Gray Matters: Getting Humboldt on Track for an Aging Population by Area 1 Agency on Aging

Gray Matters: Getting Humboldt County on Track For an Aging Population 2011

Area 1 Agency on Aging Promoting Independence for a Lifetime

Promoting Independence for a Lifetime

Gray Matters: Getting Humboldt County on Track For an Aging Population 2011 A Survey of Older Adults in Humboldt County

Produced by Area 1 Agency on Aging and The California Endowment

ACKNOWLEDGMENTS

TABLE OF CONTENTS

Fernando M. Torres-Gil, PhD, Board of Directors, The California Endowment Patty Berg, former California Assemblymember Connie Stewart, Executive Director, California Center for Rural Policy Jessica L. VanArsdale, Director, Health Research, California Center for Rural Policy Gwyn Mahoney, California Center for Rural Policy Marissa Oâ&#x20AC;&#x2122;Neill, MSW, PhD, Humboldt State University Chris Martinek, Chris Martinek Consulting Carol Harrison

Introduction

Siobhan Calderwood Board of Directors, Area 1 Agency on Aging Steve Beckman Diane Bennett Judy Bennett Nyle Henderson Sharon Hunter Sharon Mellett Jim Pedrotti Joan Rainwater-Gish Victoria Onstine Scott Sattler Karen Suiker Doris Whalen Advisory Council, Area 1 Agency on Aging Sharon Allen Lupe Barrett Clif Clendenen Jeff Davis Jackie Glenn Jamie Jensen Chris Jones Dorothy Lincoln Howard Rien Mike Sullivan Nancy Wilson We thank the people of Humboldt County and Del Norte County, especially the seniors, caregivers, volunteers and local government officials who participated in the development of this report. This report was developed in collaboration with Chris Martinek Consulting and the California Center for Rural Policy.

Executive Summary ........................................................... 8 Literature Review .............................................................10

Accidents In The Home ........................................... 10

Loneliness/Isolation ............................................... 14

Household Chores ................................................... 11 Health Care ............................................................. 12 Money To Live On .................................................... 13

Access To Information ............................................ 15

Senior And Caregiver Survey ........................................... 16 Local Government Assessment Survey ........................... 38 Advocacy Survey Via Survey Monkey .............................. 48

SENIORS MATTER IN HUMBOLDT COUNTY

20%

have serious problems with grocery shopping

38%

want to know more about how to contact local officials

17%

cannot prepare even one hot meal a week

32%

have trouble getting transportation

52%

are concerned about falling and accidents in the home

INTRODUCTION

33%

are lonely or worry about being isolated

39%

are worried about having enough money to live on

52%

have problems doing household chores

58%

have difficulty walking – or cannot walk at all

11%

cannot stand long enough to cook

10%

cannot drive or arrange a ride

n 1980, there were 11,303 seniors living in Humboldt County: 10.2% of the population.

OUR OBJECTIVES

In 1990, 14,631 seniors lived in Humboldt County: 12% of the population.

Provide an understanding of the needs of seniors living in Humboldt and Del Norte counties.

In 2000, 15,804 seniors called Humboldt home: 13% of the population.

Provide an understanding of the needs of caregivers living in Humboldt and Del Norte County.

Thirty years ago, authorized and mandated by the 1965 Older Americans Act and the 1980 Older Californians Act, the Area 1 Agency on Agency was created. Entering our fourth decade of service to the seniors of Humboldt County, it is essential to know: who are today’s seniors? More than 26,000 seniors live in Humboldt County today — over 18% of our population. Almost half of seniors who live alone and 10% of senior couples do not have enough resources to meet their basic needs. Half of Humboldt’s seniors have a disability that affects daily activities. One in every six seniors have some level of cognitive impairment. Hundreds are raising their grandchildren. One in every six people over age 60 provides care for another senior. Throughout California, but especially in its rural areas, seniors are coping with escalating economic and funding challenges. North Coast seniors have fewer resources to assist and support them as useful county and state-funded programs are eliminated or severely limited. Growing numbers of seniors are experiencing increasing need for support — support provided by fewer resources of all kinds: programs, opportunities, staff. The decades of support for Humboldt’s seniors will focus on the Boomer generation. There are 67,168 Humboldt Boomers — 41% of the population. Forty-five percent won’t be able to afford to retire. Half are raising one or more young children. One in three provides assistance to a parent. Thirteen percent are raising a child AND providing assistance to a parent. One in ten lives in poverty. Ninety percent intend to remain in the communities in which they currently live. The critical concerns of seniors today are likely to be similar to the critical concerns of seniors tomorrow. Concerns about the ordinary rhythms of living: How to handle household chores when strength and balance are unreliable? How to avoid trips and falls that can be so damaging to fragile bodies? How to have enough money to pay the bills? How to find transportation to the dentist and market? Concerns that will escalate as technology and a changing economy put distance between family: How to find information when the complexities of future technology — the progeny of computer, Internet, fax, wi-fi, Bluetooth, phone tree — make connections dauntingly

Provide information about public/government agencies’ provision of services for Humboldt County seniors. Provide information about community members’ satisfaction in contacting local decision-makers in Humboldt County and their experiences in grassroots advocacy efforts. Provide objective information for use in the development of public policy on issues affecting seniors. ●

complex? How to manage loneliness and isolation? And the enduring concern of those growing old: How to ensure that adequate health care will be available when needed? To enable informed and effective planning for the need’s of today’s seniors and tomorrow’s seniors — Boomers on the cusp of their senior years — the Area 1 Agency on Agency initiated a project, funded and supported by The California Endowment, to gather information about the needs and concerns of seniors, their families and caregivers. Our primary focus was to seek this information from Humboldt County seniors but we were pleased to be able to expand the scope of investigation, in some cases, to include Del Norte seniors. This study provides information and understanding of the challenges, difficulties, problems and concerns of seniors — as reported by the seniors of Humboldt and Del Norte counties. It is our hope that this report helps local government, non-profit organizations and business groups, community organizations, and individuals understand the needs of the seniors of the North Coast. ●

An African proverb reminds us that “when the music changes, so does the dance.” The music is changing yet the melody remains the same. Today’s seniors and tomorrow’s — and the people and organizations that assist them — are dancing as fast as they can.

EXECUTIVE SUMMARY “A single breaker may recede; but the tide is coming in.” ─ Thomas Babington Macaulay, Historian

a Senior and Caregiver Needs Survey to gather first-hand information regarding senior and caregiver needs, concerns, issues, difficulties in performing daily activities as well as information from caregivers and others who help seniors with these activities. Using a standardized survey form developed by the California Department of Aging, the A1AA distributed 3,000 surveys throughout Del Norte and Humboldt counties from 30 distribution sites. Four hundred fifteen of the returned surveys were valid and appropriately completed to allow for data entry. The analysis of data and summary report were completed in 2010.

than 26,000 seniors with 18.3% of its population 60 years of age and older. Del Norte County’s senior population is 5,776 with 18% of its population sixty years of age and older. Both counties have higher percentages of seniors than the state of California, which has a higher percentage of seniors than that of the nation. By 2040, Humboldt’s senior population will double as its large Boomer population become seniors. By 2020, Del Norte’s senior population will increase by 77%.

Demographically, survey respondents mirror the senior population found in the bi-county area. The percentage of respondents in the following five categories exceeds the percentage of these categories in the general age 60+ population: over the age of 75, over the age of 85, living alone, economically needy and older Native Americans. For purposes of this survey, this over-representation is desirable—information is coming from the group in which the A1AA is most interested.

The aging of the Boomer population and its unavoidable impact on all aspects of society has been referred to as the Silver Tsunami and the Boomer Quake--powerful designations, though misleading. These forces of nature are unexpected, spontaneous, and unforeseen in their timing and their impact. The aging of the Boomers—27% of Humboldt County’s population—and their eventual need for services and accommodations is none of these. It is as predictable as tomorrow’s tides.

A1AA has released, compiled and analyzed similar surveys at four-year intervals since 1989 – a useful pattern of research that will allow for comparison and identification of trends over time. Five of the top ten needs identified in 2009 were also top need categories in 2005, 2001, 1997, 1993 and 1989. Three need areas (crime/feeling safe, energy/utilities, and having enough money to live on) have dropped in the ranking of needs from 1989 to 2009. Crime/feeling safe has decreased from the number one concern in 1993 to the number twelve concern in 2009.

What is not predictable is the quality of life that our North Coast counties will offer to its future senior population. What services must we, in our communities and as a society, provide to support this large and emergent group? As our counties gray, as the public resources available to care for our aging populations are threatened, reduced or eliminated, and as individual savings for retirement are jeopardized, it is increasingly important that our planning be based in fact, that our goals be founded on the realities of need and opportunity. We must understand the concerns and needs of today’s seniors and address them. We must prepare for the demands of the huge Boomer population, just now entering their senior years. We must prioritize need, develop opportunities and provide support that is based on the real needs and experience-based concerns of today’s seniors, their caregivers and families.

As nutrition is an essential component of healthy living, respondents were asked questions about their ability to afford nutritious food, frequency of eating hot meals, and their ability to prepare their meals. Over one-third of respondents indicated that there are times when they cannot afford to purchase fruit, vegetables and protein. Two-thirds of respondents prepare an average of less than one hot meal a day for themselves, 40% less than every other day and 17.3% do not prepare themselves a single hot meal in a week. Many of these individuals have hot meals prepared by others, but 43.1% still average one hot meal per day per week or less. Almost 7% have a hot meal, on average, less than every other day or not at all.

In 2009, the Area 1 Agency on Aging, in partnership with The California Endowment, embarked on a months-long effort to gather information. The undertaking included:

Respondents were given a list of homecare activities and asked if they had problems with their own care or the care that they give to someone else. Of the activities list provided to respondents, five concerned food preparation (grocery shopping, preparing meals, standing to cook, cooking hot meals, and carrying hot meals from stove to table). Over one-third of respondents (38.6%) have minor difficulty, serious difficulty, or are unable to do their own grocery shopping; almost one-fifth (19.8%) have serious difficulty or are unable to do it at all. One-third of respondents are unable or have difficulty with preparing meals and standing to

EXECUTIVE SUMMARY

• Senior and Caregiver Needs Assessment Survey • Local Government Assessment Survey • On-line Advocacy Survey • Literature review of gerontological studies During the fall of 2009 the Area 1 Agency on Aging (A1AA) released

areas to be: health care (77.8%), household chores (77.8%), transportation (55.6%), crime (55.6%), and receiving information about services/ benefits (44.4%).

cook those meals. Just under one-third have difficulty with cooking hot meals and carrying hot meals from the stove to the table. In the Senior and Caregiver Needs Assessment Survey, we found Humboldt County concerns settle within ten categories: Household Chores, Accidents in the Home, Health Care, Money to Live on, Loneliness, Nutrition/Food, Energy/Utilities, Transportation, Isolation, Obtaining Information.

To better understand local seniors’ experiences and their abilities to participate in grassroots advocacy efforts, respondents were asked about their contacts with elected officials in an Advocacy Survey via Survey Monkey. Forty-five percent of respondents had been in contact with an elected official while 40.7% had been in contact with elected officials’ staff. Over a third of the respondents had asked the elected official to do something about an issue they cared about. Over twenty percent (20.7%) of respondents felt that their contacts had made a difference, with 19.3% judging these consequences to have successfully addressed their concerns. Nearly one-half of respondents are comfortable contacting an elected official or their staff. Nearly a one-quarter of respondents would feel more comfortable if they had more information about contacting elected officials. Thirty-eight percent indicated they would or might be interested in attending a workshop on contacting elected officials and 44.3% answered “yes” or “maybe” to a question asking about their interest in attending a workshop on having their concerns heard by elected officials.

Reported difficulties in performing daily domestic activities and anxiety about accidents in the home emerged as the most significant Humboldt concerns and need in this assessment. Most seniors (72%) report some degree of difficulty in doing heavy housework with fewer seniors, still a majority, experiencing difficulty in walking. Almost half of reporting seniors have difficulty grocery shopping and standing to cook and preparing meals. Many (over 40%) have problems driving or arranging for transportation. Many indicated that health problems prevented them from doing household chores. While some have found someone to help them with these activities, most frequently a relative or paid caregiver, others need help and cannot find or afford to pay for it. Recent research has found that Humboldt County seniors fall at a greater rate than the state average, that seniors are less likely to seek medical assistance after a fall than the state average, and that posthospitalization costs are significantly higher than the state average. Reported concerns about accidents in the home of seniors reflect this statistical reality.

A Local Government Assessment Survey was sent to local governmental officials in Humboldt County with the intent of receiving information relevant to long-term public agency planning for the county’s growing senior population. Respondents were asked about the availability of senior services and the role of local government in providing these services. As we did not receive a generous return of survey information, conclusions must be tempered by the limited participation of local officials. Of those responding, many report no or limited local government role in such senior services as: access to health care and prescription programs, transportation to and from medical appointments, wellness programs, preventative screenings, immunizations, nutrition programs, exercise classes, and public safety programs.

Overall, the survey revealed a significant increase in concern regarding nutrition/food (affording or preparing). Concerns related to household chores, accidents in the home, health care, income, and loneliness continue to be high in both counties. Humboldt County senior and disabled adult respondents identified their top five problem areas to be: accidents in the home (51.8%), household chores (51.4%), health care (45.3%), money to live on (38.8%), and loneliness (38.2%).

Results of these information-gathering activities, employing traditional paper surveys, Survey Monkey, town hall meetings, and mailed and e-mailed surveys provide policy and decision-makers and service providers with information essential to the development of collaborative efforts, the elimination of duplicated or redundant services and, most critically, to informed and productive planning and decision-making. The graying of our North Coast communities is a reality that is becoming more urgent each day, as more Boomers enter their senior years. Planning for appropriate support for today’s and tomorrow’s seniors is essential to the health, safety and independence of this growing population.

Del Norte County senior and disabled adult residents identified their top five problem areas to be: health care (53.0%), household chores (49.0%), money to live on (40.8%), accidents in the home (36.7%), and obtaining information about service/benefits (36.7%). Humboldt County caregiver respondents identified their top five problem areas to be: accidents in the home (62.8%), health care (61.1%), household chores (57.6%), money to live on (50.5%), and energy/utilities (49.6%). Del Norte County caregiver residents identified their top five problem

Cindy Denbo, Executive Director Area 1 Agency on Aging

EXECUTIVE SUMMARY

Humboldt County is home to more

HOUSEHOLD CHORES

LITERATURE REVIEW ACCIDENTS IN THE HOME

C O

1 Douglas, A., Lette, L., Richardson, J. A Systematic Review of Accidental Injury from Fire, Wandering, and Medication Self-administration Errors for older adults with and Without Dementia. Archives of Gerontology and Geriatrics. 2011; 5; e1-e10. 2 Center for Disease Control and Prevention Website. Falls among Older Adults: An Overview. Available at http://www.cdc.gov/HomeandRecreationalSafety/Falls/adult falls.html. Last updated September 13, 2010. Accessed October 2010. 3 Mertz KJ, Lee D, Sui X, Powell K, Blair SN. Falls Among Adults: The Association of Cardiorespiratory Fitness and Physical Activity with Walking-Related Falls. American Journal of Preventive Medicine. 2010; 39(1):15-24. 4 American Geriatric Society Foundation for Health in Aging. Preventing Serious Falls: Tips for Older Adults and Their Loved Ones. Available at http://www.healthinaging. org/public_education/falls_tips.php. Created March 14th, 2008. Accessed October, 2010. 5 Vellas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Garry PJ. Fear of falling and restriction of mobility in elderly fallers. Age and Ageing. 1997; 26:189–193. 6 Hernandez, S.S.S., Coelho, F.G.M., Stella, F. Effects of Physical Activity on Cognitive Functions, Balance, and Risk of Falls in Elderly Patients. Revista Bras Fisioter, 14(1); 68-74. 7 Jones, Melissa Esq. It Takes a Village...To Prevent a Fall. Humboldt State University: The California Center for Rural Policy, 2010. 8 California Health Interview Survey, 2007. Available at http://www.chis.ucla.edu. Accessed November, 2010. 9 Coben J, Tiesman H, Bossarte R, Furbee P. Rural-urban differences in injury hospitalizations in the U.S., 2004. American Journal Preventive Medicine. 2009; 36(1):49-55. 10 Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and non-fatal falls among older adults. Injury Prevention. 2006; 12(5):290-5.

1 Aberg AC, Sidenvall B, Hepworth M, O’Reilly K, Lithell H. On loss of activity and independence, adaptation improves life satisfaction in old age – a qualitative study of patients’ perceptions. Quality of Life Research. 2005; 14:1111-1125. 2 Landreville, P., Desrosiers, J., Vincent, C., Verreault, R., & Boudreault, H.V. The Role of Activity Restriction n Poststroke Depressive Symptoms. Rehabilitaion Psychol ogy. 2009; 54(3); 315-322. 3 Stenzelius K, Westergren A, Thorneman G, Hallberg IR. Patterns of health complaints among people 75+ in relation to quality of life and need of help. Archives of Gerontology and Geriatrics. 2005; 40:85-102. 4 Chou KL. Everyday competence and depressive symptoms: Social support and sense of control as mediators or moderators? Aging and Mental Health. 2005; 9:177183. 5 Arslantas D, Unsal A, Metintas S, Koc F, Arslantas A. Life quality and daily life activities of elderly people in rural areas, Eskişehir (Turkey). Archives of Gerontology and Geriatrics. 2009; 48:127-131. 6 Hammarstrom G, Torres S. Being, feeling and acting: A qualitative study of Swedish home-help care recipients’ understandings of dependence and independence. Journal of Aging Studies. 2010; 24:75-87. 7 Oswald F, Wahl HW, Schilling O, et al. Relationships between Housing and Healthy Aging in Very Old Age. The Gerontologist. 2007; 47:96-107. 8 Pushkar D, Chaikelson J, Conway M, et al. Testing Continuity and Activity Variables as Predictors of Positive and Negative Affect in Retirement. Journal of Gerontology: Psychological Sciences. 2010; 65:42-49. 9 Schultz-Larsen K, Avlund K. Tiredness in daily activities: A subjective measure for the identification of frailty among non-disabled community-living older adults. Archives of Gerontology and Geriatrics. 2007; 44:83-93. 10 Department of Social Services. In-Home Supportive Services. 2007. HYPERLINK “http://www.dss.cahwnet.gov/cdssweb/PG139.htm.%20Accessed%20October%20 2010”http://www.dss.cahwnet.gov/cdssweb/PG139.htm. Accessed October 2010. 11 Phinney, A., Chaudhury, H., & O’Connor, D., Doing as Much as I can do: The Meaning of Activity for People with Dementia. Aging and Mental Health. 2007; 11(4); 384-393. 12 Martinek, C. Humboldt Community Resource Center Survey. Summary Report 2011. Prepared for St. Joseph Health System. HYPERLINK “http://www.stjosepheu reka.org/attachments.communityNeedsAssessment2011.pdf” www.stjosepheureka.org/attachments.communityNeedsAssessment2011.pdf 13 Eggermont, L.H.P., Millberg, W.P., Lipsitz, L.A., Scherder, E.J.A., & Leveille, S.G. Physical Acitivity and Executive Functioning in Aging: The Mobilize Boston, Study. Journal of the American Geriatrics Society. 2009; 57; 1750-1756. 14 Sofi, F., Valecchi, D., Bacci, D., Abbate, R., Gensini, G.F., Casini, A., & Macchi, C. Physical Activity and Risk of Cognitive Decline: A Meta-Analysis of Prospective Stud ies. Journal of Internal Medicine. 2010; 269(1); 1365-2796.

and can lead to fatigue or injury.9component ommunity-dwelling older adultsthereport that having the capability chores is an important Researchers for happiness have foundand a link for between the ability lder adults report that having capability to perform householdto perform household 1 havefor shown declineand in quality life, higher rates of depression and lessened feelings of control when in older adultsfunctioncan no tochores live independently. fatigue from daily activities and subsequent decreases physical is an importantStudies component happiness for the of ability to 9 1 the daily activities that constitute household chores.2,3,4,5 Oldering. adults That who is,can fatigue no longer caused manage by increased their household efforts tochores performtend daily to activities feel that longer perform basic Studies have shown decline in quality of life, higher rates live independently. 4 they have lessand control over their environments and that they are less or chores able to had live alone. an impact on later development of disability. For many older of depression lessened feelings of control when older adults can competent, no longer less adults, household chores require more energy and effort than necessary perform basic the daily activities that constitute household chores.2,3,4,5 Older Many adults also have trouble acceptingchores that they aretounable to they functioninastheir theyyounger did in their younger years,fora greater realization thatcan canincrease lead to perception years; this need effort the risk of adults older who can no may longer manage their household tend feel that 3,11 For some, theand decline confidence of their capability to live independently thatCounty accompanies inability to perform household of declining qualityover of life. injuries. In a Humboldt community needs assessment, 18% chores of adults have less control their environments that in they are less competent, 4 adults express about becomingchores more dependent they when not live can lead symptoms.2 Along with depressive symptoms, older 17 to 86 years old worry reported household as an area should of concern less able to to increased live alone.depressive close to trusted family or friends.6 asked about quality of life.12 Eligible California senior citizens have the option of receiving in-home services to assist with cleaning, meal preparation Many older adults may also have trouble accepting that they are unable Studies have a greater sense of well-being is associated withtoliving in aand home thathousehold provides easy mobility and accessibility andliving with control overorhousother chores to maintain independent and delay to function as shown they didthat in their younger years, a realization that can lead 10 3,11 able to choose independent living reported ing situations.6 That is, quality adults who higher relocation perceptionstoofnursing health homes. and well-being. In addition, living in homes that prevent For some, the decline in confidence perception of declining of life.were were accessible (e.g., stairs, clear inability walkways, etc.) provided more continuity and less change in daily activities.7,8 of theirperceived capabilityastoeasily live independently thatno accompanies to perform 2 Cognitive functioning has also been found to be associated with physical household chores can lead to increased depressive symptoms. Along with Decreases physical functioning makeworry daily activities more challenging and can lead such to fatigue or injury.9 Researchers havework. foundInaalink between fatigue activity, as household chores and yard study of older adults depressive in symptoms, older adultscan express about becoming more 9 6 That is, fatigue caused by increased to perform daily activities or chores had an from daily activities and subsequent decreases in physical functioning. in Boston, physical activityefforts was related to cognitive functioning, specifically dependent should they not live close to trusted family or friends. impact on later development of disability. For many older adults, household choresexecutive require more energy and effort than necessary in their younger this functioning measures. Executive functioning occurs years; in the frontal 13 Even thise need forhave greater effortthat cana increase the risk injuries. In Humboldtwith County community needs assessment, of adults to 86independently. years old reported housebrain and is necessary for18% planning, and17 living Studies shown greater sense of of well-being is aassociated 12 Eligible citizens have theexecutive option of functionality receiving in-home services who senior have low to moderate are less likely to assist show with hold chores as an area of concern asked quality and of life. living in a home that provides easy when mobility and about accessibility with control California 14 6 cleaning, mealsituations. preparation andis,other household maintain independent living and delay or prevent relocation to nursing homes.10 cognitive decline. That adults who werechores able totochoose independent over housing living reported higher perceptions of health and well-being. In addition, living Performing household chores can work. be a protective olderinadults and Cognitive functioning has also as been found to be associated with physical activity, such as household chores and yard In a study factor of olderforadults Boston, in homes that were perceived easily accessible (e.g., no stairs, clear walk7,8 functioning canmeasures. have a salutary effectfunctioning on their lives. These allowand them to live physical activity was more relatedcontinuity to cognitive executive Executive occurs in theactivities frontal brain is necesways, etc.) provided andfunctioning, less changespecifically in daily activities. are to less likelyless to show cognitive more functionality independently, suffer depression, to decline. enjoy a14better quality of life sary for planning, and living independently.13 Even who have low to moderate executive and to reduce cognitive decline. ● Decreases in physical functioning can make daily activities more challenging Performing household chores can be a protective factor for older adults and can have a salutary effect on their lives. These activities allow them to live more independently, to suffer less depression, to enjoy a better quality of life and to reduce cognitive decline. ●

LITERATURE REVIEW

isk of injury from accidents in the home is of particular concern when assessing whether older adult can live independently. Common some of which an have been implemented in communities arounddomestic the country. accidents and assessing whether behaviors an older thatadult cause caninjury live independently. are falls, burns,Common and self-medication injuries can during of dailycoalition living tasks One errors. of theseThese recommends theoccur creation of aperformance regional or county 1 such as bathing domestic accidents andand cooking. behaviors that cause injury are falls, burns, and to prevent falls, a coalition which unites all service-providers (such as 12 Thirty percent and of older adults fall year.toBalance Falls errors. have consistently beencan found to during bet theperformance number one of source in older adults.home self-medication These injuries occur daily of injury medical workers, modifiers, caregivers) in each an effort devise the 1 and disorders, heart disease, functional and cognitive impairment, medication side effects, visual impairment, and foot livinggait tasks such asmuscle bathingweakness, and cooking. most effective and comprehensive means and methods of fallproblems prevention. bruises, internal organcan injuries, head trauma, andprevention death. Falls that by do are associated with increased risk of falling. 3,4 Falls can lead to bone fractures, cuts, County and city planners also contribute to fall efforts for not lead to deathbeen can found often result in disability can lead to a loss independence a significant decrease quality life.2 It is common Fallsdirectly have consistently to be the number which one source of injury in of providing safe and sidewalks and easy accessin to publicofbuildings. Such atten1,2 5 Thirty percent of older fall each year. Balance Reducedand activity older adults be damaging to seniors to develop fear of falling whichadults can lead to decreased activityand andgait decreased physical fitness. older adults. tion to community walkability safe in mobility for all can citizens can support seniors. disorders, Physical muscleactivity weakness, has been heart found disease, to reduce functional the and risk cognitive of cognitive impairdecline and to increase balance andfiscally agility,prudent. resultingOther in a reduction of riskinclude for falls.6 community health and be opportunities ment, medication side effects, visual impairment, and foot problems are building ‘universal design structures’ that can be used by people of all In the Redwood Coast Region (Humboldt, Mendocino, can leadTrinity, to bone andfractures, Del Norte counties) fallscreating experienced peoplespecifically over 65 years of agetoare reported associated with increased risk of falling.3,4 Falls abilities, elder by villages designed mitigate themore physi7 Inthat Humboldt County, the percentage of seniors, seniors reporting more than fall in the pastcare frequently cuts, bruises, thaninternal for theorgan same injuries, population head in the trauma, stateand of California. death. Falls cal challenges faced by and educating and one informing health 7 year, fromto14.8% 2003 to result 18.3%inindisability 2007. This is significantly than the state-wide fall rates of resources 11.9% in 2003 andprevention. 14.5% in 2007. Even do notincreased directly lead death in can often which can lead to higherproviders about available local for fall 2 It ispercentage of seniors who had experienced more than one fall--18.6% in 2003 and though and Del Norte showed a slight decrease in the a loss ofTrinity independence and aCounties significant decrease in quality of life. 8 common seniors tonumbers develop fear of falling which can lead to decreased Injury from fire and burns has been found to be the second most frequent 17.9% in for 2007--these are higher than state-wide statistics. activity and decreased physical fitness.5 Reduced activity in older adults can source of in-home injury for older adults, although the frequency is low; 9 The direct medical costs of both fatal be seniors. Physical activity has been reduce risk in rural Thedamaging per-capitatocost of hospital visits has been foundfound to betohigher forthe seniors to urban. this populations type of injurycompared is experienced two to five times less frequently than 10 and nonfataldecline falls among 65 years of age olderresulting totaled over billion ininjuries Unitedresulting States forfrom the falls. year 2000. of cognitive and toadults increase balance andoragility, in a $19 reducInjuries were most apt to result from faulty tion of risk for falls.6 smoke detectors and resultant lack of fire alarms, and mobility limitations 1 There have been many proposals concerning fall prevention for seniors, some ofinwhich been implemented in communities around the country. One olderhave adults. In Redwood Coastthe Region (Humboldt, Mendocino, Trinity, and Del Norte falls, a coalition which unites all service-providers (such as medical workers, of the these recommends creation of a regional or county coalition to prevent Self-medication errors had aoflow incidence to counties) falls experienced by people agemost are reported home modifiers, and caregivers) in anover effort65toyears deviseofthe effective and comprehensive means andalso methods fallfrequency prevention.ofCounty andcompared city-planners 7 falls. Medication errors were Such the fifth sourcetoofcommunity injury in the home, followed more frequently thantofor theprevention same population in providing the state of California. can also contribute falls efforts by safe sidewalks and easy access to public buildings. attention walkability and In Humboldt the percentage of seniors reporting one prudent. byOther injuries resulting from not building eating and failure to reportstructures’ other medical safe mobility County, for all citizens can support community healthmore and than be fiscally opportunities include ‘universal design that can fall used in theby past year,ofincreased from 14.8%elder in 2003 to 18.3% in 2007.designed This to mitigate conditions. errors included adverse reactions, be people all abilities, creating villages specifically the Self-medication physical challenges faced by seniors, andmedication educating and informis significantly thanabout the state-wide of 11.9% and 7 change of the medication regimen, and inability or unwillingness to follow ing health carehigher providers available fall localrates resources for infall2003 prevention. 14.5% in 2007. Even though Trinity and Del Norte Counties showed a slight medical advice.1 Injury frominfire burns hasof been found be the second most decrease theand percentage seniors whotohad experienced morefrequent than source of in-home injury for older adults, although the frequency is low; this type of report injury due to reported wandering asinjuries the most safety injury is experienced twoand to five times less frequently than injuries resulting falls. Only .03 to 5% of seniors burn or common deaths from burns. one fall--18.6% in 2003 17.9% in 2007--these numbers are higher than from Caregivers 8 1 for seniors. Although thereinisolder little adults. data and research to support Injuries were most apt to result from faulty smoke detectors and resultant lack ofconcern fire alarms, and mobility limitations state-wide statistics. this statement, wandering is reported as a very high source of stress for 1 Self-medication errors also hadvisits a lowhas frequency of incidence compared to falls. Medication the fifth source in of this injuryarea. in the home, followed by The per-capita cost of hospital been found to be higher for seniors caregivers.errors More were research is needed 9 Thetodirect costs ofconditions. both injuries resulting from not eating failure reportmedical other medical Self-medication errors included adverse medication reactions, change of the in rural populations compared to and urban. fatal and nonfatal fallsand among adults 65 years of age or older totaledadvice. over 1 medication regimen, inability or unwillingness to follow medical Older adults with decreased cognition and dementia experience more 10 1 Caregivers injury duefor to the wandering as the most common safety concern for seniors. Although thereaccidents is little data andcompared research to all support stateInjury $19 billion inreport United States year 2000. injuries from all in-home when older this adults. 1 ment, wandering is reported as a very high source of stress for caregivers. Morefrom research falls is the needed mostinfrequent this area. source of in-home accidents for this fragile There adults have been many proposals concerning fall prevention for seniors, from falls ● Older with decreased cognition and dementia experience more injuries from all in-home accidents when to all older adults. population, followed by fire andcompared burns, medication errors and1 Injury wandering. is the most frequent source of in-home accidents for this fragile population, followed by fire and burns, medication errors and wandering. ●

HEALTH CARE

MONEY TO LIVE ON

of low-income adultsofinand Humboldt County and 32% adequate of low-income he availability opportunity for receiving healthadults care is 2 in Delessential Norte County report inability to access needed Elderly for health and well-being, especially forhealthcare. elderly populations. patients frequently report thatthe their fears of high medicalcare, coststheoutweigh the While many factors determine accessibility of health unique chalurgency of severe symptoms deters them from seeking medical lenges facing elderlyphysical populations can beand particularly burdensome, especially In Humboldt County the estimated yearly cost of health care of for forattention. seniors 5living in rural communities. Cost of medical services, number 6 How people pera person over 65 distance years of age, in goodoptions health, for is $4,584. medical providers, to services, transportation and availceiveofthe availability medical care inoftheir community also affects their use ability specialists allofaffect the ability seniors to access necessary health of these services. Those who perceive access to health care to be limited care. have higher rates of hospitalization for chronic diseases — diseases which couldofhave been managed lesstoexpensive care andfor bythe lesselderly expensive Costs health care can be awith barrier medical services poor. 3 primary physicians. One in tencare of the elderly poor living in rural California has Medicare coverage with no private supplementary insurance policy, resulting in high out of pocket 1 Thirty percent low-income Approximately of U.S. physicians practice in rural areasofalthough costs, especially10% for those with chronic illness. 8 There are approximately adults in Humboldt County 32% areas. of low-income adults in Del Norte120 County 25% of the population livesand in rural 2 Elderly patients frequently report physicians perto100,000 people in rural areas, compared to 290 physicians report inability access needed healthcare. 4 Humboldt a shortage that fearspeople of highinmedical costs outweigh the County urgencyhas of severe physical pertheir 100,000 urban centers. In Humboldt of healthcare when statewide. With a 5population of symptoms and providers deters them fromcompared seeking medical attention. County the estimated yearly cost of has health for a person over 65 years of approximately 129,000, Humboldt fourcare hospitals with 217 beds and 103 9 Many6 How people people livingperceive in rural areas the availability rely on doctors of mediage, in good is $4,584. primary carehealth, providers. cal who care liveinoutside their community their community. also affects Due their to inadequate use of these medical services. equipment, Those who 8 he access availability of andcare opportunity for receiving adequate health care is for and/or shortage with of specialty perceive to health to be limited have higher rates of hospitalization higher chronic feesdiseases--diseases for services in theirwhich communities, could have beenamanaged less essential for health well-being, especially for elderly 3populations. providers,2 13% of Humboldt County adults report regularly leaving the expensive care and by lessand expensive primary care physicians. While many factors determine the accessibility of health care, the unique County to access medical services.10 challenges facing populations be particularly burdensome, Approximately 10%elderly of U.S. physicianscan practice in rural areas although 25% of the population lives in rural areas.8 There are approximately 120 physicians 4 especially forpeople seniorsinliving rural compared communities. Cost of medicalper services, Humboldt Countyas has a shortage of healthcare providper 100,000 rural in areas, to 290 physicians 100,000 people in urban centers. Transportation is consistently reported a barrier to access of healthcare number medical providers, distance services,ofoptions for transportation ers whenofcompared state wide. With a to population approximately 129,000, Humboldt has with 217 beds and 103 primary care providers. 9 services in four ruralhospitals areas with limited or non-existent public transportation. and of specialists all affect thedoctors ability of seniors to access Manyavailability people living in rural areas rely on who live outside theirnecescommunity. Due to inadequate medical higher in their Forty-four percent of Del Norteequipment, County adults andfees 38%forofservices those living in 8 10 sary health care. and/or a shortage of specialty providers2, 13% of Humboldt Countytheadults reportCoast regularly leaving County to access medicalinservices. communities, Redwood Region cite the transportation as a problem accessing health care. The average travel time in Humboldt County to needed medical 2 Costs of healthiscare can be a reported barrier toas medical services for the elderly services Transportation consistently a barrier to access of healthcare in rural areasfrom with 15 limited or minutes. non-existent public transportation. Forty-four services ranges to 105 poor. One of the elderlyadults poor and living38% in rural California Medicare percent of in Delten Norte County of those living has in the Redwood Coast Region cite transportation as a problem in accessing health care. The coverage with no private supplementary insurance high fromThese are significant average travel time in Humboldt County to needed policy, medicalresulting servicesinranges 15 to 105 minutes.2 barriers to obtaining health care and medical services out of pocket costs, especially for those with chronic illness.1 Thirty percent for seniors living in rural and Humboldt County communities. ● These are significant barriers to obtaining health care and medical services for seniors living in rural and Humboldt County communities. ●

LITERATURE REVIEW

1 Durazo, E.., Jones, M.R., Wallace, S.P., Van Arsdale, J., Aydin, M., & Stewart, C. Health Policy Brief. The Health Status And Unique Health Challenges of Rural Older Adults in California: UCLA Center for Health Policy Research. 2011. 2 Rural Community Vital Signs. Community Health Indicators for the Redwood Coast Region. The California Center for Rural Policy at Humboldt State University. 2010. 3 Bindman A. Preventable Hospitalizations and Access to Health Care. Journal of the American Medical Association. 1995; 274(4):305-311.. 4 Rosenthal T, Chester F. Access to Health Care for Rural Elderly. Journal of the American Medical Association. 2000; 284(16): 2034-2036. 5 The Federal Interagency Forum on Aging-Related Statistics. Older Americans 2010: Key Indicators of Well-Being. Available at http://www.agingstats.gov/Agingstatsdotn et/Main_Site/default.aspx. Last updated July 2010. Accessed October, 2010. 6 Wallace SP, Padilla-Frausto DI, Smith SE. Older Adults Need Twice the Federal Poverty Level to Make Ends Meet in California. Los Angeles, CA:UCLA Center for Health Policy Research, 2010. Available at: http://www.healthpolicy.ucla.edu/pubs/files/elder_index-brief-0910.pdf. Accessed November, 2010. 7 Barley G.E., et al. Characteristics of and issues faced by rural female family physicians. Journal of Rural Health. 2001; 17(3): 251-258.8 California Health Interview Survey, 2007. Available at http://www.chis.ucla.edu. Accessed November, 2010. 8 Gamm L., Castillo G., Pittman S. Access to Quality Health Services in Rural Areas—Primary Care: A Literature Review. Rural Healthy People 2010: A Companion Document to Healthy People 2010. Volume 2. The Texas A&M University System Health Science Center, School of Rural Public Health. 9 Robert Wood Johnson Foundation. Aligning Forces for Quality in Humboldt County California. A Community Snapshot. HYPERLINK “http://www.rwjf.org/qualityequality/ af4q” www.rwjf.org/qualityequality/af4q. 10 Van Arsdale, J., & Berr, J.S. Humboldt County Selected Findings from Rural Health Information Survey 2006. Access to Health Care and Food Security. 2008. 12

aving avingenough enoughmoney money to live to live on isona challenge is a challenge for many for elderly many elderly people but people especially but especially for thosefor living those in non-metropolitan living in non-metropolitan areas. Rural seniors areas. Rural are more seniors likely , the to arebemore poor. likely Low lifetime to be poor. earnings Lowcorrelates lifetime with earnings lower Social correlates Security withbenefits lower 1Social 1 , the primary income elderly people. primary source of income for manysource elderly of people. Withforthemany average annual income Security benefits 6 , approximately 45% of unmarried With the average annual income women at $12,155 and that of men for women at $12,155 and that of menfor$15,620 6 , approximately 45% ofto unmarried on Social Secuwomen depend on Social Security provide 90%women of their depend income. The ramifications $15,620 rity to provide 90%ofoflifetheir Theand ramifications of poverty on quality of poverty on quality are income. unsurprising commonplace. People identified asof life unsurprising andofcommonplace. People living in housing, poverty livingare in poverty are at risk having inadequate moneyidentified to provideasfood, safe are at care, risk of having inadequate to provide health and the resources to livemoney independent lives.2food, safe housing, health care, and the resources to live independent lives.2 The cost of housing is often the largest expenditure in a senior’s budget although there can be variation depending on the type of housing The cost of much housing is often the largest expenditure in a involved—rental, senior’s budget 3 Rent payments canonrequire as much as half of an mortgaged home,can or owned home. although there be much variation depending the type of housing 8 3 Healthhome, care costs increasehome. dramatically Rent with payments age andcan often elderly person’s income. involved—rental, mortgaged or owned 8 Health care costs require require aas large much partas of ahalf senior’s of anincome elderlywith person’s variation income. determined geographic location Transportation cana also a significant increase dramatically withsenior. age 2,3 and often require largerequire part of a senior’sporand the health status of the tion of anwith elderly person’sdetermined income. Forgeographic the 75 yearslocation of age and older were income variation and thecohort healthwho status 2, 3 Transportation can also require a significant portion of an able drive, vehicle insurance accounts for approximately 25% of total transportation of theto senior. elderlyAgain, person’s income. For the 75 on years of age andvaries oldergreatly. cohortMany whoare were costs. the amount seniors spend transportation able totodrive, insurance accounts for approximately 25% of totalothers unable drive vehicle themselves and must pay for third-party transportation services; basicand needs--more than twice theexpense National Poverty Guideline. transportation costs. Again, the amount seniors spend transportation var- Foodmeet live in areas where public transportation is nonexistent and notona part of their budgets. purchase provision is another major forFederal elderly populations and is 8 2 ies greatly. Many unable to unable drive themselves and must pay for third-party especially costly for are those who are to cook or buy groceries for themselves. In Humboldt County, the estimated yearly income needed by a senior who transportation services; others live in areas where public transportation is a home is is $19,176 — an amount significantly higher thanis the naThe National Federal Guideline, the yearly income deemedand necessary for a senioristorenting meet basic needs, set at $10,8907 for a single person. This amount based nonexistent and notPoverty a part of their budgets. Food purchase provision Based on who U.S.live Census statistics from 2005-2009, 7.2% level.4For on national averages and does take into consideration costs ofcostly living in partspoverty of the country. seniors in California, the maximum Social Security is another major expense fornot elderly populations andvariable is especially fordifferenttional seniors living in Humboldt 8.2% Del Norte County lived in Income payment is $10,440. Those on Social Security as2 their sole source ofofincome after retirement will haveCounty incomesand below theinNational Federal Poverty those who are unable to cook or who buy depend groceries for themselves. poverty, compared to 8.4% for of theliving State of California. percent of Guideline. According to the California Elder Economic Security Index, a measure that acknowledges the differences in costs in different parts ofForty-seven the country, older adults 8 years Federal of age and older report having a difficult time making ends The National Federal Poverty Guideline, the yearly to income deemed neces- than people living in California who rent housing require $21,763/year meet basic needs--more twice the65National Poverty Guideline. sary for a senior to meet basic needs, is set at $10,8907 for a single person. meet.8 Of people living in poverty, 29% report very low food security — un4 certain access toamount food, reduced foodhigher intake, This food insecurity Based In Humboldt the on estimated yearly incomeand needed a senior is renting a home is $19,176—an significantly thanand the hunger. national poverty level. This amountCounty, is based national averages doesbynot take who into considerramifications, Many health concerns associated with on U.S.variable Censuscosts statistics from 2005-2009, living in Humboldt County 8.2%major in Delhealth Norte County lived in poverty, compared to 8.4%are for the State of Califoration of living in different7.2% partsofofseniors the country. For seniors who and has 5 8 food insecurity including diabetes, heart disease andvery obesity. Of people living in poverty, 29% report low food security-- unnia. percent of people 65 yearsSecurity of age and older report having a difficult time making ends meet. live Forty-seven in California, the maximum Social Income payment is $10,440. certain to food,on reduced intake,as andtheir hunger. foodofinsecurity major health ramifications, Many health concerns are associated with food insecurity including Those access who depend Socialfood Security soleThis source incomehas after 5 Having enough money to live on and making ends meet is a challenge for diabetes, heart and obesity. retirement willdisease have incomes below the National Federal Poverty Guideline. many elderly people in rural California. The average income for people over According to the California Elder Economic Security Index, a measure that 65 oninSocial SecurityThe is barely over the poverty to is Having enough money to live on and making is a challenge many elderly people rural California. average income for peopleguideline; over 65 oninadequate Social Security acknowledges the differences in costs ofends livingmeet in different parts for of the councover expenses. ● barely overadults the poverty inadequate to cover expenses. try, older livingguideline; in California who rent housing require●$21,763/year to 1 Rosenthal T, Fox C. Access to Health Care for Rural Elderly. Journal of the American Medical Association. 2000; 284(16): 2034-2036. 2 The Federal Interagency Forum on Aging-Related Statistics. Older Americans 2010: Key Indicators of Well-Being. Available at http://www.agingstats.gov/ Agingstatsdotnet/Main_Site/default.aspx. Last updated July 2010. Accessed October 2010. 3 Wallace SP, Molina LC. Federal Poverty Guideline Underestimates Costs of Living for Older Persons in California. UCLA Center for Health Policy Re search, Los Angeles. 2008. Available at: http://escholarship.org/uc/item/0fb3f5dg;j. Accessed November, 2010. 4 Wallace SP, Padilla-Frausto DI, Smith, SE. Older Adults Need Twice the Federal Poverty Level to Make Ends Meet in California. Los Angeles, CA:UCLA Center for Health Policy Research, 2010. Available at: http://www.healthpolicy.ucla.edu/pubs/files/elder_index-brief-0910.pdf. Accessed November, 2010. 5 Van Arsdale J, Peeters-Graehl L, Patterson K, Barry J, Bayer A. Rural Poverty and its Health Impacts: A Look at Poverty in the Redwood Coast Region. Humboldt State University: California Center for Rural Policy 2008. 6 Social Security Administration. Social Security is Important to Women. 2011 HYPERLINK “http://www.ssa.gov/pressoffice/factsheets/women.htm” http:// www.ssa.gov/pressoffice/factsheets/women.htm 7 US Department of Health and Human Services. Annual Update of HHS Poverty Guidelines. 2011. HYPERLINK “http://aspe.hhs.gov/poverty/11fedreg. shtml” http://aspe.hhs.gov/poverty/11fedreg.shtml 8 Insight Center for Community and Economic Development. California Elder Economic Security Initiative. n.d. HYPERLINK “http://www.insightcced.org/ communities/besa/cal-eesi/elder-index.html” http://www.insightcced.org/communities/besa/cal-eesi/elder-index.html 13

LITERATURE REVIEW

LONELINESS/ISOLATION

ACCESS TO INFORMATION

or many older adults, mobility transportation become conindependent compared to their and urban counterparts; manygrowing were less 2 Interventions that cerns asabout they age. problems isolation. can greatly impact an individual’s distressed theirThese geographical promote socialsocial relationships haveparticipate helped improve the health and ability to maintain relationships, in community activities, 3 well-being older services adults suffering from loneliness. and/or accessofneeded and resources. Researchers have found that maintaining social relationships can predict well-being in community-dwelling, Studies that loneliness social isolation candespite negativeolder adults.have Thatshown is, those who were ableand to maintain friendships hav4,5,6 influence adults’ perceived well-being physical health. inglyillnesses or older mobility impairments reported havingand better health than those 1 Rural, communityResearchers have found thatsocial having a small social network and feelwho were not able to keep these relationships. dwelling olderare adults havetobeen foundblood to display high resilience in oldolder age if ing lonely related systolic pressure. Specifically, Interestingly, residents New their socialwho networks consist friends. adults felt they wereoflonely or2 isolated wererural more likely toof have York Statesystolic were shown be more independent compared urban higher bloodtopressure that remained high fortoattheir least four research hasdistressed shown a about relationship between loneliness counterparts; many were less their geographical isolation.2 years. 4 Other Interventions and metabolic that promote syndrome, social which relationships is a risk factor have helped for developing improve the other 3 health illnesses and well-being (e.g., cardiovascular of older adultsdisease, sufferingdiabetes) from loneliness. and death. That is, older adults who experience constant feelings of loneliness are Studies have shown that loneliness of and social isolation5 can negatively at Studies greater have risk for the development other diseases. also found relationship between loneliness and depressive sympinfluence olderaadults’ perceived well-being and physical health.4,5,6 ResearchResearchers thatsocial reported social increased erstoms. have6,7found that havingfound a small network andisolation feeling lonely are fromwere depressive symptoms in olderSpecifically, adults. 6 Older related to systolic blood pressure. olderadults adultssuffering who felt they chronic loneliness also more likelyhigher to require emergency hospital lonely or isolated wereare more likely to have systolic blood pressure that 8 loneliness metabolic syndrome, which is a risk factor for develvisits rather thanand planned health care appointments. remained high for at least four years.4 Other research has shown a relationship between oping or other illnesses cardiovascular diabetes) and death. That is, older adults who experience constant feelings of loneliness are at greater many older (e.g., adults, mobility anddisease, transportation become growing 6,7 Researchers found that risk forconcerns the development other diseases.5 Studies alsoimpact found an a relationship The between populations loneliness of Humboldt and depressive and Del symptoms. Norte Counties are 129,623 as they of age. These problems can have greatly 6 Community-dwelling older adults suffering from chronic loneliness are also reported social isolation increased depressive symptoms in older adults. and 29,114 respectively, as of 2009. The population density of more each individual’s ability to maintain social relationships, participate in comlikely to activities, require emergency hospitalneeded visits rather than and planned health care county8 is approximately 36 persons/square mile for Humboldt and 29 munity and/or access services resources. Re-appointments. persons/square mile for Del Norte. 9 In a Humboldt County community searchers have found that maintaining social relationships can predict isolation by density 20% ofofadults surveyed populations Humboldt and who Del Norte are 129,623 and needs 29,114 assessment respectively, as of 2009.was Thereported population each county well-beingThe in older adults.ofThat is, those were Counties able to maintain 9 10 In a Humboldt GivenCounty the risk community factors associated needs assessment with loneliasfor anDel area of concern. is approximately 36 persons/square mileorfor Humboldt and 29 persons/square mile Norte. friendships despite having illnesses mobility impairments reported riskrural factors associated should with loneliness, rural communities should be isolation was reported by 20% of adults surveyed as antoarea of these concern.10 Given the ness, communities be particularly aware of their elderly having better health than those who were not able keep 1 particularly aware of their elderly populations and been their access populations and their access to social settings. ● Rural, older adults have found to social displaysettings. ● social relationships. high resilience in old age if their social networks consist of friends. 2 Interestingly, rural residents of New York State were shown to be more

he ability to obtain information about community resources and events is an important support for elderly populations as they seek to maintain dependent living and remain in control of their lives. To take an active role in decisions affecting their health and well-being, people need reliable, accurate information about illnesses and medical therapies, locations of doctors and hospitals, local government and nonprofit support agencies, and the complexities of medical insurance.1

A 2009 report from the National Academies found that most older adults get their information from national and local television and from newspapers.2 Other studies have found that older people do not seek information until they are in a life transition and do not know the questions that should be asked to obtain the information they need. Older adults reported turning to trusted people in their informal support network for counhe ability to obtain information about community resources and sel. Rather than seek information from traditional information providers, events is an important support for elderly populations as they seek they sought dependent advice fromliving people knewinwho hadofsimilar experiences. to maintain andthey remain control their lives. To take They reported that this advice played a stronger role in their decision an active role in decisions affecting their health and well-being, people 3 adults also making processaccurate than information from formal sources. need reliable, information about illnesses andOlder medical therareported that they were unaware that they could obtain information from pies, locations of doctors and hospitals, local government and nonprofit 4 County or local social services providers. supportsources agencies, and the complexities of medical insurance.1

Although a technological divide occurs between young and older income, andfrom limited homeand internet many A 2009 report from the National Academies found that most olderage adults get level, their information national local services televisionavailable and frominnewspa6 groups, rural areas. In a survey of Humboldt, Del Norte, Trinity and Mendocino 2 the gap has decreased in the last six years with those 70 to 75 pers. Other studies have found that older people do not seek information until they are in a life transition and do not know the questions that should years old showing increase Internet useadults of all reported ages. This counties, Redwood Connect group foundforthat those who did be asked to obtainthe thelargest information theyinneed. Older turning to trusted the people in theirCoast informal support network counsel. Rather group of older adults has increased its Internet usage from 26% 2005 advice not have connection citehad lacksimilar of availability and excessive cost than seek information from traditional information providers, theyinsought from internet people they knew who experiences. They reported to 45% 2008. played Overall,aadults agerole 65 in and older have increased Internetthanas primary reasons for the lack of3 connectivity. survey Older adults The also same reported thatshowed they that thisinadvice stronger their decision making process information from formal sources. use from 22% in 2004 to 48% in 2008. The most popular use of the Inthat approximately 45.7% of 4respondents reported Broadband as their were unaware that they could obtain information from County sources or local social services providers. ternet for older adults is communication through email. General informaInternet mode.7 tion searching and health information searches are ranked second and Although a digital divide occurs between young and older age groups, the gap has decreased in the last six years with those 70 to 75 years old third for seniors’ Internet use. in Broad access adults 65This and group older has Older adults still get most of theirusage information fromintraditional sources showing the largest increase Internet use for of all ages. of older adults has increased its Internet from 26% 2005 to 45% in 5 however, a gap remains between urban and tripled during this time; such as their personal support network, television and newspapers. 2008. Overall, adults age 65 and older have increased Internet use from 22% in 2004 to 48% in 2008. The most popular use of the Internet for older rural access. Studies have shown that seniors living searching in rural ar-and health However, use of the Internetare as ranked an information is increasing, adultsseniors’ is communication through email. General information information searches second source and third for seniors’ eas are less likely to use the Internet than those who live in urban areas. ● especially for athe health urban care information. 5 however, gapsearches remainsfor between and rural seniors’ access. internet use. Broad access for adults 65 and older has tripled during this time; These haveseniors been attributed to factors as education Studiesdiscrepancies have shown that living in rural areassuch are less likely to use the Internet than those who live in urban areas. These discrepancies have

1 Livingston G, Cooper C, Woods J, Milne A, Katona C. Successful ageing in adversity: The LASER-AD longitudinal study. Journal of Nerology, Neurosurgery & Psychiat try. 2008; 79:641-645. 2 Wells M. Resilience in rural community-dwelling older adults. The Journal of Rural Health. 2009; 25:415-419. 3 Pitkala KH, Routasalo P, Kautiainen H, Tilvis RS. Effects of psychosocial group rehabilitation on health, use of health care services, and mortality of older persons suffering from loneliness: A randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2009; 64:792-800. 4 Hawkley LC, Thisted RA, Masi CM, Cacioppo JT. Loneliness predicts increased blood pressure: 5-year cross lagged analyses in middle-aged and older adults. Psychology and Aging. 2010; 25:132-141. 5 Whisman MA. Loneliness and the metabolic syndrome in a population-based sample of middle-aged and older adults. Health Psychology. 2010; 29:550-554. 6 Cacioppo JT, Hawkley LC, Thisted RA. Perceived social isolation makes me sad: 5- year cross-lagged analyses of loneliness and depressive symptomatology in the Chicago Health, Aging and Social Relations Study. Psychology and Aging. 2010; 25:453-463. 7 Patterson AC, Veenstra G. Loneliness and risk of mortality: A longitudinal investigation in Alameda County, California. Social Science and Medicine. 2010; 71:181-186. 8 Molloy GJ, McGee HM, O’Neill D, Conroy RM. Loneliness and emergency and planned hospitalizations in a community sample of older adults. J Am Geriatr Soc. 2010; 58:1538-1541. 9 U.S. Census Bureau Website. Available at: HYPERLINK “http://factfinder.census.gov/home/saff/main.html?_lang=en” http://factfinder.census.gov/home/saff/main. html?_lang=en. Accessed January, 2011. 10 Martinek, C. Humboldt Community Resource Center Survey. Summary Report 2011. HYPERLINK “http://www.stjosephureka.org/attachements/communityNeedsAs sessment2011.pdf” www.stjosephureka.org/attachements/communityNeedsAssessment2011.pdf

1 Kaufman D, Rockoff M. Increasing Access to Online Information About Health: A Program for Inner-City Elders in Community-Based Organizations. Technology Innova tions and Aging. 2006; 55-57. 2 The National Academies. Advancing Behavioral and Social Research on the Elderly in Disasters. Committee on Population Expert Meeting. 2009. 3 Godfrey, M. Johnson, O. Digital Circles of Support: Meeting the Information Needs of Older People. Computers in Human Behavior. 2009; 25; 642-633. 4 Propsom, G. Elder Choice: How do Older People Make Long-term Care Choices? Bureau of Aging and Long Term Resources. Division of Disability and Elder Ser vices. Wisconsin Department of Health and Family Services. 2004 5 Jones, S. PEW Internet Project Data Memo. Pew Internet and American Life Project. 2009. 6 Hale T, et al. Rural-Urban Differences in General and Health-Related Internet Use. American Behavioral Scientist. 2010; 53(9): 1304-1325. 7 Redwood Coast Connect Executive Summary. Humboldt State University, 2009. Available at: HYPERLINK “http://www.humboldt.edu/rcc/?content=docs” http://www.humboldt.edu/rcc/?content=docs. Accessed February, 2011.

Older adults still get most of their information from traditional sources such as their personal support network, television and newspapers. However, use of the Internet as an information source is increasing, especially for the searches for health care information. ●

LITERATURE REVIEW

been attributed to factors such as education level, income, and limited home internet services available in many rural areas.6 In a survey of Humboldt, Del Norte, Trinity and Mendocino counties, the Redwood Coast Connect group found that those who did not have internet connection cite lack of availability and excessive cost as primary reasons for the lack of connectivity. The same survey showed that approximately 45.7% of respondents reported Broadband as their Internet mode.7

SENIOR AND CAREGIVER SURVEY RESULTS January 2009

Top 5 Needs

Health Care Accidents in the home Household Chores Health Care Money to live on Loneliness Energy/Utilities Getting Information about Benefits and Services Transportation Crime

SENIOR AND CAREGIVER SURVEY RESULTS

Demographically, the survey respondents mirror the senior population found in the bi-county area. The percentage of respondents in the following categories exceeds the percentage of these categories in the general age 60+ population: over the age of 75, over the age of 85, living alone, economically needy and older Native Americans. For purposes of this survey this over representation is desirable as it enables the views of persons A1AA most seeks to reach to be well represented.

Humboldt Humboldt County County Seniors & Caregivers Disabled 52% 63% 51% 58% 45% 61% 39% 51% 38% 50% -

Del Norte Del Norte County County Seniors & Caregivers Disabled 37% 49% 78% 53% 78% 41% 37% 44% -

56% 56%

of activities concerned food preparation [grocery shopping, preparing meals, standing to cook, cooking hot meals, and carrying hot meals from stove to table]. Over one-third of respondents (38.6%) have minor difficulty, serious difficulty, or are unable to do their own grocery shopping with 19.8% having serious difficulty or are unable to do it at all. One-third of respondents also are unable or have difficulty with preparing meals and standing to cook those meals. Just under one-third have difficulty with cooking hot meals and carrying hot meals from the stove to the table.

A1AA has released similar surveys at four-year intervals since 1989 allowing for comparison and the identification of trends. Five of the top ten needs identified in 2009 were also in the top need categories in 2005, 2001, 1997, 1993 and 1989. Several need areas (crime/feeling safe, energy/utilities, and having enough money to live on) have shown a drop in predominance from 1989 to 2009. Crime/feeling safe has decreased from the number one concern in 1993 to number twelve in 2009.

In an effort to understand local seniors’ experience and ease in participating in grassroots advocacy efforts, respondents were asked about their contact with elected officials. Forty-five percent of respondents had been in contact with an elected official while 40.7% had been in contact with elected officials’ staff. Over a third of the respondents had asked the elected official to do something on an issue they cared about and 20.7% of respondents felt their contact had made a difference, although only 19.3% had the results they hoped for. Nearly half of respondents are comfortable contacting an elected official or their staff. Nearly a quarter of respondents would feel more comfortable if they had more information about contacting elected officials. Thirtyeight percent indicated they would or might be interested in attending a workshop on contacting elected officials and 44.3% answered “yes” or “maybe” to their interest in attending a workshop on getting their concerns heard by elected officials.

Overall, the 2009 survey revealed a significant increase in concern regarding nutrition/food (affording or preparing). Concerns related to household chores, accidents in the home, health care, income, and loneliness continue to be high in both counties. As nutrition is a vital part of staying healthy, respondents were asked questions about their ability to afford nutritious food, frequency of eating hot meals, and their ability to prepare their meals. Over one-third of respondents indicated that there are times when they cannot afford to purchase fruit, vegetables and protein. Two-thirds of respondents prepare an average of less than one hot meal a day for themselves, 40.0% less than every other day and 17.3% do not prepare themselves a single hot meal each week. Many of these individuals have hot meals prepared by others, but 43.1% still average one hot meal per day per week or less, with 6.7% having a hot meal on average less than every other day to not at all.

Background The California Department of Aging (CDA) requires the Area Agencies on Aging to conduct ongoing needs assessment activities to gather pertinent information on areas of senior citizen needs. One method frequently used by Area Agencies to collect needs data is a senior needs assessment survey.

Respondents were requested to identify if they had problems with their own care or the care they give to someone else. Five of the list

Design The CDA developed a standardized senior citizen survey form to be used by California’s Area Agencies. Area 1 Agency on Aging used the CDA survey, amending it slightly after discussion with its Advisory Council and A1AA staff, to include questions pertaining to caregivers, food security, and contact with elected officials.

• Hispanic elders through members of El Heraldo (a local Hispanic newspaper) and Open Door Community Clinic in Arcata. All surveys were returned to the A1AA for computer data processing of the results. The process allowed for needs data to be processed and reported separately for each county.

Special Assistance Offered to Respondents

Intent The senior and caregiver survey is intended to provide first-hand information to the A1AA regarding senior and caregiver needs, concerns and issues. The information gathered was tallied and analyzed by the A1AA staff, Chris Martinek Consulting and Advisory Council. The information received was cross referenced with the results from other needs assessment activities conducted by the A1AA. The information received from the survey directs A1AA’s efforts for the Area Plan period of 2009-2013.

If requested, survey respondents were offered assistance with completing the form. Additionally, a unique feature of the survey was the opportunity for older adults to request information regarding senior services or financial assistance (SSI). I&A staff followed up with those requesting information. Twenty-seven respondents requested senior services information and nine requested financial assistance information. Respondents Approximately 3,000 senior surveys were distributed by A1AA. Four hundred seventeen surveys were returned; 415 were completed sufficiently to be considered valid. A response rate of 13.8% was achieved. Surveys were entered into a SPSS database and analyzed for this report. The A1AA Planner individually reviewed the few surveys that were received after the analysis was completed.

Distribution A1AA staff worked with the Advisory Council to develop a survey distribution plan. The goal was to distribute surveys, by census division, in proportion to the census division’s population to the total senior population. The distribution plan was developed to ensure complete geographic coverage. A complete list of the distribution sites is on file at the A1AA office. Surveys were distributed between December 2008 and April 2009.

Demographic Characteristics Survey respondents were primarily residents of Humboldt County. Since the percentage of residents in Humboldt County is four times that of Del Norte, this was expected. Table 1 demonstrates the percentage of the actual population of the two counties combined and the percentage of surveys received from each county.

Persons who were in strategic positions by virtue of their location or employment were asked to distribute and collect surveys within the designated time period. Contacts were established with senior housing units, senior centers, churches, in-home support programs, nutrition programs, public health clinics, social organizations, medical clinics, home health agencies and other social service agencies. The surveys were also distributed by A1AA staff (including staff from the VCOR/ RSVP and the I&A programs), senior service providers and Advisory Council members.

The demographic composition of the survey respondents is shown in Table 2. Of the 415 survey respondents, 389 were over the age of 60 or indicated they had a disability or chronic illness, and 122 were caregivers. Comparison of the characteristics of these respondents with those of the general age 60+ population, indicates the survey was successful in reaching more than a proportionate share of persons who are considered “target populations” under the Older Americans Act.

The A1AA identified four particular focus groups to target with the surveys: • Native Americans through the Title VI Nutrition programs including those operated by Blue Lake Rancheria and the Bear River Band of the Wiyot Tribe • Institutionalized elderly through Humboldt Senior Resource Center’s Ombudsman program and the local skilled nursing facilities • Older adults living in remote areas through identification of key community groups

Table 1. Respondents by County of Residence

The percent of survey respondents in the following categories exceed the percentage of these categories in the general age 60+ population: • Over the age of 75 • Over the age of 85 • Living alone

County of Residence

Percentage of Total Population

Number of Valid Surveys Received

Percentage of Valid Survey Received

Humboldt

82%

364

87.7%

Del Norte

18%

12.3%

SENIOR AND CAREGIVER SURVEY RESULTS

During the Fall of 2009 the Area 1 Agency on Aging (A1AA) released a Senior and Caregiver Needs Survey to gather first-hand information regarding senior and caregiver needs, concerns, issues, difficulty in performing daily activities and, if needed, who helps them with those activities. Using a standardized survey form developed by the California Department on Aging, the A1AA issued 3,000 surveys throughout Del Norte and Humboldt Counties via 30 distribution sites. Four hundred fifteen of the returned surveys were valid and completed in a manner to allow for data entry. The analysis and summary report were completed in February 2010.

% All 415 Survey Respondents

% of 389 Senior Respondents

% of 122 Caregiver Respondents

Female

68.9%

69.2%

71.3%

Male

29.2%

30.6%

27.9%

No Response

Demographic Category Gender:

1.9%

0.3%

0.8%

Age:

Average 75.4

Average 76.3

Average 71.7

Range of Ages

30 to 98

45 to 98

30 to 97

30-59

7.2%

4.1%

17.2%

60-69

20.2%

21.6%

22.1%

70-79

32.3%

34.4%

27.9%

80-89

28.2%

30.1%

21.3%

90+

8.0%

8.5%

4.9%

No Response

4.1%

1.3%

6.6%

White

82.4%

84.3%

78.7%

Native American

10.6%

11.1%

14.8%

Hispanic

1.7%

1.8%

0.0%

African American

0.5%

0.3%

0.8%

Asian

0.2%

0.0%

0.8%

Other

1.7%

1.3%

3.3%

No Response

2.9%

1.3%

1.6%

Yes

49.6%

51.2%

29.5%

45.3%

46.0%

65.6%

No Response

5.1%

2.8%

4.9%

Yes

34.7%

36.5%

33.6%

54.0%

58.2%

No Response

11.3%

9.5%

8.2%

Yes

26.0%

27.0%

26.2%

58.3%

59.1%

60.7%

No Response

15.7%

13.9%

13.1%

To Senior

21.9%

20.1%

74.6%

To Disabled Adult

14.9%

14.7%

50.8%

To Minor/child

4.8%

3.6%

16.4%

Not a Caregiver

63.9%

72.5%

0.0%

No Response

11.1%

10.5%

0.0%

Yes

49.6%

53.0%

52.5%

43.6%

42.2%

45.1%

No response

6.7%

4.9%

2.5%

Ethnicity:

Table 3a. Combined Totals for Del Norte and Humboldt Counties “Minor and Serious” Problem/Concern Ranking Problem/Concern

Ranking

Number of Respondents

% of Total Respondents

Household Chores Accidents in the home Health Care Money to live on Loneliness Nutrition/Food (affording or preparing) Energy/Utilities Transportation Isolation Obtaining information about services/benefits

1 2 3 4 5 6

199 194 180 152 143 138

7 8 9* 10

135 126 123 123

SENIOR AND CAREGIVER SURVEY RESULTS

Receiving Medi-Cal:

Caregiver

Disabled or Chronic Illness

Prior Ranking 1997 1 -4 2 5 --

Prior Ranking 1993 2 -4 -3 --

34.7% 32.4% 31.6% 31.6%

7 6 9* 8

6 7 -9

6 10 -9

5 --7

Table 3b. Combined Totals for Del Norte and Humboldt Counties: “Serious” Problem/Concern Ranking Problem/Concern

Ranking

Number of Respondents

% of Total Respondents

Prior Ranking 2005

Prior Ranking 2001

Health Care Accidents in the home Household Chores Money to live on Transportation

1 2 3 3 5

68 58 51 51 50

17.5% 14.9% 13.1% 13.1% 12.9%

1 2 4 2 5

1 5 2 3 --

Prior Ranking 1997 3 -1 2 5

Prior Ranking 1993 2 -1 5 --

For the purpose of this report, this over-representation is desirable as it enables the views of persons A1AA most seeks to reach to be well represented.

be the largest. The top 10 problems are listed. The ranking reflects bicounty combined totals for “minor problem” and “serious problem”. Table 3b identifies what the respondents considered to be their most serious problem. The top 5 problems are listed. The ranking reflects bi-county totals for “serious problem”. Additionally, prior survey rankings are shown to indicate how these priorities have changed since 1989.

Senior and Disabled Adults The following is a summary of the 389 responses from survey respondents over the age of 60 or who indicated they had a disability or chronic illness.

Problem/Concern Areas: Humboldt County Table 4a identifies what Humboldt County respondents considered to be their largest problem areas. Table 4b shows what Humboldt County respondents considered to be their most serious problem.

Problem/Concern Areas: Del Norte and Humboldt Counties Combined The survey contained a list of problems or concerns that could affect one’s quality of life. Respondents were asked to indicate which items were a problem to them personally and to what degree they were a problem. Respondents selected from three categories: no problem, minor problem, or serious problem.

Problem/Concern Areas: Del Norte County Table 5a shows what the Del Norte County respondents considered to be their largest problem areas. Table 5b identifies what Del Norte County respondents considered to be their most serious problem.

• Economically needy • Older Native Americans

Daily Activity Levels: Del Norte and Humboldt Counties Combined Respondents were requested to indicate if they had any difficulty with daily activities. Table 6 demonstrates the level of difficulty respondents have with varying activities. The daily activities are ranked by the

Table 3a shows which problems respondents considered to

Prior Ranking 2001 1 2 3 4 5 --

*received a larger number of “Serious” Problem/Concern respondents

Lives Alone:

Receiving SSI:

51.1% 49.9% 46.3% 39.1% 36.7% 35.5%

Prior Ranking 2005 2 1* 3 4 5 --

SENIOR AND CAREGIVER SURVEY RESULTS

Table 2. Demographic Composition of Survey Respondents

Table 4a. Humboldt County: “Minor and Serious” Problem/Concern Ranking Ranking

Number of Respondents

% of Total Respondents

Prior Ranking

2005

2001

1997

Accidents in the home

176

51.8%

Household Chores

175

51.4%

Health Care

154

45.3%

Money to live on

132

38.8%

Loneliness

130

38.2%

Energy/Utilities

121

35.6%

Nutrition/Food (affording/preparing)

121

35.6%

Isolation

111

32.6%

Transportation

109

32.1%

Obtaining information about services/ benefits

105

30.9%

*received a larger number of “Serious” Problem/Concern respondents Table 4b: Humboldt County. “Serious” Problem/Concern Ranking

SENIOR AND CAREGIVER SURVEY RESULTS

Problem/Concern

Ranking

Number of Respondents

% of Total Respondents

Prior Ranking

2005

2001

1997

Health Care

16.2%

Accidents in the home

15.6%

Household Chores

13.5%

Money to live on

12.6%

Transportation

12.4%

Table 5a. Del Norte County: “Minor and Serious” Problem/Concern Ranking Problem/Concern

Ranking

Number of Respondents

% of Total Respondents

Problem/Concern

Ranking

Number of Respondents

2001

1997

Health Care

53.0%

Household Chores

49.0%

Money to live on

40.8%

Accidents in the home

36.7%

Obtaining information about services/ benefits

36.7%

Transportation

34.7%

Nutrition/Food (affording/preparing)

34.7%

Receiving services/benefits

32.6%

Crime

32.6%

Energy/Utilities

28.6%

2005

2001

1997

26.5%

Money to live on

16.3%

Transportation

16.3%

Nutrition/Food (affording/preparing)

14.3%

Accidents in the home

10.2%

Household Chores

10.2%

Receiving services/benefits

10.2%

Table 6. Del Norte and Humboldt County Combined Totals Respondent’s Level of Difficulty to Perform Daily Activities Daily Activity

No Difficulty

Minor Difficulty

Serious Difficulty

Unable to Do

%**

Doing heavy housework

109

28%

24.9%

21.3%

18.3%

Walking

166

42.7%

127

32.6%

11.1%

4.9%

Grocery Shopping

209

53.7%

19.3%

9.3%

10.8%

Standing to cook

212

54.5%

19.3%

10%

Preparing meals

215

55.3%

20.6%

7.7%

8.7%

Doing light housework

221

56.8%

19%

8.2%

Ability to drive or arrange a ride

227

58.4%

17.5%

6.9%

10.3%

Cooking hot meals

235

60.4%

15.9%

6.7%

7.7%

Shopping for personal items

241

62%

15.7%

6.7%

9.8%

Bathing

249

64%

17.5%

6.9%

3.3%

Carrying hot meals from stove to table

258

66.3%

13.9%

5.7%

* Number of Respondents ** Percent of Total Respondents (389)

combined totals of three categories: minor difficulty, serious difficulty and unable to do. This ranking represents bi-county totals.

* Note: Respondents were asked to check all those that apply. Many respondents had more than one person helping them with daily activities.

Respondents were asked who helped them with the activities they had difficulty in performing. The bi-county totals are:

Daily Activity Levels: Humboldt County Table 7 identifies the level of difficulty Humboldt County respondents have with varying daily activities. The daily activities are ranked by the combined totals of three categories: minor difficulty, serious difficulty and unable to do.

• Other relative (114 respondents) • Paid worker/caregiver (111 respondents) • Friends (69 respondents) • Spouse (62 respondents) • No one (53 respondents) • Agency volunteer (7 respondents)

Table 8 identifies the level of difficulty Del Norte County respondents have with varying daily activities. The daily activities are ranked by the combined totals of three categories: minor difficulty, serious difficulty and unable to do.

*received a larger number of “Serious” Problem/Concern respondents 20

Prior Rank- Prior Rank- Prior Ranking ing ing

Health Care

Prior Rank- Prior Rank- Prior Ranking ing ing 2005

% of Total Respondents

SENIOR AND CAREGIVER SURVEY RESULTS

Problem/Concern

Table 5b. Del Norte County: “Serious” Problem/Concern Ranking

Table 7. Humboldt County Respondent’s Level of Difficulty to Perform Daily Activities Daily Activity

No Difficulty

Minor

Serious Difficulty

Unable to Do

Difficulty #*

%**

Doing heavy housework

26.5%

24.4%

22.4%

19.1%

Walking

141

41.5%

111

32.6%

12.1%

5.3%

Grocery Shopping

177

52.1%

20.0%

9.7%

10.9%

Standing to cook

179

52.6%

19.4%

8.2%

10.9%

Preparing meals

181

53.2%

20.9%

8.2%

Table 9. Del Norte and Humboldt County Combined Totals Respondent’s Issues of Care Ranking Issue

No Problem

Minor Problem

Major Problem

%**

Coordinating help from several agencies

117

30.1%

14.1%

8.5%

9.4%

Finding provider for meal preparation/house cleaning

137

35.2%

10.3%

128

32.9%

11.3%

5.9%

Doing light housework

189

55.6%

19.4%

8.2%

9.1%

Dealing with a break down in care arrangements

Ability to drive or arrange a ride

199

58.5%

16.5%

7.6%

10.0%

Finding provider for personal care/bathing assistance

149

38.3%

8.5%

5.7%

Shopping for personal items

206

60.6%

16.2%

6.8%

10.3%

Finding provider for respite care

135

34.7%

5.9%

7.2%

Cooking hot meals

200

58.8%

15.6%

7.1%

8.5%

Finding provider for nursing care

145

37.3%

4.4%

6.7%

143

36.8%

6.7%

3.6%

140

36%

4.9%

5.1%

Bathing

212

62.4%

17.9%

7.4%

3.8%

End of life issues

Carrying hot meals from stove to table

220

64.7%

13.8%

5.9%

6.5%

Caregiver counseling & support groups

* Number of Respondents ** Percent of Total Respondents (389)

Daily Activity

Issue

No Difficulty

Minor

Serious Difficulty

Unable to Do

SENIOR AND CAREGIVER SURVEY RESULTS

Difficulty #*

%**

Doing heavy housework

38.8%

28.6%

14.3%

12.2%

Walking

51.0%

32.7%

4.1%

2.0%

Ability to drive or arrange a ride

57.1%

24.5%

12.2%

Grocery Shopping

65.3%

14.3%

6.1%

10.2%

Doing light housework

65.3%

16.3%

8.2%

2.0%

Standing to cook

67.3%

18.4%

6.1%

4.1%

Preparing meals

69.4%

18.4%

4.1%

Shopping for personal items

71.4%

12.2%

6.1%

Cooking hot meals

71.4%

18.4%

4.1%

2.0%

Bathing

75.5%

14.3%

4.1%

Carrying hot meals from stove to table

77.6%

14.3%

4.1%

SUMMARY OF NARRATIVE RESPONSES

Issues About One’s Care or Care for Someone Else Respondents were asked to identify if they had problems with their own care or the care they give to someone else. Table 9 demonstrates the level of a problem they have with various issues. The issues are ranked by the combined totals of two categories: minor problem and major problem. This ranking represents the bi-county totals. Tables 9a and 9b show the level of a problem respondents have with various issues by county.

Survey respondents were given the opportunity to write a description of the problem(s) that affected them the most and statements about why it was a problem for them. Two hundred seventy-seven respondents completed a written description of the problem that most affected them (229 described a second problem). The A1AA Planner read all surveys. The responses are summarized by the most frequently listed item. See page 24.

No Problem

Minor Problem

Major Problem

%**

Coordinating help from several agencies

100

29.4%

14.1%

8.8%

Finding provider for meal preparation/house cleaning

118

34.7%

10.6%

11.2%

Dealing with a break down in care arrangements

109

32.1%

11.5%

6.8%

Finding provider for personal care/bathing assistance

128

37.6%

9.1%

6.2%

Finding provider for respite care

114

33.5%

5.9%

8.2%

End of life issues

124

36.5%

6.8%

3.5%

Finding provider for nursing care

124

36.5%

4.7%

7.4%

Caregiver counseling & support groups

119 35% 18 5.3% 19 5.6% * Number of Respondents ** Percent of Total Respondents (340)

Table 9b. Del Norte County Respondent’s Issues of Care Ranking Issue

No Problem

Minor Problem

Major Problem

%**

Coordinating help from several agencies

34.7%

14.3%

6.1%

Finding provider for meal preparation/house cleaning

38.8%

8.2%

4.1%

Dealing with a break down in care arrangements

38.8%

10.2%

End of life issues

38.8%

6.1%

4.1%

Finding provider for personal care/bathing assistance

42.9%

4.1%

Finding provider for respite care

42.9%

6.1%

Finding provider for nursing care

42.9%

* Number of Respondents ** Percent of Total Respondents (49)

SENIOR AND CAREGIVER SURVEY RESULTS

Table 9a. Humboldt County Respondent’s Issues of Care Ranking

Table 8. Del Norte County Respondent’s Level of Difficulty to Perform Daily Activities

• Seven respondents wrote that they do not have enough money to hire someone to help them. • Five respondents have trouble doing chores. • Three respondents indicated that IHSS cut hours for help with chores. • Three respondents expressed frustration with spouses that will not help with chores. • Three respondents have trouble with chopping firewood or brining it into the house. • Two respondents have spouses who are no longer able to help with chores. • Two respondents cannot wash windows. • Two respondents wonder how long it will be before they can no longer do chores and how to pay for help. • Two respondents need help with trash removal or vehicle to take trash to dump. • Two respondents expressed frustration that they can no longer do what they used to do. • Additional comments included: hate to bother people, bathing, and taking care of spouse. Health Care: 75 responses • Nineteen respondents stated that health care is a problem due to their medical conditions (arthritis, balance, weakness, feet problems, joint pain, dementia and Alzheimer’s, breast cancer, COPD, hearing, depression, blindness, diabetes, seizures, stroke, and high or low blood pressure). • Fourteen respondents indicated that medical and prescription expenses are too high (many stated they do not get care unless an emergency). • Nine respondents indicated that insurance costs were too high, including private insurance, Medicare supplemental or part D insurance. • Eight respondents stated they are having trouble finding primary care doctors or specialists. • Seven respondents did not have health insurance (some disqualfied for coverage due to preexisting conditions). • Seven respondents need transportation to doctor appointments, including outlying areas. • Five respondents stated that health care was a concern because they are getting old and/or frail. • Five respondents need help with medication management. • Five respondents wrote about not knowing how to plan for future care for aging. • Five respondents noted that doctors are not accepting new Medi Cal or Medicare patients. • Four respondents indicated that insurance co-pay is higher or more expensive than they can afford. • Four respondents live in outlying areas and find it hard to get to doctors. • Three respondents wrote about needing help paying for Adult Day Health Care. • Three respondents stated that they couldn’t afford dental care or care is not covered. • Three respondents found Medicare or MediCal insurance confusing.

Household Chores: 76 responses • Fifty-one respondents indicated that health problems, mobiity issues, lack of balance, low vision/blindness, or physical pain prevented them from doing household chores. • Twenty-one respondents wrote that they were no longer able to do household chores or heavy chores. • Fifteen respondents indicated having trouble finding good, trust worthy or affordable help. • Fifteen respondents have help with chores. • Fourteen respondents said that they lacked the energy or strength required to do chores. • Fourteen respondents need help with chores. • Twelve respondents need help with house maintenance and repairs. • Nine respondents wrote that they needed help with yard work, gardening, or maintaining acreage. • Seven respondents are concerned about use of ladder and falling (to change a light bulb, reach a top shelf, etc.).

• Three respondents commented on government cuts to health care. • Three respondents noted they have trouble accessing health care. • Two respondents wrote that they are not yet 65 so do not qualify for Medicare. • Two respondents indicated they are having trouble finding care givers. • Two respondents noted that there are no doctors overseeing all medications prescribed for patients with multiple doctors, which leads to negative side effects or overdoses. • Two respondents are worried they may not be able to be indepen dent and take care of themselves for much longer. • Two respondents need health condition or disease specific educa tion/information. • Two respondents indicated that there are very few gerontologists MDs in area. • Two respondents find medical services confusing. • Two respondents did not like having to depend upon others for care. • Two respondents’ insurance did not cover needed medical treat ments. • Two respondents stated their insurance is not paying for prescriptions. • Two respondents must travel over 45 miles to see a doctor. • Additional comments included: many of their prescriptions are not covered by MediCal; their doctor had moved out of the area; they must travel out of the area for medical care and/or local medical options are too limited; prescription side effects are a problem; need end of life services; difficult communicating with doctor; get ting forgetful, don’t want to continue to live if pain level can not be helped; need doctor’s prescription for electric chair; no relatives in area; and doctor not providing follow through.

• Six respondents were concerned about how much longer they would be able to drive. • Six respondents indicated that they no longer drive a vehicle and they do not have anyone to drive them. • Five respondents do not like to bother others to take them on errands. • Five respondents have vision deterioration problems, or are blind. • Four respondents indicated that they do not drive after dark. • Four respondents live in remote areas and have a hard time getting to town. • Three respondents stated getting to doctor visits out of town is difficult. • Three respondents commented that they do not socialize or atend activities much since they gave up driving. • Three respondents commented that it is hard to get errands done since they stopped driving. • Two respondents worry about spouse or family members’ driving ability. • Two respondents stated that not driving limits their independence. • Additional comments included: outlying areas need van funding to get seniors to town; insensitivity of public transit employees; need transportation to get to work; Dial-A-Ride is too expensive; need information on public transportation; recommendation for taxiscript for grocery shopping, doctor appointments, etc; and Del Norte’s taxi service is great. Money to Live on: 49 responses • Twenty-nine respondents stated they did not have enough money to cover monthly expenses (most stated fixed or low income). • Fifteen respondents wrote that increases in cost of living or infla= tion were a problem. • Twelve respondents worry about running out of money/retirement funds. • Eleven respondents have difficulty having money for food. • Eleven respondents worry about paying bills. • Eight respondents wrote about increasing and high rent costs. • Seven respondents stated they were having trouble managing money. • Six respondents stated paying for heating oil or gas was difficult. • Five respondents indicated that money was a problem due to medical and prescription expenses. • Five respondents do not have money for home repairs. • Two respondents noted that transportation is expensive. • Two respondents stated they are unemployed/laid off or their spouse was. • Additional comments included: going back to work to get by after retirement; have to pay for house and yard work we used to do ourselves; no money to take classes, seminars, or going out; and medical expenses ate away retirement savings.

Transportation: 62 responses • Twenty-three respondents wrote that public transportation was not suitable or was unavailable (especially in rural areas). Specific comments included the following: walkers not allowed on bus; unavailable on weekends or nights; only two wheelchair spots per bus; not enough busses; affordability of service; waiting times; and distance from home to bus stop. • Thirteen respondents do not have transportation to go grocery shopping, get to doctor appointments, pick up prescriptions, pick up commodities, or run errands. • Twelve respondents do not have a car or had to give up their car. • Eleven respondents said they no longer drive a vehicle and rely on friends, family, or public transportation. • Eleven respondents do not drive or cannot drive anymore. • Nine respondents indicated that transportation was a problem due to mobility issues, difficulty walking, wheelchair use, walking to parked car, getting in and out of a vehicle, or client’s disability requires two people to help them in and out of vehicle. • Seven respondents find it hard or frustrating to wait for others or buses for transportation. • Six respondents stated that transportation was a problem due to the cost of driving a car (including gas, insurance, repairs and maintenance).

Nutrition/Food: 39 responses • Twelve respondents wrote they cannot cook due to medical condition, blindness/low vision, lack of strength, or inability to stand. • Eleven respondents indicated they couldn’t afford groceries (specifically for balanced diet or fresh food: meat and vegetables). • Ten respondents stated they have difficulty going or need help

SENIOR AND CAREGIVER SURVEY RESULTS

Accidents in the Home (i.e. Falling): 78 responses • Thirty-one respondents indicated that falling was a problem due to health conditions (osteoporosis, arthritis, diabetes, neuropathy, bad back/hips/knees or replaced joint, cerebral palsy, COPD, strokes, and uses wheelchair, walker, or cane). • Twenty-nine respondents stated falling was a problem due to balance, trouble walking, weak legs and/or unsteady on feet. • Twenty-five respondents wrote that they had fallen recently and many had broken bones. • Fifteen respondents expressed a fear of falling (some will not leave house). • Six respondents worry about falling because they live alone and worry they may not be found for days. • Six respondents have trouble getting back up from falling. • Five respondents can’t help spouse or care recipient get up from a fall. • Four respondents stated they are afraid to leave spouse or care recipient alone because they might fall. • Four respondents cannot afford grab bars in the bathroom or minor home repairs to help prevent themselves from falling. • Four respondents have difficulty with stairs. • Four respondents indicated that if they fall they will no longer be able to live alone. • Three respondents are afraid to be left alone as they may fall when no one is home. • Two respondents stated they are afraid to go out in yard due to falling and no one finding them. • Two respondents indicated that poor vision or blindness was the cause of their concern with falling. • Two respondents have home safety issues that contributed to their falls. • Two respondents indicated having a spouse or care recipient who is unwilling to get medical care after a fall. • Additional comments included: sometimes forget to be careful, have no one to call for help but 911, having to climb to get things out of cupboard, forget to take medications, and now have Life Alert for when they fall.

Isolation: 18 responses • Four respondents wrote lack of transportation keeps them isolated. • Four respondents’ medical condition makes visiting hard or confines them to home. • Four respondents find it hard to find or make friends. • Three respondents stated they live alone. • Three respondents lack the energy to go out. • Three respondents stated that no one comes to visit them. • Three respondents live in rural or remote areas. • Two respondents have no friends or relatives here. • Two respondents’ only contact is with care provider. • Two respondents indicated that there are only minimal activities avaiLable. Obtaining Information about Services/Benefits: 17 responses • Six respondents find service information confusing or do not under stand services. • Five respondents commented that it is hard to find help for grocery shopping, caregiving, or handyman repairs. • Four respondents indicated that they have trouble finding out what services are available or know what questions to ask. • Three respondents are unaware of services or benefits. • Additional comments included: need information services representative at senior center, few local services available, and need factual and kind people to provide information on services and aging.

SENIOR AND CAREGIVER SURVEY RESULTS

Energy/Utilities: 32 responses • Twenty-eight respondents indicated that utilities are too expensive or utility bills are ever increasing (many mentioned fixed or low income, not turning on heat due to cost or going without heat and one is bathing in cold water to save money). • Five respondents are having trouble getting/chopping wood (eleCtric heat is too expensive). • Three respondents wrote about water and sewer rates being expensive. • Additional comments included: they have grandchildren who use a lot of electricity and cannot afford to fix leaking propane gauge.

Taking care of an adult person: 15 responses • Five respondents are caring for an adult child with physical or mental health disabilities. • Four respondents stated that they are overwhelmed with the stress of caregiving. • Three respondents indicated fatigue from caring for ill spouse or relative. • Three respondents are concerned for their aging parents. • Three respondents wrote that they are providing long distance caregiving. • Two respondents are taking care of spouse and adult child with dis abilities. • Additional comments included: sadness at watching spouse deteriorate day by day; they needed respite care; they are caring for parent with dementia; and their own illness makes it difficult to care for another.

Crime: 29 responses • Fourteen respondents were concerned about increased incidents of drugs or gangs in their neighborhood. • Thirteen respondents stated they were fearful of criminal activity or personal harm, especially at night. • Six respondents had been victims of crime. • Five respondents indicated concern due to a lack of police or sheriff patrols, especially in the rural areas. • Three respondents stated they are too old to protect themselves. Loneliness: 21 responses • Six respondents wrote that they wished they had more family, friends, and/or visitors, don’t know many people in the area, or do not have enough to do. • Four respondents stated they are alone most of the time. • Four respondents wrote that they haven’t many or any friends. • Three respondents have difficulty getting places due to mobility issues. • Three respondents live remotely or are far from neighbors. • Three respondents indicated that they live alone. • Three respondents wish there were more activities for seniors. • Two respondents do not have family living in the area. • Two respondents stated that the death of spouse or friends has left them lonely. • Two respondents wrote that they are homebound. • Additional comments included: do not drive at night and cannot get out of their house due to spouse’s medical condition.

Housing: 14 responses • Six respondents indicated it is difficult to find affordable housing and rent is much too high, specifically one has rent at 75% of income and lack of section 8 housing. • Four respondents wrote about their home needing minor to major home repair or maintenance. • Two respondents can no longer afford their assisted living facility’s rent but cannot live alone. • Two respondents need ADA accessible housing. • Additional comments included: housing is cold due to lack of insulation; too many people living in house; can no longer afford mortgage payments; homeless or staying with friends or living in car; uncomfortable at senior living apartments; mother needs 24 hour care soon (not sure

how to plan for the event); lived 12 years with daughter and son-in-law, she died and he is moving/selling house and does not know where to live now.

• Decrease in IHSS hours due to budget cuts (1 respondent) • Keeping healthy (1 respondent) • Marital problems (1 respondent) • Concern if disabled programs will continue to exist (1 respondent) • Finding quality care providers (1 respondent) • Need help repairing appliances (1 respondent) • Wildlife (1 respondent) • Computer repair (1 respondent) • Communicating with others (1 respondent) • Forced retirement to care for family (1 respondent) • Need book mobile for seniors including individual homes (1 respondent) • Pet care (1 respondent) • Reliable caregivers (1 respondent) • Trouble sleeping (1 respondent) • Need Medic Alert (1 respondent) • Rat infestation (1 respondent)

Receiving services/benefits: 10 responses • Four respondents are living in rural area with no services available. • Four respondents indicated trouble finding care provider. • Two respondents wrote they make just over the income for qualifying for services. • Additional comments included: need more assistance/help at home than what is available, unavailable or unaffordable services in Southern Humboldt, service takes too long to access, caregivers not available in Rio Dell, lack of home health in Willow Creek, needs help with house work due to illness, and transportation for caregiver to get to them. The following categories received less than 10 responses each: Legal (8 responses), Employment (8 responses), and Taking Care of Child-Minor (2 responses). Additional Concerns The following are additional concerns that seniors and disabled adults had that did not fit into the categories listed above.

Additional Comments from Seniors and Disabled Adults: At the end of the questionnaire, space was provided for “Additional Comments”. These are included for the “flavor” they add to the survey results.

• Yard work or gardening (11 respondents) • Getting things down from tall cupboards and changing light bulbs (7 respondents) • Home repairs or maintenance and plumbing (7 respondents) • Vision problems and blindness (6 respondents) • Want to remain independent (6 respondent) • Social and recreation activities (5 respondent) • Fear of no longer being able to take care of self (4 respondents) • Hearing problems or hearing problems inhibit social life (4 respondents) • Managing money (4 respondents) • Dental care (3 respondents) • Trash removal or dump runs (3 respondents) • Lack of parking at Silvercrest (3 respondents) • Medication management (3 respondents) • Fear of outliving savings or retirement (3 respondents) • Memory problems and forgetfulness (3 respondents) • Paperwork (2 respondents) • Exercise classes (2 respondents) • Caregiver training needed, specifically on sanitation and food handling (2 respondents) • Translation services needed (2 respondent) • Staying mentally active (2 respondents) • Staying in touch with family (2 respondents) • Getting rid of things and reducing clutter (2 respondents) • Walkable communities: safe crosswalks and areas to walk (2 respondents) • Lack of energy (2 respondents) • Need ramp for house (2 respondents) • Phone and computer scams for their money (2 respondents) • Ombudsman funding cuts (2 respondents) • Fear of not being able to continue working part-time (1 respondent) • Water quality (1 respondent)

• At the present time I’m able to get my groceries, go to the medical facilities locally & cook my meals. I am a little concerned about remembering. When should I reorder my medications, where I left my cane/ etc. I haven’t made any serious errors yet. • Have you had need of a plumber or electrician lately? The older we get the older our homes are and the more urgent the repairs. We get sad looking at our drab walls and peeling paint or what used to be pristine homes and yards. • I don’t want to live until my last breath and heart beat. I want to be able to have dignity during my dying period. I want California to adopt a policy like Oregon and Washington. • Because I live in an isolated rural part of the county, I am most coccerned about the availability of emergency and sheriff services. This past year, I had to test both. Mad River Ambulance was very quick to respond. The sheriff’s response was slower but satisfactory. • I am weak and tired. • For my age, I am blessed with health, employment, and friends, organizational activities and volunteerism. Not everyone in my age group has that and I am thankful and grateful for my “status.” Consequently, I try & help others. • I am grateful for the bus service we have. It would be nice if it ran later - the senior bus and meals are great • Government and sponsored senior lunch sites should be compelled to furnish information regarding ingredients used in preparing all food served. Should use corn starch instead of wheat flour or identify when gluten from wheat, barley, rye or oats are an added ingredient used in food preparation. Digestive disorders aggravated by gluten is a major malady in all seniors • Having a hot meal that I didn’t have to stand to make is great. Some times I hurt too much to eat! • I do have Dial-a-Ride and senior bus available but shopping, going to town to get my mail every day and going out of town for walking exercise is very difficult with these facilities.

SENIOR AND CAREGIVER SURVEY RESULTS

with grocery shopping. • Nine respondents cannot prepare a meal. • Four respondents have no store nearby to purchase fresh food. • Four respondents stated that it is hard to bother to cook for just one. • Three respondents wrote they pay bills first then purchase food. • Two respondents indicated that memory affects their ability to cook: one cannot remember how to cook and the other cannot remember their recipes. • Two respondents have a caregiver to help them with purchasing and preparing food. • Two respondents stated they did not like the meals offered at lunch sites (not diabetic or special diet meals). • Additional comments included: they like the Fortuna lunch site; have a hard time cooking while in a wheelchair; and living alone – no incentive to cook for self.

Table 10a. Combined Totals for Del Norte and Humboldt Counties Caregivers: “Minor and Serious” Problem/Concern Ranking Ranking

Number of Respondents

% of Total Respondents

Prior Ranking 2005

Health care

62.3%

Accidents in the home (e.g., falling)

61.5%

Household chores

59%

Problem/Concern

Ranking

Number of Respondents

% of Total Respondents

Prior Ranking 2005

Money to live on

50%

Accidents in the home (e.g., falling)

62.8%

Energy/utilities

49.2%

Health care

61.1%

Nutrition/food (affording/preparing)

45%

Household chores

57.6%

Obtaining information on services/benefits

42.6%

Money to live on

50.5%

Transportation

41.8%

Energy/utilities

49.6%

Crime

40.1%

Nutrition/food (affording/preparing)

45.2%

Loneliness

10*

39.4%

Obtaining information on services/benefits

42.4%

Taking care of another person: Adult

10*

39.4%

Transportation

40.7%

39.4%

Loneliness

39.8%

Taking care of another person: Adult

39.8%

Legal affairs

*received a larger number of “Serious” Problem/Concern respondents

Table 10b. Combined Totals for Del Norte and Humboldt Counties Caregivers: “Serious” Problem/Concern Ranking Problem/Concern

SENIOR AND CAREGIVER SURVEY RESULTS

Table 11a. Humboldt County Caregivers: “Minor and Serious” Problem/Concern Ranking

Ranking

Number of Respondents

% of Total Respondents

Prior Ranking 2005

Table 11b. Humboldt County Caregivers: “Serious” Problem/Concern Ranking Problem/Concern

Ranking

Number of Respondents

% of Total Respondents

Prior Ranking 2005

Health care

27.9%

Health care

25.7%

Money to live on

23.8%

Money to live on

24.8%

Accidents in the home (e.g., falling)

23%

Accidents in the home (e.g., falling)

23.9%

Energy/utilities

19.7%

Energy/utilities

20.4%

Transportation

18%

Transportation

17.7%

• I don’t believe in bypass surgery after 80 years of age or organ trans plants. Life comes to an end! • I feel getting information about senior concerns and problems is a very important issue. There are so many agencies who offer help, but it takes persistence and effort to find the proper help. Something many seniors do not have. • In this rural area, we don’t have many specialists in the medical field. Some don’t accept MediCal/Medicare. • Keep the Quail please! • More curb cuts-back are need, some sidewalks force wheelchairs into the streets. I have been hit by a car in a crosswalk. • We need a fresh food store near here that seniors can go to close to get meat and vegetables that are not in a can or dried without going across town. I have to get a bus or ride and it takes three hours just to get vegetables and meat once a month. There are over 160 people in this apartment building to buy there. • My concern is my money running out before I die, as rent in this assisted living facility is expensive ($3060.00 a month) and goes up every year. I need some help but not 24 hours a day. I am legally blind but still mentally alert but need things like grab bars and walk-in-showers which are not available in most rentals.

• Thank you for taking the time to care about our needs. • There are very few alternatives for senior care. Either stay home and receive no care or move to a facility and receive inadequate or mediocre care. Care facilities need regulatory upgrade and adequate staff. Staff is horrible in many ways. Language skills and professional training. • Transportation on highway 36 is almost non-existent. Caltrans needs to fund community transportation vans to the highway 101 corridor. Please coordinate transportation so all seniors have safe, reliable transportation to get to doctor appointments, shopping, and other necessary services. Thank you for doing this survey • We have had no reason to contact elected officials but would not hesitate to do so if necessary. We have contacted the Senior Resource Center - they were most helpful for suggestions. • While it is true that processes like this survey are necessary to evalu ate and plan future directions, it seems clear that it will be a while before change will occur. There is no money in a shrinking economy, and the worst is still ahead • Without a caregiver and social worker through Adult Services I couldn’t survive on my own.

Caregivers The following is a summary of the 122 survey respondents who indicated they provided care to a senior, disabled adult, or minor (child under the age of 18). Demographics on the caregivers are located on page 18.

be their largest problem areas. Table 11b shows what Humboldt County respondents considered to be their most serious problem. Problem/Concern Areas: Del Norte County Caregivers Table 12a shows what the Del Norte County respondents considered to be their largest problem areas. Table 12b identifies what Del Norte County respondents considered to be their most serious problem.

Problem/Concern Areas: Del Norte and Humboldt Counties Caregivers Combined The survey contained a list of problems or concerns that could affect one’s quality of life. Respondents were asked to indicate which items were a problem to them personally and to what degree they were a problem. Respondents selected from three categories: no problem, minor problem, or serious problem.

Respondents were requested to indicate if they had any difficulty with daily activities. Table 13 demonstrates the level of difficulty respondents have with varying activities. The daily activities are ranked by the combined totals of three categories: minor difficulty, serious difficulty and unable to do. This ranking represents bi-county totals.

Table 10a shows which problems respondents considered to be the largest. The top 10 problems are listed. The ranking reflects bi-county combined totals for “minor problem” and “serious problem”. Table 10b identifies what the respondents considered to be their most serious problem. The top 5 problems are listed.

Respondents were asked who helped them with the activities with which they have difficulty. The bi-county totals are: • Other relative (37 respondents) • Paid worker/caregiver (36 respondents) • Spouse (34 respondents) • Friends (26 respondents)

Problem/Concern Areas: Humboldt County Caregivers Table 11a identifies what Humboldt County respondents considered to

SENIOR AND CAREGIVER SURVEY RESULTS

Problem/Concern

Table 12a. Del Norte County Caregivers: “Minor and Serious” Problem/Concern Ranking Problem/Concern

Ranking

Number of Respondents

% of Total Respondents

Prior Ranking 2005

Health care

77.8%

Household chores

77.8%

Transportation

55.6%

Crime

55.6%

Receiving services/benefits

44.4%

Obtaining information about services/benefits

44.4%

Legal affairs

44.4%

Money to live on

44.4%

Accidents in the home (e.g., falling)

44.4%

Energy/utilities

44.4%

Nutrition/food (affording/preparing)

Table 14. Humboldt County Caregivers Respondent’s Level of Difficulty to Perform Daily Activities Daily Activity

No Difficulty

Minor

Serious Difficulty

Unable to Do

Difficulty

4 44.4% 10 *received a larger number of “Serious” Problem/Concern respondents

Table 12b. Del Norte County Caregivers: “Serious” Problem/Concern Ranking Problem/Concern

Ranking

Number of Respondents

% of Total Respondents

Prior Ranking 2005

Health care

55.6%

Household chores

33.3%

Receiving services/benefits

33.3%

Legal affairs

22.2%

Loneliness

22.2%

Obtaining information on services/benefits

22.2%

Transportation

22.2%

%**

Doing heavy housework

29.2%

28.3%

18.6%

19.5%

Walking

44.2%

28.3%

16.8%

5.3%

Grocery Shopping

52.2%

20.4%

9.7%

11.5%

Doing light housework

54.9%

22.1%

8.0%

10.6%

Preparing meals

53.1%

23.9%

6.2%

10.6%

Standing to cook

55.8%

18.6%

8.8%

10.6%

Shopping for personal items

59.3%

20.4%

8.0%

8.8%

Cooking hot meals

56.6%

18.6%

8.8%

Managing money

65.5%

19.5%

8.8%

3.5%

Bathing

61.9% 22 19.5% * Number of Respondents

9.7% 4 3.5% ** Percent of Total Respondents (113)

Table 15. Del Norte County Caregivers Respondent’s Level of Difficulty to Perform Daily Activities Daily Activity

No Difficulty

Minor

Serious Difficulty Unable to Do

Doing heavy housework Table 13. Del Norte and Humboldt County Caregivers Combined Totals Respondent’s Level of Difficulty to Perform Daily Activities Daily Activity

No Difficulty

Minor Difficulty

Serious Difficulty

%**

22.2%

33.3%

Ability to drive or arrange a ride

33.3%

Unable to Do

Grocery Shopping

44.4%

22.2%

11.1%

Preparing meals

55.6%

33.3%

11.1%

Standing to cook

55.6%

33.3%

11.1%

44.4%

33.3%

11.1%

%**

Walking

Doing heavy housework

28.7%

17.2%

20.5%

Carrying hot meals from stove to table

66.7%

11.1%

22.2%

Walking

44.3%

28.7%

15.6%

5.7%

Using the telephone

66.7%

11.1%

22.2%

Grocery Shopping

51.6%

20.5%

10.7%

11.5%

Cooking hot meals

66.7%

22.2%

11.1%

55.6%

33.3%

Preparing meals

53.3%

24.6%

5.7%

10.7%

Bathing

Doing light housework

55.7%

20.5%

8.2%

10.7%

Dressing and undressing

66.7%

33.3%

Standing to cook

55.7%

19.7%

8.2%

10.7%

Getting in and out of bed

66.7%

33.3%

Shopping for personal items

60.7%

18.9%

8.2%

9.0%

Cooking hot meals

57.4%

18.9%

8.2%

Ability to drive or arrange a ride

59%

14.8%

8.2%

10.7%

Bathing

61.5%

20.5%

3.3%

*Number of Respondents

* Number of Respondents

** Percent of Total Respondents (122)

** Percent of Total Respondents (9)

SENIOR AND CAREGIVER SURVEY RESULTS

Difficulty

Issue

No Problem

Minor Problem

Major Problem

%**

Coordinating help from several agencies

36.1%

23%

18%

Finding provider for meal preparation/house cleaning

34.4%

17.2%

18.9%

Dealing with a break down in care arrangements

32%

22.1%

13.1%

Finding provider for personal care/bathing assistance

34.4%

19.7%

10.7%

Finding provider for respite care

36.1%

11.5%

17.2%

Caregiver counseling & support groups

36.9%

13.9%

10.7%

Finding provider for nursing care

38.5%

9.8%

13.9%

End of life issues

51 41.8% 13 * Number of Respondents

10.7% 10 8.2% ** Percent of Total Respondents (122)

Table 16a. Humboldt County Caregivers Respondent’s Issues of Care Ranking Issue

No Problem

Minor Problem

Major Problem

%**

Coordinating help from several agencies

35.4%

23.9%

17.7%

Finding provider for meal preparation/house cleaning

32.7%

18.6%

Dealing with a break down in care arrangements

31.9%

22.1%

14.2%

Finding provider for personal care/bathing assistance

33.6%

20.4%

11.5%

Finding provider for respite care

34.5%

12.4%

18.6%

Finding provider for nursing care

37.2%

10.6%

15%

Caregiver counseling & support groups

35.4%

15%

10.6%

End of life issues

42.5%

10.6%

7.1%

SENIOR AND CAREGIVER SURVEY RESULTS

* Number of Respondents

** Percent of Total Respondents (113)

Table 16b. Del Norte County Caregivers Respondent’s Issues of Care Ranking Issue Coordinating help from several agencies

No Problem

Minor Problem

Major Problem

%**

44.4%

11.1%

22.2%

End of life issues

33.3%

11.1%

22.2%

Finding provider for meal preparation/house cleaning

55.6%

22.2%

Dealing with a break down in care arrangements

33.3%

22.2%

Caregiver counseling & support groups

55.6%

11.1%

Finding provider for personal care/bathing assistance

44.4%

11.1%

Finding provider for nursing care

55.6%

Finding provider for respite care

55.6%

* Number of Respondents

** Percent of Total Respondents (9)

• No One ( 18 respondents) • Agency Volunteer (1 respondents)

monthly expenses (including: low paying or minimum wage jobs, limited or fixed income, and cutbacks to SSI). • Two respondents indicated that money was a problem due to medical and prescription expenses. • Ten respondents stated inflation or cost of living increases made it difficult. • Two respondents wrote that there is no extra money for home repair or maintenance. • Three respondents indicated their unemployment benefits ending or spouse laid off. • Three respondents wrote about the difficulty due to increased cost of healthy and special diet food. • Three recipients indicated they are concerned they will outlive their assets. • Additional comments included: having trouble managing money, not able to find a job because of caregiving 24 hours/7 days a week, transportation is expensive, working more hours providing care than being paid for, and have several jobs just to pay bills.

Daily Activity Levels: Humboldt County Caregivers Table 14 identifies the level of difficulty Humboldt County respondents have with varying daily activities. The daily activities are ranked by the combined totals of three categories: minor difficulty, serious difficulty, and unable to do. Daily Activity Levels: Del Norte County Caregivers Table 15 identifies the level of difficulty Del Norte County respondents have with varying daily activities. The daily activities are ranked by the combined totals of three categories: minor difficulty, serious difficulty, and unable to do. Issues About One’s Care Or Care For Someone Else: Respondents were asked to identify if they had problems with their own care or the care they give to someone else. Table 16 demonstrates the level of problem they have with various issues. The issues are ranked by the combined totals of two categories: minor and major problems. This ranking represents the bi-county totals. Table 16a shows the ranking for Humboldt County and Table 16b illustrates the ranking for Del Norte County.

Health Care: 20 responses • Eight respondents indicated that medical and prescription expenses are too high (many stated their co-pay was more than they could afford and one does not purchase their prescriptions due to the cost). • Five respondents wrote that insurance was not affordable or costs were too high. • Three respondents stated that health care is a problem due to difficulty of travel to town for medical services. • Three respondents have trouble with transportation to medical appointments. • Two respondents wrote that they must travel out of the area for medical care and/or local medical options are too limited. • Two respondents indicated that health care was a concern because they are getting old and/or frail. • Two respondents did not have health insurance. • Two respondents stated their doctor had moved out of the area. • Two respondents wrote about the lack of doctors taking new patients. • Additional comments included: difficulty paying for Adult Day Health Care, reduced government services and benefits, patient hostility toward medical care and caregivers, can’t afford Medicare supplemental plans or the 20% not covered by Medicare – so go without medical care, not knowing what to do when care-recipient can no longer live independently, and preexisting condition prevents access to health insurance.

SUMMARY OF NARRATIVE RESPONSES FROM CAREGIVERS Survey respondents were given the opportunity to write a description of the problem(s) that affected them the most and statements about why it was a problem for them. Ninety nine respondents completed a written description of the problem that most affected them (eighty eight described a second problem). The responses are summarized below by the most frequently listed item. Accidents in the Home (i.e. Falling): 28 responses • Nine respondents wrote that they had fallen recently and many had broken bones. • Nine respondents worry about care recipient falling. • Seven respondents indicated that falling was a problem due to health conditions (osteoporosis, arthritis, wheelchair use, and problems with knees, hips, or legs). • Six respondents stated falling was a problem due to balance, agility, trouble walking, and/or unsteady on feet. • Four respondents stated they have difficulty with stairs. • Four respondents indicated if they fall, their care-recipient cannot help them get up. • Two respondents worry about falling because care recipient lives alone. • Two respondents have a fear of falling. • Two respondents stated their spouse/care recipient refused care after a fall. • Additional comments included: have trouble assisting care recipient getting up from falls.

Household Chores: 19 responses • Nine respondents indicated that health problems, blindness, mobility issues, can’t stand for long, or physical pain prevented them from doing household chores. • Six respondents said that they lacked the energy or strength required to do chores. • Five respondents wrote that they were no longer able to do household chores or heavy chores. • Six respondents have trouble doing chores. • Two respondents indicated lack of time or too busy to do chores. • Two respondents cannot afford to get needed assistance. • Additional comments included: taking care of spouse, need help with

Money to Live on: 26 responses • Thirteen respondents stated they did not have enough money to cover

SENIOR AND CAREGIVER SURVEY RESULTS

Table 16. Del Norte and Humboldt Counties Caregivers Combined Totals Respondent’s Issues of Care Ranking

Table 17. Nutrition Concerns of Survey Respondents

Housing (9 responses), Nutrition/Food (7 responses), Employment (5 responses), Isolation (5 responses), Receiving Services/Benefits (5 responses), Legal Affairs (4 responses), Loneliness (4 responses), and Obtaining Information About Services/Benefits (4 responses).

Transportation: 16 responses • Three respondents wrote that public transportation was not suitable or unavailable. Specific comments included the following: non-existent in their area, affordability of service (specifically Dial-A-Ride), accessibility and only two spots for wheelchairs. • Two respondents stated that transportation was a problem due to the cost of driving a car (specifically the rising price of gas). • Two respondents said they no longer drive a vehicle and rely on friends, family, or public transportation. • Two respondents indicated that they no longer drive a vehicle and they do not have anyone to drive them. • Two respondents were concerned about how much longer they would be able to drive. • Two respondents wrote they were no longer able to do long distance traveling. • Additional comments included: their vision was deteriorating, transportation is barrier to accessing services, funding for Bridgeville van is running out, client’s disability requires two people to help in and out of vehicle, getting to appointments and errands, no vehicle, lack of public transportation options, appreciate Del Norte’s taxis, and hard to get to store to purchase food.

Additional Concerns of Caregivers: The following are additional concerns that caregivers had that did not fit into the categories listed above. • Memory problems and dealing with Alzheimer’s (4 respondents) • Mobility difficulty including arthritis (2 respondents ) • Support groups needed (3 respondents) • Home repairs, including plumbing, electrical, and weatherization (4 respondents) • Depression (3 respondents) • Ramps to access house or trailer (3 respondents) • Stress (2 respondents) • Trash pickup (1 respondent) • Wheelchair accessible sidewalks (1 respondent) • Dental care (1 respondent) • Finding people to talk to (1 respondent) • Difficult to communicate needs (1 respondent) • Decrease in IHSS hours due to budget cuts (1 respondent) • Vision decreasing (1 respondent) • Aging (1 respondent), and • Time management (1 respondent)

SENIOR AND CAREGIVER SURVEY RESULTS

Energy/Utilities: 15 responses • Twelve respondents indicated cost of heating or propane is too expensive, specifically they wrote about not using the heater due to cost of propane, hard to pay electricity bills, and bathing in cold water. • Additional comments included: they have grandchildren who have high usage and propane gauge is leaking and cannot afford to fix it.

Additional Comments from Caregivers: At the end of the questionnaire, space was provided for “Additional Comments”. These are included for the added dimension they add to the survey results. • I filled this out for my mother. She is in a nursing home because she needs more care than I could give. There needs to be some kind of assistance for people who only have $1000 a month income to help them stay at home! I had no choice but to place my mom in a nursing home. • So far my husband and I have been able to cope with problems, but my husband’s memory is failing and it would be helpful to attend a work shop or something to learn ways to help him deal with this and me to care for him.

Taking Care of an Adult Person: 14 responses • Six respondents indicated they take care of their adult child with physical disabilities. • Four respondents commented on the difficulty of their caregiving due to their spouse’s illness: dementia, Parkinson’s, stroke, and Lupus. • Two respondents wrote about taking care of their adult child with mental health issues. • Two respondents commented on caring for parents in their 90s. • Two respondents indicated they are taking care of their spouse and adult child with disabilities. • Additional comments included: adult child out of work, long distance caregiving, understaffing at their parent’s care facility, taking care of their parents and their teenagers.

Areas of Concerns with Nutrition: Food Preparation and Food Security As nutrition is a vital part of staying healthy, respondents were asked questions about their ability to afford nutritious food, frequency of eating hot meals, and their ability to prepare their meals. Over one-third of respondents indicated that there are times when they cannot afford to purchase fruit, vegetables and protein. Two-thirds of respondents prepare an average of less than one hot meal a day for themselves, 40.0% of respondents prepare one less than every other day and 17.3% do not prepare themselves a single hot meal each week. Many of these individuals have hot meals prepared by others, but 43.1% still average one hot meal per day per week or less, with 6.7% having a hot meal on average less than every other day to not at all.

Crime: 12 responses • Eight respondents indicated illegal drugs were a problem, specifically: grow houses next door, drug dealers in neighborhood, drug houses move into neighborhood. • Two respondents indicated that they live alone. • Additional comments included: caregivers stealing from their parents, minor crimes in the neighborhood, isolated, and homeless in forest next door..

Respondents were given a list of problems that could affect one’s quality of life. Respondents were asked to indicate which items were a problem

The following categories received fewer than 10 responses each:

% of 389 Senior Respondents

% of 122 Caregiver Respondents

Yes

12.8%

13.1%

16.4%

Sometimes

21.7%

21.1%

24.6%

59.5%

61.7%

54.1%

No Response

4.1%

4.9%

None

17.3%

18.5%

18%

1 to 3

22.7%

23.4%

20.5%

4 to 7

27.7%

27.2%

23.8%

8 or more

29.2%

29.6%

36.9%

No Response

3.1%

1.3%

0.8%

% All 415 Survey Respondents

% of 389 Senior Respondents

% of 122 Caregiver Respondents

None

0.7%

0.8%

1 to 3

6.2%

7.4%

4 to 7

36.4%

37%

30.3%

8 or more

53%

54%

59.8%

No response

3.9%

2.1%

1.6%

No problem

57.6%

58.4%

52.5%

Minor problem

25.1%

24.7%

31.1%

Serious problem

11.1%

10.8%

13.9%

No Response

6.3%

6.2%

2.5%

No difficulty

53.5%

53.7%

51.6%

Minor difficulty

18.8%

19.3%

20.5%

Serious difficulty

9.4%

9.3%

10.7%

Unable to do

10.4%

10.8%

11.5%

No Response

6.9%

5.7%

No difficulty

54.2%

55.3%

53.3%

Minor difficulty

21.4%

20.6%

24.6%

Serious difficulty

7.2%

7.7%

5.7%

Unable to do

8.4%

8.7%

10.7%

No Response

8.7%

7.7%

5.7%

There are times when respondent cannot afford to buy healthy foods for a diet high in fruit, vegetables, and protein:

Average number of hot meals respondent prepared for themselves each week

Average number of hot meals respondent eats each week

Level of problem or difficulty: Nutrition/food (affording or preparing)

Grocery shopping

Preparing meals

Standing to cook

SENIOR AND CAREGIVER SURVEY RESULTS

chores, trouble finding help with chores, afraid to climb ladders, need help with yard work, and garbage removal.

% All 415 Survey Respondents

Table 17. Nutrition Concerns of Survey Respondents (continued) 54.5%

54.5%

55.7%

Minor difficulty

19%

19.3%

19.7%

Serious difficulty

7.7%

8.2%

Unable to do

9.6%

10%

10.7%

No Response

9.2%

8.2%

5.7%

No difficulty

59%

60.4%

57.4%

Minor difficulty

16.6%

15.9%

18.9%

Serious difficulty

6.7%

Unable to do

7.5%

7.7%

8.2%

No Response

10.1%

9.3%

No difficulty

65.1%

Minor difficulty

Table 18. Contact with Elected Officials for Survey Respondents (continued) % All 415 Survey Respondents

% of 389 Senior Respondents

% of 122 Caregiver Respondents

By phone

24.8%

25.4%

32%

By letter

16.1%

16.2%

24.6%

6.6%

By Email

11.1%

10.5%

17.2%

In person or at an event (face to face)

24.6%

25.2%

27.9%

66.3%

64.8%

Other

1.4%

1.5%

0.8%

14.5%

13.9%

No Response

54%

53.5%

45.9%

Serious difficulty

5.5%

5.7%

7.4%

Unable to do

5.5%

5.7%

8.2%

No Response

9.4%

8.5%

5.7%

By phone

27.5%

28%

36.1%

By letter

10.4%

10.5%

19.7%

By Email

6.9%

11.5%

In person or at an event (face to face)

18.6%

19.3%

19.7%

Other

1.5%

2.0%

0.8%

No Response

58.1%

57.1%

48.4%

Yes

44.8%

45.2%

51.6%

13.3%

13.9%

I do not know

12%

11.8%

13.1%

No Response

29.9%

29%

21.3%

Cooking hot meals

Carrying hot meals from stove to table

Table 18. Contact with Elected Officials for Survey Respondents % All 415 Survey Respondents

% of 389 Senior Respondents

% of 122 Caregiver Respondents

Yes

45.5%

46.3%

55.7%

49.4%

49.9%

41%

No Response

5.1%

3.9%

3.3%

Yes

40.7%

42.2%

48.4%

53%

52.7%

45.9%

No Response

6.3%

5.1%

5.7%

Have you ever been in touch with an elected official?

SENIOR AND CAREGIVER SURVEY RESULTS

Have you ever been in touch with the staff of an elected official?

If yes, was it to ask them to do something on an issue you cared about? Yes

37.3%

38%

49.2%

20.2%

19.8%

15.6%

No response

42.4%

42.2%

35.2%

Yes

20.7%

21.3%

23.8%

12%

11.6%

14.8%

I do not know

20.7%

21.1%

23.8%

No response

46.5%

46.0%

37.7%

Yes

19.3%

20.1%

20.5%

13.3%

13.1%

18.9%

I do not know

19.3%

19%

20.5%

No Response

48.2%

47.8%

40.2%

Do you feel that your contact made a difference?

Was the result what you hoped for?

If you have been in touch with an elected official, how did you contact them?

If you have been in touch with an elected official’s staff, how did you contact them?

Are you comfortable contacting an elected official?

Are you comfortable contacting an elected official’s staff?

Contact with Elected Officials In an effort to understand local seniors’ experience and ease in participating in grassroots advocacy efforts, respondents were asked about their contact with elected officials. Forty-five percent of respondents had been in contact with an elected official while 40.7% had been in contact with elected officials’ staff. Over a third of the respondents had asked the elected official to do something on an issue they cared about and 20.7% of respondents felt their contact had made a difference, although only 19.3% had the results they hoped for. Most respondents (24.8%) contacted these officials by phone and with their staff by phone as well (27.5%). Nearly half of respondents are comfortable contacting an elected official or their staff. Nearly a quarter of respondents would feel more comfortable if they had more information about contacting elected officials. Thirty-eight percent indicated they would or might be interested in attending a workshop on contacting elected officials and 44.3% answered “yes” or “maybe” to their interest in attending a workshop on getting their concerns heard by elected officials. Details of respondents’ answers are located in the Table 18. ●

to them personally and to what degree they were a problem. One problem from the list was “Nutrition/food (affording or preparing)”. Thirty-six percent of respondents have a minor or serious problem with affording or preparing food. Respondents were requested to identify if they had problems with their own care or the care they give to someone else. Five of the list of activities concerned food preparation [grocery shopping, preparing meals, standing to cook, cooking hot meals, and carrying hot meals from stove to table]. Over one-third of respondents (38.6%) have minor difficulty, serious difficulty, or are unable to do their own grocery shopping with 19.8% having serious difficulty or are unable to do it at all. One-third of respondents also are unable or have difficulty with preparing meals and standing to cook those meals. Just under one-third have difficulty with cooking hot meals and carrying hot meals from the stove to the table. Specific results for these nutrition questions are located in the tables located on the following pages.

SENIOR AND CAREGIVER SURVEY RESULTS

No difficulty

Local Government Assessment Survey Summary Report 2009

The survey was modeled after the International City/County Management Association’s 2006 nation wide survey (“Maturing of America”). The survey was intended to provide information relevant to long-term public agency planning for the increasing older adult population.

A wellness program for older adults was provided, funded all or part of program, and partnered by two of the respondents but no respondents indicated publicizing the program. Five respondents indicated having no role in a wellness program. Preventive screenings, such as blood pressure checks and mammograms were available as noted by five respondents. One respondent indicated they provided, funded all or part of program, and partnered in preventative screenings and six indicated no role. Immunizations, such as flu shots, were provided, funded, and publicized by one respondent and two additional respondents partnered in these programs. Four respondents checked no role.

Respondents Approximately 76 surveys were distributed by Area 1 Agency on Aging. Twelve surveys were returned and were completed sufficiently to be considered valid. Surveys were entered into an SPSS database and analyzed for this report.

An additional health care service noted by a respondent was dental care as part of a wellness program.

Five respondents identified their local government entity as providing local parks and other venues that have safe, accessible walking or biking

Table 1. Summary of Respondents’ Local Government Entity’s Role in Program or Service Specific for Older Adults Local Government Role

Survey Responses Survey respondents were asked about the availability of senior services in their community in areas specific to health care, nutrition, exercise, transportation, public safety, housing, taxation/finance, workforce, civic engagement/volunteer, human services, and policy. Each of these categories listed multiple specific types of services or programs. They were asked if the service or program was provided in their community and what role their local government entity had in the program, ranging from providing, funding, or partnering in program to no role. Respondents were also asked about other policies or services for older adults that were provided or being planned/ proposed in their community, as well as challenges their community faced in meeting the needs of or planning for the growing older adults population. Health Care Programs/Services for Older Adults Six programs or services in health care for older adults were listed in the survey. General access to health care services was considered available

No role

Table 1 summarizes the number of responses by each program or service and the level of the local governments’ role based on the respondents’ answers.

Respondents represented Humboldt County Supervisors; City Council Members for Arcata, Blue Lake, Eureka, Ferndale, Fortuna, and Trinidad; and Tribal or Rancheria Council Members.

Transportation Programs/Services for Older Adults Six programs or services addressing transportation needs for older adults were listed in the survey. Public transportation to and from senior centers, adult day services, grocery stores, pharmacies, faith communities, cultural events, etc. were identified by four respondents as being available in the their community. One respondent indicated their local government entity provided a program for this type of public transportation, while five respondents indicated funding all or part of the service. Three respondents indicated they publicize

Partner in program

LOCAL GOVERNMENT ASSESSMENT SURVEY

Distribution The surveys were initially distributed in June and July 2009 through the U.S. Postal Service. After receiving only several responses, a second distribution was made through emails and the U.S. Postal Service in October 2009. In March 2010, a final effort through phone calls to government officials was attempted. Surveys were distributed to local governmental officials including County Supervisors; City Council Members for Arcata, Blue Lake, Eureka, Ferndale, Fortuna, Rio Dell, and Trinidad; and local Tribal or Rancheria Council Members.

Table 3 summarizes the number of responses by each program or service and the level of the local governments’ role based on the respondents’ answers.

Exercise Programs/Services for Older Adults Two programs or services addressing exercise or physical activity needs for older adults were listed in the survey. Exercise classes tailored to specific health concerns were checked by four respondents as existing in their community. Two respondents indicated that they (through their local government entity) provide, fund all or part, and publicize these classes. One individual indicated they partnered in the classes and four respondents checked that their local government had no role in this type of program.

Access to health care services that meet a range of needs

4 [33%]

1 [8%]

2 [17%]

6 [50%]

Access to prescription programs that meet a range of needs

3 [25%]

2 [17%]

7 [58%]

Transportation to and from medical appointments

3 [25%]

2 [17%]

5 [42%]

2 [17%]

1 [8%]

3 [25%]

Wellness programs for older adults

4 [33%]

2 [17%]

5 [42%]

Preventive screenings, such as blood pressure, mammograms

5 [42%]

1 [8%]

2 [17%]

1 [8%]

6 [50%]

Immunizations, such as flu shots

4 [33%]

1 [8%]

3 [25%]

4 [33%]

Average number of respondents for program/service category

3.8

1.2

1.8

1.2

1.5

5.2

Nutrition Programs/Services for Older Adults Three programs or services addressing nutritional needs for older adults were listed in the survey. Communal meals, such as lunch at a senior center, were identified by five respondents as being available in their community but only two provided the program or contributed towards the funding of those programs. One respondent indicated their local government entity publicized the program and partnered in the program, while six respondents identified they had no role in a communal meal program.

Health Care Programs or Services

Nutrition education, such as information above, was checked by four respondents indicating that the service was available in their community. One respondent indicated their local government entity provided, publicized, partnered and funded all or part of these services and one additional person indicated they funded all or part. Six respondents said they had no role in nutrition education services.

Specific for Older Adults

Home delivered meals were indicated as being available in five respondents’ communities. One respondent indicated their local government en-

LOCAL GOVERNMENT ASSESSMENT SURVEY

Transportation to and from medical appointments was checked by two respondents as being providers of a program and five respondents fund all or part of this type of program but only one indicated being a partner. Three respondents indicated having no role in this type of health care access transportation program.

Table 2 summarizes the number of responses by each program or service and the level of the local governments’ role based on the respondents answers.

Publicizes program

No local government role for access to prescription programs was noted by seven respondents and none of the respondents indicated that they provide, fund in all or part, or partner in a program for access to prescriptions. Two respondents checked that they publicize existing programs.

trails. Two respondents checked that they fund all or part, publicize, and partner in these types of parks or venues. One respondent indicated that they had no role. Additional exercise programs include: • city providing low cost and sometimes free space for exercise classes at town hall; • senior park with walking track; • bocce ball court is being built; • senior exercise program being funded through CDBG; • Health Sport memberships available; and • Independent exercise classes being held at Town Hall and West haven Apartments.

Funds all or part of program

Background, Design, and Intent Humboldt County, California is on the verge of experiencing a tremendous growth in its older adult population. In 2000, there were 20,574 individuals over the age of 60 in Humboldt County, according to the 2000 Census. By 2010, those census numbers jumped to 26,759 older adults -- a 30% increase in 10 years. Based on California Department of Finance population projections, Humboldt County will have 34,744 older adults by 2020 -- a 68.9% increase. In light of this tremendous growth in older adults, the Area 1 Agency on Aging administered a survey for local government officials to assess the senior programs in their area.

tity provided, publicized, partnered and funded all or part of these services and one additional person indicated they funded all or part. Six respondents indicated they had no role in any home delivered meal program. Additional nutrition programs noted were: • frozen lunches for home delivered meals; • food banks; • community gardens; and • limited delivery available for home delivered meals.

Provides program

by four of the respondents while only one respondent indicated that the local government they represented provided the program, participated in funding the program and publicized the program. Two respondents indicated they partner in the program and six indicated they have no role.

Is available regardless of provider

Getting Humboldt County On Track For An Aging Population

Table 2. Summary of Respondents’ Local Government Entity’s Role in Program or Service Specific for Older Adults

Partner in program

No role

5 [42%]

2 [17%]

1 [8%]

6 [50%]

Nutrition education (e.g. heart-healthy diets, diabetes, etc.)

4 [33%]

1 [8%]

2 [17%]

1 [8%]

6 [50%]

Meals delivered to homes

5 [42%]

1 [8%]

2 [17%]

1 [8%]

7 [58%]

Average number of respondents for program/service category

4.7

1.3

6.3

Provides program

Table 4. Summary of Respondents’ Local Government Entity’s Role in Program or Service Specific for Older Adults Local Government Role

Transportation Programs or Services Specific for Older Adults

No role

Partner in program

Funds all

Specific for Older Adults

Provides program

Exercise Programs or Services

Publicizes program

Table 3. Summary of Respondents’ Local Government Entity’s Role in Program or Service Specific for Older Adults

Is available regardless of provider

LOCAL GOVERNMENT ASSESSMENT SURVEY

Funds all or part of program

Publicizes program

Is available regardless of provider

Communal meals, such as lunch at a senior center

Specific for Older Adults

Knowledge of where older adults reside so services can be provided in severe weather or other situations that prevent residents from leaving their homes was provided, funded all or part of program, and partnered by two of the respondents. Only one respondent indicated publicizing the program. Five respondents indicated having no role in this type of program.

Elder abuse and neglect prevention services were checked by three respondents as being providers of a program but only one indicated being a partner and one other indicated funding all or part of this type of program. Four respondents indicated having no role in this type of elder abuse prevention program.

Local Government Role

Nutrition Programs or Services

Three respondents checked that their local government provided emergency energy assistance programs, but only one indicated funding all or part of this program. Two respondents publicized and one partnered in these efforts, while another four respondents indicated they had no role.

Public transportation to and from senior centers, adult day services, grocery stores, pharmacies, faith communities, cultural events, etc.

4 [33%]

1 [8%]

5 [42%]

3 [25%]

2 [17%]

4 [33%]

Discounted taxi cab and/or bus fares

2 [17%]

4 [33%]

3 [25%]

2 [17%]

3 [25%]

Dial-a-ride (e.g. door-to-door para-transit)

3 [25%]

5 [42%]

3 [25%]

2 [17%]

3 [25%]

Road design that meets the needs of older drivers (e.g. large signs)

1 [8%]

2 [17%]

6 [50%]

Sidewalks and street crossings that are safe and accessible for older pedestrians (e.g. flashing walk signs, sidewalk bump-outs)

2 [17%]

6 [50%]

2 [17%]

1 [8%]

2 [17%]

3 [25%]

Exercise classes tailored to specific health concerns

4 [33%]

2 [17%]

1 [8%]

4 [33%]

Local parks and other venues that have safe, accessible walking/biking trails

2 [17%]

5 [42%]

2 [17%]

1 [8%]

Sidewalk system linking residences and essential services

2 [17%]

5 [42%]

3 [25%]

2 [17%]

Average number of respondents for program/service category

3.5

1.5

2.5

Average number of respondents for program/service category

2.3

3.2

1.7

3.5

LOCAL GOVERNMENT ASSESSMENT SURVEY

Sidewalks and street crossings that are safe and accessible for older pedes-

Public Safety/Emergency Services for Older Adults Seven programs or services in public safety or emergency services for older adults were listed in the survey. General access to elder abuse/neglect identification and reporting programs were considered available by four of the respondents while three respondents indicated that the local government they represented provided the program. Two participated in funding the program and partnering in the program. One respondent indicated they publicize the program and four indicated they have no role.

No role

Additional transportation programs noted by respondents included: • No current transportation services but planning is underway; • Sidewalks and crossing system is partial and not throughout community;

Plans for notification and evacuation of older adults in the event of a natural disaster or homeland security event were available as noted by five respondents. Four respondents indicated they provided the plans, two funded all or part of program, one publicized the program and two partnered in plans. Three indicated no role.

Partner in program

Six respondents indicated their local government entity had no role in road designs that meet the needs of older drivers (such as large signs) and no respondent checked that they funded all or part, publicized, or partnered in this type of effort; although two respondents indicated that the provided this service.

Table 4 summarizes the number of responses by each program or service and the level of the local governments’ role based on the respondents’ answers.

Publicizes program

Five respondents checked that their local government provided sidewalk systems that linked residences and essential services. Three fund all or part of this effort. Two respondents publicized and partnered in these efforts, while another two respondents indicated they had no role.

Neighborhood watch programs are provided by three of the respondents; three publicize; and two fund all or part of these crime deterrent programs. Two respondents are aware of their local government entity partnering in the program. Three respondents did not see their local government as having a role in this program.

Funds all or part of program

Discounted taxi cab and or bus fares are provided by two of the respondents; three publicize; and four fund all or part of these discounted forms of transportation. Two respondents are aware of their local government entity partnering in the program. Three respondents did not see their local government as having a role in this program.

• Minimal sidewalks in many areas, some areas ok without due to ruralness, while other areas are unsafe to walk without sidewalks; and • Humboldt Transit Authority services.

Provides program

trians (such as flashing walk signs, sidewalk bump-outs, etc.) were provided by half of the respondents (6). Two respondents funded all or part of this effort and two respondents partnered. One respondent saw their local government entity as publicizing this availability, while three respondents saw no role being taken by their local government.

Is available regardless of provider

this type of service and two checked they partner in the effort. Four respondents have no role in this type of service.

Table 8 summarizes the number of responses by each program or service and the level of the local government’s role based on the respondents’ answers.

3 [25%]

2 [17%]

1 [8%]

2 [17%]

4 [33%]

Elder abuse/neglect prevention

4 [33%]

3 [25%]

1 [8%]

2 [17%]

4 [33%]

Neighborhood Watch programs

3 [25%]

2 [17%]

3 [25%]

2 [17%]

3 [25%]

Plans for notification and evacuation of older adults in the event of a natural disaster or homeland security event

5 [42%]

4 [33%]

2 [17%]

1 [8%]

2 [17%]

3 [25%]

Emergency energy assistance program

2 [17%]

3 [25%]

1 [8%]

2 [17%]

1 [8%]

4 [33%]

Knowledge of where older adults reside so services (e.g. home-delivered meals) can be provided in severe weather or other 4 [33%] situations that prevent residents from leaving their homes.

2 [17%]

1 [8%]

2 [17%]

5 [42%]

Specialized training for staff in dealing with older adults

4 [33%]

3 [25%]

2 [17%]

1 [8%]

3 [25%]

Average number of respondents for program/service category

3.7

1.7

1.6

1.7

3.7

Table 6. Summary of Respondents’ Local Government Entity’s Role in Program or Service Specific for Older Adults Local Government Role Housing Programs or Services Specific for Older Adults Home maintenance/repair assistance and modification of existing home to accommodate the needs of older adults (e.g. building a ramp for easier access or modifying showers).

2 [17%]

3 [25%]

2 [17%]

6 [50%]

Modification of service delivery to meet the needs of older adults (e.g. backyard trash collection)

1 [8%]

2 [17%]

7 [58%]

Subsidized housing

1 [8%]

3 [25%]

2 [17%]

3 [25%]

Average number of respondents for program/ service category

1.3

1.7

2.3

5.3

No role

4 [33%]

LOCAL GOVERNMENT ASSESSMENT SURVEY

Civic Engagement/Volunteer Programs/Services for Older Adults Two programs or services in civic engagement or volunteer services for older adults were listed in the survey. Senior Corps programs (specifically RSVP, Senior Companions, and Foster Grandparents) were noted

No role

Partner in program

Publicizes program

Funds all or part of program

Provides program

Is available regardless of provider

LOCAL GOVERNMENT ASSESSMENT SURVEY

Elder abuse/neglect identification and reporting

Additional workforce development programs were noted as available through Humboldt State University.

Table 7 summarizes the number of responses by each program or service and the level of the local governments’ role based on the respondents’ answers.

Local Government Role

Specific for Older Adults

Assistance with preparation of tax forms was noted as being provided by one of the local government entities represented, while three publicize the program, and two partner in the program. No local government respondent funds all or part of these programs and five indicated they have no role. One respondent indicated they provide, fund, and partner in education and information about financial fraud and predatory lending, while two respondents indicated publicizing the programs. Five respondents checked they had no role in these types of programs.

Table 5. Summary of Respondents’ Local Government Entity’s Role in Program or Service Specific for Older Adults

Public Safety/Emergency Services

Discounts for older adults who want to take classes at local colleges or universities was checked as being available in four of the respondents’ communities but only one provides or publicizes these programs. None of the respondents check that they funded all or part or partnering in these programs. Four respondents indicated they had no role in these types of discounted educational opportunities.

Partner in program

Three respondents indicated they provided, funded all or part, or partnered in subsidized housing while two checked that they publicized these programs. Three respondents checked that their local government entity had no role in subsidized housing.

Flexible job opportunities (such as job sharing or part-time work) were provided by one respondent while two respondents publicize such programs. Five respondents checked that they had no role in these opportunities and funding all or part or partnering in these programs was not checked by a single respondent.

Publicizes program

Table 5 summarizes the number of responses by each program or service and the level of the local governments’ role based on the respondents’ answers.

Taxation and Finance Programs/Services for Older Adults Three taxation and finance programs for older adults were listed in the survey. No local government role for property tax relief for older adults on limited incomes was noted by seven respondents and none of the respondents indicated that they provide, fund in all or part, nor publicize existing programs. One respondent checked that they partner in a property tax relief program.

Funds all or part of program

Modification of service delivery to meet the needs of older adults (such as backyard trash collection) was not checked as being provided by a single respondent and seven respondents indicated they had no role in service delivery modifications. One respondent indicated they funded all or part of this type of program while two indicated they partnered or publicized similar programs.

See Table 6 below.

Is available regardless of provider

Additional public safety services included were: • Plans in development for notification/evacuation with local fire district/department; • Would like to have neighborhood watch program; • Police and fire personnel are aware of specific households with special needs; and • Existing volunteer fire/emergency medical department that will stabilize a patient until an ambulance arrives.

Workforce Programs/Services for Older Adults Three workforce development programs or services for older adults were listed in the survey. Job retraining opportunities were provided by three respondents and another three indicated they publicize these opportunities. Two respondents indicated they fund all or part of the program and partner in the program. Five respondents checked that they have no role in these types of programs.

Additional housing programs for older adults noted by respondents included: • New senior housing project; and • “Home” grant housing project and redevelopment agency projects.

Provides program

Housing Programs/Services for Older Adults Three programs or services addressing housing needs for older adults were listed in the survey. No local government role for home maintenance, repair assistance, and modification of existing homes to accommodate the needs of older adults (such as building a ramp for easier access or modifying bathrooms) was noted by half of respondents (6) and only two of the respondents indicated that they provide, fund in all or part, or partner in a program for increased access and safety in the home. Three respondents checked that they publicize existing programs.

Specialized training for staff in dealing with older adults was identified by four respondents as being available in their community. Three respondents indicated their local government entity provided this type of training, while two respondents indicated funding all or part of the training. Two respondents indicated they publicize this type of training and one checked they partner in the effort. Three respondents have no role in this type of specialized training.

checked that they had no role in these activities. Additional civic engagement or volunteer programs for older adults noted by respondents were: • SCOP (Senior Citizens on Patrol) program with police and sheriff departments; • Wah-Nika Women’s Club; • Mad River Grange; • Dell Arte; • Village Keepers provide social, recreational, and educational

Civic engagement or volunteer opportunities that use all adults, including older adults were identified as being provided by three respondents but only one funds all or part of the program. Four respondents partner in these opportunities while only two publicize them, and one respondent

Table 7. Summary of Respondents’ Local Government Entity’s Role in Program or Service Specific for Older Adults

Publicizes program

Partner in program

No role

1 [8%]

7 [58%]

Assistance with preparation of tax forms

3 [25%]

1 [8%]

3 [25%]

2 [17%]

5 [42%]

Education and information about financial fraud and predatory lending

2 [17%]

1 [8%]

2 [17%]

1 [8%]

5 [42%]

Average number of respondents for program/service category

0.7

0.3

1.7

1.3

5.7

Provides program

Property tax relief for older adults on limited incomes

Taxation and Finance Programs or Services Specific for Older Adults

Table 9 summarizes the number of responses by each program or service and the level of the local governments’ role based on the respondents’ answers.

Building codes that support the development of assisted living facilities (such as codes that address mobility like wheelchair accommodation) were identified by five respondents as being provided by their local government entity, while three indicated they funded or partnered in the effort. Two checked that they publicized the building codes and one respondent indicated they had no role.

Aging/Human Service Programs/Services for Older Adults Two programs or services in aging or human services for older adults were listed in the survey. In-home support services that enable older adults to live independently (such as home care and chore or homemaker services) were identified by seven respondents as being available in their community. Four respondents indicated they provided the services, while three publicize or partner in the services. Two indicated they funded all or part of the service program and three respondents checked that they had no role.

Zoning requirements, subdivision regulations or building codes that promote or support other senior housing options (such as shared housing and accessory apartments) were identified by five respondents as being provided in five local government entities. Three indicated they funded all or part of these efforts and two indicated they partnered or publicized these efforts. One respondent checked that their local government had no role in this area.

Five respondents indicated their local government entity had no role in a single entry information point for services (such as a one-stop shop for all services) and no respondent checked that they provided this service. Three checked that they publicized the service, while two partnered in the service, and one checked that they funded all or part of the service.

Planning processes that consider the needs of older adults were checked as being provided by six respondents, while only two partnered in these efforts and only one funded or publicized these efforts. One respondent did not see their local government as having a role in these processes.

Additional aging and social service programs for older adults noted by respondents included: • Ferndale Senior Resource Agency has lunch program five days a week and also provides some transportation services; and • The Village Keepers of Trinidad is a loosely organized volunteer network of neighbors helping neighbors.

Seven respondents indicated that they provided for community design or redesign that supported walkability. Two respondents checked that they funded, publicized, and partnered in these efforts while one respondent saw no role at all.

Table 10 summarizes the number of responses by each program or service and the level of the local governments’ role based on the respondents answers. Table 8. Summary of Respondents’ Local Government Entity’s Role in Program or Service Specific for Older Adults

Table 9. Summary of Respondents’ Local Government Entity’s Role in Program or Service Specific for Older Adults

Local Government Role Partner in program

No role

Job retraining opportunities

2 [17%]

3 [25%]

2 [17%]

3 [25%]

2 [17%]

5 [42%]

Flexible job opportunities (e.g. job sharing, parttime)

2 [17%]

1 [8%]

2 [17%]

5 [42%]

2 [17%]

1 [8%]

2 [17%]

Discounts for older adults who want to take classes at local colleges/universities

Senior Corps programs (RSVP, Senior Companions, Foster Grandparents)

4 [33%]

1 [8%]

4 [33%]

5 [42%]

3 [25%]

1 [8%]

2 [17%]

4 [33%]

1 [8%]

Average number of respondents for program/service category

Civic engagement/volunteer opportunities that use all adults, including older adults.

2.7

1.7

0.7

4.7

Average number of respondents for program/service category

3.5

1.5

2.5

1.5

No role

Partner in program

Publicizes program

Funds all or part of program

Civic Engagement/Volunteer Programs or Services Specific for Older Adults

Provides program

Local Government Role Is available regardless of provider

Specific for Older Adults

Provides program

Workforce Programs or Services

Funds all or part of program

Publicizes program

Is available regardless of provider

LOCAL GOVERNMENT ASSESSMENT SURVEY

Funds all or part of program

Is available regardless of provider

Local Government Role

Policy/Guidelines that Benefit Older Adults Five policy or guideline efforts that benefit older adults were listed in the survey. Zoning requirements that support the development of active older adult community (such as density levels or lots per acre) were provided by half of the respondents (6). Two respondents funded all or part of this effort and two respondents partnered. One respondent saw their local government entity as publicizing this effort, while one respondent saw no role being taken by their local government.

programs and a network for specific needs like errands, reading aloud, and others; • Council Advisory Committees; and • Volunteers help run the city including the museum board.

LOCAL GOVERNMENT ASSESSMENT SURVEY

by two respondents as being available in their community but only one respondent indicated they provide the program, fund all or part, publicize, or partner in the programs. Two respondents checked that their local government entity played no role in the program.

Table 11 summarizes the number of responses by each program or service and the level of the local governments’ role based on the respondents’ answers. No role

Partner in program

Publicizes program

Funds all or part of program

Specific for Older Adults

Provides program

Is available regardless of provider

Local Government Role

Aging and Human Service Programs In-home support services (e.g. home care, chore/homemaker services) that enable older adults to live independently

7 [58%]

Single entry point for services (e.g. one-stop for all services)

1 [8%]

3 [25%]

2 [17%]

5 [42%]

Average number of respondents for program/service category

1.5

2.5

4 [33%]

2 [17%]

3 [25%]

Table 11. Summary of Respondents’ Local Government Entity’s Role in Program or Service Specific for Older Adults

No role

Partner in program

Publicizes program

Funds all or part of program

Provides program

Is available regardless of provider

LOCAL GOVERNMENT ASSESSMENT SURVEY

Local Government Role

Policy or Guidelines that Benefit Older Adults Zoning requirements that support the development of active older adult community (eg. density levels, lots per acre)

4 [33%]

6 [50%]

2 [17%]

1 [8%]

2 [17%]

1 [8%]

Building codes that support the development of assisted living facilities (e.g. codes that address mobility such as wheelchairs accommodation)

3 [25%]

5 [42%]

3 [25%]

2 [17%]

3 [25%]

1 [8%]

Zoning requirements, subdivision regulations or building codes that promote/support other senior housing options (e.g. shared housing, accessory apartments)

3 [25%]

5 [42%]

3 [25%]

2 [17%]

1 [8%]

Planning process that considers the needs of older adults

3 [25%]

6 [50%]

1 [8%]

2 [17%]

1 [8%]

Community design/redesign that supports walkability

3 [25%]

7 [58%]

2 [17%]

1 [8%]

Average number of respondents for program/service category

3.2

5.8

2.2

1.6

2.2

and one respondent indicated they also had programs specifically for those 80 and older. Two-thirds of the respondents indicated that their local government had solicited information within the past three years from their community from older adults on their needs. These activities included older adults participating in planning or community meetings including IHSS Advisory Board and Humboldt Transit Authority meetings, older adults volunteering in city projects, and several informational surveys. Half of the twelve respondents have an advisory board or other body for older adults to participate in the planning process for senior programs and services. It was further noted that most of these advisory boards are program or service specific and are limited in their scope of influence.

Additional information was provided by a respondent indicating that Trinidad has few empty lots and is practically built out.

Additional Planning Information Respondents wrote about other policies or services for older adults that are being planned, proposed or provided in their community. Those items not addressed above include: • Emerging General Plan to address seniors’ needs; • Adult housing project in planning process; and • 30-unit housing complex for low income persons is being built.

Half of the respondents were aware of their local government’s planning for a growing senior population in their community. These activities include looking at senior housing, working with the Area 1 Agency on Aging, and an awareness of need for planning but lack of time and funding have deferred action.

The primary challenges facing the respondents’ communities in meeting the needs of older adults or planning for their need were: • Funding, written about by seven respondents, including a general lack of funding for needed services (transportation, clinics, and adult care facilities), major improvements and operations, and overall general budget problems. • Housing, noted by six respondents, including need for affordable housing for very low/low/moderate senior housing, senior develop ments in general, smaller units or apartments/condos. • Health Care, indicated by four respondents, including geriatric care, rehabilitation facilities, access to services, in-home care, and trained workers for senior care. • Planning or Information, written about by three respondents, including lack of people to create a plan or carry out a plan, limited services within the city limits, and lack of information to know what to plan for. • Transportation, indicated by three respondents, in general and including getting to medical services.

Additional Comments Respondents were provided space to allow sharing of additional comments. These comments were as follows: • The city has a lot of old buildings that are not ADA compliant. There is a lack of funding sources to facilitate making these buildings accessible despite the desire by building owners to make them accessible. • Their city is very small with large unincorporated areas and is outside most local resources service areas. Their population is poor and graying. They are in need of expertise as much as money. • The Area 1 Agency on Aging is essential for senior planning and needs. They advise the county on areas of concern. • Their community is largely older adults with few children or young families. When elders die, the properties are often turned into vacation rentals leaving large gaps in neighborhoods. ●

Respondents were asked about the age their local government used to identify “older adults”. Half of the twelve respondents indicated 65 or older, while a third indicated 60 or older, two respondents indicated 55,

LOCAL GOVERNMENT ASSESSMENT SURVEY

Table 10. Summary of Respondents’ Local Government Entity’s Role in Program or Service Specific for Older Adults

GETTING HUMBOLDT COUNTY ON TRACK FOR AN AGING POPULATION Advocacy Survey via Survey Monkey Summary Report 2009

Contact with Elected Officials for Survey Respondents

Background, Design, and Intent Humboldt County, California is on the verge of experiencing a tremendous growth in its older adult population. By 2010, those census numbers jumped to 26,759 older adults -- a 30% increase in 10 years. Based on California Department of Finance population projections, Humboldt County will have 34,744 older adults by 2020 -- a 68.9% increase. In light of this tremendous growth in numbers of older adults, the Area 1 Agency on Aging (A1AA) administered an Internet survey using Survey Monkey. The survey was intended to gather information on community members’ experience and ease in participating in grassroots advocacy efforts and their needs. Distribution The surveys were accessible through a link on the A1AA website (www.a1aa.org) during May and June 2009. The survey was publicized through flyers, A1AA newsletter, public service announcements, Senior News, newspapers, media releases, and KIEM’s Monday “Live at 5”.

ADVOCACY SURVEY

Respondents Fifty-seven surveys were completed sufficiently to be considered valid. Surveys were analyzed for this report using the Survey Monkey website. Respondents represented primarily central Humboldt County with 19 respondents living in Eureka, eight in Arcata, four in Fortuna, two in McKinleyville, and two in Rio Dell. One respondent came from each of the following towns: Blocksburg, Briceland, Carlotta, Cutten, Ferndale, Garberville, King Salmon, Manila, and Trinidad. Respondents were between the ages of 41 and 91, with an average age of 62.6. Over 40% of respondents were between 56-65. The average length of residence in Humboldt County was 30.2 years with a range of 4 to 68 years. Over half of the respondents had been in Humboldt for 11-40 years. Most respondents were college educated; with 35.1% having an Associate Degree or some college, while 24.6% had a Bachelors Degree, and 14% had a graduate degree. Specifics on respondents’ demographic information are located in the table to the right.

Demographic Composition of Survey Respondents Number of Respondents

% of Total Respondents (57)

Female

49.1%

Male

29.8%

No Response

21.1%

Demographic Category Gender:

Age:

Average 62.6

Range of Ages

41 to 91

41-55

14.0%

56-65

42.1%

66-75

19.3%

76-91

3.5%

No Response

21.1%

Number of Years Lived in Humboldt County:

Average 30.2

4-10 years

12.3%

11-20 years

17.5%

21-30 years

14%

31-40

17.5%

41-68

19.3%

No Response

21.1%

White

77.2%

Multi-ethnic

3.5%

Native American

No Response

19.3%

$0-19,999

10.5%

$20,000-29,999

22.8%

$30,000-49,999

19.3%

$50,000 and above

26.3%

No Response

21.1%

Ethnicity:

Annual Household Income:

Education: 9-12th grade

5.3%

Some College

22.8%

Associate Degree

12.3%

Bachelor Degree

24.6%

Graduate Degree

14%

No Response

21.1%

Survey Responses Survey respondents were asked about their experience in contacting elected officials or their staff. Additionally, respondents were asked about their areas of concern or needs. Contact with Elected Officials In an effort to understand local community members’ experience and ease in participating in grassroots advocacy efforts, respondents were asked about their contact with elected officials. Seventythree percent of respondents had been in contact with an elected official while 57.9% had been in contact with an elected official’s staff. Nearly two-thirds of the respondents had asked the elected official to do something on an issue they cared about and 36.8% of respondents felt their contact had made a difference and had the results they hoped for. Most respondents (42.1%) contacted these officials by email and another 42.1% by meeting them face to face or at a public event. Respondents primarily contacted staff by phone (35.1%). Over half of respondents are comfortable contacting an elected official or their staff. Nearly a third of respondents would feel more comfortable if they had more information about contacting elected officials. Forty-nine percent indicated they would or might be interested in attending a workshop on contacting elected officials and 57.9% answered “yes” or “maybe” to their interest in attending a workshop on getting their concerns heard by elected officials. Details of respondents’ answers are located in the table to the left. Respondents were asked about issues or areas of concern they would like to discuss with elected officials. The responses are summarized at right. Eighteen respondents wrote about health care, including: • Health insurance • Single payer health care • Mental health • Universal health care • Specifically for seniors • Decline in local general practitioners • Home health in rural areas • Medicare Part D “donut hole” • National health

Number of Respondents

% of Total Respondents (57)

Yes

73.4%

24.6%

No Response

1.8%

Yes

57.9%

40.4%

No Response

1.8%

Yes

64.9%

17.5%

No response

17.5%

Yes

36.8%

14%

I do not know

26.3%

No response

22.8%

Yes

36.8%

24.6%

I do not know

15.8%

No Response

22.8%

By Email

42.1%

In person or at an event (face to face)

42.1%

By phone

35.1%

By letter

21.1%

Other

1.8%

No Response

24.6%

By phone

35.1%

By Email

24.6%

In person or at an event (face to face)

22.8%

By letter

10.5%

Other

1.8%

No Response

45.6%

Have you ever been in touch with an elected official?

Have you ever been in touch with the staff of an elected official?

If yes, was it to ask them to do something on an issue you cared about?

Do you feel that your contact made a difference?

Was the result what you hoped for?

If you have been in touch with an elected official, how did you contact them?

If you have been in touch with an elected official’s staff, how did you contact them?

ADVOCACY SURVEY

Prepared for: Area 1 Agency on Aging | Prepared by Chris Martinek Consulting

• Cost of care • Eight respondents indicated concerns about housing, including • Affordable traditional and non-traditional senior housing • Assisted living • HUD low income senior housing

Additional comments included concern about isolated older adults and the General Plan update. Problem/Concern Areas: Del Norte and Humboldt Counties Combined The survey contained a list of problems or concerns that could affect one’s quality of life. Respondents were asked to indicate which items were a problem to them personally and to what degree they were a problem. Respondents selected from three categories: no problem, minor problem, or serious problem.

Eight respondents noted concerns about the built environment or community development, including: • Aging in place • Walkability • Over development • Planned communities that address service needs in a walkable community and integrated with public transportation • Lack of planning for unincorporated areas • Building permits • Sewer issues and charges Seven respondents indicated concerns about money to live on, including: • Social Security • Protecting their union retirement • Cost of utilities • Seven respondents wrote about transportation issues, including • access to public transportation • gas prices • rural areas Seven respondents discussed environmental concerns, including: • Pollution • Water • The myth of global warming • Noise pollution • Human overpopulation and remedies • Fishing restrictions • Cleaning channel at King Salmon Five respondents wrote about the budget or economy, specifically about taxes and budget processes.

ADVOCACY SURVEY

Four respondents wrote about elder care, specifically in-home care availability and cost, and access to services. Two respondents wrote about crime, including gangs and lack of effective law enforcement Two respondents’ concerns were about equality for gay and lesbian individuals

The table below shows which problems respondents considered to be the largest. The top 10 problems are listed. The ranking reflects combined totals for “minor problem” and “serious problem”. The following table identifies what the respondents considered to be their most serious problem. The top 5 problems are listed. ●

“Minor and Serious” Problem/Concern Ranking Problem/Concern

Ranking

Number of % of Total Respondents Respondents (57)

Health Care

57.9%

Energy/Utilities

47.4%

Money to live on

23*

40.4%

Crime

40.4%

Transportation

36.8%

Obtaining information about services/benefits

20*

35.1%

Household Chores

35.1%

Accidents in the home

33.3%

Taking care of another person: adult

29.8%

Loneliness

16*

28.1%

Isolation

28.1%

*received a larger number of “Serious” Problem/Concern respondents “Serious” Problem/Concern Ranking Problem/Concern

Ranking

Number of Respondents

% of Total Respondents (57)

Health Care

42.1%

Energy/Utilities

19.3%

Money to live on

19.3%

Employment

12.3%

Crime

10.5%

Housing

10.5%

Loneliness

10.5%

Obtaining Information about services/benefits 5

10.5%

Receiving services/benefits

10.5%

Area 1 Agency on Aging Promoting Independence for a Lifetime 434 Seventh Street 52 â&#x20AC;˘ Eureka, CA â&#x20AC;˘ 95501