Trends/ Critical Issues/Future Implications/Challenges
According to the U.S. Census Bureau, in 2010 there were an estimated 3.7 million persons in Texas over the age of 60. This figure represents about 14 percent of the estimated 25 million Texans overall. By the year 2040, Texas' 60 and older population is expected to grow to 10 million. Figure 1, Attachment C shows the growth of the over-60 population in Texas from 2000 to 2040.
As the aging population steadily grows, Texans 60 years of age and older will comprise over 20 percent of the Texas population by 2040. See Figure 2, Attachment C. As this occurs, Texas can anticipate an increasing need for health and human services, accessible and safe housing, transportation options, employment opportunities as well as an increasing need for volunteer and community engagement activities. Figure 2 compares projected percentages of persons 60 and over to the total population over a forty year period. Also in Attachment C, Table 1 shows the projected population change for persons age 60 and older from 2007 through 2009 by area agency on aging (AAA) which ranges from 2.1 percent in West Central Texas to 13.6 percent in the Houston-Galveston area.
Diversity
While Texas has the fourth largest population of older adults in the nation, it has the second largest older Hispanic population in the nation (604,963). See Table 2, Appendix C. To succeed in reaching diverse aging populations, DADS and the AAAs must implement culturally sensitive approaches to service delivery.
Limited English Proficiency
Nearly one million older Texans report having limited English proficiency. According to the U.S. Census Bureau over 33 percent of the Texas population speaks a language other than English at home. This provides many challenges to the local aging service network. AAAs use technology, such as language line services, and employ bilingual staff to effectively provide direct services to consumers and to work with diverse communities in the development of culturally appropriate publications, training materials and programs. With the expected growth of minority populations, demand for community services for non-native speakers will continue to rise. Growth among Texas' older Hispanic population is expected to outpace that of Anglos and Blacks. See Figure 3, Attachment C.
To support good health and self-sufficiency the Texas-Mexico border colonias, the Texas Legislature required agency strategic plans to target the enhancement of service delivery in these areas. The colonias initiative is a collaborative effort of all health and human service agencies. Health and Human Service agencies using promotoras, who serve as liaisons between the colonias residents, work to increase access to services for colonias residents and provide needed services.
Rural and Frontier Counties
Of the 254 counties in Texas, 177 are rural, with a combined total population of 3.1 million, approximately 12 percent of the state's total population in 2010. Texas is among the few states with a large number of frontier counties. Texas' 64 frontier counties have an average of fewer than seven individuals per square mile. See Figure 4, Attachment C.
Texas faces a number of challenges in meeting the needs of older Texans living in rural and frontier areas, including providing support for informal caregivers, in-home programs, and adequate transportation. According to the Texas State Data Center, the general population is expected to grow most rapidly in urban areas, while rural counties may show slow or even negative growth. Because of migration of younger people to the cities, by 2040, older Texans will make up a higher proportion of the population in rural and frontier areas and areas surrounding cities, decreasing the proportion of younger people who could provide services to an ever increasing aging population.
Persons with Disabilities
Approximately 1.4 million, or nearly 40 percent, of Texans aged 60 or older have a disability. Figure 5, Attachment C illustrates the rise in disability rates as an individual's age increases. The population of older Texans with a disability is expected to be more diverse than previous generations and the prevalence of disabilities will vary by ethnic group (see Figure 6, Attachment C). Forty-two percent of women over age 60 report having a disability compared to 37 percent of men in this age group reporting a disability (see Figure 7, Attachment C). These higher need consumers are more at risk for institutional placement and caregiver stress is exacerbated, requiring a greater need for a creative response to developing a consumer-oriented service delivery system.
Growth of the 85+ Population
Among Texans over age 60, those 85 and older represent the fastest growing age group. In the United States, there were approximately three million people age 85 or older in 2010, with an estimated 300,000 living in Texas. The national number is expected to more than triple by 2040, and in Texas rise to 944,000. Figure 8, Attachment C illustrates the incremental growth projected for Texas through 2040. Since this population often has severe, chronic conditions, the rapid growth of this group is expected to have significant implications for the demand for
long-term services and supports.
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Caregivers
Current estimates indicate 50 million caregivers in the United States provide $350 billion worth of unpaid services each year. In Texas, this informal system of caregiving has been valued at $26 billion annually, higher than total Medicaid expenditures statewide. This is more than double the national expenditure for nursing facility care and paid home care combined. In Texas, there are approximately 655,000 older persons and persons of all ages with disabilities who require help with activities of daily living, and who are at or below 220 percent of the federal poverty level, or have monthly incomes below 300 percent of the monthly income limit for Supplemental Security Income. This does not include the unknown numbers of Texans who live above these thresholds yet depend on informal caregivers on a daily basis. Identifying and meeting the needs of the estimated 2.7 million caregivers in Texas often determines whether the older individual can remain at home. Yet, as in the rest of the nation, Texas caregivers tend to be under-prepared for their role. The aging network in Texas will become more pressed to provide supports, including education and training, respite, and in-home supports for caregivers.
Service Utilization/Service Users
DADS long-term services and supports system includes Medicaid entitlement and waiver services, Title XX, OAA and general revenue services and services to persons living in institutional settings, including nursing facilities, assisted living facilities, intermediate care facilities for persons with mental retardation (ICFs/MR) including state supported living centers (SSLCs). At the end of 2009, 66 percent of Medicaid entitlement recipients were age 65 or older. Attachment D, Table 1 compares the costs and numbers served in each of DADS Medicaid waiver programs in fiscal year 2008 and fiscal year 2009. As of November 30, 2007, 66 percent of those enrolled in non-Medicaid community services and supports programs (Title XX of the Social Security Act) were over age 65. Attachment D, Table 2 compares the number of persons receiving social services and the average monthly cost of those services for fiscal year 2008 and fiscal year 2009. Table 3 shows the breakdown of persons on interest lists in the community service waiver programs.
Table 4 in Attachment D compares the consumers served and the consumer costs of nursing facility care for Medicaid eligible consumers. Table 5 compares consumers served and the consumer costs for care provided in Medicare facilities licensed by DADS for fiscal years 2008 and 2009. The consumers served in Medicare facilities include Medicaid Qualified Medicare Beneficiaries, the Qualified Medicare Beneficiaries, and consumers whose Medicare co-insurance is paid by Medicaid. Promoting Independence data is available in Table 6 showing the monthly average number of consumers served and the average monthly costs for both federal fiscal years 2008 and 2009. Even a cursory review of the information in these tables will indicate the important role the aging network in Texas plays in supporting older persons wanting to remain in the community and for those living in facilities to have a visible, trusted advocate.
Critical Issues and Funding Challenges
Texas will face critical issues and challenges in the future. Texas, as all states, is experiencing difficult economic times. State agencies in Texas have been required to trim operating budgets through savings ranging from hiring freezes to no new programs or services for the current fiscal year. State agencies have been asked to prepare legislative appropriations requests for the
2012-2013 fiscal year biennium with reduced funding.
Texas faces a shortage of direct service workforce for community-based services which will threaten the independence of frail or at risk older persons, especially in rural areas. Finding ways to reverse this critical shortage will be one of the many issues facing Texas policymakers and providers of long-term services and supports.
Health care reform, resulting from the new Patient Protection and Affordable Care Act will have an impact on the service delivery system. DADS will gain a better understanding of what the impact will be as the reforms are rolled out in the coming months.
The informal caregiver system is experiencing increased stress as the pool of family caregivers gets smaller and its average age increases. In 1990, there were 11 potential caregivers for each individual needing care. By 2050, the expectation is for this ratio to fall to four to one. Caregivers will continue to impact the success for providing community-based services so older persons can remain at home as long as possible.
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Updated:
March 11, 2011
