A cloth bag on Mary Pixley’s metal walker carries her phone, an emergency call button and other supplies as she moves about her modest Cedar Grove home.
The 89-year-old former hairdresser and quilting instructor gave up her car keys a few years ago. She no longer attends church or two quilting groups; vision loss makes it hard for her to quilt anyway. It’s also hard for her to ask for help, she said, but a friend’s daughter now drives her to the Passmore Senior Center in Hillsborough once in a while, and to appointments and the store.
While Pixley doesn’t have any children, and her husband died in 2002, she still has nieces and nephews who check in on her, she said. It’s more support than some older folks have, but it still gets a little lonely.
“I used to say too bad I didn’t have children because I wouldn’t have anybody to look after me when I got old,” Pixley said. “Somebody who had children said, well, that’s no sign they’re going to look after you.”
The American Community Survey estimated there were 5,149 people age 65 and older living in rural Orange County in 2016, up from 4,046 in 2010.
At least 367 men and 737 women were living alone in 2016, the ACS reported, and nearly 370 households that included senior adults were receiving federal food benefits – more than double the number reported living in poverty in 2010.
The county’s rural senior population could double by 2020, said Nancy Holt, with the nonprofit Orange County Rural Alliance (OCRA). By 2050, older adults could be 25 percent of the population, according to Janice Tyler, director of the county’s Department on Aging.
It’s not an unique challenge. U.S. Census officials estimated the population over age 65 could grow from 43.1 million in 2012 to 83.7 million in 2050 when the last of the baby boomers will be over age 80. At least a million of those seniors will be childless and living alone by 2020, according to a 2013 AARP Public Policy Institute report.
Meanwhile, the number of people available to care for older adults is shrinking.
There are now seven potential caregivers for each “frail older person” – someone over age 65 with a disability – the AARP report said. By 2030, when seniors will comprise roughly 20 percent of the U.S. population, there will be four caregivers per person, and by 2050, only 2.9 caregivers, it said.
Community ties are crucial, like OCRA, Seniors and Law Enforcement Together (SALT) and Project Engage, a 13-week senior leadership program, Holt said. They collaborate with the Department on Aging to form a network of businesses, volunteers and deputies who deliver meals, repair homes, address individual needs and offer conversation.
County officials said those partnerships are vital to the county’s Master Aging Plan, which addresses housing, transportation, outdoor spaces, accessibility, civic participation, jobs, community support, health services and social inclusion.
OCRA volunteers Kitty and June Bradshaw deliver 15 meals each week to “some of the nicest people,” Kitty Bradshaw said.
“We talk grandchildren and children,” she said. “At Christmas, we gave them a wish list: their favorite cake, their favorite jelly, their favorite color, and I made each one of them a cake, what they liked. One of them, he cried when I gave him his.”
Pixley said she initially resisted help from OCRA, but it’s been good for her.
“Sometimes I feel guilty about having a meal a week, because I can still cook. I got to thinking about it and everyone said take it, you deserve it,” she said. “It does come in handy, but I’ve told them if they find somebody who needs it a lot worse than I do, take it and give it to them.”
’Like a fire’
OCRA and SALT share about 80 volunteers, as well as rely on Orange County Sheriff’s Office deputies. Last year, SALT, OCRA and others served about 270 people, providing 7,387 in-person visits, 1,601 phone calls and 4,559 meals.
SALT only visited 70 residents when the program started in 1989, retired Capt. Archie Daniel said. Now, it also takes residents to appointments, and Daniel leads a Handy Helpers group that makes repairs and installs bathroom grab bars and ramps. Anyone can make a difference, but they are looking especially for young people to continue the work
“It’s been a real challenge and a real joy to knock on that door the first time; we’re a stranger,” Daniel said. “Knock on that door a second time, and they acknowledge who you are. Knock on it a fifth time, and all of a sudden, you’ve got a friend.”
OCRA heads up the weekly delivery of about 90 hot meals, including food donated or discounted by local businesses and a monthly hotdog plate that deputies prepare. They want to add more hot meal days, Daniel said.
Meanwhile, Holt maintains an emergency pantry in her home for non-perishable food and water. Donations come from as far away as Salisbury, she said, where a group of women use coupons to maximize what they can give.
The groups are beginning to partner with UNC’s nursing, medical and business schools, which Holt hopes will help them teach seniors about nutrition and diabetes. It also could help with grants and more student volunteers seeking real-world experience, Daniel said.
Interim UNC Hospitals chaplain Veamarea Burton is among those who have gotten involved.
“Just to know that they are appreciative and we are having an impact on their lives does my heart good,” Burton said.
The good and bad
Holt noted the alternative for many lower-income seniors is a nursing home. Roughly 1.4 million people were living in 15,600 U.S. nursing homes in 2014, according to the Centers for Disease Control and Prevention.
The average annual cost for a private room was $92,000 in 2016, compared with $82,000 for a share room, according to a 2017 AARP fact sheet. Medicaid, the federal program that covers low-income people, helped pay for roughly 62.9 percent of nursing home residents, the CDC reports. The Medicare health insurance program for people over 65 does not pay for nursing home care.
Another 1 million people were living in 30,200 assisted living and residential care communities. AARP reported the 2016 base rate for assisted living care was about $46,000 a year; only 15.1 percent of those residents paid through Medicaid, the CDC said.
Nursing home care is the worst outcome for those who want to age with dignity, Holt said, because many patients are sedated and spend their day sitting in wheelchairs in the hall.
“Aging in place is where it’s at, and where it should be,” she said. “Even if you don’t have a lot of money to pay for custodial care 24/7, most of the time, if your family will participate and you can divide (the duties) up ... you can manage it without the custodial care.”
Holt also urged neighbors and local congregations to check in with people they don’t see anymore. Most rural seniors are independent and won’t ask for help when their health or their home is in bad shape, she said, adding that isolation can exacerbate the problems.
A separate AARP study reported that social isolation cost the federal Medicare program an estimated $6.7 billion last year.
“You get so much more out of volunteering and working with these people, because they all have a story to tell,” Holt said. “This is the greatest generation, [which] has been forgotten.”
George Thompson was 90 when he wrote his story about growing up in Cedar Grove as one of 12 children for the book, “Your Head is a Storehouse.” His nine children ensure he’s not forgotten – those who live nearby visit daily and those living out of state send money to help.
He couldn’t make it without his family, said Thompson, now 97. He’s not as alert or as coherent as he used to be, but he didn’t hesitate when asked how people should treat their elders.
“I’d tell them to be good to them. Any way they could be good to them, if it ain’t nothing but ‘thank you’,” he said. “Be good to them, because one day you might be them.”
How to help
If you want to volunteer with the Orange County Rural Alliance and Handy Helpers, signups are online at ocrahub.com. For more information, contact Nancy Holt at 919-732-8527, or firstname.lastname@example.org, or Archie Daniel at 919-210-7876 or email@example.com.
Tammy Grubb: 919-829-8926; @TammyGrubb