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ITHACA, NY – In the coming years, the elderly and disabled in Tompkins County may find it increasingly difficult to find the care that they need.

Today, we ran a story about a 68-year old disabled Trumansburg woman who was left for nearly two months without the home care aide she says she needs to continue to live independently. Her situation may become increasingly common in the years to come.

Here, we sum up the issues facing the long term care system in an easily digestible format. Read on to learn more.

1 – The elder population continues to grow…

2 – … but the number of home care workers does not

3 – Training troubles limit opportunity, lead to poor care

4 – Tompkins-specific challenges

5 – Tompkins-specific advantages

Nurse and elderly man spending time together — Image by © Jose Luis Pelaez, Inc./Blend Images/Corbis
Nurse and elderly man spending time together — Image by © Jose Luis Pelaez, Inc./Blend Images/Corbis

1 – The elder population continues to grow…

According to the Tompkins County Office for the Aging (TCOFA) 2015 Strategic Plan, the population of individuals age 60 or more is growing rapidly relative to the younger generation. In 2000, the 60+ population in Tompkins was was roughly 12,000. Today, it’s over 16,000. By 2030, it’s expected to be close to 20,000.

This is largely attributed to the huge number of “baby boomers” who recently turned or will soon turn 60. The report notes that many people in this age group are still “actively employed, socially engaged, own their homes, drive themselves, and have relatively few long term care needs” but “This will change over time.”

Many in this age group do not self-identify as senior citizens, the report notes. “Many have very specific and individual ideals and they want to design their own experiences,” it reads. Remaining in their homes and in their communities is a priority for many older people in Tompkins, increasing the need for home care aides as opposed to assisted living facilities.

Even if this weren’t the case, Tompkins is lacking in affordable assisted living options. As such, those who are unable to secure a home care aide can find themselves stuck in unsafe, unsanitary living conditions.

2 – … but the number of home care workers does not

There is currently a shortage of home care aide workers in Tompkins and across the country. “As the demographics indicate that those age 25-44 are far fewer than those age 60+, there simply will not be enough young or middle aged adults to provide the support needed by older adults,” reads the TCOFA report.

Despite rapidly growing demand, there are a number of factors that limit the employment growth of the home care industry. At its most basic, the problem is the job just doesn’t pay enough. According to Lisa Holmes, Director for TCOFA, wages for home care aide work top out at around $10 an hour, often less, with no benefits. Hours can be limited and unpredictable.

Low-skill job opportunities at Cornell University that offer better compensation, benefits and consistency may also exacerbate the problem here in Tompkins County.

Holmes also notes that people in this line of work get little respect and have limited opportunities for growth. Combined with the low wages, this leads to an extremely high turnover rate. An estimated 25 to 50 percent of people in this career leave it annually.

There is also stigma that home care aides are a “low-skill” job. The Paraprofessional Healthcare Institute, or PHI, challenges that assumption in a report on how poverty-level wages limit growth in the sector: “Home care is physically punishing and mentally challenging. It requires emotional sensitivity, knowledge of body systems and chronic diseases, and important skills that are often learned on the job (current formal training requirements are inconsistent and largely inadequate).”

3 – Training troubles, lacking regulations lead to poor care

The agencies responsible for training home care aides struggle to keep up with the demand for training newcomers, according to Holmes. Training sessions are hard to organize because they require a certain number of interested applicants. Once started, training programs can take several weeks.

In addition to further limiting the hiring pool, difficulties in training sometimes lead to aides who are not only not qualified for the task, but could pose a physical, emotional, or even financial threat to their charges, an AARP report suggests. Many organizations do not test potential aides for drug use, and even fewer test to see if the applicant even has a basic understanding of caregiving.

A study on the prevalence of elder abuse in New York State says that elder abuse is a widespread yet under-reported issue. “Approximately 3.2 elder abuse cases are reported for every thousand individuals age 65+ in Tompkins County. Financial exploitation is self-disclosed at a rate of 42 per every thousand individuals age 65+ in Tompkins County.”

4 – Tompkins-specific challenges

Many of the issues presented above are widespread, but Tompkins County faces it’s own unique challenges. The ongoing housing crisis in Ithaca plays a role here. The TCOFA report states, “consistent themes in the survey included the need for affordable housing options located in the City of Ithaca, close to services and public transportation.”

The report also notes that nearly half of the people surveyed plan to move within 5 years, seeking to downsize and reduce maintenance costs. If the housing crisis persists, this may force more people into rural areas where home care needs are even more difficult to fulfill, or force them out of the county entirely.

The TCOFA report also points to transportation as an ongoing problem: “The lack of transportation, especially in rural areas, creates barriers to services and medical care and puts older adults at risk for social isolation which can result in declining health. Same-day transportation service, out of county transportation to regional medical centers, after hours and weekend transportation are all needed.”

Finally, there is also a lack of geriatricians in the county, which makes it difficult for those who rely on Medicare to find a new doctor.

5 – Tompkins-specific advantages

The TCOFA report provides some counterpoints to the all the gloom, offering a list of strengths specific to Tompkins County that may help in facing the oncoming crisis.

The report points to the county’s strong academic sector as one advantage. Both Ithaca College and Cornell have research programs focused on the aging, which offer training opportunities to help the aging prepare for their futures. In addition, “both institutions have an emphasis on community service, and opportunities for inter-generational programming abound. Several hundred students work with local organizations and actively volunteer with local older adults on an annual basis.”

The region’s strong focus on community activism and philanthropy is also a boon. Many volunteer opportunities offer ways for the older residents to remain an engaged parts of their communities. The county also has a relatively strong human services network that offers a number of useful services and wellness programs that help older residents maintain their health and independence.

Despite the housing and transportation challenges noted above, Tompkins has a relatively strong base in these areas, compared to similarly-sized counties. Services like Gadabout, TCAT and Ithaca Carshare and others provide solid options for those without their own transportation.

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Michael Smith

Michael Smith reports on politics and local news for the Ithaca Voice. He can be reached via email at msmith@ithacavoice.com, by cell at (607) 229-0885, or via Google Voice at (518) 650-3639.