CHEYENNE, Wyo. — Wyoming is starting to show its age, betrayed by a few shocks of gray hair and silver-tinged temples.
But within a few years, it's projected that aging will be a fact of life in Wyoming.
The U.S. Census Bureau found that in 2010, 12 percent of Wyoming residents were 65 or older. By 2030, an estimated 32.2 percent of the state's population will be 60 years old or older, according to April Getchius, senior administrator of the Wyoming Department of Health's Aging Division.
If that holds true, Wyoming will be the fourth-oldest state in the country.
The projections trouble Getchius, and she wonders if Wyoming is ready for such a change. She questions whether the state will have enough geriatric specialists to treat the unique needs of senior citizens.
The increase in the senior population raises other questions, too, like whether there will be enough nursing home beds and home health care agencies.
The squeeze on resources could start sooner than 2030. By Jan. 1, 2013, state agencies could face 7 to 9 percent cuts in federal funding if the U.S. Congress can't agree on a budget, Getchius said.
"That would be huge for some of our centers," she said. Many of the 39 senior centers in Wyoming serve lunches to senior citizens. Any cuts would have a dramatic effect there.
Access to medical and mental health care and finding places to live could be big issues for older people, too.
Whether enough resources will be available is a special issue for the rural areas, she said.
Will enough nursing homes be available?
Steve Bahmer, executive director of the Quality Health Care Foundation of Wyoming, represents 28 nonprofit nursing homes and assisted living facilities in Wyoming. He said the increase will put pressure on existing resources.
"We've got quite a hill to climb to get ready," he said. "I would say that we aren't where we need to be yet."
He questions if there will be enough skilled nursing home beds in the state.
"The latest information I had is that there were more than 500 skilled nursing home beds available in Wyoming," Bahmer said. "If we're looking at a doubling of the population in the next 15 years or so, I'm not sure that will be sufficient capacity."
There is no shortage now. About 20 percent of beds statewide are available, he said.
The condition of the federal budget and possible state budget cuts raises questions about the long-term viability of nursing homes, he said.
In Wyoming, 65 to 70 percent of the nursing home patients are on Medicaid now. Nursing homes get reimbursed for Medicaid residents at about 84 cents on the dollar, he said.
"That means fundamentally that nursing homes aren't able to be paid at a rate that even covers the cost of Medicaid residents," Bahmer said.
"Even today in Wyoming, there are some nursing homes that are pretty fragile because it is difficult to keep the doors open when you lose 20 cents on the dollar."
The state and nation need to improve Medicaid reimbursement or change the long-term care model, he said.
Most people who enter nursing homes today have complex health conditions, he said. As a result, employees need more training to provide care, which increases costs, he added.
The state Legislature told the state Health Department to prepare a report about Medicaid options. The Legislature wants to find out what drives the cost of Medicaid and how best to control costs while providing high-quality care, Bahmer said.
The Legislature's Joint Labor, Health and Social Services Interim Committee will consider the Medicaid options study when it meets starting Wednesday in Lovell.
Joanne Mai, an AARP Wyoming spokeswoman, said Wyoming will experience a significant aging population as baby boomers get older. Many came to Wyoming in the 1980s to work in the oil and natural gas boom and remained when the bust occurred, she said.
Baby boomers do not want to go to nursing homes. They want to stay at home if possible, Mai said.
Bahmer said nursing home administrators have told him that aging baby boomers are different from other generations.
"They come into the nursing home environment with a heightened sense of expectations about what is available," he said.
There isn't a problem with those expectations, he said, but such services cost money.
The state needs to consider today how it will provide funding for future services for older residents, said Sarah Green, executive director of Aspen Wind Assisted Living and Memory Care Community and Sierra Hills Assisted Living Community.
It's important to take time now to better understand available resources and how an older person could use them, she said.
More geriatric care will be needed
The state is not ready for a major increase in older populations, said Christine McKibbin, director of the Wyoming Geriatric Education Center at the University of Wyoming.
Wyoming isn't alone. The Institute of Medicine of the National Academies found the United States is "woefully unprepared" for the challenges of the aging population, she said.
The Census Bureau expects the national population of those 65 years old and older to climb to 88.5 million by 2050 from 40.2 million in 2010.
Many seniors function at a very high level and are healthy, McKibbin said. For others, their needs can be fairly complex.
The Wyoming Geriatric Education Center recently surveyed health care providers in Wyoming. Of the 214 responses, a large percentage said at least 25 percent of their caseloads are 65 years old and older. But 80 percent of these health care workers lacked formal training in geriatrics.
The center provides education to health care professionals and those training for future care in geriatrics. It soon will help train professionals about Alzheimer's disease. The free training will be offered at workshops across the state and a webinar series this fall.
Wyoming also needs to recruit more geriatric specialists, McKibbin said.
Getting more of these specialists is difficult because of additional training costs and low pay relative to other disciplines. The specialty needs better reimbursement of care to help make it a more viable career choice, she said.
Is this a problem? Some say not really.
Dick O'Gara, a Cheyenne economist, said he agreed with the population projections. "But I don't view this as a potential crisis. I think the market forces will address the issues," he said.
"Home care now has become a major industry across the country," he said. "People understand that we do not want to be in a nursing home unless it's absolutely necessary. The (private) market is responding.
"I really see a very limited role for government in attacking this issue or issues," he said.
The population is aging because Wyoming's young people continue to leave for jobs elsewhere.
"We have not developed an economy in the state that keeps our graduates in the state," O'Gara said.
Wyoming needs industries that use its oil within the state, he said. The state needs to add value to oil, coal and natural gas supplies instead of just shipping them out.
Bahmer agreed with O'Gara that the private market can respond to try to meet the needs of the senior population.
It would be a challenge for a private company, Bahmer said, given the money Medicaid pays for services. "It doesn't pay enough to make it a viable business model."
Some local efforts already under way.
There are many efforts under way to prepare for the high number of older people, said Laurie Wright, director of hospice and palliative care at Cheyenne Regional Medical Center.
One idea is to set up medical homes for senior citizens, she said. A medical home coordinates a patient's care through one central spot instead of treating symptoms at the hospital emergency room.
This one-stop facility is important for older adults, she said. Getting all medications from one doctor reduces duplications if a patient went to more than one place for care.
CRMC has established a medical home with Cheyenne Health and Wellness Center. Several medical practices in Cheyenne also are moving toward the medical home concept.
Medical providers also need to beef up outpatient services for the elderly, she said.
She also heads a palliative care program to help the elderly manage their chronic pain.
CRMC is working to establish a future Program of All-Inclusive Care for the Elderly, or PACE, Wright said.
This total health program will be for people 55 years old and older. The Medicare and Medicaid program provides those who enroll with access to all their health care needs so they can remain at home. It offers an adult day center.
There are positive aspects to the future of older people in the state, AARP's Mai said. Today's aging baby boomers tend to be healthier than their parents' generation, she said. They are more optimistic and age better.
"It's not all doom and gloom," Mai said.
Information from: Wyoming Tribune Eagle, http://www.wyomingnews.com