2023 Report to the Community

Publication of Pima Council on Aging, Helping Pima County Age Well Since 1967

Aging in Pima County A REPORT TO THE COMMUNITY

Acknowledgments Thanks to all who contributed to the 2022-2023 Community Needs Assessment process and development of this report. PCOA STAFF Danyelle Moreno Community Outreach Specialist Gretchen Luhr Data Analyst Jan Slonaker & Rebecca Manchester Communications and Design Specialists Sarah Spearman Vice President of Philanthropy & Communications Victor Quiros Vice President of Operations W. Mark Clark President & CEO CONTRACTOR Maddy Bynes-DeVaney Bynes Consulting Group, LLC Photography provided in part by Tom Spitz, Scott Griessel/Creatista, Jocelyn Markeson, and iStock.

Letter from PCOA President & CEO . . . . . . . . . . . . . .............. 4-5 Executive Summary . . . . . . . . . . . . . . . . . . . . ..................... 6-7 Key Comparable Findings to Previous Assessments . . . . . . ....... 8-9 Falls/Fear of Falling . . . . . . . . . . . . . . . . . . . .................... 8 Transportation . . . . . . . . . . . . . . . . . . . . . ...................... 8 Caregiving . . . . . . . . . . . . . . . . . . . . . . ........................ 8 Aging in Place . . . . . . . . . . . . . . . . . . . . . ...................... 9 Identified Issues & Problem Areas . . . . . . . . . . . . ............... 10-11 Homelessness/Affordable Housing . . . . . . . . . . . . ............. 12-13 Aging in Place & Living Independently . . . . . . . . . . ............ 14-16 Social Isolation & Loneliness . . . . . . . . . . . . . . . ................ 16-18 Access to Health Care & Social Services . . . . . . . . . . ........... 18-19 Family Caregiving . . . . . . . . . . . . . . . . . . . . ..................... 20-21 Transportation . . . . . . . . . . . . . . . . . . . . . ....................... 21-22 Alzheimer’s and Other Forms of Dementia . . . . . . . . . .......... 23-24 Barriers to Technology . . . . . . . . . . . . . . . . . ................... 24-25 Demographics . . . . . . . . . . . . . . . . . . . . . ...................... 26-29 Historical Perspective . . . . . . . . . . . . . . . . . . ................... 30-31 TABLE OF CONTENTS

Our communities across Pima County are full of stories about the lives of older people. Here in the pages of A Report to the Community: Aging in Pima County 2023 , data and survey responses provide a compelling narrative for all of us to better understand the key issues identified by more than three thousand adults aged 50 and older who engaged with PCOA during this process. We are excited to engage our community through the results of this report. Education and advocacy are core to our role as an Area Agency on Aging, and the results of our 2022-2023 Community Needs Assessment, published in this report, allow us to not only provide the most effective services possible to our community, but also advocate for and educate community leaders about aging in Pima County. As the only comprehensive community assessment of its kind for and about the needs and concerns of older adults and their caregivers in Pima County, A Report to the Community: Aging in Pima County A Message from our President & CEO

2023 , affords a look at the current state of older adult residents, highlighting what we are collectively doing well, and where we need to improve. This new report is the official compilation and analysis of that data and an exploration of the critical issues facing our community. We know that aging well often leads to positive health outcomes for our entire population. Among them: improving the health and well-being of older adults and benefiting other residents, businesses, organizations, and local governments by fostering the economic and environmental health of the community. Since the last time we published this report, we used the data and information gathered to guide some of our most important and impactful projects, programs, and initiatives of the last five years. One such innovation and impact has been our involvement establishing the city of Tucson as a livable community. Since our last Report to the Community, published in 2017, we have proudly partnered with the City of Tucson, United Way of Tucson and Southern Arizona, and AARP Arizona to draft, adopt, and implement the Age-Friendly Tucson Plan, which lays out an effort to make our community more livable and friendly to people of all ages and backgrounds. In an effort to make our community more livable, we have heavily invested our time and resources over the past decade into quality family caregiver support and direct care worker programs. Our three-pronged approach for ensuring that older adults can age well in our community includes our Older Americans Act family caregiver support programs and services, professional in-home care through PimaCare at Home, and creating a pipeline of qualified and trained caregivers and medical professionals through our 2020 acquisition of the CareGiver Training Institute. We know there continues to be work to do to make our community livable, but the foundation we have built over the past decade gives us a strong path forward in addressing today’s challenges. To engage with and build a healthier and more vibrant community, our Board of Directors and Executive Leadership worked together to open the Katie Dusenberry Healthy Aging Center in 2019. While “The Katie,” as we affectionately refer to it, was closed to most public services during the height of the COVID-19 pandemic in an effort to protect public health, we have been excited to

A Report to the Community

Pima Council on Aging

re-eng age in services over the recent years - finally realizing the full vision of what our leadership intended prior to the pandemic. In 2020, we partnered with the Administration for Community Living and the United Way of Tucson and Southern Arizona to launch Dementia Capable Southern Arizona. Dementia Capable Southern Arizona is a federally-funded initiative focused on screening older adults for Alzheimer’s disease and related dementias and referring them to appropriate providers to ensure they get the help and resources they need. Gathering stakeholders in the community, we provide resources, Memory Cafés, and so much more to help people living with dementia and their caregivers. Though we have led in visionary work, over the past several years our focus has been addressing the needs and concerns of older adults and caregivers during a once-in-a-generation pandemic that wreaked havoc on our older adult communities. COVID-19 drastically changed the way in which we serve the community and operate our business. Over the past four years, we have worked hard to ensure that quality services were provided to our community in a safe and effective manner that took into account our changing environment. Now that we have emerged from the COVID-19 pandemic, we use the data and information in this report to inform how to move our services forward, keeping flexibility and access at the forefront of our delivery modality while continuing to provide the same quality and dedication Pima County has come to expect and trust from PCOA. When our community comes together, remarkable things are possible. As a community, as leaders, as policy makers, and concerned citizens, I’m proud of the partnerships and collaboration that allowed us to get to this point. Using the information and data in A Report to the Community: Aging in Pima County 2023 , I know we will continue to take the collective steps to improve the health and well-being of older people and those who love them. In this report you will find data, information, and recommendations for how we can continue to grow our community efforts over the next decade - strengthening our supports and services, and providing bold leadership for older adults and their families. Together, using A Report to the Community: Aging in Pima County 2023 , government, non-profit, and private business leaders can work to make Pima County the premier location in the Southwest to age in place. Yours in Service,

W. Mark Clark President & CEO

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Pima Council on Aging

Executive Summary

Every four years since 1975, PCOA conducts a Community Needs Assessment in Pima County that affords the community a look at the current state of older residents and the supportive services available to them, highlighting what we are collectively doing well, and where we need to improve. The Community Needs Assessment is a mandatory function of an Area Agency on Aging, which PCOA was designated in 1973, under the Older Americans Act of 1965. In the 2022-2023 Community Needs Assessment, we bolstered our time-tested three-pronged approach by revising our survey to reflect best practices in validated measurement, survey design, and data collection. Over a four-month period, we administered a 52-question survey to 3,626 people 50 years of age and older in Pima County, we held 11 listening sessions that were available both in person and digitally with Spanish interpretation, and we conducted five focus groups of providers in our community to assess the boots-on-the-ground perspective of aging in Pima County. Though the format for the assessment remained the same as years past, we significantly modified the 52-question survey. Rather than asking respondents to rank areas of concern, PCOA designed a survey to explore various aspects of their daily lives, including their home environment, neighborhood, community engagement, access to healthcare, personal health, and demographics. The data collected offers a comprehensive perspective on the experiences of older adults, as shared by those who participated. Our assessment had several key findings. Chief among them is the strength of our neighborhoods. Close to 70% of survey respondents spent time outside of their home, enjoying our beautiful desert Southwest. Whether in their yard, walking around, or visiting with neighbors, we know that regular time outdoors in nature is proven to decrease anxiety and depression and leads to better health outcomes. Our survey found this to be particularly true for people in their 60s and 70s, with accessibility to neighborhoods declining significantly with age. We also found that older adults were able to connect via technology–more so than the national average. Nearly 84% of survey respondents access the internet multiple times per week and 76.5% access the internet daily. This rapid adoption of new technologies helps to give home-bound older adults an opportunity to find community and engage, but it also leaves us vulnerable to new frauds and scams that can hurt older populations–a problem we must address in the coming years.

We found that older adults were able to connect via technology–more so than the national average. Nearly 84% of survey respondents access the internet multiple times per week and 76.5% access the internet daily.

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Pima Council on Aging

Feelings of loneliness ranked high for older adults, with our youngest respondents indicating that 71% of them felt lonely, with numbers increasing as people age. In fact, 82% of our oldest respondents reported feeling lonely during our survey process. Social isolation and loneliness are linked to higher rates of both physical and mental health conditions, with a study from Brigham Young University finding that social isolation could be as negative for an older adult’s health as smoking or obesity. Isolation, and its associated loneliness, can result from the death of a partner, spouse, loss of mobility, separation from or limited time with friends and family, lack of transportation, and/or the death of a pet. We all long for satisfying and healthy relationships in our lives, and mobility challenges, changes in working status, and health can have a big impact on how and who we are able to connect with.

Feelings of loneliness ranked high for older adults, with our youngest respondents indicating that 71% of them felt lonely, with numbers increasing as people age.

Mirroring the 2017 Report to the Community, another concern of older adults in our community is the ability to remain independent and in the home of their choosing as they age. We found that this concern was cross-sectional and was impacted by affordable and accessible housing, the ability to maintain a home and/or yard, lack of access to healthcare, fear of falling, and trouble completing activities of daily living–including bathing, other personal hygiene, and feeding/dressing oneself. While moving around in their home is not a significant factor for most people participating in this assessment, climbing stairs, bending, kneeling, or stooping all posed significant concern for over 85% of those responding to our survey. Notably, social service organizations, listening session participants, and survey respondents all found that one of the most pressing issues facing Pima County is access to affordable, sustainable, and quality housing. While we have known for some time that the affordable housing crisis was having a real impact on older adults in our community, the results of this assessment provides quantifiable data that show the need for increased housing services, affordable housing stock, and reliable local, state, and federal regulations protecting older adults and other vulnerable populations from experiencing homelessness. This report was compiled using the latest data and survey methods available to PCOA and provides us a clear roadmap that we can take to make services and support for older adults stronger and more accessible in our community for years to come. To read the full Community Needs Assessment survey, please visit https://bit.ly/PimaCoSurvey.

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Pima Council on Aging

Key Comparable Findings to Previous Assessments Historically, A Report to the Community: Aging in Pima County has published the top concerns of older adults in Pima County. During the 2022-2023 Community Needs Assessment, we drastically changed our survey tool from one that allows participants to rank their top concerns to one that allows us to infer more in-depth information using the data provided. The following are key findings that are comparable to previous Community Needs Assessments conducted by PCOA. Falls and Fear of Falling

In 2016, 44% of survey respondents reported falling at least once in the previous year. In response to falling and fear of falling being the top concern listed for older adults in Pima County, our leadership made the strategic decision to join the Southern Chapter of the Arizona Falls Prevention Coalition. Through this coalition, our staff have gained tools and resources that we regularly share with the community, including balance exercises and prevention practices that evidence shows helps to reduce falls. In the 2022-2023 Community Needs Assessment survey, when asked if falls or near falls were an issue, 63% of respondents indicated that they were.

What’s more, 59% of respondents indicated that their activities were limited due to a fear of falling. Notably, fear of falling increases with age, with only 42% of those ages 50-59 reporting that they limit their activity due to a fear of falling. Transportation More people are driving their own car today than in 2016. In 2016, when asked, 62% of survey respondents drove their own vehicle, 18% counted on friends and family for transportation, and 13% counted on public transportation. Volunteer and paid services were limited in their reliance with only 2% and 3% relying on them respectively. To address concerns around transportation, PCOA continued to build the Neighbors Care Alliance which is a network of neighborhood volunteer programs where an older adult can get the transportation they need to go to the grocery store, medical appointment, or other important outings through various community groups. In our 2022-2023 survey, when asked about their primary source of transportation, 70% responded that they drive their own vehicle, 11% count on family, friends, or a neighbor, and only 4% count on public transit. Volunteer transportation services remained similar to the 2016 survey responses, with 2%, but the use of paid services dropped. As adults age, their reliance on alternative forms of transportation increases. Caregiving In our 2016 survey, 17% of respondents identified as a caregiver for a family member, neighbor, or friend. After investigating leading research and policy work in this area, we embraced caregiving–both formal and informal–as a central concern for PCOA. It is through this understanding that we increased

A Report to the Community

Pima Council on Aging

our programming to specialize in caregiving for people with dementia through Dementia Capable Southern Arizona, we built the Raskob-Paulus Caregiver Skills Lab at the Katie, and acquired the CareGiver Training Institute. In our current year’s survey, 23% of respondents reported being a caregiver. In comparison, the total caregivers reported in 2016 were 362 people and the total number in 2022-2023 were 732 caregivers. In addition to showing increased need in this area, the increase in reported caregivers may also result from successful education of staff, volunteers, and community members about identifying as a caregiver. Aging in Place

Aging in place–older adults choosing to stay in their homes and community as they age–was amongst the top concerns in the 2016 community needs assessment. In 2016, 27% of respondents rated their community as an excellent place to age, while 45% rated it as a good place to age. As a result, PCOA conducted significant advocacy and public policy efforts to increase funding for in-home services that enable people to stay in their own homes and communities as they age. Since 2016, the State of Arizona has increased more than $10 million in funding to these services, with PCOA taking one of the lead roles in advocacy for this change. We have also worked to address the previously identified in-home care workforce shortage through a significant investment in both training and public advertising.

In the 2022-2023 survey, 40% of respondents rated their community as very easy for them to age in place, while another 40% said it was somewhat easy to age in place. Though there is still work to do, the work we have done has been of benefit for many older adults in Pima County. What is “Aging in Place”? When older adults choose to stay in their homes and community as they age. Using our Community Needs Assessment, including our Community Health and Aging Survey, we have identified important issues

and problem areas that PCOA and our community partners can work to improve over the coming years. The following high-level recommendations are ways in which we, as community providers, can help to make a positive impact and difference, for older adults in our community.

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Pima Council on Aging

Identified Issues & Problem Areas Homelessness and Affordable Housing • Support the production of affordable housing units designated for older adults throughout Pima County. • Support the funding of the Arizona Housing Trust Fund and funding for other affordable housing navigation programs that help older adults either find new homes or remain in their existing home. • Encourage homeless services providers to eliminate age barrier criteria such as “job searching” for older adults in homeless shelters. • Support the continuation of funding to Area Agencies on Aging to provide housing and housing-related services. Aging in Place and Living Independently • Integrate with and support the implementation of the Age-Friendly Tucson Plan. • Support additional funding and access for lower-income residents to get assistance with home maintenance, repairs, adaptations, and landscaping to ensure they are able to remain in their own homes safely. • Encourage additional funding and support for in-home supportive services through both Title IIIB of the Older Americans Act of 1965 and AHCCCS’s Arizona Long-Term Care System. Social Isolation and Loneliness • Deepen our network of community providers and partners to ensure that more people have easy access to PCOA and our services and resources. • Continue to provide evidence-based health promotion programming under Title IIID of the Older Americans Act to give older adults access to socialization opportunities that they indicate they enjoy and utilize. • Continue to ensure that services and socialization opportunities are available to all older adults in Pima County. Access to Health Care and Social Services • Support continued funding for the non-biased State Health Insurance Assistance Program (SHIP), which provides education and assistance for Medicare. • Support continued funding and support for Arizona’s Medicaid system—Arizona Health Care Cost Containment System (AHCCCS). • Support increased funding for the Older Americans Act of 1965 for Title III. • Promote and support professional development and training for lower-level healthcare professionals. • Continue to support and participate in the development of a community care hub in Pima County.

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Pima Council on Aging

Family Caregiving • Using evidence-based programs and practices, train informal/family caregivers in practices they can implement in their day-to-day lives to better care for both themselves and others. • Address the direct care workforce shortage through collaborative and innovative training and recruitment efforts. • Advocate for increased funding for family caregiver supportive services through the Older Americans Act. Transportation • Continue to build the Neighbors Care Alliance program to enhance the availability of door-to-door transportation services for medical appointments. • Continue to work with key stakeholders to share expertise surrounding the needs of older adults and transportation. These stakeholders include the City of Tucson, Pima Association of Governments, the Regional Transportation Authority, Pima County, and Arizona Department of Transportation. Alzheimer’s and Other Forms of Dementia • Continue and broaden access to free memory screenings to assist with early detection. • Conduct public awareness campaigns to educate the community about Alzheimer’s disease and related dementias, emphasizing the importance of early detection, available resources, and reducing stigma. • Continue providing support and resources to caregivers. Barriers to Technology • Continue to build out content for The Virtual Katie Dusenberry Healthy Aging Center, including trainings and videos about safe usage of technology. • Continue to identify and promote information about how older adults can avoid fraud and scams. • Work with health care systems, nonprofit organizations, and government partners to ensure that accessibility to services is not solely reliant on internet access–even if that is the primary option for enrollment.

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Pima Council on Aging

Homelessness and Affordable Housing In our 2022-2023 Community Needs Assessment, one of the most pressing concerns we heard surrounded the “housing crisis” in Arizona. Many older Arizonans cannot find sustainable housing that they can afford. Already increasing housing and rental prices skyrocketed during the pandemic and continue to rise. According to Arizona State University’s Morrison Institute for Public Policy, Arizona’s median rents increased approximately 18.3% between January 2021 to January 2022, a larger increase than the national average of 14.1%. 1 These increases in housing and rental prices have continued and led to a particularly vexing community problem. According to the Arizona Department of Economic Security, the largest group of people who are experiencing or at risk of homelessness are over age 55. 2 With numerous financial setbacks plaguing older adults, such as the impact from the 2008 financial crisis, increases in housing costs, unexpected medical bills, and other financial indicators with little increase in income makes it uniquely difficult for older adults to adapt to sharp and drastic increases in the housing market.

Housing cost burden, which is defined as a person spending more than 30% of their monthly income on housing, is more prevalent among renters than it is among homeowners, with 47% of renters being housing cost burdened in Pima County and 22% of U.S. homeowners being burdened. 3 These trends are more drastic for older renters, with the U.S. Census Bureau reporting that 56.7% of people 65 and older pay more than 30% of their monthly income on housing. 4 A significant issue facing Pima County residents is the lack of available and affordable housing stock. According to the Arizona State University Morrison Institute for Public Policy, for every rental vacancy, there are 14 prospective renters. 5 To find affordable housing, older adults are often competing in an environment with younger populations who have more ability to quickly change their income and credit, affecting

The largest group of people who are experiencing or at risk of homelessness are over age 55.

the ability of older renters to be competitive in finding affordable and sustainable housing. Between 2010 and 2019, 76.8% of the relatively scarce new builds in Pima County were single-family homes and not affordable units for renters. 6 Housing security is a cornerstone to the social and economic conditions that create environments in which people thrive and their well-being flourishes. Available and affordable housing determines the

1 (Kurtz, 2022) 2 (“04. #038642 Annual Report on Homelessness 2022,” 2022) 3 (Kurtz, 2022) 4 (Population 65 Years and Over in Pima County, n.d.)

5 (Kurtz, 2022) 6 (Kurtz, 2022)

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Pima Council on Aging

environment in which a person lives, subsequently impacting their ability to have access to quality and nutritious food, air quality, transportation, medical services, and so much more. According to the Center on Budget and Policy Priorities, only 30% of a person’s health is determined by their own behavior. The other 70% of a person’s health is comprised of environmental, social, and economic factors, and access to quality and affordable health care. 7 Housing impacts much of a person’s health outcomes, and is subsequently important to focus on as we build a more livable and healthy community in Pima County.

Older Adults Reporting How Often They Have Trouble Paying Monthly Bills

0% 10% 20% 30% 40% 50% 60%

Never

Rarely

Sometimes

Often

Rent or Mortgage

House Utilities

Other Bills & Living Expenses

Since the last Community Needs Assessment, we have worked with our local county and city housing departments to increase the affordability and available housing stock in Pima County. In 2022, we supported a City of Tucson effort to allow more accessible dwelling units, which would increase housing stock and likely decrease the overall price of rental units in the city. In 2023, we worked with AZAging, our statewide association of Area Agencies on Aging, to advocate for funding for the Area Agencies on Aging to launch a pilot program that had already been proven successful in Pima County–helping older adults in need to pay for one-time fees related to moving, housing, and utilities. For many older adults, when a person does find affordable and sustainable housing, one-time fees, first and last month rental deposits, utility set up fees, and the cost of movers can make it nearly impossible for them to seize the more affordable opportunity. Through our pilot program, people in need access a limited fund of money available one-time for these types of expenses. In the coming years, we need to make a concerted effort to continue to advocate for more frequent and effective solutions to our affordable housing crisis. These solutions can be numerous and wide-ranging in nature, but should include: • Supporting the production of affordable housing units designated for older adults throughout Pima County. • Supporting the funding of the Arizona Housing Trust Fund and funding for other affordable housing navigation programs that help older adults either find new homes or remain in their existing home. • Encouraging homeless services providers to eliminate criteria such as “job searching” for older adults in homeless shelters. • Supporting the continuation of funding to Area Agencies on Aging to provide housing and housing related services.

7 (Chart Book: Housing and Health Problems Are Intertwined. So Are Their Solutions., 2022)

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Pima Council on Aging

Aging in Place and Living Independently A 2021 AARP Home and Community Preference Survey reported that 77% of Americans ages 50 and older want to remain in their current residence as they age. 8 The ability for a person to remain in their own home as they age depends on many factors, including safety and mobility within the home, availability of transportation, availability of food and other essentials such as health care services, and caregiving. In our 2022-2023 Community Needs Assessment, 81.6% of survey respondents Older Adults Who Have Difficulty with Maintenan c e, Housekeeping, and Yard Work

indicated that they had issues with the regular maintenance and repair of their home. 71.8% of respondents indicated an issue with housekeeping–with need only increasing with age. In line with this trend, 69.1% of respondents reported an issue maintaining their yard, with need increasing with age. These results show that many older adults in Pima County have difficulty independently living in their own home without support and services that help them with some tangible daily tasks.

10% 15% 20% 25% 30% 35% 40% 45%

0% 5%

Never

Rarely

Sometimes

Often

Regular home maintenance and repairs

Housekeeping Yard work

According to the National Institute on Retirement Security, 40.2% of retirees rely solely on Social Security Income. 9 With the average Social Security monthly benefit being $1,907 10 it is easy to see how so many older adults could struggle to pay for unexpected home maintenance, repairs, and modifications. Since 1977, home maintenance, repair, and adaptation have been at the forefront of our critical work to help older people live with dignity and independence as they age. These important services have been underfunded in recent years, with increased financial strain from the COVID-19 pandemic causing particular impact to services in subsequent years.

Yardwork and maintenance are often areas of one’s home that can be easily neglected, leading to falling home values and increased complaints to the city or county code enforcement. In Pima County, though we have the opportunity to help many with safety-related issues to their home, the ability to help someone complete yard work and maintenance is highly limited. Living on one’s own depends on one’s ability to safely accomplish home maintenance. As we get older, many people struggle with the ability to safely complete activities of daily living such as bathing or personal hygiene. 36.8% of survey respondents reported some level of difficulty with bathing and/or other personal hygiene. This struggle only increased with age, with the highest level of people needing assistance being in 8 (AARP, n.d.) 9 (Bond & Porell, 2020) 10 (KA-01903, 2024)

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Pima Council on Aging

their 90s (57.6%). 31.2% of survey respondents indicated difficulty in getting dressed, showing that they likely need in-home supportive assistance. As previously mentioned, falling or nearly falling was reported as a problem for 63% of survey respondents, with difficulty increasing with age. Nearly 50% of all respondents reported that they had difficulty walking one block, and 67.2% reported they had difficulty climbing stairs. 75% of all respondents indicated a difficulty with bending or kneeling. These difficulties also grew with age.

For 10 hours of in-home care services per week in Pima County, the average cost is $906.40 per month. 11 Though this is more affordable than the average in-home care services in both Arizona and the United States, it is still difficult for those living on a low fixed income to afford. We know that keeping people in their own homes and communities is not only what people want, but it’s also more affordable, with the average cost of assisted living in Tucson being $4,575 per month, with costs going as high as $10,000 per month. 12 For many,

Ease of Aging and Staying in Current Home

10% 15% 20% 25% 30% 35% 40% 45%

0% 5%

Very Easy

Somewhat Easy

Not Too Easy

Not Easy at All

Unsure

assisted living is simply not an option until they can qualify for Arizona Long-Term Care Services under the Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid program. Until then, these older adults remain vulnerable to increased falling, hospitalization, and reports of self-neglect to Adult Protective Services. Community safety can also impact one’s ability to remain in their own home and community as they age. 82% of survey respondents felt safe in their own

neighborhoods, and most people were able to spend some amount of time outside every day. Access to the outdoors can help with many mental and physical health concerns, including reducing levels of anxiety, depression, and anger. 13 69.4% of respondents spend time outside of their homes - whether in their yard, walking around, and/or visiting with neighbors,

though frequency of outdoor activity decreases with age. While older adults, in general, felt safe in their own neighborhoods, nearly 60% of respondents reported that neighborhood crime was a concern. 80.1% of those we surveyed indicated their desire to remain in their own community as they age, with 40% finding that this would be very easy and 40.1% reporting that it would be somewhat easy for them to do. The other nearly 20% of people reported having at least some difficulty remaining in their own home and community as they age. 11 (How Much Does Home Care Cost in Tucson, AZ?, n.d.) 12 (Genworth’s 2024 Cost of Care Study) 13 (3 Ways Getting Outside Into Nature Helps Improve Your Health, 2023)

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Pima Council on Aging

Since our 2016 Community Needs Assessment, we have focused heavily on increasing the accessibility of in-home supportive services to ensure that people are able to remain in their own home and community as they age. Working with AZAging and the Arizona State Legislature, one-time significant increases have been made to Area Agencies on Aging to provide in-home care services. At the same time of these increased investments, the standard cost of providing services has increased due to Arizona’s and Tucson’s new minimum wage laws. With the growing need and increased cost of providing services, funding for in-home services still remains insufficient to address the needs of our community. Aside from funding, we have also implemented the nation’s first Friends and Neighbors program for in-home care. Through this program, we are able to use our Older Americans Act funds to reimburse our clients with an hourly rate to pay a friend, family member, or neighbor to help them in their own home. This innovative program has helped us address our workforce shortages. Though we have done much to help older adults remain independent and in their own communities as they age, we know there is still much more left to do. Some areas in which we will focus our efforts in the coming years include: • Integrate with and support the implementation of the Age-Friendly Tucson Plan. • Support additional funding and access for lower-income residents to get assistance with home maintenance, repairs, adaptations, and landscaping to ensure they are able to remain in their own homes safely. • Additional funding and support for in-home supportive services through both Title IIIB of the Older Americans Act of 1965 and AHCCCS’s Arizona Long-Term Care System.

Social Isolation and Loneliness Approximately three-quarters of all survey respondents experience feelings of loneliness based on a validated measurement tool to assess emotional and social loneliness. The percentage of respondents that are lonely increases by age, with nearly 82% of people who are 90 and older reporting they feel lonely. According to the National Council on Aging, we know that social isolation and loneliness increase an older adult’s risk of high blood pressure, heart disease, obesity, a weakened immune system, anxiety, depression, cognitive decline, Alzheimer’s disease, and even death. 14 The COVID-19 pandemic increased our ability to relate to and empathize with older adults who feel socially isolated and lonely. These feelings can be strong, and subsequently have negative impacts on both physical and mental health. The U.S. Surgeon General

Our Community Lunch program brings older adults together.

14 (Garcia & Jordan, 2022)

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Pima Council on Aging

noted that loneliness, which results from social isolation, is far more than a feeling, hurting both individual and societal health. 15 Not only does social isolation and loneliness impact our societal connectedness, it is costly. According to the U.S. Surgeon General, social isolation accounts for an estimated $6.7 billion in excess Medicare spending every year. 16 These Medicare claims come through increased stays in the hospital or extra time spent with social workers post discharge. Involvement in social networks is reducing over time. We can see this right here in Pima County, with many of our neighborhood associations struggling to recruit younger members to be involved. Social connection is a fundamental human need and we must continue to nurture meaningful relationships across generations. On the positive side, 55.8% of survey respondents indicated that they are already engaged in volunteer activities or are Time Spent Outside

interested in participating. As people age, they also tend to become more involved in their community. Pima County’s older adults are most likely to be involved in volunteering, lifelong learning, and group exercise activities. For those who want to be involved, many activities currently exist to engage with the community. Using Older Americans Act funding, we provide Aging Mastery Programming, A Matter of Balance, and EnhanceFitness classes.

13%

Every day A few times a week About once a week Less than once a week Never

36%

17%

10%

24%

The pandemic allowed us to think about delivering these evidence-based programs through new avenues. Our programs are now available both in person at our Katie Dusenberry Healthy Aging Center and online through our Virtual Healthy Aging Center. Over the past several years, we launched other programs to decrease isolation. Our volunteer services activities include our Neighbors Care Alliance, which is a network of neighborhood volunteer programs that help older adults receive meals, get assistance with yard and house chores, and attend doctors appointments. In our Dementia Capable Southern Arizona program, people with Alzheimer’s disease and other related dementias and their caregivers gather to socialize in a space they can feel understood and validated. So much of what we do relies on ensuring that we have culturally responsive and appropriate communication that is easy to understand and accessible. That’s why, in 2020, we engaged with a consultant to objectively study how our organization was effectively serving varied communities. Though we still have work to do, we have made tremendous strides since 2017, including upgrading our website so content can be translated into multiple languages, accessible for the visually impaired, and ensuring all front-facing programmatic departments have bilingual/bicultural staff. Over the coming years, we plan to continue this effort to increase accessibility as an organization and as service providers–which will decrease social isolation in hard to reach communities.

15 (Our Epidemic of Loneliness and Isolation, 2023) 16 (Our Epidemic of Loneliness and Isolation, 2023)

A Report to the Community

Pima Council on Aging

Tackling social isolation in our community takes all of us reaching out to our friends, family, and neighbors and building healthy and long-standing relationships. Some of the ways we will contribute in this space in the coming years include: • Deepening our network of community providers and partners to ensure that more people have easy access to PCOA. • Continuing to provide evidence-based health promotion programming under Title IIID of the Older Americans Act to give older adults access to socialization opportunities that they indicate they enjoy. • Continuing to implement a work plan to ensure that services and socialization is available to all older adults in Pima County. • Expanding our Community Lunch program to more communities throughout Pima County. Access to Health Care and Social Services

On average, one-third of those who responded to our survey reported their health as being fair or poor, regardless of age. On the other hand, 68% of respondents rated their health as good or excellent. Though these are self-reported numbers, and we understand that some accuracy is lost through bias, we know that many older adults in Pima County struggle to remain in good health. According to the National Center for Health Statistics through the U.S. Centers for Disease Control and Prevention, 23.5% of older adults are in poor to fair health, aligning well with our self-reported data. Additionally, 9.4% of older

adults struggle to maintain their self care. 17 We know that health-related social needs (previously known as social determinants or social drivers of health) are a major factor in changing health outcomes for people. Safe housing, affordable transportation, a walkable environment, access to affordable and nutritious food, and other important social factors of health can play a large role in one’s ability to prevent and manage chronic and major disease. Since 2017, we have worked hard to align the activities of health care to social services, especially in light of the COVID-19 pandemic. During the pandemic, Older Adults Reporting Issues of Affordability with Health Care

0% 10% 20% 30% 40% 50%

we launched the award-winning Take YOUR Shot Campaign, which helped homebound older adults get transportation to vaccination sites early in the vaccine efforts. Getting vaccinated is key to ensuring that our community remains safe and healthy.

Never

Rarely

Sometimes Vision Care

Often

Medical Care

Dental Care

Prescription Medications

17 (FastStats - Older Persons Health, n.d.)

A Report to the Community

Pima Council on Aging

Beyond our work during the COVID-19 pandemic, we work every day to increase access to social care services including nutritious Pima Meals on Wheels and Community Lunch programs to increase people’s health outcomes. Access to health care, in large part, depends on the affordability of the care. Most adults over 65 have health coverage through Medicare and/or Medicaid. Despite the high rates of health insurance coverage, 58.8% of people we surveyed had some difficulty affording healthcare, with the highest rates among people in their 50s and 60s who were not yet likely to have Medicare. Though Medicare does cover health insurance costs, it does not waive cost-sharing or premium requirements. These out-of-pocket costs can make it difficult for those living on a fixed income to afford health care. Among the greatest concerns of older adults throughout our Community Needs Assessment process was the lack of available and affordable medical providers, and being forced to use telehealth despite wanting in-person interaction. We continue to work to improve access to health care through our State Health Insurance Assistance Program (SHIP). This federally funded program provides training and one-on-one counseling to older adults who want to enroll in or are currently enrolled in Medicare. Through our services, we can help people save thousands of dollars by switching to plans that meet their medical needs with lower deductibles. Our unbiased Medicare counselors work to ensure that people understand their options when both enrolling in and changing their Medicare benefits, and are able to access resources to make the change.

Older Adults Reporting How Often They Have Trouble with Hearing or Vision

Moreover, PCOA is a founder and lead partner in the creation of Southwest Community Care Partners, an independent non-profit community focused on aligning health and social care through better organized service provision from health care and social care providers. We continue to build business relationships and community partnerships that help to meet our community’s health-related social

0% 10% 20% 30% 40% 50%

needs and increase their health outcomes. We still have work to do in this area. Some of the ways in which we can better improve access to health and social care services in our community include the following: • Supporting continued funding for the non-biased State Health Insurance Assistance Program (SHIP), which provides education and assistance for Medicare. • Supporting continued funding and support for the Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid system. • Supporting increased funding for the Older Americans Act of 1965 for Title III. • Promoting and supporting professional development and training for lower-level medical professionals. • Continuing to support and participate in the development of a community care hub in Pima County. Never Rarely Sometimes Often Hearing Vision

A Report to the Community

Pima Council on Aging

Family Caregiving Slightly less than a quarter of respondents in our 2022-2023 Community Needs Assessment reported that they are caring for an adult 60 years of age or older. Seemingly low at face value, caregivers fail to identify themselves as anything other than committed and loving family or friends versus the label of a “caregiver.” Of those who are caring for an older adult, nearly 40% care for a spouse or partner and 30% care for a parent or in-law.

We know that caregivers, who are often older themselves, have unique struggles in their aging journey. The majority of caregivers, both formal and informal are women, providing both child care during their younger years and care for older loved ones later in life. The Urban Institute found that over a lifetime, women lost $237,000 in wages for caregiving reasons because of time out of the workforce, unrealized employment opportunities, and other employment-related concerns. 18 These cumulative lost wages also have very real impacts later in life for retirees. In 2023, the Urban Institute found that women lose an average of $58,000 over their lifetime in employment-based retirement benefits and Social Security. 19

Older Adults Reporting How Often They Need Assistance with Daily Activities

0% 10% 20% 30% 40% 50% 60% 70% 80%

Never

Rarely

Sometimes

Often

Bathing and Personal Hygiene

Getting Dressed

Mobility Aids (walker, wheelchair, etc.)

This tangible cost of caregiving leaves many caregivers of older adults more vulnerable to poverty and in need of care themselves as they age—perpetuating a continuous cycle. That’s why, with guidance through the Older Americans Act Title IIIE, we have focused on providing caregivers the support and resources they need to ensure their health and well-being remain intact while continuing to provide care. More than just lost wages, caregivers often defer maintenance on their own health care and needs. According to the Centers for Disease Control and Prevention, more than 20% of caregivers over the age of 45 did not have a routine checkup in the past year. 20 According to the same study, 17.4% of Arizona’s caregivers report that they experience frequent mental distress and nearly 50% of caregivers in Arizona report having two or more chronic conditions. 21

18 (Johnson et al., 2023.) 19 (Johnson et al., 2023.)

20 (Caregiving for Family and Friends — A Public Health Issue, n.d.) 21 (Caregiving for Family and Friends — A Public Health Issue, n.d.)

A Report to the Community

Pima Council on Aging

In our 2022-2023 Community Needs Assessment, we found that 72% of all caregivers surveyed reported they need more support than what they currently have. Our Family Caregiver Support program provides family caregiver support groups, caregiver training, respite services, one-on-one consultation for family caregivers, and resources. Since our 2016 Community Needs Assessment, we have implemented a new program designed to give informal caregivers the appropriate compensation for the care they provide to their loved ones. Our Friends and Neighbor program began offering respite care to family caregivers by providing a stipend to qualifying older adults who could then pay a friend or family member to provide their care. This program’s success has also led to our implementation of the Friends and Neighbor program for our home and community-based services clients, ensuring that more community members are compensated for at least some of the work and care they give to older adults in our community. We still have a long way to go. Though we have worked hard to enhance our caregiving services and provide significant support to family caregivers, it’s evident that many of our community members still need additional support. In the coming years, we will do the following to provide these continued supportive services to our community: • Using evidence-based programs and practices, train informal-family caregivers in practices they can implement in their day-to-day lives to better care for both themselves and others. • Address the direct care workforce shortage through collaborative and innovative training and recruitment efforts. • Advocate for increased funding for family caregiver supportive services through the Older Americans Act of 1965. Transportation Transportation Options

In our 2022-2023 Community Needs Assessment, 70% of people surveyed responded that they rely on their own vehicle as their primary source of transportation, with 11% counting on family, friends, or neighbors. These numbers were a significant increase from our 2016 Community Needs Assessment survey.

Drive my own car Family, friends, or neighbors Public transit Volunteer or other ride service Taxi or service like Lyft or Uber Walking or Biking NA, I don’t have transportation Electric scooter or wheelchair NA, I don’t leave the house

0% 10% 20% 30% 40% 50% 60% 70% 80%

In a county spanning over 9,000 square miles, transportation to and from vital services and supports can be difficult for anyone–especially for older adults–to access the services they need. 22 The Center for the Future of Arizona ranks the city of Tucson as the 39 th most accessible transit city in the country out of 75 cities assessed, putting it in the bottom 50 th percentile of cities. 23 Tucson’s urban core has various transportation options, including walking, biking, SunVan, SunTran, and SunLink. This mixture of services makes central Tucson fairly accessible to older adults and people with disabilities. However, because Tucson is such a geographically large city, areas outside of the urban core can be difficult to easily get to without a personal vehicle.

22 (Pima County, Arizona - Census Bureau Profile, n.d.) 23 (Public Transportation, n.d.)

A Report to the Community

Pima Council on Aging

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