Marilou Johanek: A giant wave heads for Ohio

A giant age wave is coming to Ohio as certain as death and taxes. Think baby boomer tsunami. The state already has the sixth highest population of the 60-plus crowd in the nation, and we're growing older by the day.

Census projections in 2020 and 2030 dramatically illustrate how fast Ohio is aging and how soon residents age 60 and up will outnumber those younger in well over half the state. But with 10,000 Americans turning 65 each day, the seismic shift in demographics was inevitable. Like getting old.

Can't stop it. Problem is we are aging in massive numbers all at once and unprepared -- financially and otherwise -- to meet the avalanche of needs that come with a ballooning older adult population. For years, advocacy organizations helping seniors navigate the health and economic challenges of aging braced for this reality.

Now, a tidal wave of aging adults living longer on fixed incomes with increased chronic disease and oppressive health care costs, faces a fraying social safety net unable to meet rising demand. Federal funding for the Older Americans Act -- which supports a wide range of social services programs for individuals 60 and older -- expires Sept. 30.

The OAA has been reauthorized and amended numerous times since it was enacted in 1965. But annual funding, which has been relatively flat for a decade, has reached critical deficiency levels. Yet even as the Senate Special Committee on Aging debates increasing the OAA funding authorization, the Trump administration's proposed 2020 budget slashes not only funding for aging services but calls for significant cuts in Medicaid and Medicare spending over the next 10 years.

The seesaw between advance and fallback distresses local entities designated by the state to facilitate support services for older residents, their families and caregivers. Recently, leaders of three Area Agencies on Aging (AAA's) in Ohio -- that serve a wide swath of territory from Cleveland to Akron-Canton and the eastern Ohio counties of Ashtabula, Trumbull, Mahoning and Columbiana -- gave me their take on the coming tsunami compounded by stagnant or declining federal funding.

On the wave:

It may be really big, said E. Douglas Beach, head of the Western Reserve Area Agency on Aging that serves Cuyahoga, Geauga, Lake, Lorain and Medina counties. "But I look at baby boomers and think at every step in history they acted differently than anybody before. I don't think they're going to act like the Depression-era babies."

Boomers also have political clout, added Gary Cook, chief at the Akron-Canton Area Agency on Aging and Disabilities. "There's too much political power that's going to be brought to bear by that age wave so it can't be ignored and can't be shortsighted beyond a certain measure."

On the value of home and community-based services:

"We have to provide people the opportunity of choice," insisted Joe Rossi, CEO of the Area Agency on Aging in eastern Ohio. "It used to be 92 percent of Medicaid dollars went to institutional care and 8 percent was home/community-based care. About five years ago that flipped to 50-50. Now it's 65-35. We have been able to keep people out of institutional care and in their homes while saving on Medicaid. If we had stayed on that same trajectory from 30 years ago, the state of Ohio would be bankrupt."

On the return of tax dollar investment:

"We can't stop the growth rate of Medicaid," Cook conceded. "It's going to continue. But we can bend that growth curve to lower the rate of growth by investing in support services that allow people to stay healthy and independent in their homes and communities for as long as possible." The state can achieve actual measurable benefits in cost reduction by funding targeted programs that include home care, meals on wheels, case management, caregiver support, transportation, health promotion, chronic disease self-management and fall prevention.

The goal, Cook continued, is "keeping Ohio seniors from declining both functionally and financially into Medicaid and consuming huge amounts of money."

On Ohio innovations with aging:

The MyCare Ohio Plan [a managed care program that allows qualifying Ohioans to have a single-point contact for both Medicaid and Medicare] came out of the Kasich administration, explained Beach. "It's recognition that if you have Medicare and Medicaid in the home at the same time they'll be pulling together -- medical side for Medicare, personal care side for Medicaid -- both working on the same individual at the same time which, from our perspective, is a huge leap forward."

The Ohio Medicaid PASSPORT waiver, another significant milestone, allows eligible seniors who require a nursing facility level of care to remain at home and receive care. The option is not only preferable to many individuals and their families but less costly than being in a nursing home.

The three CEOs, whose agencies serve older Ohioans in 13 northeast counties, struggle daily to balance care and cost. Their shared mission is to help people age with dignity while staying engaged and secure. It is a tough task increasingly frustrated by low funding and high wait lists.

But they persist, searching for solutions in advance of a tsunami that has yet to peak. Because, ready or not, a giant age wave is about to hit Ohio.

Johanek is a veteran print and broadcast journalist.

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