Iowa last year saw a 2.6-percent increase in the number of people over the age of 60. Almost 21 percent of the state's population now falls into this age group, and the numbers continue to rise.

By 2030, the projected population for the 65-plus age group in Iowa is 663,186, according to the U.S. Census Bureau.

When it comes to being prepared for the effects of this growing elderly population, the state looks good on paper. According to the Centers for Medicare and Medicaid Services, Iowa has 58 nursing home beds for every 1,000 residents over the age of 65 - a higher ratio than any other state.

But Iowa also has the second-highest institutionalization rate in the nation, with 26,092 residents ages 65-plus in assisted-living or long-term care environments.

“Facilities are only a small part of long-term care,” said Ingrid Wensel, executive director of the Heritage Area Agency on Aging in Cedar Rapids.

About 6 percent of Iowans aged 65 and older are in institutional care - the remaining 94 percent are at home.

Wensel said baby boomers have much greater expectations than previous generations for what they want and expect in terms of care. They're asking for basic services, such as grocery shopping, bathing and cooking - and they're asking for these services at home instead of in a long-term care facility.

“Not only is it what people want,” Wensel said, “but it's the only way we can keep the cost of long-term care down. It's not about building more facilities.”

Twenty-six percent of the population in long-term care facilities has what are considered “low-care needs” - that is, they require help only with basic services.

The Iowa Department on Aging said facility-based care for these services costs approximately $160 per day. For the same services offered at the in-home level, costs are $78.84 per day.

If these basic health care needs could be met at home, the Iowa Department on Aging estimates the state would save approximately $201 million per year.

Coming Together

Segmenting the elderly, children with special needs and people with disabilities is hurting Iowa as it prepares for future care needs, said Di Findley, executive director at Iowa CareGivers Association in Des Moines.

“These populations all have very similar needs,” she said. “Because we continue to segment people by their need, age or injury, it makes it difficult to build infrastructure to ensure we have a work force that can serve people, no matter what their needs are.”

Separation isn't necessary when it comes to basic care needs and maintaining independence as long as possible, Findley said.

“People with disabilities get old. People who age acquire disabilities,” Findley said. “They're different, but there are similarities. To meet needs, we need to be talking in more global terms about serving people where they are by what their needs are.”

With titles such as certified nurse aides, home care and home health aides, personal care attendants, and direct support professionals, 73,000 professionals across Iowa serve the elderly population in homes, hospitals, assisted-living and long-term care facilities, and adult day centers.

Direct-care workers make up Iowa's largest occupation - a population larger than nurses, teachers or public safety officers. Three of the top 10 high-growth, high-demand jobs in the coming decade are in direct care.

But as this occupation becomes more important, its traditional population - women aged 25 to 44 - is projected to shrink, according to Findley. Iowa will need more than 15,000 additional direct-care workers in the next five years to meet growing demand.

“There's a need for more long-term care professionals, whether it's mental health, oral care, dental care, geriatric doctors or psychiatrists. But where we see the greatest need is in the area of the direct-care work force,” Findley said.

“They're providing about 80 percent of the direct care - bathing, managing medication, dressing, feeding, etc. This is true of all direct care workers, whether they're receiving long-term care in their own homes, in nursing homes, or other settings.”

Educational standards

While trying to recruit new people, the industry also faces the challenge of keeping existing employees in the field.

“Turnover is one of the bigger challenges we face,” Findley admitted.

Based on an Iowa Department of Human Services report, Findley estimated that the average annual turnover for direct-care workers is between 60 and 65 percent. That churn rate adds up to almost $200 million per year for Iowa ($199 million in 2011).

But that money would be better spent investing in the work force, Findley said.

“We need educational standards for the work force and a wage that's reflective of the importance of the work they do,” Findley said. “We also need to make sure these employees have access to affordable health care.”

According to a survey from the Iowa Child and Family Policy Center, 25 percent of direct-care workers don't have access to health care coverage or retirement plans.

Setting minimum training and skills standards, creating opportunities for workers to obtain specialized training, and creating compensation systems that reflect the amount training acquired are just some of the suggestions Findley and Iowa CareGivers Association have for improving the system.

“Legislation being introduced this year calls for the establishment of a board of direct-care professionals,” Findley said.

“This board would establish educational standards for cross-care settings and support settings, which will provide more professional status for (certified nursing assistants) and other direct-care workers. We hope this will translate into better wages and the things that going along with it.”

Local facilities are doing what they can to provide opportunities for staff professional growth.

“Many of them have mentoring programs for direct-care workers, but it has to be bigger than that,” Findley said.