Where will the elderly go?
Those are the words statisticians use to describe what happens to the senior citizens of Eagle County when their health reaches a point they can no longer take care of themselves. Because the county lacks an assisted living or nursing home facility, many are forced to move away from their community, family and friends.
Local government leaders describe the situation as a financial and social dilemma. The seniors and their friends and family who take care of them call it a problem.
There is an assisted living/nursing home facility in Eagle’s future; but it’s far enough out that nobody’s willing to put a date on it. A 30-bed assisted living facility, 60-bed extended care, and an adult day care service are included in plans for the combined medical campus that Vail Valley Medical Center in Vail and Valley View Hospital in Glenwood Springs plan to build on a 16-acre parcel in the Eagle Ranch subdivision.
Assisted living facilities accommodate people who are ambulatory and somewhat independent, but need help with aspects of everyday living such as cooking meals. Extended care facilities, often called nursing care or long-term care, are for people who have physical disabilities that prohibit them from living independently. Adult day care provides supervised help for clients during daytime hours.
Eagle Ranch donated the 16-acre parcel for the health care facility. Groundbreaking for the first phase, the medical clinic, is tentatively scheduled for 2005. The future phases of the project are distant enough that nobody is willing to put even a tentative date on them.
“It would be welcome… nobody wants to leave if they don’t have to,” says Joyce Reiche, 71, of Eagle.
Before the skiers
Peggy Buckau of Eagle points out that her parents, Eileen and Rolland Randall, lived in Eagle County all of their lives until three years ago, when they could no longer stay in their own home. Because there was no facility locally, the family moved them to a nursing home in Garfield County where they died this year, at the ages of 91 and 97. For three years, Buckau made the drive to Carbondale from one to three times weekly.
“I do not think it is fair to the residents and their ancestors who held this county together before the first skier got here. I know at one time we were the second richest county (in the state), and still may be. The whole situation is unbelievable,” says Buckau.
“We definitely need both assisted living and a nursing home. We should take care of our own,” says Eagle resident Terry Schiessl, 67. For the past three years, she’s been driving at least twice a week to Carbondale to visit her mother, who is a resident of Heritage Park Nursing Home. Since her mother suffered a stroke on Jan. 3, Schiessl has stepped up those trips to every other day.
“That’s two hours on the road, and that doesn’t include the actual visiting time. It’s rough. There’s a lot of stress involved,” she adds. Ticking names off on her fingers, Schiessl counts at least nine valley residents who have ended up in the Carbondale facility in the past six months.
“Surely, surely, surely somewhere there’s some money,” for building an assisted living facility locally, she says.
Need vs. finances
Money, however, is the issue that prompted Eagle County to step back from announced plans for construction of an assisted living facility. Three years ago, the county commissioners assured local senior citizens they intended to build some assisted living units adjacent to the Golden Eagle senior citizen apartment complex in Eagle. So certain were the commissioners of their project, they ordered the community garden plots that occupied some of the space to be dismantled, and paid for blueprints, and an architect’s model of the proposed facility.
It never happened.
County Administrator Jack Ingstad says that despite “full-speed ahead” directions from the county commissioners, the county staff was nervous about the financial feasibility of the project. Experts were consulted and after further investigation, county officials concluded the intended site was too small and the operating costs of such a facility was more than the county could handle.
County Commissioner Tom Stone says the problem was that the commissioners wanted a facility in which 25 percent of the residences would be available to seniors with limited incomes eligible for Medicaid. The balance of the units would be rented out at market prices.
Medicaid payments run somewhere between $500-$600 less per month than the actual costs of keeping a person in assisted living, explains Elisabeth Borden, of the Boulder-based Highland Group, a business that does market research and feasibility studies for all forms of senior housing.
Stone says that in order to make the project financially feasible, all of the residential units would have to be rented at free-market prices.
“We did further research and determined that though we have a few people who are vocal about the need… there is not really as much need as we thought,” says Stone.
“You cannot cash flow (an assisted living facility) in the positive, using any kind of Medicaid,” says Eagle County Housing Director KT Gazunis, “Our whole purpose is to help people who are in the most need.”
A common problem
“It is extremely difficult in Colorado to serve low income people right now,” says Borden. “Rural communities trying to do some assisted living facilities around the state are finding it somewhere in between impossible and extremely difficult.”
Jim Sheehan, executive director of the Grand County Housing Authority, which owns and operates Cliffview, a 24-bed assisted living facility in Kremmling, echoes Borden’s observations. At that facility, 50 to 60 percent of the inhabitants are Medicaid patients. He credits strong community support, and a dedicated staff that has gone two years without a pay raise, for helping keep the cash flow positive.
“It’s definitely a struggle,” says Sheehan.
Economy of scale is an issue. The beds in the Kremmling facility are typically full, which helps the cash flow. Sheehan says some assisted living facilities in rural areas go under because they can’t fill the beds. Rising utility rates compound the problem. A facility in Craig in northwestern Colorado is currently struggling for those reasons.
Borden says the demographic rule-of-thumb for operating an assisted living facility is that somewhere between 7 and 12 percent of the local population must be age 75 or older. The 2000 census estimates only about 3 percent of Eagle County’s population is over the age of 65.
Both Borden and Teri Whelan, executive director of Senior Housing Options, a private, nonprofit organization that promotes creating different types of housing for seniors, say state finances and politics are playing a role in the current financial dilemma assisted living facilities face.
When the state budget crisis hit, less money became available for such projects. There’s also been a change in standards for who is eligible for assisted living type care, says Whelan. The end result is that people have to be in poorer health in order to qualify. Whelan says that 10 years ago, when the Grand County facility was built, the assumption was the state would keep Medicaid funding highest enough to cover costs. Things changed with the new state administration.
“For a number of us who spent years helping rural communities to develop affordable assisted living, it is really sad,” says Borden, noting that in some states such as Washington and Oregon, the state pays more for such programs – and low income people have much more access to care options.
Turning the situation around will require a recovery of the state budget and “an increasing sort of political will to divert more people away from nursing homes,” she predicts.
Borden said the Bush administration and other politicians are promoting the philosophy of keeping people out of nursing homes and moving them to alternative care facilities. “I think it’s going to take a while,” she says.
Buckau, however, points out there comes a point when home care is not possible. Local residents and their caregivers would still prefer to see care facilities locally.
Searching for solutions
Eagle County hasn’t turned its back on the senior population. The county recently stepped up as the buyer when the Golden Eagle senior housing complex went on the market. County officials were concerned about keeping rents affordable at the facility.
Stone says the county is exploring the possibility of building more senior apartments on the undeveloped parcel that is part of the Golden Eagle complex. As for assisted living, he says, the county is still exploring options.
“Maybe we will do it in different way,” he says, citing a partnership with the hospitals in their facility at Eagle Ranch as a possible option.
“It’s not that assisted living is not a focus or an interest. It is. The question is, can we make it work?” says Stone.
Gazunis says she will discuss the issue further with the commissioners in the spring. Options including exploring ways to increase the level of services for people in order to foster independent living, such as through increased in-home care services.
“What (seniors) really, really want in life is independent living. They need additional help to stay independent longer,” says Gazunis.
“It would be nice if something could happen. People really need and want it,” Borden adds. “They don’t want to go down to the flatlands just because they need some extra assistance.”
This story first appeared in the Eagle Valley Enterprise.