JCCI Re-Think Aging Report by JCCI

RE-THINK AGING:

Making Northeast Florida An Age-Friendly Region

A REPORT TO THE CITIZENS OF NORTHEAST FLORIDA FALL 2015

ABOUT JCCI

WE BRING PEOPLE TOGETHER TO LEARN ABOUT OUR COMMUNITY, ENGAGE IN PROBLEM SOLVING, AND ACT TO MAKE POSITIVE CHANGE. JCCI is headquartered in Northeast Florida, and works in the local area and beyond; from Walla Walla, Washington to Londrina, Brazil, our efforts in community engagement span six continents. Across the world, we understand that tracking only GDP as the measurement of success for nations misses the human side of progress. Quality of life has become the new standard benchmark for success, and we’re proud at JCCI to be recognized internationally for being the first organization to track community quality of life progress with an annual report card spanning 30 years. We bring people together to act on these indicators, and have created lasting community change through our inquiries and subsequent implementations. We have seen and documented real improvement in the quality of life in dozens of communities. At JCCI, we do the work that we do because we believe in community – and we believe in the power that the people who live in those communities have to shape their future. Are you involved with JCCI yet? From Forward, our action program for new leaders, to implementing inquiry recommendations, there are always opportunities to get engaged and make the community vision for JAX2025 a reality. We are a volunteer-based organization and continually strive to involve you – the caring citizen, the community hero, the devoted doer – in our work in celebrating our community and making it the place we all know it can be.

2014-2015 JCCI BOARD OF DIRECTORS Chair: James Stevenson Chair-Elect: Kevin Hyde Immediate Past Chair: Rabbi Joshua Lief Secretary/Treasurer: Jennifer Mansfield Martha Barrett Lee Brown, III J.F. Bryan, IV S. Roger Dominey Anne Egan Angelia Hiers Coley Jones David Meyer Peter O’ Brien Stephen Pollan Jay Posze Derrick Smith Brooks Terry

JCCI STAFF Ben Warner

Former President & CEO

Clayton Davis

President & CEO

Laura Lane

Vice President & COO

Susan Cohn

Director of Policy & Planning

Candace Long

Administrative Assistant

Aschelle Morgan

Director of Community Outreach

Kathy Pandich

Business Development Director

Steve Rankin

Director of Implementations & Special Projects

RE-THINK AGING: MAKING NORTHEAST FLORIDA AN AGE-FRIENDLY REGION

RE-THINK AGING RESOURCE SPEAKERS Terri Barton Aging True

Lori Boyer

Jacksonville City Council

Cathy Brown

Volunteer, St. Johns County Council on Aging

Diane Burfeindt

Presbyterian Senior Living

Dave Bruns AARP

TA B L E O F C O N T E N T S

Fran Carlin-Rogers CarFit

EXECUTIVE SUMMARY. . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Margaret Lynn Duggar

FINDINGS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Margaret Lynn Duggar and Associates, Inc.

Brian Grimard Mayo Clinic

Lindsay Haga

Starting Points for this Report. . . . . . . . . . . . . . . . . . 7 Population Projections for Northeast Florida. . . . . 8 Livable Communities. . . . . . . . . . . . . . . . . . . . . . . . . 10

Northeast Florida Regional Council

AARP Livability Index . . . . . . . . . . . . . . . . . . . . . . . . 11

Michael Korn

Housing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Korn & Zehmer

Bill Lazar

St. Johns Housing Partnership

Linda Levin

Transportation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Environment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

ElderSource

Engagement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Sandy Markwood

Opportunity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

National Association of Area Agencies on Aging

Sharan Merriam

Neighborhoods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Promising Pathways. . . . . . . . . . . . . . . . . . . . . . . . . 38

University of Georgia

CONCLUSIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Larry Polivka

RECOMMENDATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Florida State University

Michael Spigel

Brooks Rehabilitation

Nancy Stanton

AARP Jacksonville

Joe Stephenson

North Florida Regional Transportation Commission

Toula Wootan

Community Hospice of Northeast Florida A 2015 JCCI INQUIRY

VOLUNTEER LEADERSHIP

HELEN JACKSON, CHAIR Women of Color Cultural Foundation

MANAGEMENT TEAM

COMMITTEE MEMBERS

Ormal Ali

Terri Barton Toni Bonfili Mickee Brown Lisa Buggs Melanie Carlson Lois Chepenik Sherri Cheshire Roger Cochran Vince and Linda Ferrigno Leslie Held Joanne Hickox Tammy Horn Nancy Lundgren Felina Martin Deanna McDonald Danielle McGrath Mary Randall Jerry Reynolds John Roberts Tourea Robinson Hillary Rotenberg Sabrina Scott Brenda Smith Christine Stryker Emily Suter Ken Tannenbaum Barbara Tidwell Marion Tischler Jeanette Toohey Hong-van Tran Debra Vasquez Jim Vearil Hermyone Walker Alzina Warner Toula Wootan Becky Yanni

Walgreens

Marion Anderson

Brooks Rehabilitation

Skip Cramer

Captain, United States Navy

Gloria Crawford

Senior Services Division, City of Jacksonville

Earl Evens

AgeWell Center for Senior Health, Baptist Health

Timothy Giles

University of North Florida

Lindsay Haga

Northeast Florida Regional Council

Angie Hiers JEA

Mary Blake Holley

Retired, City of Jacksonville

Wendy Khan JTA

Michael Korn

Korn & Zehmer

Michelle Leak Mayo Clinic

Linda Levin ElderSource

Susan Ponder-Stansel

Community Hospice of Northeast Florida

Nancy Stanton

AARP Jacksonville

RE-THINK AGING: MAKING NORTHEAST FLORIDA AN AGE-FRIENDLY REGION

EXECUTIVE SUMMARY

IN 2015, A LITTLE MORE THAN ONE IN FIVE NORTHEAST FLORIDA ADULTS IS A 55+ YEAR-OLD. IN JUST 25 YEARS, BY 2040, AT LEAST TWO IN FIVE WILL BE 55+.

HILE NORTHEAST FLORIDA IS NOT A LEGENDARY DESTINATION for retirees like South Florida, the region is projected to see a doubling in the number of residents 65+. The aging of Northeast Florida will create remarkable changes, some that we’ve planned for and others that are unplanned. Contrary to popular belief, population aging is not a result of the Baby Boom generation. U.S. residents have been living longer for decades: in 1900, residents who reached 65 lived an average of 12 more years. In 2010, they lived an average of 19 more years. Future generations will live even longer past 65 years as health and healthcare continue to extend lives. This remarkable change requires a shift in thinking. Aging is often mistakenly limited to people who reach an arbitrarily chosen age (e.g., 65). However, everyone is impacted by aging. Our housing, work, how we organize families, how our medical care is structured and options for moving about towns and cities—all of this will change as our population ages.

A 2015 JCCI INQUIRY

EXECUTIVE SUMMARY Two federal programs associated with positive aging—Social Security and Medicare—celebrate birthdays this year. Now both can be considered “older.” Social Security turns 80 years old while Medicare turns 50, and these milestones were noted at the White House Conference on Aging this year. What is clear from the White House Conference on Aging and other similar meetings is that responses to population aging are not coming from ‘the top down.’ Responses are coming from the bottom up as communities engage new realities already underway and plan for a future only glimpsed at recently. For more than 40 years, JCCI has been recommending local policy inspired by engaged, informed citizens. This 2015 inquiry is part of JCCI’s long history of bringing citizens together to learn about a policy issue, engaging citizens and industry professionals in discussions, inviting a range of points-of-view, and arriving at consensus on a shared path forward.

The inquiry committee realized that its work is a community initiative to improve livability for all, not an aging initiative.

This inquiry represents a shift in thinking no less massive than the demographic shift already underway. The inquiry committee realized that its work is a community initiative to improve livability for all, not an aging initiative. Local governments, corporations, small businesses, nonprofits, educational services, in fact all sectors of Northeast Florida are already serving and supporting older adults. Now is the time to bring together leadership from all sectors to make public goals and celebrate ongoing accomplishments. In 2005 and 2010, the National Association of Area Agencies on Aging in Partnership with national planning organizations, conducted a survey of county and city officials, asking them: ‘is your community ready for population aging?’ Very few local government officials were preparing in 2005. The 2010 survey results show a slightly increasing percent of public officials preparing. On the other hand, AARP estimates that 8,000 U.S. residents turn 65 every day. Policy changes needed to prepare for our future must start now, for the window of opportunity for planning is closing quickly.

With this inquiry, Northeast Florida joins a quiet national discussion emerging in our nation; not about program budgets or agency services. It is a discussion about making every community livable. The facts, conclusions, and recommendations in this report are a citizen-informed blueprint for making Northeast Florida a good place to grow up and grow old.

RE-THINK AGING: MAKING NORTHEAST FLORIDA AN AGE-FRIENDLY REGION

FINDINGS

OTHER THAN OLDER ADULTS THEMSELVES, NOT MANY PEOPLE IN THE UNITED STATES THINK ABOUT AGING.

HE CONCEPT OF DEVELOPMENT FROM THE AGE OF 50 THROUGH 80 and beyond is not only denied—it is viewed in the reverse, as decline. Geriatric psychologists have found that the American cultural frame for thinking about aging is not the norm in other societies. In many countries, older adults (persons over age 50) are seen as paragons of spiritual and intellectual development. Outside the United States older adults are held in high esteem because they have accrued wisdom not possible except through experience. Older adults are considered assets to their communities and families. This characteristic American misapprehension about the joys and privileges of aging is an area deserving greater attention. To “re-think aging” is a paradigm shift already happening across the globe because populations in both emerging and industrialized countries are “graying.” According to the World Health Organization, “the world is rapidly aging: the number of people aged 60 years and over as a proportion of the global population will double from 11 percent in 2006 to 22 percent by 2050. By then, there will be more older adults than children (aged 0-14 years) in the population for the first time in human history.” It is commonplace for families and communities to plan for the early development of young children. At the beginning of life an entire series of decisions are triggered at birth: parents plan for new housing, re-locate for the best schools, invest in college 18 years in advance, purchase toys for intellectual stimulation, and optimize their home for good health and well-being. Along this same line of thinking, the Re-think Aging inquiry is inspired by the need for Northeast Florida families

A 2015 JCCI INQUIRY

FINDINGS and communities to plan for the second half of life with similar care and enthusiasm. Advances in public health and medicine have extended life expectancies at the same time that the largest population cohort in the developed world is entering the older adult phase. A great deal of attention is placed on the Baby Boom generation (adults born between 1946-1964) because they are re-shaping the journey of growing older through their sheer numbers. More people than ever are reaching retirement, traveling new avenues for meaningful lives, relocating to age friendly places, and finding the best options for healthy Advances in public aging. In 2011, the first wave of the Baby Boom generation turned 65 years old. Since then and for another fifteen years, approximately 8,000 U.S. resihealth and medicine dents will turn 65 years old every day. (AARP) It is also important to note that the first wave of Generation X (adults born between 1965-1980) are turning have extended life 50 in 2015.

expectancies at the same time that the largest population cohort in the developed world is entering the older adult phase.

The complexity of aging increases as our life expectancies increase. In the United States older adults are working longer and delaying retirement. In 1965, the federal government defined age 60 as ‘old’ in the Older Americans Act. In 2015, this seems unrealistic as more workers extend employment into their late sixties and seventies and may delay collecting Social Security until age 70, when the maximum retirement benefit is achieved, or later. The language used to refer to people who are older is also changing. The term “senior” is giving way to “older adult,” because new words are needed to define the many sub-groups of older Americans. AARP, the nation’s largest advocacy group for older adults, considers anyone age 50 years and over within their demographic, and yet, an older adult at age 89 is living a wholly different experience than someone who is 59 years old.

For example, that 59-year-old is likely to be working and in the process of planning for future retirement, while the 89-year-old is probably living on a fixed income reliant on savings and Social Security. It is even possible that the 59-year-old is a caregiver for his or her 89-year-old mother. The financial, social, and health implications of getting older are complicated and intertwined across the aging continuum from midlife through late adulthood. There is no ‘one size fits all’ plan for aging. Planning for the second half of life—from 50 years onward—is personal, familial, and communal. All of us are inextricably connected to the decisions that our older loved ones are making right now. At the same time, our children’s lives are similarly shaped by the success or failure of our efforts to plan for our later years. Aging, then, is about all of us, not only those who are considered older adults. It is against this backdrop that JCCI undertook a three-year community project to re-think aging in Northeast Florida. Our community is at the beginning of several decades of unprecedented demographic change that is already affecting the local economy, healthcare institutions, local government, housing markets, social services, workplaces, neighborhoods, and communal spaces—our entire community. We can decide to plan now while there is a window of opportunity, or we can ignore the fact that our community is aging and live with the unintentional consequences of poor preparation. The citizens who served on the Re-Think Aging committee are committed to planning now for the future. This report provides a set of guiding principles for making policy decisions, aligning Northeast Florida’s resources, and advocating for community improvements. Older adults are consumers, investors, job creators, volunteers, and change agents with aspirations that go beyond stereotypes of the sick, cantankerous, helpless, and unproductive senior citizen. Impending demographic

RE-THINK AGING: MAKING NORTHEAST FLORIDA AN AGE-FRIENDLY REGION

FINDINGS changes mean the region’s quality of life is tied to older adults’ quality of life due to the sheer number of people who will reach age 50 each year. The region will catapult into a powerful future to the extent that Northeast Florida’s leadership attends to the quality of life of its older residents at the same level it does for younger generations. Northeast Florida has a limited amount of time to prepare and the question to politicians and leaders from all sectors of the community is, “How are you preparing for this change?” If we take advantage of the time-limited opportunity to plan and advocate, we can improve Northeast Florida’s quality of life for ourselves, our children, and our grandchildren.

Starting Points for This Report

his report begins with the assumption that if all older adults in Northeast Florida suddenly moved away, our community would suffer in myriad ways. Consider what older adults bring to the table. Floridians over age 65 contribute more in state and local taxes than they take in services. The state’s older adults are also entrepreneurs who volunteer, raise grandchildren, and are integral to the social, civic, and economic health of our region. Aging is a process and older adulthood is a time to embrace, plan for, and enjoy. Getting older is a normal part This report begins with of human development. Recognizing that we are all aging provides an opporthe assumption that if tunity to join the generations, not draw us apart with misinformation about aging.

all older adults in

These misperceptions are driven by stereotypes seen in various media Northeast Florida formats - television commercials, political satire, and cartoons where aging is viewed “as a process of deterioration, dependency, reduced potential, [and] suddenly moved away, family dispersal.” (FrameWorks Institute) This view is countered, however, by an idealized set of assumptions Americans make about retirement and physical our community would health. These images often illustrate silver-haired retirees enjoying a life of no work obligations, visiting grandchildren, living debt-free, and travelling the suffer in myriad ways. world. Most Americans’ understanding of aging is caught between these two extremes, one that is ‘real’ in the sense that aging appears to be about deterioration and isolation, and the other aspirational—if we keep physically fit and financially solvent—all of us can ‘age positively.’ The divide in beliefs about ‘real aging’ and an ‘ideal aging’ builds the assumption in America that aging is something to fight, put off. “These deep and negative shared understandings [of aging] make the process of aging something to be dreaded and fought against, rather than embraced as a process that brings new opportunities and challenges for individuals and society.” (FrameWorks Institute) Another starting point for this report is the primacy of health in managing the aging process. All other quality of life dimensions — housing, social connections, opportunities for work, and so on — are impacted by the natural and eventual decline of our bodies. According to the United States Department of Health and Human Services, 45 percent of adults 65 and over lived with two of nine selected chronic conditions in 2009-2010. In the same period, 21 percent of people 45-64 years lived with two or more of nine selected chronic conditions (including hypertension, heart disease, stroke, and diabetes). While we are living longer and many infectious diseases and acute sickness are no longer major threats, we are still living with lingering diseases that do not have cures or life-saving treatments. Still, longer life spans have not changed the healthcare establishment’s primary focus on acute conditions A 2015 JCCI INQUIRY

FINDINGS and curing disease. “Positive aging” then is management of the inevitable changes in physical and mental capacities, social connections, and financial resources. Necessarily aging well may also require adaptations being made with regard to housing, mobility, and financial expectations with the help and support of loved ones. The United States health system is slowly beginning to shift its focus from eradicating disease in young people and adults toward prevention of chronic conditions such as diabetes, coronary heart disease, and depression. All of this is crucial to “re-think aging,” which is synonymous with re-thinking health care. The overlap of health care, family caregiving, and social services available in the community are emerging, and this report pays special attention to these connections.

Another starting point for this report is the primacy of health in managing the aging process. All other quality of life dimensions — housing, social connections, opportunities for work, and so on — are impacted by the natural and eventual decline of our bodies.

For the purpose of this report, Northeast Florida is a five-county region that includes Baker, Clay, Duval, Nassau, and St. Johns. However, the organizations responding to the demographic changes underway may evolve to cover additional counties. Some agencies are already responsible for a seven-county region, which includes the five mentioned counties, plus Flagler and Volusia. When applicable, the report identifies when regional data references seven counties or five.

Population Projections for Northeast Florida

ge structures, which are the distribution of age groups across an entire population, have changed in the past 50 years. Until 1960, the age structure of Florida resembled a pyramid, illustrating a higher number of younger residents than older residents. As the number of older adults increases in proportion to younger residents, the pyramid will come to resemble a rectangle in 2050 indicating significant growth in the number of people who reach older adulthood. Well into the mid-21st century Baby Boomers are projected to be a significantly large group of older adults. The same demographic shifts illustrated in the age structure graphs (Figures 1 – 3) are also occurring in Northeast Florida now.

The Florida Population by Age and Sex diagrams show the proportion of the population in each age/sex group. Baby Boom groups are highlighted in each diagram. The bars represent the proportion of total population in each age/sex group at a given point in time. CURRENTLY, in 2015, Northeast Florida is home to an estimated 198,247 people who are 65 years of age and over and 183,522 people between the ages of 55-64. Added together, the population 55 years and over (381,769) makes up 35.2 percent of the adult population, or approximately 1 in 3 adults. IN 2040, 25 YEARS FROM NOW, it is estimated that Northeast Florida will be home to 388,605 residents who are age 65 years and over, and 205,783 residents 55 to 64 years old. Together, these age groups will make up 40.4 percent of the population age 18 years and over or at least 2 in 5 adults. The projections in Figure 4 do not include deaths or those adults who will move into the region. In order for demographers to get a more accurate picture of older adult population growth in Northeast Florida, net in-migration must be considered. Because Florida is a preferred destination, retiree

RE-THINK AGING: MAKING NORTHEAST FLORIDA AN AGE-FRIENDLY REGION

FINDINGS FLORIDA POPULATION BY AGE AND SEX FIGURES 1-3

Source: U.S. Census decennial censuses; Bureau of Economic and Business Research, unpublished population projections.

NORTHEAST FLORIDA: OLDER ADULT POPULATION AS PERCENT OF ADULT POPULATION FIGURE 4

A 2015 JCCI INQUIRY

FINDINGS in-migration is frequent. Although Northeast Florida’s older adult population is lower than South Florida’s, it is projected that more than 400,000 Northeast Floridians will be aged 65 years and over by 2040 – double the current number of older adults in this age range currently living in the area. Right now, Florida has fewer retirees than workforce age residents and children. The data indicate this will change in the future. Other regions in the Southeast are re-defining their future given impending demographic shifts. Nashville, TN and Macon-Bibb, GA – like Jacksonville with their consolidated city-county government – have community-wide plans for creating an age-friendly region. Macon-Bibb has an Age-Friendly Community Action Plan that focuses on road infrastructure, directional signage for driving, housing options, and other quality of life dimensions. The Nashville Livability Project, led by the city’s Vice Mayor, engages Nashville residents in planning for the needs of all citizens. The Nashville Area Chamber of Commerce also held a Baby Boomer Business Conference in 2013 sponsored by local businesses and universities.

Livable Communities

he national discussion about population aging is emerging under different names and movements. Some of these include: • Age-friendly communities • Lifelong communities • Livable communities for all ages • Elder-friendly design • Livability • Lifetime communities

The descriptors above offer different names for the same goal: a community that prioritizes intergenerational activity, social inclusion, and aging well. In response to population aging, think-tanks and policy organizations are also developing frameworks for communities to use as they plan for population aging. Examples include Best Cities for Successful Aging, a report by the Milken Institute, AARP’s Livable Communities Network, and the World Health Organization’s Global Age-Friendly Cities: A Guide. In these frameworks, researchers offer a comprehensive picture of the components necessary for positive aging: transportation options, housing choice, community supports, access to assistance, health and wellness, civic engagement, and other quality of life dimensions. Rather than make arguments for policy, infrastructure, and investment for a sub-population (even if the number of older adults is growing in relation to the rest of the population), it is more effective to make an argument for infrastructure projects that benefit everyone, people at all stages of life. A livable community accommodates everyone, regardless of age. For example, a curb cut made for a safe walkable street benefits an individual using a motorized wheelchair and a pedestrian pushing a child’s stroller.

RE-THINK AGING: MAKING NORTHEAST FLORIDA AN AGE-FRIENDLY REGION

FINDINGS AARP Livability Index

ARP’s Livability Index was released while the committee was in its learning phase, and offers a well-timed lens for looking at baseline data on Northeast Florida and the policies that affect our lives. It is simply a tool for citizens and decision makers to use for determining how age-friendly the region is now, and what needs to change. The Index also provides a framework for this report, which describes seven quality of life domains as outlined below.

Housing: Choices and options for where to live are important to all residents. Housing units are designed for all stages of life, and to accommodate physical limitations. A range of affordable and diverse housing options attract and retain residents of all ages. Transportation: Getting around easily and safely is a cornerstone of an individual’s identity and self-sufficiency. Young and old have options including cars, walking, and public transit. Safety and accommodation for physical disabilities are priorities in livable communities. Health: This is the key ingredient to positive aging and a large portion of everyone’s health depends on lifelong healthy habits acquired within communal groups such as families, schools, places of worship, neighborhoods, and workplaces. Environment: Clean air and water are the foundations of a good quality of life. Natural disasters and emergencies can jeopardize access to these daily resources. Livable communities have policies that improve and protect natural resources and plan for everyone to have access to them during extreme weather events. Engagement: Volunteering, leadership, and civic involvement are just some of the gifts older adults “give back.” A forward-thinking region fosters community engagement, lessens social isolation, and offers everyone a range of flexible options for contributing talent and time. Opportunity: Most adults count on the chance at getting a good job paying a competitive wage. A welcoming community offers this opportunity to everyone, regardless of age, family responsibilities, or background. Multi-generational communities facilitate residents’ spontaneous encounters with older and younger neighbors. Neighborhoods: A healthy place to live allows residents easy access to necessities (healthy food, exercise) and choices when it comes to amenities (libraries, parks). Healthy neighborhoods are a dynamic mix of “people” and “place” where everyone grows up and ages well.

The remainder of this report takes an in-depth look into the seven domains above to provide a picture of the conditions in which older adults live in Northeast Florida, and the policy issues shaping their lives. The next section begins with Housing.

A 2015 JCCI INQUIRY

FINDINGS Housing

ositive aging lies squarely in a community’s options for housing. Older adults have to ask: ‘how will my living situation need to change as my health and capacities change?’ At the beginning of many adults’ lives, the choice of where to live is an exciting marker of self-definition. Housing choice—decisions about which neighborhood to live in, whether apartment or house, rural or urban— is highly valued in Northeast Florida. In fact, it is not uncommon for residents to identify with their neighborhood or housing choice; it is often a lifestyle indicator. This same value on housing choice remains as people age. Older adults want to choose where they live and having options is crucial for positive aging. AGING IN PLACE Nationally, 86 percent of people over age 45 years somewhat or strongly agreed with the statement: “What I’d really like to do is stay in my current residence for as long as possible.” Northeast Florida residents feel the same. In 2014, AARP Florida surveyed 1,200 registered voters in Jacksonville, aged 45 years and older, and found that 78 percent want to receive care for themselves or a loved one at home.

Of 1,200 registered voters in Jacksonville aged 45

years and older, surveyers found that 78 percent want to receive care for themselves or a loved one at home.

For many older adults, living in their own home is the best choice. Research suggests that older adults are most interested in staying in their home for as long as possible and then having housing options (such as a condominium) close to where they currently live should they choose to move. While a small percentage of older adults are relocating to walkable, services-rich, mixed-use urban communities, the majority will retrofit their current home or organize their lives so they can stay close to where they currently reside for as long as possible. Not only is staying healthy and aging in place the preferred ideal, it is cost-effective for individuals, families, and taxpayers because care in an institutional setting can be costly. AARP reports that in 2015 the average annual cost of a semi-private room in a nursing home in the Jacksonville area is $76,000. (AARP long-term care calculator)

AGE-RESTRICTED COMMUNITIES While aging in place is the goal for a majority of older Northeast Floridians, many will move out of their homes. For healthy individuals with financial resources, housing choices include active adult communities and continuing care retirement communities as described below.

•

55+ communities or active adult communities: According to ProMatura Group, a market research firm specializing in older consumers, 20 percent of 55-65 year olds look for a home in an age-restricted community, also known as an active adult community. These communities are planned subdivisions like any other, but the developer targets homeowners over age 55. The age requirements are written into the development’s governing documents. Northeast Florida is home to several 55+ communities including Del Webb Ponte Vedra, Sweetwater in Jacksonville, Cascades at World Golf Village, and Villages of Seloy in St. Augustine.

According to ProMatura, 4.5 percent of United States residents 55-65 years move in any given year. While 20 percent look for an active adult community, a higher percent (40-50) are looking

RE-THINK AGING: MAKING NORTHEAST FLORIDA AN AGE-FRIENDLY REGION

FINDINGS for intergenerational communities. According to AARP, these are communities that (1) provide for the safety, health, education and basic necessities of life for people of all ages; (2) promote programs, policies, and practices that increase cooperation, interaction, and exchange between people of different generations; and (3) enable all ages to share their talents and resources to benefit individuals and their community. The preference for intergenerational communities noted previously indicates a greater market for planned, livable communities that serve the needs of all people regardless of age. â&#x20AC;˘

Continuing Care Retirement Community (CCRC): Unlike an active adult community, CCRCs are targeted toward adults aged 70 years and above who are anticipating changes in their healthcare and mobility. Residents might move to a CCRC, occupying a home or apartment much like a dwelling in an active adult community. Later, the resident will have the option to move into an assisted living apartment on the CCRCs property and perhaps later an onsite skilled nursing facility. Northeast Florida is home to at least eight CCRCs, which may charge residents entrance and monthly fees.

While CCRCs will always remain a popular option for aging in place, especially in Florida, they are only part of the solution to the problem of how our communities will change and develop because of massive demographic shifts. It is also unlikely that Northeast Florida can build and operate enough CCRCs to meet the needs of adults over age 70 today and in the future.

AFFORDABLE HOUSING A commonly used test of affordable housing is whether or not an individual or family pays more than 30 percent of their monthly income for housing. Many older adults look for affordable housing in Northeast Florida while living on a fixed income and end up paying more for housing than they can afford. This is the same situation that many renters and homeowners in Northeast Florida face, regardless of age.

4.5 percent of United States residents 55-65 years move in any given year. While 20 percent look for an active adult community, a higher percent (4050) are looking for intergenerational

In St. Johns County, the fair market rent for a two bedroom apartcommunities. ment requires wages of more than $17/hour. For two minimum wage earners that is only possible if they both work 40 hours a week. In order for a single parent or grandparent to meet the rent in that same community requires working well beyond 40 hours weekly or earning pay far in excess of the minimum wage. In St. Johns, Duval, and Clay counties 36,330 older adults pay more than 30 percent of their monthly income for housing and utilities. In these same counties, 18,462 older adult households pay more than 50 percent of their income for housing and utilities â&#x20AC;&#x201D; an even higher cost burden. Housing affordability is addressed locally with housing subsidies from the federal government (such as the HUD Section 8 program) and managed by local government (e.g., the Jacksonville Housing Authority). Another way of making housing affordable is through tax credits â&#x20AC;&#x201C; a private sector option for incentivizing the construction of affordable housing. Florida counties receive State Housing Initiatives Partnership (SHIP) program funds to construct and rehabilitate housing for very low, low, and moderate income families from the Sadowski Affordable Housing Fund. The Fund is supported by revenue from the document stamp tax paid by Florida property buyers. SHIP funds can also be used for rental subsidies, credit counseling services, and/or housing for special needs populations. A 2015 JCCI INQUIRY

FINDINGS HOUSING POLICIES AND PRACTICES Anticipating aging Accommodating the needs, restrictions, and activities of all age groups when constructing buildings, pathways and landscapes is called Universal Design (UD). Homes and communities can be designed to anticipate aging in place and caregiving support. As we age, a variety of physiological changes take place that differ from individual to individual. These include the loss of vision, hearing, strength, flexibility, and mobility. Ramps, wide doorways, non-slip floors, plentiful natural light and other safety features can be attractive and functional primary building elements, rather than awkward add-ons years later. These and other techniques can be adapted into seamless, integrated, non-institutional forms that cater AFFORDABILE HOUSING: to families at all stages and support independence and positive healthy aging for adults of all ages. In St. Johns, Duval, and

Clay counties 36,330 older adults pay more than 30 percent of their monthly income for housing and utilities.

Accessory dwelling units Local governments and developers can also concentrate on re-developing existing properties to accommodate older adults. One example is accessory dwelling units, which are not allowed in areas zoned for single family housing. In Duval County these on-site apartments or independent living spaces are sometimes called “in-law suites.” For some older adults these units, built on a family member’s property, are an affordable housing solution. It should be noted that today it is possible to build a bedroom or bathroom over a garage, but a kitchen is not allowed in such a renovation.

The argument against accessory dwelling units include pressure being placed on lawmakers to decrease lot sizes and the possible eventuality that these units might be occupied by a student or younger person, rather than an older relative. Neighbors anticipate this transition and sometimes object. SHIP administration As mentioned earlier, SHIP funds can be used for rental subsidies, building and rehabilitating housing, and credit counseling. These funds are helpful in affordable housing planning because counties can rely on funding from year-to-year and plan long-term projects. However, in recent years, the Florida Legislature has used funds from the Sadowski Affordable Housing Fund to pay for other state functions—effectively reducing affordable housing resources for the counties. Each county also manages its SHIP funds differently. In St. Johns County, the St. Johns Housing Partnership coordinates affordable housing projects, from home renovations to apartment complex maintenance, using SHIP funds. The impact of these funds is increased when one agency is able to envision and plan for the community’s affordable housing needs. In Duval County, SHIP funds are managed by the City of Jacksonville’s Housing and Community Development Division, which takes a twofold approach; managing contracts with multiple area nonprofits and operating its own internal affordable housing projects as well. Prior to the 2008 recession, the Housing Partnership of Jacksonville managed Duval County’s SHIP funds like St. Johns County. Because the Partnership was a nonprofit led by Jacksonville residents there was greater community stewardship of affordable housing funding.

RE-THINK AGING: MAKING NORTHEAST FLORIDA AN AGE-FRIENDLY REGION

FINDINGS Transportation

ince World War II, the United States has been building communities organized around roads. We are a country that values “flat,” spread out communities connected by freeways. The few exceptions are densely populated cities like New York, Chicago, and San Francisco all of which have well-used public transportation systems. In the 70 years since World War II, our culture has developed a bias towards the personal vehicle, which shapes how we view public investment in different components of the country’s transportation system. To many everyday voters and policy-makers, infrastructure projects appear to be better investments than transit projects. We see an empty bus and think nobody rides it. Then we drive on a new stretch of Jacksonville’s I-295 outer beltway and enjoy the lack of traffic. We do not see the new road as “empty” in the same way we see the bus as “empty.” In our car-centric culture, federally-funded transportation projects favor roads. In fact, 80 percent of all federal transportation dollars are spent on roads and bridges. The remaining 20 percent is spent on the ‘people side’ of the equation covering public transportation. Typically, most transit dollars are spent in highly urbanized areas because theoretically it is best to invest where there is the greatest population density. However, this works against Northeast Florida. In the five-county area, only Jacksonville is considered a highly-urbanized area by federal policy-makers. This policy position leaves nearly 200,000 Northeast Florida residents (number of persons aged 65 years and older) with few options for getting around if they do not drive a car. Making medical appointments and keeping connected to family and friends is difficult for older adults who do not or cannot drive, which affects their emotional and physical health.

In our car-centric culture, federallyfunded transportation projects favor roads. Only 20 percent of federal transporation

dollars are spent on OPTIONS OTHER THAN PERSONAL VEHICLES The personal vehicle is the only way to be independent and self-sufficient in public transportation. a car-centric region like Northeast Florida. However, options that preserve riders’ self-determination, reduce costs, and require little new transit infrastructure are often overlooked. These options include: volunteer driver programs, ride-sharing, car-sharing, carpooling, use of private vehicles to get to public transit, and smaller buses with more flexibility. The ElderSource Needs Assessment found that 29 percent of older adults in the seven-county area are willing to pay for transportation services, which identifies a viable market and public need warranting entrepreneurial solutions. All Northeast Florida residents are on a continuum of lifetime mobility and community connection. One day each of us may have to consider giving up the keys to the car. The majority of our lives, about 70 percent is optimal for driving, while 20 percent is spent trying to determine how we are going to stay connected to the community because we do not or cannot drive. During the remaining 10 percent of our lifetimes we are transitioning from drivers to non-drivers, often in our later years. It is the confluence of younger and older individuals who are deciding whether or not to drive that suggests a mutual and multigenerational interest in varied public and private transportation options. Data indicating a decrease in the number of young adults with driver licenses and an increase in the number of persons over the age of 80 – who may be giving up driving – in Northeast Florida also creates a diverse market with varying needs for public transportation beyond traditional services and paratransit. Again, truly livable communities accommodate the needs of multiple generations with varying levels of ability.

A 2015 JCCI INQUIRY

FINDINGS LIFETIME DRIVING CONTINUUM FIGURE 5

DRIVING AND OLDER ADULTS Driving is a functional ability, like walking. Age alone is not a valid predictor of driving ability; it is only a risk factor just as age is a risk factor for falling while walking. The per person crash rate for older drivers is lower than the rate for any other age group. Older drivers do a good job of self-limiting and modifying their behavior for the sake of safety. For example, some older adults forgo driving at night because they do not feel safe on the roads.

CRASH INVOLVEMENT RATE FIGURE 6

Source: National Highway Traffic Safety Administration

Driving assessment for older adults The warning signs of not being a safe driver include scratches and dents in a car, riders not wanting to get in the car, or one too many conversations on the side of the road with law enforcement. Older adults can stay safe in their cars with education and assessment. Examples include programs like CarFit created by the American Society on Aging, an educational program offering older adults the opportunity to check how well their personal vehicles â&#x20AC;&#x153;fit.â&#x20AC;? Attention is given to proper mirror adjustment, foot positioning on the gas and brakes, and proximity to the steering wheel. CarFit

RE-THINK AGING: MAKING NORTHEAST FLORIDA AN AGE-FRIENDLY REGION

FINDINGS has been made available in Northeast Florida by Brooks Rehabilitation Hospital. The DriveABLE Cognitive Assessment Tool is another instrument that measures a driver’s ability to operate a vehicle. This evidence-based tool measures memory, attention, judgment, and other cognitive abilities and is administered by licensed assessment providers. Per the DriveABLE website there are no licensed providers in Northeast Florida. All drivers aged 80 years and over must pass the standard vision test administered to all drivers, regardless of age. If a physician, agency, or family member has concerns about a driver’s abilities, they are authorized to make a report, in writing, to the DMV. A case-by-case medical review and investigation process is triggered by that report. Currently, 295,140 older adults ages 60 and over in the Northeast Florida seven-county region have driver licenses. An honest conversation, before a driving crisis occurs, is the best way to get an TABLE 1

Licensed Drivers - Elderly*

Population Estimate, 71 and over**

% of those 71+ who are licensed drivers

2012 2013 2014

Baker

1,439 1,514 1,557

1,843 1,899 1,941

78.1% 79.7% 80.2%

Clay

12,503 13,301 13,778

14,329 14,909 15,349

87.3% 89.2% 89.8%

Duval

49,668 51,852 53,049

64,073 66,157 67,767

77.5% 78.4% 78.3%

6,620 7,067 7,352

7,547 7,781 8,118

87.7% 90.8% 90.6%

17,238 18,262 19,263

19,926 20,660 21,550

86.5% 88.4% 89.4%

Nassau St. Johns

*Source: Bureau of Economic and Business Research (BEBR); Total number of licensed drivers aged 71 and over and by county of driver’s mailing address. Includes restricted, operator, chauffeur, and commercial licenses. Data are as of January 1 of each year. **Source: Florida Charts Population Estimates, http://www.floridacharts.com/FLQUERY/Population/PopulationRpt.aspx

older driver to think about safety vs. independence. Because driving is Americans’ route to independence and identity, there may be great resistance from older adults when their driving privileges might be revoked. A livable community supports both the older adult drivers and their need for independence, which suggests policy-makers and citizens explore better road design, signage, and transit opportunities benefiting the entire community. Vision and aging Because driving ability is dependent on visual acuity, residents living with a vision disability are disadvantaged when it comes to mobility. According to the U.S. Census, approximately 25,000 Northeast Florida residents have a vision disability. At the same time, the U.S. Department of Transportation estimates that 12 percent of all disabled persons in the U.S. have trouble getting the transportation they need to leave the house. Using this percentage to calculate for Northeast Florida means 3,000 disabled persons – some of whom are older adults – cannot find the transportation they need. This may be a low estimate considering the 2014 Older Americans with a Disability study by the National Institute of Health which states that 19 percent of people aged 65 and older have a vision disability. In Northeast Florida that is equivalent to 39,649 older adults living with a vision issue that cannot be corrected with eye glasses. A 2015 JCCI INQUIRY

FINDINGS TRANSPORTATION POLICIES AND PRACTICES From paratransit to full public transit In St. Johns County, the Sunshine Bus Company, operated by the St. Johns County Council on Aging, has seen increasing public transportation ridership over the past decade. Ten years ago, Sunshine had 300 riders per month. Today ridership is 23,000 persons per month. It costs riders $1 and allows them to disembark anywhere along fixed routes, but curb-to-curb paratransit services for the disabled can still be arranged with advance notice. Though the St. Johns County Council on Aging manages Sunshine, it is a public system utilized by riders of all ages. Its success lies in citizens engaging in the policy-making process in order to learn the rules of transportation funding, planning, and policy. St. Johns County Council on Aging learned that if a community already has a paratransit system, then there are ways of unlocking federal policies and budgets to build a public transit service that serves persons of all ages. This is particularly true for communities classified as “Urbanized Areas” by the federal transportation planning process. The Jacksonville Transportation Authority ( JTA) offers free bus service to senior citizens (defined as individuals 65 and older). In 2014, 17 percent of riders for the fixed route service qualified for this free service for older adults. JTA also operates a paratransit service – Connexion – in Northeast Florida, which provides transportation services to disabled and disadvantaged riders unable to use fixed route buses or rail service. Assessments to qualify for the paratransit service are conducted in person at JTA’s offices. The fares for paratransit service are discounted. The Beaches Council on Aging provides paratransit services through its Dial-A-Ride program to persons living in the Duval and St. Johns County beach communities. This transportation service aids disabled individuals and anyone aged 60 years and over who would be otherwise homebound – no prequalification is required. This is a door-to-door service; pick-up and-drop off is available for doctor appointments, shopping, and errands. Riders either lack transportation or are limited in some way from providing their own. Donations of $5 dollars are encouraged. Approximately 400 people took advantage of the service in 2014. In Nassau, Baker, and Clay counties paratransit services are also operated by Councils on Aging, nonprofit agencies serving older adults. Florida state policy A recent development in State policy will work against the quality of paratransit services. The Florida Legislature has enacted Medicaid managed care for indigent disabled residents in order to reduce overall Medicaid costs, which can compromise the quality of service associated with getting patients to the doctor. Currently, the Florida Agency for Health Care Administration subcontracts with national transportation brokers who coordinate Medicaid patients’ trips to the doctor. The outcome of this new way of delivering services means that taxis, ill-equipped to transport disabled persons, are sent. Another consequence of Medicaid managed care is dollars being siphoned off from Northeast Florida’s local coordinated public paratransit services. Nassau, Baker, and Clay county are the most likely to see their paratransit system weaken because of Medicaid managed care. Because Beaches Dial-A-Ride and JTA’s paratransit service, Connexion, are not Medicaid providers, neither will be adversely affected. In St. Johns County, the Sunshine Bus Company is meeting some of the paratransit service need.

RE-THINK AGING: MAKING NORTHEAST FLORIDA AN AGE-FRIENDLY REGION

FINDINGS Health

ging bodies experience naturally-occurring changes that have nothing to do with disease or sickness. For example, as skin ages, it becomes fragile, thin, and more vulnerable to bruising. With time, a body will lose 30-50 percent of muscle mass and space between the spinal vertebrae narrows. Older adults also lose 2-4 inches in height, generally. In addition, sensory function in the feet, eyes, and ears will decrease, making body orientation and walking more difficult. This increased instability while walking, plus decreased bone density makes a bone fracture more likely when an adult falls. Immune function diminishes as well, increasing susceptibility to infection and cancers. While none of the above conditions signal a disease state, all are perceived as problems that affect a person’s mobility, physical capacity, social connection, and overall quality of life. HEALTH THROUGHOUT OLDER ADULTHOOD As people age from 50 through to 100 years and beyond, what “health” means changes because it is a moving baseline. What is “healthy” for a 59 year old is different than for an 89-year-old. Take a look at how one geriatrician described changes in health as people age over time. >> From age 50-65, older adults are beginning to show signs of common chronic diseases such as increased cholesterol levels indicating risk for heart disease, or high blood pressure that if left unchecked might affect kidney function and place an individual at risk for stroke. Preventive drugs exist for these conditions; however, individuals can also control their risk factors with changes in diet, exercise, and management of stress responses. >> Between the ages of 65 and 80, people are living with more chronic diseases. Coronary heart disease is a common diagnosis within this age group. Exercise and healthy eating are even more important at this point because the body requires fewer calories as it ages, making a healthy weight more difficult to maintain. >> At age 80 years and beyond, older adults are focused on postponing frailty. They exercise in order to stay limber and stable on their feet. Mobility problems are common. Also, individuals are more likely to struggle to maintain connections with family and friends, making social isolation a common problem. It is a fact that some people live healthy, fully-functional lives until they die. ‘Dying in one’s sleep’ after living a life full of activity is an ideal. The fact is, however, most people living into old age have chronic conditions that currently have no cures. For example, there are surgeries and procedures that can slow the progression of heart disease, but it cannot be cured. Positive aging depends on how well individuals manage chronic health conditions and our mental and physical health issues, which goes beyond treating disease or dysfunction. In an effort to move away from the assumption that growing older is a disease process, one local geriatrician makes distinctions between problems (situational difficulty) and diagnoses (identified disease). Each of his patients has a Problems List, and during doctor visits he updates the List. This allows him to widen his lens and take a more holistic view of each patient. To prompt discussion he talks with each patient about their mobility, social/emotional life, access to health care, capacity to manage medication, and their ability to advocate for themselves as they adapt to new life situations. He observed that older patients who stay active, fit, and maintain a healthy weight enjoy a better quality of life as they age. Every day he sees that a 75 year-old can be in better health than a 65 yearold, depending on how well older individuals take care of themselves. A 2015 JCCI INQUIRY

FINDINGS LOCAL AND CURRENT TRENDS At least four major concerns emerged from meetings with resource speakers. These issues are connected to larger national and global trends. Solutions, however, depend on local planning and decision-making. One: Alzheimer’s, dementia and cognitive disorders Based on population projections used by healthcare and business planners, Northeast Florida will have four times the current number of people living with cognitive and dementia disorders by the year 2040. In the decades to come, the costs of cognitive and dementia disorders will far exceed costs for cancer treatments and other higher-profile diseases.

TABLE 2

2015 Number of Probable Alzheimer’s Cases

Persons 65+ with a Cognitive Difficulty

Clay 3,011 Duval 14,161 Nassau 1,520 St. Johns 4,397

14.5% 9.5% 8.3% 7.8%

Source: Florida Department of Elder Affairs

Currently, memory care facilities serve only those families who can afford expensive care. This is in spite of the fact that in-home care for a person living with a dementia disorder is physically taxing, isolating, and very difficult for families. In the future, due to expected increases in demand, healthcare businesses serving people 65 and older might be driven to develop and deliver new services that accommodate a wider range of people. This may require re-thinking building design, use of space, and health care staffing in order to provide dignified caregiving outside the home. The Alzheimer’s Disease Initiative, which subsidizes case management and respite for caregivers, is a state-funded program targeting low-income families. Respite can be provided in the home or in a facility setting. While 27 Northeast Florida residents are currently being served by the program, 581 families remain on a waiting list for subsidized help caring for their loved one. The need for expansion of services is so great that publicly-funded programs such as the Alzheimer’s Disease Initiative cannot keep pace. New solutions to accommodate an expanding 65 and over population living with Alzheimer’s, dementia, and cognitive disorders may have to come from private businesses serving older adults and their families. Two: Mental health Mental health is essential for good overall health in all people. In older adults, declining health and isolation heighten the risk for mental disorders such as depression and anxiety. Depression affects about 6 million Americans aged 65 years and older, but only about 10 percent of them receive treatment for depression. In some cases, older adults may display symptoms of depression that are effects of illnesses and/or the medicines used for treatment. In Northeast Florida, the older adult suicide rate is more than 20 percentage points higher than the youth suicide rate. The loss of hope in the face of severe medical diagnoses like end-stage cancer

RE-THINK AGING: MAKING NORTHEAST FLORIDA AN AGE-FRIENDLY REGION

FINDINGS

FIGURE 7

SUICIDE RATES PER 100,000 PEOPLE

Baker, Clay, Duval, Nassau & St. Johns Counties

DEPRESSION: MEDICARE POPULATION (%) TABLE 3 County

< 65

65+

Overall

Baker Clay Duval Nassau St. Johns

27.3% 12.5% 15.6% 29.0% 13.0% 15.3% 25.3% 13.6% 16.4% 25.3% 11.5% 13.3% 27.8% 11.9% 13.7%

Persons under 65 who receive Medicare are disabled or suffering from renal failure, so rates of depression may be higher than the national average of 10 percent for older adults. Source: Centers for Medicare and Medicaid Services via Northeast Florida Counts. 2012 data.

PRINCIPAL DIAGNOSIS FROM ACCIDENTAL FALLS, AGE 65 AND OVER Baker, Clay, Duval, Flagler, Nassau, St. Johns, and Volusia Counties TABLE 4

Diagnosis Fracture of Lower Limb Fracture of Neck and Trunk Intracranial Injury, Excluding those with Skull Fracture

Discharges 6,501 2,186 1,468

Percent of Total 37.40% 12.60% 8.40%

Source: Health Planning Council of Northeast Florida, data from Sept 2011-2014

A 2015 JCCI INQUIRY

FINDINGS is a contributing factor to this high suicide rate. Older men have the highest rate of suicide in the United States, particularly single men.

According to

According to JCCIâ&#x20AC;&#x2122;s 2014 Mental Health Inquiry, there are not enough mental health service providers, therapists, or psychiatrists available to meet the current need for treatment in Northeast Florida, and that holds true for mental health providers specializing in treatment for older adults as well. The prevalence of mental disorders among older adults along with the lack of access to treatment have major implications for Northeast Florida. When mental disorders are left untreated, results can include difficulty rehabilitating after an illness and an increased risk of cardiovascular disease as well as a greater chance of death from illness and suicide. In the JCCIâ&#x20AC;&#x2122;s absence of adequate services, screening for depression and other mental illnesses is often of little help since treatment is difficult to obtain.

2014 Mental Health

Inquiry, there are not enough mental health service providers, therapists, or psychiatrists available

Three: Falls The Centers for Disease Control (CDC) reports one-in-three adults 65 years and older fall annually and fewer than half tell their doctor about it. By 2040, since there will be approximately 400,000 people aged 65 years and older in Northeast Florida, it is likely that 120,000 residents will experience a fall. Falls can result in hip fractures and traumatic brain injuries. Among older adults, falls are the leading cause of both fatal and nonfatal injuries. Because of the number of people impacted, this is a public health issue.

to meet the current

Four: Caregiving workforce The Florida Department of Economic Opportunity projects that the second and third fastest growing occupations in Northeast Florida from 2014-2022 need for treatment in will be personal and home care aides and home health aides. Job openings will Northeast Florida. increase by 36 percent and 35 percent, respectively. The average hourly wage for workers in these occupations is $10/hour, and a high school diploma is the only educational requirement. These fast growing occupations lack a structure for professional development and ladder for higher compensation, which prompts high staff turn-over. This is due, in part, to the lack of Medicare reimbursement for training and routine duties. All together this perpetuates non-competitive wages in a fast-growing occupation. Non-certified caregivers Non-certified home care workers include aides, assistants, homemakers, chore-workers and companions. Generally these paid caregivers perform a wide range of custodial, supportive, long-term personal care services including housekeeping, meal preparation, and laundry. Non-certified aides and assistants typically work as either private-duty hires for families or as employees of non-medical home care agencies. Their services are not reimbursable under Medicare or private health insurance regardless of whether they are employed with a non-medical home care agency or hired privately, though some long-term care insurance plans may cover these services. Homemakers and chore-workers do not typically provide personal care services. Elder companions are likely to provide only comfort and companionship to older adults who cannot be left alone or unsupervised. The cost for non-certified caregivers is typically borne by the older adult or his/her family. Certified caregivers Certified nurseâ&#x20AC;&#x2122;s aides (CNA) and home health aides (HHA) are employed at both medical home

RE-THINK AGING: MAKING NORTHEAST FLORIDA AN AGE-FRIENDLY REGION

FINDINGS health agencies and non-medical home care agencies. The services provided by CNAs and HHAs when employed with Medicare / Medicaid home health agencies, may be reimbursed when certain requirements are met. These requirements include working under supervision of licensed professionals and a physician approved plan of care authorizing supplemental aide services to skilled care. In contrast, aide services are usually not covered by Medicare and private insurance when provided through a non-medical home care agency or private hiring. CNAs and HHAs both assist patients with activities of daily living including personal care, ambulation, nutritional, medications, toileting, health monitoring (i.e., blood pressure) and sometimes light housekeeping. The certified assistant must be skilled in actual procedures and also make competent observations of a patient’s condition for reporting to professionals. HEALTH CARING Many Northeast Floridians maintain their mental and physical wellbeing by adapting to new situations and inevitable physical limitations through good health and wellness practices. However, in-home health care visits and time spent in a rehabilitation hospital or other post-acute care institution are part of the landscape for many older adults healing from injury or sickness. Northeast Florida’s hospitals and their associated multi-specialty physician groups, plus the region’s many outpatient rehabilitation centers are a great benefit to local older adults. While many older adults will recover without the need for additional support, some will require the assistance of family to meet their health and welfare obligations. FAMILY CAREGIVERS The backbone of the long-term services and supports system in the United States is the family caregiver. In Florida thousands of family caregivers serve as single-family nursing homes. A family caregiver might live in the same house or give care in their loved one’s home providing various activities that include, but are not limited to: • cooking meals, housework, and maintenance; • around-the-clock care for a cognitively impaired loved one; • mowing the lawn; • transportation to medical appointments; • bill paying; • help with bathing, dressing, and eating; and • administering medicines and in-home healthcare.

In Jacksonville, more than half of all voters over age 45 (54 percent) have been, or currently are, family caregivers according to an AARP survey of registered voters.

The typical caregiver is a 49-year-old female working full-time and providing 20-hours of care per week for an older parent. As healthcare technology improves, there has been a trend toward more complex medical/nursing care in the home. Family caregivers are likely to be asked to manage multiple medications, wound care, and complicated medical equipment. Caregiving also happens across age groups. For many older adults in Northeast Florida, family and social relationships create interdependence where care is sometimes provided by older adults to their peers who become receivers of care as well. Figure 8 demonstrates the interdependence of caregiving in families and neighborhoods. In Jacksonville, more than half of all voters over age 45 (54 percent) have been, or currently are, family caregivers according to an AARP survey of registered voters. This means approximately 155,000 voters are, or have been, responsible for the care of an older loved one or a disabled family member.

A 2015 JCCI INQUIRY

FINDINGS

CAREGIVING AND INTERDEPENDENCE FIGURE 8

Currently, few Americans recognize the growing need for family caregiving in relation to their own future needs for long-term care. According to the Remington Report, an estimated 70 percent of Americans who are now 65 years and older will need some kind of long-term care. In 2012, the National Health Interview Survey, conducted by the Centers for Disease Control, found that 60 percent of respondents thought they were unlikely to need long-term services and supports in the future. In Jacksonville, 1,200 respondents to a December 2014 AARP telephone survey were asked, “When it comes to your retirement, how important is it to pay for long-term care needs, like in-home care or assisted living?” Eighty-five percent of respondents replied it was “extremely important” or “very important.” At the same time, 44 percent of Jacksonville respondents say they have faced obstacles to saving for retirement, including no funds left after paying bills. Fifty-two percent have not saved more for retirement because they are paying down debts. As the demographic shifts take place over the next 25 years, the number of potential family caregivers will decrease. According to national research by AARP, from 1990 to 2010, the number of potential caregivers ages 45-64 increased 77 percent due to the number of Baby Boomers caring for their older loved ones. This outpaced the increase in the number of 80 year-olds during the same timeframe. In 1990, for every person likely to need a family caregiver, there were 6.6 potential caregivers. In 2010, the ratio jumped to 7.2. This ratio is likely to decrease in the future as the Baby Boom generation leaves caregiving and moves into old age. By 2050, the caregiver support ratio is projected to decrease to 2.9 caregivers for each person older than 80. THE COST OF CAREGIVING The majority of older adults do not need assistance from ElderSource. Most families find a mix of paid and unpaid caregiving to meet the needs of their loved ones. In general, family caregiving is unpaid labor. The RAND Corporation estimated that in 2014, 30 billion hours of family caregiving was performed in the United States. The replacement cost for those 30 billion hours of family caregiving is $642 billion at the skilled nursing rate and $221 billion at the unskilled labor rate.

RE-THINK AGING: MAKING NORTHEAST FLORIDA AN AGE-FRIENDLY REGION

FINDINGS RAND also calculated the cost of sacrificing paid labor for unpaid labor. This is an “opportunity cost” because when family caregivers leave work early, arrive late, and make other accommodations to meet the demands of caregiving, they lose opportunities for income. The RAND study estimates the annual lost income for family caregivers in the United States at $522 billion. The 2014 AARP Jacksonville survey results show the following. • •

Two-thirds of employed caregivers say they had to go into work early or late or miss work to care for loved ones. Two in five either cut back from full-time to part-time work or gave up working entirely to devote themselves to caregiving.

RESPITE FOR CAREGIVERS Family caregivers frequently experience isolation as they spend increasing amounts of time juggling commitments to both their paid and unpaid jobs. This isolation from outside interests can rob caregivers of time once used for relaxation and social connection. As a result, some experience poor mental health as their caregiving responsibilities increase. The AARP Jacksonville survey results show half (49.6%) of respondents think respite care - a break from the responsibilities of caregiving - is “very helpful.” Significant findings from the AARP Jacksonville survey also include the following. • Six in 10 respondents said caregiving responsibilities caused them heavy emotional stress. • More than half reported not being able to get enough sleep. • Four in 10 reported their own nutrition suffered. In Jacksonville, respite care is available through for-profit companies, nonprofit agencies, and subsidized community services. Aging True, the region’s largest nonprofit provider of older adult services, negotiates with families to pay for some service days, and the family pays for the remaining service days. Aging True will pay $60/day for an 8-hour day, including meals and transportation to an adult day care center. NAVIGATING THE OLDER ADULT HEALTH CARING SYSTEM In Northeast Florida, family caregivers seeking assistance can find help through organizations, agencies, and programs. Below is a sample selection of agencies helping older adults and their families define pathways for optimal health and the transition from self-care. •

Caregiver Coalition of Northeast Florida consists of more than 12 for-profit and nonprofit organizations partnering to support family caregivers with: > a caregiver support line; > newsletter; > conferences; and > advocacy for state legislation, supportive workplace policies, and practices

The Coalition’s primary purpose is to help family caregivers navigate the sometimes formidable healthcare and long-term supports system. Since its inception in 2010, the Coalition has held 58 conferences and expos at which attendees learn about agencies and companies serving older adults. These events also connect family caregivers with each other, providing them with a support network.

A 2015 JCCI INQUIRY

FINDINGS •

United Way 2-1-1 helps older adults, people living with disabilities, non-English speakers, and persons having a personal crisis, among others by providing referrals to, and information about, health and human services organizations and agencies. For older adults and their families in particular, a 2-1-1 operator can provide information about adult day care, community meals, respite care, home health care, transportation, homemaker services, health insurance, and other services that help individuals maintain a quality standard of living as they age.

•

Northeast Florida Coalition for Coordinated Care for Seniors is focused on improving the quality of care for older adults and reducing avoidable re-admissions to hospitals. The Coalition is a comprehensive, collaborative community effort involving Northeast Florida health providers as well as community-based organizations that offer social services, and home care. Participation in the Coalition is open to organizations and individuals interested in planning and coordinating care.

•

The Care Transition Coach© program is a four-week initiative offered to recently discharged patients who have complex care needs. The program ensures a smooth transition from the hospital environment to the home. Patients learn self-management skills so they can monitor their care, ultimately avoiding an unnecessary re-admission to the hospital. Patients and families learn new behaviors and communication skills in order to manage common problems arising after a hospital stay. The facilitator/navigator will arrange for community-based services to help with the transition (e.g., home delivered meals, transportation, mental health counseling). The facilitator/ navigator will then visit the patient at home within three days after discharge, as well as make three follow up calls to the patient, checking on his or her progress. Throughout the transition, facilitator/navigator will be available to the patient for 30 days, providing information, encouragement and guidance.

•

Aging and Disability Resource Centers (ADRCs) function as a single, coordinated system for information and access to services for all Floridians seeking long-term care resources. ADRCs provide information and assistance about state and federal benefits, as well as available local programs and services. By sharing a common information and referral system, ADRCs are able to provide all Floridians with uniform assistance no matter where they live. ElderSource is the Aging and Disability Resource Center for the seven counties in Northeast Florida.

WHEN FAMILY CAREGIVING IS NOT AN OPTION Not all older adults have a caregiver who is reliable, and in some instances family caregivers fall ill or die before their loved one. Community and public services intervene where possible, to get an older adult out of crisis and into a better situation. The mission of these publicly funded services for older adults is to prevent crisis and facilitate a caregiving support network that a frail older adult can rely on as they age. However, according to the Florida Council on Aging, in fiscal year 2011-12, 3,055 frail or homebound older adults went into nursing homes when they could have remained living in their own home. These premature nursing home placements cost taxpayers $66 million. Nursing home care illustrates the complexity of caregiving decisions and the ways that family and community resources blend to care for a frail older adult. Nursing home care costs in Northeast Florida range from $76,000 to $ 82,500 annually. After 2-4 years of staying in a nursing home, all assets of the typical older adult (retirement savings, sale of a family home) have been exhausted by the fees for the private pay nursing home placement. At that point, the older adult is eligible for a Medicaid program that reimburses the nursing home for care. Most nursing home residents have to exhaust their assets to qualify for Medicaid so they can afford long-term care.

RE-THINK AGING: MAKING NORTHEAST FLORIDA AN AGE-FRIENDLY REGION

FINDINGS Medicare covers limited periods of inpatient care in skilled nursing and rehabilitation facilities. In fact, all types of publicly-funded assistance for an older loved one are structured by eligibility guidelines and have rules for reimbursements. Many older adults think the entire cost is reimbursed by their insurance, whether private or Medicare, when it is not. Throughout the healthcare system, individuals face gaps in coverage that become barriers to maintaining health as they age. For various reasons, including Americans resisting aging and avoiding thoughts about what happens as loved ones age, many Northeast Florida residents are unaware of the types of health care and transition services available to help older adults move from the hospital to rehabilitation, and from rehabilitation back home successfully. The continuum of care for older adults in Northeast Florida includes geriatric medical practices, in-home health care, assisted living facilities, a rehabilitation hospital, and skilled nursing homes that provide long-term and short-term care. Access to these services is determined by eligibility, ability to pay, and family resources.

Nursing home care costs in Northeast Florida range from

HEALTH AND CAREGIVING POLICIES AND PRACTICES This Re-Think Aging report is being published in the 80th anniversary year of Social Security and the 50th anniversary year of Medicare, Medicaid, and the Older Americans Act. These federal programs have changed the landscape of aging in the United States as much as, and in many cases more than, medical advances and technology.

$76,000 to $ 82,500

Fifty years ago, families had limited options for a loved one who was frail or homebound. Institutional care in a nursing home was the only way to provide long-term care. When the Older Americans Act (OAA) was passed, the federal government began to lay a foundation for an aging network offering supports to caregivers, in-home assistance, and nutrition at home or in congregate settings for the most vulnerable older adults. This 50 year-old system of supports has been strengthened by state-level investments with the aim of making it possible for very low and low-income older adults to age with dignity and grace.

(retirement savings,

annually. After a 2-4 year stay, all assets of the typical older adult sale of a family home) have been exhausted.

The OAA established Area Agencies on Aging (AAAs), which operate throughout the United States. Florida’s 11 AAAs cover every county in the state. ElderSource, Northeast Florida’s AAA, covers seven counties: Baker, Clay, Duval, Flagler, Nassau, St. Johns and Volusia counties. OAA funds “pass through” ElderSource and support Councils on Aging, Senior Centers, and other nonprofits throughout Northeast Florida, such as Aging True. ElderSource was also recently designated as an Aging and Aging Disability Resource Center, which means it now functions as a single coordinated system for information and access to services for those seeking long-term care resources. Currently, one in five older adults in the U.S. — 11 million people — receive services from an OAA program. Last year, in Northeast Florida, a total of 9,441 low-income and vulnerable older adults were served by ElderSource, which is approximately 25 percent of all persons aged 60 years and older living below the federal poverty level in the seven county region. In 2013, an older adult with an annual income below $11,490 was considered as someone living below the federal poverty level. The number of vulnerable older adults served by the traditional aging network (funded through OAA programs) is a relatively small portion of the total number of vulnerable adults. The majority of A 2015 JCCI INQUIRY

FINDINGS

OLDER ADULTS SERVED BY ELDERSOURCE IN 2014 COMPARED TO OLDER ADULTS LIVING BELOW THE FEDERAL POVERTY LEVEL IN 2013 TABLE 5 County

# served, 2014

# of persons 60+ year-old

# of 60+ adults living below poverty, 2013

Baker 285 Clay 802 Duval 5,388 Flagler 399 Nassau 367 St. Johns 699 Volusia 1,501

277 2,345 14,925 2,089 1,734 3,436 12,954

4,919 38,150 162,623 34,440 19,806 50,093 149,850

Total 9,441

37,760

459,881 Source: ElderSource; U.S. Census

NORTHEAST FLORIDA WAITING LISTS, 2015 TABLE 6 Program Assessment of needs and care plan (CCE) Long-term care (nursing home placement) Home-delivered meals Alzheimerâ&#x20AC;&#x2122;s Disease Initiative Home Care for the Elderly

# of Older Adults on Waiting List 3,847 3,683 1,555 581 461

RE-THINK AGING: MAKING NORTHEAST FLORIDA AN AGE-FRIENDLY REGION

Source: ElderSource; U.S. Census

FINDINGS Northeast Florida’s older adults do not participate in programs, nor receive assistance from an Older Americans Act funded program because their support networks meet their needs. In addition to OAA funding, the State of Florida uses general revenue funds to support aging in place. These are Community Care for the Elderly (CCE) funds and in 2014, the Florida Legislature increased funds for the program by $5 million dollars. Despite this increase, Florida has approximately 56,000 older adults on wait lists for community assistance programs, according to a Department of Elder Affairs Report published in February 2015. The public dollars—both federal and state-- available for community and home-based services are not keeping pace with current or future needs. All older adults, however, will interact with the health care system in Northeast Florida at some point, and in 25 years, one in four adult residents of Northeast Florida will be aged 65 years or older. This has implications for post-acute healthcare facilities and services, which provide medical and rehabilitative services to people discharged from the hospital. These include rehabilitation centers, skilled nursing facilities and home Last year, in Northeast health agencies. Health care planners calculate the number of people who will need services in the future by taking the number of persons living with a speFlorida, 9,441 low-income cific condition now and projecting out. For example, Brooks Rehabilitation is counting on twice as many Northeast Florida residents needing their services and vulnerable older by 2040. Northeast Florida institutions leading change A multitude of service providers in the community are working with older adults such as non-profit organizations, for-profit companies, faith-based institutions, and local government agencies. The services provided include meals, in-home services, home health care, case management, senior centers, hospice, and fitness and recreation. Some services are paid for by the consumer, others are covered by health insurance or grant funding. It is not possible to inventory the range and depth of services available to older adults in this report. However, it is possible to describe a few organizations leading the way in response to the demographic changes that will continue for the next 25 years.

adults were served by ElderSource, which is

approximately 25% of all persons aged 60 years and older living below the federal poverty level in the seven county region.

ElderSource The purpose of an Area Agency on Aging is to plan, promote, and coordinate a network of services for individuals 60 years and up in an effort to prevent or delay premature placement in a long-term care facility and to serve as an advocate for older adults. Responsibilities include: • identify needs of older adults in the region; • plan for meeting those needs; • contract for services to meet those needs, and • manage contracts, including monitoring performance. Services funded by ElderSource include, but are not limited to: • home delivered and congregate meals; • senior center activities; • in-home services; • adult day care; • caregiver support services such as respite; • services for grandparents raising grandchildren; A 2015 JCCI INQUIRY

FINDINGS • transportation; • legal services; and • evidence-based health and wellness programs. Current contracted agencies include (but are not limited to) Aging True, the County Councils on Aging, the City of Jacksonville, Flagler County, Northeast Florida Area Health Education Center, Jacksonville Area Legal Aid and Central Florida Legal Aid. AgeWell Center for Senior Health In 2012, Baptist Health launched Northeast Florida’s only comprehensive geriatric assessment and treatment center. The Center serves patients who are aged 65 and beyond using an interdisciplinary team approach to caring for older adults. The interdisciplinary team includes a psychologist, geriatrician, social worker, physical therapists trained in fall prevention, care coordinators and elder care advocates. Interdisciplinary team meetings about each patient also include the caregiver, if possible. Each patient has a care plan which includes a personal medication record, goals for therapy, and strategies for medication management. One of the aims of the care plan is to make it possible for the patient and caregiver (if available) to manage medications independently. All AgeWell Center staff are trained in motivating patients for lifestyle changes that maintain lifelong healthy weight and behaviors. Brooks Rehabilitation Brooks is a rehabilitation hospital (or post-acute facility) that serves people who are required to have medical care in addition to physical, speech, and/or occupational therapy following a hospital stay. Approximately 80 percent of Brooks’ patients are aged 65 years and older. Brooks also operates a geriatric physical therapy program, a unique offering at a hospital and one of only a few in the United States. Care transitions from hospital to home Frail older adults often require an advocate who can navigate both the health care system and the systems of support and care within the community. According to congressional testimony, Medicare beneficiaries with five or more chronic conditions see, on average, 13 different doctors during the year and fill an average of 50 prescriptions during the year. This level of intervention and treatment can become overwhelming for older adults and their families. One of the accomplishments made by the Life: Act 2 Partnership Council, a community collaboration led by United Way of Northeast Florida, was receipt of a $1 million grant award from the Robert Wood Johnson Foundation (RWJF) in 2004. These funds were used to pilot the Advocacy and Transition Care Model (ATCM) in four area hospitals. Three of those institutions – Baptist, UF Health Jacksonville, and St. Vincent’s - have sustained the model beyond the pilot and without funding from the RWJF. Each facility has secured funding or is using its own resources to make sure an Elder Care Advocate works with discharge planners to provide services that meet the needs of vulnerable older patients upon release from the hospital. The success of this effort lies in the fact that the program has continued beyond the grant period and the culture of the hospitals has shifted. AARP is leading the effort to pass legislation called the Caregiver, Advise, Record, Enable (CARE) Act in various states throughout the U.S. The legislation ensures information is shared between hospitals and home caregivers. This bill facilitates planning when an older loved one is ad-

RE-THINK AGING: MAKING NORTHEAST FLORIDA AN AGE-FRIENDLY REGION

FINDINGS mitted and discharged from a hospital. Oklahoma, New Jersey, and Virginia legislatures have passed this legislation, ensuring that a family caregiver’s name is recorded at the time of hospital admission, a caregiver is notified at discharge, and live instruction about the medical tasks required at home are given to the person responsible for the older adult. Disconnect between elected officials and voters The local AARP survey found that 9 in 10 voters say it is extremely or very important that visiting nurse services, well-trained home-health aids, and hospice care are available in Jacksonville. Only three percent of respondents said that it is ‘not very’ or ‘not at all important’. At the same time, the public funds available to provide these kinds of services are not increasing—in most cases, budgets are decreasing. The State of Florida is one of 20 states that have not expanded Medicaid as part of the Affordable Care Act. Nearly one million low-income Floridians would be eligible for Medicaid health insurance if the program were expanded.

Environment

ood air and water quality are the basis of a healthy environment, which is crucial for the health of all Northeast Florida residents. The inquiry committee did not focus its fact-finding on defining or discussing air and water quality as components of a livable community for people of all ages. Information about these environmental concerns are available for review via The City of Jacksonville and JEA. JCCI has also examined both of these environmental concerns in two previous inquires – Air Quality (2007) and River Dance: Putting the River in the River City (2005).

FIGURE 9

Source: Modified from Erik Erikson’s Stages of Phychosocial Development

A 2015 JCCI INQUIRY

FINDINGS Engagement

esidents in a livable community take for granted diverse social interactions; they have opportunities to “give back,” and vote on issues they care about. All residents, regardless of age, attend events and festivals, and identify with the unique features of their neighborhood, city, and region —whether natural, historical or cultural. Livable communities are also populated by people who care about each other, support the arts, and the institutions dedicated to improving lives. The health of a community depends on a mix of for-profit and nonprofit organizations that create equity and opportunity. A healthy nonprofit sector is crucial because its “organizations ... navigate the space between government and the individual,” providing a “connective tissue” or “glue” holding together people from different faiths, income levels, neighborhoods, and backgrounds. Opportunities to contribute to the health of a community that goes beyond the natural course of community-building can be described as civic investment, which requires that residents consciously invest their time, talent, and treasure for the good of community. For many older adults, their experience leading companies, families, and faith communities has given them leadership skills that translate well to civic pursuits, such as getting involved in election campaigns or speaking at Town Hall meetings. In addition, retired older adults often have time to “give back” to their community, further advancing nonprofits and service agencies with volunteer hours. In terms of civic and social engagement, older adults are at the pinnacle of human development because they are fully socially connected and aware due to accumulated experience and wisdom. Many of Northeast Florida’s most effective leaders are aged 50 years or older. Regardless of skill, wealth, or background, older adults are leading big and small communities throughout Northeast Florida as grandparents, parents, faith leaders, managers, supervisors, elected officials, CEOs, mentors, and activists. Figure 9 offers a re-thinking of human development, demonstrating why older adults are crucial to a livable community. The St. Johns Communities for a Lifetime Leadership Council recently recognized that many of its new residents have retired from careers in leadership positions, have family wealth and broad experience in philanthropy, and are eager to share their knowledge and resources in a new community. As a result, the Leadership Council is launching a volunteer center to capture the expertise of these residents. LIFELONG LEARNING Lifelong learning is the ongoing, voluntary and self-motivated pursuit of knowledge that enhances social inclusion, active citizenship, personal development and self-sustainability. Lifelong learning is considered a quality of life issue for healthy communities as well as for older adults in Northeast Florida. Research conducted in Great Britain and Australia demonstrates that adult learners report better coping skills and increased willingness to engage with others. Adult learners also report better dietary practices, more satisfactory social interaction, and better driving practices as a result of learning opportunities. Although similar research has not been carried out in Northeast Florida, it is expected that the effects are the same and that all residents of Northeast Florida benefit from lifelong learning opportunities. Lifelong learning is also critical for maintaining social connections and supports as older adults age. For older adults who want to continue making contributions to their neighborhoods and communities, learning opportunities are important. Finally, lifelong learning to acquire new knowledge and skills is crucial for older adults to remain competitive in the workplace especially beyond traditional retirement age.

RE-THINK AGING: MAKING NORTHEAST FLORIDA AN AGE-FRIENDLY REGION

FINDINGS One local community model is the Osher LifeLong Learning Institute at UNF. This is a member owned and operated organization offering over 300 educational, cultural and social opportunities to adults 50 years old and over. The Cummer Museum, the World Affairs Council, senior centers, libraries, and 55+ age-restricted communities also offer lifelong learning programs to older adults in Northeast Florida. Because of distance to learning centers, lack of transportation or conflicting work or care giving schedules, however, many older adults in the community cannot take advantage of these opportunities. ENGAGEMENT POLICIES AND PRACTICES Engagement opportunities for older adults The City of Jacksonville’s Senior Services Division matches 600 volunteers annually with more than 100 nonprofit agencies, resulting in nearly 96,000 hours of volunteer time donated to civic improvement. The same service program, RSVP, reaches out to the city’s senior centers, engaging nearly 750 more volunteers for an additional 46,400 of donated volunteer time. The Senior Services Division also matches more than 70 older adults each year with Duval County Public School classrooms to support children’s academic and social/emotional development. In Northeast Florida’s five-county area, Baker, Clay, Nassau and St. Johns counties each have a Council on Aging, nonprofits that operate senior centers where older adults can socialize, eat, learn about community resources, exercise, and use a computer. Many larger counties in Florida do not have a Council on Aging, which is the case in Duval. In Duval, the City of Jacksonville operates 19 Senior Centers where older adults socialize, eat, exercise, and get connected to resources. All senior centers have distinct constituencies and a leadership group that plans activities and events. In 2014 Jacksonville’s Senior Centers: • engaged 4,564 older adults; • offered 40,300 hours of exercise and recreation; and • made 10,200 trips from older adults’ homes to Senior Centers The region’s senior services and events are not reaching a wide audience, and only a small percentage of older adults choose to attend and participate. The 2011 ElderSource Needs Assessment found the majority of older adults in Northeast Florida have never visited a senior center.

THE CITY OF JACKSONVILLE HOSTS ANNUAL events that bring area older adults together for a range of social activities. In 2014, 11 large-scale events were hosted, including the Senior Games, safety seminars, a fishing tournament, a Senior Prom, and a Walk for Fitness. 18,000 attendees were counted, although the number of attendees includes persons who attended multiple events.

A 2015 JCCI INQUIRY

FINDINGS Intergenerational engagement In 1998, United Way of Northeast Florida launched Life: Act 2, to instigate a cultural shift towards thinking of older adults as assets rather than liabilities and increase the independence and quality of life for older adults through community leadership and innovative and collaborative services. The tagline for the 15-year project was A New Approach to the Second Half of Life. Project leaders realized early that stereotypes about older adults in the United States were pervasive in the culture. Images of helpless older adults who are isolated and anti-social were inescapable. Few young people, apart from their own grandparents, have opportunities to interact with older adults, so those negative images are all that they know of older generations. In December 2002, Life: Act 2 launched the Multigenerational Early Learning Collaboration (MELC) to combat those stereotypes. In MELC’s first phase, hundreds of Duval County Public school students interviewed older adults about their lives, and in a second phase, those same students wrote a story based on their interview. Ultimately, the best of these stories were published and resulted in 10,000 children’s books distributed, free of charge, to children learning to read. The books were distributed to hospital waiting rooms, early learning centers, elementary schools, and pediatrician offices. It was a popular project that lifted up stories and life experiences of Northeast Florida older adults and shared them with tens of thousands of young readers.

Opportunity “A binary system of working 100 percent until retirement and then suddenly moving to zero percent at an arbitrary age of around 65 is one of the great anachronisms of today’s labor market in many … countries.” Wolfgang Fengler and Johannes Koettl.

ne of the effects of the Great Recession on employed older adults was job loss. According to an AARP survey of 2,492 older Americans who were jobless in the previous five years – 45 percent (55 and older) have been 27 weeks or more without work. For many older workers who lost a job during the recession, the struggle to find paid work was so overwhelming they faced little choice but to retire. A 2014 survey conducted by the Federal Reserve found that among current retirees, of those who retired since 2008, 15 percent said they retired earlier than planned; only four percent said the recession prompted them to retire later. The ElderSource Needs Assessment found that 15 percent of adults aged 60 years and older considered their finances either a “moderate” or a “major” problem in the last 12 months. This is reflected in national data on financial insecurity amongst older adults. According to the National Council on Aging, 14 percent of adults aged 64 years and over face retirement with negative net worth (savings and assets minus debts) and one-third of senior households go into debt in order to meet their monthly expenses. Financial insecurity is prevalent throughout Northeast Florida as well as the United States, contributing to older adults’ need to retire later, or slowly ease out of the workforce. Another reason older adults work longer and delay retirement is that health insurance tied to a job is crucial to living well. Workers who have paid 10 years of Medicare taxes are eligible for public health insurance at 65 years old. However, Medicare does not cover all tests, treatments, and prescriptions. Medicare Supplement Insurance, which must be paid by the insured, is required to provide full coverage. This out-of-pocket expense surprises many Medicare-eligible adults.

RE-THINK AGING: MAKING NORTHEAST FLORIDA AN AGE-FRIENDLY REGION

FINDINGS 2011 ELDERSOURCE SURVEY TABLE 7 Percent Who Rarely or County Never Visit a Senior Center Baker 77% Clay 78% Duval 90% Nassau 82% St. Johns 84% Source: ElderSource

EMPLOYMENT FOR WORKERS 65+ (IN THOUSANDS) FIGURE 10

Source: U.S. Bureau of Labor Statistics

EMPLOYED PERSONS AGE 65+ TABLE 8 2011

Total 65+

In Labor Force

Total 65+

2012 In Labor Force

Total 65+

2013 In Labor Force

Baker 2,957 267 3,097 231 3,221 266 Clay 22,433 3,203 23,760 3,291 25,055 4,039 Duval 96,759 16,071 100,238 17,961 104,406 18,893 Nassau 12,058 1,520 12,755 1,886 13,423 1,970 St. Johns 30,176 5,068 31,942 5,119 34,216 5,942 Jax MSA 164,383 26,129 171,792 28,488 180,321 31,110

15.9% 16.6% 17.3% Source: U.S. Census Bureau, 3-Year American Community Survey, Table B23001

A 2015 JCCI INQUIRY

FINDINGS The trend to delay retirement started well before the Great Recession, and in 2008 the trend became even more pronounced as shown in figure 10. The numbers of persons 65 years and older who are employed has been increasing for three decades, with even sharper increases after 2008. Older adults represent a high ratio of workers who are defining new opportunities and services. Among Florida’s employed, 15 percent of 50-64 year-olds are self-employed entrepreneurs, compared with 11 percent of 25-49 year-olds. Many of these older adults have launched an encore career (second career) that makes the most of their talents and experience. Oxford Economics, which forecasts economic trends using quantitative analysis, found that “when it comes to starting new businesses and job creation, people ages 45-64 start companies at almost twice the rate of people ages 20-34.” The average age of the 500 recent applicants for a Florida entrepreneurship program funded in part by the U.S. Labor Department was 51 years. OPPORTUNITY POLICIES AND PRACTICES A plan for working as an older adult Life Reimagined is a series of online and offline experiences to help people evaluate the next steps in their life. The program targets people 50 years-old and over and is marketed by AARP. One of the focus areas is careers and working longer. Part of the program is called “Life Reimagined for Work,” which is informed by the work of leading life coaches and professional development experts who help individuals focus on getting the most from their current career, redefining their work life, and exploring new options for work. AARP has begun deepening its reach from state-level advocacy to community mobilization and education. Thirteen communities were chosen to pilot this new approach to mobilizing older adults, including Jacksonville, Fla. As a result, Life Reimagined workshops have been conducted in Northeast Florida, and AARP is committed to bringing more of them to corporate environments and workplaces in the future. Work programs for older adults The State of Florida offers two programs for older job seekers. The Employ Florida Marketplace - Silver Edition is a partnership with United Way’s Life: Act 2 Partnership and Work Source. This web portal allows job seekers aged 50 years and older to look for paid and volunteer work within age friendly businesses. This online career resource allows the user to search for jobs within a 25–50 mile radius of a given zip code. Once in the portal the user can apply for jobs and access more information about services for older adults. Older adults aged 55 years and older who are unemployed or looking to re-enter the workforce may qualify for the Senior Community Service Employment Program (SCSEP), which is administered in each of Florida’s 67 counties. The SCSEP is a U.S. Department of Labor administered program. Eligible individuals are placed in part-time community service positions with a goal of transitioning to unsubsidized employment. In addition to the age requirement, participants must be unemployed, and have a family income of no more than 125 percent of the federal poverty level. Enrollment priority is given to veterans and qualified spouses, and then to individuals who are over age 65 who have a disability, low literacy skills or limited English proficiency, reside in a rural area, are homeless or at risk of homelessness, or have low employment prospects. In Northeast Florida the program is managed by Experience Works, Inc.

RE-THINK AGING: MAKING NORTHEAST FLORIDA AN AGE-FRIENDLY REGION

FINDINGS Neighborhoods

s use of the health care system in the United States increases, greater emphasis is being placed on preventing chronic disease through interventions in behaviors such as eating and exercising, and it has become much more clear how place matters to a population’s health. Where we live can impact our health outcomes. Neighborhoods, in general, provide roads, utility services, electricity, and sometimes amenities such as recreational space or shopping. Neighborhoods impact the day-to-day lives of people, and as such, are determinants of lifelong health. Research continues to build a picture of social determinants of health. Livable neighborhoods encourage walking, promote healthy eating with options for buying nutritious food, and promote social interactions that are healthy, not stressful or damaging. Health professionals increasingly link overall population health to availability and access to safe streets, stable community networks, and a physical environment that promotes exercise and social connection. Taken as a whole, neighborhoods in the United States have become an uneven playing field on which ‘behavior’ and ‘choice’ cloak a system of unequal access. While all of this information may appear obvious, these ideas are not informing the majority of neighborhood planning in the United States. For example, in Florida, regulation of housing developments focuses on answering two questions: 1) What does the law say developers and owners can do with their property? 2) How will the larger community pay for roads, sewer lines, and other capital improvements needed to accommodate development plans? A large-scale development such as Nocatee, straddling both Duval and St. Johns counties is planned within regulations that address expected impacts on the public education system, the environment, and on traffic. Regulations are not written with a concern for opportunities to exercise, how well neighbors will interact, or how residents who do not drive might be accommodated. Very recently the Northeast Florida Regional Council has begun to ask about the health impacts of new neighborhoods and developments. Health impact assessments can demonstrate how a specific neighborhood design adds or subtracts from life expectancy. Nevertheless, many planners, concerned residents, and leaders in Northeast Florida are retrofitting and re-designing already existing neighborhoods for livability. In 2013 the Florida Department of Elder Affairs conducted an Aging-in-Place Housing Survey of 750 adults. The majority want to live in neighborhoods (89.8 percent) where they are treated with respect, and where their contributions are appreciated (82.4 percent). Respondents also wanted to live in a safe neighborhood (94.8 percent), where there are affordable housing options (80.5 percent) and available transportation (93.8 percent). NEIGHBORHOOD POLICIES AND PRACTICES The City of Jacksonville has established a Crosswalk Coalition to review pedestrian crash data and identify locations for improvements. A continuous right turn lane, or a green signal for a pedestrian that is not long enough for safe passage, can make a crosswalk dangerous. The first focus of the Coalition is middle schools because many students walk to and from school. The second focus is senior centers and senior living facilities. The Coalition aims to catalogue all the senior centers and senior living facilities that do not have a crosswalk within 300 feet of the entrance. The Jacksonville City Council also established a Special Council on Context Sensitive Streets in 2012. This work began when city leadership realized that design standards can calm traffic. SubseA 2015 JCCI INQUIRY

FINDINGS quently, a citizen committee, the Context Sensitive Street Committee, was formed. The committee’s purpose is to re-write design standards for sidewalks, parking, and other neighborhood features, making them more pedestrian-friendly.

Promising Pathways

any communities throughout the U.S. are finding ways to build livable communities for everyone, regardless of age. Some policies and programs were selected for this report because of their potential for success in Northeast Florida. ATLANTA REGIONAL COMMISSION The Atlanta Regional Commission (ARC), a large, quasi-governmental agency, acts as an Area Agency on Aging. ARC is the regional planning and intergovernmental coordination agency for the 10-county area as well as the City of Atlanta. In contrast to city and neighborhood planning in Florida, which is primarily focused on regulation and balancing economic and environmental impacts, planning in the Atlanta region is proactive and focused on livability. Within ARC is the Center for Community Services, which plans for civic infrastructure, as opposed to physical infrastructure. The Center’s purpose is to increase community involvement in regional planning processes. Within the Center for Community Services is the region’s Area Agency on Aging (AAA), which contracts with 13 aging agencies and 10 programs in the region’s 10 counties. This structure for an AAA represents a more advanced approach to planning and development of community. One of the divisions within the AAA is Lifelong Communities, which brings urban planners to neighborhoods to envision more livable streets and public spaces. Ten years ago, the Atlanta Regional Commission was awarded a Robert Wood Johnson grant to launch the Lifelong Communities program. It has been transforming policy-making and infrastructure in Atlanta neighborhoods. As a result, they have a series of Lifelong Community projects promoting housing and transportation options, encouraging healthy lifestyles, and expanding access to information and services. Eighteen neighborhood associations, county agencies, town centers, and civic associations have adopted or incorporated Lifelong Community principles into their plans for signage, construction, infrastructure improvements, wellness programs, residential renovations, and transit plans. HOUSING PLUS SERVICES At Presbyterian Senior Living (PSL), a senior living corporation managing properties in Pennsylvania, Maryland, Delaware, and Southeastern Ohio, many residents living in various senior housing communities need an advocate. One way to improve residents’ health outcomes while saving healthcare costs, is to bring a team of health professionals and social workers to a housing community. The team includes a physician, the supportive services coordinator at the housing community, and a medical social worker. In a pilot program launched in 2010, diabetes management was an early focus for the team. Since 2010, the housing plus-services team has been helping residents get to primary care, advocating for the patient with their insurance, and promoting overall wellness in the housing community. The diabetes case management at the downtown high-rise senior community produced a 75 percent reduction in ER usage and a 50-60 percent reduction in hospital utilization. After producing good outcomes for patients in one housing community, PSL decided to take the model to four housing communities in which the residents are of moderate income and serious health conditions are not as prevalent. These residents have patient-centered medical homes, so the team’s

RE-THINK AGING: MAKING NORTHEAST FLORIDA AN AGE-FRIENDLY REGION

FINDINGS work is done in conjunction with that model. PSL has learned that they can save healthcare partners money, reduce Medicare penalties for hospital re-admisssion, and improve population health. This is a powerful model that can be adapted to more housing communities, whether serving low, middle, or high income older adults. The process of researching the success factors and defining the developmental patterns for creating sustainable partnerships has resulted in many insights, including: •

PSL needs to continue to identify and work with people who “get it,” such as the director of Diabetes Management in a local hospital, their first partnership. Because the Director understood the benefit to the hospital if residents did not use the ER for primary care, the hospital invested resources in a partnership that changed health care service delivery and improved health outcomes.

•

The healthcare partner has to accrue a quantifiable benefit, (e.g., reduction in Medicare reimbursements, reduction in hospital re-admissions). A partnership sustained over time is based on mutual benefit. The outcome of the work has to be a “have to do” for both partners, not a “nice to do.”

NATURALLY OCCURRING RETIREMENT COMMUNITIES Naturally Occurring Retirement Communities, also known as NORCs, are geographically defined communities in which at least 40 percent of the population is 60 or older and live in their own homes. One of the first steps to creating a NORC is to survey older adults in the area, assessing their strengths and preferences. A community-based intervention is subsequently designed to foster aging in place. Most NORCs include: • • • •

Case management and social work services; Health care management and prevention programming; Socializing and recreation; and Volunteer opportunities.

The first NORCs launched in densely populated areas with private philanthropic support in the 1980s. The model was successful in shifting the position of older adults from recipients of services to agents of change and improvement who direct the community intervention. Now NORCs exist in suburban, rural, and urban communities across the U.S. Federal agencies have supported the development of NORCs in 25 different states. Three neighborhoods located in Houston, Texas utilized already existing senior centers and senior apartment complexes and formed Elder Care Action Teams made up of elders who want to advocate for themselves and their neighbors. As a result, these sites expanded their evidence-based health prevention programming, developed a volunteer driver voucher program, including mobility options counselors. THE VILLAGE MODEL In 2001, residents of a wealthy Boston neighborhood, Beacon Hill, enlisted the help of experts from the Harvard Business School to write a business plan. The aim of the new business was to keep older adults in their neighborhood from having to move. By 2006, five years later, 340 members were paying between $550 and $780 annually for the service. They also had secured enough foundation grants to subsidize residents whose annual income fell below an agreed-upon benchmark. Ten years ago, the New York Times wrote that the business model might catch on in subsequent years. In 2015, at least 150 Villages are operating in the U.S. In all of them, neighbors help each other stay at home for as long as possible. In Washington, D.C., it took three years to build a 350-memA 2015 JCCI INQUIRY

FINDINGS ber village that has paid staff and a long list of volunteers. While many villages begin in wealthier neighborhoods where family resources can be pooled to start a nonprofit, many of the villages support residents living in subsidized housing. In the case of marketing a Village, a consistent barrier is the fact that older adults do not ask for help naturally. Many older adults are not ready for a membership until a crisis occurs which makes it clear that they might not be able to live at home much longer. For older adults who want to avoid relying on children or moving into a retirement home, a Village provides a “one phone call away” service. Help includes: • Watering the garden • Putting a rail on the stairs • Fixing a computer • Programming a watch • Delivering medicine • Exercise classes • Companionship The practical assistance and security of accessing help at the end of the phone line gives many older adults the confidence they need to stay months and years longer in their homes. ITN ORLANDO According to the ElderSource Needs Assessment for 2011-12, “transportation was most often identified by participants as the one issue most important to them.” Independent Transportation Network (ITN) is a national network of organizations developing volunteer rides for older adult customers. Proprietary ITNRides software establishes a centralized logistics service for volunteers who drive and members who want to pay a small cost for a ride. ITNOrlando began in 2006 within the Senior Resource Alliance. In 2011, it became its own agency, one of 23 ITN affiliates in the U.S. ITNOrlando costs $60 per year to join. Each time a member uses the service, they pay approximately $1.50/mile plus a $4 pick-up charge. If a member shares the ride, they receive a 20 percent discount. The service operates within a 15-mile radius of Orlando and is available 24 hours a day, 7 days a week. Volunteers use their own cars and a background check is conducted on all volunteers. COMMUNITIES FOR A LIFETIME INITIATIVE Communities for a Lifetime is a statewide initiative, begun in 1999 and administered by the Department of Elder Affairs, that assists Florida cities, towns and counties in planning and implementing improvements that benefit their residents of all ages. The Communities for a Lifetime Bureau is comprised of the following focus areas: Housing, Transportation and Mobility, Employment, Health, Wellness and Injury Prevention, Volunteerism, and Intergenerational Programs. Jacksonville is one of 128 CFALs in the State. The steps for creating a CFAL were: • pass a proclamation or resolution; • form a senior advisory committee/task force; • create a community inventory or needs assessment; • create a senior survey and needs assessment; • develop a community vision or action plan; • initiate partnerships; and • develop a maintenance plan.

RE-THINK AGING: MAKING NORTHEAST FLORIDA AN AGE-FRIENDLY REGION

FINDINGS That process is being revised along with the emphasis of the initiative, which will focus on providing education and outreach presentations about myriad topics vital to aging in place. These free presentations will be offered in partnership with CFAL communities at libraries, colleges, community meeting rooms, faith-based locations, and anywhere that offers a venue. Presentation topics include retrofitting a home, fire prevention, transportation safety, and fraud prevention. In addition to presentations, the CFAL staff will provide technical assistance to communities through the involvement of established partnerships, collaboration on best practices, and community events that define what assistance is most important to supporting that CFAL community. AGE-FRIENDLY SARASOTA Age-Friendly Sarasota is an intergenerational initiative seeking to build upon the community’s assets and aspirations to optimize active, healthy and engaged living for all Sarasota County residents across several interconnected domains, such as transportation and social participation. These efforts aspire to support the work of a broad range of entities to develop a more livable community, including organizations serving older residents. Through learning and sharing the aspirations of these residents, Age-Friendly Sarasota facilitates a process for people to engage and plan for Sarasota County’s future so that every generation has the opportunity to thrive in a livable community. Age-Friendly Sarasota is Florida’s first World Health Organization (WHO) age-friendly community. The WHO initiative was established in 2010 to connect cities, communities and organizations worldwide with the common vision of making their community a great place in which to age and thrive. The Age-Friendly Sarasota Partners are AARP, Sarasota County Health and Human Services, Florida Department of Health in Sarasota, University of South Florida Sarasota-Manatee, and the USF Florida Policy Exchange Center on Aging. JACKSONVILLE INTERFAITH COLLABORATIVE FOR SENIOR OUTREACH The Jacksonville Interfaith Collaborative for Senior Outreach ( JICSO) was established in 2014 to help the frail elderly remain in their homes. JISCO is a pilot project in partnership with Jewish Family & Children’s Services ( JFCS), the AgeWell Institute of Baptist Health, and Seniors on a Mission. The program’s goals are as follows. •

Work with houses of worship to identify their older members and former members that disappeared from view and may require assistance in terms of transportation, meals, healthcare, socialization or other social services.

•

Refer these identified individuals to a JFCS social worker who would visit them in their homes and conduct an assessment of their needs.

•

Provide those needed services, as appropriate, by one of the three founding-agencies, or another agency that could most effectively provide such services, while optimizing collaboration among the agencies.

The objective is to improve the quality of life for the individuals identified. Funding for the pilot is provided by the Jewish Federation of Jacksonville and The Community Foundation for Northeast Florida. To date, 20 individuals have been identified by Congregation Ahavath Chesed, Etz Chaim Synagogue, and Hendricks Avenue Baptist Church. Other houses of worship were invited to participate but declined for a variety of reasons.

A 2015 JCCI INQUIRY

CONCLUSIONS

Conclusions represent the value judgments of the committee, based on the Findings

POSITIVE AGING: THE PROCESS OF MAINTAINING A POSITIVE ATTITUDE, FEELING GOOD ABOUT OURSELVES, KEEPING FIT AND HEALTHY, AND ENGAGING FULLY IN LIFE. Positive aging requires careful attention and good planning by each of us from our early adult years onward. At the same time, an individual’s positive aging is enhanced by residing in a livable community most often described as safe, accessible, and vibrant. Northeast Florida, as with the rest of the nation, is undergoing an unprecedented shift from a culture of youth to a culture of maturity. A significant change in the average age of our population is underway, and with each passing year, a greater percentage of Northeast Florida residents – more than ever before - will face the challenges and opportunities of living longer. Policy and planning are the most powerful tools available to prepare for community-wide improvements whether in healthcare, job creation, transportation, housing, or neighborhood development. Currently, aging is rarely considered in civic planning or local community development decision making. As a result, when strategic decisions about the future of the region are being made, a key demographic group - which will comprise 40 percent of the adult population in coming decades – will not be adequately considered. Planning now for these inevitable demographic changes means taking advantage of opportunities for overall community improvement. It is also more effective to plan properly than correct problems after the fact. Civic action and planning by local leadership and residents must start now, using a comprehensive understanding of how all sectors are changing and will continue to change in the future. No comprehensive and sustained framework exists in Northeast Florida for proactive, long-term, age-friendly planning, which means efforts to promote positive aging will continue to be piece-meal and isolated, lacking the synergy of a regional effort at improving quality of life for all residents. A livable community framework is a powerful way to assess both the positive and negative conditions shaping Northeast Floridians’ lives because it focuses public attention on quality of life improvements benefitting all residents.

1. TRANSPORTATION

2. HOUSING

Northeast Florida residents deserve more choices when it comes to mobility, whether they reside in urban, suburban, or rural communities. Northeast Florida lacks innovative and safe mobility solutions supporting older drivers and non-drivers, leaving some of them with no choice but to use vehicles for hire that are not equipped to serve them well. In too many areas, transportation infrastructure (signage, sidewalks, curbs) is not age-friendly.

Aging in place is strongly desired by nearly everyone and is far more cost effective for individuals and society. Widespread community development and planning that incorporates aging in place concepts does not yet exist in Northeast Florida. For example: •

RE-THINK AGING: MAKING NORTHEAST FLORIDA AN AGE-FRIENDLY REGION

The absence of policies which facilitate Universal Design, adaptable homes, and residential zoning to allow for “in-law suites.”

CONCLUSIONS •

The Florida Legislature’s use of State Housing Initiatives Partnership program funds (SHIP) to fund other budget priorities, along with continued underfunding of programs supporting aging in place, reduces housing choices for low-income residents of all ages.

3. NEIGHBORHOODS Currently, neighborhood development and design does not consider the needs of older adults in the same way that local and regional planning efforts consider the needs of children and families. As a result, opportunities are missed to plan for livable communities emphasizing more intergenerational connections, walk-ability and easy access to amenities. Innovative neighborhood design that facilitates aging in place benefits all, regardless of age. 4. OPPORTUNITY Population aging will change Northeast Florida in dramatic ways. Northeast Florida’s business and government sectors’ failure to recognize and respond to one of the biggest demographic changes in recent history could mean years of reactive and inadequate decisions. •

•

Businesses that ramp-up efforts to evaluate traditional practices in order to assist older adults who desire new career paths and meaningful work will have an edge in the marketplace. Failure to adapt to the reality that older adults are working longer and delaying retirement leaves businesses vulnerable to the possibility of a mass exodus of institutional knowledge. Without succession planning and other retention strategies businesses will likely experience interruptions in service, loss of profits, and weakening of Northeast Florida’s local economy. Northeast Florida’s organizations have an opportunity to reach out to older adults in the same way many cultivate young professionals for their insight, knowledge, perspective, and support. Older adults’ experiences are available to both for-profit and nonprofit enterprises, but their talents are often overlooked because they may be viewed as a

population group with little to offer or whose time has passed. 5. HEALTH AND CAREGIVING As Northeast Florida prepares for the inevitable changes that population aging will bring, large-scale changes in healthcare systems and public health policy are urgently needed. In particular, residents needing long-term care experience significant gaps in our current healthcare system. Now and in the future, Northeast Florida’s health system will be increasingly challenged by the number of older adults living with chronic cognitive, physical, and mental illnesses; those who need care and rehabilitation for accidental injuries; and patients who require long-term services and supports. •

Aging in place frequently requires non-medical supports (such as help with activities of daily living or home-delivered meals) and healthcare and, non-medical supports are not well-integrated currently.

•

Government funding for assistance to older adults and their families cannot keep pace with the increase in the number of people seeking aid. This is not a new problem; however, it will become more urgent and evident in the future. Therefore, community resources, built from a collaborative mix of private entrepreneurial innovation and public investment must create new solutions for support services.

•

Regardless of socio-economic differences, many families will not be able to take care of their older relative’s housing, health, and engagement needs despite their willingness to do so. At the same time, those differences including ethnicity, religion, culture, sexual orientation, family income, and race can influence perceptions about and access to services for older adults and their caregivers. Policy and planning can be misguided or ineffective without considering the impact of these social, cultural, and economic identities on aging and caregiving.

A 2015 JCCI INQUIRY

CONCLUSIONS •

As more Northeast Floridians live longer, the structures and patterns of caregiving will change. In particular, the following must be better understood and acted on in the context of policy and planning:

•

The staggering costs of long-term care on our local economy and individual families.

•

The stunning impact of family caregiving on businesses and their employees which often leads to absenteeism, low productivity, and loss of family income.

•

The urgent need for consistent workplace policies supporting family caregiving, which will only increase in coming years.

•

The difficulties and complications caregivers face while navigating the healthcare system with their loved one.

•

The thoughtful development of community support systems for older adults who lack family, friend, or faith networks, which makes them especially vulnerable to not receiving the assistance needed for positive aging.

•

The benefits of advance care planning and patient-centered care to individuals, families, and institutions.

often the catalyst for choosing and adapting to new housing, mobility, and healthcare as we age. At such a point, it may be too late to effectively plan and choices become limited. Planning for the inevitability of aging can help prevent adverse financial exposure, loss of independence, and diminished social connection. •

Few people have the resources (i.e., time, knowledge, money, etc.) to prepare for the social, emotional, physical, and financial changes that come with aging. However, it is of the utmost importance for people under the age of 50 to become better acquainted with aging and quality of life issues that impact older adults. Having the right information and tools increases our ability to age well, and support our aging family and community members as they strive to maintain their independence, autonomy, dignity, and a positive outlook on life. In particular, too few people under the age of 50 understand the benefits and limitations of Medicare, Medicaid, and Social Security.

•

Too few older adults have access to diverse lifelong learning opportunities, without regard for where they live, ability to pay, or access to transportation.

•

Negative stereotypes that marginalize older adults still persist. Northeast Florida’s leaders and residents have not fully embraced the reality that many older adults are thriving, experienced, consumers with flexible schedules and significant disposable income. As a result, the region may be missing opportunities to attract older adults and utilizing the talents of those already here.

As the healthcare system evolves, healthcare worker shortages will become severe and unable to meet demands. There is a tremendous need for workforce certification, development, and supervision of non-family caregivers who work with older adults to ensure greater client safety and competency of care.

6. ENGAGEMENT • Every adult in Northeast Florida has a personal and family responsibility to create a personal vision and a plan for aging positively. Additionally, many residents (about 15 percent) do not know how to access services, which causes adverse financial impacts when seeking care. A financial or health crisis is too

RE-THINK AGING: MAKING NORTHEAST FLORIDA AN AGE-FRIENDLY REGION

RECOMMENDATIONS

NORTHEAST FLORIDA HAS THREE PRIORITIES AS IT PLANS FOR A FUTURE IN WHICH ALL RESIDENTS THRIVE, REGARDLESS OF AGE. •

Reframe our public conversation so that we understand, as we begin to address the needs of our aging population, that we are also moving toward the creation of a livable community that works well for all ages.

•

Educate and inspire municipal leadership throughout Northeast Florida to adopt and use the AARP Livable Communities framework.

•

Ensure the AARP Livable Communities framework informs future master plans, comprehensive plans, needs assessments, and strategic plans written by businesses, nonprofits, and public agencies throughout Northeast Florida, whether in suburban neighborhoods, rural counties, or a population-dense city.

•

Adopt a comprehensive policy framework as a guide for creating a livable community and coordinate decision-making, policy, and practices in transportation, housing, health services, economic development, and regional planning, in order to realize the goal of making Northeast Florida a livable community.

•

Engage residents in this work and support the importance of their role in developing livable communities through neighborhood action plans and grassroots community development.

•

Develop a communication strategy for promoting livable communities that increases awareness amongst residents and their elected representatives.

In order to achieve these overarching outcomes, Recommendations for change are offered below, which are based on the Findings and Conclusions.

•

Secure elected officials’ endorsements of an age-friendly designation and participation in AARP’s Network of Age-Friendly Communities.

1. EDUCATION AND ADVOCACY FOR LIVABLE COMMUNITIES ElderSource, the Health Planning Council of Northeast Florida, and the Northeast Florida Regional Council take initial steps to convene a diverse group of agencies and individuals throughout Northeast Florida, (including but not limited to, Chambers of Commerce, Councils on Aging, educational institutions, elected officials, faith-based institutions, community-based organizations, transportation organizations, religious institutions, medical providers, libraries, municipal services departments, museums, philanthropists, and AARP Jacksonville) to form a regional Livable Communities Coalition.

•

Strengthen the coalition over time so that it evolves into a single, consolidated regional advisory organization ensuring leadership, advocacy, planning, and resources are available to create a nationally-recognized age-friendly region.

The coalition’s goals include (but are not limited to):

The JCCI Implementation Task Force should facilitate the Coalition initially, supporting the three lead agencies in gaining active involvement of targeted partner organizations, and monitoring their progress toward an age-friendly Northeast Florida. The Coalition’s initial tasks are outlined below in recommendations specific to improvements in transportation, housing and neighborhoods, opportunities for paid and unpaid work, health, and social engagement; all the dimensions of a livable community. The following recommendations should be the focus A 2015 JCCI INQUIRY

RECOMMENDATIONS of partners’ work as they plan together as a Livable Communities Coalition. 2. TRANSPORTATION - INCREASE MOBILITY OPTIONS AND ROAD SAFETY • JTA revises the Northeast Florida Coordinated Mobility Plan to increase mobility choices for older drivers and non-drivers. The Plan should identify specific steps to increase mobility choices through new and innovative solutions. •

•

Northeast Florida Regional Council, JTA, North Florida TPO (Transportation Planning Organization), Transportation Disadvantaged providers, and ElderSource coordinate policy, planning, and funding to maximize the efficiency, ease of use, and affordability of services so that older adults and the transportation disadvantaged have a range of mobility choices. These entities and local governments should work together to ensure that the built environment is safe and comfortable for everyone to walk, bike, drive, and access the mobility option of choice. Brooks Health expands the reach of its driver assessment opportunities and driver training aimed at older adults.

•

JTA and North Florida TPO convene local entrepreneurs, nonprofit service providers, and faith-based organizations to determine the feasibility of a membership service providing low-cost, safe rides in private vehicles by trained drivers.

•

Jacksonville’s Citizen Planning and Advisory Councils (CPACs) and similar entities throughout Northeast Florida support the identification of dangerous crosswalks, utilizing neighborhood associations and their resident members. Those crosswalks should be communicated to Jacksonville’s Crosswalk Coalition and similar responsible parties in Northeast Florida for consideration of corrective action.

3. HOUSING & NEIGHBORHOODS INCREASE HOUSING CHOICES AND ENSURE RESIDENTS LIVE AT HOME INDEPENDENTLY •

The Florida Legislature continues to fund programs supporting aging in place and allocates SHIP funds appropriately so that they support programs increasing housing choices for low-income residents.

•

The Northeast Florida Regional Council includes the principles of a livable community in all of its planning activities. In addition, the Council adopts policies and utilizes programs promoting aging in place, promoting age-friendly design principles and access in existing homes.

•

Northeast Florida Builders Association and all affordable housing programs encourage and promote to their members and agencies the use of Universal Design principles in new construction as well as renovation of existing homes and structures, especially in micro-communities with large populations of older adults. Housing developers also implement Universal Design principles.

•

Councils on Aging and the City of Jacksonville’s Senior Services Division identify, support, and provide technical assistance to naturally occurring retirement communities (NORCs) and promote the Village Approach. These strategies ensure an increased number of older adults age in place, live independently with dignity, and with appropriate assistance. These types of assistance might include fall prevention, guidance on hiring contractors for accessibility retrofits, and integration of social work expertise into services and programs residents are utilizing as they age in place.

•

Local government planning and zoning agencies review and amend their residential zoning laws to make them more amenable to accessory dwelling units.

•

The City of Jacksonville’s Housing and Community Development Division, AARP Jack-

RE-THINK AGING: MAKING NORTHEAST FLORIDA AN AGE-FRIENDLY REGION

RECOMMENDATIONS sonville, and local faith communities develop programs engaging youth and older adults to maintain neighborhood appearance. 4. OPPORTUNITY - VALUE INCLUSION AND RE-THINK RETIREMENT • AARP Jacksonville, Society for Human Resource Management (SHRM Jacksonville), United Way of Northeast Florida, the Jacksonville Regional Chamber of Commerce, and similar Chambers of Commerce throughout the region collaborate to increase business leaders’ awareness of, and plans for, Baby Boom generation retirement. •

OneJax leads a community-wide awareness campaign involving religious communities and faith-based organizations to specifically address discrimination against older adults and stereotypes of them.

•

AARP Jacksonville and HandsOn Jacksonville collaborate to engage residents ages 50+ who are seeking meaningful paid and unpaid work. The partnership involves best practices in engaging residents ages 50+ in discovery of encore careers and matching older career professionals with local organizations needing their expertise.

•

The Caregiver Coalition of Northeast Florida continues to engage the business community and to advocate for the adoption of best practices in workplace policies that support the vital role of family caregivers and protect them from job and income loss. ElderSource continues to engage local businesses in earning an Elder Friendly Business Certification, building awareness of best practices for accessibility and customer service.

5. HEALTH - EMPOWER FAMILY CAREGIVERS AND SUPPORT HEALTH PROFESSIONALS • Local colleges, universities, and technical schools develop strategies to increase the number of professional healthcare providers trained in geriatrics.

•

ElderSource expands sensitivity training for front line staff and administrators in medical and non-medical agencies serving older adults and their families.

•

The Caregiver Coalition of Northeast Florida continues to explore promising practices that increase its support of families with medically frail loved ones and strengthen the Coalition’s work helping families plan for, and successfully deal with, changes in health, housing, transitions in care, including continued focus on the importance of advanced care planning.

6. ENGAGEMENT - CONNECT & THRIVE • The Northeast Florida Regional Council identifies, celebrates and utilizes the region’s elected officials and agencies who are vigorously adopting the livable community framework and prioritizing aging in place in their community development activities. These successful examples provide demonstrated best practices and serve as an opportunity for learning about what works in Northeast Florida. •

Libraries, higher education institutions, faithbased organizations and other knowledge-focused organizations promote and provide more lifelong learning opportunities. Osher Lifelong Learning Institute (OLLI) expands its reach to offer programs to a wider audience living in diverse areas throughout the region.

•

The City of Jacksonville’s Senior Services Division and County Councils on Aging promote intergenerational programs.

•

The Women of Color Cultural Foundation engages youth in intergenerational programs throughout Northeast Florida, training and teaching them the value of older adults’ wisdom and knowledge.

•

AARP Jacksonville teaches older adults how to advocate for their interests and advocate for local and state-level policy changes.

A 2015 JCCI INQUIRY

SUGGESTED READING Being Mortal – Atul Gawande Home Matters: The 2014 Report from the Florida Housing Coalition www.flhousing.org Report on the Economic Well-Being of U.S. Households in 2013 http://www.federalreserve.gov/econresdata/default.htm Senior Citizens – Their Place in Florida’s Past, Present, and Future www.bebr.ufl.edu The Baby Boom and the Aging of Florida’s Population www.bebr.ufl.edu Gauging Aging: Understanding Aging in America www.giaging.org Livability Index https://livabilityindex.aarp.org/ AARP Public Policy Institute http://www.aarp.org/ppi/ Toula’s Tips for Caregivers http://www.toulastipsforcaregivers.com/ Addressing Rising Healthcare Costs and Challenges of Aging in Place http://healthcare-executive-insight.advanceweb.com/ A Critical Window for Policymaking on Population Aging in Developing Countries www.prb.org Livable Communities http://www.aarp.org/livable-communities/ NORC Supportive Service Programs: An Overview and Literature Review www.orcs.org American’s Expectations about Future Use of Long-Term Services and Supports http://remingtonreport.com/images/cover_story_ma15.pdf Seniors Take Manhattan – How NYC Became a Global Leader for Senior Living – One Zumba Class at a Time www.politico.com 65+ in the United States: 2010 – United States Census Bureau. www.census.gov The Maturing of America: Communities Moving Forward for an Aging Population www.n4a.org

RE-THINK AGING: MAKING NORTHEAST FLORIDA AN AGE-FRIENDLY REGION

PAST JCCI INQUIRIES Year

Inquiry Title

Inquiry Chair

Year

1977 Local Government Finance

Robert Davis

1977 Housing

Thomas Carpenter

1992 Young Black Males

Chester A. Aikens & William Scheu

1977 Public Education (K-12)

Robert W. Shellenberg

1993 Planning for Northeast Florida’s Uncertain Military Future

David L. Williams

1978 Public Authorities

Howard Greenstein

1993 Public Education: The Cost of Quality

Royce Lyles

1978 Strengthening the Family

Jacquelyn Bates

1994 Reducing Violence in Jacksonville Schools

Dale Clifford

1979 Citizen Participation in the Schools

Susan Black

1979 Youth Unemployment

Roy G. Green

1994 Jacksonville Public Services: Meeting Neighborhood Needs

Michael Korn

1979 Theatre Jacksonville

Richard Bizot

1995 Teenage Single Parents and Their Families

Afesa Adams

1979 Civil Service

Max K. Morris

1995 JAXPORT: Improvement and Expansion

Jim Ade

1979 Planning in Local Government

I.M. Sulzbacher

1996 Creating a Community Agenda: Indicators For Health & Human Services

Bruce Demps

1980 Capital Improvements for Recreation

Ted Pappas

1996 Leadership Meeting Community Needs

Bill Brinton

1980 But Not in My Neighborhood

Pamela Y. Paul

1997 Improving Public Dialogue

Jim Crooks

1980 The Energy Efficient City

Roderick M. Nicol

1997 Transportation for the Disadvantaged

Cathy Winterfield

1981 Coordinating Human Services

Pat Hannan

1997 Children with Special Needs

Virginia Borrok

1981 Higher Education

R.P.T. Young

1998 The Role of Nonprofit Organizations

Sherry Magill

1982 Disaster Preparedness

Walter Williams, Jr.

1998 Incentives for Economic Development

Henry Thomas

1982 Teenage Pregnancy

Mari Tebrueggen

1999 Improving Adult Literacy

Edythe Abdullah

1982 Downtown Derelicts

Earle Traynham

1999 Arts, Recreation and Culture in Jacksonville Ed Hearle

1983 Mass Transit

David Hastings

2000 Affordable Housing

Bill Bishop

1983 Indigent Health Care

Linda McClintock

2000 Improving Regional Cooperation

Jim Rinaman

1984 Jacksonville’s Jail

Eleanor Gay

2001 Services for Ex-Offenders

Dana Ferrell Birchfield

1984 Growth Management

Curtis L. McCray

2001 Growth Management Revisited

Allan T. Geiger

1985 Visual Pollution

Doug Milne

2002 Making Jacksonville a Clean City

Brenna Durden

1985 Minority Business

Jack Gaillard

1986 Private Delivery of Public Services

George Fisher

2002 Beyond the Talk: Improving Race Relations

Bruce Barcelo & Brian Davis

2003 Neighborhoods at the Tipping Point

Randy Evans

1986 Mental Health and Drug Abuse

Inquiry Title

Inquiry Chair

Flo Nell Ozell

2003 Public Education Reform: Assessing Progress J.F. Bryan, IV

1987 Child Day-Care Services

George W. Corrick

2004 Town & Gown: Building Successful University-Community Collaborations

Audrey Moran

1987 Infrastructure

Joan Carver

1988 Local Election Process

Jim Rinaman

2004 Public Education Reform: Eliminating the Achievement Gap

Bill Mason

1988 School Dropout Prevention

Gene Parks

2005 River Dance: Putting the River in River City

Ted Pappa

1989 Reducing the Garbage Burden

Jack F. Milne & James L. White III

2006 Attracting and Retaining Talent: People and Jobs For the 21st Century

Adrienne Conrad

1989 Independent Living for the Elderly

Roseanne Hartwell

2007 Air Quality

A. Quinton White, Jr.

1990 Future Workforce Needs

Yank D. Coble, Jr.

2008 Infant Mortality

Howard Korman

1990 Philanthropy in Jacksonville

Juliette Mason

1991 Adequate Water Supply

Russell B. Newton, Jr.

2009 Our Money, Our City: Financing Jacksonville’s Future

J.F. Bryan, IV

1991 Positive Development of Jacksonville’s Children

2011 Recession Recovery … and Beyond

Elaine Brown

Henry H. “Tip” Graham

1992 Long-Term Financial Health of the City of Jacksonville

2012 Children: 1-2-3 Creating Early Learning Success

Jill Langford Dame

Mary Alice Phelan

2014 Unlocking the Pieces: Community Mental Health in Northeast Florida

Michelle Braun

Services for Children and Youth

A 2015 JCCI INQUIRY

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