Aging & Long Term Care of Eastern Washington, the Spokane-based agency that provides a range of services aimed at promoting the well-being and independence of older people in a five-county area, is intensifying its focus on the anticipated needs of retiring baby boomers.

A new draft plan for 2012 through 2015 that the taxpayer-supported agency has developed includes a few major thrusts to prepare for the looming larger population of seniors, says Nick Beamer, its executive director. The plan will be reviewed by a local governing board, then at the state level, before being implemented next January.

The focuses include increased support for unpaid family caregivers caring for elderly relatives, for example, and expanding a pilot project helping Medicaid patients with chronic illnesses better manage their health.

As the first among baby boomers hit age 65, their collective wave is expected to continue to propel health and long-term care over the next two decades. Among Spokane County's 470,000 residents, those ages 60 and older make up almost 19 percent of the population, based on the 2010 U.S. Census. That number is projected to grow to almost 22 percent by 2020, and just over 23 percent by 2030—for a total increase of about 4.5 percentage points during those 20 years.

This growing population of older adults is what the popular media is calling the Gray Tsunami, or the aging of the large number of people born between 1946 and 1964. The U.S. Census Bureau considers a baby boomer to be someone born during that time period and estimates that 78 million people in the U.S. are in that demographic group.

"Our baby boomers are aging, and just as we (baby boomers) came through the educational system and made a tremendous impact, now we are going to make a big impact on our health care system and on our long-term care," Beamer says. "Medical care has helped us live longer, but we still haven't overcome those five major health issues, or chronic conditions."

He lists those top five conditions as diabetes, obesity, cancer, stroke and heart disease, and Alzheimer's disease.

The agency, with a 2011 annual budget of $11 million, offers a network of services for in-home and long-term care—mainly for seniors ages 60 and older. It also provides such services to younger people with disabilities who have Medicaid eligibility. Funding for the agency comes from local, state, and federal sources.

In 2010, the agency with 58 employees in its Spokane office served more than 9,400 people in the five counties it covers: Spokane, Stevens, Ferry, Pend Oreille, and Whitman. It contracts with other agencies to provide some services, such as Spokane Mental Health for elder services, the Spokane Neighborhood Action Program, Rural Resources-Community Action in Colville, and the Council on Aging in Whitman County.

"On top of that 9,400 people served, we get about 20,000 who call just for information," he says.

At its core, Beamer says the agency helps people stay in their homes for as long as possible as they age, including many who have chronic health conditions. It does this by coordinating, monitoring, or funding several services, including senior meal programs, minor home repairs that may include a wheelchair ramp, in-home care providers to assist those who are Medicaid eligible, respite care for family caregivers, adult day care, volunteer-driven transportation, and many other support programs.

"There are a lot of options now," says Beamer. "If you came to me 15 years ago, there were very few options to a nursing home."

Sometimes, a nursing home is the only way a person can receive the level of care needed, "but not everyone needs that high level of care, and would prefer to stay in a home care environment or stay in their own home," he adds, and at a much lower cost. The average cost of nursing home care in Spokane for a Medicaid patient is about $140 a day, he says.

Beamer says the agency's proposed four-year plan does look ahead to serving a larger population of seniors. Although it's had state and federal budget cuts amounting to about $100,000 during the past four years, Beamer says the agency has received additional funding in certain areas, such as for family caregiver services supporting family members who care for elderly relatives.

Family caregiver services statewide received about $6 million from the state Legislature for July 1, 2010, through June 30, 2011. It allocated an additional $3.45 million for July 1, 2011, through June 30, 2012, Beamer says, for a total of $9.45 million. For the agency he oversees, these services are funded at $580,000, and the new funding will add about $320,000 starting July 1, he says.

This support helps cover the costs for counseling, some household repairs such as handle grips for bathtubs, and training for the unpaid family caregivers. It also helps provide what the agency calls respite care, or providing a trained in-home care provider temporarily to give a break to a family member who is the primary caregiver.

Between July 1, 2010, and June 30, 2011, Beamer says, the agency provided family caregiver support to almost 600 people.

Another focus will expand the agency's information and assistance programs, he says. As an example, it will grow a pilot project called Aging and Disability Resource Network in Spokane to assist people ages 50 and over through counseling to plan ahead for the next 10 to 15 years.

"Most of the time, people don't find us until they have a crisis," Beamer says. "If we can reach them when they're 50, we can help them plan what to expect as they age, provide them with some counseling. Do you have long-term care insurance? Do you need to plan ahead for changes to your home?"

It also will continue to expand its counseling assistance for seniors who need help understanding Part D Medicare prescription coverage plans. He says, "In Spokane, I think we're up to 46 plans."

Another upcoming focus is to grow a pilot project aimed at working proactively with those who have chronic health issues. The agency started the chronic care management project three years ago with about 45 people. A nurse and a case manager assist clients who have high Medicaid costs—around $10,000 or more a year—to find better ways to manage their illnesses.

"This is going into the home, and a typical client is a person with diabetes," Beamer says. "We're working to see what special things we can do in the home setting to reduce costs and help them manage their illness."

Because of some additional state and federal funding, he says he expects this project to expand to include a maximum of 200 individuals.

A chronic disease self-management class also will continue. Through this program, people with chronic conditions who are Medicaid eligible can take a class that costs $20 for a book and training about managing their health better.

Part of what the agency continues to do is monitoring in-home personal care for people eligible for Medicaid who otherwise would likely go into a nursing home because they have two or more problems handling daily living activities, such as preparing meals and bathing.

After a home assessment is done, an in-home personal caregiver may be provided for a few hours a day to help with personal care tasks, Beamer says. The agency works with about 10 private in-home care entities that employ these caregivers, as well as several self-employed home care providers, for a total of about 3,000 caregivers.

He says the caregivers have to be certified and trained through the state and pass background checks.

Other services under its umbrella are options for adult family home care or adult day care environments for Medicaid patients.

For adult day care, Beamer says the agency refers clients who need a more rehabilitative environment to Providence Adult Day Health, and it contracts with East Central Community Center to work with clients who need more of an activity-based environment.

The agency offers support in several additional areas, Beamer says. These include legal advice, support to seniors who care for minor relatives, arrangement for basic home repairs on a sliding fee schedule, and area senior meal programs including Meals on Wheels and congregate-site meals.

All of these are aimed at helping people to remain in their own homes, if possible, Beamer adds.

"Sometimes it can be as simple as delivering a meal," he says. The agency funded $608,000 for 2011 senior meal programs administered by Spokane Valley Meals on Wheels in Spokane County.

Beamer says health care reforms may expand some of its home- and community-based services, perhaps by providing Medicare coverage for some programs that it currently doesn't cover. However, Beamer says the full impact of possible health care reforms on the agency isn't yet known.

"It appears one of the goals of health care reform is to more closely integrate long-term care with medical care—care outside the traditional medical community, hospital stays, nursing homes," he says. "They'd go into the home more."