ALAMANCE An Overview of the COUNTY Aging Population & Individuals with Disabilities
Publication Date: June 2018
Alamance County
Letter from the Piedmont Triad Regional Council Area Agency on Aging Director ...... iii Introduction ...... 1 Health Care...... 2 Health Outcomes ...... 3 Chronic Disease ...... 4 Health Care Cost ...... 5 Medicare ...... 5 Health Care Facilities ...... 6 Long-Term Care Facilities ...... 8 Agencies Serving Older Adults and Individuals with Disabilities Directory ...... 10 Demographics of the Total Population ...... 12 Past and Present Total Population ...... 12 Projected Total Population ...... 12 Demographics of the Older Adult Population ...... 13 Past and Present Older Adult Population ...... 13 Projected Older Adult Population ...... 14 Working Adults ...... 15 Piedmont Triad Region Growth ...... 16 Population Density ...... 17 Household Types ...... 19 Race & Ethnicity ...... 20 Income ...... 22 Health Insurance ...... 23 Vehicle Access ...... 24 Language ...... 26 Nutrition and Food Insecurity ...... 27 Individuals with Disabilities ...... 27 Grandparent Caregivers ...... 28 Family Caregivers ...... 28 References ...... 29
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Alamance County
Figure 1: County Land Cover ...... 1 Figure 2: Total Population (1990-2016) ...... 12 Figure 3: Projected Total Population Change (2016-2037) ...... 13 Figure 4: Older Adult Population (1990-2016) ...... 13 Figure 5: Projected Older Adult Population Change (2016-2037) ...... 14 Figure 6: Population by Age Group (2000-2037) ...... 14 Figure 7: Ratio of Working Adults to Older Adults (1990-2035) ...... 15 Figure 8: Living Arrangements of the Population Age 65+ (2016) ...... 19 Figure 9: Income Benchmark Comparison ...... 22
Table 1: Population Overview (2016 & 2036) ...... 1 Table 2: Chronic Conditions of the Fee-for-service Population Ages 65+ (2015) ...... 4 Table 3: County Expenditure by Service Category for Clients 60+ (FY16-17) ...... 5 Table 4: Medicare Enrollment (2013-2017) ...... 5 Table 5: Health Care Professionals (2017) ...... 6 Table 6: Health Care Facilities Directory ...... 7 Table 7: Long-Term Care Facilities & Beds in Alamance County ...... 8 Table 8: Provider Agencies Directory ...... 11 Table 9: Total Population Change (1990-2016) ...... 12 Table 10: Older Adult Population Change (1990-2016)...... 14 Table 11: Percent Growth (2015-2035) ...... 16 Table 12: Older Adult Population in Rural Areas (2016) ...... 19 Table 13: Population by Race & Ethnicity (2016)...... 20 Table 14: 2016 Poverty Guidelines...... 22 Table 15: Health Insurance Coverage (2016) ...... 23 Table 16: Disability by Type (2016) ...... 27 Table 17: Grandparent Caregivers (2016) ...... 28
Map 1: 2018 NC Health Factors Map ...... 3 Map 2: 2018 NC Health Outcomes Map ...... 3 Map 3: Health Care Facilities ...... 7 Map 4: Long-Term Care Facilities ...... 9 Map 5: Provider Agencies ...... 10 Map 6: Population Density of Older Adults (60 Year and Older), 2016 by Block group ...... 17 Map 7: Density of Older Adults in Rural, Suburban and Urban Areas (2016) ...... 18 Map 8: Percent Minority of the Total Population by Block Group (2016) ...... 21 Map 9: Older Adult Population without Access to a Vehicle (2016) ...... 24 Map 10: Transit Routes in Alamance County (2017) ...... 25 Map 11: Older Adult Population: Speak a Language Other than English (2016) ...... 26
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Alamance County
Letter from the Piedmont Triad Regional Council Area Agency on Aging Director
Health Care, Behavioral Health, and Human Services have undergone tremendous change in recent years. The Affordable Care Act (ACA), Medicare Access and CHIP Reauthorization Act (MACRA), the imminent transition from traditional Medicaid to Managed Care, the expected change of the Community Care Network and transformation in NC Department of Health and Human Services personnel, policies, and processes has significantly impacted service delivery systems. The mergers and acquisitions ongoing in Piedmont healthcare, bring new energy and potential to the industry. Other changes in Community Based Organizations (CBO) and the new Veterans Administration medical facility in Kernersville are adding potential and capacity to the regional healthcare system. While these reorganizations will help position the healthcare industry to manage the demographic realities of aging, they alone are not enough to ensure the system’s sustainability going forward. In the face of revenue and funding pressure, our thinking about service delivery and program development must change. Leaders in the Aging industry have impressed upon the members of the Aging Network the need to adopt a new operating model. The imperatives of the present and challenges of the future demand we innovate and modernize how we do business. That does not mean we change the quality of service or downsize. It means that we focus our attention on the nexus between the social determinants of health and the health care delivery system. Not only does this make business sense, it is a moral imperative. The Aging industry, including the Administration for Community Living, the Administration on Aging, National Council on Aging, and the National Association of Area Agencies on Aging, among others, has signaled big changes in the Aging Network. These changes have been a necessary response to the realities of the Affordable Care Act, the Budget Control Act, the political landscape, and economic downturn of 2008. We recognize that we cannot continue with business as usual. We must adopt practices that incentivize financial responsibility and standardize the administration of a highly complex, and sometimes redundant service delivery system. Our primary concern must be and will remain that our delivery system provide beneficial health outcomes for as many people as possible. A streamlined approach will help us to coordinate a cohesive and comprehensive plan of programs and services across the region, develop new partnerships, provide person centered care, diversify sources of revenue, and remain relevant as leaders of Home & Community Based Services. Sincerely,
Blair Barton-Percival Area Agency on Aging, Director
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Alamance County
Introduction
The Area Agency on Aging, a division of the Piedmont Triad Regional Council, serves 12 counties in central North Carolina, including Alamance County. Covering 435 square miles, the County’s land area is 44% forest cover, 30% agriculture/pasture, and 17% developed [1].
Figure 1: County Land Cover
OtherOther 11%11%
DevelopedDeveloped ForestForest 18%18% CoverCover 42%42%
Agriculture/Agriculture/ PasturePasture The population in Alamance County and across North 30%30% Carolina is changing. In 2016, Alamance County’s population reached 159,054. The number of people in Alamance County under age 18 was about equal to the number of people age 60 years and older. Over the next two decades, the child population (under age 18) will only By 2036, 1 in 4 grow by 19.1% while the older adult population (age 60 Alamance County years and over) will increase by 57.6%. In 2036, the older adult population will reach 56,282 people and will residents will be outnumber the child population in Alamance County [2]. over age 60. Table 1: Population Overview (2016 & 2036) 2016 2036 Change Total Population 159,054 204,285 45,231 28.4% Children (Ages 0-17) 35,461 42,226 6,765 19.1% Adults (Ages 18-59) 87,882 105,777 17,895 20.4% Older Adults (Ages 60+) 35,711 56,282 20,571 57.6% Source: NC OSBM 2016 Population Estimates & 2036 Population Projections
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Alamance County
Health Care
As this age-related demographic shift occurs and as chronic disease and comorbidities become more prevalent, there will be a corresponding increase in the need and demand for chronic disease self-management, physical health, fiscal health and social supports to ensure a sound quality of life for residents in Alamance County. The growing aging population will challenge federal entitlement programs such as Social Security, Medicare and Medicaid, and will significantly increase the demand for Home and Community-Based Services (HCBS), like those offered by the Area Agency on Aging (AAA) and through its network. HCBS allow individuals to remain at home and make choices. They live with dignity and independence at a fraction of the cost of skilled nursing care or other institutional settings. Social determinants, such as housing, transportation, financial support and food security, can account for 80% of health outcomes [3]. The HCBS offered by the AAA influence social determinants of health, benefiting population health through community interventions and collaborative efforts. HCBS drive down the cost of healthcare by utilizing the lower cost of in-home and community-based programs [4]. Successful transitions from institutional facilities to these community based settings, communicating with primary care physicians and the coordination of care is key to success. Although there is a lot of attention and controversy on health care coverage in the national spotlight, the movement towards evolving the health care system from “volume to value” makes steady progress. Historically, under its “fee for service” payment system, Medicare paid for tests and procedures with minimal requirements for their quality or effectiveness. Under the recent bipartisan MACRA legislation (Medicare Access and CHIP Reauthorization Act), Centers for Medicare & Medicaid Services (CMS) is moving towards paying for improved health outcomes. In 2015, CMS set two goals in its push for greater value, and is on track to meet them. 1. 30% of all Medicare payments are tied to quality through alternative payment models by the end of 2016 (met) and 50% by the end of 2018 (on track to meet). 2. 85% of Medicare fee-for-service payments are tied to quality or value by the end of 2016 (met) and 90% by the end of 2018 (on track to meet). These goals will provide incentive for health care providers to partner with ready and capable Community Based Organizations in new ways. North Carolina has many innovative health systems that may, with the right approach, be productive partners for helping to improve the lives of older adults in a way that benefits health care providers, Community Based Organizations, and the citizens they both serve. Partnerships remain one of the best opportunities to improve the lives of our older citizens. Changes allowing Medicare Advantage plans to be reimbursed for HCBS is positive and beneficiaries will reap the benefits.
Centers for Medicare & Medical Services is moving towards paying for improved health outcomes.
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Alamance County
Health Outcomes
Every county in the United States is assessed annually to reveal how healthy residents are and how long they will live. Each county is given a Health Factors Rank, based on health behaviors, clinical care, social and economic factors, and the physical environment. Each county is also given a Health Outcomes Rank, based on length and quality of life. In the North Carolina 2018 County Health Rankings, Alamance County ranks 50th for health outcomes and 48th for health factors [5]. The higher ranking counties tend to be located in the urban areas around the Triangle, Charlotte and Asheville. Communities can use these rankings to help identify issues and opportunities for local health improvement, as well as to garner support for initiatives among government agencies, healthcare providers, community organizations, business leaders, policy makers and the public.
Map 1: 2018 NC Health Factors Map
Map 2: 2018 NC Health Outcomes Map
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Alamance County
Chronic Disease
Chronic diseases and conditions - such as heart disease, stroke, cancer, type 2 diabetes, obesity and arthritis – are among the most common, costly and preventable of all health problems. Across the nation, about 32% of the population have multiple chronic conditions, and 86% of all health care expenditures are for people with chronic and mental health conditions. Table 2 shows the prevalence of certain chronic conditions for the older adult population, ages 65 years and older, that are Medicare beneficiaries. [6]
Table 2: Chronic Conditions of the Fee-for-service Population Ages 65+ (2015)
62% 49% 29% High Blood High Heart Pressure Cholesterol Disease (Hypertension) (Hyperlipidemia)
28% 27% 21% Arthritis Diabetes Chronic Kidney Disease
13% 11% 10% COPD Alzheimer’s Cancer Disease or Dementia
Source: CMS Chronic Conditions Prevalence
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Alamance County
Health Care Cost
Skilled nursing care, paid by Medicaid, is the most costly service utilized by older adults (ages 60 years and over) each year. In fiscal year 2016-17, skilled nursing care represented 42% of the County’s total older adult expenditures and had the highest cost per client ($22,408 per client). The County spends much less on Adult Care Homes/Assisted Living Facilities and Home Health/In-Home Care, and these services have a much lower expenditure per client (see Table 3) [7]. Skilled nursing care is an important component on the continuum of long term care. Without exception, every senior asked stated they want to remain in their home for as long as possible and receive formal services in their home or the community if that will allow them to remain independent. The Medicaid Waiver Program, Community Alternatives Program for Disabled Adults (CAP DA), reports that an individual who is nursing home eligible can remain at home for approximately two-thirds of the cost of an institutional setting. As healthcare costs continue to rise and Merit and Incentive payment models are implemented, HCBS grow in importance as a delivery model which saves money, provides greater customer satisfaction and creates more jobs in the local economy.
Table 3: County Expenditure by Service Category for Clients 60+ (FY16-17) Service Category Clients Expenditure Exp. by Client % of Exp. Adult Care Homes/Assisted Livings 1,112 $3,310,321 $2,977 4.6% Economic Support (indirect financial support) 15,677 $22,790,384 $1,454 31.7% Hospitals, Physicians, and Other Health Care 10,380 $7,346,355 $708 10.2% Home Health and In-Home Care 2,136 $6,779,582 $3,174 9.4% Institutional Care (Skilled Nursing Care) 1,361 $30,497,709 $22,408 42.4% Social Support (outside home) 861 $1,207,618 $1,403 1.7% TOTAL 31,527 $71,931,969 $2,282 Source: NCDHHS, County Expenditure Reports, 2017
Medicare
The number of Medicare beneficiaries with Hospital/Medical Coverage increased almost 11% between 2013 and 2017. Medicare beneficiary participation in Medicare Advantage Plans is increasing at a faster rate than enrollment in Original Medicare. The number of Medicare beneficiaries with Prescription Drug Coverage increased at a slightly higher rate (15.0%) during the same time frame. [8]
Table 4: Medicare Enrollment (2013-2017) Medicare Enrollment 2013 2017 Change Percent Change Hospital/Medical 29,040 32,124 3,084 10.6% Original Medicare (fee-for-service) 16,368 14,846 -1,522 -9.3% Medicare Advantage and Other Health Plans 12,672 17,278 4,606 36.3% Prescription Drug 22,279 25,613 3,334 15.0% Prescription Drug Plans (stand-alone) 11,258 9,837 -1,421 -12.6% Medicare Advantage Prescription Drug Plans 11,021 15,776 4,755 43.1% Source: CMS Medicare Enrollment Dashboard
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Alamance County
Health Care Facilities
Table 5: Health Care Professionals (2017)
Alamance NC The County’s health care needs are Count Rate Rate served in part by Alamance Regional Physicians 279 17.3 23.8 Medical Center (ARMC), located in Primary Care Physicians 111 6.9 7.0 Burlington, and several urgent care Family Practice 49 3.0 2.6 centers (see Map 3). ARMC, a 238-bed Internal Medicine 24 1.5 1.9 community hospital, is a part of the Cone Health network. The hospital had Obstetrics/Gynecology 9 0.6 1.1 11,930 discharges and 68,151 Pediatric 31 1.9 1.5 emergency room visits in fiscal year Geriatric 1 0.1 0.2 2016 [9]. In 2017, Alamance County Dentists had 279 physicians with a rate of 17.0 Dentists 63 3.9 5.0 per 10,000 population compared to a Dental Hygienists 115 7.1 6.0 rate of 23.8 across the state [10]. Nurses Registered Nurses 1,156 71.8 100.7 Nurse Practitioners 51 3.2 6.5 Certified Midwives 9 0.6 0.3 Licensed Practical Nurses 166 10.3 17.9 Other Health Care Professionals Chiropractors 23 1.4 1.7 Occupational Therapists 40 2.5 3.4 Occupational Therapy Assistants 18 1.1 1.7 Optometrists 16 1.0 1.1 Pharmacists 135 8.5 11.4 Physical Therapists 97 6.1 6.3 Physical Therapy Assistants 26 1.6 2.9
Physician Assistants 50 3.1 5.9 Podiatrists 3 0.2 0.3 Practicing Psychologists 11 0.7 2.2 Psychological Associates 2 0.1 0.8
Respiratory Therapists 25 1.6 4.2 Source: NC Health Professions Data System
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Alamance County
Map 3: Health Care Facilities
Table 6: Health Care Facilities Directory
Map ID Name Address City ZIP Phone Alamance Regional H 1240 Huffman Mill Rd Burlington 27215 (336) 538-7000 Medical Center 1 FastMed Urgent Care 104 Huffman Mill Rd Burlington 27215 (336) 506-1720 2 NextCare Urgent Care 1713 S Church St Burlington 27215 (888) 381-4858 3 Graham Urgent Care 217 E Elm St Graham 27253 (336) 228-9671 4 MedCenter Mebane 3940 Arrowhead Blvd Mebane 27302 (919) 568-7300 Source: PTRC AAA
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Alamance County
Long-Term Care Facilities
Long-Term Care facilities provide up to 24 hour care for individuals who are unable to live safely by themselves. There are various types of facilities, including Skilled Nursing Facilities (SNF), Adult Care Homes and Family Care Homes. Each differs in size and services provided. Nursing facilities must be licensed in accordance with North Carolina state law by the North Carolina Division of Health Service Regulation. In addition, nursing facilities that wish to receive Medicare and Medicaid reimbursement must be certified in accordance with federal law. Nursing facilities that are Medicare and Medicaid certified receive annual licensure inspections by the Division of Health Service Regulation. The Regional Long Term Care Ombudsman program at the AAA works with all facilities across the region and is responsible for approximately 18,000 long term care beds. The program has developed deep relationships with every facility in the region and provides trainings and education to help them meet the needs of their population. Adult Care Homes and Family Care Homes provide care for persons age 18 and older who do not need nursing home care, but are no longer able to remain in their own home because they need help in meeting daily needs such as meal preparation and housekeeping. These facilities care for people who only need occasional and incidental medical services. Room and board, personal assistance, supervision of medications, and social activities are provided. The private cost rates vary from facility to facility and supplemental assistance may be available to cover the cost for those with limited incomes. These are commonly referred to as Assisted Living
Facilities.
Table 7: Long-Term Care Facilities & Beds in Alamance County
Total # of Total # of Facilities Beds Adult Care Homes 18 666 Family Care Homes 42 210 Skilled Nursing Facilities 8 932 TOTAL 68 1,808
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Alamance County
Source: PTRC AAA
Map 4: Long-Term Care Facilities
Source: PTRC AAA
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Alamance County
Agencies Serving Older Adults and Individuals with Disabilities Directory
Map 5: Provider Agencies
Source: PTRC AAA
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Alamance County
Table 8: Provider Agencies Directory
Map NAME ADDRESS CITY ZIP PHONE ID
1 Alamance Eldercare, Inc. 3019 South Church Street Burlington 27215 336-538-8080
2 HomeCare Providers 3025 South Church Street Burlington 27215 336-538-8557 3 John Robert Kernodle 1535 South Mebane Burlington 27215 336-222-5135
Senior Center Street 4 Alamance County Meals 411 West 5th Street Burlington 27215 336-228-8815
On Wheels 5 Piedmont Health 1214 Vaughn Road Burlington 27217 336-532-0000
SeniorCare (PACE) 6 Alamance Cooperative 209 N Graham Hopedale Burlington 27217 336-570-6740
Extension Road, Suite C 7 Alamance County 1206 Vaugh Rd D Burlington 27217 336-229-7031 Community Services
Agency
8 Alamance County D.S.S. 319 N Graham-Hopedale Burlington 27217 336-570-6532 Street, Suite C 9 Alamance County Health 319 N Graham-Hopedale Burlington 27217 336-513-5514
Department Street 10 Alamance County 1946C Martin Street Burlington 27217 336-222-0565
Transportation Authority 11 Friendship Adult Day 1946B Martin Street Burlington 27217 336-222-9966
Services 12 Alamance County 217 College Street, Ste D Graham 27253 336-570-6763
Veterans Service Office Source: PTRC AAA
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Alamance County
Demographics of the Total Population
Past and Present Total Population
In 2016, the County had a total population of 159,054 [2]. Between 1990 and 2016 the County added just over 50,000 residents. Alamance County saw higher percent changes in total population than the Piedmont Triad on average, but lower than the state.
Figure 2: Total Population (1990-2016)
160,000
150,000
140,000
130,000
120,000 Total Population Total 110,000
100,000 1990 1995 2000 2005 2010 2016 Alamance: 108,213 118,066 130,800 138,281 151,131 159,054
Source: NC OSBM, US Census Bureau
Table 9: Total Population Change (1990-2016)
Alamance County Piedmont Triad North Carolina Change % % % 1990-1995 9,853 9.1% 8.8% 10.8% 1995-2000 12,734 10.8% 8.4% 9.6% 2000-2005 7,481 5.7% 4.7% 7.9% 2005-2010 12,850 9.3% 7.0% 9.8% 2010-2016 7,923 5.2% 3.7% 6.5% Source: NC OSBM, US Census Bureau Projected Total Population
Between 2016 and 2037, Alamance County is projected to add 47,525 residents (over 10,000 new residents every 5 years) to grow to a population of 206,579 people in 2037 – almost a 30% increase. This rate of change is higher than the Piedmont Triad as a whole (15.4%) and the state (23.6%). The annual rate of change for the total population in Alamance County is expected to remain around 1.25% between 2016 and 2037, which is similar to the annual growth rate in previous years – 1.23% between 2000 and 2016. [2]
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Alamance County
Figure 3: Projected Total Population Change (2016-2037)
35% 29.9% 30% 25% 23.6% 20% 15.4% 15% 10% 5% 0% Alamance: Piedmont Triad North Carolina
Source: NC OSBM
Demographics of the Older Adult Population
Past and Present Older Adult Population
In 2016, the older adult population (60 years of age and older) reached 35,711 people in Alamance County. Beginning in 2000, the percent change of the older adult population has been higher than that of the total population. Between 2005 and 2010, the older adult population grew 18.3%, double the rate of the total population. Between 2010 and 2016 the older adult population grew 16.6%, triple that of the total population, which only grew 5.2% during this time period [2].
Figure 4: Older Adult Population (1990-2016)
Source: NC OSBM, US Census Bureau
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Alamance County
Table 10: Older Adult Population Change (1990-2016)
Alamance County Piedmont Triad North Carolina Change % % % 1990-1995 978 4.5% 7.2% 8.7% 1995-2000 1,205 5.3% 7.2% 8.6% 2000-2005 2,101 8.8% 10.1% 13.1% 2005-2010 4,747 18.3% 17.9% 21.2% 2010-2016 5,092 16.6% 17.5% 22.4% Source: NC OSBM, US Census Bureau Projected Older Adult Population
Over the next 20 years, Alamance County is projected to grow by 47,525 total residents, of which 44% (or 21,094 residents) will be age 60 years or over. By 2037, the older adult population will reach an estimated 56,805 people. The older adult population will continue to grow at a rate double that of the total population. Between 2016 and 2037 the older adult population will grow by 59.1% while the total population will only grow by 29.9%.
Figure 5: Projected Older Adult Population Change (2016-2037) 80% 59.1% 60% 53.3% 39.7% 40% 20% 0% Alamance: Piedmont Triad North Carolina
Source: NC OSBM In 2016, the older adult population (60 years of age and older) represented 22% of the County’s total population. This percentage has risen from 18% in 2000, and is projected to rise to 27% by year 2037. In 2037, Alamance County will have an estimated older adult population of 56,805. [2]
Figure 6: Population by Age Group (2000-2037) 100% 18% 20% 22% 80% 27% 60% 58% 56% 55% 52% 40% 20% 24% 23% 22% 21% 0% 2000 2010 2016 2037
Children (Age 0-17) Adults (Age 18-59) Older Adults (Age 60+)
Source: NC OSBM
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Alamance County
Working Adults
Pressure will increase on the agencies providing care for the aging population of Alamance County. One factor of this pressure is the relative decline in the ratio of working age people (ages 18 to 64) compared to the number of retirement age adults (ages 65 years and older). Figure 7 below illustrates the ratio and numbers of working age and retirement age adults from 1990 to 2015, along with the projected figures to 2035 (separated by the brown dashed line). In 2005, there were 4.41 working adults for every retirement-age adult. In 2015 that ratio dropped to 3.79, and will continue to drastically drop to 2.65 by year 2035. [2]
Figure 7: Ratio of Working Adults to Older Adults (1990-2035)
160,000 4.50
140,000 4.00
120,000 43,880 3.50
39,736
34,715
29,648 25,458
100,000 22,081 3.00
19,383 18,464
Population 80,000 2.50 16,065
60,000 2.00
116,371
68,473 81,182 85,524 93,607 96,399 101,926 107,132 111,595 40,000 1.50
1990 2000 2005 2010 2015 2020 2025 2030 2035 Adults Older to Adults ofWorking Ratio Working Adults (Ages 18-64) Older Adults (Ages 65+) Ratio of Working Adults to Older Adults
Source: NC OSBM, US Census Bureau
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Alamance County
Piedmont Triad Region Growth
Alamance County will experience a 28.5% growth in the total population between 2015 and 2035 – this is the fastest growth rate for any county in the region. The older adult population in Alamance County will grow by 60.5% in this same time frame – again, the fastest growth rate for any county in the region and more than double the rate of the total population. [2]
Table 11: Percent Growth (2015-2035)
Older Adults (Age 60+) Total Population County: Percent Growth Rank Percent Growth Rank Alamance 60.5% 1 28.5% 1 Davie 56.1% 2 24.8% 2 Guilford 47.8% 3 14.5% 4 Forsyth 45.9% 4 21.1% 3 Randolph 44.3% 5 13.5% 5 Davidson 40.6% 6 12.1% 6 Stokes 31.8% 7 -0.4% 12 Yadkin 24.4% 8 0.3% 9 Montgomery 23.5% 9 6.3% 7 Caswell 19.7% 10 0.3% 8 Rockingham 19.3% 11 -0.4% 11 Surry 18.5% 12 -0.3% 10
Piedmont Triad 42.5% 14.6% North Carolina 55.4% 22.7% Source: NC OSBM
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Alamance County
Population Density
In 2016, older adults (ages 60 years and over) accounted for 22% of the total population in Alamance County. Map 6 below displays the population density of these older adults by block group based on the 2016 American Community Survey. Density is highest in the Twin Lakes Community in the Town of Elon and near downtown Burlington.
Map 6: Population Density of Older Adults (60 Year and Older), 2016 by Block group
Source: US Census Bureau, ACS 2012-2016, TIGER/Line Block Groups
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Alamance County
Rural Population Alamance County has an overall population density of 363 people per square mile. The NC Rural Center defines rural as an area with an average population density of 250 people per square mile or less. The NC Rural Center defines Alamance County as a suburban county, with an average population density between 250 and 750 people per square mile. Map 7 below identifies rural, suburban and urban census block groups in the County, overlaid with the older adult population density. The majority of the older adult population lives in the County’s urban areas, but 24% of the County’s older adult population resides in rural areas.
Map 7: Density of Older Adults in Rural, Suburban and Urban Areas (2016)
Source: US Census Bureau, ACS 2012-2016, TIGER/Line Block Groups
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Alamance County
Table 12: Older Adult Population in Rural Areas (2016)
Total Population Population of Older Adults Percent of Older Adults County of Older Adults (60+) in Rural Census (60+) in Rural Census (60+) Block Groups Block Groups Alamance 34,354 8,201 23.9% Caswell 6,077 5,489 90.3% Davidson 37,140 11,217 30.2% Davie 10,738 6,618 61.6% Forsyth 73,893 4,543 6.1% Guilford 99,073 11,174 11.3% Montgomery 6,936 6,929 99.9% Randolph 32,276 14,328 44.4% Rockingham 23,447 13,402 57.2% Stokes 12,133 8,831 72.8% Surry 18,525 10,474 56.5% Yadkin 9,486 7,889 83.2% Piedmont Triad 364,078 109,095 30.0% Source: US Census Bureau, ACS 2012-2016, TIGER/Line Block Groups
Household Types
In Alamance County, just under two- Figure 8: Living Arrangements of the Population Age 65+ (2016) thirds of the older adult population (age 65 years and over) live in family Group Non-family households. Nearly one-third of these Quarters 607 975 older adults live alone. The majority 3% 4% of these adults living alone are women. In the County, 5,689 older adult women live alone, 22.7% of the entire older adult population. A small Living percentage (3%) live in non-family Alone households and 4% live in group 7,849 Family quarters. Group quarters include such 31% 15,611 places as residential treatment centers, 62% skilled nursing facilities, group homes and correctional facilities. [11]
Source: US Census Bureau, ACS 2012-2016, Table B09020
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Alamance County
Race & Ethnicity
Table 13 below breaks down the racial and ethnic categories for the older adult population (age 65 years and over) compared to that of the total population in the County. 74% of the older adult population is white, compared to 71% of the total County population. Only 2.2% of the older adult population is Hispanic, compared to 12.1% of the total County population [11]. Higher percentages of minorities live in and around Burlington, as seen in Map 8. The Centers for Disease Control and Prevention (CDC) reports that minorities experience a disproportionate burden of preventable disease, death and disability compared to non-minorities [12].
Table 13: Population by Race & Ethnicity (2016)
Population 65+ Total Population Total 25,042 156,372 By Race: White 18,495 73.9% 110,548 70.7% Black or African American 3,516 14.0% 29,039 18.6% American Indian and Alaska Native 71 0.3% 621 0.4% Asian 77 0.3% 2,214 1.4% Native Hawaiian and Other Pacific Islander 0 0.0% 282 0.2% Some Other Race 345 1.4% 9,386 6.0% Two or More Races 85 0.3% 4,282 2.7% By Ethnicity: Hispanic or Latino 547 2.2% 18,879 12.1% Not Hispanic or Latino 24,495 97.8% 137,493 87.9% Source: US Census Bureau, ACS 2012-2016, Table B02001
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Alamance County
Map 8: Percent Minority of the Total Population by Block Group (2016)
Source: US Census Bureau, ACS 2012-2016, TIGER/Line Block Groups
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Alamance County
Income
The average earnings income for the older adult population (60 years of age and over) in Alamance County is $53,102, compared to the average of $60,011 for the total population. The older adult population also receives income from sources other than wage earnings, such as Social Security and retirement income. 81.2% of older adult households receive Social Security income with an average income of $18,635; while 41.5% of older adult households receive retirement income with an average income of $21,389. Only 10.5% of the older adults (60 years of age and over) live below the poverty level, compared to 18.5% of the County’s total population. Rising health care costs impact budgets of older adults, resulting in the inability to pay for necessities such as housing, utilities and food. [11]
Figure 9: Income Benchmark Comparison
$70,000 $60,011 $60,000 $53,102 $50,000
$40,000
$30,000 2016 Poverty $21,389 $18,635 Threshold $20,000 $9,888 $11,880 $10,000 $2,371 $0 Mean Earnings Mean Earnings Mean Retirement Mean Social Mean Mean Cash Public (Total Population) (60+) Income (60+) Security Income Supplemental Assistance Income (60+) Security Income (60+) (60+)
Source: US Census Bureau, ACS 2012-2016, Table S0102
Table 14: 2016 Poverty Guidelines
Persons in 2016 Poverty Family/Household Guidelines 1 $11,880 2 $16,020 3 $20,160 4 $24,300 For families/households with more than 4 persons, add $4,160 for each individual person. Source: US Department of Health & Human Services
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Health Insurance
Most older adults (ages 65 years and over) in Alamance County and across the state have some type of health insurance coverage. Only 0.7% of the older adults in the County are not covered, compared to 14.2% of the County’s total population. The majority of these older adults have either Medicare only coverage or Medicare combined with employer-based or direct purchase insurance [11]. As a result, seniors impact the cost of public and private healthcare disproportionately than the non-senior population. The most effective way to positively impact public and private healthcare outcomes with seniors is by addressing their social determinants of health and assuring that they are safe in their homes with access to home-based community services.
Table 15: Health Insurance Coverage (2016)
Alamance County Region State Older Adult Population (65+) 24,172 - - - Employer-based only 376 1.6% 1.6% 1.4% Direct purchase only 83 0.3% 0.3% 0.3% Medicare only 6,919 28.6% 30.4% 26.5% TRICARE/Military/VA only 0 0.0% 0.1% 0.1% Employer-based & Direct purchase 42 0.2% 0.1% 0.1% Employer-based & Medicare 4,400 18.2% 16.9% 17.9% Direct purchase & Medicare 5,797 24.0% 22.6% 21.4% Medicare/Medicaid public only 1,409 5.8% 6.3% 7.0% Other 4,982 20.6% 21.3% 24.8% No health insurance coverage 164 0.7% 0.5% 0.5% Total Population no health insurance coverage - 14.2% 13.3% 13.2% Source: US Census Bureau, ACS 2012-2016, Table B27010
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Alamance County
Vehicle Access
In Alamance County, an estimated 1,267 households with an individual 65 years of age and over do not have access to a vehicle – 7.8% of these older adult households. This statistic is higher than that for the total households in the County, where 5.5% of all households do not have access to a vehicle [11]. Transportation is delivered through the AAA Network to support seniors. This is an important social determinant of health which can be positively impacted through coordination with Community Based Organizations (CBO) and healthcare systems.
Map 9: Older Adult Population without Access to a Vehicle (2016)
Source: US Census Bureau, ACS 2012-2016, TIGER/Line Block Groups
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Transit Options The Alamance County Transportation Authority (ACTA) serves the elderly, disabled and general public through on demand service throughout the County. Link Transit also serves Burlington, Gibsonville and Alamance Community College with five bus routes operating daily Monday through Friday. The Elon University Biobus provides services not only to University students but to the general public in Elon and Burlington. Alamance County citizens are also served by the Piedmont Authority for Regional Transportation (PART) Route 4, which travels along I- 40/85 in Alamance County from downtown Greensboro to Chapel Hill stopping in Burlington, Graham, Alamance Community College and Mebane.
Map 10: Transit Routes in Alamance County (2017)
Source: PTRC
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Alamance County
Language
English is the most common language spoken in Alamance County. An estimated 4.0% of older adults (60 years of age and over) speak a language other than English. Only 1.9% of the older adult population speaks English less than very well. Of the total County population, 12.6% speak a language other than English and 5.6% speak English less than very well [11].
Map 11: Older Adult Population: Speak a Language Other than English (2016)
Source: US Census Bureau, ACS 2012-2016, TIGER/Line Block Groups
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Nutrition and Food Insecurity
In a study released in 2015, AARP published national rankings for food insecurity. North Carolina ranked 11th for the number of individuals age 60 years and over who experience food insecurity, at a rate of 17.5%. Food insecurity is indicated by experiencing a moderate degree of not having enough to eat; often prioritizing payment for rent, medical care, prescriptions or utility bills from the money they would normally use for food. Individuals experiencing food insecurity often go without food in order to meet these other vital living expenses [13]. According to Feeding America, in 2016 Alamance County had 22,930 individuals experiencing food insecurity (14.7% of the total population). The average cost of a meal in Alamance County is $2.96, higher than the statewide average of $2.88. 82% of the individuals experiencing food insecurity are income-eligible for federal anti-hunger programs, the other 18% are dependent on charitable food assistance [14]. Malnutrition within the senior population places them at higher risk of hospitalization and institutionalization. Planning and integrating healthcare with community based services can address this issue with certain benefits of a healthier senior.
14.7% of Alamance County’s population is food insecure.
Individuals with Disabilities
In Alamance County, 9,073 older adults (age 65 years and older) have a disability, representing 37.5% of the older adult population. Only 12.2% of the adult population (ages 18 to 64) and 5.4% of the child population (under age 18) have a disability. Table 16 below illustrates the type of disability for each age group. A person may have more than one type of disability. The American Community Survey (ACS) defines a cognitive disability as a physical mental or emotional condition that causes a person to have serious difficulty concentrating, remembering or making decisions [11].
Table 16: Disability by Type (2016)
Population Population Ages 18- Population 65+ Under Age 18 64 # % # % # % Total Population by Age Group 35,666 - 95,426 - 24,172 - Total Population with a Disability 1,931 5.4% 11,630 12.2% 9,073 37.5% Hearing Difficulty 335 0.9% 2,434 2.6% 4,055 16.8% Vision Difficulty 383 1.1% 2,718 2.8% 1,891 7.8% Cognitive Disability 1,242 3.5% 4,937 5.2% 2,211 9.1% Ambulatory Disability 212 0.6% 6,031 6.3% 5,680 23.5% Self-care Disability 248 0.7% 1,715 1.8% 1,661 6.9% Independent Living Difficulty n/a n/a 3,782 4.0% 3,413 14.1% Source: US Census Bureau, ACS 2012-2016, Table S1810
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Alamance County
Grandparent Caregivers
Of the total grandparent population in the County (60 years of age and over), 21.8% (548 grandparents) are responsible for their grandchildren under age 18. This statistic represents 1.6% of the total older adult population (ages 60 years and over). Table 17 below details specific information about this group. 48% of the grandparent caregivers are minority; 4.7% speak a language other than English; 21.4% live in poverty; and 36.7% have a disability [11].
Table 17: Grandparent Caregivers (2016)
Grandparent Caregivers Older Adult Population (60 years and over) 34,354 Grandparents responsible for Grandchildren (#) 548 Grandparents responsible for Grandchildren (%) 1.6% Minority Population 48.0% Speak other language than English 4.7% Speak English less than very well 4.6% Below Poverty Level 21.4% With any disability 36.7% Source: US Census Bureau, ACS 2012-2016, Table S1002
Family Caregivers
Family caregivers assist with daily activities, administer medications, and provide transportation, financial support and companionship to a family member, friend or neighbor. One in four persons in North Carolina report providing regular care for someone age 60 years or older. Almost half are caring for someone with dementia [15]. The AAA provides support for caregivers through home and community-based services (HCBS) including respite services, home-delivered meals, adult day services, transportation and in-home aid services.
1 in 4 people in North Carolina are caregivers for an older adult age 60 years or older.
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References
[1] US Geological Survey, "NLCD 2011 Land Cover (2011 Edition, amended 2014)," Sioux Falls, 2014.
[2] NC OSBM, "Sex and Single Years of Age (2000-2037)".
[3] Integra Service Connect, "Why Payers Should Care about the Social Determinants of Health," 2015.
[4] U.S. Department of Housing and Urban Development, "Measuring the Costs and Savings of Aging in Place," 2013.
[5] Robert Wood Johnson Foundation & University of Wisconsin Population Health Institute, "2018 County Health Rankings North Carolina," 2018.
[6] Centers for Medicare & Medicaid Services, "Prevalence State/County Level: All Beneficiaries by Age, 2007-2015," 2017.
[7] NC Department of Health and Human Services - Aging and Adult Services Division, "County Expendiutre Reports 2017," 2018.
[8] Centers for Medicare & Medicaid Services, "Medicare Enrollment Dashboard," 2017.
[9] Cone Health, "Cone Health Fact Sheet," 2016.
[10] The Cecil G. Sheps Center for Health Services Research, "NC Health Professions 2017 Data Book," 2017.
[11] US Census Bureau, American Community Survey (2012-2016), 2016.
[12] Centers for Disease Control and Prevention, "Health Disparities," 2017.
[13] AARP, "Food Insecurity Among Older Adults," 2015.
[14] Feeding America, "Food Insecurity in North Carolina," 2014.
[15] AARP, "Family Caregiving in North Carolina," 2008.
[16]
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This report was prepared by the Piedmont Triad Regional Council Regional Planning Department with assistance from the Area Agency on Aging.
June 2018
About the Piedmont Triad Regional Council The Piedmont Triad Regional Council (PTRC) is a voluntary association of local governments comprised of municipal representatives, county commissioners, and other civic leaders who function as the voice of the citizens of the Piedmont Triad. It serves 73 member governments in the twelve-county area designated as Region G located in and around the Greensboro, Winston-Salem, and High Point areas. There are 16 Regional Councils in North Carolina. The PTRC is designated by the State of North Carolina to serve as the lead regional organization for the Piedmont Triad region. Funded from federal, state, and local sources, the PTRC houses the regional Area Agency on Aging and is engaged in workforce development, data and information services, transportation planning, water resources, housing programs, regional planning, criminal justice work, and technical assistance. More information is located at http://www.ptrc.org or by contacting Matthew Dolge, Executive Director, PTRC at 336-904-0300 or via email at [email protected].