HomeMy WebLinkAboutOur Island Home Future A Future Demographic PerspeciveOur
Island
Home’s
Future:
A
Demographic
Perspective
Peter
A.
Morrison
December
8,
2015
As
the
Town
modernizes
Our
Island
Home
(OIH)
to
meet
today’s
standards,
thought
should
be
given
to
refining
its
fit
with
tomorrow’s
demographic
landscape.
That
future
landscape
highlights
one
option
for
immediate
consideration
and
further
choices
to
contemplate
in
the
future.
The
following
technical
analysis
is
intended
to
inform
these
choices.
In
what
follows,
I
describe
the
evolving
demographic
context
likely
to
affect
OIH
20
years
into
the
future
and
estimate
the
likely
magnitude
of
potential
future
need
for
the
services
OIH
now
offers.
Based
on
this
analysis,
I
see
a
strong
case
for
preserving
the
future
option
to
expand
OIH.
Looking
20
years
ahead,
potential
demand
for
OIH
beds
will
intensify
sharply,
possibly
prompting
taxpayers’
support
for
that
option.
Thereafter,
other
complex
choices
may
arise
as
beds
become
scarce.
Nantucket
is
one
of
a
few
communities
offering
its
elderly
residents
access
to
local
care
at
local
taxpayer
expense.
That
collective
consensus
reinforces
universally
held
principles
of
family
responsibility
within
the
complex
affiliations
that
define
present-‐day
families.
The
Town
will
soon
finalize
decisions
affecting
availability
of
such
care
in
future
decades.
It
behooves
us
to
look
into
what
the
future
holds,
and
how
to
refine
our
concept
of
OIH’s
mission
on
our
collective
behalf.
Simply
put,
here
is
what
the
future
holds.
Nantucket
likely
will
be
home
to
many
more
seniors,
who
will
likely
enjoy
unprecedented
longevity.
A
rising
proportion
of
Nantucket
residents
will
be
their
80s
and
90s
as
the
baby
boom
generation
matures
into
those
ages.
This
demographic
surge
will
boost
the
absolute
number
of
elderly
residents
who
cannot
live
independently—from
roughly
63
today
to
roughly
103
by
2035.
The
appendix
that
follows
provides
technical
details
supporting
this
projection.
For
some
seniors,
family
members
with
the
emotional
will
to
care
for
their
elderly
will
find
they
have
no
practical
means
of
doing
so.
Against
this
demographic
backdrop,
what
are
the
limits
and
realistic
future
possibilities
for
OIH
to
sustain
its
core
mission?
Today,
OIH
meets
the
needs
of
41
such
residents,
most
(but
not
all)
of
them
elderly.
Twenty
years
from
now,
Nantucket’s
elderly
population
will
surely
2
overwhelm
its
capacity.
With
that
demographic
future
in
mind,
what
are
the
priorities
of
today’s
taxpayers?
• Future
capacity:
Are
45
beds
the
permanent
upper
limit
of
what’s
wanted?
Or
do
today’s
taxpayers
want
to
maintain
the
option
to
add
another
15-‐bed
pod
at
some
future
time?
At
this
conceptual
design
stage
of
OIH,
this
choice
deserves
immediate
consideration.
Two
distant—and
more
complex-‐-‐choices
may
present
themselves
as
the
future
unfolds:
• Standards
for
admission:
Who
among
us
would
be
entitled
to
an
available
bed
at
OIH-‐-‐and
to
the
peace
of
mind
among
that
occupant’s
family
members
on
island-‐-‐at
taxpayers’
expense?
Would
preference
be
given
to
those
elderly
who
have
a
well-‐established
network
of
local
support
in
place?
• Length
of
stay.
Would
admission
to
OIH
guarantee
lifelong
residence,
regardless
of
one’s
cognitive
or
health
status?
Would
an
occupant
who
no
longer
recognizes
any
visiting
family
member
or
acquaintance
be
entitled
to
stay
on,
postponing
entry
by
another
deserving
occupant
whose
existing
network
of
local
support
is
strained
to
the
breaking
point?
Unless
the
latter
two
choices
can
be
arrived
at
through
future
deliberation,
they
will
in
most
instances
ensue
tacitly.
3
APPENDIX
SUPPORTING
DATA
AND
ANALYSIS
1.
Persons
65
and
older,
especially
those
80
and
older,
will
comprise
an
increasing
proportion
of
Nantucket’s
future
residents.
How
many
Nantucket
residents
65
and
older
will
there
be
in
the
future?
No
one
can
say
for
sure,
but
a
plausible
scenario
can
be
derived
from
the
Commonwealth’s
official
population
projection
for
Nantucket,
summarized
in
Table
1.1
Table
1.
Projected
Population
of
Nantucket,
by
Age
Noteworthy
points:
• In
the
next
20
years,
Nantucket’s
total
(all
ages)
population
is
projected
to
increase
13%.
• Persons
65
and
older,
by
comparison,
are
projected
to
increase
56%.
• Persons
80
and
older,
while
comparatively
few,
may
increase
80%.
2.
As
Nantucket’s
population
ages,
the
number
of
elderly
residents
needing
assistance
with
activities
of
daily
living
will
increase
markedly,
and
accelerate
after
2030.
One’s
ability
to
perform
certain
routine
everyday
activities
without
needing
assistance
often
declines
markedly
after
about
age
80.2
Needing
the
help
of
other
persons
becomes
imperative:
with
bathing
or
showering,
dressing,
eating,
getting
in
or
out
of
bed
or
chairs,
using
the
toilet,
including
getting
to
the
toilet,
and
getting
around
inside
the
home.
Needing
help
with
such
activities
rises
sharply
with
advancing
age
(see
Figure
1
and
Table
2
below).
1
Massachusetts’
State
Data
Center,
the
UMass
Donahue
Institute
(UMDI),
publishes
population
projections
for
all
Massachusetts
municipalities
at
5-‐year
intervals
to
2035.
Accessed
at:
http://pep.donahue-‐institute.org
2
The six basic “activities of daily living” (ADLs) are: eating, bathing, dressing, toileting, transferring
(walking) and continence. An individual's ability to perform ADLs is important for determining what type of
long-term care (e.g. nursing-home care or home care) and coverage the individual needs (i.e. Medicare,
Medicaid or long-term care insurance).
4
Figure
1
Source:
DHHS,
Administration
on
Aging,
A
Profile
of
Older
Americans:
2011,
Figure
9.
Table
2.
Period
Prevalence
of
Limitations
in
Activities
of
Daily
Living
by
Age:
2003-‐2007
(civilian
noninstitutionalized
population)
Noteworthy
points:
1. Prevalence
of
2+
ADLs
increases
sharply
from
75-‐84
to
85+.
2. Growth
of
residents
85+
after
2030
implies
accelerating
growth
in
assistance
needs.
Total None 1 2+
65#74 100.0%97.1%0.7%2.2%
75#84 100.0%93.9%1.4%4.7%
85+100.0%82.2%4.7%13.2%
Source:6CDC,!Limitations!in!Activities!of!Daily!Living!and!
Instrumental!Activities!of!Daily!Living,!2003;2007,6Table64.
%-Distributions-of-No.-of-Limitations-in-ADLs
Limitations-in-Activities-of-Daily-Living-(ADL)
Age-Group
5
Table
3.
Projected
Increase
in
Nantucket’s
Noninstitutionalized
Population
65+
With
Limitations
in
Two
or
More
Activities
of
Daily
Living
Source:
Morrison’s
calculations
applying
Table
2
prevalence
rates
to
Table
3
projected
population.
A
straightforward
demographic
projection
quantifies
the
future
in
store
(see
Table
3).
Simply
put,
Nantucket’s
noninstitutionalized
population
65
and
older
is
projected
to
increase
33%
by
2025,
46%
by
2030,
and
56%
by
2035.
Assuming
that
the
prevalence
rates
shown
in
Table
2
remain
constant
in
the
future,
this
noninstitutionalized
population
65+
will
generate
28%
more
members
who
experience
limitations
in
2
or
more
ADLs
by
2025,
47%
more
by
2030,
and
63%
more
by
2035.
To
grasp
the
significance
of
these
changes,
imagine
substituting
today's
population
of
10,667
persons
with
their
projected
counterpart
population
in
2035
(12,004
such
persons).
What
would
change?
The
13%
increase
in
overall
numbers
conceals
a
56%
increase
in
persons
65
and
older
(Table
1
above,
comparing
“All
ages”
with
“65+”).
Furthermore,
the
56%
increase
in
overall
elderly
persons
65+
itself
conceals
a
63%
increase
in
persons
with
limitations
in
2
or
more
ADLs
(Table
3
above,
comparing
“Total
65+
population”
with
“Total
65+
Estimated
with
Limitations
in
2+
ADLs”).
In
short,
Nantucket
would
be
home
to
just
13%
more
residents,
but
the
number
of
elderly
among
them
possibly
unable
to
live
independently
without
assistance
would
increase
from
63
to
103—a
63%
increase.
By
way
of
comparison,
OIH
has
41
residents
(late
2015),
37
of
whom
are
65+.
6
3. The
structural
changes
detailed
above
appear
to
be
independent
of
whether
one
defines
Nantucket’s
“resident
population”
according
to
the
Census
Bureau’s
concept
or
the
Town
Clerk’s
concept.
The
Census
Bureau
defines
Nantucket’s
resident
population
as
persons
who
report
Nantucket
as
their
“usual
place
of
residence”
on
April
1.
That
definition
undoubtedly
excludes
many
additional
Nantucket
residents.
The
Town
Clerk’s
annual
census
identifies
many
more
residents,
based
on
a
more
inclusive
definition
(including
eligibility
to
vote).
The
substantial
differences
between
these
two
sources
raises
the
possibility
that
one
or
the
other
definition
may
prove
misleading
about
the
future
elderly.
To
explore
this
possibility,
I
compare
age-‐
specific
data
from
each
source
in
Table
4.
Table
4.
Age
Distribution
of
Nantucket
Residents
55
and
Older
Based
on
Census
Bureau
and
Town
Census
Enumerations
Noteworthy
points:
1. Town
Census
(2015)
and
Census
complete
count
(2010)
closely
agree
in
relative
terms
(compare
“%
of
55+”
columns).
2. Agreement
between
Town
Census
(2015)
and
MA
State
Data
Center’s
2015
projected
elderly
distribution
is
even
closer
(data
not
shown).
3. Scale
differences
are
apparent
(see
“Town
minus
U.S.
Census”
column)
but
do
not
distort
relative
agreement.
7
4. The
concept
of
“healthy
life
expectancy”
(HLE)
offers
a
useful
objective
starting
point
for
setting
future
priorities
in
coming
years.
Healthy
life
expectancy
(HLE)
is
a
population
health
measure
that
combines
mortality
data
with
morbidity
or
health
status
data
to
estimate
expected
years
of
life
in
good
health
for
persons
at
a
given
age.
HLE
accounts
for
quantity
and
quality
of
life
and
can
be
used
to
describe
and
monitor
the
health
status
of
populations.
Life
expectancy
(LE)-‐-‐expected
years
of
life
at
a
given
age-‐-‐is
the
average
remaining
years
of
life
a
person
can
expect
to
live
on
the
basis
of
the
current
mortality
rates
for
the
population.
HLE
estimates
the
equivalent
healthy
years
that
a
person
can
expect
to
live
on
the
basis
of
the
current
mortality
rates
and
prevalence
distribution
of
health
status
in
the
population.
The
state-‐specific
HLE
for
65-‐year-‐old
Massachusetts
residents
is
13.8
years
(males)
and
15.9
years
(females).3
Simply
put,
one
expects
a
population
of
65-‐year-‐old
males
to
have,
on
average,
13.8
“healthy”
future
years
of
life
expectancy.
The
corollary
is
that
78.8
years
of
age
marks
the
stage
of
life
at
which
OIH
becomes
relevant
to
the
remaining
non-‐healthy
years
of
life.
For
females,
the
corresponding
age
marking
the
conclusion
of
HLE
is
80.9
years
of
age
(i.e.,
65
plus
15.9).
In
round
numbers,
then,
age
79
for
men
and
age
81
for
women
are
objective
criteria
for
anticipating
the
average
age
of
the
onset
of
need
for
a
stay
at
OIH.
For
any
particular
individual,
of
course,
that
onset
may
occur
at
a
younger
or
older
age.
The
corresponding
entire
life
expectancy
(LE)
for
65-‐year-‐old
Massachusetts
residents
is
18.2
years
(males)
and
20.9
years
(females).
These
LE’s
mean
that
at
age
78.8,
the
average
male
faces
an
additional
4.4
non-‐healthy
years
of
life;
and
that
at
age
80.9,
the
average
female
faces
an
additional
5.0
non-‐healthy
years
of
life.
Again,
these
durations
may
be
shorter
or
longer
for
any
particular
individual.
However,
they
furnish
objective
measures
for
anticipating
future
durations
of
stay
at
OIH
by
those
needy
elderly
who
gain
admission.
In
round
numbers,
then,
the
duration
of
stay
would
be
around
4.4
-‐
5.0
years
for
the
average
would-‐be
OIH
resident.
5. Our
Island
Home
capacity
vs.
current
and
projected
future
need.
OIH
currently
has
41
residents,
27
of
them
ages
80
or
older.
This
population
of
27
corresponds
roughly
to
persons
who
are
passing
through
non-‐healthy
years
of
life
expectancy,
and
whose
average
duration
of
stay
at
OIH
will
be
4.4
-‐
5.0
years.
These
27
residents
comprise
7.2%
of
all
373
persons
80
and
older,
as
enumerated
by
the
Town
Clerk’s
census
(see
“80+”
row
in
Table
5).
These
data
imply
that
OIH
now
meets
roughly
7%
of
the
latent
need
for
assistance
among
Nantucketers
as
they
live
out
their
remaining
non-‐healthy
years
of
life
expectancy.
We
can
anticipate
a
52%
increase
in
3
Source:
CDC,
“State-‐Specific
Healthy
Life
Expectancy
at
Age
65
Years
—
United
States,
2007–2009,”
MMWR
(access
at
www.cdc.gov/mmwr/index.html
)
8
Nantucket’s
population
80
and
older
by
2030
and
an
80%
increase
by
2035
(see
Table
1
above).
Those
increases
imply
that
a
fixed
OIH
capacity
(27
persons
80+)
would
meet
a
declining
percentage
of
this
latent
need
for
assistance:
from
7%
in
2015
to
just
5.2%
(2030)
and
4.4%
(2035).
Contemplating
this
scenario
opens
our
eyes
now
to
the
necessity
of
refining
our
collective
priorities
and
vision
of
Our
Island
Home’s
place
in
the
community.
Otherwise,
we
could
face
the
prospect
of
one
needy
population
segment
(e.g.,
persons
80+)
crowding
out
another,
with
no
explicit
public
consensus
on
how
to
balance
competing
needs
of
younger
and
older
residents.
The
ultimate
justification
for
focusing
a
modest
amount
of
local
support
on
a
need
of
far
broader
proportions
could
be
a
continuing
local
commitment
to
what
families
alone
do
best—care
for
their
own
members,
whatever
their
age—and
to
sustaining
that
function
within
Island-‐resident
families.
Table
5.
Our
Island
Home
Residents
vs.
Town
Census
and
U.S.
Census
Counts
Observations:
1. Today,
ages
75+
account
for
19-‐21%
of
census
populations
but
83%
of
OIH
residents.
2. Populations
generate
OIH
residents
at
noticeable
rates
starting
around
ages
75+.