1. Juneau Senior Housing and Services Market Demand Study
Funded by: City and Borough of Juneau, Alaska Mental Health Trust Authority and Senior Citizens
Support Services, Inc.
Prepared by: Agnew::Beck Consulting and Northern Economics, Inc. October 2014

2. Study Purpose
Forecast demand for senior housing and services in Juneau, with emphasis on assisted living for seniors
Educate the public about the resources available, what’s needed, and what the issues are
Why Now?
Assisted living, senior independent living, options for downsizing, supportive in-home services, skilled nursing, are inadequate today
Seniors (65+) as percentage of Juneau population will double by 2032
Very Elderly (85+) will quadruple by 2042
Good market data is required to attract capital
Consequences for inaction
Data reaching local agencies, thought leaders, local government and the business community more likely to result in inspired problem solving
Pioneer Home active waitlist 2+x available beds, the inactive waitlist is 33 x the number of beds. Limited senior housing options exists within Juneau’s high-cost, limited supply, housing market.
Seniors (65+) % of Juneau population will double to 20% by 2032 – increase of 3,400.
Very Elderly (85+) will quadruple by 2042 and continue to rise – increase of 1,100+ – from 285 today to 1,393. This age group is, nationally and in Juneau, the one most likely to need and most often uses assisted living.
Juneau is a small market, 100-unit development is typical for national organization projects. Larger projects are more economic (ED, Kitchen, purchasing but more difficult to fill). Putting a project together will require stakeholders to pull together and be creative.
Consequences if seniors leave – notwithstanding psychic and civic contributions of seniors on boards, local government, volunteering (how would we even vote?), local purchasing, charitable contributions, the impacts on certain economic sectors – such as healthcare could be serious -- impacts on physician retention, seniors support local pharmacy/physical therapy, hospital/health provider revenues

3. Study Methodology Research –
Department of Labor population numbers, governmental employment, retirement benefits/trends, seniors in the workforce, migration trends (PFD)
Key informants – 30 in-depth stakeholder interviews including social service agencies, state agencies, state and local commission on aging, DHSS long-term care and senior services personnel, operators of senior independent living and senior assisted living in Juneau and in other communities
Community workshop in July – 120 participants, half retirees (presentation, polling results posted to
Previous studies include 2010 Senior Survey, DHSS long-term care study, JEDC’s 2012 and 2010 housing needs assessment, etc.
Findings –
Current demand = usage + waitlists -- not really able to quantify those who moved away because they couldn’t be served or those who are still here not receiving services because they are not available or unmet need from existing providers. Data collection from agency annual/grant reports focuses on what agency did, not what they could not do because of lack of resources.
Current supply = housing usage. Services agencies provided good data for the subsidized services. Limited data available about private pay services being performed by individuals or businesses operating casually outside third-party payer system
Gaps – Clearly identified in the report == UNMET NEED
Trends – Population, health/Alzheimer’s age related dementia/memory issues.
Forecast & Recommendations
Hard numbers on assisted living
Broad order of magnitude on services

4. Senior Population Projections
Focusing on baby boom makes it seem as if the problem will be short lived – just one generation. Baby boomers born 1946 – 1964 – Those folks today, who are years old. -- Those born in appeared on the chart for the first time in The youngest boomers appear in An interesting fact – though Juneau’s median age of 37.9 in 2013 was about the same as the US according the US Census Quick Facts, Juneau has a significantly lower percentage of population over 65. Boom skews later in Juneau than other parts of US.
14.1% for the US
9.0% for Alaska
9.9% for Juneau – Juneau has higher percentage of year olds than Alaska or US (late baby boomers)
18.7 for Florida
13.6% for Washington
According to the State of Alaska DOL projection, on a percentage of total population basis, the percentage over 65 starts to decline after But, there will still be over 3,000 more seniors in Juneau in 2042 than there are in Juneau today.
The elderly segment is still rising at the end of the state’s population projections. In 2042, the youngest boomers will be 78. The oldest, if living, will be 96.
In 2012 Juneau had 279 residents over 85. By 2042, we’ll have almost 1,400. These are the super heavy users of assisted living, nursing homes and in-home supports.
According to the US Census projections for the next 45 years all of the age brackets below 65 decline as a percentage of the total and the over 65% segment will increase from just under 15% to almost 22% -- that almost doubles again. The biggest change overall will be folks over 100 – we’ll have almost 700,000 – an increase of 785%
Source: Alaska Department of Labor and Workforce Development, 2014

5. Juneau’s Senior Continuum of Care

6. Current Utilization
Total universe in this picture is Juneau seniors age 60 and over – 17.3 % of Juneau’s 2013 population – eligibility basis – the group is 7.1 % of total so, we’re still looking at about 10% of current population 65% or older the “seniors” – that’s the segment that will double by 2032.
Of those, the vast majority don’t use any services at all, but as seniors age, service use increases and becomes more intense.
The supply limitations occur all along the Continuum of Care with respect to housing. Stats include occupancy figures from May.
53 Assisted living for Seniors includes ALL the 48 beds at the Pioneer Home, the one senior in the one small private assisted living home and the 4 seniors on general relief in assisted living homes operated for the developmentally disabled. The Juneau Pioneer Home always has around 100 on the active wait list (people ready to move in within 30 days) and 1,573 on the inactive list. Getting into the Pioneer Home from the active wait list can take from 1 month to 3 years. This is because the wait lists are not triaged and your place in line is based on the date you sign onto the inactive list.
Skilled Nursing – Wildflower Court 57 bed fully occupied facility offers long-term care with nursing to developmentally disabled, elderly, traumatic brain injury residents. 50 beds occupied by seniors. 15 Juneau residents on waitlist – average length of stay is just over 4 years vs. 2 years nationally.
Juneau has no short term nursing or assisted living beds.
No palliative or hospice residential beds for people who come to Juneau
No respite beds for assisted living or people receiving skilled nursing at home
No rehabilitation facilities for folks transitioning out of the hospital
No flexible beds for stabilizing people who don’t need to be in the hospital but aren’t ready to go into a facility
Senior Independent housing includes:
Fireweed Place 67 Units – 72 tenants – 16 on waitlist. This is the only age-restricted property in Juneau with fair market rentals. But over ¼ are set aside for low-income seniors.
Smith Hall – 24 units – average waitlist is 35-45
Mountain View Apartments 62 units – 45 on waitlist
There is clearly an unmet need for senior apartments or condos – Housing in walking distance to services was identified as the 2nd biggest gap in continuum of housing and service options for seniors at the July public Workshop, behind assisted living. Folks are interested in mixed-age, aging in place facilities, with a flexible menu of services.
Meals, Rides and “Other” Senior Services
Southeast Alaska Independent Living, Inc., operates as the regional Aging and Disability Resource Center (ADRC). ADRCs connect seniors, people with disabilities, and caregivers with long-term services and supports in their area. They provide info and referrals, in-home safety and accessibility assessments and taxi voucher program. Served 239 seniors over 60 in 2013.
CCS operates Southeast Senior Services which runs the Senior Center downtown, provides congregate meals there and at the Douglas Methodist Church and operates meals on wheels. They offer door-to-door rides via the Care A Van. In the last year, SESS provided 446 seniors with meals and 573 seniors with rides – serving 652 seniors with meals and rides. SESS operates Bridge Adult Day, which served 21 seniors last year. SESS also provides case management, care coordination, in-home chore services and the Gatekeeper Program to identify and connect isolated seniors.
CCS also runs Hospice and Home Care of Juneau, deploying nurses and therapists to provide skilled care to end of life patients, and medical care to those recovering from surgery or major illnesses at home. During fiscal year 2012, HHCJ provided home health and hospice services to 191 patients in Juneau – 4,833 service units skilled nursing, home health aides, physical therapy, occupational therapy, speech and language therapy, and social worker visits to individual homes – these were not included to estimate demand for community based services – not all or narrowly focused on helping seniors with managing activities of daily living.
Personal Care Assistance Services – funded by grants (through agencies, such as SAIL or SESS), through Medicaid or by private pay. There are only a handful of private pay / freelance PCAs. There are 4 Medicaid eligible PCA providers. The three who focus on seniors are Priority Healthcare, Center for Community/Compass Home Care and Cornerstone Home Care. These organizations served 83 seniors last year. It’s not known how many private pay seniors use PCA services.

7. Housing/Service Utilization Increases with Age
Methodology – track service and housing utilization by age group. First focus was on entire population over 60 because that’s the age when eligibility starts for many programs. However, by focusing on the 75+ and 85+, we can take some subjectivity out of the forecast, and see more clearly what services and housing options are really being used, and can be expected to be required in the future.

8. Demand for Home + Community Based Services
[1] Units of senior services are the number of people that SAIL and SESS provide services to in Many individuals receive multiple services. As a result, this number does not reflect the total number of individuals served but is the number of service units provided.
[2] Does not include an estimate of the number of Hospice and Home Care of Juneau (HHCJ) service units required to meet the demand from a growing senior population. In fiscal year 2012, HHCJ provided 4,833 service units to 191 patients. Assuming the same ratio of service units to seniors, by 2032, the HHCJ program would need to provide almost twice the number of service units in Juneau.

9. Demand for Senior Assisted Living

10. Unmet Needs / Business Opportunities
Improved senior center
Private pay PCA services
Planning for growth in senior population
Senior independent housing
Assisted living with memory care
Short-term skilled nursing/assisted living beds for rehab, respite, transition, end of life
Improved senior center – – Senior center could also serve more as a place for information and referrals about services, housing, activities for seniors. Could provide exercise space, more programs, health checks, outings,
“Juneau’s burgeoning senior population is clearly going to need an all-day gathering place and service “node” as we head toward almost 7,000 seniors. Socialization is now identified as one of the most important factors in maintaining seniors’ health; it is simply unacceptable for Alaska’s capital city to continue without such a critical element in the continuum of care when many much smaller Alaskan communities provide a very active senior center with all-day programming.” MaryAnn VandeCamp
PCA – Agencies that accept Medicaid cannot charge less for private. There could be opportunity for an efficient, full service agency to provide a range of services to a number of affluent clients with screened, trained staff and offer more pay and benefits than and steadier employment than individual workers and seniors trying to find each other. These services could include meal prep, housekeeping, repairs, transportation, support with ADL’s, medication management, errands, companionship.
Planning for growth in senior population – modeling and planning for future staffing, funding, facility expansion for existing providers or new ones. One reviewer of the report felt boomer seniors were more likely to access services and demand they be high quality compared to older generations not as facile with research and knowledgeable about what exists elsewhere, coming trends and best practices. This needs to be a community focus and the organizations currently providing services need support and funding. Valley lunch program at St. Paul’s was cut due to lack of funding. Not sure how many used the service, but we do know more people live in the Valley
Senior independent housing –– more downsize options all along price continuum. Accessible design, one floor sf. Close to services, with options for meals, rides, welfare checks. Seniors want to age in place. If seniors have downsize options in Juneau, larger homes will become available for families and possibly smaller assisted living homes. Independent housing with some services – supported housing – less costly than assisted living, can keep seniors healthier longer.
Assisted living with memory care – 1,000 seniors with Alzheimer's by 2032 in Juneau based on projections for Alaska.
Short-term skilled nursing/assisted living beds for rehab, respite, transition, end of life

11. Recommendations for Juneau Assisted Living
Co-location of assisted living/independent housing to create aging in place community
Distribute report to potential investors
Identify/assess locations
Plan to meet demand in a variety of ways
Feasibility testing to refine near-term project
Anticipate public-private partnership will likely be required
Bring in more financial resources, advertise them to potential developers
Engage/involve tribal health system as partner
Plan for additional independent senior housing
Ensure home and community based services can keep pace with population growth
Support referral network Aging and Disability Resource Center/information sharing
Preferred option of workshop participants as well as 2010 JCOA survey. Aging in place less disruptive and upsetting to residents, allows graceful transition as greater levels of services needed. Larger facility could possibly incorporate some housing for PCA/CNA staff which could make it easier to fill jobs in tough wage range for Juneau. Senior center other senior services could co locate (ADRC) for better service and efficiency – One Executive Director, One kitchen, shared janitorial & maintenance…. Mix of assisted living, memory care, independent, supported housing for fair market and low-income would have to be determined.
4) Plan to meet demand in variety of ways. In addition to a larger campus facility (#1) options used successfully in other places include smaller assisted living homes and 5-10 bed facilities – repurposed larger homes. Flexible design – one concept at the workshop was onsite senior independent/assisted living combined with daycare for grandparents raising small children and caregivers.
Public-Private partnership – options include use of CBJ land, allocation of some portion of additional tax revenues/possible trade off for reduction in senior tax exemptions, incentives/grants to help operators acquire or convert or license assisted living homes, CDBG grant, establishing an enterprise board, like the airport and hospital to run the operation financed by municipal bonds. An outside operator could be brought in for a period of time while workforce training in management and administrative, nursing positions gained experience. Synergies with UAS’s nursing program and hospital.
Engaging tribal health system essential especially as Alaska Native residents tend to be less affluent, there are designated resources through SEARHC, THRHA operates Fireweed Place and CCTHIA has an Elderly Service Program to support aging tribal members. We learned at the July public workshop that Native residents do not feel included and want to be part of the design and planning process so their values, culture and contributions are included.
More independent housing.. More downsize, easy to maintain and operate. Rentals and condos or cottages within walking distance of services. Freeing up larger homes may enable smaller independent assisted living homes to be licensed. Indpendent housing with some services --- housekeeping, laundry, welfare checks, transportation, outings
Keeping pace – programs will need to expand with the growing senior population including programs that require physical space – adult day care for example. We’ll need more workforce housing for the PCA’s/CNAs, nurses, physical therapists, care coordinators. Entrepreneurs focused on this growing market will require business planning and coaching, financing and specialized training for licensing, medical billing, etc. Capital transit routes and frequency will likely need to increase as folks become less able/willing to drive. We can estimate that most existing services for seniors will double – how much funding, staff, space is needed for that?
ADRC is supported with state and federal grants – primary source for senor housing and service option referral. If AARP can start sending birthday cards to everyone when they’re still in their 50’s we should be able to find seniors and make sure they know where to access information. Listserves, service groups, churches and other organizations

12. Questions? Contacts? Margaret O’Neal 523-2326 JEDC moneal@jedc.org
Sioux Douglas
SCSSI
To be added to listserve
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