The proportion of Wyoming residents over the age of 65 is growing faster than any other state. In order to adequately address this societal phenomenon, the state’s economy will need to fill the needs created by this new generational dynamic. And it will take a combination of federal, state and private services to empower Wyoming residents to successfully navigate their vulnerable years of older adulthood, officials say.
The Wyoming Department of Administration and Information’s Economic Analysis Division released a report in June confirming that the trend of Wyoming’s population growing older has slowed some, but continues to outpace the rest of the nation. Wyoming Chief Economist Wenlin Liu said the state’s moderate-paced recovery from economic recession likely played a role, as young workers were more likely to move to neighboring states that experienced stronger growth.
Furthermore, those officially belonging to the baby boomer generation are now ages 54-72. In the next decade, they will graduate into being classified as senior citizens.
“With the currently low unemployment rate, and if millennials continue to move to big metro areas, the state may face a serious labor force shortage and faster population aging in the near future,” Liu said.
Wyoming Department of Health statistics estimate that in 2017, there were 16.8 working-age adults for every resident over the age of 80. By 2030, that ratio is projected to be 10.1 to 1. This means there will be fewer people paying into social safety net programs and fewer adults available to provide informal unpaid care.
“I think one of the challenges for Wyoming is the very rural, frontier nature of our state,” Wyoming Department of Health Aging Division Senior Administrator Lisa Osvold said.
The existing spectrum of resources for senior citizens begins with state-funded help in private residences that may involve a few hours every other week and may progress into more hours or more frequent visits for help with things like light housekeeping, cooking or transportation to run errands. These services are provided at senior centers around the state to anyone over 65 who requests them.
When someone’s age prevents them from living at home safely, assisted living or nursing homes often prove to be too costly for many people who spent their lives solidly in the middle class. People who saved their whole lives to accumulate a respectable retirement income can see their bank accounts drained in a matter of years due to the high cost of institutionalized care.
As it stands, community entities that provide much-needed support for the elderly are walking a logistical tightrope.
“Wyoming has what seems to be a pretty limited number of resources for health-care needs, and those needs increase as one ages,” said Catherine Carrico, associate director of the University of Wyoming Center on Aging. “Someone might require additional specialty care, more services that help them stay in their homes, home health or other home services, and there are areas in the state that do have shortages of those services, and that is a concern.”
Carrico said one of the biggest issues on her office’s radar, as well as the state Legislature’s, is the need for certified nursing assistants.
“One specific need we have in the state is CNAs. They are the ones that provide a lot of direct care, especially in nursing home settings,” she said. “We are struggling to get people into those jobs because of how hard the work is for low pay.”
CNA pay is generally $10-$12 per hour, and the profession has a notoriously high turnover rate. Carrico said many CNAs vacate their positions because they advance to higher certifications or administrative jobs.
Osvold said the state-run Wyoming Retirement Center in Basin is one of many that is constantly challenged to attract and retain its workforce. She said the facility’s turnover rate for direct caregivers is 40%.
“Across the spectrum, it’s low pay and very hard work, and, unfortunately, it doesn’t get the respect it deserves,” she said.
Jonni Belden, senior administrator at Legacy Living and Rehab in Gillette, said her facility, like many in the state, hosts an in-house certification program to continually train new care providers in order to keep staffing levels as balanced as possible.
“Do I feel like we have the workforce in place that we need right now? No,” she said. “I feel like health care, as a whole, is in crisis in terms of having enough qualified, confident staff to take care of our aging population.”
Rachel Brown, assistant director of the Casper Senior Center, said her center presently has a wait list of 40-50 individuals who have requested home services because of the shortage of qualified workers.
“We were awarded money by the state to hire more direct caregivers,” she said. “Our problem is finding folks who want to work.
“It breaks your heart when people call and ask, ‘Where am I on the list?’ You know they need those services.”
Casper Senior Center Director Rita Wagner agreed. “The programs we are talking about – they don’t sound like a lot, but it’s those little things that help those folks stay at home, and that’s what they want.”
Osvold said many Wyoming counties do not have a strong support system in place for unpaid caretakers.
“Currently, we only have the National Family Caregiver Support Program in 11 counties,” she said, referring to the federal program that provides respite care, resource referrals and supportive services to informal caregivers.
“The reason is because that program requires a 25% match from the state or local entity,” she explained. “That match was provided by the state in years past, and that was reduced. What happened was that the 25% match required by the feds was passed on to providers, and many, many providers cannot provide that match, and it’s a shame because then we miss out on a lot of money.”
Patricia Stewart of Sheridan has worked as a direct care professional for 20 years. She started her own business, Phoenix Private Care, five years ago to avoid some of the classic pitfalls of her profession.
“Nursing homes overload you with work. They never have enough staff,” Stewart said, adding that she strongly wanted to stay within the realm of direct care, instead of moving on to nursing, which would decrease her time with patients and increase her time doing paperwork.
“My goal is to keep them home until they take their last breath in the comfort of their own home,” she said, adding that most of her clients require 24-hour care. That means she must put together a staff of four to six employees for each person. The task of finding caretakers takes a few months.
Stewart said her background as a direct care worker has translated to more worker-friendly policies for her employees, but even then, she feels the shortage of the right people.
“It feels like I work more as an employer than an employee,” she said.
The longstanding workforce shortage is likely to increase in the coming years, as one-fifth of the state’s population is expected to be over 65 by 2030. The Wyoming Department of Health believes Wyoming Medicaid for long-term care could increase from $130 million in 2017 to as much as $312 million in that timeframe.
“We have seen so much growth we had to amend our waiver to keep up with enrollment,” Medicaid Community-Based Services Administrator Tyler Dienes said.
The area where the state can have the most leverage in keeping costs down is by promoting home care in lieu of institutions, which is also what most patients desire.
Dienes said Medicaid’s Participant-Directed Care Program allows seniors to act as an employer to hire and train their caretakers.
“Someone can hire their friends, neighbors or a family member, and we can pay for those services,” he said. “We also try to encourage providers that are serving other populations to enroll with the Medicaid waiver and serve adults, as well.
“We do our best to recruit providers and maintain a network to provide statewide access to care. In some areas, even in the Capital City, it can be difficult to find a Medicaid provider for CNA or nursing.”
“I feel like policymakers and lawmakers are really aware of this boom, and we are trying to address it through a variety of means,” Osvold said.
The state’s safety net programs will undoubtedly face increasing costs related to senior care. These challenges will be met with a decreased ratio of workers to retirees, and stripped down workforce availability.
“It’s going to take all levels of community and state government to be in alignment for us to address this creatively and with innovation, because it’s coming, and we can’t stop it,” Belden said.