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“…to raise new ideas and improve policy debates through quality information and analysis on issues shaping New Hampshire’s future.”

Board of DirectorsTodd I. Selig, Chair

David Alukonis

Michael Buckley

William H. Dunlap

Sheila T. Francoeur

Stephen Reno

Stuart V. Smith, Jr.

Donna Sytek

Brian F. Walsh

Kimon S. Zachos

Martin L. Gross, Chair Emeritus

John D. Crosier, Sr., Emeritus

Mapping the Aging Maze

AGING IN COMMUNITY:What’s Being Done to Prepare?Thursday, August 25, 2011

Steve Norton, Executive DirectorNH Center for Public Policy Studies

2

The Past

333

• Here’s a basic overview of New Hampshire’s population according to the Census data from 2010. Not many surprises here.

• The most densely populated areas are in the state’s southern areas, particularly Rockingham, Hillsborough and Merrimack counties.

• The highest population centers are in and around Manchester and Nashua, with pockets of density scattered in the cities.

• The North Country remains sparsely populated.

• Total state population increased 6.5 percent since 2000, with 1.3 million people now calling New Hampshire home. But let’s look at how that population has shifted over the past decade…..

44

• This map details where the growth and loss in population, town by town, occurred since 2000.

• Some obvious points: the biggest increases came in Hillsborough and Rockingham counties. We can also see the influence that Interstate 93 has on population growth over the past decade.

• Other pockets of large increase: the Conway and Plymouth regions, the Lakes Region and the Upper Valley. We’ll return to those later.

• And while nearly every region saw some increase in population, the declines were focused largely on the North Country.

55

• But while the overall state population increased, the number of school-aged children fell: a loss of more than 22,000 students, or a 7 percent decline since 2000.

• As this map shows, that drop was spread across the state, with a few towns gaining in school-age population.

• But flip back to the previous map. You’ll see that many of the areas that had the biggest gains in total population saw a decline in their school-aged numbers: portions Hillsborough County and the Rochester area, for instance. How might that trend shape discussions about education spending, both at the state and local level?

• More broadly, policymakers will have to consider what steps to take to build the education system in a state where the student population is declining.

66

• Numbers released earlier this year offered an overview of the state’s population, but the recent figures provide a more detailed portrait. For instance, this map plots the median age of New Hampshire’s cities and towns. The darker the shade of the community, the older the median age of its residents. (The statewide median age was 41.1 in 2010, up from 39.3 in 2000.)

• New Hampshire can essentially be divided into two regions when it comes to age: an older half north of the Lakes Region, and a younger half below.

• But even in the “younger” half, there is a further subdivision, with the region between Interstate 93 and the Seacoast significantly younger than the western portion.

• How might those divisions shape future policy discussions related to health care, education and public spending?

• (White areas of the map are unincorporated areas for which the Census Bureau did not release information.)

7

• This map plots the oldest segment of the population – those aged 85 and older – town by town. (Statewide, 1.9 percent of New Hampshire’s population was 85 or older in 2010.)

• The darker communities, those whose populations included a higher share of elderly residents, will face additional challenges in the coming years to care for that population. The pressures will be felt in healthcare expenditures, in municipal budgets, and in familial and community ties.

• As New Hampshire ages faster than the national average, these communities will pave the way for much of the rest of the state in coming years.

8

Here come the baby boomers ….

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Why is it Difficult to Predict What’s Going to Happen in the Future?

Patterns (Migratory) Change

1010

Myth #1 We are a state of natives who have been

living here for 100s of years? Percent Born in State of Residence

New Hampshire, 45

United States, 67

0

10

20

30

40

50

60

70

80

90

Louis

iana

Mich

igan

Ohio Iowa

Mas

sach

uset

ts

Alabam

a

Kentu

cky

Califo

rnia

India

na

Nebra

ska

Utah

United

Sta

tes

Hawaii

New Je

rsey

Oklaho

ma

Conne

cticu

t

South

Car

olina

Georg

ia

Virgini

a

Mar

yland

Was

hingt

on

Delawar

e

Colora

do

New H

amps

hire

Arizon

a

Alaska

Source: 2000 Census

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Migration

12

We’re still growing – but slower

Percent Change in NH Population

8.5%

13.8%

21.5%

24.8%

20.5%

11.4%

6.9%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

1950 1960 1970 1980 1990 2000 2010

U.S. Census figures released in December show that the 2000s saw the slowest rate of population growth in New Hampshire in six decades. Later this year, the Census Bureau will release specific population figures for counties and communities. What will those numbers tell us about the state’s demographic patterns over the past decade? And what will they mean for the redrawing of electoral districts in the New Hampshire Legislature later this year?

Source: New Hampshire Center for Public Policy Studies, analysis of U.S. Census data

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Myth #2 We are OLD?

Median Age• Oldest? Maine = 42• Youngest? Utah = 29• Average of US = 37• New Hampshire = 40

NH Rank = 42

• Percent Over 65• Oldest? Florida = 17%• Youngest? Alaska = 7%• Average of US = 13%• New Hampshire = 13%

NH Rank = 32

2006-2008 American Community Survey 3-Year Estimates

2008 Census Population Estimates

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Are we old? Not yet, but getting there …

Population Projections For those Over the Age of 65

191,403245,952

311,144

383,087437,194

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

500,000

2010 2015 2020 2025 2030

~120,000

~126,000

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Significant variation from community to community in the share of the population over the age of 65

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The new 60? Significant growth of the population 75 -

79Change In Population over the Age of 65 2010-2030

58,646

78,415

61,173

34,277

13,280

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

65-69 70-74 75-79 80-84 85+

Age

17

18

Elderly Poverty Rates are Higher in

the North

19

20

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What do the baby boomers want?

• World War II cohort (born from 1928 to 1945) – Key characteristics: conformity, conservatism, traditional family values

• Baby Boomer cohort #1 (born from 1946 to 1954) – Key characteristics: experimental, individualism, free spirited, social

cause oriented • Generation Jones or Boomer cohort #2 (born from 1955 to 1964)

– Key characteristics: less optimistic, pragmatic, general cynicism • Generation X cohort (born from 1965 to 1980)

– Key characteristics: quest for emotional security, independent, informality, entrepreneurial

• Millennial Generation cohort also called Generation Y (born from 1981 to 2001) – Key characteristics: quest for physical security and safety, heightened

fears, acceptance of change, technically savvy, environmental issues • Source: William Strauss and Neal Turning “Fourth Turning”

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Aging and the Healthcare System - Simulations

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Health Care Market Impacts?

The Impact of Aging Only

$992

$1,871

$2,277

$1,496

$2,507

$5,766

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

Medicaid Private Medicare

2010 2030

24

Medicare will play a growing role in driving the healthcare

system2010

Millions of $

Medicaid, $992, 19%

Private, $1,871, 36%

Medicare, $2,277, 45%

2030 Millions of $

Medicare, $5,766, 59%

Medicaid, $1,496, 15%

Private, $2,507, 26%

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Workforce Issues

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The Caregiver Crunch

NH residents over 85 years old per 100 woman aged 25-44

9.5

15.214.0

20.3

0.0

5.0

10.0

15.0

20.0

25.0

2000 2010 2020 2030

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… varies by community

NH residents over 85 per 100 women aged 25-44

0.0 10.0 20.0 30.0 40.0 50.0

Belknap

Carroll

Cheshire

Coos

Grafton

Hillsborough

Merrimack

Rockingham

Strafford

Sullivan

2010

2030

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The Workforce Is Aging As Well!

Distribution of Family Practitioners by Age (2004)

11%

31%

40%

1%

18%

5%2%

4%

13% 15%

31%29%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

FP < 35 FP 35 - 44 FP 45 - 54 FP 55 - 64 FP 65 to 74 FP 75 +

Age Group

Per

cetn

of T

otal

New Hampshire

United States

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Capacity Questions

• Home Health• Home and Community Based Care slots• Geriatric hospital services• Assisted Living Facilities• Alzheimers Support (Hospital, Nursing

Homes)• Prisons• Inpatient versus Outpatient services

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With all this pressure, the system structure will have to change, right?

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What’s the Care Continuum?

Physician(general)

Physician(spec)

Outpatient(ASC, Other)

Inpatient LTC

Community

Institution

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And the LTC system?

33

HomeHealth

Providers

Hospitals

Nursing HomesHospice

Physicians

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Acute Medical

ChronicMedical

Community Based LTC

Assisted Living

NursingHome

FFS

PCCM

P4P

Capitation

Care Continuum, Care Management and Reimbursement

Hospitals

Home Health Care

Nursing Homes

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Acute Medical

ChronicMedical

Community Based LTC

Assisted Living

NursingHome

FFS

PCCM

P4P

Capitation

Care Continuum, Care Management and Reimbursement

What does an LTC ACO look like?

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Want to learn more?

• Online: nhpolicy.org• Facebook: facebook.com/nhpolicy• Twitter: @nhpublicpolicy• Our blog: policyblognh.org• (603) 226-2500

“…to raise new ideas and improve policy debates through quality information and analysis on issues shaping New Hampshire’s future.”