As a wave, or tsunami rather, of baby boomers is expected to populate the Vineyard in the coming years, the Island faces a number of challenges delivering health care to its seniors. Six rural health scholars from the University of Massachusetts Medical School recently documented those challenges in a report on the current mental health needs of the Island’s elderly population. Transportation, isolation and access to mental health services emerged as major areas needing improvement.
From Oct. 17 to Oct. 28, the six students shadowed Island health care providers and interviewed more than 40 Island physicians, home health care workers, mental health workers and Island clergy members to assess the state of elderly mental health care on the Island. The project advisor, Paddy Moore of West Tisbury, said they found there were inherent barriers to treatment when dealing with senior citizens.
“I had probably underestimated the stigma about mental illness,” she said. “It isn’t surprising when you think about the older generation, but I thought we’d made more progress than we actually had.”
Dukes County already claims the third largest elderly population of any county in the state but that population is expected to explode in the coming decades. In Massachusetts the elderly population is expected to grow 50 per cent between 2000 and 2020, but in West Tisbury alone the number is over 225 per cent. And the other five towns are not far behind.
According to the 2010 U.S. census, a third of the population in Dukes County is over the age of 55. Oak Bluffs claims the most seniors, while Chilmark claims the highest percentage of its population aged 55 and older topping 40 per cent. Almost a quarter of its population is over 65. With so much of the elderly population living up-Island and most of the elderly services concentrated down-Island, Mrs. Moore said transportation emerged as a key issue on the Vineyard.
“None of the students had grown up in rural areas and I think they were shocked actually at the distances,” said Mrs. Moore. “The Vineyard Transportation Authority is marvelous compared with what it was like five years ago, but if you live significantly off the main road and are 85 years old with mobility problems, it doesn’t do you any good. You need door-to-door service.”
Indeed, in the dozens of interviews with Island health care providers, “current transportation system not meeting elders’ needs,” and “on-Island transportation issues” were the top two topics mentioned. Until recently the all-Island council on aging operated a van to carry seniors to appointments and even to the grocery store and library, but the service was cut after state funding dried up, Mrs. Moore said.
In addition to the physical distances that separate the elderly from services, there is the emotional distance many suffer from isolation, which was the third most discussed topic during interviews.
“The students were very struck by how isolated people were,” Mrs. Moore said.
For Oak Bluffs council on aging director Roger Wey, the answer is more programming at the Island senior centers.
“There need to be more programs to get people out of their homes and get them into an environment where there are other people,” he said. “The tendency as people get older is to be by themselves. I see the senior center as a teen center for the seniors.”
The study also explored substance abuse issues among the elderly. Extrapolating self-reported data from the 2004 Health Report of Martha’s Vineyard to the 2010 census, the rural health scholars estimated that there were nearly 200 seniors on the Island abusing alcohol and prescription drugs.
“If you spent any time here you’d probably know that my generation is fairly familiar with alcohol,” said Mrs. Moore. “It’s a challenge. When people are alone it can enhance their propensity to abuse it.”
While substance abuse remains a problem, few seniors take advantage of programs like New Paths, an intensive 12-week substance abuse program offered at Martha’s Vineyard Community Services.
“Unfortunately many services are unknown or overlooked,” wrote the students in a presentation of their final results last week.
The students also studied the effectiveness of the Counseling Outreach and Referral for the Elderly or CORE program, a home counseling service in its first year. The program, which was conceived by Mr. Wey several years ago, is funded by a five-year $51,670 community initiative grant through the Martha’s Vineyard Hospital
The referral program “fills a gap in services” according to the students’ report. “It does a great job of bringing resources from different agencies together”.
“A senior just has to be referred by an outreach worker, or by the senior center of the town they live in, or anyone, and it’s free,” said Mr. Wey. “It’s been very, very successful and this is just the first year. It’s helped over 50 people.”
The rural scholars recommended expanding awareness of the CORE program among the public and health care providers with formal presentations at town meetings, council on aging events and elderly housing meetings, advertisements and brochures at churches and libraries. More broadly, they proposed establishing a Web site that connects health care providers to all the services available on the Island.
With the coming demographic shift on the Vineyard, these services will likely be in higher demand, but Mrs. Moore was cautious when asked whether a wave of new elderly residents will strain Island resources.
“It’s a simple question but also a complicated question,” she said. “First of all we need to avoid getting into a battle between the need for services among the elderly and the child and adolescent population. We need to put it in the context of Community Services. They’ve been criticized in the past for not having adequate services for adolescents and kids and they’re really working hard on that. While I certainly encourage the growth of their services to the elderly, one hopes that it can be done by expanding the pie and not reslicing it.”
The rural scholars work was funded through a community benefits grant from the Martha’s Vineyard Hospital. The $1 million grant paid for eight separate projects, including a Lyme disease study and the study of mental health in the Island elderly population. The work of the rural scholars will continue. On Jan. 18, 2012, the Dukes County Health Council, elder services committee and Island health care providers will meet to discuss the report and its recommendations.