Action plan zeroes in on Marin's aging population

01/29/2020

Marin is undergoing an unprecedented population shift. Residents are living longer than ever before, and the number of older adults continues to climb. 

Today, adults age 60 and over represent 28 percent of the population, making Marin one of the oldest counties in California, and their share will keep rising. By 2025, one in three residents will have celebrated their 60th birthday, and in 10 years, 38 percent will have passed this milestone. The population growth for adults over age 80 is even more profound.

This trend, reflected in the United States, has created a growing focus on programs, policies and places for aging adults. Following in the footsteps of nine cities in Marin, the county has created an age-friendly plan, a guide to creating a livable place for all adults.

“This plan represents a significant undertaking and is meant to serve as a framework and starting point,” Lee Pullen, the director of aging and adult services, told the Board of Supervisors before the plan was approved on Tuesday. “It is the culmination of public—not staff or consultant—but public input.”

The county surveyed over 1,800 older adults and held seven focus group discussions last spring and summer. “Over 2,000 individual voices from nearly every corner of the county have given shape to this plan,” the plan states.

Of the six focus areas the plan identifies, three were reflected in a survey of all adults: housing, transportation and disaster preparedness. The focus areas unique to older folks are community services, social connection and unincorporated areas. For each focus area, the plan outlines a goal and several action items. For each action item, it identifies steps that could be taken by the community, the Board of Supervisors and county departments.

 

Housing

The county’s goal is to provide affordable housing options to all residents, because housing costs create stress for older adults and prevent service providers for aging adults from living in the area. The salaries for caregiving positions are often lower than what is needed to afford market-rate housing, the plan says. 

“Ensuring that older adults can age in their desired setting, within their means and with necessary accommodations should be a priority for any age-friendly community,” it states.

Many older adults say they want to remain in their homes, but not all believe there is enough support to stay. A key factor is accessibility—one-third of older adults said they had fallen in the past year, and many were in need of bathroom modifications. 

To promote affordability, the plan encourages the county to subsidize rental costs with Measure W tax revenue and calls on the Marin Housing Authority to explore partnerships with home-sharing platforms. The plan asks supervisors to foster an increase in accessory dwellings by reducing permit fees. (Earlier this month, the board adopted an ordinance that streamlined the application process and lowered the costs of permitting accessory dwellings.)

To make it easier for seniors to alter their homes so they are age-friendly, the plan says that the Community Development Agency should initiate programs that support home modifications, especially for renters. The Board of Supervisors should waive permit fees for accessibility enhancements, and nonprofits should offer financing for such projects. 

“These measures can benefit all residents and offer much-needed access to affordable and appropriate housing for people with disabilities, lower income, and minority older adults,” the plan says.

This week, the Community Development Agency proposed an ordinance that would increase building permit fees but allow for a full fee waiver if the scope of the work is limited to accessibility improvements. A merit hearing, when the board can adopt the ordinance, is scheduled for Feb. 11. 

 

Unincorporated areas

County staff conducted three group discussions in West Marin last summer—with Spanish-speaking community members, with all community members, and with West Marin Senior Services. After those meetings, staff decided to create a specific focus area for those living outside city boundaries, where the experience of aging is considerably different. 

“Residents express concern with higher costs of care and services in rural settings, limited transportation options, higher risk of natural disasters, and limited pedestrian infrastructure,” the plan says.

Over half of the people living in Inverness, Muir Beach and Stinson Beach are over 60 years old, with Point Reyes Station and Tomales not far behind. West Marin is generally older than the rest of the county, and its residents over the age of 60 are poorer: 22 percent of older adults in West Marin rely on less than $30,000 a year. 

Mr. Pullen said the Spanish-speaking focus group was concerned about the basic economics of affordable health care and food. Other groups indicated that they would like to see more accessible paths and trails, and expanded programs that encourage seniors to visit parks.

Chris Chamberlain, the assistant director of Marin County Parks, told supervisors that some progress has been made, and stressed the importance of continued funding. Through the county’s Breathe/Respira Community Grant Program, organizations that encourage park visits are supported, and the parks department continues to improve trail accessibility. Mr. Chamberlain said this work depends on tax revenue from Measure A, the quarter-cent sales tax for parks.

“It’s really allowed us to take on some of this challenging and very fruitful work,” he said. “But as seen in the recommendations and the road map moving forward, we’ve got a lot of work to do.”

The plan’s recommendations encourage the parks department to improve the targeted promotion of events in parks and to work with the Department of Public Works to improve pedestrian infrastructure.

Beyond parks, the plan pushes the county to utilize the robust volunteer culture in West Marin to provide home repairs, social visits, rides and home hardening services. It also calls for expanded funding for groups serving West Marin. 

“West Marin communities can serve as incubators of ideas and solutions for people living in and organizations and agencies serving unincorporated areas beyond West Marin,” the plan says.

 

Mobility

Rural areas are challenged by a relatively lower demand for transportation services, a lack of existing infrastructure, and a large and uneven landscape.

To encourage on-demand transportation options, the plan says the county should fund ride-hailing services in rural areas and expand volunteer driver programs. Public-facing departments should better integrate transportation to events into their planning, and the board should develop an accessibility policy that will help people who need transportation to appointments.

For pedestrians and cyclists, more curb ramps should be installed and information on how to submit a pedestrian infrastructure modification request should be communicated. The parks department, volunteers and private health care providers should offer outdoor balance and fall prevention training. 

In general, infrastructure should be improved, though survey respondents were split on adding sidewalks and pedestrian lighting, as some preferred to preserve the area’s rural character. The plan nevertheless recommends accessible paths and improved lighting “where there is evidence of high demand or danger.”

 

Disaster preparedness

In 2018, Marin applied to join the World Health Organization’s network of age-friendly communities, which requires having an age-friendly plan. The health organization has a series of domains to look at when crafting these plans, which Marin adapted to fit its own focus areas. The county also added another domain: disaster preparedness.

Disaster was the second-most frequently cited concern among older adults in Marin; about 40 percent of respondents felt unprepared. Residents’ barriers to preparedness include unfamiliar evacuation plans, crowded roads and the need to stock supplies and assemble an emergency go-bag. The barriers are exacerbated for lower-income, minority and geographically isolated older adults, the plan says.

What can be done to prepare older adults for disaster? According to the plan, periodic emergency drills for sheltering in place and for going to shelters should be conducted. The county should increase Ready Marin and FIRESafe Marin outreach. Marin’s efforts to harden homes for fire safety should include more households with frail occupants. 

The Marin Medical Reserve Corps is a team of volunteers who deploy in response to natural disasters and public health emergencies. This program should be expanded to include home visits before there is an emergency, the plan says.

 

Social connection

People who feel isolated or who live alone also tend to be more concerned about emergency preparedness. This ties into another focus area: social connection. The plan differentiates between social isolation, an objective physical separation from other people, and loneliness, a subjective feeling of being disconnected from others. Both are dangerous and affect older people, and research shows they can lead to cognitive decline, depression and heart disease. 

The plan falls short of defining just how lonely or socially isolated the older population is in Marin, but it does say that older adults place a high degree of importance on activities, especially educational and self-improvement classes.

“Older adults have indicated a desire to interact more with other generations, they want greater opportunities to participate in a plethora of affordable social activities, and they want to figure out ways to identify and address people who are isolated and lonely, while respecting those who wish to be ‘loners,’” the plan says, citing surveys, focus groups and interviews.

The first action item to address social isolation is to identify those who are chronically isolated. Residents should learn how to detect and respond to cases of isolation, and community health organizations should lead a campaign to teach this skill.

Intergenerational programs should be expanded and discounted or free events should be better promoted. The plan stresses equity in this approach, as low-income older adults live alone at twice the rate of those who are not low income.

 

Community services

Many of the plan’s recommendations are not about creating new programs but promoting ones that already exist. “Residents are often challenged in knowing what programs and services are available to them, and in finding where and how to navigate and access those services,” it says.

When the plan looks at community services for adults, it pushes for an improved online presence, as three-quarters of older adults access the internet at least once a day. It also calls on the library to help older adults learn how to navigate resources and connect with friends and family.

The plan says that the availability of and wages for professional caregivers should be improved. The Marin Center for Independent Living provides a registry of caregivers to hire directly, but many people needing assistance use someone employed by a home care agency. It is more difficult and expensive for those agencies to send workers to rural areas, Mr. Pullen said. 

County departments are called on to “add more requirements to service contracts and agreements with home care agencies in exchange for higher rates and broader coverage; explore cost-sharing with clients.” 

Mr. Pullen said the exact mechanism for raising wages is unclear. “These are ideas, and there is a lot of work to be done around them,” he said. “This is a little bold in saying, ‘Let’s bring the private sector in as part of the solution.’”

With the plan come three recommendations for how to implement it. One is to establish an age-friendly oversight committee within the Board of Supervisors; Supervisor Dennis Rodoni and Supervisor Katie Rice indicated they would like to serve. The second recommendation is for the county’s Commission on Aging to create a new committee that can advise and oversee staff.

The final recommendation is to establish a new position, an age-friendly coordinator, to ensure follow-through of the plan’s action items. That individual would work across departments and reach out to ones that weren’t involved. Supervisor Judy Arnold said the board would work with the administrator’s office to look at the budgetary implications of a new position.

Now that supervisors approved the plan, it will be submitted to the American Association of Retired Persons, which administers the age-friendly effort in the United States. In 2023, the county will conduct a comprehensive evaluation of all action items and focus areas, with the intention of updating the plan.