Virginia’s “Destiny”:The Reality is in the Numbers

Kevin F Byrnes, AICP kevin.byrnes@vda.virginia.gov

Aging Demographer

Virginia Department for the Aging

Virginia’s Aging Program: 25 Planning & Service Areas

Changing Age Structure: The Aging of the Baby-Boom Generation

• Boomers born between 1946 & 1964• Year 2000: Boomers = Persons aged 36-54• Year 2004: Boomers = Persons aged 40-58• Year 2006: Boomers = Persons aged 42-60• Year 2010: Boomers = Persons aged 46-64• Year 2016: Boomers = Persons aged 52-70• Year 2024: Boomers = Persons aged 60-78

Demographic

Trends: USA

Demographic Trends, 2000 - 2025

Short-term Trends: 2000 – 2003

1. Migration > Natural Increase

2. Uneven Sub-State Regional Growth

3. Increasing Racial & Ethnic

Diversity

Demographic Change:

P1 = P0 + Components of Change:

Natural Increase: (Births0-1 – Deaths0-1) + Net Migration: (In-Migrants0-1 – Out-Migrants0-1)

+ residual

Cumulative Estimates of the Components of Population Change for Virginia: April 1, 2000 to July 1, 2003

Geographic area

Total population

change*

National Residual

Natural increase Net migration

Total Births Deaths TotalNet

international migration

Net internal

migration

Virginia 307,847 2,352 137,243 321,528 184,285 168,252 90,536 77,716

Share of Change 100.0% 0.76% 44.58% 104.44% 59.86% 54.65% 29.41% 25.25%

Table 4: Cumulative Estimates of the Components of Population Change for the United States and States: April 1, 2000 to July 1, 2003 (NST-EST2003-04)

Source: Population Division, U.S. Census Bureau; Release Date: December 18, 2003; Last Revised Date: May 11, 2004.

-2,5000

2,5005,0007,500

10,00012,50015,00017,50020,00022,50025,00027,50030,00032,50035,00037,50040,00042,50045,00047,50050,000

1 2 3 4 5 6 7 8A 8B 8C 8D 8E 9 10 11 12 13 14 15 16 17/18 19 20 21 22

Population Change, 2000 - 2003, by AAA-PSA

Total Pop Abs Change 60+ Pop Abs Change

Increasing Racial Diversity

-5,000

-2,500

0

2,500

5,000

7,500

10,000

12,500

15,000

17,500

20,000

22,500

25,000

27,500

30,000

32,500

35,000

1 2 3 4 5 6 7 8A 8B 8C 8D 8E 9 10 11 12 13 14 15 16 17/18 19 20 21 22

Comparative Change, White & Non-White Population, 2000 - 2003, by AAA-PSA

All Whites Total Pop Abs Change All Non-Whites Total Pop Abs Change

A New Diversity: Growth in Virginia’s Non-English Speaking Population• From 1990 – 2000, English-only speakers

declined from 92.7% to 88.9% of VA population

• From 1990 – 2000, the Spanish speaking population more than doubled, reaching 316,274 persons, representing the largest non-English language group

• In 2000, among persons age 65 & over, 94.5% only speak English

• Among persons age 65 & over in 2000, 12,869 (1.6%) don’t speak English “well” or “at all”

A New Diversity: Virginia’s Non-English Speaking Population (cont.)• Among Spanish-speaking persons age 65 & over, 2,850 or 22.1% don’t speak English “well” or “at all’

• 2,131 or 75% of the State total resides in Northern Virginia (PD 8), 198 or 7% in SE VA & 106 or 3.7% in Metro Richmond (PD 15)

• The 2nd largest language group for persons age 65 & over with English-deficiency is “Asian & Pacific Island” languages (principally Korean, Tagalog, Chinese & Vietnamese).

-2,500

0

2,500

5,000

7,500

10,000

12,500

15,000

17,500

20,000

22,500

1 2 3 4 5 6 7 8A 8B 8C 8D 8E 9 10 11 12 13 14 15 1617/1819 20 21 22

Change in Hispanic Population, 2000 - 2003, by AAA-PSA

All Hispanics and/or Latinos Total Pop Abs Change

All Hispanics and/or Latinos 60+ Pop Abs Change

Increasing Ethnic Diversity

Top 15 Non-English-Speaking Population Groupsin Virginia by Age Cohort, 2000

0 5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000 45,000 50,000 55,000 60,000

Spanish

Tagalog

French

Korean

German

Chinese

Vietnamese

Persian

Arabic

Hindi

Urdu

Italian

Russian

Greek

Japanese

60+ Early Boomers: Age 45-54 Late Boomers: Age 36-44

Virginia’s Projected Population Growth

Trends in Life Expectancy

0.05.0

10.015.020.025.030.035.040.045.050.055.060.065.070.075.080.085.0

Tota

l

Mal

e

Fem

ale

Tota

l

Mal

e

Fem

ale

Tota

l

Mal

e

Fem

ale

All Races White Black

US Life Expectancy by Age, 2000

At Birth 1 Year 20 Years 40 Years 60 Years 80 Years 100 Years

Life Expectancy Change (in Years): by Age, Race, and Sex, United States

(1950 - 2000)

Age

All Races White Black

Total Male Female Total Male Female Total Male Female

At Birth 8.93 8.83 8.74 8.58 8.59 8.07 11.17 9.39 12.50

1 7.41 7.07 7.36 7.05 6.89 6.83 9.25 7.34 10.83

10 6.96 6.65 6.92 6.62 6.52 6.44 8.60 6.64 10.23

20 6.80 6.38 6.77 6.49 6.28 6.34 8.31 6.27 9.83

30 6.59 6.22 6.52 6.38 6.11 6.10 7.61 5.79 8.98

40 6.29 5.91 6.14 6.11 5.93 5.86 6.72 5.01 7.98

50 5.70 5.31 5.60 5.60 5.37 5.44 5.52 3.95 6.43

60 4.66 4.22 3.78 4.65 4.24 4.76 3.63 2.39 4.25

70 3.58 2.89 3.33 3.61 2.93 4.02 1.82 0.76 2.21

80 2.36 1.66 2.58 2.33 1.62 2.61 0.88 0.23 0.95

90 1.26 0.80 1.75 1.19 0.73 1.29 1.03 0.62 1.07

100 0.78 0.48 0.89 0.48 0.28 0.58 1.06 0.87 1.06

What Lies Ahead? Projected US Life Expectancy Range:

Life ExpectancyAT BIRTH 1999 2025 2050 2100

Total Male 74.0 – 74.1 76.5 – 79.1 79.5 – 83.8 85.0 – 92.3

Total Female 79.7 – 79.8 82.6 – 84.6 84.9 – 88.4 89.3 – 95.2

White, NH Male 74.7 – 74.7 76.9 – 79.2 79.5 – 83.5 84.8 – 91.8

White, NH Female 80.1 – 80.1 82.6 – 84.5 84.8 – 88.0 89.0 – 94.6

Black, NH Male 68.3 – 68.5 72.4 – 75.3 76.6 – 81.3 83.9 – 91.4

Black, NH Female 75.1 – 75.2 79.3 – 81.7 82.7 – 86.5 88.4 – 94.5

Am Indian, NH Male 72.8 – 73.0 77.2 – 80.1 80.3 – 84.9 85.6 – 92.9

Am Indian, NH Female

82.0 – 82.1 85.3 – 87.7 87.3 – 91.0 90.6 – 96.5

Asian, NH Male 80.8 – 80.9 81.5 – 83.8 83.2 – 87.1 86.6 – 93.5

Asian, NH Female 86.5 – 86.6 86.8 – 88.7 88.1 – 91.2 90.7 – 96.2

Hispanic Males 77.1 – 77.2 79.0 – 81.5 81.4 – 85.5 85.8 – 92.9

Hispanic Females 83.7 – 83.8 85.1 – 87.1 86.8 – 90.0 90.1 – 95.6NH = “Non-Hispanic”

Source: National Projections Program, Population Division, U.S. Census Bureau, Wash. DC 20233. Jan 13, 2000.

Expectancy Range (in Years): Low – High Projection Series

0 1000 2000 3000 4000 5000 6000 7000 8000 9000 10000

Persons

1990

2000

2010

2020

2030

Yea

rAging Trends in Virginia

Under 60 60 - 74 75 - 84 85+

Possible Impact of Aging Trends on

Virginia’s Long-Term Care Industry

Prepared by VDA for Secretary Woods’

Task Force on Assisted Living Facilities

• Nursing Facilities (Part A)• Assisted Living Facilities (Part B)• Home Health Care (Part C)• Adult Day & Respite Care (not

included)• Community-Based Care (Part D)• LTC Work Force (Part E)

Virginia’s Long Term Care Industry

Modeling Aging Impact: Sector SpecificPopulation Projections, by Age Group (6)

- Nursing Facility Forecast (2 Scenarios)= LTC Residual, by Age Group

- Assisted Living Facility Forecast (1 Scenario)

= LTC Residual, by Age Group- Home Health Care Forecast (1 Scenario)

= LTC Residual/Community-Based Care Forecast, by Age Group

LTC Workforce Impact (2 scenarios)

A. Nursing Facility Forecasts• Scenario 1: VDH Bed Need Forecast Model (2002 nursing home use rate & average facility size constant)

2003 2010 2020 2030

Existing & Future Facilities

292 +32= 324

+108= 400

+212= 504

Existing Beds: 2003

31,802

Existing & Approved (2003) & Future Beds

32,509 +3,420=

35,929

+11,216= 43,725

+26,817=

59,326

Existing & Future Residents

29,448 +3,822= 33,270

+11,041= 40,489

+25,488=

54,936

Source: VDA Application of VDH Nursing Bed Forecast Methodology for COPN Review; additional facilities calculated by dividing forecasted additional future NF residents by minimum facility size (120) criteria.

2003 2010 2020 2030

Existing & Future Facilities

292 +12= 304

+72= 364

+181= 473

Existing/Future Bed Need

31,802 + 781= 33,920

+ 8,614=

41,123

+21,699=

54,208

Existing & Approved (2003) /Future Beds

32,509 + 1,411=

33,920

+ 8,614=

41,123

+ 21,699

= 54,209

Existing & Future Residents

29,448 + 1,961= 31,409

8,631=

38,079

+20,749=

50,197

• Scenario 2: VDH Bed Need Forecast Model (Selected)(’98 – ‘02 rate trends extended to 2010,

constant NF use rate post 2010)

B. Assisted Living Facility Forecast 2000 2010 2020 2030

Existing (2000) & Projected Facilities

683 +102= 785

+340= 1,023

+601= 1,284

Existing (2000) & Projected Licensed Capacity

35,720 +7,458=

43,178

+ 20,582= 56,302

+ 34,927 = 70,647

Existing (2000) & Projected Residents

27,091 +11,769=38,860

+24,989=52,080

+40,024=67,115

Estimated (2000) & Future Assumed Occupancy Rate 85% 90% 92.5% 95%

Source: Developed by VDA Methodology: Based on historic 2000 DSS licensing data, 2004 DSS survey reported facility occupancy rate of 86.1% and estimated 2000 utilization rate per 1,000 of population age 65 & over applied to forecast population age 65 & over. Occupancy rates assumed to increase from 85% to 95% over forecast period. 2000 avg. beds per facility (55) held constant over forecast period.

Comparative State Demographic Data

• In 2003, 22.4% of Florida’s population was age 60 & over (ranked 1st), compared to Virginia’s 15.6%

• Between 2000 & 2003, Virginia gained 79,020 persons age 60 & over, a 7.3% increase since 2000

• Based on national projections, Virginia’s population age 60+ (24.3%) in 2025 will be roughly comparable to Florida’s current age structure (persons age 60+ =22.4% of total in 2003).

Comparative Statistics for Virginia & Florida, 2003 Virginia Florida FL : VA

Total Population 7,386,330 16,851,256 2.3X

Population, Age 60 & over 1,150,368 3,772,911 3.2X

Assisted Living Facilities, # 683 2,278 3.3X

ALF Beds 35,720 74,455 2X

Beds per 1,000 (Total Population) 4.84 4.42

Beds per 1,000 (60+) 31.05 19.73

Nursing Facilities, # 292 669 2.3X

NF Beds 31,802 82,180 2.6X

Beds per 1,000 (Total Population) 4.31 4.88

Beds per 1,000 (60+) 27.65 21.78

C. Home Health Care Forecast

Age Group

Rate per

10,000 in age group

Estimated Patients,

2000 Projected

Patients, 2010 Projected

Patients, 2020

Projected Patients,

2030

#Pct of Total #

Pct of Total #

Pct of Total #

Pct of Total

Total Populatio

n 44.4331,03

5100.0

% 39,178 100.0% 47,363 100.0%59,66

3 100.0%

Under 65 Years 16.4

10,309 33.2% 11,281 28.8% 11,878 25.1%

12,338 20.7%

65 - 69 Years 103.1 2,196 7.1% 2,787 7.1% 3,973 8.4% 4,744 8.0%

70 - 74 years 159.3 3,393 10.9% 4,307 11.0% 6,139 13.0% 7,329 12.3%

75 - 79 years 310.3 3,932 12.7% 4,632 11.8% 5,795 12.2% 8,569 14.4%

80 - 84 years 404.1 5,121 16.5% 6,032 15.4% 7,546 15.9%

11,159 18.7%

85 years + 697.1 6,083 19.6% 10,140 25.9% 12,032 25.4%

15,524 26.0%

Source: Developed by VDA from National Center for Health Statistics, Current Home Health Statistics (Feb. 2004) http://www.cdc.gov/nchs/data/nhhcsd/curhomecare.pdf.

Methodology: National rates of home health care usage applied to LTC residual population by age group.

D. Community-Based Care (e.g. AAA)

Target Population for Community

Based Care Programs 2000 2010 2020 2030

Under 65 Years 6,273,115 6,865,007 7,227,712 7,507,938

65 - 74 Years 420,364 533,641 760,590 908,119

75 - 84 Years 244,405 287,861 360,143 532,551

85 Years & over 52,128 96,943 107,433 138,652

TOTAL, 65 & over 664,769 918,445 1,228,166 1,579,322

% of Total Population 9.4%

11.6%14.2% 17.0%

Estimated/Projected* AAA

Client PopulationApprox.

60,00082,700*

110,500* 142,000*

% of 65+ Population

Approx. 9.0%

9.0%9.0% 9.0%

Source: Developed by VDA. Methodology: Residual population by age group remaining after subtracting forecasted institutionalized population (by age group) in nursing and assisted living

facilities and patients receiving home health care services. *Projected clients served based on assumed proportional increased funding and same market share over projection period.

E. LTC Workforce Forecast, by Sector

Estimated 2000Long-term Care

Sector Employment

Skilled Worker by License Type

Estimated Unlicense

d Direct Care

Workers

Total Employe

d by Type Of Care

Pct. Employe

dby Type

of CareCNA LPN RN

CNS LNP

Nursing Homes 12,038 4,055 2,098 1 44 9,523 27,759 42.5%

Assisted Living Facilities 3,695 652 614 0 12 10,673 15,646 24.0%

Home Health & Personal Care 5,375 1,164 3,122 10 9 11,056 20,735 31.8%

Hospice 364 71 665 1 3 3,320 4,423 6.8%

Total: LTC Sector

21,472 5,941 6,500 12 68 31,251 65,244 100.0%

Pct of all Active Licensees, by type of license 50.8% 20.9% 7.5% 2.8% 1.7% N/A 100.0% Licensed

Estimated Total, All LicensedDirect Workers 42,270

28,381

86,638 427 4,093 161,809 21.0%

Source: Developed by VDA in consultation with Virginia Board of Nursing staff.

Methodology: Based on Nursing survey performed by VA Tech in Oct 2001 for Board of Nursing and July 2000 active number of nursing licensees by license type. Unlicensed worker estimate based on national trends.

• Scenario B: BLS Occupational Demand Forecasts = 146% increase by 2030

Employed in LTC Sector CNA LPN RN CNS LNP

Estimated Unlicensed

Direct Care Workers

Total Direct Care

Workers

2000 21,472 5,941 6,500 12 68 31,251 65,244

2010 30,900 8,252 9,808 19 94 52,167 101,240

2020 38,827 10,369

12,323 23 118 66,498 128,158

2030 48,787 13,029

15,485 28 148 83,045 160,522Source: Developed by VDA staff in consultation with Board of Nursing staff. NF forecast series #2 used for NFs.

Methodology: A) LTC nursing workers (by type) forecast based on 2000 nursing rate per 1000 care population. B) 2000 LTC nursing workers forecast based on BLS occupational growth rates by decade published in: U.S. HHS, Report to Congress: "The Future Supply of Long-Term Care Workers in Relation to the Aging Baby Boom Generation", May 14, 2003, (Assumed Growth Rates) Table 8, page 16

E. LTC Workforce Forecast (continued)

Employed in LTC Sector CNA LPN RN CNS LNP

Estimated Unlicensed Direct Care

Workers

Total Direct Care

Workers

2000 21,472

5,941 6,500 12 68 31,251 65,244

2010 26,065

7,120 8,261 15 83 44,164 85,708

2020 32,177

8,733 10,080 19 102 55,121 106,231

2030 41,770

11,380

12,965 24 133 71,035 137,307

• Scenario A: Maintain 2000 Work Force Patterns = 110 % Increase by 2030

HJR 103 Study: Interim Report Findings – Trends in State Employee Retirement Age

Trends in State Government Retirement Age

Aging Population =

Increased Cost for Health Insurance Plans

Future Aging-Related Societal Issues

• Stability of Social Security, Medicare & Medicaid Programs

• Expansion of LTC Skilled & Unskilled Work Force

• Public Acceptance of Additional LTC Facilities

• Expansion of Public Funding Support to Meet Demand for Community-Based Service Delivery

• Continued Economic Growth with Shrinking Labor Supply

• Alternative Work Programs for Job & Benefit-Sharing

• Transportation System Access for Senior Citizens

• Emergency Contingency Planning & Response for Significant Home-bound Senior Population

Helpful Data Sources on Aging Demographics:

• 2000 Census Special Tabulation on Aging:http://www.aoa.gov/prof/statistics/tab/aoacensus2000.html

• VDA Web Site: Statistics:http://www.vda.virginia.gov/downloadable.htm

• CDC, National Center for Health Statistics:http://www.cdc.gov/node.do/id/0900f3ec8000ec28

• The Lewin Group: Disability Forecast Model:http://lewingroup.liquidweb.com/cgi-bin/woodwork.pl

• Boston College Ctr. for Retirement Research:

http://www.bc.edu/centers/crr/

Contact Information:

Kevin F Byrnes, AICPDemographerVirginia Dept. for the Aging1610 Forest Ave, Suite 100Richmond, VA 23229

(804) 662-7047Kevin.Byrnes@vda.virginia.gov http://www.vda.virginia.gov/downloadable.htm