Story by Chris Graham
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It was hard enough getting Kitty Lough to go into an independent-living facility, harder still to get her to accept the change in her lifestyle.
She never would have guessed back then that she’d miss it as much as she does now.
“She’s finally gotten over the stage of saying, I just don’t understand what’s going on, I don’t understand why this all had to happen,” said her son, David, talking about his mother’s forced departure from a retirement community in Waynesboro, in January.
Kitty Lough, 89, was asked to leave after a dispute over the degree of independence that she wanted to be able to maintain.
I wrote about Kitty’s independent streak several years ago when I was on the staff at The News Virginian after meeting her one day at the Waynesboro YMCA. She never had a driver’s license, but she didn’t have trouble getting around town, going on treks to the Y, the post office and the Kroger grocery store from her home in the Tree Streets every day.
It was her walking that had begun to cause concern for administrators at her former home community, which in the fall asked the family to agree to put Kitty through a mental-health evaluation to determine whether or not she might need to be moved from independent living to assisted living within the community.
After some back-and-forth on that issue, the facility asked Kitty to leave or face possible eviction.
And so it is that Lough is now living across town with her daughter, Kathie Kincheloe, who has had to change her routine to accommodate her new roommate.
“We take walks around the block so she can get some exercise. Actually, it’s been good for me, because I wouldn’t be out there doing that otherwise,” Kincheloe said.
Kincheloe works outside the home, though, meaning mom is left to her own devices for hours at a time. And though Kincheloe’s home is probably two miles, if that, from Kitty’s old digs, it might as well be on the other side of the world to get there.
“I miss my friends. I have so many dear friends there, and I don’t get to see them that much anymore,” Kitty said.
“And I don’t call. It’s so hard to hear, and it’s hard for them to hear me.”
***
The first thing that jumped out at me was learning that the family felt there was basically no recourse for them once the decision was made to turn their mother out onto the streets.
My gut told me that there had to be some kind of mechanism in place for families to turn to in these kinds of situations. And in fact there are ombudsmen who are empowered by the state code to review cases like these, I found out after making a couple of quick phone calls. Only, there are so few of them out in the field that it is really hit-or-miss at best as to whether you can get one to give you a few minutes to plead your case.
Which led to my next moment of clarity. Maybe I’m just scratching the surface of the problem here, it occurred to me. Maybe this is bigger than just not having enough ombudsmen to review disputes between administrators and nursing-home residents.
I said something about this to the Lough family, and it made me feel better that they agreed that this was where they wanted the story about their mom’s plight to go.
“This point needs to be impressed. This population is growing, and it’s only going to get worse. This kind of situation is going to come up more, more and more – because this is a growing population,” David Lough told me.
So I had my mission. Should I choose to accept it, it would involve me learning everything that I could about senior living in Virginia, what challenges are on the horizon as the Baby Boom generation advances into their senior years, what the state is doing to address the already-existing gaps in service with an eye to the future, and what else will need to be done to get our senior-care infrastructure ready for the Senior Boom.
***
Virginia’s senior population is growing rather substantially – overall, the 60-plus population in Virginia has grown more than 60 percent in the last decade, and the fastest-growing age demographic in the Commonwealth is 80 and over.
And it can be said that it is growing twofold – both from within and from without.
“We’re clearly becoming a retirement destination, if you will. Certainly retirement is a growth industry where I’m from in the Williamsburg area and in the Shenandoah Valley out where you are,” said Tony Conyers, the commissioner of the Virginia Department of Social Services.
Native Virginians have their own set of issues to deal with, but most at least have family somewhere nearby to provide care when it is needed.
“But when people who moved here to retire aren’t doing as well from a health perspective, and their families are farther away, their families can’t offer the kind of assistance that would have traditionally been the norm in Virginia and the rest of the country,” Conyers said.
It’s harder today for even native Virginians to get help from their children when they need it, as it turns out. About 80 percent of senior care in Virginia and the United States has traditionally been provided by families, but with divorce breaking up more and more families, and more women being employed alongside men in the workforce today than in past generations, “the dynamic has just changed,” said Andy Carle, the director of the Assisted Living/Senior Housing Administration program at George Mason University.
Carle talks about senior care being a three-legged stool, with the first leg being “time,” “which has already collapsed, because women entered the workforce 30 years ago – appropriately, long overdue, but, you know, for hundreds of years it was the daughter or daughter-in-law that took care of the elderly parent. So now with both spouses in the workforce, they don’t have as much time – they go over on the weekend. In fact, the most recent studies show that 44 percent of the caregivers are now actually men – so it’s almost 50-50, which is really cool,” Carle said.
“The problem is that they have less combined time. Instead of the daughter being home all week, and grandma living in the house, or down the street, they go over on a Saturday, the son mows the lawn and pays the bills, the wife goes in and sets up the pills for the week and puts little frozen meals in Ziploc bags and puts them in the freezer. They take mom out to dinner, and they go home – because Sunday, they’ve got to take care of their stuff and get back to work,” Carle said.
The second leg of Carle’s stool is proximity. “About 20 percent of those 34 million live on average about 500 miles or more away. And probably another 20 percent are a good hundred miles away. For centuries, we were born and lived and died within 50 miles of where we were born, but nowadays we’re all over the country,” Carle said.
“The third leg, which I think is going to collapse soon, in the next 20 years, is what I call energy. People are living longer. If your mom is 100, how old are you? I mean, you’re 80. So you’ve got your own problems. Even if your mom’s 85, you’re 65. Who’s going to do the two-person lift? It’s really hard work,” Carle said.
***
Richard Lindsay, a member of the Commonwealth Council on Aging and the former head of the Division of Geriatrics at the University of Virginia, is among those who use the term “aging tsunami” to describe the coming Senior Boom.
“Pretty soon, we’re going to have one in five Americans over the age of 65, which is a lot of people. And the point you’re making of course is, Is the country prepared, is the real question. And I think it depends somewhat upon the parts of the situation you’re looking at,” Lindsay said.
“I come from the standpoint of the part that has to do with manpower. That’s the piece, in my mind, that we’re the least prepared for – and the reason that I say we’re the least prepared is it takes such a long lifetime to produce trained people to deal with an aging population,” Lindsay said.
“It isn’t like you and I sitting here today can say, We both agree that there’s this huge increase in elderly population coming down the road tomorrow, so let’s just put all the people in place to take care of it. If you’re talking about training nurses and doctors and so forth, the lag time you’re talking about is five to eight to nine years, sometimes even more, to produce increased numbers of people,” Lindsay said.
And let’s face it, jobs in the senior-care industry aren’t the most lucrative ones out there.
“The wage scale is lower than it needs to be for some of the jobs that people have to perform, and as a result there’s a tremendously high turnover in the level of personnel where the rubber meets the road, like nursing assistants and those kinds of people in nursing homes. They give most of the care, but they do it at a relatively low wage scale, and with very few benefits. And so as a result, it’s an industry that has trouble keeping and attracting personnel,” Lindsay said.
“My concern is that you have to declare it a crisis now in order to even get this manpower pump primed for eight to ten years down the road,” Lindsay said.
***
We recognize the problems, and they are legion.
But, and I hate to have to even write this, isn’t it usually true that we tend to wait until some sort of crisis comes up before we do anything?
Think about the myriad issues with our mental-health system, for example. We knew that there were things that needed to be done to address our shortcomings there for years, but it took 33 people losing their lives at Virginia Tech last spring to get us moving in the right direction.
“We’ve actually discussed that, too, that same scenario. Because this year what we’re seeing is the General Assembly is focusing on the mental-health issues. And as far as the aging community goes, other than the fact that older adults vote, there hasn’t been a lightning rod,” said Bert Waters, the program manager at the Virginia Center on Aging at Virginia Commonwealth University.
“And actually, what’s happened is over the last five to seven years, whenever there’s been a budget shortfall, agencies receive cuts, and they receive percentage cuts. And something like the Virginia Department for the Aging, which also receives federal funds, they had to cut – and they couldn’t cut through their area agencies on aging, and they chose not to cut programs like Meals on Wheels, but they did have to make some substantial cuts, and once those cuts were made, a lot of them didn’t come back,” Waters said.
“So actually the state monies are getting smaller while we’re getting more and more older adults and more issues involved with seniors,” Waters said.
“You’re right on the button with how we had this one issue with Virginia Tech, and now the state’s focusing on it, but really there’s not going to be a specific issue with aging,” Waters said.
“We’ve been too laissez-faire – that it will just happen. And yet when you have just the sheer numbers that we have, that isn’t a very logical assumption,” said Karen Roberto, the director of the Virginia Tech Center for Gerontology.
“The government has its head completely and totally in the sand,” George Mason University’s Andy Carle said. “They don’t want to know. They’ve got enough to deal with, frankly, with Medicare and Medicaid and Social Security, which as you know are such hot-button issues, and they don’t even like to bring them up, because nobody has an answer. They have not even pretended to address the collapse of the three-legged stool or what’s going to happen in this country. No one is even talking about it, because either they don’t know, which is possible, or they simply don’t want to.
“The basic position of the government is, Well, the family members will just keep providing this care, like they always have. And it’s a flawed assumption. It’s not a realistic assumption,” Carle said. “It has nothing to do with whether or not sons and daughters love their mommas and papas. It has to do with the three legs of the stool that I’ve been talking about. But the government’s attitude is that 80 percent of the care has always been provided by family members, so 80 percent of the care will be provided by family members in the future.”
***
There are efforts being made locally to get some kind of solutions to the Senior Boom crisis worked out ahead of time. I talked with Paul Lavigne, the executive director of the Valley Program for Aging Services, a Waynesboro-based nonprofit that works with local governments in the Shenandoah Valley to provide services to seniors and runs several senior centers in the region, and learned that there is a campaign under way to get local leaders to begin planning ahead for the Senior Boom.
For instance, the Central Shenandoah Planning District Commission and the Shenandoah Valley Partnership, which coordinate regional planning and regional economic-development activities in the Central Shenandoah Valley, have integrated senior-care planning into their lists of long-range planning and development objectives, Lavigne said.
“I noticed about four years ago that there was nothing in there about the aging population, so we proposed a strategic objective be added that basically says something like, We recognize the changing demographics and the increase in the population of people aged 60 and over, we see the opportunities and challenges of that, and should address that,” Lavigne said.
“They don’t add too many of those objectives every year, but they do circulate them to a wide audience, to the 10 jurisdictions that work with them, and the nonprofits and those that work with them in the private sector. I thought it was important to get something in there that said, and it did resonate. They said, Yeah, let’s put that in,” Lavigne said.
At the state level, the governor and General Assembly have their attention on 100 different other things. But Tony Conyers feels the bureaucracy is properly focused on the Senior Boom challenge.
“The awareness is there,” Conyers said. “I think throughout Virginia and throughout the country, people in the human-services business are aware of the issues and the problems. We are confronted with unprecedented challenges in terms of having to deal with issues with young children, mental-health issues – there’s simply a lot on our plate today. And yet another issue that we have to put on our plate, and is a little more complicated, has to do with seniors.
“I can name you, just within our secretariat, three senior leaders, including myself, who are dealing with these issues every day when we go home,” Conyers said. “I have an 86-year-old mom. So this is not just an academic or professional exercise for me. And many of our other folks in this administration find themselves in the same position. What that means is we are aware of the issues and the problems. That doesn’t mean that we’re putting the resources there today to solve them. But I certainly think the awareness is there.
***
Andy Carle and Richard Lindsay offer us two competing visions for dealing with the Senior Boom.
First to Carle and his Golden Triangle.
“We need to consolidate the staff that we have, because we’re going to have a labor crisis in this country,” Carle said. “We’re going to be 2 to 4 million nurses aides short of what we need to take care of the seniors – so we’re mathematically eliminated from having the human labor. So the first thing we’ve got to do in the Golden Triangle is consolidate the human labor that we have into centralized locations – obviously assisted livings and retirement communities. Because the most inefficient thing you can do is send one nurse’s aide to spend half the day looking at her windshield driving around house to house. She could have seen three times as many people if the people were consolidated.
“The second thing is to consolidate and congregate seniors in housing,” Carle said. “My passion there is to make sure that we build housing for them where they want to live. You know, the reason that people are so terrified about leaving their homes is that they don’t want to go to a nursing home. But as it turns out, and what we’ve learned, is if you build them a really nice home, and some of these assisted livings are way better-looking than my house – you’ve got the baby grand piano and the fine dining with linens and nice china, and activities and this and that – so what we’ve learned is it wasn’t so much that they didn’t want to leave their homes as the alternative was a nursing home. But if we can continue to build nice homes for them, then they will congregate into their homes.
“The third part is what I call nanna-technology, technology for your nanna – where even if we congregate seniors, even if we consolidate the human labor, quite frankly it’s still not going to be enough. So we’re going to need technology that’s going to be able to make one nurse’s aide in the future as productive as three are today. And so we’re going to need robots and sensors and these kinds of monitoring and surveillance technologies and things that can send us data and make it more efficient,” Carle said.
So Carle is in favor of centralization – of seniors into central facilities, of nurses and doctors into providing care in these facilities, and using technology to make the whole system hyperefficient.
I said Carle’s and Lindsay’s visions were competing.
“The way to do it is to depend less upon paid care and use more training of family members,” Lindsay said.
“In other words, what you do is you try to get family members trained up to a level where they can do most of the things that a nurse’s aide or anybody else can do. And to do that, you have to have eductional programs and somehow get them so they can get there – in other words, they may be involved in caregiving, so it may be hard to get them to some place to train them.
“The point is, 70, 80 percent of the long-term care today is provided by families. That’s a huge percentage, at a tremendous cost. But were we not to shore up that system in some way, then the country would be facing the cost of the care that these people are providing, and that’s a huge bill. And the country couldn’t sustain it,” Lindsay said.
***
No banner proclaiming Mission Accomplished need be tacked up here.
We’re still a long, long, long way from solving the Senior Boom.
If we ever do.
I reported back to Kitty Lough and her family before sitting down to write this article. I had learned that there should have been some way for them to have raised issue with the way their mother had been treated, I told them. The problem isn’t in the people who are in place to fight those battles, but rather in how few of them there are to do the fighting.
And in the availability of senior-care options that are out there, or rather not out there, considering the situation.
I heard back from the family that they had taken Kitty off the waiting list at another local home.
“This is the solution, for now,” Kathie Kincheloe said to me, her mother at her side.
“At least until she doesn’t need more in the way of care. And then we might have to revisit things,” David Lough said to me.
“It’s up to Mom. Mom’s here as long as she wants to be,” Kincheloe said.
“It’s up her,” Kitty said a half-second later.
“Kathie is so good to me taking me in. But I don’t want to take advantage of her,” Kitty said.
“This is where we are,” Kincheloe said.
‘Tis, indeed.
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