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This is the first of a monthly series examining themes of the 2020 Iowa Ideas Conference. This article examines the crucial need for senior living and services in rural Iowa.
WEST UNION — In a community room at Copper Creek Senior Living, residents try their luck at 'Name 5,' a game to keep the mind sharp.
Kari Otto, an activity and dietary manager, offers a prompt: 'Name five Elvis songs.'
The 70 and 80-year-olds as well as staff struggle at first to recollect titles — it's a collective effort — but they quickly get on a roll.
'Hound Dog.' 'Jailhouse Rock.' 'Blue Suede Shoes.' 'Teddy Bear.' 'Love Me Tender.' They keep going.
James Baker, 78, who's been at the facility for two years by way of Jewell and Strawberry Point, has been the quickest to answer.
Durwin Gilson, 86, a three-year resident who lived 10 miles east in Elgin until a fall in his driveway, struggles to hear the questions but is more engaged in friendly banter anyway.
Judy Blockhus, 77, is more of a quiet observer. After her daughter and husband died, she had been living with a niece 30 miles west in New Hampton before moving to Copper Creek.
Nearly all residents of Copper Creek — a facility offering a continuum of care from independent to assisted living to memory care to respite — come from within a 30-mile radius, company officials said.
'Generally people want to stay close to home as they age,' said Krista Ward, the Copper Creek administrator. 'They want to pick a place that most reminds them of home. They want to be close to family, maybe close to the church they've always attended, close to friends.'
Most people want to stay nearby as they age, but it is seldom that simple.
A 2018 AARP survey found 76 percent of Americans age 50 and older prefer to remain in their current residence and 77 percent would like to live in their community as long as possible. But many don't believe that is realistic. Only 46 percent anticipate being able to stay in their home and 13 percent being able to stay in a different home in the community.
West Union, a northeast Iowa town of 2,350 people, has attractive options for seniors, they say, such as Gundersen Palmer Hospital, a downtown thriving more than many communities of this size, transit service, a senior center and updated public infrastructure including sidewalks and parks.
But many small communities can't say the same. They lack affordable and suitable housing, transportation, home care services and infrastructure designed for people with disabilities.
To be sure West Union has limitations as well.
Fayette County's low 2.8 percent unemployment rate, which is only slightly above the statewide average of 2.3 percent, strains the workforce. While in a good position now, Copper Creek has struggled to maintain adequate staffing, Ward said, adding regulations are increasingly onerous and expensive.
Graying rural Iowa only getting older
Rural and small town Iowa is among the grayest parts of the country, and it's getting older.
Iowa as a whole ranks close to the middle of the pack at No. 18 for the number of people at least 65 — 526,057 people as of 2017, or 16.7 percent of the state's population, according to data compiled by Iowa State University Extension. Iowa's handful of urban centers, which attract a younger population, skew the data's impact.
A 2014 report called Housing an Aging Rural America: Rural Seniors and Their Homes' by the Housing Assistance Council, which aims to boost housing in rural America, found seniors 65 and older accounted for 277,915 people, or 17.69 percent, of the 1.57 million people living in rural areas and small towns in Iowa, which ranked No. 3 nationally.
By 2050, one in five people are expected to be at least 65 years old in 74 of Iowa's 99 counties, up from the current 53 counties, according to data from Woods & Poole Economics and the census.
Increasingly, seniors and their families are confronted with hard choices:
• Do they stay in their own homes, which many prefer?
This can mean being isolated. Physical and mental deterioration can happen more rapidly when people are disconnected from the outside world. Rural homes often are older and not designed for aging in place. They can be difficult to maintain and finding someone to make accessibility improvements can be a challenge.
• Can they find an affordable home locally that meets their needs?
The Iowa Rural Development Council points to a shortage of affordable, quality housing — including condos and senior-specific communities — as one of the most critical rural needs.
More than half of Iowa's senior population lives in rural areas and small towns, but more than half or 48,508 of the 95,295 senior living units are located in just 15 counties, primarily Iowa's most populated.
Memory care is one of a number of specialty services in short supply in rural settings. In the case of Copper Creek, the facility has struggled to fill its basic assisted living units, but has found strong demand for memory care units.
Copper Creek is remodeling a wing of its facility to add new secure homestyle units to allow couples where one partner has dementia and the other is independent to remain together — another accommodation in demand but not abundant in more remote areas, they said.
• Do they leave their rural community and move to an urban center
where senior housing developments are booming and specialized medicine and other services are more readily available?
Creative housing solutions help seniors live in rural communities
As of 2017, the Iowa Department on Aging counted 151,121 people age 65 and older with at least one disability, underscoring challenges such as outdated housing stock and town squares where infrastructure has not been updated to meet the Americans with Disabilities Act rules.
Brad Anderson, the Iowa director of AARP, said his organization hopes to work with communities — particularly on housing — to help people age locally.
'The main point we need to understand is there is no magic wand that can easily solve this issue,' said. 'At AARP Iowa, our state office is really just beginning to roll up our sleeves and work on the rural affordable housing issue. We plan to work closely with groups like Main Street Iowa and the Iowa Rural Development Council over the coming years to identify creative solutions that fit communities in need.'
He cited examples of creative solutions:
• In Gowanda, N.Y., population 2,622, a vacant school building was converted into 28 one-bedroom and four two-bedroom apartments for low-income adults age 62 or older. Commercial space, medical services, an adult day care facility, a food pantry and counseling services occupy the ground floor.
• In Hallowell, Maine, population 2,365, the vacant Maine Industrial School for Girls was transformed into Stevens Commons, which includes trails, offices, market-rate rental apartments and affordable rental units for people 55 or older.
• In the Mount Washington Valley area of New Hampshire, a rural home-share called HomeShare MWV matches homeowners who have an extra bedroom with home seekers of any age 'allowing older residents to age in place, generate some income from rent and feel connected to younger generations.' The model has popped up around the country.
Seniors seen as an opportunity for shrinking rural Iowa
According to 2019 Census estimates, 69 of Iowa's 99 counties are losing population, which in turn has strained local resources, but some see hope in seniors.
'The opportunity that exists for rural towns is that 51 cents of every dollar is spent by those over the age of 50, so there is economic benefit in making sure our rural Iowa communities are age-friendly and cater to citizens of all ages,' the AARP's Anderson said.
Making a community more walkable and easier to get around is not just desirable for seniors but for most people who would live there, he said.
In Charles City, 23 percent of the population that has slid to 7,650 residents is at least 65. Jim Erb, 79, wants to see his community do more to cater to seniors.
Seniors could strengthen a community financially and through social involvement, the now retired longtime mayor said. Supporting seniors should not be seen as a chore, he said.
'We know the demographics and we have a sizable number of seniors,' Erb said. 'The long and the short of it is we see the seniors component of our population as having great potential, not only to be taken care of, but a group that can make excellent contributions to our community and our economy.'
Abbie Gaffey, community development program specialist at Iowa State University Extension & Outreach, notes, 'While there are 'low income' seniors, there aren't 'no income' seniors. Between Social Security and disability, they have some disposable income.'
Building senior communities also about luring investment
Efforts to embrace seniors appear to have attracted some economic development, in some cases.
Charles City, which was named a 'livable community' by AARP last year, undertook a major infrastructure project in sprucing up its riverfront to be fully accessible to seniors. Erb noted officials 'go the extra mile — not just the minimum required by law' to be welcoming to seniors.
Last month, Solon developer Mark Holtkamp announced plans for a $13 million assisted living community in Charles City adjacent to the Floyd County Medical Center, according to the Charles City Press.
Similarly, West Union's efforts to create an eco-friendly downtown and other upgrades, along with amenities such as a hardware store, a hospital and local senior transit service, were all positive factors in investments at Copper Creek.
Northern Oaks Senior Living, which is based in Fargo, N.D., and has nine facilities in rural communities in North Dakota, South Dakota, Minnesota and Iowa, acquired Copper Creek in 2019 and invested $4 million in the purchase and upgrades, said Amy Deacon, an owner and president of the company.
'When it comes to assessing a location, we won't enter a community unless we see it's investing in itself,' Deacon said. 'It's not uncommon to see a population mix declining. If you are not looking to increase, that would be a deterrent for us.'
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About the Iowa Ideas Conference
The Iowa Ideas Conference, now in its fourth year, is designed to discuss key questions, policies and ideas that will shape the future of our state.
This year's conference will take place Aug. 28-29 at the DoubleTree by Hilton Hotel & Convention Complex in Cedar Rapids. Full conference passes are $75 and can be purchased online at www.iowaideas.com.
Tracks for the day-and-a-half event, with more than 50 sessions and 200 panelists, feature conversations on workforce, diversity and inclusion, education, health care, regional development, energy and environment and more.
Conference keynotes and the full schedule will be announced in March.