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As the Wilmington-area region ages, nursing home populations decline

Star-News - 8/11/2018

Aug. 11--America is aging fast. By 2035, the number of Americans aged 65 and older is expected to reach 78 million, up from 43.1 million in 2012.

Yet the population in nursing homes is actually declining. Statistics from the Kaiser Family Foundation put the occupancy rate of skilled nursing facilities in the United States at roughly 81 percent, down from 86 percent in 2003. (North Carolina's nursing home occupancy is slightly higher than the national average, at 82 percent.

Between 2000 and 2010, the number of nursing home residents aged 65 and older fell by nearly 20 percent, from roughly 16 million to 13 million, according to the U.S. Census Bureau.

What's happening?

"Most people don't want to go to a nursing home if they can possibly avoid it," said Anne P. Glass, professor and coordinator of the gerontology program in the School of Health and Applied Human Sciences at the University of North Carolina Wilmington. "Most people, if they had the option, would rather stay at home."

And a variety of programs are evolving to let them do just that.

The N.C. Senior Care Council lists 13 different agencies providing home care for seniors in New Hanover County alone. Aides will visit seniors to help them with such tasks as bathing ("One of the most common," Glass said), dressing, grooming, light housework and preparing meals. Rates typically range from $20 to $40 per hour, with higher fees for 24-hour and live-in care. Some agencies even provide respite care, offering a break to spouses, children and others who might be caring for an older relative.

Medicare now offers PACE (Programs of All-Inclusive Care for the Elderly), which works to keep older people in the community rather than nursing care or other institutions.

Medicare does not pay for long-term institutional nursing care. "Those who think they're going to rely on it when the time comes are going to be very disappointed," Glass said.

One of the oldest PACE programs in North Carolina is Elderhaus, launched in 1981 at St. James Episcopal Church.

Elderhaus has long been known for its adult day-care facility beside Greenfield Lake, offering a supervised outing for seniors with dementia or other issues and a break for family caregivers. It also provides a PACE service, headquartered across South 17th Street from New Hanover Regional Medical Center.

PACE provides in-home medical care, skilled nursing, occupational therapy, meal preparation, chore services and transportation for adults aged 55 and older who are able to live safely in the community. Medicaid and long-term care insurance can cover much of the cost.

The Davis Community offers "Concierge Care" to residents of Landfall, Porters Neck and Wrightsville Beach. Aides come to the client's home at scheduled times to provide specific requested services such as meal preparation, help with bathing or laundry, or short-distance transportation to church, bridge club or golf course.

The year 2014 was a watershed, Glass said. In that year, Medicaid paid out more for in-home and community care than it did for nursing facilities.

Continuum of care

"Back in the old days, most older people stayed at home," said Julie Rehder, community relations administrator at The Davis Community in Porters Neck. As seniors grew less able to care for themselves, they might move in with an adult child, or a relative -- typically, an unmarried daughter -- might move in with them.

As more people lived into their 80s, however, and as families scattered across the nation, nursing homes became more and more of a necessity.

In the 1960s, Champion McDowell Davis, retired president and board chairman of the Atlantic Coast Line railroad, became increasingly concerned about the fate of aged former railroad workers.

In 1963, Davis set up a foundation and announced plans to erect a community for the elderly -- "as modern as the day after tomorrow," he promised -- on land once occupied by his family's peanut plantation. In 1965, the foundation's money was augmented by a $462,000 grant under the federal Hill-Burton Act, and in 1966, the Cornelia Nixon Davis Nursing Home (named for "Champ" Davis' mother) opened on the site.

Davis would visit the residents each Sunday until very late in his life. He insisted the hallways remained clean and smelled fresh, Rehder said. After he died in 1975, at the age of 95, his ashes were scattered on the grounds.

Since those days, The Davis Community has evolved. It actually encompasses three separate facilities: Plantation Village, an independent living complex; Champions, an assisted living facility; and Davis Health Care Center, which offers memory care, skilled nursing and rehabilitation services.

This is becoming a more common pattern. Brightmore of Wilmington maintains three separate complexes on its 41st Street complex: Brightmore, for active, independent seniors, the Kemptons for assisted living and The Commons for skilled nursing and memory care.

The three divisions are typical, said Glass. Independent living has many definitions, but residents generally live in their own apartments or duplexes and often still drive their own cars. The facility will typically serve one meal a day, with an option for more, but residents generally have kitchen or kitchenette units and have the option of dining elsewhere. Housekeeping is generally provided, along with an array of optional activities.

Brightmore, for example, has a regular chapel service, a variety of games and local tours, plus a "Brightmore University" lecture series. according to Marianna Stacy, community outreach director for the campus.

Assisted living offers a slight higher degree of care for those who need a little help. Living facilities are much like those in independent living, but 24-hour nursing care is on hand, and residents may be assisted with daily medications, dressing, eating, personal hygiene or basic mobility. Three meals a day are typically served, and in addition to entertainment and social activities, there's often a health an exercise component.

"At Champions, we try to keep people in assisted living as long as possible," Rehder said.

At the Kemptons, Gerald and Jeri Wingard were in their suite one rainy morning, reading their newspaper. "It's a good place to stay," Gerald Wingard said.

The Wingards, from Lexington, South Carolina, moved here a little more than a year ago to be near children. Gerald Wingard has vision problems and needs a large magnifier to read, but they love to walk the path around the pond on the Brightmore grounds. "They're out as soon as the sun comes out," Stacy said.

They have three meals a day at the Kemptons and can join in a number of periodic events for residents, from a big band concert to a "Barbecue and Bluegrass" evening.

Reinforcing memories

Skilled nursing facilities, meanwhile, are polishing their image and combating stereotypes of institutional grimness.

About the only thing that distinguishes the Commons from its neighboring facilities, at first glance, are the keypad locks on the Memory Care unit, to keep residents from wandering off.

Wards with names like "Azalea" and "Oleander" lead to hallways and common areas in bright pastels.

The Commons were architecturally designed "to promote independence," Stacy said. Residents like to walk, so common areas offer plenty of strolling space. Facilities are designed to look familiar to residents with memory loss or impairment, with cheerfully retro furnishings and even a mini-mall. One dining area is basically a bar set up like an oldtime diner.

There, on one recent day, staff member Tanya Langley was leading residents on a memory exercise, camouflaged as a game.

"OK," Langley said. "Gentlemen Prefer ... " Hands went up with the right answer. ("Blondes!")

"Listen my children and you shall hear ... " Langley called out. "Who said that?"

Beyond the design lies a corporate philosophy. "We call it the 'Best Friend Approach,' " Stacy said. "You're not their keeper. You're their friend."

The Davis Community has a similar approach. "In the old days, if you saw a CNA (certified nursing assistant) sitting down and talking with a resident, they'd be fired," Rehder said.

Nowadays, that sort of thing is positively encouraged. Davis broke up its two former nursing care wings into a series of "cottages," with 10 to 22 residents each. Each cottage has a theme: The Breakers features beach decoration, while the Walker Taylor has plenty of mementos likely to appeal to Old Wilmington residents.

And instead of rotating staff, each cottage has the same employees working with the same residents day after day, getting to know them, their families, their likes and dislikes. Instead of a large cafeteria-style setting, meals are served in small dining areas.

"It's a mixed blessing," said 87-year-old Gerry Lockyard. She'd much rather be on her own, "but if you don't have anyone to take care of you, what are you going to do?"

Lockyard, who grew up loving New York's city parks, spends much of her time working in the Davis herb garden, with help from her son-in-law.

A question of money

All of that care, and the high staff-to-resident ratio in nursing facilities, comes at a price.

Monthly rates for independent and assisted living facilities are "all over the place," depending on amenities, Glass said. Skilled nursing care can cost as much as $4,000 to $7,000 per month.

Who pays that money? Medicare does not cover long-term residential care, Glass said. Medicaid does, but only once a patient's other resources have been exhausted. This fact puts many families in the position of "spending down" an estate that a senior spent decades to build up.

One alternative is long term care insurance, private policies that can cover some or most of the cost of assisted living, nursing care or home care. "But long-term care hasn't really caught on as much as planners had hoped," Glass said. Premiums average $2,700 per year, according to the AARP, which puts the policies out of reach for many Americans. (The younger you are when you can up for a policy, the less it costs.) And some plans have reported large price increases in recent years.

Glass has written extensively on ideas adapted by other countries. One alternative in the Netherlands is the "Apartment for Life," small, homelike units housing eight to ten seniors. As individuals age or their conditions change, assisted living or nurse care is provided to them on site, without moving them to a separate facility.

Reporter Ben Steelman can be reached at 910-343-2208 or Ben.Steelman@StarNewsOnline.com.

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