Skip to the main content of the pageSouth Carolina Mature Adults Count: A Profile of South Carolina's Older Population

2003 State Report: How We Are

Healthy Lifestyles

The health-conscious lifestyle of Baby Boomers is making a difference in the health of the population reaching mature adulthood. Disease prevention messages continue to increase awareness of the need for good nutrition, exercise, weight control, and smoking cessation in contributing to increased years and a healthier, more active mature life.

Medical research and breakthroughs are also contributing to a vigorous old age: angioplasty and bypass surgery are sustaining hearts and saving lives at a stunning rate. New pharmaceuticals are helping prevent costly hospital stays and keeping potentially deadly diseases in check.

Still, our greatest fears in growing old center around our health. In a 2002 study by the National Council on the Aging, the greatest fears of Americans with regards to growing old were memory loss, suffering physical pain, and the costs of long term care.

With the aging of Boomers and their market force, medical and health care will increasingly focus on those fears. Prevention measures taken at early ages will assist in improving the health quality of older Americans.

Top 10 Preferred Health And Leisure Activities Among South Carolina Mature Adults

1. Walking Paths
2. Swimming
3. Shopping
4. Fishing
5. Gardening
6. Golfing
7. Boating
8. Bicycle Riding
9. Health Club
10. Home Computer

Source: Center for Carolina Living, August 1996. Based results from a survey in their magazine. Majority of respondents ages 50-62.
 

Health Insurance And Long-Term Care

Insurance is an important part of feeling economically secure. The majority of us, particularly those who work, are covered by insurance during our lifetime. Coverage becomes a more important security measure as we age and the chance of developing acute, chronic and disabling conditions increases.

Nationally, 61 percent of people over 65 have private health insurance to cover acute care conditions. The majority, however, use Medicare as their payment method for services. The number of Americans who have purchased long-term care insurance has increased ten-fold in the last fifteen years. According to the Health Insurance Association of America, in 2000, the average premium cost for long term care insurance for a person age 50 was $409 annually for benefits of $100 per day nursing home care with a 20 day deductible. Premiums increased dramatically for those older than 50, and when an inflation protection feature and/or non-forfeiture benefits were included with the plan. In 1999, 454,448 (96.0 percent) of South Carolinians 65 and over were enrolled in Medicare, the federal insurance coverage program for persons 65 and over. At the same time, 13.9 percent of South Carolinians 65 and over live below the poverty level and are therefore eligible for Medicaid.

A critical component of economic security is planning for the time, however short or long, a person may have to spend with specialized care in a nursing home. While only 5 percent of Americans, and 4 percent South Carolinians 65 and over live in an institutional setting at any given time, the lifetime risk at 65 of spending some time in a nursing home is about 40 percent. Ten percent will be in a nursing home for 5 years or longer. The average length of stay for nursing home patients is 870 days (2.4 years), though the figure is higher for females at 907 days (2.5 years), and increases with age, climbing to 932 days, (2.6 years), for ages 85 and over.

Ironically, the population most likely to need coverage does not have long term care insurance. The general population believes that Medicare will provide for long term care, but in reality, Medicare generally does not pay for long term care expenses. It does not pay for intermediate or residential care. It pays only for skilled nursing care and is limited to 20 days of full coverage and partial coverage for days 21–100. Medicare provides an average of only 20 days of a long term care stay due to its strict eligibility. A person is eligible for Medicare if he/she or the spouse worked at least 10 years in Medicare-covered employment and the person is at least 65 years old and a citizen or permanent resident of the U.S. A person may also qualify if he/she has a disability or chronic kidney disease.

Medicaid provides for about 75 percent of the cost of nursing facility utilization by Medicaid contracting facilities. The S.C. Medicaid program covers long term care in a nursing facility and for persons participating in the home and community-based waiver. To be eligible, a person must be 65 or over; blind or totally and permanently disabled (based upon Supplemental Security Income guidelines). Individuals on Temporary Assistance for Needy Families may also be eligible. A recipient must be a U.S. citizen or a permanent resident alien and a resident of S.C. The gross income limit for an institutionalized person is $1,656 a month, and resources owned by the individual cannot exceed $2,000 (after exclusions). If a person has income greater than $1,656 per month, he/she may become eligible for Medicaid by establishing an Income Trust.

Roughly 40 percent of nursing home stays are for less than one year, and 16 percent are less than three months. Medicaid pays for the majority of nursing home stays. The total average cost of a nursing home stay in South Carolina is about $103 per day as of October 1, 2001. The average daily recurring income rate for S.C. is $18.32 which is paid for with income from the patient, leaving a net cost of $84.81 to the state.

The rising cost of prescription medications is increasingly becoming a troublesome issue for senior citizens. Seniors are increasing their use of prescription drugs at the same time that the prices of these drugs are increasing. According to one study, the prices of the 50 prescription drugs most commonly used by older Americans rose at two times the rate of inflation during 1999, and some drugs increased by much more. Since most seniors have fixed incomes and receive only a modest cost of living increase adjusted to keep up with the rate of inflation, the fact that the prices of prescription drugs are increasing at several times the rate of inflation is a serious problem for seniors.

At the forefront of public debate lately is the fact that Medicare does not cover the cost of prescription drugs. To help with this problem, the state of South Carolina introduced the Silverxcard program on January 1, 2001 to serve people 65 and over who do not have access to insurance coverage or other assistance for prescription drug purchases. As of June 2002, there were 12,776 men and 28,332 women statewide enrolled in the program, for a total of 41,108 enrollees.
 

Access To Care

Having a physician or medical facility nearby to provide for basic and appropriate levels of health care will become more critical as the older population increases. With the increase in the aging population, including those moving into the state, some areas will face serious shortages of primary care and other medical care services. The need for geriatric specialists will rise. Rural areas will be particularly hard hit, where care is now inadequate and transportation is not always available, particularly for the low income elderly. Because of low Medicare and Medicaid reimbursement rates, a significant number of mature adults are having difficulty finding a medical home.

Geriatric medicine, the specialty that focuses on the health and well-being of the old, is a relatively new field. Geriatricians are primary care physicians with one extra year of fellowship training who must also pass a certifying exam and be recertified every ten years. Though the US should have 20,000 geriatric trained physicians, there are only around 9,000 and that number is expected to drop. As Baby Boomers begin to age, this shortage will become more severe.

There are many reasons that geriatricians are needed to treat older people rather than a regular physician. There are differences between the elderly and younger adults just as there are between adults and children. Seniors sometimes have different symptoms of a disease, or drugs work differently on them. Also, the elderly often take many medications at once, or have numerous chronic illnesses at once. Often, treatments need to be coordinated between several physicians treating the same patient for different ailments.

The shortage of geriatric physicians is largely due to the low compensation received by these doctors. Paid primarily by Medicare, they receive relatively small amounts of money for treating challenging and time-consuming patients. Currently, Medicare payments are being cut (5.4% in 2002 and 4.4% in 2003) rather than increased. Also, few medical schools offer specialized training in geriatrics.

In South Carolina in January 2002, there were 30 licensed active nonfederal geriatric physicians. The only training program for family and internal physicians who want to take a fellowship exam in geriatrics in South Carolina is at Palmetto Health/University of South Carolina School of Medicine in Columbia. They train about 2-3 new geriatricians each year. However, due to decreases in Medicare reimbursement and increasing patient complexity, geriatrics has the lowest rate of recertification of any specialty, so there is actually a net decrease in the number of geriatric specialists in SC each year.
 

Limitations On Independent Living

As we age, our ability to perform the activities we once did may decrease. Most elderly mature adults and their family members prefer for them to remain at home until necessity, cost and inconvenience require that they be placed in an institutional facility. When considering basic “activities of daily living” such as bathing, dressing and feeding ourselves, the number of South Carolinians with problems increases with age. For those age 65 to 74 in 2000, approximately 7 percent experience a self-care disability. That percentage rises to 18 percent for persons age 75 and over.

In addition, mature adults may experience problems performing other basic living activities known as “instrumental activities of daily living,” therefore requiring special assistance from others. These instrumental activities include shopping, preparing meals and cleaning their homes. Such problems affect 29 percent of those 55 to 64, 40 percent between the age of 65 to 74, 67 percent between 75 to 84 and 87 percent of the population 85 and over. As persons age, the need for assistance in personal care increases. Additionally, as the level of dependency increases, the number of average hours spent by caregivers per week also increases.

Home health and community long term care services often delay the need for institutionalization, saving money for families and government providers. The Community Long Term Care Program (CLTC) provides home and community-based services to Medicaid eligible people with long term care needs at an annual cost that is less than nursing home care. The average cost of these services was $7,104 from October 2000 to September 2001. Also, the trend towards assisted living provides an intermediate option to persons who might otherwise need nursing home care. In SC in January, 2003, there were 514 Community Residential Care Facilities with a total of 16,981 beds.

Likewise, programs funded under the Older Americans Act provide cost–effective support services that may also delay or prevent institutional care. Examples include receiving service for a year’s worth of home–delivered meals at an average cost of $1,100 or having personal care provided in the home four hours per week at a cost of approximately $3,000.
 

Help In Maintaining An Independent Lifestyle

As we get older, factors from minor disabilities to chronic illness and diseases begin to determine where we live. Family, private and government support helps to provide opportunities to sustain independent living:

Graph: South Carolina Projected Alzheimer's Cases for Persons 65 and Over 1995-2025

As people age, both the nation and the state of South Carolina will face the soaring costs of Alzheimer’s Disease and dementia. Currently it is estimated that the lifetime cost of care for an Alzheimer’s patient is $174,000. Based upon National Alzheimer’s Association statistics, 3 percent of all persons aged 65-74 will have Alzheimer’s Disease. Of those 75-84, 18.7 percent will have it, and of those 85 and over, 47.2 percent will have it. Based upon South Carolina statistics, it is estimated that the number of Alzheimer’s patients will increase from 43,020 in 2000 to 125,190 in 2025. The total cost impact of this growth together with health care inflation of 5 percent annually will result in a total impact on the state, insurance companies, and families of $794 million in 2000, and will increase to $7.7 billion in 2025.
 

Institutional And Home/Community Care

The need for in–hospital services and nursing home care increases with age. In 2001, South Carolinians ages 50–64 used 773.9 days of inpatient hospital services per 1,000 population. At age 65 and over, the days increased to 2242.1 days per 1,000 state population.

For those needing skilled nursing care, there were 18,820 licensed nursing home beds in 196 facilities in South Carolina in January 2003. The occupancy rate was 91.9 for nursing home beds in the state. In South Carolina, 81.3 percent of available beds are filled by those over 65. As of December, 2001, 262 people were awaiting placement in a nursing home.

The trend toward home and community–based care for those needing nursing home level of care has created 11,000 places for CLTC eligible people while 3,612 are on waiting lists. Community based services allow older residents to “age in place” by bringing needed services into the patient’s home, enhancing their quality of life and delaying or reducing the cost of nursing home care. Examples of cltc services available to all counties are Personal Care Services, Attendant Care, Home Management, Home Delivered Meals, Adult Day Health Care, Environmental Modifications, Respite Care, and Medical Social Services. The Older Americans Act funds similar services, including home care, home delivered meals and transportation services. Over 33,000 persons were served in fiscal year 2001–02.

Home health services provide health care to the homebound or those confined to their homes because of illness or injury. Home health services include skilled nursing care; occupational, speech and physical therapy; social and dietetic services and personal care aides. About 20 percent of all patients over 65 in medical practices have functional impairments that require home care services.
 

Other Health Related Issues

As of January 2002, the S.C. Department of Disabilities and Special Needs cared for 2,515 individuals between the ages of 50 and 64, and another 646 individuals who were age 65 and over. The majority – over 90 percent – of those 50 to 64, are mentally retarded; 9.1 percent have head and spinal cord injuries and less than 1 percent are autistic. A similar percentage breakdown applies to state residents that are 65 and over. There were no autistic individuals 65 and over served by DDSN.

Alcohol and drug use tends to decline with age. During fiscal year 2002, the Department of Alcohol and Other Drug Abuse Services had 39,573 new client intakes, and only 3,207 of these individuals, or 8.1 percent, were age 50 and over.

Multiple medications, their suitability and adverse drug reactions particularly impact the elderly. The elderly take 4 times as many prescriptions per capita as the non–senior population. Hospital admissions for adverse drug reactions among the elderly are almost six times the rate for the general population. One report found that 28 percent of hospitalizations of the elderly were due to adverse drug reactions (17 percent) or non–compliance (11 percent). According to a 1990 Panel Study of Older South Carolinians, 63 percent ages 55–64, 75 percent of those 65–84 and 82 percent of those 85 and over used prescription drugs to maintain their health. In each of these age groups, the majority were using an average of one to three drugs at the time of the survey. Overuse and underuse can be problems as well as high drug costs. Many individuals take drugs that are not suitable for their illnesses or age. A 1996 study found that nearly 1 million older persons were prescribed one of 11 drugs deemed unsuitable for the elderly.

Mental health presents a problem for many of the elderly in South Carolina. A significant number of older residents responding to a Panel Study of Older South Carolinians survey expressed problems:

The frequency of these problems increased with age and among non–whites. Frequency decreased among higher educated, higher income elders.

The S.C. Department of Mental Health reports that during fiscal year 2001, 907 people 50 and over were treated in a hospital for a psychiatric disorder, and 312 were treated in a hospital for substance abuse problems. 840 individuals 50 and over were treated in a nursing care facility. 15,601 South Carolinians received community mental health services for psychiatric disorders. In addition, 586 state residents received community services for substance abuse problems. These figures do not reflect persons treated privately or those who fail to seek or refuse treatment.

Diabetes is also a common problem for the elderly, and its frequency has been increasing. According the 2000 BRFSS, 12.7 percent of those 55–64 and 15.5 percent of those 65 and older reported having been told by a doctor that they had diabetes. The rates are twice as high for African-Americans. Hypertension (high blood pressure) is one of the leading risk factors for heart disease, a common cause of death among older persons. In South Carolina, 44.8 percent of people ages 55–64, and half of those ages 65 and over reported that they had been told that they had high blood pressure. This problem is most common in African-American females. High cholesterol, which can contribute to hypertension, was reported in 40.4 percent of people 55–64, and 37.2 percent of those 65 and over.

Some health problems that the elderly frequently experience may be improved by behaviors such as exercising and eating a healthy diet. Being overweight or obese is a common problem for many South Carolinians that can cause a variety of health problems, such as heart disease, stroke, some kinds of cancer, and diabetes. According to the 2000 BRFSS, 39.7 percent of 55–64 year olds are overweight, as are 32.4 percent of those 65 and over. The rates for obesity are 28.7 percent and 36.9 percent, respectively. Nutrition is a related issue where there is room to improve. Though it is recommended that people eat a low-fat diet with at least five servings of fruits and vegetables daily; 70.5 percent of 55–64 year olds and 68.5 percent of persons 65 and over said they did not eat 5 or more servings of fruits and vegetables a day. Physical exercise is another necessary ingredient for maintaining optimum health. Only 39.7 percent of 55–64 year olds, and 36.4 percent of those 65 and older reported engaging in regular physical activity. 29.3 percent and 38.9 percent of those age groups, respectively, reported engaging in no leisure time physical activity at all.

Safety Is A Key Issue

Good health, financial stability, a support network of family and friends, and safe neighborhoods and environments combine for a quality life. The loss of just one factor, however, can result in increased vulnerability for older Americans to become victims of crime, fire deaths, financial scams, neglect, abuse or exploitation. Older South Carolinians living alone can be more vulnerable to crime and financial exploitation, increasing the need to make sure the growing numbers of elderly living alone are safe and secure. Churches and civic groups, however, are coming to the rescue with innovative ways to make sure the elderly in their communities are staying safe. An example of this type of action is the Neighborhood Crime Watch.

In 2000, 1,789 South Carolinians 55 and over were reported victims of violent crimes. Aggravated assaults and robberies are the most common of violent crimes committed against South Carolina’s 55 and over residents, with murder and rape occurring infrequently. In South Carolina, 998 individuals were victims of aggravated assaults and 741 were victims of robbery.

While the state’s mature adult residents are targeted in certain crimes, they are not often the perpetrators. According to the Department of Corrections, of the 22,666 inmates housed on June 30, 2002, only 609, or 2.7 percent were 55 and over. Only 2.2 percent of female and 2.7 percent of male inmates are 55 and over.

Abuse, Neglect, And Exploitation

The 1993 Omnibus Adult Protection Act provides for the protection of vulnerable adults over the age of 18 from abuse, neglect and exploitation by others. These vulnerable adults may also experience self–neglect when they become unable to meet their own basic needs. The Department of Social Services and the Long Term Care Ombudsman program in the Office of the Lieutenant Governor, Office on Aging are responsible for investigating complaints of abuse, neglect and exploitation.

In state fiscal year 2001, 4,333 adults were reported to the Department of Social Services as needing Adult Protective Services due to abuse, neglect, or exploitation. Sixty–five percent of the total adults reported were over the age of 60 and fifteen percent were over the age of 85. Of the 4,333 situations reported, sixty–eight percent were substantiated as involving abuse, neglect, or exploitation. Thirty percent of the cases involved neglect by another, forty–seven percent involved self-neglect, nine percent involved abuse, two percent involved psychological abuse, and eight percent involved exploitation. It is estimated that as many as 70,000 cases need to be brought to the attention of Adult Protection Services. Also, it is estimated that for every report received, 14 go unreported because of the vulnerable adult’s inability or reluctance to get help.

During fiscal year 2001, 4,791 cases of abuse, neglect, and exploitation regarding long-term care facility residents were reported to the Long Term Care Ombudsman Program and met the definition of the 1993 Omnibus Adult Protection Act. These cases occurred in an institutional setting such as a nursing home, community residential care facility, Disability and Special Needs, or Mental Health facility. Forty–nine percent of the state’s reported cases involved residents’ rights (alleged physical, sexual or verbal abuse or neglect), and 35% percent involved resident care (accidents, dental care, physical restraints). The remaining 16% involved quality of life, administration, or were not against the facility.

Mature Adults 2003 Index.