Utah is the youngest state in the U.S., with only about 11 percent of its population at 65 or older. Older Utahns are projected to represent 22.8 percent of the state’s population by 2060, however.
Geriatric leaders discussed options to ensure this growing population has the resources needed to thrive at the 2024 Utah State of Reform Health Policy Conference in March.
Paul Leggett, division director at Salt Lake County Aging and Adult Services, said representation is vital when discussing services for older adults. He said all health issues—such as housing, access to care, domestic violence, and more—have an impact on older adults.
“Just because somebody turns 60, all of the indicators and identities and everything else that they had prior to turning 60, that doesn’t go away,” Leggett said. “So all of our social issues that are with us throughout our entire life continue with us as we get older, and they all have an aging perspective that’s different.”
Leggett said services for older adults also need to be adaptable.
Nels Holmgren, director of the Division of Aging and Adult Services (DAAS) at the Utah Department of Health and Human Services, said many older adults go through their lives without ever needing or interacting with the division’s services.
“They are healthy, they’re independent, they have planned well, [and] they’ve got family and formal support structures,” Holmgren said. “The bad news is, the people who need our services tend to really need our services.”
Holmgren said many people who need DAAS services may not have the same support or opportunities as others throughout their lives.
Anne Asman, program manager at the Huntsman Mental Health Institute Geriatric Psychiatry Clinic, said ageism plays a large role in how older adults receive care and support, and is detrimental to their health. Ageism is more prolific than ever, she added, and many organizations and groups perpetuate it.
Leggett said a micro-version of ageism often comes from well-intentioned people. His agency runs Salt Lake County’s Meals on Wheels program, which many older adults participate in.
“We have so many [people saying], ‘My neighbor needs Meals on Wheels,’” Leggett said. “Well, we need to talk to your neighbor because it’s their choice about whether they’re going to receive Meals on Wheels.”
DAAS runs the state’s Adult Protective Services (APS). Holmgren said APS gets similar calls from well-intentioned people about older adults who may need help, but are actually doing well on their own.
Holmgren said APS deals with situations of self-neglect, as well as family issues, and financial exploitation, but many older adults do not need APS.
“The operative word there is ‘adult.’ APS frequently gets compared with Child Protective Services and it is not the same thing. We don’t remove seniors from their homes. They’re adults. We bring in services and we may have to help them navigate a different situation, but it’s not a custody situation.”
— Holmgren
Alan Ormsby, state director at the American Association of Retired Persons (AARP) Utah, said arbitrary age caps on certain things play into ageism. He said there does not need to be a “magic number” representing when someone needs to stop doing a certain activity.
“Think about the function,” Ormsby said. “If a person is functionally able to be a pilot and they’re 72, God bless. If they’re 77, God bless. These are the kinds of things, policy-wise, we can fight against.”
Asman said older adults need to change the narrative, and the way they think and talk about themselves. She noted that learning to adapt as an individual ages is beneficial because adults who have a positive attitude toward aging live around 7.5 years longer than those who view aging as negative.
“If you are not willing to adapt to whatever circumstances you face as an older adult, whether it’s using a cane, whether it’s not driving, whether it’s having to have someone come in and take care of you, you are not going to thrive.”
— Asman
Caregiving is another major aspect of older adult care. While not everyone will need it, many people will experience caregiving in one capacity or another. Asman referenced a Rosalynn Carter quote, who founded the Rosalynn Carter Institute for Caregivers.
“Her quote is, ‘There are only four kinds of people in the world. Those who have been caregivers, those who are currently caregivers, those who will be caregivers, and those who will need caregivers,’” Asman said. “And I don’t think that’s disputable at all.”
Holmgren said caregiving is often an open-ended necessity. He discussed the division’s centenarian celebration, which displays many different caregiving relationships.
“We’ve had situations where the 103-year-old mother was pushing their 85-year-old son in a wheelchair into the [celebration],” Holmgren said.
Leggett said caregiver burnout is a pressing issue. Anecdotally, Leggett said he has heard of many caregivers dying before the person they care for. He said caregivers carry the burden of making up for the lack of funding for services for older adults.
The cost and need for services has only gone up, and will continue to do so, Leggett said. He highlighted the Utah Legislature’s approval of almost $2.4 million to support the Meals on Wheels program across the state, but said the one-time funding is just enough to keep current services operating.
Leggett said lawmakers need to know about the real cost for services, which is why older adult representation matters. He said people need to think about the services they might want when they are older.
“We’re all getting older. That’s the goal, right? If we’re not getting older, what’s the alternative? We’re not around anymore.”
— Leggett
Ormsby said caregivers often experience major financial burdens.
“We have done studies at AARP and found that, on average, a caregiver spends about $7,000 of their own money caregiving,” Ormsby said. “They’re never going to see any of that back. So what about tax breaks? What about tax opportunities? If you can document the spending you’ve done, maybe you ought to be able to write that off on your taxes.”
Utah has been creative in providing some financial resources for caregivers, Ormsby said. He said if a spouse or child is providing their family member with extraordinary care, there is an opportunity for that person to receive funding. He said this is especially important for women, as they often become caregivers, though the gap between male and female caregivers has been closing in recent years.
“When they [become caregivers], they frequently stop earning as much money, they are out of the social security program potentially for years, and so when retirement rolls around it’s very difficult for older women, especially, to have a secure financial future when they retire,” Ormsby said.
Leggett said male caregivers are less likely to accept or ask for help, which leads to crises. He said it is important to move away from the gender dynamic of women being the only caregivers, and move to a family caregiving system.
Holmgren highlighted Utah’s caregiver support system, which is administered by the state’s counties. He said the program was updated about 25 years ago to include support for grandparents caring for their grandchildren.
Asman highlighted the Centers for Medicare and Medicaid Services’ program called Guiding an Improved Dementia Experience (GUIDE), which provides up to $2,500 per year for respite care to caregivers in order to keep people with dementia in their homes longer. While GUIDE does not provide enough money to fully support caregivers, it is an important start, she said.