With the population aging, is Butler County ready to care for them?

Aug. 18--Ruth Courtney, a 91-year-old Cincinnati native, sat on a recent afternoon with friends and enjoyed a meal at the Belle Tower Senior Apartments in Hamilton.

Belle Tower has been helpful to Courtney during her eight years at the complex. She has made friends, and she can participate in events like bingo, which happens twice a month. She moved to Hamilton 10 years ago with her mother, who also stayed at Belle Tower.

"We take care of one another here," said Courtney. "If there is trouble, someone can always help."

That help happens for most residents, like Jack Bishop, who received a stack of get-well cards after breaking his femur bone in March.

Courtney and Bishop are among thousands of seniors in Butler County, a population that is growing here and seemingly everywhere in the country. By 2035, the U.S. Census is predicting that the 65 and older population will be higher than the under-18 population. Roughly 78 million Americans will be 65 or older then, an increase of nearly 30 million from 2016.

Data from Miami University's Scripps Gerontology Center project that 17.6 percent of the county's population by 2030 will 65 or older, up from 14.6 percent in 2020.

The county has taken steps to address both the medical and financial issues that can rise with an aging population. population so far, including Belle Tower's meal program, the Crimes Against the Elderly Task Force, and the Council on Aging of Southwest Ohio's (COA) deal with Butler County Elderly Services.

Ken Wilson, COA vice president for program operations, said Butler County must offer a variety of services and organizations must work together to properly assist the aging population.

"It takes everything from the community to be age-friendly," said Wilson. "There is always a need for housing, transportation, a community services."

Addressing medical concerns

Lifespan has increased over the past century due to breakthroughs in the world of medicine, said Dr. Marcus Romanello, Chief Medical Officer at the Fort Hamilton Hospital. Yet, as people have lived longer, more chronic cases of Alzheimer's, the most prominent and deadly form of dementia, have been diagnosed.

The Alzheimer's Association estimates there will be a 13.6 percent increase in Ohio cases by 2025, up from 220,000 this year to 250,000. Ohio has the seventh-most diagnoses in the U.S..

"There is not just one illness, but rather a constellation of illnesses," Romanello said.

Arthitis is also on the rise. The Centers for Disease Control and Prevention (CDC) projects up to 72 million cases could be diagnosed in 2030, adding nearly 20 million cases to 2015's total. About 28 percent of Ohioans above the age of 18 had arthritis in 2016.

Romanello said that more services and more providers will be needed as the population ages. That process will be a challenge.

"We have not seen an immediate toll on hospitals," Romanello said. "But more on families and nursing care facilities."

The demand for older resident care remains high in Butler County, but how and where seniors are receiving that care is changing.

Dr. Robert Applebaum, Director of the Ohio Long-Term Care Research Project at the Scripps Gerontology Center, has studied occupancy rates of nursing homes since 1993.

"Even though we have a lot more older people than we did in 1993, nursing home occupancy rates have actually dropped," Applebaum said.

Occupancy rates fell to 81 percent last year, a reduction from 92 percent in 1993. Seniors instead have been looking into more assisted living or at-home care options, Applebaum said.

According to Butler County Elderly Services Program's 2018 Annual Report, at-home services cost $294 per month on average, compared to more than $4,000 per month for Medicaid nursing home care, which is funded by tax dollars.

Nursing homes in the state are regulated by the Ohio Department of Aging, where surveyors are sent on three- to four-day inspections.

"Sometimes the citations are really minor and trivial," Applebaum said. "Sometimes the citation are dramatic and they'll even identify if a resident is in immediate jeopardy."

Of the 25 Butler County nursing homes identified on the Ohio long-term care consumer guide, none are listed under immediate jeopardy, yet some have racked up a high number of citations.

Several organizations that provide services for seniors, such as Community First Solutions, one of Hamilton's largest employers, provide homecare services and meal delivery options. Otterbein SeniorLife, for example, has constructed new centers to prepare for an aging population.

"In the last seven years, we have added 142 new independent living units, bringing (our) total capacity to 531," said Gary Horning, Otterbein SeniorLife Vice President of Marketing and Communications.

Since 2012, it has built such structures as the Otterbein Lebanon Life Enrichment Center, which includes 24 independent living apartments, a fitness center, walking track, pool room, swimming pool and spa, and the Gallery at Otterbein, which includes 45 single-bedroom independent living apartments, café, art studio, movie theatre, wood shop, and train room.

Seniors have access to services like these primarily through COA's continued support of Butler County Elderly Services. In 2017, after a 20-year contract, the two groups agreed to a new five-year, $3.8 million deal for COA to manage Elderly Services.

Through the deal, seniors can receive medical care at home or receive transportation to doctor's appointments, among other services. Yet, because of these medical services, Butler County Prosecutor Michael Gmoser is asking seniors to act with an abundance of care.

Gmoser says that seniors should take a hard look at their medical bills as it is quite possible that there will be extra charges for short visits or medication that is supposed to be taken care of through insurance.

"In these cases, the beneficiaries are those who make the mistake," said Gmoser, who added that these charges drive up the cost for health care for everyone.

Addressing financial concerns

The Ohio Department of Job and Family Services found a total of 19,492 reports of abuse, neglect and exploitation between July 1, 2017 and June 30, 2018, with 14,597 of those reports coming from adults age 60 and over.

There were 191 cases of elder exploitation reported in Butler County in that same fiscal year, which Gmoser said is "reaching levels of epidemic concern."

Gmoser said that seniors are preyed on by scam artists because of their assets and they are often less cautious, more trusting, and sometimes far away from family and friends.

This high volume of elder exploitation cases led Gmoser to create the Butler County Crimes Against the Elderly Task Force in 2011 to remove some of the burden placed on police departments throughout the county.

He said the task force has had many successes over the past eight years, but that the threat of scammers still persist. These scammers can come from as close as a nearby family member to as far away as someone from Russia, which brings out a mixed bag of success for them.

One example if a "grandparent scam," a fraud technique used for many years that includes claims family members have been arrested in Mexico and they need money wired to them immediately to get bail.

"Now, the way it works is the scammer looks up the name of a person, looks up the Internet and finds out who their relatives are, then they call up," said Gmoser.

Ohio lawmakers have also attempted to fight elder exploitation, most recently with the passage of Senate Bill Number 158 on Dec. 6. The bill, which went into effect on Match 20, would force scammers to pay full restitution and a fine up to $50,000.

Gmoser said this bill falls short because it is very hard to actually catch scammers, with most of them living overseas outside of U.S. legal jurisdiction.

"There is an inundation in society right now of telephonic communication with the elderly in an attempt to obtain money from them," said Gmoser. "The frequency of attempts is much larger than the success rate, but even with that, there is significant amounts of money that is involved when they're successful."

The bill would also require the attorney general to "distribute at least six public awareness publications each year that provide information on elder fraud and financial exploitation of the elderly," something of which Gmoser is in favor.

When financial exploitation comes from a family member, these often go unreported and are more successful for the scammers. Many of these cases go unreported because seniors are aware that they could be responsible for prosecuting a relative.

"There's also an embarrassment factor that they allowed it to happen and they also have a conflict about whether or not to report it and eliminate the caregiver that is providing some level of service," Gmoser said.

While medical and financial issues remain a concern for Butler County services, service providers focus most on giving seniors like Courtney and Bishop the highest quality of life above all else. For Applebaum, that means ensuring that all seniors, even those with cognitive and physical disabilities, have access to the life that everyone wants.

"Just because someone has a disability, that doesn't mean they stop living," Applebaum said. "They still have the need for social interaction, they still have the need to see family and friends, they still have the need to engage in leisure activities."

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