The Aging of Martha’s Vineyard: Community needs, community costs

Over recent decades, the life expectancy of people over the age of 65 has dramatically increased. The Social Security Administration reports, “A man reaching age 65 today can expect to live, on average, until age 84. A woman turning age 65 today can expect to live, on average, until age 86.5. About one out of every three 65-year-olds today will live past age 90, and about one out of seven will live past age 95.” Longevity, however, does not equal wellness. Few individuals over the age of 85 are free of problems. The National Health and Aging Trends Study estimated that over 50 percent of adults 85 to 89 have poor physical, sensory, or cognitive capacity. Limitations for many occur much earlier. Twenty-one percent of individuals ages 65 to 69 have similar limitations. As we age, we need more help to do the things we would like to do.

In 2015, Healthy Aging Martha’s Vineyard (HAMV) conducted a community survey of 4,750 Vineyard residents 65 or older — a large sample of the 5,600 seniors who call the Vineyard home. We found that 21 percent of seniors were 80 years old or older; 29 percent reported living alone; 25 percent stated they had limited mobility; 7 percent noted limited ability to live independently; 28 percent had a fall in the preceding year; 15 percent reported “no or not sure” when asked about the availability of short-term help; and 56 percent answered “no or not sure” when queried about the availability of long-term help. These statistics describe a picture of vulnerability for a large segment of our community. This already large number of vulnerable neighbors will continue to increase as our community ages.
We also know that the older residents of our community like where they live, and would like to stay here. The overwhelming majority of residents over 65 live in a single-family home (90 percent), and own their home (88 percent). Eighty-eight percent reported no plans or desires to leave the Vineyard. These expectations may not be future reality. The federal Administration on Aging estimates that approximately 70 percent of individuals over the age of 65 will spend at least some time in a nursing home or need similar support. And 20 percent will become long-term-care residents.

Living longer well requires the help of others. This need for help occurs in all areas that affect older adults — healthcare, housing, community services, transportation, organized volunteer services, and the support of family and caregivers.

These needs provoke a wide array of questions. In healthcare, older adults need access to specialists who treat the diseases that come with aging. How can these specialized services be provided to an Island population? All those who treat older adults need to be competent in the special issues that age brings — especially in the frail elderly. In a small community of healthcare providers, how can geriatric expertise be maintained? Large single-family houses often become “too much” for a senior who lives alone. A large home without appropriate modifications can be ill-suited to a person with mobility issues. We know that a majority of seniors want “to age in place.” Who can help them to do that? We know that families provide most of the care to their frail older adult members. The burdens of such care can be overwhelming. With our Island status and smaller families, how can we as a community help one another make that burden less?

Fortunately, our community is blessed with a number of excellent services focused on the needs of older residents. We have an excellent hospital, devoted healthcare professionals, and an organizational affiliation with a world-class health system. Our four Councils on Aging (COA) provide social engagement for seniors who might otherwise become isolated. Additionally, the COAs as well as M.V. Community Services have outreach programs for frail or distressed elders. The Center for Living provides critically important services for our neighbors with dementia. Elder Services of Cape Cod and the Islands (ESCCI), our designated area-wide agency on aging, works to protect the most vulnerable seniors and provide “meals on wheels” to those at risk of poor nutrition. Island Elderly Housing provides homes for some who are able to live alone. Our libraries, our Y, our churches, and many other organizations engage seniors. HAMV’s survey found that 53 percent of respondents participated “often” in some community activity; an additional 35 percent participated “occasionally.” However, 12 percent reported they did not participate at all.
The services that exist all require resources. These resources come from a variety of sources — federal and state funds, philanthropy, health insurance, local government, and family and personal expenditures. Volunteerism is a substantial noneconomic resource. As our senior population increases, our needs will increase. We know that our town budgets already appear to be strained. Yet a review of town expenditures estimated that towns spend less than 5 percent of their annual budgets on direct social services — for all ages, not just seniors. Despite their relatively small size, these town expenditures are critical to enable the services that make it possible for older adults to live on the Island.

What can be done? First, we can reframe the “community costs” incurred in taking care of each other as “community investments.” We rightly consider our expenditures on schools and public works as investments in our community. Expenditures on making our community “age friendly” are also community investments. Being an age friendly community brings considerable benefits, not just costs. In future essays, we will discuss these economic and social benefits of an aging community. 

This essay is the third in a series written by Leon L. Haley, Ph.D., and Robert Laskowski, M.D., on the aging phenomenon on Martha’s Vineyard. Haley is a Professor Emeritus of Public Policy at the University of Pittsburgh. Dr. Laskowski is a retired geriatrician and healthcare executive. Both writers are active members of Healthy Aging M.V.