Silver Linings

When George Moore took the podium in the state capitol’s House Chamber in October 2012, he could have seen before him a room full of old folks. It was, after all, a meeting of the Silver Haired Legislature, made up of seniors from across the state. What Moore saw, though, was a room full of experience. “Among the people sitting in that room, there were over 4,000 years of history,” he recalls. “That goes back past the pyramids. I told them, ‘If we can get ourselves organized right, we really should be of some value to the people of the state.’” A sage observation from a man who’s accumulated 78 years of history himself.

West Virginia, we’ve been hearing for a decade and more, is staring down a senior tsunami. More than 500,000 of us will turn 65 between 2011 and 2030—a quantity that, like a tsunami, is incomprehensible. The nation’s baby boomer retirement wave started rolling in in 2011 and, even as it engulfs our ankles, we are not prepared. “This is real,” says Phil Schenk, director of the West Virginia Partnership for Elder Living, of the rising level of need. “We can no longer keep our heads in the sand. We have to do something.”

But this tide also carries a gift that, in our dread, we risk overlooking: a larger population of seasoned humans than our society will enjoy again for many decades to come—veteran problem-solvers whose community and political engagement could be a grand moderating force. As the baby boomers begin retiring in earnest, a vast well of know-how will be freed up to volunteer, start new businesses, and mentor us all.

It says a lot about our society that many of our names for people 65 and better are disrespectful—geezers and biddies, dotards and fogys, fossils and old timers. For this story, we’ll mostly use “elders” for its resonance of life experience, wisdom, and gravitas.

How Big is This Wave?

The boomer wave—the slug of babies born in the exuberant post-World War II years of 1946 to 1964—is proportionally bigger in West Virginia than most anywhere. Have a look at West Virginia’s population charted by five-year age cohort. In 2010 West Virginia’s boomer wave bulges at ages 45 to 64—poised on the verge of retirement. By 2030 the bulge smooths out, according to March 2014 projections from West Virginia demographer Christiadi (he uses only one name).

That 2010 bulge represents 540,000 boomers. Right now, three years into their upward push into the retirement part of the pyramid, nearly 500 people are turning 65 in West Virginia each week. How much is that? It’s like whole towns the size of Ghent, Lashmeet, and Valley Bend marching into retirement. As the crest of the wave rolls through 10 years from now, it’ll be the populations of larger towns like Paw Paw, Junior, and Masontown. This, week after week after week for 20 years.

The charts give a visual sense of a key indicator, the “old age dependency ratio” or OADR: the number of people 65-plus relative to the number of people 20 to 64 helping them in their communities and paying taxes that finance senior services. A bottom-heavy chart represents few elders, at the narrow top, relying on many workers, in the wide lower part; a top-heavy chart has many elders relying on few workers. What are the numbers? In 2010 the state had 27 elders relying on every 100 working-age people—the U.S. had 22. By 2030 West Virginia’s OADR comes closer to 42; the U.S. projection is 37.

The Challenge

Three factors create a current and impending crisis, according to Schenk. His West Virginia Partnership for Elder Living (WVPEL) convenes groups from the various fields of aging to develop policy improvements.

First among the three factors—that booming population of elders. It’s the wave turning 65, but Schenk says there’s more to it than that—and this may answer that question rising in the back of your mind: Why aren’t we ready for this? “What snuck up on us was, ‘Ooh, we’re keeping all these people alive,’” he explains. “And this is nationwide. Several decades ago, it wasn’t that common to hear that someone’s parents were in their 80s or 90s. Now that’s more normal.” The unanticipated over-85 boom is especially dependent on services.

Second, the changing population of elders. “The folks at the senior centers tell you that the new 65-year-olds want travel activities, computers, and no bingo,” Schenk says. “Nursing homes are hiring chefs and setting up Wi-Fi routers.” The elaborate, decades-old network of agencies and organizations that helps elders in the deepest hollers in every county needs a serious update.

Third, an ill-timed stagnation in government funding for that elaborate network. Many of the senior service and care providers are county-level programs that receive federal and state dollars distributed by the state Bureau of Senior Services (BSS). They provide things like meals in homes and at senior centers, housekeeping, personal care, and transportation to doctors’ appointments and for grocery shopping, according to BSS Commissioner Robert Roswall—the difference for tens of thousands of elders between day-to-day life that’s enjoyable or overwhelming.

BSS’s budget peaked in fiscal 2013 at about $90 million a year, but dropped a bit since, according to Brandon Merritt, health policy analyst at the West Virginia Center on Budget and Policy (WVCBP)—just as boomers edge into their late 60s. More worrisome is the changing composition of BSS funding. “State lottery funds used to make up about 75 percent of the budget,” Merritt says. “Now it’s about 50 percent lottery funds, with a lot of the rest being made up from general revenue,” he says. “These are obviously tight budget times, and general revenue dollars are the ones everyone fights over.”

Consider another funding red flag. This goes back to that OADR. If our senior services relied most heavily on federal funding, the relevant dependency ratio would be the nation’s: 37 elders, in 2030, to 100 working-age people. But federal funds make up less than 20 percent of BSS’s budget. As BSS relies increasingly on state general revenue funding, derived mostly from personal income tax revenues, it’s the state dependency ratio that applies: 42, in 2030, to 100 working-age people. Worse, our labor force participation rate—the share of those working-age people who are working or looking for work—is dismal.

To recap: More old people, and more older-still people. A different kind of old people than our systems are set up to serve. And less, and less reliable, funding to serve them.

Unhealthy Statistics

Baby boomers don’t smoke as much their parents. But that’s about the extent of the good health news, says Dana King, chairman of WVU’s Department of Family Medicine. A nationwide study he and colleagues published in 2013 found boomers have more diabetes, more high blood pressure, more high cholesterol, more obesity, and twice as much disability as their parents. “In the study, 6.9 percent versus 3.3 percent (of the previous generation at the same age) use a walking-assistance device,” King says. “This is people 46 to 64 years of age at the time of the study—you just don’t think of that in that age group. It’s more than twice as much as the previous generation.” Disability is highest in West Virginia: About 18 percent of working-age people, boomers and younger, were disabled in 2012, compared with 10 percent nationally.

Elder finances are also pretty grim. Consider the U.S. Census Bureau’s “supplemental measure” of poverty, which takes into account rent or mortgage and regional costs of living and health care. Under the supplemental measure, 43 percent of elder West Virginians had incomes under 200 percent of the poverty threshold in 2009–11. That was $22,000 for a single senior and $27,000 for a couple, in 2011—modest at best for a homeowner, making ends meet if there’s still a mortgage to pay, according to a 2010 state-specific report from the Elder Economic Security Initiative. Due to our low cost of living and relatively affordable health care, that’s actually 12th lowest among states, with wealthier states faring far worse—Maryland, for example, at 48 percent, and California at 56 percent. Still, it’s 128,000 elder West Virginians already struggling financially, just as tight senior services funding is about to serve many more people.

It has to be noted that the state’s intractable workforce problems com-bine with poor health and poverty like quicksand under the feet of our current and future elders. Our lowest-in-the-nation labor force participation rate and educational attainment mean lower-paying jobs, less tax revenues supporting senior programs, and less worker income directed to Social Security and personal retirement savings. And the flight of our young people increases the OADR.

Suppose We Change Nothing

At this question, Schenk picks his way through an exploratory and unpleasant train of thought. “It’s hard to get data on what was happening to elders before Medicare,” he says. When Medicare was established in 1965, nearly half of elders had no health insurance at all; many more had inadequate coverage. “Families took care of elders a lot more than they can these days—adult children have moved away to get jobs and that kind of thing.” A lot of good work is done, he emphasizes, both by the network of care and services and by volunteers, including billions of dollars’ worth of family caregiving. But,  he says, “In the past, people didn’t get services they needed, and they died. People are dying now waiting to get on the Medicaid Aged and Disabled Waiver program”—the largest program providing home health services for frail elders, with a waiting list of 2,300 in April 2014. People are dying waiting for other services too, he says.

It boils down to this: Better and more accessible medical care are keeping people alive longer, but we haven’t planned the follow-through. “Perhaps that’s the ultimate question,” Schenk says. “Can we afford in this country and this state to keep a large population of people alive through their 90s?”

But the expense that implies is not lost on younger generations, and a recent spate of articles and books portends a backlash. Headlines rounded up in the April 2014 issue of AARP Bulletin included the phrase “parasitic baby boomers.” Bloomberg financial expert Neil Grossman, author of the 2013 e-book Generation W.T.F.: How millennials can stop the mushrooming costs of Social Security, Medicaid and Medicare, told a Forbes contributor millennials should “insist that seniors bear a far larger part of the actual cost of the benefits they receive.”

Solutions, Anyone?

BSS Commissioner Roswall is already thinking along those lines. People seek BSS services more regularly around age 75, he says. That gives a little time—the boomer wave won’t hit BSS hard until about 2020, when the 75–79 age group goes from 144,000 to 170,000 in five years. When it does, it’s going to find the bureau’s services tightly focused. “We haven’t set priorities yet, but I think they’re going to be more on individuals’ conditions, not first-come, first-serve—so if there’s a waiting list for meals, we’ll target the person with the greatest need, not the first one to sign up,” Roswall says. “We’re also going to be cost-sharing. If people have some ability to contribute, that helps us provide more services to more people.”

King at WVU says people can always make healthier choices. “You might ask,  ‘Is it too late at 60? At 65?’” he says. “Allow me to answer that question: It’s not too late. In fact, it’s hugely beneficial.” His 2007 study of nearly 16,000 baby boomers showed healthy choices make a difference at any age. “The ones who decided to follow the healthy habits of eating five fruits and vegetables a day, walking three or more times a week, stopping smoking, and maintaining a healthy weight were almost 40 percent less likely to have a heart attack or die in the next four years. It has an immediate effect,” he says.

“If West Virginians would just have a banana in the morning and an apple for afternoon snack, eat some vegetables at supper and walk for 20 minutes afterward, it would revolutionize the state—we would go from the 49th state in health to number one. And it would have a tremendous impact on the quality of life of elderly West Virginians.”

King urges medical students to consider geriatrics. “Ten years from now when you finish your training, you’ll be the most in demand.” Also on his wish list, a little state support that could go a long way. “Twenty-five of our 55 counties are short of primary care doctors right now—doctors’ offices are about to be bulging at the seams. But without a doctor to treat people for arthritis or high blood pressure or screen them for cancer, they put off care until a condition becomes more severe.” Just $1.5 million a year could create 15 additional family medicine residency slots in West Virginia, he says, raising from 45 to 60 the number of family physicians produced each year who could spot problems before they get serious.

What about a comprehensive policy solution? Past recommendations have brought achievements, including the recent creation of a state-level certification for direct-care workers who provide care in elders’ homes—West Virginia is only the 16th state to have a state-run registry, Schenk says. But he feels the scope and scale of what’s coming calls for something less piecemeal. “We have to look at the realities and decide how the system can be changed to meet the needs elders have today,” he says. The WVPEL is collaborating with AARP West Virginia on substantive recommendations for the 2015 legislative session.

Schenk also thinks money and policy won’t fix everything—society may just have to bend to the need: elders paying more of their own way and trading abilities with others, and greater reliance on volunteers. He finds hope in the village movement—“basically, moderate-income elders who get services they need for lower prices by doing it cooperatively.” Kanawha Valley Village People and Shepherdstown Area Independent Living are examples.

Addressing West Virginia’s workforce problems would also help. Higher educational attainment, higher labor force participation, and keeping and attracting younger workers would all ease the near-term and long-term challenges.

The Boomer Windfall

The challenges of the boomer retirement wave have been much studied, if little solved yet. But the windfall—an uncounted tens of thousands of people arriving in their later lives healthy and active, with perspective that can only be gained through experience—goes underappreciated. George Moore, a member of the previous generation, is just one example of the resource we might tap into, and he sees the Silver Haired Legislature (SHL) as a great way to tap into it.

Structured like the lawmaking Legislature it was created to augment, the SHL is made up of 34 senators and 100 delegates from across the state, with one big difference: many more years of life experience. Members are over 60. They’re also mostly native, women and men alike, and from all backgrounds—a truly representative body. They are elected every two years by their peers and held their 32nd annual session in October 2013 in Charleston.

A South Charleston resident who  retired from Walker Machinery 14 years ago and keeps five llamas, Moore was not politically active as a younger man. But he was so active in his first term on the SHL, in 2010–12, he was elected House speaker in 2012. He grounds his efforts in the two reasons the SHL was originally established: one, for seniors to learn about and become involved in government; the other, to identify problems of West Virginians—“not just seniors, but everybody,” he emphasizes—and provide reasonable, feasible solutions. The group generates position papers on issues its members agree to address.

The SHL’s role in shaping state policy has in the past been limited mostly to senior issues, although its positions on stricter penalties for driving under the influence, greater electioneering distance from polling places, and some other broad matters have had influence. But Moore has a higher vision for the SHL and has worked to apply its members’ perspectives to complex issues.

“In this country, we have an opt-in way of signing up to be an organ donor,” he says of an issue considered in the last session. “About 90 percent of people say they would be organ donors, but only a third have signed up—yet 120,000 people are waiting for organs and something like 18 a day die for lack of them. In Austria they changed to opt-out and more than 99 percent are donors. Why shouldn’t we change the law here? It just made sense to us.” On considering the prison overcrowding that caused the state in 2013 to dictate shorter sentences, the SHL saw a different solution. Legalize marijuana, the members said. Taxed at 6 percent, it would bring in an estimated $30 million a year—taxed like tobacco, significantly more. And eliminating the policing would save another $40 million a year. “If you legalize it, regulate it, and apply the money to rehab and that kind of thing, you begin to solve about three problems,” Moore says.

“It’s amazing to me that the Silver Haired Legislature embraced legalizing marijuana as one of its positions,” says House Speaker Tim Miley, Moore’s counterpart in the lawmaking Legislature. The state Legislature would likely not support it, he observes, noting that one might expect the older generation to be more conservative on that issue. “You know, when you’ve lived a long time, you’ve been exposed to a lot of different circumstances and with each one you realize that the sun came up the next day and the world kept turning,” he reflects. Miley believes the Legislature could benefit from a closer relationship with the SHL. “I think there is tremendous opportunity that we as a group are failing to take full advantage of.” It’s an observation we might apply to the state and its elder population as a whole.

Moore, at 78, is just getting started in his political career. While continuing to promote the SHL, he’s now its immediate past speaker—he was so energized by his experience that he resigned to throw his hat in the ring as a lawmaking delegate for the 36th District. “Primarily it’s to raise some questions where I’m not getting answers I’m happy with,” he says. “Maybe some of my ideas will rub off on some of the younger folks.”

Written by Pam Kasey

Photographed by Elizabeth Roth