By Thomas Goldsmith
During a recent congregate lunch with Hertford County peers, Laura Sessoms, 71, reflected on her early years on a tenant farm, her 14 years in military service and her life these days as an older North Carolinian.
In mid-conversation, Sessoms brought up adult day care centers, a state-backed service that provides daily support and nurture for qualifying people with dementia and other conditions. Having a safe place for older people who can’t stay at home also makes it possible for caregivers to have jobs and take care of daily errands.
“There used to be one in the area, but the closest one now is over 40 miles away, in Halifax,” she said. “I don’t know whether people have interest in doing it anymore.”
At the state capital in Raleigh, roughly a two-hour drive away, low-profile discussions of state funding for older people’s services — such as adult day care, senior centers, respite for caregivers, congregate meals and protective services for vulnerable adults that collectively cost tens of millions of dollars — tend to give way to louder debates with billions on the line.
Gov. Roy Cooper’s administration is working on a plan called All Ages, All Stages NC, employing government, businesses and nonprofits that would address many concerns of older people like Sessoms, contingent upon buy-in by the state General Assembly.
Tops on the list is a cross-department structure to confront the state’s dire shortage of direct-care workers who provide hands-on help for frail older people, Cooper said after a May event announcing efforts to boost services for aging people.
“We hope they take us up on it, because not only are we going to need that, we’re going to need housing,” he told NC Health News. “We’re going to need money for transportation. I know the Department of Transportation wants to put in more plans, particularly in communities where we know we have a lot of seniors.”
Parts of the program are already underway: matching provider companies who need direct-care workers with nonprofit agencies partially funded with state tax dollars.
But even as Cooper proposes such plans to support older North Carolinians, the reality is that few of those plans can be realized without new funding — something that’s largely under the control of the General Assembly. And as Republican-led lawmakers there have held the purse strings for the past decade, funding for priorities for seniors have received scant funding increases and sometimes have even been on the chopping block.
NC residents older than 85 to more than double
Over the past 10 years, the number of North Carolinians older than 65 has risen from more than 1.4 million, or 14.3 percent of the state’s population, to 1.8 million, or 17 percent. The number of people older than 85 is projected to more than double in the next 20 years — a sharp increase in a demographic that is more likely to need medical and long-term care.
“For the seniors, it needs to get better,” said Rosa McMillan, 64, of Murfreesboro, who was also at the congregate meal. “You notice the seniors have been put on the back burner.
“What we’re putting on the back burner we look at as being useless.”
McMillan returned to her childhood home of Hertford County after building a career as a senior project analyst at Memorial Sloan Kettering Cancer Center in New York City.
Cooper’s ongoing plan will involve picking priorities so that leaders can put together resources — including state spending amounting to hundreds of millions of dollars — among the legislature, local governments, business and nonprofits, according to state documents and interviews with principals.
“There’s been a lot of work done so far,” Cooper said. “But now if we can put this blueprint in place, I think we’ll have a more specific action plan to follow.”
In practice, Cooper and the Republican legislative majority have tussled over frying bigger fish: legislation that will determine how deeply taxes should be cut for individuals and corporations, whether Medicaid will be expanded and how much state employees, including teachers, can expect in raises.
Adult day care center numbers fall
Several topics often listed as priorities for the state’s capital-based North Carolina Coalition on Aging and other advocates for older people soon arose in talks with people and officials on the ground in low-income, diverse counties.
For example, the regional shortage of adult day care centers that Sessoms mentioned isn’t just a Hertford County or northeastern North Carolina problem. A waiting list has grown to more than 11,000 people for this and other mostly state-funded aging services because of the legislature’s and Cooper’s focus on those billion-dollar priorities, political observers say, as well as the pandemic and competition among provider agencies.
A recent NC Department of Health and Human Services list of North Carolina providers of the in-demand adult day care centers listed them in only 32 of 100 counties. Overall, adult day care agencies fell from more than 125 in 2007 to about 80 in early 2020 and have continued to drop. Their ranks were decimated by the pandemic and seemingly haven’t been rescued by legislation that lets county commissions adjust fees that were long stuck in place by North Carolina statute.
Was Sessoms interested in making use of adult day care?
“Not right now, but I’d like it to be there in case I had to do it myself later on,” she said.
She then noted that adult children’s role in looking after older parents has in many cases been lost to changes in small-town economies and changing patterns of family life: “Some people around here don’t have their children around.”
Within a few minutes, Sessoms had touched on North Carolina caregivers’ need for support, short-funded agencies competing for state-federal NC Home and Community Care Block Grants, and many counties’ situation of having more residents older than 65 than they do 17 and younger. Hertford County is among 85 North Carolina counties where young people tend to leave home.
“They have no choice,” said Claude Odom, 76, also among those gathering at the Murfreesboro NC Nutrition Site. “To have a decent quality of life, they need to go where the jobs are. The county has a limited number of people making hires.”
‘A bath on Tuesday and Thursday’
Like several of the older North Carolinians interviewed in mid-May, Odom has a deep, diverse background. He’s a decorated Army veteran and ordained Missionary Baptist pastor who retired in 2012 as the eastern counties administrator of the state Division of Juvenile Justice.
Odom cited the value of state-supported congregate meals for Hertford County’s older population as a chance for people to tell their widely varying stories in a setting in addition to church.
“Seniors like the fellowship; they like to socialize,” he said.
Another county seeing an outflow of young people who could take care of their elders is Robeson, in the southeastern corner of the state.
In Pembroke, Jo Ann Chavis Lowry, 75, head of the Lumbee Elders women’s group, related her own observations on low levels of state-mandated staffing at adult care homes such as Red Springs Assisted Living, where a relative lived.
“I’m from a big family, and we were in and out at odd times, so that was a plus,” Lowry said. “But some of those folks didn’t have anybody come in to check on them.”
On a weekend visit, she alleges she heard a staff member respond to other residents’ complaints about insufficient staffing.
“That gentleman at the desk says, ‘We don’t have but two people on staff this weekend,’” Lowry claimed. ”He says, ‘And they don’t get past [residents’ rooms] every day.’ He said, ‘They only get a bath on Tuesday and Thursday.’”
In 2021, the state Department of Health and Human Services fined Red Springs Assisted Living an amount settled at $1,000 after investigating an incident in which staff failed to provide “adequate supervision,” according to a state report.
The result was that a resident with dementia was documented as “wandering from the facility and being found by a local citizen on a busy road,” the report said.
Legislators looking at the issue in 2022 heard that state inspectors had cited 54 centers in the previous year for staffing lower than the mandated number: one personal care aide for 20 or fewer residents on first and second shifts and one aide per 30 residents overnight.
Long-term care industry leaders have long asserted that low staffing stems from inadequate state reimbursements for Medicaid residents.
Earlena Lowery, 80, of Pembroke, said her fellow members of the state-founded advocacy group Tar Heel Senior Legislature have worried that essential agencies such as the state-mandated, but largely county-funded Adult Protective Services units seem to take a back seat to similar services for children.
Two kinds of protective services
“One of the issues that we’ve been pushing ever since I’ve been with this group has been Adult Protective Services,” she said after the Lumbee Elders gathering at tribal headquarters in Pembroke.
Figures from the state NC Office of State Budget and Management show that Child Protective Services support rose from $181.89 million in 2017 to $231.7 in 2022, about a 27 percent increase. Making comparisons in actual spending is difficult given the sections’ varying purposes, funding and the variety of people served.
Could state government favor children above seniors? She’s aware that such a claim could set off alarm bells.
“The state doesn’t give Adult Protective Services any money,” Lowery said. “But when you look at Child Protective Services for children — don’t get me wrong now; they need that money — But then when you look at what they do for adults, it’s nothing. We need to be protecting all of our people.”
State coffers have provided little funding for Adult Protective Services, relying on county and federal taxpayers to pick the tab.
In 2021, the state budget directed a federal grant of $2,579,576 to support Elder Justice and Adult Protective Services. The legislature sent $893,041, also in federal funds, to pay state workers to assist counties, whose funds were running thin to meet their state-mandated charge to protect vulnerable adults under Adult Protective Services.
In the most recent budget, the state listed $574,871 for both Adult Protective Services and Guardianship for the year, up less than $25,000 from $520,649 per year in the 2017-19 biennium. In the same budget, legislators provided $21,006,583 annually in state funds to Child Protective Services.
Lowery also cited the value of socialization after a meeting at one of the tribe’s 15 such sites; Robeson County operates one senior center, paid for in part by federally- and state-funded Home and Community Care Block Grants.
“Someone had the foresight to do this,” Lowery said during a gathering of the Lumbee Elders women’s group. “Sometimes we come in and just talk. We have a business meeting the first of the month and sometimes all that morning is spent, just to share what’s going on.”
Also at the Pembroke gathering, Jo Ann Lowry brought up the modest state Personal Needs Allowance that the General Assembly increased last year for Medicaid-assisted residents of assisted living facilities. Under a House bill with bipartisan sponsors, residents of nursing homes who rely on Medicaid would also get an increase in the allowance. Residents have said the amount goes quickly when needed to pay for anything from snacks to haircuts, sodas to rides to church.
“If they got her a drink, it was a canned drink,” Lowry said of a relative’s stay at a Robeson County assisted living home. “It came out of her personal money.”
Small counties’ aging funding can fall short
Based on changing county population levels, money to pay for services such as senior centers varies widely across the state. Funding formulas are such that counties losing population can see overall decreases. That’s what happened with a reduction of nearly $25,000 for aging services in largely rural Hertford County, where more than one in five of about 21,000 residents is 65 or older.
Diedra Evans, 61, director of the Hertford County Center for Aging in Winton, population 625, said when asked whether she would like to see more state support for older people in her county: “I can’t imagine anybody in my position saying anything different. There’s always more need than we can provide for.”
A long-standing complaint in state government and politics, held by many in eastern and western counties, that big shots in “Raleigh” — shorthand for government and legislative leaders — only give lip service and run out of money when it comes to meeting their needs.
Feeling neglected across the state
“East of [Interstate] 95 we kind of get neglected,” said Claude Odom, the minister and retired state official in Hertford County.
In a telephone interview from Western North Carolina, Norma Duncan, 86, nearly echoed Odom’s take from her vantage point as a longtime state employee and speaker of the Senior Tar Heel Legislature.
“In the west, we are left out. We feel left out,” Duncan said. “We are aging in the west, we are older and not as affluent.
“We need some help from the General Assembly — a feel for how it’s different here.”
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