Miss. Code. tit. 18, pt. 2, ch. 1, 18-2-1-IX, att. 18-2-1-IX-M
GENERAL BACKGROUND
POPULATION CHARACTERISTICS
Mississippi, and the country as a whole, is aging, and this will bring new challenges for those who serve the older population. The needs of older adults are often interrelated, so it is important to understand who makes up the aging population and how a state's aging population compares to the nation as a whole.
In Mississippi, the characteristics of the general 55-and-older population tend to mirror those in the nation as a whole. Even when trends in Mississippi are more pronounced, they follow essentially the same path as the nation. In fact, historical population trends at the state level show that Mississippi's older adult population has similar growth patterns to those of the nation. According to U.S. Census figures, between 1900 and 2000 the number of adults aged 65 and older in Mississippi increased by more than 600 percent from 45,000 to more than 343,000 individuals. Mississippians aged 65 and older grew from less than 3 percent of the state's population in 1900 to nearly 13 percent of the state's population today (see Figure 1).
Current census projections indicate that the number of Americans aged 65 and older will more than double between 2010 and 2050. If this projection holds true, older adults will account for approximately 20 percent of the country's population by as early as 2030 (Vincent and Velkoff 2010). These same estimates project the number of Mississippians aged 65 and older to increase from approximately 343,000 in 2000 to over 499,000 in 2020. This is an increase of over 45 percent in twenty years (U.S. Census 2005). Also by 2020, Mississippians aged 85 and older are projected to increase from approximately 43,000 in 2000 to nearly 60,000, an increase of over 39 percent (U.S. Census 2005). Table 2 displays the projected growth of each age cohort 55 and over based on 2009 population estimates and 2020 projections for Mississippi.
TABLE 2. PROJECTIONS FOR MISSISSIPPI'S 55 AND OLDER POPULATION, 2009-2020.
| AGE COHORT | POPULATION 2009 | PCT. OF POPULATION | POPULATION 2020 | PERCENT CHANGE |
| 55 TO 59 | 176,904 | 6.0 | 210,908 | 19.2% |
| 60 TO 64 | 148,519 | 5.0 | 204,445 | 37.7% |
| 65 TO 69 | 113,242 | 3.8 | 170,187 | 50.3% |
| 70 TO 74 | 89,706 | 3.0 | 131,955 | 47.1% |
| 75 TO 79 | 70,066 | 2.4 | 84,058 | 20.0% |
| 80 TO 84 | 53,882 | 1.8 | 54,360 | 0.9% |
| 85 AND OLDER | 50,019 | 1.7 | 58,630 | 17.2% |
| TOTALS | 702,338 | 23.7% | 914,543 | 30.2% |
Sources: U.S. Census Bureau, Population Estimates 2009.
U.S. Census Bureau, Interim State Projections, 2005.
Workforce participation is another important characteristic of the aging population. Employment data from the Bureau of Labor Statistics provide information on the employment situation for older adults in Mississippi. In 2010 those between the ages of 55-64 recorded a workforce participation rate of 55.5 percent compared to 13.6 percent for those 65 and older. Both rates are lower than the national rate, as adults between the ages of 55 to 64 reported a workforce participation rate of nearly 65 percent, while those 65 and older reported a rate of over 17 percent.
The figure below displays CPS data on the prevalence of full-time workers in the 55 and older age group. Data for the most recent three year averages show that the prevalence of full-time workers in Mississippi for this age group is consistent with the nation and that Mississippi generally records a higher rate of full-time workers than the national average for this age group.
Regarding unemployment, Mississippians 55 to 64 had an unemployment rate of 5 percent compared to 7 percent for the nation in 2010. Mississippians aged 65 and older had an unemployment rate of 4 percent compared to nearly 7 percent for the nation. The chart below displays the unemployment rates for these age groups from 1999 to 2010.
Poverty can have tremendous impacts on a variety factors, including health, well-being, and demand for services. Current Population Survey data show that poverty among older adults in Mississippi has been consistently higher than that of the nation, which follows historical trends for overall poverty. Most recent averages from 2008-2010 indicates a poverty rate of 17 percent for those adults aged 55 and older compared to 12.6 percent for the nation.
HEALTH
While the general population trends in the state and the nation mirror one another, so do the trends in health for the aging population. In terms of self-reported health status of older adults, Figures xxx and xxx show that Mississippians are more likely than the rest of the nation to classify their health status as either Fair' or Poor.' Estimates from the Behavioral Risk Factor Surveillance Survey (2009) show that over 31 percent of 55 to 64-year-olds and nearly 40 percent of those aged 65 and older rated their health as Fair' or Poor' compared to 20 percent and 26.1 percent for the nation. Results from the GNAS show that over 15 percent of respondents rated their health as Fair' or Poor.' By comparison, nearly 40 percent of WLNAS respondents rated their health as Fair' or Poor.'
Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance Survey, 1995-2009
Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance Survey, 1995-2009
Data related to other major health indicators show that older adults in Mississippi tend to fair worse than the nation as a whole. Disability rates from the Current Population Survey show that over 29 percent of older Mississippians reported living with a disability in 2010 compared to 24 percent of older adults nationwide.
Source: U.S. Census Bureau, Current Population Survey March Supplement, 1992-2010.
Obesity and diabetes are two major future health concerns facing the aging population. Historic data trends show that obesity is already a concern in Mississippi, as state-level rates consistently exceed those of the nation. Figures 11 and 12 show that over 37 percent of Mississippians aged 55 to 64 and nearly 28 percent of Mississippians aged 65 and older are classified as obese compared to national rates of 32 percent and 24 percent, respectively.
Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance Survey, 1995-2009.
Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance Survey, 1995-2009
High rates of obesity in Mississippi have been accompanied by high rates of diabetes. As Figure 13 shows, over 21 percent of 55 to 64 year olds and over 24 percent of adults aged 65 and over reported being diagnosed with diabetes.
Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance Survey, 2004-2009
SERVICE
Population estimates for 2009 report that there were over 525,000 Mississippians aged 60 and older, which comprised nearly 18 percent of the state's population (U.S. Census 2010). The Administration on Aging's Aging Integrated Database (AGID) show that MDHS's Division of Aging and Adult Services has served over 26,000 clients in 2009 (Administration on Aging 2011), which is approximately six percent of the state's 60 and older population. Assuming six percent represents the most needy elderly Mississippians, DAAS can expect an increase of 14,000 clients by 2020.
Source: Administration on Aging, Aging Integrated Database, 2011.
A review of the specific services provided shows that the most used service of AAA is Home Delivered Meals (HDM). Between 2000 and 2009, approximately three percent of Mississippians over 60 received HDM. Assuming these conditions persist, DAAS can expect to see an increase of 7,000 clients seeking Home Delivered Meals by 2020.
Source: Administration on Aging, Aging Integrated Database, 2011.
Homemaker Services is the second-most accessed service provided by AAA. Between 2000 and 2009, approximately one percent of Mississippians over 60 received Homemaker Services. Assuming these conditions persist, DAAS can expect to see an increase in demand for Homemaker Services of close to 2,300 by 2020.
Source: Administration on Aging, Aging Integrated Database, 2011.
Though trending down, Congregate Meals is the third-most popularly received service provided by AAA. Between 2000 and 2009, just under one percent of Mississippians over 60 received Congregate Meals. Assuming these conditions persist, DAAS can expect to see an increase in demand for Congregate Meals of just over 2,000 by 2020.
Source: Administration on Aging, Aging Integrated Database, 2011.
2011 MISSISSIPPI OLDER ADULTS NEEDS ASSESSMENT RESULTS
The 2011 Mississippi Older Adults Needs Assessment surveyed adults aged 55 and older on a variety of topics, including service awareness, everyday activities, health status, living arrangements, quality of life, and future concerns. In order to gain greater perspective into the everyday lives and unmet needs of older Mississippians, two telephone surveys of adults aged 55 and older were conducted.
The first was a random sample survey of the state's older adult population (GNAS), and the second was a survey of individuals who are currently on waiting lists for DAAS services (WLNAS). The minimum age was set at 55 so that the needs and concerns of this age group could be documented to help agencies prepare not only for those who are currently eligible for services but for those who will become eligible for services in the next five years.
A general set of questions was developed for both surveys and were asked of the GNAS and WLNAS respondents. WLNAS respondents were, however, asked additional questions specific to how long they have been waiting for services, their level of urgency for receiving services, and how they were coping with the lack of service. Results for the two surveys and the focus group session are provided below.
2011 MISSISSIPPI OLDER ADULTS NEEDS ASSESSMENT RESULTS
The 2011 Mississippi Older Adults Needs Assessment surveyed adults aged 55 and older on a variety of topics, including service awareness, everyday activities, health status, living arrangements, quality of life, and future concerns. In order to gain greater perspective into the everyday lives and unmet needs of older Mississippians, two telephone surveys of adults aged 55 and older were conducted. The first was a random sample survey of the state's older adult population (GNAS), and the second was a survey of individuals who are currently on waiting lists for DAAS services (WLNAS). The minimum age was set at 55 so that the needs and concerns of this age group could be documented to help agencies prepare not only for those who are currently eligible for services but for those who will become eligible for services in the next five years.
A general set of questions was developed for both surveys and were asked of the GNAS and WLNAS respondents. WLNAS respondents were, however, asked additional questions specific to how long they have been waiting for services, their level of urgency for receiving services, and how they were coping with the lack of service. Results for the two surveys and the focus group session are provided below.
ASSESSMENT SURVEYS
Overall, the results of the GNAS show that Mississippi's older adult population report high scores on quality of life and health status. Specifically, 94 percent of respondents ranked their quality of life as "good" or better with 76 percent ranking their quality of life as very good or excellent. In general these respondents were less dependent on alternative sources of transportation, had lower levels of food insecurity, and were less concerned with being able to meet their basic needs.
Concerns arise, however, with the examination of the WLNAS results, which show striking differences between the two survey populations. These results encapsulate the major issues that face the state's aging population. WLNAS respondents faired much worse on self-reported quality of life and health assessment scores, and they also reported higher levels of dependence on transportation and much higher levels of food insecurity than those from the GNAS.
With the projected increase of older adults in Mississippi, the state can expect an increase in the number of older adults who have difficulty meeting basic needs without assistance. As the results of these two surveys demonstrate, this is especially true for older adults living on low incomes and those who reside in rural areas. Special attention should also be paid to older adults who provide care for others, as an increase in older adults could also result in an increase in caregivers who may be in need of some type of relief.
Ultimately, potential clients will need to know what services are available and how and where these services can be accessed. The DAAS currently serves a small share of the state's aging population. An increase in awareness, especially among low-income and rural individuals, could result in more people receiving the services and assistance they need.
* QUALITY OF LIFE AND LIFESTYLE
GNAS
* Seventy-six percent of respondents reported their Quality of Life as being Very Good or Excellent.
* Physical health was the most pressing quality of life concern among GNAS respondents, as over 46 percent of respondents reported a high level of concern for this indicator.
* Other major concerns included Financial Problems (26.6 percent), Access to Adequate Healthcare (21.3 percent), Affordable Medications (20.3 percent), and Depression (18.2 percent).
* Physical Health was a major quality of life concern for Low Income Respondents (60.2 percent). In contrast, only 23 percent of High Income Respondents saw their current Physical Health as a major concern.
WLNAS
* In contrast to the GNAS results, only 40 percent of respondents reported their Quality of Life as being Very Good or Excellent.
* Physical Health (79.5 percent) and Financial Problems (50.2 percent) were the most pressing quality of life concerns for WLNAS respondents.
* WLNAS respondents were more concerned with issues related to Loneliness and Isolation, the Ability to Perform Everyday Activities like bathing or preparing meals, and Accessing Transportation than those who participated in the GNAS.
FAMILY AND SOCIAL SUPPORT
GNAS
* Ninety-eight percent of respondents believed that they had a reliable contact in the case of an emergency.
* Over 11 percent of respondents reported having no family members living within 25 miles of their residence.
WLNAS
* Ninety-one percent of respondents believed that they had a reliable contact in the case of an emergency.
* Almost 12 percent of respondents reported having no family members living within 25 miles of their residence.
CAREGIVING
GNAS
* Over 33 percent of respondents reported that they provide care for a family member or friend on a regular basis.
* Seventy-four percent of caregiving respondents were female.
* About 30 percent of respondents spent more than 20 hours per week providing care for others.
* Eight percent of caregivers reported a high need for respite care.
* Twenty-three percent of caregivers reported that their future ability to care for others was a major concern.
WLNAS
* Twenty-two percent of respondents reported that they provide care for a family member or friend on a regular basis.
* Eighty-three percent of caregiving respondents were female.
* Over 37 percent of caregivers spent more than 20 hours per week providing care for others.
* Over 33 percent of caregivers reported that their future ability to care for others was a major concern.
LIVING ARRANGEMENTS
GNAS
* Nearly 73 percent of respondents reported they were Very Satisfied with their current living arrangements.
* Over 24 percent of respondents reported that the ability to continue living independently was a major concern for them as they continue to age over the next five or more years.
* Eighty-nine percent of High Income Respondents (those with Household Incomes of $75,000 or greater) were Very Satisfied with their Living Arrangements, compared to less than 63 percent of Low Income Respondents (those with Household Incomes of $20,000 or less).
WLNAS
* Over 44 percent of respondents reported they were Very Satisfied with their current living arrangements.
* Nearly 47 percent of respondents reported that the ability to continue living independently was a major concern for them as they continue to age over the next five or more years.
DIET AND FOOD SECURITY
GNAS
* Nearly 12 percent of the sample reported that there had been times over the last year when they were unable to afford enough food to eat.
* The inability to afford food was a major issue for low-income groups. Over 38 percent of respondents with household incomes below $10,000 reported that the inability to afford enough food to eat had been a problem for them over the last year.
* Over 24 percent of respondents were unable to afford the kinds of foods they wanted to eat at one time or another over the last 12 months, and for 6 percent of respondents this was a frequent occurrence.
* Over 20 percent of respondents were unable to afford to eat healthier meals over the last 12 months. This was a frequent problem for nearly 6 percent of respondents.
* The ability to afford basic needs like food and rent was a major future concern for nearly 23 percent of respondents.
* Nearly 15 percent of respondents reported a high level of need for Food Stamps.
* Nearly 23 percent of African-American Respondents claimed that there had been times over the last year when they were unable to afford enough food. This was a problem for only 8.3 percent of White Respondents.
WLNAS
* Over 49 percent of the sample reported that there had been times over the last year when they were unable to afford enough food to eat.
* Over 66 percent of respondents were unable to afford the kinds of foods they wanted to eat at one time or another over the last 12 months.
* Over 63 percent of respondents were unable to afford to eat healthier meals over the last 12 months.
* The ability to afford basic needs like food and rent was a major future concern for 46 percent of respondents.
TRANSPORTATION
GNAS
* Approximately 15 percent of respondents reported that they did not use their own vehicle as a primary means of transportation for most local trips.
* Of those respondents who did not use their own vehicle as a primary means of transportation:
* Over 47 percent reported that a lack of transportation was a problem for them over the last year.
* Nearly 49 percent resided in rural areas.
* Over 53 percent reported household incomes of less than $10,000 in 2010.
* Nine percent of respondents reported a high level of need for transportation services.
* Twenty-three percent of respondents reported a high level of future concern with their ability to drive on their own.
* Sixteen percent of respondents had high levels of concern with the availability of adequate transportation over the next five or more years.
WLNAS
* Nearly 53 percent of the sample reported that they did not use their own vehicle as a primary means of transportation for most local trips.
* Over 74 percent of respondents reported that a lack of transportation was a problem for them over the last year.
* Over 28 percent of respondents reported a high level of future concern with their ability to drive on their own.
* Nearly 37 percent of respondents had high levels of concern with the availability of adequate transportation over the next five or more years.
HEALTH STATUS
GNAS
* Over 54 percent of respondents reported being in Very Good or Excellent health.
* Over 40 percent of respondents reported that their physical health did not interfere with their ability to perform basic daily activities.
* High Blood Pressure was the most common health condition, as nearly 64 percent of respondents reported they had been diagnosed with this condition within the last two years.
* Some of the other major health concerns included Arthritis (58 percent), Vision Problems (38.8 percent), Back Pain (36.4 percent), and other Joint Problems (32.0 percent).
* 13 percent of the sample reported there had been times when they needed medical attention but elected not to seek it.
* Of those who decided not to seek medical attention, over 54 percent reported cost issues, over 27 percent decided to treat themselves, and nearly 16 percent reported other reasons for not seeking medical attention, such as nursing experience and not being able to miss work.
* Over 75 percent of High Income Respondents reported their overall health as being Very Good or Excellent. In contrast, slightly over 43 percent of Low Income Respondents reported their overall health as being Very Good or Excellent.
* Over 76 percent of African-American Respondents reported being diagnosed with High Blood Pressure, and nearly 32 percent had been diagnosed with diabetes. These percentages were at 64 percent and 25 percent for the GNAS as a whole, respectively.
WLNAS
* Nearly 23 percent of respondents reported being in Very Good or Excellent health.
* Nearly 63 percent of respondents reported that their physical health made it difficult to perform basic daily activities like bathing or preparing meals.
* High Blood Pressure was the most common health condition, as nearly 79 percent of respondents reported they had been diagnosed with this condition within the last two years.
* Some of the other major health concerns among respondents included Arthritis (77.4 percent), Back Pain (61.1 percent), Vision Problems (58.0 percent), and other Joint Problems (54.1 percent).
* 24 percent of the sample reported there had been times when they needed medical attention but elected not to seek it.
* Of those who decided not to seek medical attention, over 44 percent reported cost issues, over 23 percent claimed they had no means of transportation, and over 19 percent decided to treat themselves.
SERVICE NEED AND AWARENESS
GNAS
* Nearly 68 percent of respondents claimed to be unaware of the services provided and facilitated through the Area Agencies on Aging.
* Of those respondents who were aware of the Area Agencies on Aging, nearly 34 percent did not know how to get in contact with local Area Agency on Aging representatives.
* Senior Discount Programs were found to be the greatest need among respondents, as over 31 percent reported a high level of need for this service.
* Other services that scored high on the list were Repair Services (22.4 percent), Physical Fitness and Exercise Programs (18.5 percent), Tax Preparation (15.9 percent), and Information and Referral Services (15 percent).
* Over 77 percent of Low Income Respondents were unaware of the services provided by DAAS, compared to 44 percent of High Income Respondents claiming to be unaware.
* Senior Discount Programs (44.8 percent) and Food Stamps (34.4 percent) were the greatest service needs among Low Income Respondents. In contrast, the greatest service needs of High Income Respondents were Exercise Programs (17.6 percent) and Repair Services (17.6 percent).
WLNAS
* Over 64 percent of respondents were on waiting lists for Home Delivered Meals.
* Other services for which respondents were waiting for included Homemaker Services (27.6 percent), Home Healthcare (17.3 percent), Congregate Meals (8.1 percent), and Repair Services (7.8 percent).
* Repair Services (63.6 percent) was reported as the most urgent need among WLNAS respondents.
* Help from family was the most consistent coping mechanism used among respondents waiting for services.
* Many respondents reported there were times they were forced to do without a service when alternative sources of support were not available.
FUTURE CONCERNS
GNAS
* Physical health (58.5 percent) was reported as the greatest future concern.
* Affording Healthcare (31.3 percent), Affording Medications (29.5 percent), Mental Health (28.5 percent), and the Ability to Care for Others (25.2 percent) were among the other major concerns.
* Declining Physical Health was the most pressing concern for the entire sample (58.5 percent); this was especially true for Low Income (66.3 percent) and Female Respondents (61 percent).
WLNAS
* Physical health (68.2 percent) was reported as the greatest future concern.
* Affording Healthcare (46.9 percent), the Ability to Live Independently (46.7 percent), Affording Basic Needs, and Affording Medications (44.9 percent) were among the other major concerns.
SERVICE PROVIDER FOCUS GROUP
A computer-assisted focus group consisting of 25 service providers from the 10 AAAs was conducted in order to gain insight on the strengths and weaknesses of the current service delivery method and what the state needed to do to prepare for the increase in the aging population.
Participants were made up of directors of AAAs, directors of non-profits, and a variety of field specialists. The focus group used innovative web-based technology that gathers information in a way that gives everyone a voice in the process while still getting the benefits of sharing ideas in a group setting. Focus group materials are available in Appendix V.
Current and Future Needs Assessment
Overall results from the focus group and the surveys indicate that service providers and elderly Mississippians share the same vision of current and future needs. Both agree that home repair services are the biggest need for today's clients. Both agree that preventative services for health and finances are the greatest needs of tomorrow's clients. Both agree that Mississippians need more awareness of available services. Both agree that caregiving is very difficult.
Participants were asked about the greatest unmet needs of their community. Service providers see keeping individuals in their homes as the biggest priority in improving the lives of older Mississippians. In order to do this, service providers are in agreement that currently general home repairs is the greatest unmet need of seniors. Specific home repairs stated included roofs and wheel chair ramps.
Participants were asked about the effect of the retirement of the Baby Boom on services. Service providers agree that Baby Boomers are more active, independent, and more educated than previous elderly generations. Thus, there will be a need for preventative services, including exercise opportunities and nutrition, and financial education on home-delivered meals, homemaking services, and transportation.
Service providers also agree that Mississippians need more training on how to get informed about the services that are available to elders, including AAA services. GNAS results show that almost 70 percent of Mississippians were not aware of AAA services. Service providers had many ideas on how to reach clients effectively. The channels of trusted information most cited were, in order, churches, wellness centers, doctors, and family members. Targeting adult children was mentioned as a strategy as well as pharmacists, senior centers, mass media, pamphlets, community meetings, health fairs, places of employment, and utility companies.
Service providers agree that Mississippians of all ages need an education campaign for all Mississippians that serves to prepare people for the stages of the aging process. Service providers think that many people are in denial about the aging process. There was general agreement that being able to communicate about aging, death, dying, the stages of grief, and costs of long-term and hospice care would help people to make choices that better prepare themselves for retirement. The educational campaign would focus on good health and financial practices throughout life so that people reach retirement more physically and financially fit. Service providers were united in the thought that successful aging starts early in life.
Service providers agreed that providing training to caregivers is a top priority. Caregivers will have an expanded role as the Baby Boomer population ages, increasing the need for caregiver training. Research on care giving shows the detrimental impacts on the caregiver. Participants overwhelmingly said that in order to prevent burn-outs, caregivers need to learn coping skills and the importance of self-care. Coping skills include stress and anger management and sensitivity to elders in terms of understanding what it feels like to be dependent on someone else. Self-care includes understanding one's limits and how to get help or find support groups. In addition to training on how to physically care for loved ones, caregivers also need training on how to make decisions that are in the best interests of the family as a whole.
Service Delivery Method and Increasing Capacity
AAA directors report that though the majority of their staffs are not trained in geriatrics, their staffs work well as a team. AAA personnel value shaping the process of improving service delivery through collaboration, are loyal to the needs of Mississippi's aging population, and enjoy interacting with the seniors they serve. The service providers at the focus group are willing to learn and desire to be active in shaping the process of improving lives of the elderly in Mississippi. Most participants in the focus group know they need more training and welcomed training opportunities. Service providers would like to see and know that DAAS personnel is personally involved and understands the plight of some of their most needy clients, especially rural individuals.
Service providers agreed that more and better communication was needed from DAAS both within and between districts. There was a strong desire for more regular meetings and for a significant increase in communication from DAAS that is timely and well-thought out. Currently, information is centralized with the directors and may not be consistent or consistently disseminated.
Service providers overwhelmingly report a "figure it out myself" approach to accomplishing their job duties. Lessons learned are not shared which maximizes the work effort. Service providers agreed that more training for all levels of personnel was a top priority. As Baby Boomer AAA directors retire, an important window of opportunity for reshaping the culture of each AAA will open. DAAS needs to be ready for the exodus of expertise.
Service providers agree that current service provision is done in "silos" with no resources spent to increase awareness of services because they have no capacity to increase services. Service providers view churches, wellness centers, doctors, and family members as trusted channels of information that would be good partners.
There was also a consensus among service providers that budgetary flexibility would increase capacity to serve more elderly Mississippians. For example, being able to switch funds from Congregate Meals to Home Delivered Meals would enable local providers to match the funds more in line with local needs.
Miss. Code. tit. 18, pt. 2, ch. 1, 18-2-1-IX, att. 18-2-1-IX-M