An Overview of the Aging Population & Individuals with Disabilities - YADKIN COUNTY - Piedmont Triad Regional Council

 
An Overview of the Aging Population & Individuals with Disabilities - YADKIN COUNTY - Piedmont Triad Regional Council
Y ADKIN                       An Overview of the
C OUNTY                        Aging Population
                                      &
                               Individuals with
                                 Disabilities

Publication Date: June 2018
An Overview of the Aging Population & Individuals with Disabilities - YADKIN COUNTY - Piedmont Triad Regional Council
PIEDMONT TRIAD
REGIONAL COUNCIL
An Overview of the Aging Population & Individuals with Disabilities - YADKIN COUNTY - Piedmont Triad Regional Council
Yadkin County

Letter from the Piedmont Triad Regional Council Area Agency on Aging Director ............ iii
Introduction ................................................................................................................................... 1
Health Care.................................................................................................................................... 2
   Health Outcomes ......................................................................................................................... 3
   Chronic Disease .......................................................................................................................... 4
   Health Care Cost ......................................................................................................................... 5
   Medicare ..................................................................................................................................... 5
   Health Care Facilities .................................................................................................................. 6
   Long-Term Care Facilities .......................................................................................................... 8
   Agencies Serving Older Adults and Individuals with Disabilities Directory............................ 10
Demographics of the Total Population ...................................................................................... 12
   Past and Present Total Population ............................................................................................. 12
   Projected Total Population ........................................................................................................ 12
Demographics of the Older Adult Population .......................................................................... 13
   Past and Present Older Adult Population .................................................................................. 13
   Projected Older Adult Population ............................................................................................. 14
   Working Adults......................................................................................................................... 15
   Piedmont Triad Region Growth ................................................................................................ 16
   Population Density.................................................................................................................... 17
   Household Types....................................................................................................................... 19
   Race & Ethnicity ....................................................................................................................... 20
   Income....................................................................................................................................... 22
   Health Insurance ....................................................................................................................... 23
   Vehicle Access .......................................................................................................................... 24
   Language ................................................................................................................................... 26
   Nutrition and Food Insecurity ................................................................................................... 27
   Individuals with Disabilities ..................................................................................................... 27
   Grandparent Caregivers ............................................................................................................ 28
   Family Caregivers ..................................................................................................................... 28
References .................................................................................................................................... 29

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An Overview of the Aging Population & Individuals with Disabilities - YADKIN COUNTY - Piedmont Triad Regional Council
Yadkin County

Figure 1: County Land Cover ......................................................................................................... 1
Figure 2: Total Population (1990-2016) ....................................................................................... 12
Figure 3: Projected Total Population Change (2016-2037) ......................................................... 13
Figure 4: Older Adult Population (1990-2016)............................................................................. 13
Figure 5: Projected Older Adult Population Change (2016-2037)................................................ 14
Figure 6: Population by Age Group (2005-2035) ......................................................................... 14
Figure 7: Ratio of Working Adults to Older Adults (1990-2035) ................................................ 15
Figure 8: Living Arrangements of the Population Age 65+ (2016) .............................................. 19
Figure 9: Income Benchmark Comparison ................................................................................... 22

Table 1: Population Overview (2016 & 2036)................................................................................ 1
Table 2: Chronic Conditions of the Fee-for-service Population Ages 65+ (2015) ......................... 4
Table 3: County Expenditure by Service Category for Clients 60+ (FY16-17) ............................. 5
Table 4: Medicare Enrollment (2013-2017).................................................................................... 5
Table 5: Health Care Professionals (2017)...................................................................................... 6
Table 6: Health Care Facilities Directory ....................................................................................... 7
Table 7: Long-Term Care Facilities & Beds in Yadkin County ..................................................... 8
Table 8: Provider Agencies Directory........................................................................................... 11
Table 9: Total Population Change (1990-2016) ............................................................................ 12
Table 10: Older Adult Population Change (1990-2016) ............................................................... 14
Table 11: Percent Growth (2015-2035) ........................................................................................ 16
Table 12: Older Adult Population in Rural Areas (2016) ............................................................. 19
Table 13: Population by Race & Ethnicity (2016) ........................................................................ 20
Table 14: 2016 Poverty Guidelines ............................................................................................... 22
Table 15: Health Insurance Coverage (2016)................................................................................ 23
Table 16: Disability by Type (2016) ............................................................................................. 27
Table 17: Grandparent Caregivers (2016)..................................................................................... 28

Map 1: 2018 NC Health Factors Map ............................................................................................. 3
Map 2: 2018 NC Health Outcomes Map......................................................................................... 3
Map 3: Health Care Facilities.......................................................................................................... 7
Map 4: Long-Term Care Facilities .................................................................................................. 9
Map 5: Provider Agencies ............................................................................................................. 10
Map 6: Population Density of Older Adults (60 Year and Older), 2016 by Block group............. 17
Map 7: Density of Older Adults in Rural, Suburban and Urban Areas (2016) ............................. 18
Map 8: Percent Minority of the Total Population by Block Group (2016) ................................... 21
Map 9: Older Adult Population without Access to a Vehicle (2016) ........................................... 24
Map 10: YVEDDI Surry-Yadkin Connector Route ...................................................................... 25
Map 11: Older Adult Population: Speak a Language Other than English (2016) ......................... 26

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An Overview of the Aging Population & Individuals with Disabilities - YADKIN COUNTY - Piedmont Triad Regional Council
Yadkin County

Letter from the Piedmont Triad Regional Council Area Agency on Aging Director

Health Care, Behavioral Health, and Human Services have undergone tremendous change in
recent years. The Affordable Care Act (ACA), Medicare Access and CHIP Reauthorization Act
(MACRA), the imminent transition from traditional Medicaid to Managed Care, the expected
change of the Community Care Network and transformation in NC Department of Health and
Human Services personnel, policies, and processes has significantly impacted service delivery
systems. The mergers and acquisitions ongoing in Piedmont healthcare, bring new energy and
potential to the industry. Other changes in Community Based Organizations (CBO) and the new
Veterans Administration medical facility in Kernersville are adding potential and capacity to the
regional healthcare system. While these reorganizations will help position the healthcare
industry to manage the demographic realities of aging, they alone are not enough to ensure the
system’s sustainability going forward.
In the face of revenue and funding pressure, our thinking about service delivery and program
development must change. Leaders in the Aging industry have impressed upon the members of
the Aging Network the need to adopt a new operating model. The imperatives of the present and
challenges of the future demand we innovate and modernize how we do business. That does not
mean we change the quality of service or downsize. It means that we focus our attention on the
nexus between the social determinants of health and the health care delivery system. Not only
does this make business sense, it is a moral imperative.
The Aging industry, including the Administration for Community Living, the Administration on
Aging, National Council on Aging, and the National Association of Area Agencies on Aging,
among others, has signaled big changes in the Aging Network. These changes have been a
necessary response to the realities of the Affordable Care Act, the Budget Control Act, the
political landscape, and economic downturn of 2008. We recognize that we cannot continue
with business as usual.
We must adopt practices that incentivize financial responsibility and standardize the
administration of a highly complex, and sometimes redundant service delivery system. Our
primary concern must be and will remain that our delivery system provide beneficial health
outcomes for as many people as possible.
A streamlined approach will help us to coordinate a cohesive and comprehensive plan of
programs and services across the region, develop new partnerships, provide person centered care,
diversify sources of revenue, and remain relevant as leaders of Home & Community Based
Services.
Sincerely,

Blair Barton-Percival
Area Agency on Aging, Director

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An Overview of the Aging Population & Individuals with Disabilities - YADKIN COUNTY - Piedmont Triad Regional Council
An Overview of the Aging Population & Individuals with Disabilities - YADKIN COUNTY - Piedmont Triad Regional Council
Yadkin County

Introduction
The Area Agency on Aging, a division of the Piedmont Triad Regional Council, serves 12
counties in central North Carolina, including Yadkin County. Covering 338 square miles, the
County’s land area is 43% forest cover, 38% agriculture/pasture, and 9% developed [1].
                                                                              Figure 1: County Land Cover

The population in Yadkin County and across North
Carolina is changing. In 2016, Yadkin County’s
population reached 37,725. The number of people in
Yadkin County under age 18 was already less than the
number of people age 60 years and older. Over the next
two decades, the child population (under age 18) will                By 2036, 1 in 3
decrease by 1.8% while the older adult population (age 60
years and over) will increase by 21.4%. In 2036, the older
                                                                     Yadkin County
adult population will reach 11,563 people and will vastly            residents will be
outnumber the child population in Yadkin County [2].
Table 1: Population Overview (2016 & 2036)
                                                                     over age 60.
                                                2016             2036                   Change
 Total Population                                  37,725           37,773              48           0.1%
   Children (Ages 0-17)                             7,975            7,830            -145          -1.8%
   Adults (Ages 18-59)                            20,222             18,380          -1,842         -9.1%
   Older Adults (Ages 60+)                         9,528             11,563          2,035         21.4%
Source: NC OSBM 2016 Population Estimates & 2036 Population Projections

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An Overview of the Aging Population & Individuals with Disabilities - YADKIN COUNTY - Piedmont Triad Regional Council
Yadkin County

Health Care
As this age-related demographic shift occurs and as chronic disease and comorbidities become
more prevalent, there will be a corresponding increase in the need and demand for chronic
disease self-management, physical health, fiscal health and social supports to ensure a sound
quality of life for residents in Yadkin County. The growing aging population will challenge
federal entitlement programs such as Social Security, Medicare and Medicaid, and will
significantly increase the demand for Home and Community-Based Services (HCBS), like those
offered by the Area Agency on Aging (AAA) and through its network. HCBS allow individuals
to remain at home and make choices. They live with dignity and independence at a fraction of
the cost of skilled nursing care or other institutional settings. Social determinants, such as
housing, transportation, financial support and food security, can account for 80% of health
outcomes [3]. The HCBS offered by the AAA influence social determinants of health, benefiting
population health through community interventions and collaborative efforts. HCBS drive down
the cost of healthcare by utilizing the lower cost of in-home and community-based programs [4].
Successful transitions from institutional facilities to these community based settings,
communicating with primary care physicians and the coordination of care is key to success.
Although there is a lot of attention and controversy on health care coverage in the national
spotlight, the movement towards evolving the health care system from “volume to value” makes
steady progress. Historically, under its “fee for service” payment system, Medicare paid for tests
and procedures with minimal requirements for their quality or effectiveness. Under the recent
bipartisan MACRA legislation (Medicare Access and CHIP Reauthorization Act), Centers for
Medicare & Medicaid Services (CMS) is moving towards paying for improved health outcomes.
In 2015, CMS set two goals in its push for greater value, and is on track to meet them.
   1. 30% of all Medicare payments are tied to quality through alternative payment models by
      the end of 2016 (met) and 50% by the end of 2018 (on track to meet).
   2. 85% of Medicare fee-for-service payments are tied to quality or value by the end of 2016
      (met) and 90% by the end of 2018 (on track to meet).
These goals will provide incentive for health care providers to partner with ready and capable
Community Based Organizations in new ways. North Carolina has many innovative health
systems that may, with the right approach, be productive partners for helping to improve the
lives of older adults in a way that benefits health care providers, Community Based
Organizations, and the citizens they both serve. Partnerships remain one of the best
opportunities to improve the lives of our older citizens. Changes allowing Medicare Advantage
plans to be reimbursed for HCBS is positive and beneficiaries will reap the benefits.

 Centers for Medicare & Medical Services is moving
 towards paying for improved health outcomes.

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An Overview of the Aging Population & Individuals with Disabilities - YADKIN COUNTY - Piedmont Triad Regional Council
Yadkin County

Health Outcomes
Every county in the United States is assessed annually to reveal how healthy residents are and
how long they will live. Each county is given a Health Factors Rank, based on health behaviors,
clinical care, social and economic factors, and the physical environment. Each county is also
given a Health Outcomes Rank, based on length and quality of life.
In the North Carolina 2018 County Health Rankings, Yadkin County ranks 69th for health
outcomes and 38th for health factors [5]. The higher ranking counties tend to be located in the
urban areas around the Triangle, Charlotte and Asheville.
Communities can use these rankings to help identify issues and opportunities for local health
improvement, as well as to garner support for initiatives among government agencies, healthcare
providers, community organizations, business leaders, policy makers and the public.
Map 1: 2018 NC Health Factors Map

Map 2: 2018 NC Health Outcomes Map

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An Overview of the Aging Population & Individuals with Disabilities - YADKIN COUNTY - Piedmont Triad Regional Council
Yadkin County

Chronic Disease
Chronic diseases and conditions - such as heart disease, stroke, cancer, type 2 diabetes, obesity
and arthritis – are among the most common, costly and preventable of all health problems.
Across the nation, about 32% of the population have multiple chronic conditions, and 86% of all
health care expenditures are for people with chronic and mental health conditions. Table 2
shows the prevalence of certain chronic conditions for the older adult population, ages 65 years
and older, that are Medicare beneficiaries. [6]

Table 2: Chronic Conditions of the Fee-for-service Population Ages 65+ (2015)

                    61%                           51%                           29%
               High Blood                       High                            Heart
                Pressure                     Cholesterol                        Disease
              (Hypertension)               (Hyperlipidemia)

                    30%                           31%                           20%
                  Arthritis                      Diabetes                Chronic Kidney
                                                                            Disease

                    17%                           11%                           10%
                    COPD                      Alzheimer’s                       Cancer
                                              Disease or
                                               Dementia

                                  Source: CMS Chronic Conditions Prevalence

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Yadkin County

Health Care Cost
Skilled nursing care, paid by Medicaid, is the most costly service utilized by older adults (ages
60 years and over) each year. In fiscal year 2016-17, skilled nursing care represented 53% of the
County’s total older adult expenditures and had the highest cost per client ($23,383 per client).
The County spends much less on Adult Care Homes/Assisted Living Facilities and Home
Health/In-Home Care, and these services have a much lower expenditure per client (see Table 3)
[7].
Skilled nursing care is an important component on the continuum of long term care. Without
exception, every senior asked stated they want to remain in their home for as long as possible
and receive formal services in their home or the community if that will allow them to remain
independent. The Medicaid Waiver Program, Community Alternatives Program for Disabled
Adults (CAP DA), reports that an individual who is nursing home eligible can remain at home
for approximately two-thirds of the cost of an institutional setting. As healthcare costs continue
to rise and Merit and Incentive payment models are implemented, HCBS grow in importance as
a delivery model which saves money, provides greater customer satisfaction and creates more
jobs in the local economy.
Table 3: County Expenditure by Service Category for Clients 60+ (FY16-17)
                 Service Category                      Clients Expenditure       Exp. by Client   % of Exp.
 Adult Care Homes/Assisted Livings                          252       $748,836           $2,972        3.4%
 Economic Support (indirect financial support)            4,426     $3,974,047             $898       18.2%
 Hospitals, Physicians, and Other Health Care             3,445     $1,784,258             $518        8.2%
 Home Health and In-Home Care                               843     $3,217,351           $3,817       14.8%
 Institutional Care (Skilled Nursing Care)                  493    $11,528,014          $23,383       52.9%
 Social Support (outside home)                              422       $558,711           $1,324        2.6%
 TOTAL                                                    9,881    $21,811,217           $2,207
Source: NCDHHS, County Expenditure Reports, 2017

Medicare
The number of Medicare beneficiaries with Hospital/Medical Coverage increased 7.6% between
2013 and 2017. Medicare beneficiary participation in Medicare Advantage Plans is increasing at
a faster rate than enrollment in Original Medicare. The number of Medicare beneficiaries with
Prescription Drug Coverage increased at a slightly higher rate (11.3%) during the same time
frame. [8]
Table 4: Medicare Enrollment (2013-2017)
                                                                    Medicare Enrollment
                                                    2013            2017       Change       Percent Change
 Hospital/Medical                                      7,995           8,602         607              7.6%
   Original Medicare (fee-for-service)                 4,097           3,766        -331             -8.1%
   Medicare Advantage and Other Health Plans           3,898           4,836         938             24.1%
 Prescription Drug                                     6,366           7,086         720             11.3%
   Prescription Drug Plans (stand-alone)               2,765           2,585        -180             -6.5%
   Medicare Advantage Prescription Drug Plans          3,601           4,501         900             25.0%
Source: CMS Medicare Enrollment Dashboard

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Yadkin County

Health Care Facilities
Table 5: Health Care Professionals (2017)

                                            Yadkin         NC      The County’s health care needs are
                                      Count       Rate     Rate    served in part two urgent care centers,
 Physicians                                  17      4.5    23.8   one each in Jonesville and Yadkinville
   Primary Care Physicians                   12      3.2     7.0   (see Map 3). In 2017, Yadkin County
    Family Practice                          12      3.2     2.6   had only 17 physicians with a rate of
    Internal Medicine                         0      0.0     1.9
                                                                   4.5 per 10,000 population compared to
                                                                   a rate of 23.8 across the state [9].
    Obstetrics/Gynecology                     0      0.0     1.1
    Pediatric                                 0      0.0     1.5
    Geriatric                                 1      0.3     0.2
 Dentists
   Dentists                                   9      2.4     5.0
   Dental Hygienists                         16      4.2     6.0
 Nurses
   Registered Nurses                        125   33.2     100.7
    Nurse Practitioners                      13      3.4     6.5
    Certified Midwives                        0      0.0     0.3
 Licensed Practical Nurses                   37      9.8    17.9
 Other Health Care Professionals
   Chiropractors                              3      0.8     1.7
  Occupational Therapists                     5      1.3     3.4
  Occupational Therapy
                                              4      1.1     1.7
 Assistants
  Optometrists                                4      1.1     1.1
   Pharmacists                               15      4.0    11.4
   Physical Therapists                       11      2.9     6.3
   Physical Therapy Assistants               13      3.5     2.9
   Physician Assistants                       2      0.5     5.9
   Podiatrists                                0      0.0     0.3
   Practicing Psychologists                   2      0.5     2.2
   Psychological Associates                   2      0.5     0.8
   Respiratory Therapists                     1      0.3     4.2
                                                                   Source: NC Health Professions Data System

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Yadkin County

Map 3: Health Care Facilities

Table 6: Health Care Facilities Directory

  Map
                         Name                  Address          City        ZIP         Phone
  ID
   1       Hugh Chatham Urgent Care         546 Winston Rd   Jonesville    28642    (336) 526-0037
   2       Express Care of Yadkin           755 S State St   Yadkinville   27055    (336) 849-4147
Source: PTRC AAA

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Yadkin County

Long-Term Care Facilities
Long-Term Care facilities provide up to
24 hour care for individuals who are
unable to live safely by themselves.
There are various types of facilities,
including Skilled Nursing Facilities
(SNF), Adult Care Homes and Family
Care Homes. Each differs in size and
services provided.
Nursing facilities must be licensed in
accordance with North Carolina state law
by the North Carolina Division of Health
Service Regulation. In addition, nursing
facilities that wish to receive Medicare
and Medicaid reimbursement must be
certified in accordance with federal law.
Nursing facilities that are Medicare and Medicaid certified receive annual licensure inspections
by the Division of Health Service Regulation. The Regional Long Term Care Ombudsman
program at the AAA works with all facilities across the region and is responsible for
approximately 18,000 long-term care beds. The program has developed deep relationships with
every facility in the region and provides trainings and education to help them meet the needs of
their population.
Adult Care Homes and Family Care Homes provide care for persons age 18 and older who do
not need nursing home care, but are no longer able to remain in their own home because they
                                     need help in meeting daily needs such as meal preparation
                                     and housekeeping. These facilities care for people who
                                     only need occasional and incidental medical services.
                                     Room and board, personal assistance, supervision of
                                     medications, and social activities are provided. The private
                                     cost rates vary from facility to facility and supplemental
                                     assistance may be available to cover the cost for those with
                                     limited incomes. These are commonly referred to as
                                     Assisted Living Facilities.
                                     Table 7: Long-Term Care Facilities & Beds in Yadkin County
                                                                        Total # of        Total # of
                                                                        Facilities          Beds
                                      Adult Care Homes                               4            189
                                      Family Care Homes                              0              0
                                      Skilled Nursing Facilities                     2            223
                                      TOTAL                                          6            412
                                     Source: PTRC AAA

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Yadkin County

Map 4: Long-Term Care Facilities

Source: PTRC AAA

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Yadkin County

Agencies Serving Older Adults and Individuals with Disabilities Directory
Map 5: Provider Agencies

Source: PTRC AAA

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Yadkin County

Table 8: Provider Agencies Directory

 Map
                    NAME                     ADDRESS              CITY         ZIP        PHONE
 ID
          Yadkin Valley Senior
   1                                   121 Delos Martin Drive   Jonesville    28642    (336) 367-7251
          Center
          Yadkin Valley Economic       533 North Carolina
   2                                                            Boonville     27011    (336) 367-7251
          Development District, Inc.   Avenue
   3      East Bend Senior Center      473 Main Street          East Bend     27018    (336) 367-7251
          Yadkin County Veterans       101 S State Street,
   4                                                            Yadkinville   27055    (336) 679-8209
          Service Office               Room 105
          Yadkin County Senior         207 East Hemlock
   5                                                            Yadkinville   27055    (336) 367-7251
          Center                       Street
   6      Yadkin County D.S.S.         250 Willow Street        Yadkinville   27055    (336) 679-4210
          New Horizons Home
   7                                   648 Carolina Avenue      Yadkinville   27055    (336) 677-3843
          Care, Inc.
Source: PTRC AAA

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Yadkin County

Demographics of the Total Population

Past and Present Total Population
In 2016, the County had a total population of 37,725 [2]. Between 1990 and 2016 the County
added just over 7,000 residents – a 23.7% growth. Yadkin County saw lower percent changes in
total population than the Piedmont Triad and the State on average.
Figure 2: Total Population (1990-2016)

                      40,000
   Total Population

                      35,000

                      30,000

                      25,000
                                 1990        1995          2000         2005         2010          2016
                      Yadkin:   30,488      33,817        36,348       37,274       38,406        37,725

                                             Source: NC OSBM, US Census Bureau

Table 9: Total Population Change (1990-2016)

                                       Yadkin County                  Piedmont Triad         North Carolina
                                   Change                %                   %                     %
 1990-1995                                3,329            10.9%                   8.8%                  10.8%
 1995-2000                                2,531             7.5%                   8.4%                   9.6%
 2000-2005                                  926             2.5%                   4.7%                   7.9%
 2005-2010                                1,132             3.0%                   7.0%                   9.8%
 2010-2016                                 -681            -1.8%                   3.7%                   6.5%
                                              Source: NC OSBM, US Census Bureau

Projected Total Population
Between 2016 and 2037, Yadkin County is projected to add only 51 residents to grow to a
population of 37,776 people in 2037 – only a 0.1% increase. This rate of change is much lower
than the Piedmont Triad as a whole (15.4%) and the state (23.6%). The annual rate of change for
the total population in Yadkin County is expected to remain around 0.01% between 2016 and
2037, which is much lower than the annual growth rate in previous years – 0.23% between 2000
and 2016. [2]

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Yadkin County

Figure 3: Projected Total Population Change (2016-2037)

 25%                                                                         23.6%

 20%
                                                      15.4%
 15%

 10%

  5%
                      0.1%
  0%
                     Yadkin                       Piedmont Triad         North Carolina

                                               Source: NC OSBM

Demographics of the Older Adult Population

Past and Present Older Adult Population
In 2016, the older adult population (60 years of age and older) reached 9,528 people in Yadkin
County. Beginning in 2000, the percent change of the older adult population has been higher
than that of the total population. Between 2005 and 2010, the older adult population grew 15%,
five times the rate of the total population. Between 2010 and 2016 the older adult population
grew 9.3%, while the total population actually lost residents during this time period [2].
Figure 4: Older Adult Population (1990-2016)

                                     Source: NC OSBM, US Census Bureau

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Yadkin County

Table 10: Older Adult Population Change (1990-2016)

                             Yadkin County                Piedmont Triad                  Nort h Carolina
                          Change             %                  %                                %
 1990-1995                       495           8.2%                      7.2%                            8.7%
 1995-2000                       384           5.9%                      7.2%                            8.6%
 2000-2005                       658           9.5%                     10.1%                           13.1%
 2005-2010                     1,139          15.0%                     17.9%                           21.2%
 2010-2016                       812           9.3%                     17.5%                           22.4%
                                     Source: NC OSBM, US Census Bureau

Projected Older Adult Population
Over the next 20 years, Yadkin County is projected to only grow by 51 total residents. By 2037,
the older adult population will reach an estimated 11,490 people and will grow by 20.6% while
the total population will only grow by 0.1%
Figure 5: Projected Older Adult Population Change (2016-2037)
 60%                                                                                     53.3%
                                                       39.7%
 40%
                       20.6%
 20%

  0%
                       Yadkin                      Piedmont Triad                     North Carolina
                                                Source: NC OSBM

In 2016, the older adult population (60 years of age and older) represented 25% of the County’s
total population. This percentage has risen from 14% in 2000, and is projected to rise to 30% by
year 2037. In 2037, Yadkin County will have an estimated older adult population of 11,490. [2]
Figure 6: Population by Age Group (2005-2035)
 100%
                14%
                                  23%                 25%                 30%
  80%

  60%
                62%
                                  54%                 54%                 49%
  40%

  20%
                24%               23%                 21%                 21%
   0%
                2000              2010                2016                2037

         Children (Age 0-17)     Adults (Age 18-59)          Older Adults (Age 60+)

                                                Source: NC OSBM

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Yadkin County

Working Adults
Pressure will increase on the agencies providing care for the aging population of Yadkin County.
One factor of this pressure is the relative decline in the ratio of working age people (ages 18 to
64) compared to the number of retirement age adults (ages 65 years and older). Figure 7 below
illustrates the ratio and numbers of working age and retirement age adults from 1990 to 2015,
along with the projected figures to 2035 (separated by the brown dashed line). In 2000, there
were 4.37 working adults for every retirement-age adult. In 2015 that ratio dropped to 3.34, and
will continue to drastically drop to 2.29 by year 2035. [2]
Figure 7: Ratio of Working Adults to Older Adults (1990-2035)

                35,000                                                                                                4.50

                                                                                                                             Ratio of Working Adults to Older Adults
                30,000                                                                                                4.00

                                                                   6,962
                                                         6,241

                                                                               7,406

                                                                                         7,937

                                                                                                   8,525

                                                                                                             8,897
                                               5,547
                                     5,144
   Population

                25,000                                                                                                3.50
                           4,529

                20,000                                                                                                3.00
                                     22,496

                                               23,027

                                                         23,227

                                                                   22,649

                                                                               22,038

                                                                                         21,283

                                                                                                   20,378

                                                                                                             19,696
                           19,119

                15,000                                                                                                2.50

                10,000                                                                                                2.00
                         1990       2000      2005      2010      2015       2020       2025      2030      2035
                     Working Adults (Ages 18-64)                            Older Adults (Ages 65+)
                     Ratio of Working Adults to Older Adults

                                              Source: NC OSBM, US Census Bureau

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Yadkin County

Piedmont Triad Region Growth
Yadkin County will experience a 0.3% growth in the total population between 2015 and 2035 –
ranking 9th out of the 12 counties in the region. The older adult population in Yadkin County
will grow by 24.4% in this same time frame – ranking 8th in the region. [2]

                               Table 11: Percent Growth (2015-2035)

                                    Older Adults (Age 60+)           Total Population
        County:
                                   Percent Growth    Rank         Percent Growth Rank
        Alamance                             60.5%           1            28.5%      1
        Davie                                56.1%           2            24.8%      2
        Guilford                             47.8%           3            14.5%      4
        Forsyth                              45.9%           4            21.1%      3
        Randolph                             44.3%           5            13.5%      5
        Davidson                             40.6%           6            12.1%      6
        Stokes                               31.8%           7            -0.4%     12
        Yadkin                               24.4%           8             0.3%      9
        Montgomery                           23.5%           9             6.3%      7
        Caswell                              19.7%          10             0.3%      8
        Rockingham                           19.3%          11            -0.4%     11
        Surry                                18.5%          12            -0.3%     10

        Piedmont Triad                       42.5%                        14.6%
        North Carolina                       55.4%                        22.7%
                                        Source: NC OSBM

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Yadkin County

Population Density
In 2016, older adults (ages 60 years and over) accounted for 23% of the total population in
Yadkin County. Map 6 below displays the population density of these older adults by block
group based on the 2016 American Community Survey. Density is highest around the Town of
Jonesville.
Map 6: Population Density of Older Adults (60 Year and Older), 2016 by Block group

Source: US Census Bureau, ACS 2012-2016, TIGER/Line Block Groups

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Yadkin County

Rural Population
Yadkin County has an overall population density of 113 people per square mile. The NC Rural
Center defines rural as an area with an average population density of 250 people per square mile
or less. The NC Rural Center defines Yadkin County as a rural county. Map 7 below identifies
rural, suburban and urban census block groups in the County, overlaid with the older adult
population density. A large portion of the older adult population lives in the County’s urban and
suburban areas, but the majority (83%) of the County’s older adult population resides in rural
areas.
Map 7: Density of Older Adults in Rural, Suburban and Urban Areas (2016)

Source: US Census Bureau, ACS 2012-2016, TIGER/Line Block Groups

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Yadkin County

Table 12: Older Adult Population in Rural Areas (2016)

                        Total Population        Population of Older Adults          Percent of Older Adults
 County                 of Older Adults           (60+) in Rural Census              (60+) in Rural Census
                              (60+)                   Block Groups                       Block Groups
 Alamance                           34,354                           8,201                             23.9%
 Caswell                             6,077                           5,489                             90.3%
 Davidson                           37,140                          11,217                             30.2%
 Davie                              10,738                           6,618                             61.6%
 Forsyth                            73,893                           4,543                              6.1%
 Guilford                           99,073                          11,174                             11.3%
 Montgomery                          6,936                           6,929                             99.9%
 Randolph                           32,276                          14,328                             44.4%
 Rockingham                         23,447                          13,402                             57.2%
 Stokes                             12,133                           8,831                             72.8%
 Surry                              18,525                          10,474                             56.5%
 Yadkin                              9,486                           7,889                             83.2%
 Piedmont Triad                    364,078                         109,095                             30.0%
Source: US Census Bureau, ACS 2012-2016, TIGER/Line Block Groups

Household Types
In Yadkin County, 63% of the older      Figure 8: Living Arrangements of the Population Age 65+ (2016)
adult population (age 65 years and                                                       Group
over) live in family households.                 Non-family                             Quarters
Another one-third of these older adults               49                                   213
live alone. The majority of these                     1%                                   3%
adults living alone are women. In the
County, 1,568 older adult women live
alone, 22.8% of the entire older adult                   Living
population. A small percentage (1%)                      Alone
live in non-family households and 3%                     2,279
live in group quarters. Group quarters                    33%                      Family
include such places as residential                                                  4,343
treatment centers, skilled nursing                                                  63%
facilities, group homes and
correctional facilities. [10]

                                                         Source: US Census Bureau, ACS 2012-2016, Table B09020

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Yadkin County

Race & Ethnicity
Table 13 below breaks down the racial and ethnic categories for the older adult population (age
65 years and over) compared to that of the total population in the County. 88% of the older adult
population is white, compared to 92% of the total County population. Only 0.4% of the older
adult population is Hispanic, compared to 10.6% of the total County population [10]. Higher
percentages of minorities live in and around Jonesville and Yadkinville, as seen in Map 8. The
Centers for Disease Control and Prevention (CDC) reports that minorities experience a
disproportionate burden of preventable disease, death and disability compared to non-minorities
[11].
Table 13: Population by Race & Ethnicity (2016)

                                                     Population 65+       Total Population
Total                                                 6,884                37,819
By Race:
   White                                              6,079       88.3%    34,612       91.5%
   Black or African American                            221        3.2%     1,285        3.4%
   American Indian and Alaska Native                      3        0.0%       111        0.3%
   Asian                                                  0        0.0%        22        0.1%
   Native Hawaiian and Other Pacific Islander             0        0.0%         0        0.0%
   Some Other Race                                        0        0.0%     1,222        3.2%
   Two or More Races                                     21        0.3%       567        1.5%
By Ethnicity:
   Hispanic or Latino                                    29        0.4%     4,010       10.6%
   Not Hispanic or Latino                             6,855       99.6%    33,809       89.4%
Source: US Census Bureau, ACS 2012-2016, Table B02001

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Yadkin County

Map 8: Percent Minority of the Total Population by Block Group (2016)

Source: US Census Bureau, ACS 2012-2016, TIGER/Line Block Groups

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Yadkin County

Income
The average earnings income for the older adult population (60 years of age and over) in Yadkin
County is $39,216, compared to the average of $57,405 for the total population. The older adult
population also receives income from sources other than wage earnings, such as Social Security
and retirement income. 81.4% of older adult households receive Social Security income with an
average income of $18,017; while 37.6% of older adult households receive retirement income
with an average income of $17,826. Only 12.7% of the older adults (60 years of age and over)
live below the poverty level, compared to 19.0% of the County’s total population. Rising health
care costs impact budgets of older adults, resulting in the inability to pay for necessities such as
housing, utilities and food. [10]
Figure 9: Income Benchmark Comparison

 $70,000

 $60,000        $57,405

 $50,000

                                   $39,216
 $40,000

 $30,000
                                                                                                   2016 Poverty
 $20,000                                            $17,826          $18,017                        Threshold
                                                                                                     $11,880
                                                                                       $8,288
 $10,000
                                                                                                       $4,472

      $0
            Mean Earnings       Mean Earning s   Mean Retirement  Mean Social           Mean       Mean Cash Public
           (Total Population)      (60+)          Income (60+)   Security Income    Supplemental Assistance Income
                                                                      (60+)        Security Income      (60+)
                                                                                        (60+)

Source: US Census Bureau, ACS 2012-2016, Table S0102

Table 14: 2016 Poverty Guidelines

     Persons in             2016 Poverty
 Family/Household            Guidelines
          1                    $11,880
          2                    $16,020
          3                    $20,160
          4                    $24,300
 For families/households with more than 4
 persons, add $4,160 for each individual
 person.
Source: US Department of Health & Human Services

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Yadkin County

Health Insurance
Most older adults (ages 65 years and over) in Yadkin County and across the state have some type
of health insurance coverage. Only 0.3% of the older adults in the County are not covered,
compared to 14.3% of the County’s total population. The majority of these older adults have
either Medicare only coverage or Medicare combined with employer-based or direct purchase
insurance [10]. As a result, seniors impact the cost of public and private healthcare
disproportionately than the non-senior population. The most effective way to positively impact
public and private healthcare outcomes with seniors is by addressing their social determinants of
health and assuring that they are safe in their homes with access to home-based community
services.
Table 15: Health Insurance Coverage (2016)

                                                         Yadkin Count y       Region     State
 Older Adult Population (65+)                              6,675         -          -          -
  Employer-based only                                         90     1.3%       1.6%       1.4%
  Direct purchase only                                         9     0.1%       0.3%       0.3%
  Medicare only                                            1,905    28.5%      30.4%      26.5%
  TRICARE/Military/VA only                                     0     0.0%       0.1%       0.1%
  Employer-based & Direct purchase                             0     0.0%       0.1%       0.1%
  Employer-based & Medicare                                  924    13.8%      16.9%      17.9%
  Direct purchase & Medicare                               1,583    23.7%      22.6%      21.4%
  Medicare/Medicaid public only                              597     8.9%       6.3%       7.0%
  Other                                                    1,550    23.2%      21.3%      24.8%
  No health insurance coverage                                17     0.3%       0.5%       0.5%
 Total Population no health insurance coverage                  -   14.3%      13.3%      13.2%
Source: US Census Bureau, ACS 2012-2016, Table B27010

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Yadkin County

Vehicle Access
In Yadkin County, an estimated 391 households with an individual 65 years of age and over do
not have access to a vehicle – 8.4% of these older adult households. This statistic is higher than
that for the total households in the County, where 5.9% of all households do not have access to a
vehicle [10]. Transportation is delivered through the AAA Network to support seniors. This is
an important social determinant of health, which can be positively impacted through
coordination with Community Based Organizations (CBO) and healthcare systems.
Map 9: Older Adult Population without Access to a Vehicle (2016)

Source: US Census Bureau, ACS 2012-2016, TIGER/Line Block Groups

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Yadkin County

Transit Options
Yadkin County is served by YVEDDI Transportation, providing on-demand transportation
services to all citizens in the County, including the elderly and disabled. YVEDDI also operates
the Surry-Yadkin Connector, connecting Jonesville to Elkin, Dobson and Mount Airy. Yadkin
County is also served by PART with two Park and Ride lots used for carpooling and vanpooling
– one at the intersection of Asbury Church Road and Flat Rock Church Road and another on
Pine Street close to the exit ramp to US-601 off of US-421.
Map 10: YVEDDI Surry-Yadkin Connector Route

Source: YVEDDI

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Yadkin County

Language
English is the most common language spoken in Yadkin County. An estimated 0.8% of older
adults (60 years of age and over) speak a language other than English. Only 0.5% of the older
adult population speaks English less than very well. Of the total County population, 8.3% speak
a language other than English and 4.2% speak English less than very well [10].

Map 11: Older Adult Population: Speak a Language Other than English (2016)

Source: US Census Bureau, ACS 2012-2016, TIGER/Line Block Groups

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Yadkin County

Nutrition and Food Insecurity
In a study released in 2015, AARP published national rankings for food insecurity. North
Carolina ranked 11th for the number of individuals age 60 years and over who experience food
insecurity, at a rate of 17.5%. Food insecurity is indicated by experiencing a moderate degree of
not having enough to eat; often prioritizing payment for rent, medical care, prescriptions or
utility bills from the money they would normally use for food. Individuals experiencing food
insecurity often go without food in order to meet these other vital living expenses [12].
According to Feeding America, in 2016 Yadkin County had 4,530 individuals experiencing food
insecurity (12.0% of the total population). The average cost of a meal in Yadkin County is
$2.91, higher than the statewide average of $2.88. 89% of the individuals experiencing food
insecurity are income-eligible for federal anti-hunger programs; the other 11% are dependent on
charitable food assistance [13]. Malnutrition within the senior population places them at higher
risk of hospitalization and institutionalization. Planning and integrating healthcare with
community-based services can address this issue with certain benefits of a healthier senior.

    12.0% of Yadkin County’s population is food insecure.

Individuals with Disabilities
In Yadkin County, 2,783 older adults (age 65 years and older) have a disability, representing
41.7% of the older adult population. Only 14.1% of the adult population (ages 18 to 64) and
4.9% of the child population (under age 18) have a disability. Table 16 below illustrates the type
of disability for each age group. A person may have more than one type of disability. The
American Community Survey (ACS) defines a cognitive disability as a physical mental or
emotional condition that causes a person to have serious difficulty concentrating, remembering
or making decisions [10].
Table 16: Disability by Type (2016)

                                        Population       Population Ages 18-
                                                                               Population 65+
                                       Under Age 18              64
                                        #        %          #          %        #          %
 Total Population by Age Group          8,299              22,573               6,675
 Total Population with a Disability       410    4.9%        3,188    14.1%     2,783     41.7%
   Hearing Difficulty                      51    0.6%         613      2.7%     1,093     16.4%
   Vision Difficulty                      101    1.2%         694      3.1%         738   11.1%
   Cognitive Disability                   318    3.8%        1,120     5.0%         745   11.2%
   Ambulatory Disability                   54    0.7%        1,694     7.5%     1,710     25.6%
   Self-care Disability                    88    1.1%         624      2.8%         621   9.3%
   Independent Living Difficulty           n/a     n/a       1,279     5.7%     1,116     16.7%
Source: US Census Bureau, ACS 2012-2016, Table S1810

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Yadkin County

Grandparent Caregivers
Of the total grandparent population in the County (60 years of age and over), 23.7% (128
grandparents) are responsible for their grandchildren under age 18. This statistic represents 1.3%
of the total older adult population (ages 60 years and over). Table 17 below details specific
information about this group. 6.0% of the grandparent caregivers are minority; 15.3% live in
poverty; and 46.6% have a disability [10].
Table 17: Grandparent Caregivers (2016)

 Grandparent Caregivers
 Older Adult Population (60 years and over)            9,486
   Grandparents responsible for Grandchildren (#)        128
   Grandparents responsible for Grandchildren (%)      1.3%
     Minority Population                               6.0%
     Speak other language than English                 0.0%
     Speak English less than very well                 0.0%
     Below
Source:     Poverty
        US Census   LevelACS 2012-2016, Table S1002
                  Bureau,                             15.3%
     With any disability                              46.6%

Family Caregivers
Family caregivers assist with daily activities, administer medications, and provide transportation,
financial support and companionship to a family member, friend or neighbor. One in four
persons in North Carolina report providing regular care for someone age 60 years or older.
Almost half are caring for someone with dementia [14]. The AAA provides support for
caregivers through home and
Community-based services
(HCBS) including respite
services, home-delivered meals,
adult day services, transportation
and in-home aid services.

   1 in 4 people in North Carolina are caregivers
       for an older adult age 60 years or older.

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Yadkin County

References

[1] US Geological Survey, "NLCD 2011 Land Cover (2011 Edition, amended 2014)," Sioux
    Falls, 2014.

[2] NC OSBM, "Sex and Single Years of Age (2000-2037)".

[3] Integra Service Connect, "Why Payers Should Care about the Social Determinants of
    Health," 2015.

[4] U.S. Department of Housing and Urban Development, "Measuring the Costs and Savings
    of Aging in Place," 2013.

[5] Robert Wood Johnson Foundation & University of Wisconsin Population Health Institute,
    "2018 County Health Rankings North Carolina," 2018.

[6] Centers for Medicare & Medicaid Services, "Prevalence State/County Level: All
    Beneficiaries by Age, 2007-2015," 2017.

[7] NC Department of Health and Human Services - Aging and Adult Services Division,
    "County Expenditure Reports 2017," 2018.

[8] Centers for Medicare & Medicaid Services, "Medicare Enrollment Dashboard," 2017.

[9] The Cecil G. Sheps Center for Health Services Research, "NC Health Professions 2017
    Data Book," 2017.

[10] US Census Bureau, American Community Survey (2012-2016), 2016.

[11] Centers for Disease Control and Prevention, "Health Disparities," 2017.

[12] AARP, "Food Insecurity Among Older Adults," 2015.

[13] Feeding America, "Food Insecurity in North Carolina," 2014.

[14] AARP, "Family Caregiving in North Carolina," 2008.

[15]

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This report was prepared by the Piedmont Triad Regional Council Regional Planning
                Department with assistance from the Area Agency on Aging.

                                          June 2018

                       About the Piedmont Triad Regional Council
The Piedmont Triad Regional Council (PTRC) is a voluntary association of local governments
comprised of municipal representatives, county commissioners, and other civic leaders who
function as the voice of the citizens of the Piedmont Triad. It serves 73 member governments
in the twelve-county area designated as Region G located in and around the Greensboro,
Winston-Salem, and High Point areas. There are 16 Regional Councils in North Carolina.
The PTRC is designated by the State of North Carolina to serve as the lead regional
organization for the Piedmont Triad region. Funded from federal, state, and local sources, the
PTRC houses the regional Area Agency on Aging and is engaged in workforce development,
data and information services, transportation planning, water resources, housing programs,
regional planning, criminal justice work, and technical assistance.
More information is located at http://www.ptrc.org or by contacting Matthew Dolge,
Executive Director, PTRC at 336-904-0300 or via email at mdolge@ptrc.org.
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