A web of health needs for older Islanders

On an Island where one in three locals is of retirement age, there’s an abundance of senior services such as meal programs and enriching events. But adults over the age of 55 on the Vineyard face a lack of affordable housing, and a dire need for more localized primary care and specialist providers. There’s also been a documented uptick in mental health concerns among older adults, including a pervading sense of loneliness. 

According to a recent report, there are emergent gaps in services for one of the largest population groups on the Island. Alex Elvin, the research and communications manager at the Martha’s Vineyard Commission, interviewed health providers and program directors and combed through available data to create the Martha’s Vineyard Older-Adult Service Analysis, which the commission released in October. 

The report outlines possible solutions and opportunities for more services going forward. It was initiated by Healthy Aging Martha’s Vineyard, a nonprofit that advocates for aging Islanders and was responsible for the last assessment of adult Vineyard residents in 2021.

Elvin said the data he collected is mostly qualitative — he took a holistic view of the resources available to older adults through interviews with and information gathered from more than 61 different institutions and providers, such as Island Elderly Housing and Martha’s Vineyard Community Services.

“It’s a pretty complex, organic system,” Elvin said of the web of programs available to older adults on the Island. “So I think the qualitative approach really worked.”

Elvin organized the report by concern level. Affordable housing, mental health services, and transportation were some areas of “high concern,” meaning there was a notable lack of support in those areas. Immigration services, assisted living facilities, and homelessness prevention were of “moderate concern,” and administrative assistance, enrichment activities, and fitness programs were considered “stable.”

While some issues didn’t come as a shock to Elvin, such as the lack of affordable housing, minimal transportation services for off-Island appointments, and not enough primary care providers, other information he gleaned was a surprise. 

“More than half the people we spoke with identified loneliness and isolation as a concern for the older adults they serve,” Elvin said, and added that he didn’t expect that to be so high on the list of problem areas. 

A lack of consistent mental health services was one takeaway in a recent Community Health Needs Assessment, published a few weeks prior to the M.V. Commission’s report. All age groups across both reports reported a lack in continued and affordable mental health services. 

“Elder Services of Cape Cod and the Islands and the M.V. Community Services CORE (Counseling, Outreach, and Referral for the Elderly) program both have waitlists, and private clinicians have few openings for new patients. Overall, there are very few options for geriatric behavioral health support on the Island,” the analysis stated. 

Highlighted in the report was the impending move or closure of the Red House — the Island’s only recovery center for substance use disorders. “A large portion of Red House Peer Recovery Support Center members are 60 and older,” the report stated. “But there are likely many older adults who are not utilizing its services due to stigma.” 

And while there are many enrichment activities, an area that the report identified as “stable,” there are not enough resources for other health needs. Primary care doctors are reportedly in severe short supply, even with an expansion in medical services since the pandemic. 

“The shortage of [primary care physicians] on the Island is closely tied to the cost and availability of housing, and the cost of living in general,” the report stated. 

The Martha’s Vineyard Hospital administration has spoken about the difficulties it has had hiring primary care and specialist physicians before, and has noted that the cost of living and exorbitant housing prices on the Vineyard have deterred possible applicants. 

Transportation, or the lack thereof, was elevated in the data findings, as many older locals who might not have their own car or the ability to drive have minimal options for getting to appointments off-Island. The Transportation Access Program (TAP), an offering through Martha’s Vineyard Community Services (MVCS), was canceled this year after state funding was discontinued. TAP provided transport on and off the Island for various appointments, and had served 600 locals since 2016 — the majority of whom were over the age of 60. 

MVCS representatives were quoted in the report saying they’re looking to keep the TAP service going — at least on a case-by-case basis. “Demand from seniors on fixed incomes has grown, and there is increased awareness and outreach among immigrant, African American, and low-income populations to access [the] TAP,” MVCS stated in the analysis. 

Telehealth, which is the use of technology to provide healthcare (usually over Zoom or other video services), is a possible solution to many of the issues that were noted in the report, like lack of providers and transportation. But the report stated there’s not enough tech assistance for aging Islanders, and fewer use it as a result. And as of September, Medicare no longer covers telehealth appointments for patients in rural areas outside of a medical facility, which includes Martha’s Vineyard. 

Elvin said the lack of telehealth support services coincides with a general sense of loneliness in the aging population, as well. He added that “social prescribing” — a healthcare model where community action is prescribed as a treatment — could be a way of engaging people and meeting them where they are. 

“It’s a huge priority for them to remain active, either fitness classes or outdoors,” Elvin said. He added that the Vineyard has many trails, conserved land, and classes specifically geared toward those activities. “That’s another example of services and opportunities interacting with each other,” he continued. 

Meanwhile, housing remains a large issue across the board — not just for healthcare providers but also the people they serve. While there are a few elderly housing options on the Island, such as Havenside in Vineyard Haven, the waitlists are extremely long. 

Skilled, long-term care facilities exist, and new developments, such as Navigator Homes, will provide more support in this area in the coming years. But even the new builds don’t address the entirety of the population that needs this type of care. And when older adults age in place and hire a caregiver instead of entering a care facility, their homes aren’t marketed to a younger generation looking to purchase a house. Experts say the cyclical nature of housing supply can get easily stunted when there’s a lack of elderly housing availability. 

The report identified accessory dwelling units (ADUs) as a way to ease housing shortages and enable either aging individuals to live next to their adult children’s homes or caregivers to live in an ADU on an elderly person’s property to assist them effectively. 

But the report also identified financial strain in older adults, with more than 5 percent of Islanders over the age of 55 living in poverty, and many more in the low-income bracket. With construction costs high, building an ADU may be out of reach for some older adults who are on a fixed income.

While Dukes County has a higher median income than the rest of the state at over $100,000 — though that is skewed by a portion of the local and seasonal population being very high-income — the median income for older adults is lower, at a little over $80,000 a year. 

“Food and financial security were also very common concerns,” Elvin said. “There have been issues with federal funding cuts, including for food programs.” But he did point to Meals on Wheels as a significant support for the older population. 

Part of Elvin’s motivation for the report was to provide an understanding of the current situation for aging locals, but also to provide a framework for their needs going forward. Dementia and cognitive support were identified as concerns that will only grow as older adults age in the coming years. Most health insurance, including Medicare, does not cover dementia care, and there is not an abundance of significant funding help or free services available on the Island. 

“We looked at ways to try to estimate how many people might need [dementia and cognitive support] in the next 10 years or 20 years,” Elvin said. “And that all overlaps with home care, respite services, so that’s something that we hope organizations will prioritize going forward.”