1. Aging in Rural Missouri

2. @ma4voice

3. A Voice For Seniors ma4 provides a voice for seniors across Missouri We work everyday to speak for those who cannot There is a true need to keep our voice strong and to chart new directions The need will only grow

4. The Area Agencies on Aging Board= Director from Each AAA

5. A Committed Board – They Meet Monthly

6. Staff We are a lean operation - efficient Staff = The Executive Director

7. …..and the mouse in my pocket

8. So What Do We Do? MA4 is dedicated to providing service, information and advocacy to improve the lives of older Missourians.

9. The Challenge: Funding Trends

10. Missouri Funding Trend Chart 2008- 2015

11. Missouri’s Rural Counties 101 rural counties Population density over 150 people per square mile or Contains part of the central city of a census-defined Metropolitan Statistical Area (MSA) 14 urban counties Boone, Buchanan, Cass, Clay, Cole, Greene, Jackson, Jasper, Jefferson, Newton, Platte, St. Charles, St. Louis, and St. Louis City 37% of Missouri population 50% of Missouri seniors

12. Services to Rural Seniors Statewide No 37.4% 48547 Unk 2.9% 3,767 Yes 59.7% 77,556

13. Health Care in Rural Missouri 98 of 101 rural counties are primary medical care Health Professional Shortage Areas 98 of 101 rural counties are primary care mental Health Professional Shortage Areas with ratios of licensed psychiatrists of at least 20,000 to 1 99 counties are dental Health Professional Shortage Areas Five rural counties in 2014 have no dental licensees, and 11 counties have no hygienist licensees

14. Missouri Seniors – Overall Comparison In 2013 Missouri ranked 33 rd for the health of its seniors. In 2013 Missouri ranked 47 th for the percentage of seniors who saw a dentist in the last year. In 2009 45% of Missouri seniors lived alone. In 2009 over 1 in 5 Missouri seniors lived at or below 150% of the poverty line of $21,855 for a 2-person household.

15. Missouri’s Seniors (2011) Rural SeniorsUrban Seniors 66% Live with family members Some Differences: 11%20% Graduated from college 11%7% Have household income below poverty level $20,668$31,286 Average annual earnings 5.3%4.5% Receiving SNAP benefits

16. Chronic Disease Among Missouri’s Seniors Rural SeniorsUrban Seniors 54%56% High cholesterol (2011) 29%25% Obese (2011) 21%22% Diabetes (2011) 124113 Deaths per 10,000 population for diabetes (2012)

17. ER Usage/Mortality Among Missouri’s Seniors Rural SeniorsUrban Seniors 4.32.9 ER Visits per 1,000 population for diabetes (2012) 5.62.9 ER visits per 1,000 for cerebrovascular disease (stroke) (2012) 295287 Deaths per 10,000 from cerebrovascular disease (stroke) (2012) 7.56.6 ER visits per 1,000 for hypertension (2012) 5550 Deaths per 10,000 from hypertension (2012) 3525 ER visits per 1,000 for heart disease 3124 Deaths per 10,000 from heart disease

18. Mental/Neurological Health in Rural Missouri Rural SeniorsUrban Seniors 171161 Reports of senior abuse per 10,000 (2011) 17.114.7 Suicide rate per 100,000 for age 65+ (2001-2011) 25.810.3 Deaths per 100,000 from Alzheimer’s Disease

19. Health Care Access in Rural Missouri Rural CountiesUrban Counties 7690 Licensed hospitals 2.54.8 Hospital beds per 1,000 residents 2386 Licensed ambulatory surgical centers 4.613.1 Primary care physicians per 1,000 seniors 2,9691,503 Residents per licensed dentist

20. Health Care Costs in Rural Missouri Medicaid long-term care costs averaging $237 per 1,000 - 200% of costs for urban seniors Average Medicaid costs of $1,365 per senior – over 140% of the average for urban seniors 58,309 ER visits for dental complaints in 2012 at a cost of ~$17.5 million 82,000 ER visits for mental disorders in 2012

21. Profile of a Senior in Rural Missouri Has household income of $20,668 Lives in a medical, mental health, and dental care shortage area Is 2.5 times as likely to die of Alzheimer’s Disease as urban counterparts Is more likely to visit an ER for a chronic disease Is 50% more likely to visit an ER overall Is more likely to commit suicide or to be abused Generates twice the Medicaid long-term care costs Generates 40% more Medicaid costs overall

22. Older Americans Act It was for seniors like these----that the Older Americans Act was passed 50 years ago Established basic nutrition programs Created planning and service areas Created network of AAA’s

23. So What Can AAAs Do

24. Nutrition is Still Key…..But From 2008 to 2014, State funding for AAAs dropped 19%. The cost of home-delivered meals increased 51% from 2008 to 2014. Malnutrition is associated with chronic health conditions and the need for (and cost of) long-term care. A need for increased funding.

25. Specific Needs- Transportation Transportation Medical appointments Extensive trips to Dialysis clinics Difficult to find and get to some addresses Roads in very poor condition

26. Specific Needs – Health Care The availability of physicians and primary care The availability of Rehab facilities

27. Specific Needs - Housing Adequate housing Alternative housing Affordable housing Property tax How to pay for needed repairs and modifications

28. Specific Needs – In Home Assistance Access to meal delivery Not able to deliver daily Availability of in home care and long-term care

29. Specific Needs – Health Conditions Blindness and Visual impairment Alzheimer’s, dementia, mental health issues Depression Dental needs

30. Specific Needs - Financial Elderly poverty Cost of healthcare and medications Energy costs Social Security remaining intact Food costs Financial abuse

31. Solutions to Barriers Transportation Opportunities Access to Information Services - allows for the design of the least restrictive (and often less expensive) care plan Medicare Boot Camps – Benefits Counseling – ACA Navigator Services Access to on-line health information Mental Wellness Partnerships Health and Wellness programs Distance Dining – Frozen meal programs

32. Finding a New Road Additional Sources of Revenue