Graying of Hilton Head could overwhelm services, drive housing even higher

Edwina Hoyle, executive director of Memory Matters, worries that Hilton Head is unprepared for the coming "silver tsunami" when today's active retirees grow older and need additional help.
Edwina Hoyle, executive director of Memory Matters, worries that Hilton Head is unprepared for the coming "silver tsunami" when today's active retirees grow older and need additional help. jkarr@islandpacket.com

About this series: Hilton Head Island is getting older fast. From 2000 to 2014, the town aged at almost three times the national rate, according to census data released in December. Today about a third of residents are older than 65 — up from 24 percent in 2000. Is this necessarily a bad thing? We take a look at why we should embrace this trend, and why we should worry.

Below part 2 explores the challenges of the aging population. Read part 1 here which explores the positive aspects of the trend.

State regulators say Beaufort County needs 1,400 nursing home beds to serve its current population. Just 491 beds exist countywide.

That could spell trouble for Hilton Head Island, a rapidly aging town that is expected to continue to “gray.”

“People don’t realize what we’ll be facing in 10, 15 years,” said Edwina Hoyle, the executive director of Memory Matters on Hilton Head, a nonprofit that helps people with dementia. “We need to prepare for it. The active 65-year-old of today will eventually need a level of care and resources that I’m not sure Hilton Head can meet.”

Hoyle, who works with people everyday who are struggling to find the support they need for themselves or a senior they love, calls it Hilton Head’s “silver tsunami.” New admissions to her daycare program for residents with dementia have nearly doubled from 24 to 49 participants in the past five years.

“I see people all the time who move here away from their families to retire. It’s destination retirement,” Hoyle said. “But they don’t have that family support system when something goes wrong. Their closest family member might live hours away so they need to rely on resources here.”

People like Wanda Eastham, 75, and her husband Thomas, are among those retirees who have now lived on the island for more than 20 years, but face an uncertain future.

Wanda Eastham often worries about what she will do when Thomas, who has dementia, passes away. She has no close family or plan for where she can go, though she has often wished she could live in a home with some of the many women in the same situation.

After spending down their assets from careers as educators on Wanda’s mother’s health care, Wanda Eastham worries about the high costs of housing and medical expenses.

“I’m not afraid to go to that big final home,” she said. “And I love my home now when I’m healthy and still have Tommy. It’s where I’m going to go in between that worries me every day.”

Increased demand for health care

Some health care resources are already in short supply, according to Hoyle and local nursing home officials.

Particularly hard hit are people who cannot afford to pay the up to $100,000 annual cost for nursing home care without government assistance or long-term care insurance.

Though many never intend to live in a nursing home, the reality is that for some people nursing homes are the only option for the 24-hour intensive care they need. A 65-year-old woman, for example, has a 44 percent chance of living in a nursing home in her lifetime for an average stay of two years, according to the U.S. Department of Health and Human Services.

But affording that care can be a problem.

Many are forced to spend down their assets on care until they are eligible for Medicaid, which has an income limit of about $2,000 a month, said Courtney Bledsoe, director of Life Care Center of Hilton Head, one of only three nursing homes in Beaufort County that accepts Medicaid patients. Even then, some patients must wait 18 months before they are approved for Medicaid, she added.

No financial motivation exists to build more nursing homes that accept Medicaid. Nursing homes lost an average of $21 for every Medicaid resident per day, according to a 2011 study by the American Health Care Association. Total losses came to $6.7 billion nationally, according to the report.

“A nursing home could never survive on just Medicaid patients,” Bledsoe said. “We lose money on those patients every day, but we still accept them because we think it’s the right thing to do.”

Forecasts are more positive for the construction of private nursing homes. Those are likely to be built elsewhere in Beaufort County where more space is available.

“You can believe that if a company thinks they can make a profit and have customers, you’ll see nursing homes popping up,” said Randy Lee, president of the S.C. Health Care Association, which represents long-term care facility operators. “I don’t think it’s something to worry about.”

The demand for other health care services will also increase. At Hilton Head Hospital, for example, the number of patients treated jumped by a whopping 35 percent from 2011 to 2015, said hospital CEO Jeremy Clark. That paired with an 18 percent increase of about 7,000 more visits annually to its emergency room.

Clark attributes those changes both to the increase in the number of Hilton Head’s elderly and improvements in the lineup of services it offers residents, including advanced cardiovascular and orthopedic care.

There is already a demand for more physicians on the island, said Susan Kelsey, a geriatric care manager for Assistance Plus, who helps guide older people to get the best medical care.

People can wait for appointments with neurologists for problems related to dementia for longer than three months, Kelsey said.

Clark, of Hilton Head Hospital, said neurology is already an area where the hospital is working to recruit more specialists, but said he is confident the hospital and medical community will grow in coming years to meet Hilton Head’s demand.

“Most people have moved here after having successful careers and they have very high expectations for health care,” Clark said. “The services will move in to meet those expectations and I think that everybody, not just older people, will benefit.”

Transportation road blocks

As Hilton Head’s population continues to age, the town will need a more reliable public transportation system for residents who are no longer able or prefer not to drive, advocates say.

Currently, this group must rely on Palmetto Breeze’s on-demand van service, which requires that residents call at least a day in advance to catch a ride. Many complain that the drop-off and pick-up times are inconvenient.

“I think transportation is the single biggest issue we have for seniors here,” said Ben Boswell, administrative manager at the Beaufort County Human Services Alliance. “There is this sense that we are at the brink of a huge change and we need to do something to solve this problem.”

In 2006, the Human Service Alliance identified transportation for seniors as one of the county’s biggest long-term concerns in an assessment of community needs. In response, the alliance formed the Coalition for Aging in Place to attempt to find solutions.

A lack of reliable and frequent public transportation is central to the problem, Boswell said.

“There is a feeling that public transit is for people that have no other choice now,” said Ginnie Kozak, planning director at the Lowcountry Council of Governments, who works on issues of transportation. “But we want to change that. We want those older people to feel like the bus can get them where they want to go.”

Changes in Palmetto Breeze services will likely come in the next year, Kozak said, as the system will receive an additional $700,000 a year from the federal government on top of its $2.5 million annual budget after Beaufort, Hilton Head and Bluffton were reclassified as a metropolitan area by the U.S. Census in 2010.

The Regional Transportation Authority is conducting studies to find routes with the most local demand for the expansion of the system and hopes to focus on transporting people between more high-traffic areas within the county, said Mary Lou Franzoni, executive director of the authority.

“The area is changing and growing and we hope this can appeal to anyone who would prefer to not drive,” Franzoni said.

In the meantime, the Aging in Place Coalition is working to fill the gaps of the current transportation system. They are organizing what they call “villages” — teams of volunteers spread throughout an area that help seniors with transportation, household chores or just provide social interaction. There are now three villages in the county on Hilton Head, and in Sun City Hilton Head and Rose Hill Plantation.

“It is not something that can solve widespread transportation issues like public transit can,” said Deborah Edmonson, who is the villages coordinator for the county Coalition for Aging in Place. “But it helps to have neighbors willing to help.”

Welcoming the next generation

Retirees bring considerable wealth to Hilton Head, but may also stifle development.

A retirement boom can raise local housing costs, pricing out younger families or locals with less wealth who are unable to afford to live in the community, said College of Charleston economist Charles Hefner.

“It’s what we always see with gentrification,” Hefner said. “When a place becomes more popular and property values get too high, people get squeezed out.”

Identifying ways for younger families to be able to afford Hilton Head is a priority for Mayor David Bennett.

“We want younger families to be a part of Hilton Head and we want to give them the opportunity to find gainful employment,” said Bennett who is spearheading an effort to create a new vision for Hilton Head. The goal is to determine what Hilton Head should aim to be in coming decades.

“We have to be asking: What are the people in the next generation going to want on Hilton Head? I think there will have to be changes,” said Bennett, who seeks to make the town more attractive to businesses that will offer high paying jobs and to build housing options younger families can afford.

It’s a goal that some retirees back.

“You want to live in a place where the teachers at the school or the health care worker you need to come to your home can afford to be,” said Hilton Head retiree Ken Meyer. “We should be willing to make this a place for them to live too.”

Erin Heffernan: 843-706-8142, @IPBG_Erinh