2014
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Community Engagement Needs Assessment
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TABLE OF CONTENTS Community and Household Demographics
4
Economy and Education
16
Health Care Access
24
Older Adult Health Indicators
32
Older Adult Chronic Conditions
38
Older Adult Mortality
42
Medicare Fee-for-Service Beneficiaries
46
Youth Health Indicators and Mortality
50
Crime and Safety
58
key informant concluSIONS
62
Appendix A: Secondary Data References
68
Appendix B: Secondary Data Terminology
69
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Report Prepared By:
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www.holleranconsult.com
Community Engagement Needs Assessment Report Background Luthercare is dedicated to improving the lives of older adults and children living in Lancaster County and Lebanon County by serving them outside of the campus’s walls. As part of their ongoing commitment to older adults and children, Luthercare initiated a comprehensive Community Engagement Needs Assessment to evaluate their health and social service needs. The Community Engagement Needs Assessment, conducted in 2014, assesses key indicators of health and well-being, including socioeconomic status, morbidity and mortality, and physical environment. The Community Engagement Needs Assessment offers a broad, but rich overview of the current status of older adults and children. Luthercare partnered with Holleran, an independent research and consulting firm located in Lancaster, Pennsylvania, to conduct community research including a Secondary Data Report, Key Informant Study, and Focus Groups. Secondary data comes from existing reputable resources, including the U.S. Census Bureau, Centers for Disease Control and Prevention (CDC), and Pennsylvania Department of Health. Secondary data represents a point in time study using the most recent data possible. When available, state and national comparisons are provided as benchmarks. Key informant testimony was gathered from 86 individuals living in and/or working in Lancaster and Lebanon Counties. Their testimony is referred to as the “Community Perspective” within the report. Key informants represented a variety of sectors, including public health and medical services, non-profit and social organizations, and faith-based organizations. The following tables detail the counties and sectors represented by key informants. It is important to note that key informant testimony reflects the perceptions of some community leaders, but may not necessarily represent all community leaders. Focus Group discussions were also held with community stakeholders and seniors to gather qualitative feedback on two key areas of identified need: mental health and social isolation among seniors and intergenerational opportunities. The completion of the Community Engagement Needs Assessment enables Luthercare to take an in-depth look at the issues facing older adults and children. Luthercare will use data from the Secondary Data Report in conjunction with results from a Key Informant Study and Focus Group Discussions to both inform and engage the greater community in a collective initiative to improve the overall quality of life of older adults and children. The following report summarizes the findings of the secondary data statistics, key informant testimony and focus group discussions.
Luthercare’s Mission Statement: HOL L ERA N
Luthercare reflects Christ’s love through service to others
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COMMUNITY and HOUSEHOLD DEMOGRAPHICS In this section: Overall Population Age-Specific Population Estimates Veteran and Disability Status Housing Tenure and Value Household Status
The total projected growth among older adults from 2014 to 2019 is approximately 9% in both counties.
Overall Population Lancaster County and Lebanon County comprise 2 of
growth of 2.3% is projected by 2019. Lebanon County
the 67 counties in Pennsylvania and sit in the southeast
is the 27th most populated county in the state with
portion of the state. Lancaster County is the 6th
an estimated population of 136,381. The population in
most populated county in the state with an estimated
Lebanon County increased by 2.1% from 2010, and an
population of 531,198. The population in Lancaster
additional growth of 2.3% is projected by 2019.
County increased by 2.3% from 2010, and an additional Lancaster County
Lebanon County
Table 1. Total County Population (2014; 2019) Lancaster County Lebanon County 2014 Estimate Growth 2010 – 2014 2019 Projection Growth 2014 - 2019
531,198
136,381
2.3%
2.1%
543,548
139,462
2.3%
2.3%
Age-Specific Population Estimates Older adults (55 years and over) account for 28.8% of
of 3,955 people). The total projected growth among
the current population in Lancaster County and 31.8%
older adults from 2014 to 2019 is approximately 9% in
of the current population in Lebanon County. By 2019,
both counties. The largest growth will be in the 65 to
older adults will account for 30.6% of the population
74 year old age group and will result in an increase of
in Lancaster County (increase of 13,776 people) and
8,900 people in Lancaster County and 2,884 people in
33.9% of the population in Lebanon County (increase
Lebanon County.
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Older adults
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Table 2. Older Adult Population by Age (2014; 2019) Lancaster County Lebanon County
2014 Estimate
2019 Projection
2014 Estimate
2019 Projection
152,818
166,594
43,370
47,325
Age 55-64
44.4%
42.4%
42.8%
40.2%
Age 65-74
29.0%
31.9%
29.9%
33.5%
Age 75-84
17.5%
16.7%
18.2%
17.3%
Age 85 and Over
9.2%
9.0%
9.0%
8.9%
Total Population Aged 55 and Over
The older adult population age 65 years and over in
and Lebanon County respectively are White. The
Lancaster County and Lebanon County is primarily
percentage is projected to decrease by 0.9% in
White and English speaking. The following table
both counties by 2019, resulting in slightly higher
presents the racial/ethnic proportions for the older
proportions for other racial groups. The Hispanic/
adult population in both counties. Currently, 95.9%
Latino older adult population is also projected to grow
and 97.4% of older adults in Lancaster County
in both counties by approximately 1%.
Table 3. Older Adult Population by Race/Ethnicity, Population 65 Years and Over (2014; 2019) Lancaster County Lebanon County 2014 Estimate 2019 Projection 2014 Estimate 2019 Projection White
95.9%
95.0%
97.4%
96.5%
1.6%
1.9%
0.6%
0.7%
0.1%
0.1%
0.1%
0.2%
1.0%
1.2%
0.6%
0.8%
0.0%
0.0%
0.0%
0.0%
Some Other Race
1.0%
1.3%
0.9%
1.3%
Two or More Races
0.4%
0.6%
0.4%
0.4%
Hispanic or Latino
2.7%
3.4%
2.9%
3.9%
Black or African American American Indian and Alaska Native Asian Native Hawaiian and Other Pacific Islander
As shown in Figure 1, more than 90% of older adults in
adults and older adults across Pennsylvania to speak
both counties currently speak English as their
another language, but 91.7% still consider English
primary language. Lancaster County older adults are
to be their primary language.
slightly more likely than Lebanon County older
Language Other than English Spoken at home Figure 1. Population 60 Years and Over, 2008 – 2012 Lebanon County
6.3%
Lancaster County
8.3%
7.0%
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Pennsylvania
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U.S.
14.4%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
Youth The youth population (19 years and younger) is
the youth population is projected to grow by 0.8% in
144,422 or approximately 28% of the total population
Lancaster County and decrease by 7.9% in Lebanon
in Lancaster County and 34,035 or approximately 25%
County. The largest population change in both
of the total population in Lebanon County. By 2020,
counties will be in the 0 – 4-year-old age group.
Table 4. Youth Population by Age (2008 – 2012; 2020) Lancaster County Lebanon County 2008-2012 Estimate 2020 Projection 2008-2012 Estimate 2020 Projection Total Population 19 Years
144,422
145,602
34,035
31,333
Age 0 – 4
24.5%
26.5%
24.7%
25.7%
Age 5 – 9
24.4%
24.8%
25.4%
24.7%
Age 10 – 14
24.8%
23.4%
24.5%
24.0%
Age 15 – 19
26.4%
25.2%
25.0%
25.6%
and Under
The youth population in Lancaster County and
County and Lebanon County respectively are White.
Lebanon County is primarily White. However, the
The second most prevalent racial group in both
percentage of White youth is notably less than the
counties is Black or African American. In addition,
percentage of White older adults in both counties.
13.4% of all Lancaster County youth and 16% of all
Currently, 85.6% and 81.9% of youth in Lancaster
Lebanon County youth are Hispanic/Latino.
Table 5. Youth Population by Race/Ethnicity, Population Under 18 Years (2008 – 2012)
White
85.6%
81.9%
Black or African American
4.4%
2.4%
American Indian and Alaska Native 0.3%
0.0%
Asian
2.1%
1.0%
Native Hawaiian and Other Pacific Islander
0.1%
0.0%
Some Other Race
3.3%
7.7%
Two or More Races
4.3%
7.0%
Hispanic or Latino
13.4%
16.0%
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Lancaster County Lebanon County
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Veteran and Disability Status Older adults Approximately 21% of Lancaster County and Lebanon
older adults is lower than both Pennsylvania (35.3%)
County older adults are veterans and approximately
and the nation (36.4%). The types of disabilities that
30% to 32% are disabled. The percentage of veterans
affect the most Lancaster County and Lebanon County
is similar to the percentage across the state (22.9%)
older adults are ambulatory disabilities, independent
and the nation (21.7%). The percentage of disabled
living disabilities, and hearing disabilities.
Table 6. Veteran Population, Population 60 Years and Over (2008 - 2012) United States Pennsylvania Lancaster County Lebanon County
21.7%
22.9%
20.7%
21.7%
Table 7. Disabled Population, Population 65 Years and Over (2010 - 2012) United States Pennsylvania Lancaster County Lebanon County Population with a Disability
36.4%
35.3%
31.6%
30.2%
Hearing Disability
14.9%
14.6%
13.9%
13.3%
Vision Disability
6.7%
6.1%
4.5%
3.9%
Cognitive Disability
9.4%
8.4%
7.4%
5.7%
Ambulatory Disability
23.5%
22.1%
18.9%
16.2%
Self-Care Disability
8.8%
7.8%
6.6%
5.8%
Independent Living Disability
16.1%
15.8%
13.8%
13.4%
Another measure of disability is the percentage of the
years and over require the use of special equipment,
population with a health problem that requires the
which is slightly lower than statewide percentages. In
use of special equipment. Special equipment includes
Lebanon County, 8% of the population age 45 to 64
a cane, a wheelchair, a special bed, or a special
years and 18% of the population age 65 years and over
telephone. In Lancaster County, 7% of the population
require the use of special equipment, which is identical
age 45 to 64 years and 16% of the population age 65
to statewide percentages.
Table 8. Population with a Health Problem that Requires the Use of Special Equipment (2010 – 2012) Pennsylvania Lancaster County Lebanon County Population Age 45 – 64
8.0%
7.0%
8.0%
Population Age 65 and Over
18.0%
16.0%
18.0%
Youth Youth are also prone to disability, but at a much lower rate compared to older adults. Less than 1% of the population under 5 years and approximately 6% of the population age 5 to 17 years has a disability in both Lancaster County and Lebanon County. The most prevalent disability among youth age 5 to 17 years is HOL L ERA N
a cognitive disability.
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Table 9. Disabled Population, Population Under 18 Years (2010 - 2012) United States Pennsylvania Lancaster County Lebanon County Population Under 5 Years
0.8%
0.8%
0.8%
0.5%
Hearing Disability
0.6%
0.5%
0.6%
0.0%
Vision Disability
0.5%
0.4%
0.5%
0.5%
Population 5 to 17 Years
5.2%
6.4%
5.8%
6.0%
Hearing Disability
0.6%
0.6%
0.6%
0.4%
Vision Disability
0.8%
0.8%
0.9%
0.4%
Cognitive Disability
3.9%
5.1%
4.6%
4.5%
Ambulatory Disability
0.6%
0.6%
0.6%
0.5%
Self-Care Disability
0.9%
1.1%
1.1%
0.6%
Housing Tenure and Value Older Adults In general, the majority of older adults in Lancaster
percentage of Lebanon County owners spending more
County and Lebanon County own their residences
than 30% of their income on housing (23.9%) is even
(76% and 79% respectively). However, the percentage
lower. Thirty-percent of a household’s total income
of older adults who rent their residences is slightly
is considered the cutoff for housing-cost burden and
higher in Lancaster County (24.2%) when compared to
avoiding financial hardship.
Lebanon County (21%), Pennsylvania (21.6%) and the nation (21%). The median home value is also higher in
The cost for older adults to rent a household differs
Lancaster County and may contribute to the reason
between the 2 counties. The median rent in Lancaster
why fewer older adults own their residences. The
County is $867, which is higher when compared to
median home value in Lancaster County is $181,600
the state ($678) and the nation ($745). Conversely,
compared to $156,600 in Lebanon County. The median
the median rent in Lebanon County is $666, which
monthly cost to own a home is also higher in Lancaster
is lower when compared to the state and the nation.
County for older adults with and without a mortgage.
However, renter costs are not proportional to income
Although owner costs are higher in Lancaster County,
in either county. Nearly 60% of older adult renters in
the percentage of owners spending more than 30% of
both counties spend 30% or more of their income on
their income on housing (26.5%) is less compared to
rent. The percentage across the state and the nation is
Pennsylvania (27.3%) and the nation (28.2%). The
closer to 50%.
Table 10. Housing Tenure, Population 60 Years and Over (2008 – 2012) United States Pennsylvania Lancaster County Lebanon County Older Adults Who Own Their Residences
79.0%
78.4%
75.8%
79.0%
Older Adults Who Rent Their Residences
21.0%
21.6%
24.2%
21.0%
Table 11. Housing Value and Costs, Population 60 Years and Over (2008 – 2012) United States Pennsylvania Lancaster County Lebanon County Median Home Value Median Monthly Owner Costs
$171,200
$152,900
$181,600
$156,600
$1,370
$1,259
$1,345
$1,232
$447
$484
$511
$472
$745
$678
$867
$666
Median Monthly Owner Costs Without a Mortgage Median Rent
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With a Mortgage
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Housing Costs Greater than or Equal to 30% of Income 23.9% 26.5%
Owner-Occupied
Figure 2. Population 60 Years and Over, 2008 – 2012
27.3% 28.2%
57.2% 55.9%
Renter-Occupied
50.0% 52.7%
0.0%
10.0%
20.0%
Lebanon County
30.0%
40.0%
50.0%
Lancaster County
60.0%
Pennsylvania
U.S.
Youth Approximately 70% of youth in Lancaster County and
conduct a point-in-time count of homeless individuals
Lebanon County live in an owner-occupied residence.
and families. Lancaster County conducted the count
The percentage is consistent with the state percentage
in January of 2013 and reported 162 homeless youth in
(70.7%) and higher than the national percentage
families. The count is down 10% from 2012, when 180
(62.8%). However, the above percentage only includes
homeless children were reported. A similar count for
youth who live in a documented residence; homeless
Lebanon County is not available.
youth are not included. Each year, several communities
Table 12. Housing Tenure, Population Under 18 Years (2008 – 2012) United States Pennsylvania Lancaster County Lebanon County Children Living in Owner-Occupied Housing Units
62.8%
70.7%
71.4%
69.9%
Children Living in Renter-Occupied Housing Units
37.2%
29.3%
28.6%
30.1%
Household Status Older Adults Households are identified as either family households
approximately 9,200 people. In Lebanon County,
or non-family households. In Lancaster County and
the percentage equates to approximately 3,000
Lebanon County, a higher percentage of households
people. In regard to marital status, Lancaster County
are family households (approximately 60%) when
and Lebanon County older adults are more likely to
compared to the state (55%) and the nation (56.9%).
currently be married (64.7% and 62.9% respectively)
However, it is still estimated that approximately 37% to
and less likely to be widowed, divorced, or never
39% of older adults living in non-family households in
married when compared to older adults across
Lancaster County and Lebanon County live alone.
Pennsylvania and the nation.
In Lancaster County, the percentage equates to
Table 13. Households by Type, Population 60 Years and Over (2008 - 2012) United States Pennsylvania Lancaster County Lebanon County
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Households
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35,040,626
1,679,235
62,854
18,442
Family Households
56.9%
55.0%
60.5%
58.6%
Non-Family Households
43.1%
45.0%
39.5%
41.4%
Householder Living Alone
40.4%
42.6%
37.1%
38.8%
Table 14. Marital Status, Population 60 Years and Over (2008 – 2012) United States Pennsylvania Lancaster County Lebanon County Now Married, except separated
57.9%
56.5%
64.7%
62.9%
Widowed
22.2%
24.6%
20.8%
22.4%
Divorced
13.1%
10.7%
8.8%
10.0%
Never Married
5.4%
6.8%
4.9%
4.1%
Approximately 3% of seniors live with one or more
are lower when compared to Pennsylvania (3.8%
grandchildren under 18 years and less than 1% of seniors
and 1% respectively) and the nation (5.4% and 1.6%
are responsible for grandchildren. These percentages
respectively).
Table 15. Population 60 Years and Over Responsible for Grandchildren Under 18 Years (2008 - 2012) United States Pennsylvania Lancaster County Lebanon County Living with Grandchild(ren)
5.4%
3.8%
3.2%
2.6%
Responsible for Grandchild(ren)
1.6%
1.0%
0.7%
0.7%
Youth A youth’s relationship to the householder is an indicator
Pennsylvania (90.5%) and the nation (88.9%). Five
of the stability of their living situation. In Lancaster
percent or less of children are the grandchild of a
County and Lebanon County, approximately 92% of
householder and less than 3% are a relative or foster
children live with a parent (biological, step, or adopted).
child of a householder.
The percentage is higher when compared to
Table 16. Youth Relationship to Householder, Population Under 18 Years (2008 – 2012)
Own child (biological, step or adopted)
88.9%
90.5%
92.2%
92.9%
Grandchild
7.2%
6.4%
5.0%
4.1%
Other relatives
2.3%
1.5%
1.3%
1.7%
Foster child or other unrelated child
1.6%
1.6%
1.5%
1.2%
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United States Pennsylvania Lancaster County Lebanon County
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Community Perspective Older adults Key informants were asked to comment on individuals
the community face, according to key informants. The
facing life transitions such as retirement or moving to a
most common transition decisions in the community
personal care home and the services available to assist
are providing caregiving services to aging parents,
with transitions. The following table represents the
downsizing, and retiring.
types of transition decisions that individuals in Percent
Count Percent
Providing caregiving services to aging parents
43
50.6%
Downsizing to smaller home with less home/yard maintenance
31
36.5%
Retiring
31
36.5%
Seeking Home and Community-Based Services to support aging in place
30
35.3%
Moving to Independent Living Community or Continuing Care Retirement Community
29
34.1%
Moving to a Personal Care Home, Assisted Living Facility, or Nursing Home
27
31.8%
Receiving Hospice or Palliative Care
23
27.1%
Elderly parents moving into their adult child’s home
16
18.8%
No/Not Applicable
15
17.6%
Attending an Adult Daycare
6
Total
251
7.1%
Among the key informants who were aware of
age-friendly communities is supported by both the
individuals facing transition decisions, 34% stated
World Health Organization (WHO) and AARP.
that individuals are able to easily find information on available services and options related to life
Key informants first rated statements related to age-
transitions. One key informant commented, “The
friendly housing and transportation. Housing and
system is cumbersome, and if they do find services,
transportation statements addressed the availability
many times seniors and their families seem surprised
of affordable housing options, affordable support
that they need to pay for services, if they have the
services to age in place, public transportation,
means to. It is an interesting test of wills.” Another
community transport services, and specialized
key informant stated, “Although there is a glut
transportation services for people with disabilities.
of services (providers) in our market, the sheer
The availability of services according to key informants
complexity of what services are available is daunting,
varies. Approximately 50% of key informants either
let alone the matrix of government and private touch-
“disagreed” or “strongly disagreed” that affordable
points for information.”
housing, affordable support services for aging in place, and public transportation are available in the
Key informants were also asked to rate how age-
community. Approximately 40% of key informants
friendly the community is. An age-friendly community
either “disagreed” or “strongly disagreed” that
encourages active aging by optimizing opportunities
community transport services and specialized
for health, participation, and security in order to
transportation are available in the community.
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enhance quality of life as people age. The concept of
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The most common transition decisions in the community are providing caregiving services to aging parents, downsizing and retiring.
Statement
Strongly Disagree Neither Agree Strongly Mean Disagree Agree nor Agree Disagree
There are a variety of appropriate, affordable housing options available in the area for older people.
5.1%
47.4%
20.5%
25.6%
1.3%
2.7
Affordable support services are available to enable older people to remain at home, to “age in place.”
5.3%
44.7%
22.4%
27.6%
0.0%
2.7
Public transportation is available for older people to reach key destinations such as hospitals, health centers, grocery stores, shopping centers, banks, senior centers, and parks.
9.0%
42.3%
12.8%
33.3%
2.6%
2.8
In areas where public transportation is limited, community transport services, including volunteer drivers and shuttle services, are available to older people.
8.2%
28.8%
31.5%
30.1%
1.4%
2.9
Sufficient specialized transportation services are available for people with disabilities.
6.8%
33.8%
25.7%
32.4%
1.4%
2.9
Key informants then rated statements related to age-
activities. According to key informants, community
friendly social and civic participation opportunities.
activities and volunteering opportunities are the
Social and civic participation statements addressed
most readily available within the community to older
the availability of suitable community activities, well-
adults. Approximately 50% of key informants either
maintained green spaces and pedestrian-friendly
“disagreed” or “strongly disagreed” that other social
walkways, volunteer opportunities, employment
and civic participation opportunities are available.
opportunities, and opportunities for inter-generational
Strongly Disagree Neither Agree Strongly Mean Disagree Agree nor Agree Disagree
A wide variety of community activities are available to appeal to a diverse population of older people.
1.3%
29.3%
26.7%
37.3%
5.3%
3.2
Safe and well-maintained green spaces and pedestrianfriendly walkways are easily accessible to older people.
5.3%
49.3%
18.7%
24.0%
2.7%
2.7
There are flexible volunteer opportunities for older people available in the community.
3.9%
11.8%
22.4%
56.6%
5.3%
3.5
There are flexible employment opportunities for older people available in the community.
5.8%
42.0%
27.5%
23.2%
1.4%
2.7
Older people are provided opportunities to share their knowledge, history and expertise with other generations.
3.9%
40.8%
30.3%
22.4%
2.6%
2.8
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Statement
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Key informants then rated statements related to the
age-friendly communities overall. When asked what
availability of age-friendly community and health
they would like to see in the communities to make
services. Community and health services statements
them better places for seniors/elderly to live, one
addressed the availability of support services to
respondent stated, “I believe more affordable housing
promote and maintain health, home care services,
and affordable support services as well as more age-
community emergency planning, and an effective
friendly transportation are needed as our population
communication system. In general, key informants
ages. Within the next two years, one in three adults in
agreed that health and community support services
Lebanon County will be over age 65. Our community
and home care services are available in the community.
needs to prepare not only for those who can afford
However, less than 35% of key informants said that
the many available living and support options, but
there is effective community emergency planning and
those aging adults who cannot.” Another respondent
a communication system that reaches residents of
stated, “Information sharing that is not from one
all ages.
entity, but is a resource of providers of reliable and affordable service options for differing needs of
Lastly, key informants rated the overall age-
seniors. i.e. maintenance, cleaning, home care, home
friendliness of the community. Forty-eight percent
health, transportation, caregiver support, food, moving,
of key informants “agreed” or “strongly agreed”
housing, etc. This could include a flier to homes, a local
that Lancaster County and Lebanon County are
internet site, and other sources.”
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Statement
14
Strongly Disagree Neither Agree Strongly Mean Disagree Agree nor Agree Disagree
A range of health and community support services is offered for promoting and maintaining health.
0.0%
10.7%
18.7%
66.7%
4.0%
3.6
Home care services are offered that include health services, personal care, and housekeeping.
1.4%
5.5%
23.3%
63.0%
6.8%
3.7
Community emergency planning takes into account the vulnerabilities and capacities of older people.
3.2%
29.0%
35.5%
27.4%
4.8%
3.0
The community has an effective communication system that reaches residents of all ages.
2.9%
42.6%
30.9%
20.6%
2.9%
2.8
Overall, I believe the local community is an age-friendly community.
2.7%
19.2%
30.1%
43.8%
4.1%
3.3
Youth Key informants were asked to rate statements
they would like to see in the community to make it
regarding support systems in place for children and
a better place for children and their families to live,
their families. The statements addressed the value
one respondent stated, “Mentorship – many programs
placed on early childcare and education and the
are in place such as parenting classes, but there is
availability of information, resources, and support
still a need for mentoring both children and adults on
services for parents in the community. Sixty-five
how to take pride in themselves and care about their
percent of key informants either “agreed” or “strongly
community which all feeds into better parenting and
agreed” that early childcare and education is valued
becoming a productive member of society.” Another
in the community. However, less than 40% of key
respondent stated, “Financial support for early
informants either “agreed” or “strongly agreed”
childhood education for low-income families. Increased
that parents are able to easily access information,
mentoring programs, greater awareness and screening
resources, and support services and less than 50% of
related to child sexual assault. Increased state funding
key informants either “agreed” or “strongly agreed”
for K-12 education. Access to low-cost healthy foods
that the community has strong systems to support
for all.”
children and their families overall. When asked what
Statement
Strongly Disagree Neither Agree Strongly Mean Disagree Agree nor Agree Disagree
People in the community value the importance of Early Childcare and Education/Early Care and Education.
2.8%
13.9%
18.1%
51.4%
13.9%
3.6
Parents in the community are able to easily access information, resources, and support services.
2.9%
28.6%
32.9%
30.0%
5.7%
3.1
Overall, the community has strong systems to support children and their families.
4.2%
16.9%
35.2%
39.4%
4.2%
3.2
HOL L ERA N
Forty-eight percent of key informants “agreed” or “strongly agreed” that Lancaster County and Lebanon County are agefriendly communities overall.
15
16
ECONOMY and EDUCATION In this section: Income and Earnings Poverty Status Employment
HOL L ERA N
Education and Child Care
16
In general, Lancaster County older adults are more likely to still earn an income while Lebanon County older adults are just as likely to still earn an income when compared to Pennsylvania and the nation.
Income and Earnings Older adults The following table depicts the percentage of older
Pennsylvania ($54,917) and the nation ($59,465). The
adult households that earn an income and/or collect
percentage of older adult households in Lancaster
from secondary sources, like Social Security, cash
County and Lebanon County with a secondary source
public assistance, or retirement savings. In general,
of income is generally lower when compared to the
Lancaster County older adults are more likely to still
state and the nation. In particular, less than 5% of
earn an income while Lebanon County older adults are
older adult households receive Food Stamp/SNAP
just as likely to still earn an income when compared
benefits compared to approximately 8% of older adult
to Pennsylvania and the nation. However, the mean
households across Pennsylvania and the nation. The
earnings of older adult households in both counties
exception is the percentage of Lebanon County older
is lower ($48,590 in Lancaster County and $45,277 in
adult households that receive Social Security income
Lebanon County) when compared to
and retirement income.
Table 17. Household Earnings, Population 60 years and Over (2008 – 2012)
Households with Earnings
46.1%
44.1%
48.9%
45.4%
$59,465
$54,917
$48,590
$45,277
76.8%
79.4%
78.0%
81.7%
$17,655
$18,003
$19,227
$18,209
6.0%
5.3%
3.6%
4.0%
$8,765
$9,097
$10,315
$8,988
1.8%
2.5%
1.4%
1.9%
Mean Income
$3,803
$2,543
$3,693
$3,841
Households with Retirement Income
44.5%
47.4%
44.3%
51.5%
$23,804
$19,779
$20,759
$18,708
7.9%
7.5%
4.5%
4.7%
Mean Earnings Households with Social Security Income Mean Income Households with Supplemental Security Income Mean Income Households with Cash Public Assistance Income
Mean Income Households with Food Stamp/SNAP Benefits
HOL L ERA N
United States Pennsylvania Lancaster County Lebanon County
17
The median household income for older adults in
In particular, the median income for householders age
Lancaster County and Lebanon County is projected
55 to 64 years will notably increase by approximately
to increase between 2014 and 2019 for all age groups.
$6,400 to $7,300.
Table 18. Older Adult Median Household Income Estimates and Projections (2014; 2019) Lancaster County Lebanon County
2014 Estimate
2019 Projection
2014 Estimate
2019 Projection
Householder Age 55 – 64
$63,718
$70,156
$62,509
$69,851
Householder Age 65 – 74
$42,340
$45,864
$46,948
$51,011
Householder Age 75 – 84
$30,440
$32,135
$33,122
$35,638
Householder Age 85 and Over $24,387
$25,722
$25,734
$28,054
Youth The following tables depict the financial security of
median family income, a notably lower percentage
families with children. The median family income for
of households in Lancaster County receive public
Lancaster County and Lebanon County is $66,669 and
assistance (17%) when compared to Lebanon County
$63,484 respectively. In addition to having a higher
(23.6%), the state (24.4%), and the nation (25.1%).
Table 19. Median Income and Receipt of Public Assistance for Families with Children (2008 – 2012) United States Pennsylvania Lancaster County Lebanon County Median Family Income in Past 12 months
$61,694
$65,788
$66,669
$63,484
Households Receiving Public Assistance*
25.1%
24.4%
17.0%
23.6%
* Public Assistance includes Supplemental Security Income, Cash Public Assistance, or Food Stamp/SNAP Benefits
The Temporary Assistance for Needy Families
for youth age 0 to 17 years is 3,387. The highest
(TANF) program is designed to help needy families
enrollment is among youth age 3 to 8 years. In
become self-sufficient through assistance, promotion
Lebanon County, total TANF enrollment for youth age
of job preparation, prevention of out-of-wedlock
0 to 17 years is 749. The highest enrollment is among
pregnancies, and encouragement of two-parent
youth age 0 to 4 years.
families. In Lancaster County, total TANF enrollment
Table 20. Temporary Assistance for Needy Families (TANF) Enrollment (2013) Lancaster County Lebanon County
HOL L ERA N
Total TANF Enrollment
18
3,387
749
Age 0 – 2
24.8%
25.9%
Age 3 – 4
14.8%
15.5%
Age 5 – 8
25.2%
24.2%
Age 9 – 11
13.6%
13.2%
Age 12 – 14
11.2%
9.9%
Age 15 – 17
10.4%
11.3%
Older adults in Lancaster County and Lebanon County are less likely to live in poverty when compared to older adults across Pennsylvania and the nation, as determined by the federal poverty level. The Supplemental Nutrition Assistance Program
The highest enrollment is among youth age 5 to 11
(SNAP), more commonly known as Food Stamps, is
years. In Lebanon County, total SNAP enrollment for
designed to offer nutrition assistance to low-income
youth age 0 to 17 years is 7,687. The highest enrollment
individuals and families. In Lancaster County, total
is also among youth age 5 to 11 years.
SNAP enrollment for youth age 0 to 17 years is 23,810.
Table 21. Food Stamp (SNAP) Enrollment (2013) Lancaster County Lebanon County Total SNAP Enrollment
23,810
7,687
Age 0 – 2
17.7%
18.0%
Age 3 – 4
13.3%
13.4%
Age 5 – 8
25.5%
25.2%
Age 9 – 11
16.3%
16.7%
Age 12 – 14
14.8%
14.0%
Age 15 – 17
12.4%
12.7%
Poverty Status Older Adults Older adults in Lancaster County and Lebanon County
Households that are at 100% to 149% of the poverty
are less likely to live in poverty when compared to
level have an income that is 1.0 to 1.49 times the
older adults across Pennsylvania and the nation, as
necessary dollar amount. In Lancaster County, 6.5% of
determined by the federal poverty level. The federal
older adults have an income below the federal poverty
poverty level represents the estimated dollar amount
level and 8.5% have an income that is 1.0 to 1.49 times
below which a household has insufficient income to
the federal poverty level. These percentages equate
meet minimal basic needs. The federal poverty level
to nearly 16,000 people. In Lebanon County, 6.4% of
may also be reported as a percentage. For example,
older adults have an income below the federal poverty
households that are below 100% of the poverty level
level and 9.9% have an income that is 1.0 to 1.49 times
have an income that is less than the dollar amount that
the federal poverty level. These percentages equate to
is deemed necessary to sustain basic needs.
approximately 5,000 people.
Table 22. Poverty Status in the Past 12 Months, Population 60 Years and Over (2008 – 2012)
Population Below 100% of the Poverty Level
9.5%
8.4%
6.5%
6.4%
Population At 100% to 149% of the Poverty Level
9.9%
10.0%
8.5%
9.9%
80.7%
81.5%
85.0%
83.7%
Population At or Above 150% of the Poverty Level
HOL L ERA N
United States Pennsylvania Lancaster County Lebanon County
19
Youth In general, poverty is more prevalent among youth
Lebanon County youth are more likely to live in a
than older adults. In Lancaster County and Lebanon
household with an income below the federal poverty
County, the percentage of youth that live in a
level. Overall, 39.4% of Lancaster County youth and
household below 200% of the federal poverty level
39.3% of Lebanon County youth live in a household
is nearly equal. However, Lancaster County youth are
with an income that is less than or equal to 199% of
more likely to live in a household with an income that
the federal poverty level. These percentages equate to
is 1.0 to 1.99 times the federal poverty level and
approximately 50,600 and 12,000 youth respectively.
Table 23. Poverty Status in the Past 12 Months, Population Under 18 Years (2010 – 2012) United States Pennsylvania Lancaster County Lebanon County Children in Households Below 100% of the Poverty Level
21.6%
18.7%
15.3%
18.6%
22.3%
20.1%
24.1%
20.7%
56.1%
61.1%
60.6%
60.7%
Children in Households at 100% to 199% of the Poverty Level Children in Households at 200% of the Poverty Level and Over
Population Under 18 Years Living in Poverty Lebanon County
18.6%
Lancaster County
15.3%
Pennsylvania
Figure 3. Population Under 18 Years Below 100% of the Poverty Level, 2008 – 2012
18.7%
U.S.
21.6%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
Employment
HOL L ERA N
Older Adults
20
The following table depicts the employment status of
for adults age 65 to 74 years and 3.7% for adults age
Lancaster County and Lebanon County older adults.
75 years and over. In Lebanon County, approximately
In Lancaster County, approximately 31% of adults age
26% of adults age 65 to 74 years and 7% of adults
65 to 74 years and 8% of adults age 75 and over are
age 75 and over are currently in the labor force. The
currently in the labor force. The combined percentage
combined percentage is higher than both the state and
is higher than both the state and the nation and
the nation but not as high as Lancaster County. Among
corresponds to an earlier finding that a higher
Lebanon County older adults who are actively seeking
percentage of households are still earning an income.
employment, the unemployment rate is 4.5% for adults
Among Lancaster County older adults who are actively
age 65 to 74 years and 5.9% for adults age 75 years
seeking employment, the unemployment rate is 5.7%
and over.
Table 24. Employment Status, Population 65 Years and Over (2008 – 2012) United States Pennsylvania Lancaster County Lebanon County Age 65 to 74 Years in Labor Force
25.0%
25.4%
30.6%
25.8%
Unemployed Civilian Labor Force
6.5%
6.1%
5.7%
4.5%
Age 75 and Over Years In Labor Force
5.8%
5.5%
7.9%
6.8%
Unemployed Civilian Labor Force
5.8%
5.7%
3.7%
5.9%
Youth The following table depicts the unemployment status
of 24.9%. The percentage of unemployed single fathers
of two-parent and single-parent families. In both
is slightly higher in Lancaster County (14.6%) but lower
counties, unemployment is highest among single
in Lebanon County (8.7%) when compared to the state
mothers; however, both fall below the state percentage
(13.4%).
Table 25. Parental Unemployment Status, Population Under 18 Years (2010 – 2012) Pennsylvania Lancaster County Lebanon County Two Parents, Neither In Labor Force
1.7%
1.0%
1.5%
Single Father, Not In Labor Force
13.4%
14.6%
8.7%
Single Mother, Not In Labor Force
24.9%
21.6%
20.9%
Education and Child Care In general, Lancaster County and Lebanon County
for Lancaster County (41.2%) falls below the
older adults are more likely to graduate from high
state percentage of 43.4% but above the national
school and less likely to attain a bachelor’s degree
percentage of 32.4%. In relation to higher education,
or higher, particularly when compared to the nation.
the percentage of graduates in Lancaster County
Lebanon County has the highest percentage of high
(19.2%) and Lebanon County (15.3%) is lower than both
school graduates (48%), while the percentage
the state (19.7%) and the nation (24%).
HOL L ERA N
Older Adults
21
Educational Attainment High School Graduate Or Higher
48.0% 41.2%
Figure 4. Population 60 Years and Over, 2008 – 2012
43.4% 32.4%
Bachelor’s Degree Or Higher
15.3% 19.2% 19.7% 24.0%
0.0%
10.0%
20.0%
Lebanon County
30.0%
40.0%
50.0%
Lancaster County
60.0%
Pennsylvania
U.S.
Youth School enrollment is lower in Lancaster County
state and the nation are 90.5% and 90.4% respectively.
and Lebanon County for children age 3 to 17 years.
Another factor of note is the high percentage of
Approximately 86% of children in Lancaster County
Lancaster County children who are enrolled in private
are enrolled in school and 88% of children in Lebanon
school (24.3%) versus public school (75.7%).
County are enrolled in school. The percentage for the
Table 26. School Enrollment, Population 3 to 17 Years (2008 – 2012) United States Pennsylvania Lancaster County Lebanon County Enrolled in School
90.4%
90.5%
86.1%
88.0%
Public
86.7%
82.3%
75.7%
83.6%
Private
13.3%
17.7%
24.3%
16.4%
Not Enrolled in School
9.6%
9.5%
13.9%
12.0%
The Head Start Program is a federal program providing
Publicly funded pre-kindergarten is another federal
early childhood education, health, nutrition, and parent
early childhood education support program for low-
involvement services to low-income children and their
income children and their families. It is available to
families. Early Head Start begins to serve families
children age 3 to 4 years who live in a household with
during pregnancy and continues through the program
an income below 300% of the federal poverty level.
year in which a child turns 3. Head Start-Federal
In Lancaster County, 85.1% of eligible children are not
and Head Start-State serve children age 3 years to
served by the program and in Lebanon County, 63.8%
kindergarten. In Lancaster County, 827 children are
of eligible children are not served by the program.
served by the program and almost all are served by Head Start-Federal. In Lebanon County, 469 children are served by the program; approximately half are served by Head Start-Federal.
Table 27. Children Served by Head Start Program (2012 – 2013)
HOL L ERA N
Lancaster County Lebanon County
22
Total Children Served
827
469
Early Head Start
0.0%
13.6%
Head Start – Federal
97.9%
51.8%
2.1%
34.5%
Head Start – State
Table 28. Unserved Children Eligible for Publicly Funded Pre-Kindergarten (2012 – 2013) Lancaster County Lebanon County Children Age 3 – 4 Years Below 300%
85.1%
Poverty Level Who Are Not Served by
63.8%
Publicly Funded Pre-K
Table 29. Availability of High-Quality Child Care (2013)* Lancaster County Lebanon County Early Child Care: Ages 0 – 4
6.2%
3.1%
School Age: Ages 5 – 12
2.4%
0.4%
*Percent is calculated by dividing the number of child care spaces available by the number of children needing child care (i.e. all parents in labor force).
The ability to access child care, particularly high-
In Lancaster County and Lebanon County, the
quality child care, is essential to early childhood
availability of high-quality child care is low. In
development. High-quality child care facilities
Lancaster County, only 6.2% of early child care and
are defined as being accredited by the National
2.4% of school age care is high quality. In Lebanon
Association for the Education of Young Children
County, only 3.1% of early child care and 0.4% of
(NAEYC), National Association for Family Child Care
school age care is high quality. In addition, the
(NAFCC), National After School Association (NAA),
percentage of children receiving subsidized child care
National Early Childhood Program Accreditation
in Keystone STARS 3 or 4 facilities is only 43.4% in
(NECPA) or STAR 4 rating through Keystone STARS.
Lancaster County and 33.5% in Lebanon County.
Table 30. Monthly Average Number of Children in Subsidized Child Care (2012 – 2013) Lancaster County Lebanon County Total Children in Subsidized Child Care
3,098
605
Infant
5.0%
4.8%
Young Toddler
10.7%
10.1%
Older Toddler
11.8%
11.7%
Preschool
32.3%
32.1%
Young School-Age
29.7%
31.9%
Older School-Age
10.6%
9.4%
Table 31. Children Receiving Subsidized Child Care in Keystone STARS 3 or 4 Facilities (June 2013)* Lancaster County Lebanon County
43.4%
33.5%
HOL L ERA N
*Keystone STARS is a set of performance standards for early learning facilities. STARS 3 and 4 represent the top standards for staff qualifications and professional development, early learning programs, partnerships with family and community, and leadership and management.
23
24
HEALTH CARE ACCESS
In this section: Health Insurance Coverage Health Care Provider Access
Lancaster County and Lebanon County older adults are more likely to be uninsured (1.9% and 1.1% respectively) when compared to Pennsylvania (0.5%) and the nation (0.9%).
Health Insurance Coverage Older Adults Lancaster County and Lebanon County older adults
County. In addition to having a higher overall
are more to be uninsured (1.9% and 1.1% respectively)
percentage of uninsured older adults, Lancaster
when compared to Pennsylvania (0.5%) and the
County has a higher percentage of uninsured disabled
nation (0.9%). The uninsured population equates to
older adults (1.5%) when compared to Lebanon County
approximately 1,500 older adults in Lancaster County
(0.5%), Pennsylvania (0.4%), and the nation (0.7%).
and 250 older adults in Lebanon
Table 32. Uninsured Population Aged 65 Years and Over (2010 – 2012) United States Pennsylvania Lancaster County Lebanon County
1.0%
0.5%
1.9%
1.1%
Population Without Health Insurance
Lebanon County
Figure 5. Population 65 Years and Over, 2008 – 2012
1.1%
Lancaster County
1.9%
Pennsylvania
0.5%
U.S.
0.9%
0.0%
0.2%
0.4%
0.6%
0.8%
1.0%
1.2%
1.4%
1.6%
1.8%
2.0%
Table 33. Health Insurance Coverage by Disability Status, Population 65 Years and Over (2010 – 2012)
Population 65 Years and Over With a Disability With Health Insurance Without Health Insurance
36.4%
35.3%
31.6%
30.2%
99.3%
99.6%
98.5%
99.5%
0.7%
0.4%
1.5%
0.5%
HOL L ERA N
United States Pennsylvania Lancaster County Lebanon County
25
Youth The percentage of uninsured youth is also higher in
(4.9%). Children’s Health Insurance Program (CHIP)
Lancaster County and Lebanon County (15.8% and
and Medical Assistance enrollment are 9,304 and
9.8% respectively) when compared to Pennsylvania
38,117 respectively in Lancaster County and 2,278
(5.2%) and the nation (7.5%). In addition, the
and 11,224 respectively in Lebanon County. Medical
percentage of uninsured disabled youth is high in
Assistance is Pennsylvania’s version of Medicaid.
Lancaster County (6.1%) when compared to Lebanon
Medical Assistance is available to low-income children
County (0.7%), Pennsylvania (2.6%), and the nation
of all ages.
Table 34. Uninsured Population Under 18 Years (2010 – 2012) United States Pennsylvania Lancaster County Lebanon County
7.5%
5.2%
15.8%
9.8%
Table 35. Health Insurance Coverage by Disability Status, Population Under 18 Years (2010 – 2012) United States Pennsylvania Lancaster County Lebanon County
HOL L ERA N
Population Under 18 Years
26
4.0%
4.9%
4.4%
4.5%
With Health Insurance
95.1%
97.4%
93.9%
99.3%
Without Health Insurance
4.9%
2.6%
6.1%
0.7%
With a Disability
The percentage of uninsured youth is also higher in Lancaster County and Lebanon County (15.8% and 9.8% respectively) when compared to Pennsylvania (5.2%) and the nation (7.5%). In addition, the percentage of uninsured disabled youth is high in Lancaster County (6.1%) when compared to Lebanon County (0.7%), Pennsylvania (2.6%), and the nation (4.9%).
Table 36. Children’s Health Insurance Program (CHIP) Enrollment (2013) Lancaster County Lebanon County Total CHIP Enrollment
9,304
2,278
Age 0 – 4
17.7%
14.7%
Age 5 – 11
41.6%
42.8%
Age 12 – 18
40.7%
42.4%
Table 37. Children Receiving Health Insurance through Medical Assistance (2013)*
Total Enrollment
38,117
11,224
Age 0 – 4
31.6%
32.3%
Age 5 – 11
37.9%
37.8%
Age 12 – 18
30.5%
29.9%
HOL L ERA N
Lancaster County Lebanon County
27
Health Care Provider Access Health care provider density, or the provider-to-
Benchmark. The National Benchmark represents the
population ratio, is a measure of overall health care
90th percentile, i.e., only 10% of locations are better. In
access. In Lancaster County, the ratio of primary care
Lebanon County, the ratio of physicians and dentists to
physicians, dentists, and mental health providers
residents is also higher than the state and the National
to residents falls short of the state ratios and the
Benchmark. However, the ratio of mental health
National Benchmarks. In particular, the ratio of mental
providers to residents is 617:1, which exceeds the state
health providers to residents is 1,413:1 in Lancaster
ratio and approaches the National Benchmark.
County, 865:1 in the state, and 536:1 for the National
Table 38. Health Care Provider Density (2014) National Benchmark Pennsylvania Lancaster County Lebanon County (90th Percentile) Physician to Population Ratio
1,051:1
1,244:1
1,326:1
1,767:1
Dentist to Population Ratio
1,439:1
1,704:1
2,124:1
2,315:1
536:1
865:1
1,413:1
617:1
Mental Health Providers to Population Ratio
Older Adults The following factors are measured and provided by
adults are less likely to have a personal health care
the Pennsylvania Behavioral Risk Factor Surveillance
provider and to receive routine checkups. In particular,
System (BRFSS). The BRFSS is headed by the Centers
residents age 45 to 64 years in Lancaster County are
for Disease Control and Prevention and is conducted
significantly less likely than peers across the state
annually to assess health status and risk factors among
to have received a routine checkup within the past
U.S. citizens. In Pennsylvania, BRFSS data is reported
two years. However, they are less likely to report cost
by county or geographic region depending on the
as a barrier to seeing a doctor. In Lebanon/Dauphin
population. Lancaster County is reported individually,
County, residents are more likely to have a personal
but Lebanon County is reported with Dauphin County.
health care provider and just as likely to have received a routine checkup within the past two years. However,
The following tables depict the ability of older adults
they are more likely to report cost as a barrier to
to access a health care provider when needed and
seeing a doctor.
HOL L ERA N
receive routine checkups. In Lancaster County, older
28
Table 39. Population without a Personal Health Care Provider (2010 – 2012) Pennsylvania Lancaster County Lebanon County / Dauphin County Population Age 45 – 64
7.0%
8.0%
5.0%
Population Age 65 and Over
3.0%
4.0%
4.0%
Table 40. Population Unable to See a Doctor Due to Cost (2010 – 2012) Pennsylvania Lancaster County Lebanon County / Dauphin County Population Age 45 – 64
11.0%
9.0%
14.0%
Population Age 65 and Over
3.0%
1.0%
4.0%
Lancaster County adults age 45-64 are significantly less likely to have had a routine health checkup in the past two years compared to the state. Table 41. Population Receiving a Routine Checkup in the Past Two Years (2010 – 2012)* Pennsylvania Lancaster County Lebanon County / Dauphin County Population Age 45 – 64
85.0%
74.0%
88.0%
Population Age 65 and Over
94.0%
91.0%
91.0%
*Data highlighted in blue denotes a value that is significantly lower when compared to Pennsylvania
Overall, there are 31 nursing homes in Lancaster
counties is approximately 95.0. The rate of licensed/
County and 12 nursing homes in Lebanon County. The
approved beds per 1,000 residents age 65 years and
average occupancy rate among nursing homes in both
over is approximately 52.0.
Table 42. Nursing Home Availability (2011) Lancaster County Lebanon County
Total Number
31
4,144
12
1,207
Certified-Medicare
31
4,144
12
1,207
Certified-Medicaid
28
3,791
11
1,188
Average Occupancy Rate
95.0
94.3
Average Length of Stay in Days
258.1
291.8
Average Semi-Private Daily Room Rate
$269
$269
51.9
52.4
Total Licensed/Approved Beds per 1,000 Population Age 65 and Older
HOL L ERA N
Nursing Homes Licensed / Nursing Homes Licensed / Approved Beds Approved Beds
29
Community Perspective Key informants were asked to identify any populations
there are underserved populations in the community.
that are currently underserved by local health and
The populations that were identified as the most
human services. Among the 75 informants who
underserved were the low-income/poor, uninsured/
responded to the question, 46 or 61% agreed that
underinsured, homeless, and children/youth.
Percent Low-income/Poor
34
73.9%
Uninsured/Underinsured
26
56.5%
Homeless
23
50.0%
Children/Youth
23
50.0%
Seniors/Aging/Elderly
19
41.3%
Caregivers
18
39.1%
People with Disabilities
15
32.6%
Veterans
11
23.9%
Immigrant/Refugee
11
23.9%
Young Adults
11
23.9%
Hispanic/Latino
10
21.7%
Black/African-American
8
17.4%
Other (please specify)
4
8.7%
None
0
0.0%
Total
251
Key informants were then asked to identify the
top barrier to individuals accessing health care.
most significant barriers that keep individuals in the
Additional barriers to individuals accessing health care
community from accessing health care when they
included lack of health insurance coverage, lack of
need it. The inability to pay out of pocket expenses
transportation, and the inability to navigate the health
(co-pays, prescriptions, etc.) was identified as the
care system.
HOL L ERA N
Percent
30
Count Percent
Count Percent
Inability to Pay Out-of-Pocket Expenses (Co-pays, Prescriptions, etc.)
62
80.5%
Lack of Health Insurance Coverage
54
70.1%
Lack of Transportation
52
67.5%
Inability to Navigate Health Care System
52
67.5%
Basic Needs Not Met (Food/Shelter)
39
50.6%
Lack of Providers accepting Medicare/Medicaid
36
46.8%
Time Limitations (Long Wait Times, Limited Office Hours, Time Off Work)
33
42.9%
Language/Cultural Barriers
32
41.6%
Lack of Child Care
32
41.6%
Availability of Providers/Appointments
26
33.8%
Lack of Trust
24
31.2%
None/No Barriers
2
2.6%
Other (please specify)
1
1.3%
Total
445
The inability to pay out-of-pocket expenses (co-pays, prescriptions, etc.) was identified as the top barrier to individuals accessing health care.
Key informants were also asked to identify health-
low-cost vision care, and mental health/ behavioral
related resources or services that are missing or
health/substance abuse services. The need for free/
lacking in the community. The top resources or
low-cost services corresponds to an earlier finding that
services identified as missing or lacking in the
individuals in the community struggle to pay out-of-
community were free/low-cost dental care, free/
pocket expenses, including co-pays.
Count Percent
Free/Low-Cost Dental Care
53
69.7%
Free/Low-Cost Vision Care
42
55.3%
Mental Health/Behavioral Health/Substance Abuse Services
40
52.6%
Free/Low-Cost Medical Care
36
47.4%
Prescription Assistance
30
39.5%
Health Education/Information/Outreach
27
35.5%
Geriatricians
21
27.6%
Medical Specialists (Cardiologist, Dermatologist, Neurologist)
13
17.1%
Primary Care Providers
13
17.1%
Health Screenings
13
17.1%
Immunizations/Vaccination Programs
9
11.8%
Pediatricians
7
9.2%
Prenatal Care Services
6
7.9%
None
5
6.6%
Other (please specify)
1
1.3%
Total
316
HOL L ERA N
Percent
31
32
OLDER ADULT HEALTH INDICATORS
In this section:
General Health Status: Physical & Mental HOL L ERA N
Body Mass Index
32
Smoking Vaccinations
20% of adults age 65 years and over in Lancaster County and 22% of adults age 65 years and over in Lebanon/Dauphin County report having fair or poor health.
General Health Status: Physical & Mental Lancaster County and Lebanon/Dauphin County older
of older adults. Twenty percent of adults age 65 years
adults are less likely to report fair or poor health in
and over in Lancaster County and 22% of adults age
general when compared to the state. However, general
65 years and over in Lebanon/Dauphin County report
health status is still an issue for a notable percentage
having fair or poor health.
Table 43. Population Reporting Fair or Poor Overall Health (2010 – 2012) Pennsylvania Lancaster County Lebanon County / Dauphin County Population Age 45 – 64
17.0%
16.0%
14.0%
Population Age 65 and Over
24.0%
20.0%
22.0%
Population with Fair or Poor Health Figure 6. Older Adults Age 45 – 64 Years and 65 Years and Over, 2010 – 2012
14.0%
45-64 Years 16.0%
22.0%
65 Years And Over
Lebanon County
20.0%
5.0%
10.0%
15.0%
20.0%
25.0%
Physical health status is primarily a concern for
at least one poor physical health day in the past
Lebanon/Dauphin County older adults. In Lebanon/
month. The percentage for adults age 65 years and
Dauphin County, 41% of adults age 45 to 64 years and
over is significantly less than the percentage across
42% of adults age 65 years and over report having at
the state. However, the percentages still encompass
least one poor physical health day in the past month.
one-quarter to one-third of the older adult population
In Lancaster County, 32% of adults age 45 to 64 years
in the county.
and 28% of adults age 65 years and over report having
HOL L ERA N
0.0%
Lancaster County
33
Lancaster County and Lebanon County have high scores of 8.4 and 8.7 respectively for the food environment index. The National Benchmark is 8.7.
Table 44. Poor Physical Health on One or More Days in the Past Month (2010 – 2012) Pennsylvania Lancaster County Lebanon County / Dauphin County Population Age 45 – 64
37.0%
32.0%
41.0%
Population Age 65 and Over
39.0%
28.0%
42.0%
*Data highlighted in blue denotes a value that is significantly lower when compared to Pennsylvania
Mental health is also a concern for many older adults
the past month. Percentages in Lancaster County are
in Lancaster County and Lebanon/Dauphin County.
less and the percentage for adults age 65 years and
In Lebanon/Dauphin County, 32% of adults age 45
over (14%) is significantly less when compared to the
to 64 years and 27% of adults age 65 years and over
state. However, the percentages are still high.
report having at least one poor mental health day in
Table 45. Poor Mental Health on One or More Days in the Past Month (2010 – 2012) Pennsylvania Lancaster County Lebanon County / Dauphin County Population Age 45 – 64
33.0%
27.0%
32.0%
Population Age 65 and Over
22.0%
14.0%
27.0%
*Data highlighted in blue denotes a value that is significantly lower when compared to Pennsylvania
The suicide death rate is an indicator of mental health
County. The rate for Lancaster County adults age 45 to
status; however, the number of suicides in both
64 years per 100,000 is 23.6, which is higher than the
counties was less than 10 for both age groups, with
state (19.0), the nation (18.6), and the Healthy People
the exception of adults age 45 to 64 years in Lebanon
2020 goal (10.2).
Table 46. Deaths Due to Suicide per 100,000, Population 45 Years and Over (2010; 2011)
HOL L ERA N
34
Healthy People United States Pennsylvania Lancaster County Lebanon County 2020 Goal
Population Age 45 – 64
10.2
18.6
19.0
23.6 ND*
Population Age 65 and Over
10.2
14.9
14.2 ND* ND*
*There is insufficient data to provide a mortality rate. Nine suicide deaths occurred in Lancaster County among residents age 65 years and over. In addition, two suicide deaths occurred in Lebanon County among residents age 65 years and over and eight suicide deaths occurred in Lebanon County among residents age 45 – 64 years.
The combination of poor physical and mental health
percentage of Lebanon/Dauphin County older adults
can often inhibit daily activity. Fewer Lancaster
who are affected is equitable to or higher than both
County older adults are limited in their activity when
Lancaster County and the state (25% among adults
compared to the state, but a notable percentage is
age 45 to 64 years and 33% among adults age 65
still affected (19% among adults age 45 to 64 years
years and over).
and 24% among adults age 65 years and over). The
Table 47. Limitation in Activity Due to Physical, Mental, or Emotional Problems (2010 – 2012) Pennsylvania Lancaster County Lebanon County / Dauphin County Population Age 45 – 64
26.0%
19.0%
25.0%
Population Age 65 and Over
30.0%
24.0%
33.0%
Body Mass Index Body Mass Index (BMI) is a factor of diet and physical
to healthy foods and food insecurity. The index is
activity and is often correlated with chronic health
based on a score of 0 (worst) to 10 (best). The first
conditions. It is calculated based on the height and
factor, limited access to healthy foods, measures the
weight of an individual. The ability to maintain a
proportion of the population that is low income and
healthy body mass index through diet and physical
does not live close to a grocery store. The second
activity is influenced by both behavioral and
factor, food insecurity, measures the percentage of
environmental indicators. Environmental indicators
the population that did not have access to a reliable
include, but are not limited to, access to healthy foods
source of food during the past year. Lancaster County
and access to exercise opportunities.
and Lebanon County have high scores of 8.4 and 8.7 respectively for the food environment index. The
The food environment index measures overall food
National Benchmark is 8.7.
access based on two indicators, limited access
National Benchmark (90th Percentile)
8.7
Pennsylvania Lancaster County Lebanon County 8.0
8.4
8.7
HOL L ERA N
Table 48. Food Environment Index (2014)
35
Access to exercise opportunities can have a profound
pools, etc.) The percentage of residents in Lebanon
influence on the overall health of a community. The
County who have access to exercise opportunities
measure is based on the proportion of residents who
(78%) is equitable to the state (80%) and slightly
live reasonably close to a physical activity location.
below the National Benchmark (85%). However, the
Physical activity locations may include parks (local,
percentage of residents in Lancaster County who have
state, and national) or facilities identified by the NAICS
access to exercise opportunities (69%) is notably lower
code 713940 (gyms, community centers, YMCAs,
than both the state and the National Benchmark.
Table 49. Access to Exercise Opportunities (2014) National Benchmark (90th Percentile)
Pennsylvania Lancaster County Lebanon County
85.0%
80.0%
69.0%
78.0%
The following table depicts the percentage of older
Dauphin County, 66% to 71% of older adults are
adults who are overweight or obese. In Lancaster
overweight and 33% to 35% are obese. In general, the
County, 68% to 70% of all older adults are overweight
percentages for the counties are greater than the state
and approximately 30% are obese. In Lebanon/
percentages.
Table 50. Overweight or Obese Population (2010 – 2012) Pennsylvania Lancaster County Lebanon County / Dauphin County Overweight Obese Overweight Obese Overweight Obese Population Age 45 – 64
68.0%
31.0%
70.0%
31.0%
71.0%
35.0%
Population Age 65
65.0%
27.0%
68.0%
30.0%
66.0%
33.0%
and Over
Overweight Population 71.0%
45-64 Years
Figure 7. Older Adults Age 45 – 64 Years and 65 Years and Over, 2010 – 2012
70.0%
HOL L ERA N
66.0%
36
65 Years And Over
Lebanon County
68.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
Lancaster County
Vaccination rates are highest in Lancaster County with 75% of adults age 65 years and over having been vaccinated compared to 64% of Lebanon/Dauphin County older adults and 71% of all Pennsylvania older adults. Smoking Smoking is also correlated with poor health and
19% (Lebanon/Dauphin County). However, a notable
chronic health conditions. The percentage of adults in
percentage of adults age 65 years and over
Lancaster County and Lebanon/Dauphin County who
in Lebanon/Dauphin County are smokers (11%)
currently smoke is highest among adults age 45 to
when compared to Lancaster County (5%) and the
64 years and ranges from 17% (Lancaster County) to
state (8%).
Table 51. Current and Former Smoking Status (2010 – 2012) Pennsylvania Lancaster County Lebanon County / Dauphin County Current Former Current Former Current Former Smoker Smoker Smoker Smoker Smoker Smoker Population Age 45 – 64 Population Age 65 and Over
20.0%
28.0%
17.0%
27.0%
19.0%
25.0%
8.0%
42.0%
5.0%
43.0%
11.0%
36.0%
Vaccinations Pneumonia vaccinations are typically recommended
having been vaccinated compared to 64% of
for older adults as a means to prevent more serious
Lebanon/Dauphin County older adults and 71% of all
illness. Vaccination rates are highest in Lancaster
Pennsylvania older adults.
County with 75% of adults age 65 years and over
Pennsylvania Lancaster County Lebanon County / Dauphin County
71.0%
75.0%
64.0%
HOL L ERA N
Table 52. Population Aged 65 Years and Over Who Have Ever Had a Pneumonia Vaccine (2010 – 2012)
37
HOL L ERA N
38 38
OLDER ADULT CHRONIC CONDITIONS
In this section: Asthma Cancer Diabetes Heart Disease
According to the American Lung Association, Lancaster County receives an “F” grade for a weighted average of 11.2 ozone days per year.
Asthma Asthma is reported as the percentage of individuals
adults age 45 to 64 years have ever had asthma when
who have ever had asthma (lifetime diagnosis) and the
compared to the state; but the percentage of adults
percentage of individuals who currently have asthma.
age 65 years and over who have ever had asthma
In Lancaster County, fewer older adults have ever had
(12%) and who still have asthma (10%) is notably
asthma when compared to Lebanon/Dauphin County
higher than both the percentage in Lancaster County
and the state. In Lebanon/Dauphin County, fewer
and the state.
Table 53. Population Diagnosed with Asthma (2010 – 2012) Pennsylvania Lancaster County Lebanon County / Dauphin County Lifetime Current Lifetime Current Lifetime Current Diagnosis Diagnosis Diagnosis Diagnosis Diagnosis Diagnosis Population Age 45 – 64
12.0%
9.0%
10.0%
7.0%
11.0%
8.0%
Population Age 65 and Over
10.0%
7.0%
9.0%
5.0%
12.0%
10.0%
Air pollution is often associated with higher rates
12.5 respectively. The average in all of Pennsylvania is
of respiratory diseases like asthma and COPD. Fine
12.9. Another measure of air quality is the frequency
particulate matter is a form of air pollution and is
of high ozone days. According to the American Lung
a measure of the overall outdoor air quality. It is
Association, Lancaster County receives an “F” grade
measured as an average daily amount in micrograms
for a weighted average of 11.2 ozone days per year.
per cubic meter. The National Benchmark for
The grading system is based on a grade of A (0 days
daily fine particulate matter is 9.5. The average in
of pollution) to F (3.3 days or higher of pollution).
Lancaster County and Lebanon County is 12.4 and
Data for Lebanon County is not available.
Table 54. Daily Fine Particulate Matter (2013)
9.5
Pennsylvania Lancaster County Lebanon County Higher
Higher
Higher
HOL L ERA N
National Benchmark (90th Percentile)
39
In Lebanon/Dauphin County, adults age 45 to 64 years and 65 years and over are generally more likely to have heart disease when compared to the state.
Cancer The total cancer incidence rate for Lancaster County
fall below both the state and the nation for both age
and Lebanon County older adults is higher when
groups; however, the colorectal cancer rate is also
compared to the nation but lower when compared
lower than both the state and the nation for adults
to Pennsylvania. In Lancaster County, the pancreatic
age 65 years and over. In Lebanon County, none of
cancer rate is the only rate to exceed both the state
the cancer incidence rates exceeded both the state
and the nation for both age groups; however, the
and the nation in both age groups; however, cancer
female breast cancer rate is also higher than both the
incidence rates for pancreatic cancer and prostate
state and the nation for adults age 45 to 64 years.
cancer were lower than both the state and the nation
The lung and bronchus cancer rate is the only rate to
in adults age 65 years and over.
Table 55. Cancer Incidence Rates per 100,000 by Site (2010; 2011) United States Pennsylvania Lancaster County Lebanon County Population Age 45 – 64 Breast, Female
236.0
329.4
331.6
262.5
Colon and Rectum
57.9
69.8
65.2
58.4
Lung and Bronchus
78.1
89.2
65.9
119.5
Melanoma of the Skin
29.6
61.8
50.1
53.1
Pancreas
15.4
16.8
20.8 ND*
Prostate
218.0
259.6
236.1
220.5
Total Cancer Incidence
694.7
901.1
839.9
887.2
Population Age 65 and Over Breast, Female
399.4
520.9
481.0
500.8
Colon and Rectum
199.6
243.6
194.2
203.9
Lung and Bronchus
345.8
366.0
280.7
364.4
the Skin
71.2
139.7
116.5
104.1
Pancreas
65.6
78.0
80.2
52.1
Prostate
649.4
670.7
654.4
587.4
Total Cancer Incidence
1,987.1
2,423.1
2,162.7
2,177.5
HOL L ERA N
Melanoma of
40
*There is insufficient data to provide a mortality rate. Nine cases of pancreatic cancer occurred in Lebanon County among residents age 45 to 64 years.
Diabetes Diabetes is caused either by the body’s inability to
for adults age 45 to 64 years when compared to the
produce insulin or effectively use the insulin that
state. However, diabetes incidence is higher in the
is produced. In Lancaster County and Lebanon/
counties for adults age 65 years and over (24%) when
Dauphin County, diabetes incidence is slightly lower
compared to the state (21%).
Table 56. Population Diagnosed with Diabetes (2010 – 2012) Pennsylvania Lancaster County Lebanon County / Dauphin County Population Age 45 – 64
12.0%
10.0%
11.0%
Population Age 65 and Over
21.0%
24.0%
24.0%
Heart Disease The incidence of heart disease in Lancaster County
a stroke compared to 24% of Pennsylvania adults age
and Lebanon/Dauphin County in comparison to the
65 years and over. In Lebanon/Dauphin County, adults
state varies by age group. In Lancaster County, adults
age 45 to 64 years and 65 years and over are generally
age 45 to 64 years are generally less likely to have
more likely to have heart disease when compared to
heart disease when compared to the state; however,
the state. Specifically, 10% of adults age 45 to 64 years
adults age 65 years and over are more likely to have
and 27% of adults age 65 years and over have had a
heart disease. Specifically, 28% of adults age 65 years
heart attack, heart disease, and/or a stroke compared
and over have had a heart attack, heart disease, and/or
to 9% and 24% respectively in Pennsylvania.
Table 57. Population Diagnosed with a Heart Attack, Heart Disease, or a Stroke (2010 – 2012) Pennsylvania Lancaster County Lebanon County / Dauphin County Population Age 45 – 64 Population Age 65 and Over
9.0%
6.0%
10.0%
24.0%
28.0%
27.0%
Table 58. Population Diagnosed with a Heart Attack (2010 – 2012) Pennsylvania Lancaster County Lebanon County / Dauphin County Population Age 45 – 64
4.0%
3.0%
5.0%
Population Age 65 and Over
13.0%
15.0%
13.0%
Table 59. Population Diagnosed with Heart Disease (2010 – 2012) Pennsylvania Lancaster County Lebanon County / Dauphin County Population Age 45 – 64
5.0%
1.0%
5.0%
Population Age 65 and Over
14.0%
15.0%
16.0
Pennsylvania Lancaster County Lebanon County / Dauphin County Population Age 45 – 64
3.0%
3.0%
4.0%
Population Age 65 and Over
8.0%
9.0%
8.0%
HOL L ERA N
Table 60. Population Diagnosed with a Stroke (2010 – 2012)
41
42
OLDER ADULT MORTALITY In this section: Overall Mortality and Premature Death Leading Causes of Mortality
HOL L ERA N
Cancer Mortality
42
The overall mortality rate is lower in both counties than in Pennsylvania and the nation for adults age 45 to 64 years. This data corresponds to the fewer years of potential life lost that is reported in both counties compared to the state.
Overall Mortality and Premature Death The following table depicts the mortality rate for older
in both counties compared to the state (see table 63).
adults in Lancaster County and Lebanon County. As
The mortality rate in Lancaster County for adults age
shown in the table, the overall mortality rate is lower
65 years and over is equitable to the national rate, but
in both counties than in Pennsylvania and the nation
the mortality rate for the same population in Lebanon
for adults age 45 to 64 years. This data corresponds
County exceeds both the state and national rate.
to the fewer years of potential life lost that is reported
Table 61. Mortality per 100,000 (2010; 2011) United States Pennsylvania Lancaster County
Lebanon County
Deaths Death Rate Deaths Death Rate Deaths Death Rate Deaths Death Rate Population Age 45 – 64
494,009
606.2
22,240
616.0
649
464.7
223
592.4
Population Age 65 and Over
1,798,276
4,465.8
97,619
4,926.4
3,575
4,479.6
1,160
5,031.7
Table 62. Premature Mortality: Years of Potential Life Lost Before Age 75 per 100,000 (2014) National Benchmark (90th Percentile)
5,317
Pennsylvania Lancaster County Lebanon County 6,973
5,871
6,115
The following table depicts age-specific mortality
County, mortality rates for adults age 45 to 64 years
rates for the 7 leading causes of death in the nation.
are unavailable for all causes except heart disease,
In Lancaster County, mortality rates for each reported
cancer, and accidents. Heart disease and accident
cause are lower than rates across Pennsylvania and
mortality rates are lower in the county compared to
the nation for adults age 45 to 64 years. Mortality
the state and the nation and the cancer mortality
rates for Lancaster County adults age 65 years and
rate is higher in the county compared to the state
over are also lower than or equitable to rates across
and the nation. Among adults age 65 years and over
Pennsylvania and the nation for all reported causes,
in Lebanon County, mortality rates for chronic lower
except stroke. The stroke mortality rate per 100,000
respiratory disease, Alzheimer’s Disease, and diabetes
is 312 in Lancaster County compared to 301.1 in
are lower when compared to the state and the nation,
Pennsylvania and 273.1 in the nation. In Lebanon
while rates for cancer, stroke, and accidents are higher.
HOL L ERA N
Leading Causes of Mortality
43
The colorectal cancer mortality rate is 105.3 in Lancaster County compared to 96.4 across Pennsylvania and 90.4 across the nation.
Table 63. Mortality per 100,000 by Leading Cause in the U.S. (2010; 2011) United States Pennsylvania Lancaster County Lebanon County Population Age 45 – 64 Heart Disease
128.6
126.2
92.4
114.2
Cancer
196.0
204.0
164.0
236.4
(CLRD)
22.9
21.6
20.0 ND*
Stroke
20.4
19.0
15.8 ND*
Accidents
41.3
45.2
32.2
1.1
0.8
0.0 ND*
21.2
20.0
13.6 ND*
Chronic Lower Respiratory Disease
Alzheimer’s Disease Diabetes
26.6
Population Age 65 and Over Heart Disease
1,185.4
1,336.8
1,160.3
1,214.5
985.1
1,036.8
892.2
1,045.4
Disease (CLRD)
293.1
291.5
274.4
281.9
Stroke
273.1
301.1
312.0
429.4
Accidents
102.6
112.9
96.5
130.1
Alzheimer’s Disease
205.2
173.8
196.7
151.8
Diabetes
122.2
131.5
105.3
91.1
Cancer Chronic Lower Respiratory
*There is insufficient data to provide a mortality rate. Four CLRD deaths, 7 stroke deaths, 1 Alzheimer’s Disease death, and 7 diabetes deaths occurred in Lebanon County among residents age 45 to 64 years.
Falls are a concern for the older adult population,
related mortality rates per 100,000 (50.1 and 43.4
particularly for those age 65 years and over. In
respectively) are lower when compared to the state
both Lancaster County and Lebanon County, fall-
(61.4) and the nation (53.8).
Table 64. Mortality Due to Falls per 100,000 (2010; 2011)
HOL L ERA N
United States Pennsylvania Lancaster County Lebanon County
44
Population Age 45 – 64
4.0
4.8 ND*
0.0
Population Age 65 and Over
53.8
61.4
43.4
50.1
*There is insufficient data to provide a mortality rate. Five fall-related deaths occurred in Lancaster County among residents age 45 to 64 years.
Cancer Mortality The five deadliest types of cancer, in ranking order,
both age groups. The exception is mortality due to
are lung and bronchial cancer, colon and rectal cancer,
colorectal cancer. The colorectal cancer mortality rate
breast cancer, pancreatic cancer, and prostate cancer.
is 105.3 in Lancaster County compared to 96.4 across
The following table depicts mortality rates for each of
Pennsylvania and 90.4 across the nation. In Lebanon
these types for older adults in Lancaster County and
County, cancer mortality rates are generally higher
Lebanon County.
when compared to Pennsylvania and the nation. The exception is mortality due to colorectal cancer.
In Lancaster County, cancer mortality rates vary
The colorectal cancer mortality rate is 69.4 in
by type; however, in general, rates are lower when
Lebanon County.
compared to all of Pennsylvania and the nation for
Table 65. Cancer Mortality per 100,000 by Site (2010; 2011) United States Pennsylvania Lancaster County Lebanon County Population Age 45 – 64 Bronchus and Lung
53.1
56.6
32.9
71.7
Colon and Rectum
17.8
16.7
14.3 ND*
Female Breast
35.7
36.8
35.0 ND*
Pancreatic
12.6
13.3
10.0 ND*
Prostate
3.7
7.9 ND* ND*
Population Age 65 and Over Bronchus and Lung
281.9
279.2
209.3
334.0
Colon and Rectum
90.4
96.4
105.3
69.4
Female Breast
103.7
110.0
95.3
113.8
Pancreatic
64.8
71.9
58.9
82.4
Prostate
63.3
146.4
121.1
162.0
HOL L ERA N
*There is insufficient data to provide a mortality rate. Four colon and rectum cancer deaths, 5 female breast cancer deaths, 4 pancreatic cancer deaths and 1 prostate cancer death occurred in Lebanon County among residents age 45 to 64 years. Four prostate cancer deaths occurred in Lancaster County among residents age 45 to 64 years.
45
46
MEDICARE FEE-FOR-SERVICE BENEFICIARIES
In this section: Common Chronic Conditions Presence of Multiple Chronic Conditions Hospital Readmissions
HOL L ERA N
Emergency Department Visits and Per-Capita Cost
46
The most common chronic conditions in both counties are hypertension (high blood pressure), hyperlipidemia (elevated level of lipids or fats in the blood), and rheumatoid arthritis/osteoarthritis.
Common Chronic Conditions The following table depicts the prevalence rates for
hypertension (high blood pressure), hyperlipidemia
chronic conditions per 100,000 Lancaster County
(elevated level of lipids or fats in the blood), and
and Lebanon County Medicare beneficiaries. The
rheumatoid arthritis/osteoarthritis. However, rates are
most common chronic conditions in both counties are
also high in both counties for cancer and osteoporosis.
Table 66. Chronic Conditions among Medicare Beneficiaries per 100,000 (2011)
Alzheimer’s Disease/Dementia
11.0
11.9
11.9
10.6
Asthma
4.7
4.7
4.2
3.0
Atrial Fibrillation
8.0
9.8
11.4
9.1
Cancer
8.1
9.0
9.5
8.6
Chronic Kidney Disease
15.3
16.0
16.4
15.6
COPD
11.5
11.5
10.4
10.6
Depression
14.8
15.7
16.5
13.9
Diabetes
27.7
27.6
26.1
26.5
Heart Failure
15.6
16.1
15.3
13.7
Hyperlipidemia
45.0
49.4
51.2
55.7
Hypertension
56.5
59.1
59.8
62.5
Ischemic Heart Disease
30.3
32.2
30.4
29.8
Osteoporosis
6.8
8.2
9.1
10.2
Rheumatoid Arthritis/ Osteoarthritis
29.3
31.6
31.9
34.0
Stroke
3.9
4.7
4.1
4.6
HOL L ERA N
United States Pennsylvania Lancaster County Lebanon County
47
Presence of Multiple Chronic Conditions The percentage of Medicare beneficiaries with two
The percentage in Pennsylvania and the nation is 71%
or more chronic conditions is 71.6% and 74.6% in
and 67.3% respectively.
Lancaster County and Lebanon County respectively.
Presence of Two or More Chronic Conditions 35.4% 32.6%
2-3 Conditions
32.0% 31.5%
Figure 8. Medicare beneficiary population with two or more chronic conditions, 2011
25.2% 23.6%
4-5 Conditions
23.4% 21.8%
14.0% 15.4%
6 Or More Conditions
15.6% 14.0%
0.0%
10.0%
Lebanon County
20.0%
Lancaster County
30.0%
Pennsylvania
40.0%
U.S.
Hospital Readmissions The rate of hospital readmissions per 1,000 Medicare
is unavailable; however, the rate is highest among
beneficiaries in Lancaster County ranges from 7.5
beneficiaries with 6 or more chronic conditions
for residents with 0 or 1 chronic condition to 19.8 for
(21.3). Hospital readmission rates for all beneficiaries
residents with 6 or more chronic conditions. The rate
in both counties are lower when compared to both
of hospital readmissions for Medicare beneficiaries
Pennsylvania and the nation.
in Lebanon County with 0 or 1 chronic condition
Table 67. Hospital Readmissions for Chronic Conditions per 1,000 Beneficiaries (2011)
HOL L ERA N
United States Pennsylvania Lancaster County Lebanon County
48
0 – 1 Chronic Conditions
8.9
8.6
7.5 N/A
2 – 3 Chronic Conditions
10.3
9.9
8.2
6.7
4 – 5 Chronic Conditions
13.5
13.2
9.9
11.4
6 or More Chronic Conditions
25.0
24.4
19.8
21.3
Emergency Department Visits and Per-Capita Cost The rate of emergency department visits and the per-
In Lebanon County, emergency department rates per
capita cost for Medicare beneficiaries with 2 or more
1,000 beneficiaries range from 199.7 for residents
chronic conditions is also lower for all beneficiaries
with 0 or 1 chronic condition to 1,560.9 for residents
in both counties when compared to Pennsylvania
with 6 or more chronic conditions. The highest per-
and the nation. In Lancaster County, emergency
capita cost for Medicare beneficiaries is approximately
department rates per 1,000 beneficiaries range from
$26,000 in Lancaster County and $27,000 in Lebanon
184 for residents with 0 or 1 chronic condition to
County. In contrast, the highest per-capita cost for the
1,496.7 for residents with 6 or more chronic conditions.
state and the nation is approximately $31,500.
Table 68. Emergency Department Visits for Chronic Conditions per 1,000 Beneficiaries (2011) United States Pennsylvania Lancaster County Lebanon County 0 – 1 Chronic Conditions
239.6
256.2
184.0
199.7
2 – 3 Chronic Conditions
452.8
432.5
322.6
318.6
4 – 5 Chronic Conditions 6 or More
804.3
748.7
563.2
631.4
Chronic Conditions
1,976.7
1,903.5
1,496.7
1,560.9
Per-Capita Costs for Chronic Conditions 2-3 Conditions
$4,540.6
Figure 9. Per-capita Medicare beneficiary cost for two or more chronic conditions, 2011
$4,660.0 $5,311.8 $5,676.7
4-5 Conditions
$9,753.4 $9,657.3 $10,981.6 $11,628.4
$26,319.8
6 Or More Conditions
$26,720.1 $31,510.9
0.0%
$5,000.0
Lebanon County
$10,000.0
$15,000.0
Lancaster County
$20,000.0
Pennsylvania
$25,000.0
U.S.
$30,000.0
$35,000.0
HOL L ERA N
$31,542.8
49
50
YOUTH HEALTH INDICATORS and MORTALITY In this section:
HOL L ERA N
Birth Characteristics
50
Infant and Child Mortality School Health
In Lancaster County, the overall percentage of infants born with low birth weight or very low birth weight (6.5% and 0.9%) is favorable when compared to Pennsylvania, the nation, and the Healthy People 2020 goal.
Birth Characteristics The following tables depict various birth
White population are significantly less. However, it is
characteristics that can contribute to the overall health
notable that while the low birth weight percentages
and well-being of children both now and in their adult
for the Black and Hispanic populations are comparable
years. For example, infants born with low birth weight
to the state and the nation, they are much higher
are more likely to suffer from respiratory distress
when compared to the White population. In Lebanon
syndrome and bleeding in the brain, and they are also
County, low birth weight percentages are higher for
more likely to develop high blood pressure, diabetes,
all reported racial and ethnic groups when compared
and heart disease.
to the state, the nation, and Healthy People 2020. In particular, the low birth weight percentage among
In Lancaster County, the overall percentage of infants
the Hispanic population is significantly higher when
born with low birth weight or very low birth weight
compared to the state. However, very low birth weight
(6.5% and 0.9%) is favorable when compared to
percentages are similar to Lancaster County and are
Pennsylvania, the nation, and the Healthy People 2020
favorable. The percentage of Black infants born with
goal. In comparison to Pennsylvania, the low birth
very low birth weight is higher, but it is only based on
weight percentages for the overall population and the
two births.
Table 69. Low Birth Weight (2011)*
Healthy People United States Pennsylvania Lancaster County Lebanon County 2020 Goal
All Races
7.8%
8.1%
8.2%
6.5%
8.6%
White
7.8%
7.1%
7.0%
5.6%
7.9%
Black
7.8%
13.3%
13.2%
13.0% N/A
Hispanic
7.8%
7.0%
8.6%
8.4%
12.5%
*Data highlighted in blue denotes a value that is significantly lower when compared to Pennsylvania. Data highlighted in red denotes a value that is significantly higher when compared to Pennsylvania.
Table 70. Very Low Birth Weight (2011)
Healthy People United States Pennsylvania Lancaster County Lebanon County 2020 Goal
All Races
1.4%
1.4%
1.5%
0.9%
0.8%
White
1.4%
1.1%
1.1%
0.9%
0.7%
Black
1.4%
3.0%
3.4%
0.6%
5.4% (2 births)
Hispanic
1.4%
1.2%
1.3%
0.9%
1.2% (3 births)
HOL L ERA N
51
The Healthy People 2020 goal for receiving prenatal
of Black and Hispanic mothers. Black and Hispanic
care in the first trimester is 77.9%. In Pennsylvania,
mothers in Lancaster County are significantly more
71.7% of mothers receive prenatal care in the first
likely to receive first trimester prenatal care in
trimester, which is short of the Healthy People 2020
comparison to the state.
goal. The percentage of mothers receiving prenatal care in the first trimester in Lancaster County and
The percentage of mothers in Lancaster County and
Lebanon County is even lower (62% and 68.7%
Lebanon County who do not receive any prenatal
respectively) and is significantly less than the state
care (0.5% and 1% respectively) is significantly lower
percentage. It is of note that in Lancaster County,
when compared to the state (1.6%), but the care that
the percentage of White mothers receiving prenatal
mothers are receiving is much later in their pregnancy
care in the first trimester is less than the percentage
than is recommended.
Table 71. Prenatal Care (2011)* Pennsylvania Lancaster County Lebanon County Prenatal Care in 1st Trimester All Races
71.7%
62.0%
68.7%
White
76.7%
61.7%
69.9%
Black
56.5%
62.0%
45.7%
Hispanic
56.7%
67.2%
60.0%
No Prenatal Care - All Races
1.6%
0.5%
1.0%
White
1.0%
0.4%
0.8%
Black
4.2% N/A N/A
Hispanic
2.2% N/A N/A
*Data highlighted in blue denotes a value that is significantly lower when compared to Pennsylvania. Data highlighted in red denotes a value that is significantly higher when compared to Pennsylvania.
In general, Pennsylvania teenagers are less likely
but it is higher when compared to Lancaster County
to give birth when compared to their national
and the state. In particular, the percentage of all White
counterparts. Approximately 2% of all births in
births that are to teen mothers (2.9%) is significantly
Pennsylvania are to teen mothers versus 8% across
higher when compared to the state (1.4%). The
the nation. In Lancaster County, the teen birth
percentage of Hispanic births that are to teen mothers
percentage (1.8%) is even lower and is significantly
in the county is not significant due to a lower count of
below the state. The exception is Hispanic teen births
20 births.
HOL L ERA N
in Lancaster County. Hispanic teen births in the county
52
are lower when compared to the nation, but they are
The Healthy People 2020 goal for non-smoking
significantly higher when compared to the state. In
mothers during pregnancy is 98.6%. In general,
Lebanon County, the percentage of births to teen
Pennsylvania falls short of this goal with a percentage
mothers still falls well below the national percentage,
of 84.7%. In Lancaster County, the percentage of non-
Approximately 2% of all births in Pennsylvania are to teen mothers versus 8% across the nation.
smoking pregnant mothers (89.1%) is significantly
than the state percentage (90.9%). In Lebanon County,
higher than the state, but it is still short of the Healthy
the percentage of non-smoking pregnant mothers
People 2020 goal. Hispanic mothers in particular are
(85.3%) is lower than Lancaster County, the state,
prone to smoking during pregnancy. The percentage
and the Healthy People 2020 goal. However, White
of non-smoking Hispanic mothers is the lowest of all
mothers are significantly more likely than mothers
racial/ethnic groups (87.1%) and is significantly lower
across the state to be non-smoking.
Table 72. Percent of All Births to Teenage Mothers (Less than 18 Years) (2011)* United States Pennsylvania Lancaster County Lebanon County All Races
8.4%
2.3%
1.8%
3.1%
White
7.8%
1.4%
1.0%
2.9%
Black
13.7%
5.3%
4.3% N/A
Hispanic
12.1%
5.5%
7.2%
7.8%
*Data highlighted in blue denotes a value that is significantly lower when compared to Pennsylvania. Data highlighted in red denotes a value that is significantly higher when compared to Pennsylvania.
Table 73. Smoking Status of Mother (2011)* Pennsylvania Lancaster County Lebanon County Non-Smoking Mother During Pregnancy - All Races
84.7%
89.1%
85.3%
White
82.8%
89.5%
85.0%
Black
86.3%
85.5%
75.7%
Hispanic
90.9%
87.1%
89.5%
Prior to Pregnancy - All Races
79.4%
84.7%
79.9%
White
76.8%
85.2%
79.1%
Black
82.8%
79.5%
73.0%
Hispanic
86.8%
82.3%
85.9%
Non-Smoking Mother 3 Months
The Healthy People 2020 goal for mothers who
In Lebanon County, the percentage of breastfeeding
breastfeed is 81.9%. In Lancaster County, the
mothers (76.7%) falls short of the Healthy People
percentage of breastfeeding mothers (81.1%) is
2020 goal, but it is significantly higher than the state
equitable to the Healthy People 2020 goal and is
percentage. White mothers in both counties are the
significantly higher than the state percentage of 71.2%.
most likely to breastfeed.
HOL L ERA N
*Data highlighted in blue denotes a value that is significantly lower when compared to Pennsylvania. Data highlighted in red denotes a value that is significantly higher when compared to Pennsylvania.
53
Table 74. Breastfeeding (2011)* Pennsylvania Lancaster County Lebanon County All Races
71.2%
81.1%
76.7%
White
73.4%
84.4%
76.6%
Black
59.1%
59.1%
74.3%
Hispanic
69.5%
66.7%
70.9%
*Data highlighted in blue denotes a value that is significantly lower when compared to Pennsylvania. Data highlighted in red denotes a value that is significantly higher when compared to Pennsylvania.
The Special Supplemental Nutrition Program for
children in Lancaster County receive WIC benefits,
Women, Infants, and Children (WIC) is a federal
which is significantly higher when compared to the
program designed to provide supplemental food,
state (73.5%). In Lebanon County, the percentage
health care referrals, and nutrition education for
of children overall who receive WIC benefits is
low-income pregnant, breastfeeding, and non-
comparable to the state. However, percentages for
breastfeeding postpartum women, and to infants
both White and Hispanic children are significantly
and children up to age 5. In Lancaster County,
higher. Approximately 35% of White children and
significantly fewer children overall receive WIC
84.3% of Hispanic children in Lebanon County receive
benefits when compared to the state. The exception
WIC benefits.
is Hispanic children. Approximately 81% of Hispanic
Table 75. Children Receiving WIC Benefits (2011)*
HOL L ERA N
Pennsylvania Lancaster County Lebanon County
54
All Races
40.0%
29.9%
38.7%
White
30.4%
20.7%
35.2%
Black
68.3%
71.8%
68.6%
Hispanic
73.5%
80.8%
84.3%
*Data highlighted in blue denotes a value that is significantly lower when compared to Pennsylvania. Data highlighted in red denotes a value that is significantly higher when compared to Pennsylvania.
The Lebanon County youth mortality rate is notably lower when compared to both the state and the nation.
Infant and Child Mortality Infant mortality is the death of any child less than 1
mortality, and 2.0 for post-neonatal mortality. In
year of age. It is further broken down in to infants
general, infant mortality in Lancaster County for all 3
who die within 27 days of birth (neonatal) and infants
categories is equitable to the state and the nation. The
who die between 28 days and 11 months after birth
rates are slightly higher but within reach of the Healthy
(post-neonatal). The Healthy People 2020 goal per
People 2020 goals. Lebanon County rates are not
1,000 births is 6.0 for infant mortality, 4.1 for neonatal
available due to low death counts.
Table 76. Infant Mortality per 1,000 births (2011)*
Healthy People United States Pennsylvania Lancaster County Lebanon County
2020 Goal
Rate Deaths Rate Deaths Rate Deaths Rate Deaths Rate Infant Mortality
6.0
23,910
6.1
930
6.5
45
6.4
9
ND*
Neonatal Mortality
4.1
15,954
4.0
643
4.5
29
4.2
7
ND*
Post-Neonatal Mortality
2.0
7,956
2.0
287
2.0
16
2.3
2 ND*
*There is insufficient data to provide a mortality rate.
The overall mortality rate per 100,000 for youth 19
The Lebanon County youth mortality rate is notably
years and under is 58.5 in Lancaster County and 35.3
lower when compared to both the state and the
in Lebanon County. The Lancaster County rate is
nation. Data by age group (ex: age 5 to 9) is limited
slightly higher when compared to the state (53.2),
for both counties due to low death counts.
but lower when compared to the nation (63.7).
Table 77. Child Mortality per 100,000 (2011)
Healthy People United States Pennsylvania Lancaster County Lebanon County 2020 Goal
Rate Deaths Rate Deaths Rate Deaths Rate Deaths Rate N/A
636,310 63.7
1,671
53.2
84
58.5
12
Age 0 – 4 N/A
390,226 164.6
1,063
146.8
53
149.5
9 ND*
19 Years and Under
35.3
Age 5 – 9
12.3
34,262
14.3
81
10.8
8 ND*
2 ND*
Age 10 – 14
15.2
44,258
17.6
106
13.5
6 ND*
1 ND*
Age 15 – 19
55.7
157,564
61.8
421
47.5
17
0
*There is insufficient data to provide a mortality rate.
45.7
0.0
HOL L ERA N
Total Population
55
School Health Schools can have a profound effect on the health of
or less. In Pennsylvania, 35.5% of schools meet the
children. The following tables depict goals for schools
recommended ratio. However, Lancaster County and
and documentation of student health indicators like
Lebanon County fall short with only 6.3% of schools
body mass index, asthma, and diabetes.
in Lancaster County and 0% of schools in Lebanon County meeting the recommended ratio.
The Healthy People 2020 goal for the nurse-to-student ratio is that 44.7% of all schools have a ratio of 1:750
Table 78. Elementary, Middle, and Senior High Schools that Have a Nurse-to-Student Ratio of 1:750 or Less (2011 – 2012)
Healthy People Pennsylvania Lancaster County Lebanon County
2020 Goal
44.7%
35.5%
6.3%
0.0%
Youth BMI is categorized by percentiles. Youth with a
are overweight or obese when compared to the
BMI that falls below the 5th percentile are at risk for
state (32.6%), but the percentages are still high
being underweight. Youth with a BMI between the 5th
(29.6% in Lancaster County and 31.6% in Lebanon
and 85th percentile have a healthy weight. Youth with
County). Among youth in grades 7th through 12th in
a BMI above the 85th percentile but below the 95th
Lancaster County and Lebanon County, 66.2% and
percentile are overweight. Youth with a BMI greater
62.4% respectively have a healthy weight. In Lancaster
than or equal to the 95th percentile are obese.
County, fewer students in grades 7th through 12th
HOL L ERA N
are overweight or obese when compared to the state
56
Among youth in grades kindergarten through 6th in
(34.1%), but the percentage is still high (31.9%). In
Lancaster County and Lebanon County, 68.1% and
Lebanon County, a higher percentage of students
66.1% respectively have a healthy weight. In general,
in this group are overweight or obese (35.4%) when
fewer students in grades kindergarten through 6th
compared to Lancaster County and the state.
Table 79. Body Mass Index (2010 – 2011) Pennsylvania Lancaster County Lebanon County Grades K – 6 Students < the 5th Percentile
2.6%
2.4%
2.3%
Students in 5th to 85th Percentile
64.8%
68.1%
66.1%
Students in >85th to <95th Percentile
15.9%
15.4%
14.4%
Students >= 95th Percentile
16.7%
14.2%
17.2%
Grades 7 – 12 Students < the 5th Percentile
2.3%
1.8%
2.1%
Students in 5th to 85th Percentile
63.6%
66.2%
62.4%
Students in >85th to <95th Percentile
16.4%
16.0%
16.7%
Students >= 95th Percentile
17.7%
15.9%
18.7%
Asthma is present among 14% of students in Lancaster
Lancaster County and Lebanon County have Type I or
County and 12.5% of students in Lebanon County. The
Type II Diabetes.
state percentage is 12.1%. Less than 0.5% of students in
Table 80. Students with Asthma (2011 – 2012) Pennsylvania Lancaster County Lebanon County
12.1%
14.0%
12.5%
Table 81. Students with Diabetes (2011 – 2012)
Percent with Type I Diabetes
0.3%
0.3%
0.3%
Percent with Type II Diabetes
0.1%
0.0%
0.1% HOL L ERA N
Pennsylvania Lancaster County Lebanon County
57
58
CRIME and SAFETY In this section:
HOL L ERA N
Reported Crime Offenses
58
Youth Maltreatment and Crime
Lancaster County and Lebanon County have lower rates of crime when compared to Pennsylvania and the nation.
Reported Crime Offenses Lancaster County and Lebanon County have lower
arrest in Lancaster County and Lebanon County is
rates of crime when compared to Pennsylvania
for murder/manslaughter, 3.2 and 2.2 per 100,000
and the nation. The total crime index is 2,141.6 in
respectively. The highest rate of arrest in both counties
Lancaster County and 2,111.8 in Lebanon County.
is for larceny/theft, 1,569.8 and 1,543.9 per 100,000
The state crime index is 2,534.5. The lowest rate of
respectively.
Table 82. Reported Crime Offenses per 100,000 (2012)
Murder/Manslaughter
4.7
5.7
3.2
2.2
Rape
26.9
26.4
21.5
18.6
Robbery
112.9
123.3
63.1
47.6
Aggravated Assault
242.3
200.5
79.9
148.7
Burglary
670.2
446.7
328.5
283.2
1,959.3
1,601.3
1,569.8
1,543.9
229.7
117.1
66.2
58.7
18.7
13.6
9.7
8.9
2,534.5
2,141.6
2,111.8
Larceny/Theft Motor Vehicle Theft Arson
Total Crime Index N/A
HOL L ERA N
United States Pennsylvania Lancaster County Lebanon County
59
Table 83. Lancaster and Lebanon County Reported Crime (2012) Lancaster County Lebanon County Murder/Manslaughter
17
3
Rape
113
25
Robbery
331
64
Aggravated Assault
419
200
Burglary
1,723
381
Larceny/Theft
8,233
2,077
347
79
51
12
11,232
2,841
Motor Vehicle Theft Arson Total Crime Index
Table 84. Lancaster County Alcohol-Related Reported Crimes (2012)
HOL L ERA N
Lancaster County Lebanon County
60
DUI
1,512
520
Liquor Laws
499
100
Drunkenness
1,320
170
Disorderly Conduct
3,200
1,014
Lebanon County has a higher rate of child maltreatment (10.2 per 1,000 children) compared to Lancaster County, the state, the nation and the Healthy People 2020 goal. Youth Maltreatment and Crime Child abuse and neglect can be physical and/or
36 of 344 reported cases of child abuse and neglect
emotional. In Lancaster County, 160 of 1,065 reported
were substantiated. More than half of the children
cases of child abuse and neglect were substantiated.
affected were between the ages of nine and 14 years.
Nearly half of the children affected were between the
The rate of child maltreatment in Lebanon County is
ages of 12 and 17 years. The rate of child maltreatment
10.2 per 1,000 children, which is higher than the rate
in Lancaster County is 6.7 per 1,000 children, which
for Lancaster County, the state, the nation, and the
is lower than the state (8.7), the nation (9.1), and the
Healthy People 2020 goal.
Healthy People 2020 goal (8.5). In Lebanon County,
Table 85. Child Abuse and Neglect by Age (2012) Lancaster County Lebanon County Reported Substantiated Reported Substantiated Child Abuse and Neglect Cases
1,065
160
344
36
Age 0 – 2
6.1%
6.3%
4.4%
5.6%
Age 3 – 4
11.0%
6.9%
12.8%
11.1%
Age 5 – 8
23.4%
12.5%
32.3%
13.9%
Age 9 – 11
17.6%
21.3%
15.7%
27.8%
Age 12 – 14
22.4%
26.3%
16.9%
27.8%
Age 15 – 17
17.1%
22.5%
16.0%
11.1%
Table 86. Maltreatment of Children Under 18 per 1,000 (2011) Healthy People United States Pennsylvania Lancaster County Lebanon County
2020 Goal
8.5
9.1
8.7
6.7
10.2
The total number of juvenile court delinquency
than 75% of the dispositions in both counties were
dispositions that occurred in Lancaster County and
filed against youth age 15 to 17 years.
Lebanon County were 988 and 227 respectively. More
Table 87. Juvenile Court Delinquency Dispositions by Age (2012) Lancaster County Lebanon County Juvenile Court Delinquency Dispositions
988
227
Age 10 – 11
1.1%
0.9%
Age 12 – 14
21.9%
26.0%
Age 15 – 17
77.0%
73.1%
HOL L ERA N
61
62
key informant concluSIONS
In this section:
Most Pressing Issues Missing or Lacking Resources/Services
HOL L ERA N
Open-Ended Feedback
62
The most pressing issues for older adults were navigating/accessing health care and social services, chronic disease management and poverty/financial insecurity.
Most Pressing Issues Older Adults Key informants were asked to identify the 5
insecurity is a major issue for many seniors, which
most pressing issues facing seniors/elderly in the
feeds into medication, hunger and food insecurity,
community. The most pressing issues identified were
housing/affordable housing and many other issues.
navigating/accessing health care and social services,
I also see many elderly people that have a lack of
chronic disease management, and poverty/financial
communication with the outside world as many friends
insecurity. In regard to the most pressing issues, one
and loved ones have died off and the fear of the new
key informant stated, “Chronic disease management
outside world is difficult for many to handle.” Another
and health clearly are burdens and navigating through
informant stated, “Hunger and poverty is an issue that
Medicare and being able to understand what a medical
is chronic. We have hunger and poverty issues with the
professional charges, pay for the services, medication,
younger population, but there is hope for them with
and the ability to care for one’s self becomes more
employment; not so with the elderly.”
difficult with age. Poverty and financial
Count Percent
Navigating/Accessing Health Care & Social Services
63
74.1%
Chronic Disease Management (Heart Disease, Stroke, Diabetes, Cancer, Arthritis)
58
68.2%
Poverty/Financial Insecurity
55
64.7%
Alzheimer’s Disease/Dementia/Memory Loss
51
60.0%
Social Isolation
46
54.1%
Affordable Housing/Homelessness
44
51.8%
Injuries/Falls
31
36.5%
Mental/Behavioral Health Issues
26
30.6%
Hunger/Food Insecurity
16
18.8%
Financial Scams/Fraud
15
17.6%
Overweight/Obesity
9
10.6%
Elder Abuse/Neglect
7
8.2%
Other (please specify)
4
4.7%
Total
425
HOL L ERA N
Percent
63
The most pressing issues for youth were poverty/financial insecurity, quality/affordable child care and early education, and affordable housing/homelessness.
Youth Key informants were asked to identify the 5 most
one key informant stated, â&#x20AC;&#x153;I do feel that it is difficult
pressing issues facing children and their families in the
for families to find quality and affordable child care
community. The most pressing issues identified were
services. Families do have a difficult time navigating
poverty/financial insecurity, quality/affordable child
through the health and social services programs,
care and early education, and affordable housing/
especially if they work, but still have a limited financial
homelessness. In regard to the most pressing issues,
situation.â&#x20AC;?
Percent
Count Percent
Poverty/Financial Insecurity
63
80.8%
Quality, Affordable Child Care & Early Education
61
78.2%
Affordable Housing/Homelessness
47
60.3%
School Readiness/Literacy
46
59.0%
Hunger/Food Insecurity
43
55.1%
Mental Health/Behavioral Health/Developmental Issues
37
47.4%
Navigating/Accessing Health Care & Social Services
33
42.3%
Overweight/Obesity
28
35.9%
Child Abuse/Neglect
27
34.6%
Other (please specify)
5
6.4%
Total
390
Missing or Lacking Resources/Services
HOL L ERA N
Older Adults
64
Key informants were asked to identify any resources or
bring seniors and children together in a mutually
services that are missing or lacking in the community
beneficial relationship. Other resources or services
to support seniors/elderly. Inter-generational programs
identified as missing or lacking in the community
were identified by the most key informants as missing
included financial management/counseling services
or lacking in the community. Inter-generational
and caregiver support services.
programs are defined as interactive activities that
Percent
Count Percent
Inter-generational Programs (Interactive Activities for Seniors & Children)
35
41.2%
Financial Management/Counseling Services
33
38.8%
Caregiver Support Services
33
38.8%
Respite Care (Short-Term, Temporary Care to Provide Relief to Caregivers)
32
37.6%
Home Modification/Repair Services
28
32.9%
Elder Fraud Prevention
27
31.8%
Home Care Services (Assistance with Bathing, Dressing, Eating)
24
28.2%
Housekeeping Services (Cleaning, Laundry)
22
25.9%
Senior Fitness Programs
21
24.7%
Social/Recreational Programs
21
24.7%
Yard Maintenance Services
20
23.5%
Adult Day Programs/Adult Daycare Centers
19
22.4%
Legal Services
19
22.4%
Meal Preperation/Meal Delivery Services
19
22.4%
Home Health Care Services(Assistance with Medical Needs)
18
21.2%
Other (please specify)
8
9.4%
Hospice/Palliative Care/Grief Counseling
7
8.2%
Total
386
Youth Key informants were asked to identify any resources or
identified by the most key informants as missing or
services that are missing or lacking in the community
lacking in the community. Other resources or services
to support children and their families. Parent education
identified as missing or lacking in the community
and support programs and quality/affordable child
included a healthy eating/nutrition program and
care and early education were
support services for children with special needs.
Count Percent
Parent Education & Support Programs
48
64.0%
Quality, Affordable Child Care & Early Education
48
64.0%
Healthy Eating/Nutrition Programs
44
58.7%
Support Services for Children with Special Needs
31
41.3%
Summer Programs
27
36.0%
Free Book/Literacy Programs
24
32.0%
After-School Programs
24
32.0%
Early Intervention & Screening Programs
22
29.3%
Before-School Programs
15
20.0%
Recreational Activities
12
16.0%
Other (please specify)
6
8.0%
None
2
2.7%
Total
303 HOL L ERA N
Percent
65
FOCUSED RESEARCH Following the compilation of secondary data and
developed in consultation with Luthercare, was used to
key informant feedback, the Luthercare Board of
prompt discussion and guide the facilitation.
Directors held a retreat to discuss the research results and prioritize the issues that were identified in the
In total, 20 people participated in the focus groups.
research. The Board members selected and prioritized
It is important to note that the results reflect the
community issues in the order listed below:
perceptions of a limited number of community members and may not necessarily represent all
• Mental Health & Depression
community members living in Lancaster County and
• Intergenerational Interaction
Lebanon County. The following section provides a
• Access to Mobile Healthcare
summary of the focus group discussions including key
• Informative Services & Beyond
themes and select comments.
• Housing that is Affordable • Wellness & Education
The focus group participants felt that many seniors
• Caregiver Support Services
in the community were dealing with mental health issues, depression, dementia, and social isolation. A
Prioritization was based on the scope and seriousness
health and human service provider said “We see quite
of the issue as well as the perceived ability to
a bit of depression, especially new onset depression.”
impact the issue. Mental Health & Depression and
Participants shared that lack of knowledge and
Intergenerational Interaction were viewed as the
understanding of mental health and dementia was an
most pressing issues. Mental Health & Depression
issue and that many people are not educated about
were frequently mentioned by key informants. Social
what happens to the mind and body as people age.
isolation was also identified as an issue that impacts
One participant said, “What is the norm? When does
the mental health in seniors. Secondary data showed
sadness become depression? When does forgetfulness
that significant numbers of older adults are living
become dementia? These issues can be so intertwined
alone. When asked about programs that were missing
and difficult to understand.”
in the community, Intergenerational programs were most frequently selected by key informants. As
According to participants, depression becomes a
Luthercare, serves both seniors and children, Board
normal expectation of aging – “I’m old and therefore
members felt that the organization was uniquely
depressed.” One senior said “Grief is a real issue as one
positioned to offer intergenerational opportunities.
is aging. Not just the loss of a spouse or a brother but
Luthercare decided to conduct focused research
the loss of strength and health. Aging in general is a
including focus groups and a literature review of best
series of losses.” Another stated, “How do we prepare
practices in order to gather more information about
people for aging? It just creeps up on you.” Loss of
these topics.
independence and connectedness often leads to social isolation and sometimes depression.
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Two focus group discussions were held in August to
66
gather additional qualitative feedback on two specific
Most felt that people in the community were reluctant
areas of focus: Mental Health and Social Isolation in
to seek help because of the stigma surrounding mental
Seniors and Intergenerational Opportunities. One focus
health. In addition, many people do not know where to
group included community experts with experience in
go to seek assistance and they often wait until there
mental health, health, community and senior services
is a crisis to look for resources. Participants shared
while the other included local seniors. Each session
that navigation of the system can be very daunting to
lasted approximately 90 minutes and was facilitated
people. One participant stated, “The first entry point
by trained staff from Holleran. A discussion guide,
can either make or break the experience and decide
whether someone pursues help. If someone doesn’t
they can give back to the community. Seniors want to
get the answer or gets shuttled around, they often end
feel like they can still contribute something. They do
up giving up.”
not want to feel like they are a drain on society.
Transportation issues and lack of mental health
Participants felt that we need to focus on getting
services and providers were seen as additional barriers.
people connected to the community and connected
Participants shared that there is a lack of psychiatrists
to services. Resource Navigation, Information
and providers accepting patients with public insurance
Referral, Educational Workshops, Intergenerational
in the area.
Opportunities, Volunteer Opportunities, Caregiver Support Programs, Socialization/Recreation
Many seniors are not comfortable asking for help and
Programs, and Volunteer Visitation/Companion/
often say, “I don’t want to be a bother.” Participants felt
Contact Programs were suggested as ways to increase
that this reluctance to request and receive help could
connectedness and reduce isolation.
be addressed by helping seniors identify ways that
COMMUNITY ENGAGEMENT AND NEXT STEPS In September, Luthercare invited community
for future service, collaboration, and impact in the
stakeholders from Lancaster and Lebanon Counties
communities in which it serves. Luthercare plans to
to attend a community forum. An overview of the
use information gathered through the Community
Community Engagement Needs Assessment was
Engagement Needs Assessment to both inform and
shared with community partners and key findings
engage the greater community in a collective initiative
were presented. Following the research presentation,
to improve the overall quality of life of older adults
the community partners participated in a facilitated
and children.
discussion. Attendees provided feedback on the research results and confirmed many of the identified
The Community Engagement Needs Assessment
issues. Community partners suggested potential
findings will be examined by the strategic planning
opportunities for Luthercare to support existing
committee of the Board and the Executive Leadership
community efforts through promotion, awareness,
Team to determine the next steps. After hearing
and resources (volunteers & funding). They mentioned
feedback from community partners who participated
several programs, initiatives, and resources that
in the Community Forum, the Board has expressed
Luthercare might be interested in partnering
interest in helping seniors and their families navigate
with: LiveWell Lancaster, Lancaster Mental Health
available programming and community resources,
Collaborative, Area Agency on Aging, Senior Centers,
connecting the families of their childcare programs
Love Inc., United Way 2-1-1, Link to Aging & Disability
with available insurance programming and community
Resources, and CHIP (Children’s Health Insurance
resources, providing intergenerational opportunities,
Program) initiatives. Community partners were also
and enhancing volunteer efforts both within the
supportive of new efforts to reduce social isolation and
walls and beyond the walls of Luthercare. Luthercare
expand intergenerational opportunities.
will also seek to develop and enhance community partnerships so they are well-positioned to create
Luthercare indicated that they will continue to work
community impact. HOL L ERA N
with community partners to determine avenues
67
Appendix A. Secondary Data Profile References American Lung Association. (2013). State of the air. Retrieved from http://www.stateoftheair.org/2013/states/Pennsylvania/boulder-08013.html Centers for Disease Control and Prevention. (2012). National vital statistics reports: Deaths: Preliminary data for 2011. Retrieved from http://www.cdc.gov/nchs/deaths.htm Centers for Disease Control and Prevention. (2013). National vital statistics reports: Births: Final data for 2011. Retrieved from http://www.cdc.gov/nchs/births.htm Centers for Disease Control and Prevention Wonder. (2014). CDC wonder, underlying cause of death, 1999 – 2010 results. Retrieved from http://wonder.cdc.gov/controller/datarequest/D76 Centers for Disease Control and Prevention Wonder. (2014). CDC wonder, United States cancer statistics, 1999 – 2010 incidence results. Retrieved from http://wonder.cdc.gov/cancer-v2010.HTML Centers for Medicare & Medicaid Services. (2013). County reports. Retrieved from http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and Reports/Chronic-Conditions/County-Reports.html County Health Rankings & Roadmaps. (2014). Pennsylvania. Retrieved from http://www.countyhealthrankings.org/app/pennsylvania/2014/overview Federal Bureau of Investigation. (2013). Crime in the United States 2012. Retrieved from http://www.fbi.gov/about-us/cjis/ucr/crime-in-the-u.s/2012/crime-in-the-u.s.-2012 Google Maps. (n.d.). Lancaster County, PA. Retrieved from https://www.google.com/maps Google Maps. (n.d.). Lebanon County, PA. Retrieved from https://www.google.com/maps Lancaster County Coalition to End Homelessness. (n.d.). About us: Homelessness in Lancaster – Point in time count. Retrieved from http://www.lcceh.org/about_lancaster.asp Pennsylvania Department of Health. (n.d.) Health statistics and research. Retrieved from http://www.portal.state.pa.us/portal/server.pt/community/health_statistics_and_research/11599 Pennsylvania Uniform Crime Reporting System. (n.d.). 2012 Online annual crime report. Retrieved from http://www.paucrs.pa.gov/UCR/Reporting/Annual/AnnualFrames.asp?year=2012 The Annie E. Casey Foundation. (2014). Kids count data center. Retrieved from http://datacenter.kidscount.org/ The Nielsen Company. (2014). Senior life 2014. Retrieved from http://www.claritas.com/sitereports/Default.jsp U.S. Census Bureau. (n.d.). American fact finder. Retrieved from http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml U.S. Department of Agriculture. (2014). Food environment atlas. Retrieved from
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http://www.ers.usda.gov/data-products/food-environment-atlas.aspx#.UvKBlPldW8S
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U.S. Department of Health and Human Services. (2014). Healthy people 2020. Retrieved from http://www.healthypeople.gov/2020/default.aspx
Appendix B. Secondary Data Terminology Age-Specific Rate: Age-specific rates are calculated in the same manner as crude rates, but the number of cases or deaths and the population are based on a specific age group. Crude Rate: Generally defined as the total number of cases or deaths divided by the total population at risk. Crude rate is generally presented as per populations of 1,000, 10,000 or 100,000. It is based on raw data and does not account for characteristics such as age, race, and gender. Family: Defined as more than one person living together, either as relations or as a married couple. Frequency: Often denoted by the symbol â&#x20AC;&#x153;N,â&#x20AC;? frequency is the number of occurrences of an event. Household: Defined as one or more people sharing a residence. Examples include college students sharing an apartment or a single male living alone. Incidence Rate: Indicates the number of new disease cases in a specified amount of time. Time is determined by the number of years candidates for the disease are observed before they are diagnosed. Infant Mortality: Refers to the death of a child less than one year of age. Low Birth Weight: Constitutes a birth weight of less than 5 pounds, 8 ounces or 2,500 grams. Neonatal Mortality: Refers to the death of a child less than 28 days of age. Post-Neonatal Mortality: Refers to the death of a children age 28 days to 11 months. Poverty Guidelines: A version of the federal poverty measure. They are issued each year by the Department of Health and Human Services. The guidelines are a simplification of the poverty thresholds for use for administrative purposes (Determining financial eligibility for federal programs).
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Very Low Birth Weight: Constitutes a birth weight of less than 3 pounds, 4 ounces or 1,500 grams.
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