‘My commission will focus on a stronger coordinated approach to delivering services to today’s seniors and the aging communities of the future.’

Do you envision living to 85, 95, or even 105? For some, it might be nirvana; for others, it might be a nightmare. In either case, our nation’s fast growing senior population will present challenges to society at large.

Rhode Island’s elder population is growing like gangbusters, while the population growth among younger residents is flat or on a downturn, according to Census data projections. In 2025, nearly 9% of the state’s population is projected to be seniors, 75 and older; in 2040, that cohort will represent 14% of the state’s population.

Put another way, in 2040, 150,910 seniors, 75 and older, are expected to call Rhode Island home. That represents a staggering 60% increase over Rhode Island’s projected 94,209 seniors in 2025. Rhode Island ranks fourth nationally in the number of nonagenarians and centenarians on a per capita basis.

That’s a key reason why Rep. Lauren H. Carson (D-Distr. 75, Newport) proposed a House legislative commission to study senior-focused services and programs. “In many conversations with Carmela Geer, executive director at the Edward King House, I learned that many aging Newport residents found it challenging to  access services; I listened to her,” said Carson. “We have many wonderful programs … but are we ready to absorb another 25,000 to 40,000 seniors? I think [the issues are] worth studying.”

State Rep. Lauren Carson – Photo by Nancy Kirsch

In May 2023, the House of Representatives approved legislation authorizing the commission, which Carson chairs and includes 16 members. At its initial monthly meetings, the commission is identifying what’s going on for the state’s aging communities, where they live, what programs and resources are available, etc. 

While she appreciates the state’s many senior-focused programs, plans and committees that the commission will review, Carson added, “My commission will focus on a stronger coordinated approach to delivering services to today’s seniors and the aging communities of the future.” 

Recognizing how diverse our aging population is – and the diversity of their needs – the commission will evaluate Census data breaking down the senior populations by gender, race and ethnicity, and urban versus rural residency.  “Once we discuss the issues and decide whether to focus on housing, aging in place [or] elder abuse, for example, we’ll … look at best practices,” said Carson, who has the Age-Friendly Massachusetts Action Plan and California’s Master Plan on Aging in “her toolbox,” as potential resources for best practices.

Aging as nirvana…?

For those of us with sufficient physical, cognitive and emotional health and financial security, it could be nirvana. “If we get it right, there’s incredible promise in having those bonus years of life,” said William J. Kole, author of The Big 100, The New World of Super-Aging, (published by Diversion Books, October 2023). The book is replete with examples of centenarians who contribute to a lively society, including a 105-year-old competitive runner who is setting world records and a 104-year-old active judge. Earlier in his career, while based in Paris for the Associated Press, he wrote about Jeanne Calment. At 122, she was the oldest person alive whose birth could be authenticated. “Calment,” Kole said, “was still riding her bike at 100.” Through his exhaustive research, Kole found that having a religious faith and an optimistic nature can contribute to our longevity.  

Samuel Bender and his daughter, Andrea Joseph – Photo by Maria Fonseca

At 107, Sam Bender still appreciates the good days; when he can get up and about with help and enjoying dinner and Scrabble with friends at Laurelmead, a retirement community on the East Side of Providence. “It’s difficult to read with only one good eye, but we have programs at Laurelmead with music, singers, dancers and old movies,” he said in a phone interview. “I go to some of them; sometimes, I’m pooped out.”

“If there’s an activity I can go to, I participate in that, with my family nearby,” said Bender, who plans to spend Thanksgiving with local and out-of-town relatives, at the nearby home of his grandson, his granddaughter-in-law and their children.

While recalling that he’d often enjoy a shot of bourbon after coming home from work, he said, “That reminds me; maybe I should [start it up again].” As he was talking, his daughter, Andrea Joseph, 75, checked his supply and confirmed he still had bourbon available. 

An aging nightmare…?

For others, money and/or health woes portend a far bleaker old age. According to this report, only 7% of U.S. elders have retirement income from three sources: Social Security, a pension and saving; 40% of elders rely exclusively on income from Social Security, which is not meant to serve as a sole source of financial support.

The U.S. Surgeon General, Dr. Vivek Murthy, named isolation and loneliness a public health crisis, one that leads to significantly higher risks of physical and mental health diseases and of premature deaths. And, approximately one in nine people, 65 and older, in the U.S., have Alzheimer’s, according to an Alzheimer’s Association report. In Rhode Island, the report projects a 12.5% increase in individuals with Alzheimer’s, from 24,000 in 2020 to 27,000 in 2025.

And, for seniors of color, aging may be more problematic. Although life expectancies can vary wildly due to where one lives, systemic racism has contributed to Black people dying, on average, six years younger than their white counterparts in the U.S. “That inequity is unconscionable,” said Kole. “We have to fix [that situation] – where our neighbors and friends of color aren’t living as long as white people.”

Aging challenges will affect us all…

“People may well live to [a very advanced age], whether they like it or not,” said Kole. “All of us – from age 18 to 81 – have a stake in the kind of society we engineer as our society ages profoundly. It’s up to us, as ordinary Americans, to pressure our political representatives to do what needs to be done, including adequate Medicare and Social Security funding. There are things the government needs to fix and things that we as individuals need to fix,” including planning for retirement’s financial challenges in our 20s, not in our 50s or 60s.

William J. Kole – Photo by Terry DeYonker Kole

Although Bender retired from his veterinary practice at age 68, he drove until he was 100. Even in his 90s, he was traveling internationally with his wife, Shirley. They were married for 73 years, until her death in 2014. “My marriage was the biggest thing in my life; Shirley was a good partner,” recalled Bender. “Shirley was active, and loved literature, music, traveling and making strong friendships with people from all over the world.”

Joseph recalled, “While she stayed home to raise my siblings and me, she helped my father with bookkeeping and administrative tasks after she graduated from the early days of swabbing out the kennels.” 

Bender, who has 24/7 care from aides, accepts what is; his life at 107. While he sometimes wonders why he’s reached this advanced age, he said, “I know there’s no answer, so I just accept the fact.”

Regardless of individual situations, myriad challenges exist as we grapple with the “graying and grannying of America.” That raises numerous questions and challenges for the state, senior-focused agencies, the health care system, housing, families of the seniors and, clearly, the seniors themselves. Flat or negative growth in Rhode Island’s youngest populations, consider the implications: With fewer contributions to the Social Security system – which could go bankrupt in the interim – a smaller workforce doesn’t bode well for an already stressed and inadequate cohort of workers caring for seniors. The caregiver shortage will only grow more dire as the population ages, though a thoughtful immigration policy could alleviate that shortage, suggested Kole.

A misplaced belief in American exceptionalism – vis a vis our health care – and ageism both concern Kole. In 2023, the United States ranks 58th in the world for life expectancy! “Ageism is a huge problem; what will our society, which values youth over age, look like, with so many people living into their 80s, 90s and beyond?”  On the other hand, Kole finds it alarming we run the risk of becoming a full-blown gerontocracy. “As we collectively age, we can’t forget the needs and desires of the younger generations; all seasons of life are important.”

Asked if she thinks ageism impacts her father’s life, Joseph said, “He doesn’t feel neglected; he’s in a community at Laurelmead where people value one another’s experiences, stories, talents and skills.”

What are state agencies doing?

The Rhode Island Office of Healthy Aging (OHA), previously named the Division of Elderly Affairs, focuses on its markedly diverse constituency – adults from 55 to 85, and adults with disabilities. With a limited budget (nearly $38.7 million for this fiscal year, most of which comes from the federal government) and 33 employees, OHA works with state agencies and community partners to elevate seniors’ needs. It works, for example, with Medicaid to address long-term care costs and with the Rhode Island Department of Health to understand nursing home trends.

“OHA is not charged with solving the housing shortage,” said OHA Director Maria Cimini. “OHA has a seat on the Housing Resources Commission and we partner with others to ensure that [they consider] Universal Design, accessibility, affordable housing and, most often, availability.  Everyone wants to age in place, but the house is too big for them and there aren’t smaller units to move to. There’s a bottleneck in individual housing units.” 

Rhode Island Office of Healthy Aging Director Maria Cimini – Photo by Jay Weber

Housing shortages aren’t the only challenge facing seniors; COVID exacerbated the pre-existing shortage of workers caring for elders. There’s room for improvement in Rhode Island, according to an AARP 2023 report, A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers. Ranking 12th overall throughout the U.S., Rhode Island falls within the second-best tier. The state ranked 17th for affordability and access; 10th for choice of setting and provider; 23rd for safety and quality; 20th for support for family caregivers and 15th for community integration.

As a partner with Rhode Island’s Executive Office of Health and Human Services and its Workforce Transformation Initiative, OHA raises the specific concerns related to caring for older adults. “They are typically women and women of color whose work is undervalued, due to sexism and racism. We need to build a workforce that is paid appropriately, and we need to support non-professional helpers, such as family members and friends,” said Cimini, referencing the need for a continuum of care, from informal family and friend caregivers, who need flexibility and accommodations in their workplaces, to sophisticated nursing care. And, said Carson, the people comprising that workforce is aging, as well. “Even before COVID, we knew we had a workforce [shortage], especially in human services.”

Almost 70% of Rhode Island’s nursing homes are understaffed, due to a shortage of Certified Nursing Assistants, according to The Rhode Ahead, the June 2023 Annual Progress by the Rhode Island Health & Human Services Workforce Initiative. “While I support people’s desire to age in place, we also need nursing homes,’ which have experienced significant problems. “It’s very expensive – $10,000 a month or so – to keep someone in a nursing home. We’ll be looking at huge Medicaid expenses if the next generation needs nursing home care,” said Carson. 

Contradicting the popular meme, “one size fits all,” Cimini said, “It’s a challenge in government, but we need to be more nuanced … we need multipronged responses. I’m always trying to build as many paths to [healthcare] service as possible; we want to support people in the ways they want and need.”

With so many diverse senior-focused organizations, figuring out where to access resources can be confusing. To that end, OHA contracts with the United Way of Rhode Island to host Rhode Island’s Aging and Disability Resource Center (ADRC), the Point, which has been responding to diverse questions about aging safely for more than a decade. Some 18 months ago, OHA expanded the Point’s work to include Person-Centered Options Counseling (PCOC). “If someone had called the Point to ask about food delivery options, they might have received information about Meals on Wheels, or other … options,” said Cimini. Now, thanks to the PCOC training several Point staff members received, there are bigger conversation. If an elderly woman calls to say she need food, the PCOC trained staff person might learn, for example, that the caller needs food because her son is worried that she’ll burn down the house while cooking. “They talk about safety and security and what’s needed,” said Cimini. “The request is not just a conversation about food; it might be about not being able to cook because of concerns about safely using appliances.” For the first time, this year’s budget includes state funds to support the ADRC.

Asked about ageism, Carson noted that seniors are huge contributors to our economic engine. According to an AARP report, in 2020, individuals 50 and older represent 24% of the world’s population, and accounted for some 34% of the world’s Gross Domestic Product. 

Whether Rhode Island’s older adults are 55 or 85 or Caucasian, Latino, Asian or Black, Cimini said, “Rhode Island state government is being thoughtful in our approach that supports caregiving and creating opportunities for people to learn and create second acts in retirement, with an eye toward equity and inclusion.” Those state-sponsored initiatives include Governor Daniel J. McKee’s 2030 Plan, Carson’s commission, OHA’s State Plan on Aging 2023-2026, and the senior centers located in every Rhode Island city and town.

While Carson’s commission is charged with running monthly meetings through May 2024, she anticipates that it will need to meet for an additional six months thereafter. This spring, she anticipates holding field hearings – one in Newport and another in Warwick – in venues more accessible to seniors than is the Statehouse. Preparing for these challenges, said Carson, “is a huge challenge. Sometimes I’m a bit scared, but most of the time, I’m raring to go.”

Although Cimini gets overwhelmed with her “wish list,” she said, “Without question, we’re moving in the right direction; our heart, money, and intention ensure that Rhode island is a great place to grow up and grow old in the way we see fit.” Throughout her tenure as OHA director, she remains hopeful, given support from Governor McKee, attention from the General Assembly, stronger connections between OHA and its community partners, and the increasing interest in and attention to serving older adults.

Thoughts for the future

Asked how he’d like to be remembered after he passes away, Bender said, “I hope that my family and friends will remember the love that I had for them and the love they had for me.” Bender’s family includes his daughter and son, Joel, as well as five grandchildren and 10 great-grandchildren. Another son, Mitchell, died of lymphoma in 1990; both of his living children are widowed.

“My father created a legacy that made a difference in all of our lives,” said Joseph. “My dad was the oldest of four children and his family grew up in poverty. He made sure his brothers understood that they needed to go to college to lead better lives.”  And journalist Kole gets the last word: “I hope to live to be 100, purely out of journalistic curiosity.”