A Note From:
IOA Director Victor Marshall

Comments from the Director, UNC Institute on Aging, to the North Carolina Study Commission on Aging

I will first tell you about the UNC Institute on Aging, as I think most of you do not know much about it, and then brief you on four initiatives that you might be dealing with legislatively, or simply that I think you should be aware of. As I tell you about the IOA, I hope you will realize that the Institute can be a tremendous resource to this committee– and that we are committed to being helpful.

The IOA was established in 1996 as an ‘inter-institutional program’ of the UNC system, but located on the campus of UNC at Chapel Hill. Our mandate includes providing state-of-the-art information to policy makers, program managers, service providers, clinicians, and the general public to ensure that research findings in aging are reflected in policy recommendations, in professional practice, and in the health and human service systems serving the needs of older adults.

Our mission statement is: To enhance the well-being of older people in North Carolina by fostering statewide collaboration in research, education and service. We have base budget funding of about $600,000 a year but each year we generate about $1.7 million additional funding through research grants and contracts, to support our activities. We have about 40 people on staff, counting students and other part-timers, but the FTE is about 20 people. Given our mission, we are a pretty small outfit, but we work actively in partnerships, which enables us to have a bigger impact.

I have time to alert you to only a few things that we do.

We initiated and sustain, as the lead partner, the North Carolina Conference on Aging. The other partners are the NCDAAS, NCAAA, NCAOA, Governor’s Advisory Council on Aging, AARP, and several universities. The conference brings together academic researchers with the aging service network, several state government agencies and the advocacy groups, and an increasing representation from the private sector. The 7th annual conference will be in Greenville in October and, like the most recent two, is expected to attract over 600 registrants.

We sponsor the Senior Leadership in Aging Program, which has just accepted nine new Senior Leaders, from across the state, for its next 18 month session. The program provides mentorship and seed funding for leader-generated projects. The idea is to increase volunteer leadership and advocacy skills. Several graduates of the program are in the Senior Tar Heel Legislature.

The IOA established and provides ongoing support (again with partners) to the North Carolina Healthy Aging Coalition, working with 25 organizations to enhance the health of older North Carolinians.

The IOA established and supports the North Carolina Gerontology Consortium, linking 11 universities in the UNC system– from Asheville and Appalachian State to Elizabeth City and Wilmington– to collaborate in developing and sharing distance education courses in aging.

We have also just created a North Carolina College Aging Network (NCCAN), which so far includes fifteen members from nine different small, independent colleges. NCCAN will support professors who are often the only faculty member in gerontology education in their entire college.

We are in the process of establishing the North Carolina Lifelong Access Libraries Collaboration, designated a Center of Excellence and Innovation by the Libraries for the Future foundation in New York. The collaboration will work with public libraries across the state to foster civic engagement of seniors and make libraries more age-friendly. North Carolina partners include the State Librarian and the Division of Aging and Adult Services. Funding comes from the New York-based foundation and from the Vice-Chancellor for Engagement at UNC Chapel Hill. The initiative is being announced this very day at a national librarianship conference in Minneapolis.

The Center for Aging and Diversity, a center within the Institute, has conducted a large ‘train the trainer’ program with vulnerable populations in North Carolina’s African American community and with Native Americans. In partnership with the Eastern North Carolina Chapter of The Alzheimer’s Association, the program not only provides training for the very difficult caregiving necessary with dementia, but also trains people to train others, so that it will have a multiplier effect.

These are just examples of many more projects at the IOA. Of more direct potential benefit to you, our outstanding library and Information Center is available for you to use. You should all be receiving our electronic newsletter, which comes monthly with news of research, education and services in aging. Our website must be of use to someone because it receives 82,000 hits per month. Our Agelib Digital Library is easy to use. You can enter keywords, such as ‘long term care’ or Alzheimers, and find digital reports, papers and even websites full of information for you to read or download free for your own use.

Spending time on our website will give you a more comprehensive idea of IOA activities, including our extensive research program (which I have not highlighted today). In addition, Representative Farmer-Butterfield is a member of our Statewide Advisory Council and has a good idea of what we do.

While the Institute cannot propose a legislative agenda, I would now like to comment on four initiatives that should concern this committee and which touch on the IOA’s basic mandate or relate directly to activities and programs of the Institute.

• Recommendations for a Statewide Aging Study
  In response to Senate Bill 448, Session Law 2007-355, the Division of Aging and Adult Services (DAAS) submitted “Report to the North Carolina General Assembly on Recommendations for a Statewide Aging Study” (January 1, 2008). Section 2 of this bill requested the DAAS to “make recommendations on a study to include all counties in North Carolina. The Division shall evaluate similar studies conducted by other states and shall make recommendations on the criteria that should be included and an appropriate funding level for a study to include all North Carolina counties”. The Report proposed Project CACE, Communities and Aging Carolinians – on Edge, which has six integrated components. These include the design and implementation of a “State and Local Awareness and Preparedness Assessment”, and the securing of supplementary studies such as the Retirement Migration Study. Specifically, the report recommends “an ongoing assessment of the needs, assets, and expectations of its older population and the aging boomer cohort”. An initial survey with follow-up over a five year period is recommended, and active collaboration would be engaged with the Area Agencies on Aging (AAAs). The UNC Institute on Aging is mentioned in relation to project coordination. The IOA is uniquely positioned for both project coordination and implementation because of its survey research expertise, its formal mandate and positive record of working with other academic institutions across the state, and its many partnerships with the AAA’s and other local-level service agencies in the ‘aging network’. Total funds for this proposed initiative are $3.72 million recurring and $600,000 non-recurring. The Institute on Aging considers this project to be of critical importance because it will generate the needed data to support planning for the aging of the baby boom generations, in a broader context including economic and social as well as health factors, and in a manner that takes into account the rapidly changing demographic structure of North Carolina’s aging and older population. The related migration study that would be part of this initiative reflects a demand from several counties across the state (not just in the eastern part) for the development of a knowledge base to guide economic, social and health policy in the context of the very large and historically unprecedented in-migration of the elderly to North Carolina.


• Addressing Public Health Issues of Older Adults
  The Institute on Aging is currently working in partnership with the Division of Public Health, the Division of Aging and Adult Services, the Healthy Aging Coalition, and the UNC Geriatric Education Center to address the growing public health issue of older adult falls. Thirty percent of adults 65 and older who live in the community fall each year. Falls cause fatal and nonfatal injuries for persons over the age of 65. In North Carolina, older adult falls accounted for 27% of all injury-related emergency department visits in 2006, and hospitalization rates due to falls increased by 35% between 2001 and 2005. Given the association of falls and fall-related injuries with increasing age, these rates are expected to grow rapidly as North Carolina’s older adult population increases. Specific funding is needed to educate health care professionals and other older adult service providers about fall prevention, evaluation and management; oversee and support demonstration projects designed to prevent falls among older adults and to prevent or reduce injuries associated with such falls; and raise awareness among older adults themselves and their caregivers and families about what they can do to prevent falls. In the interim, the IOA is working with our partner organizations to develop the North Carolina Falls Prevention Coalition, to bring together NC health care professionals and service providers to address this issue in a more systematic way. Thus the Institute on Aging supports these falls prevention initiatives. The Institute on Aging and its partners have yet to identify someone who will lead this charge legislatively, but we are hopeful that this can be addressed soon.


• Support for the Win A Step Up Program
  The IOA’s Win A Step Up program has conducted skills upgrading for direct care workers and managers in nursing homes and other settings, reaching more than half of the counties in the state. The goal is to reduce the huge turnover rate in this sector, enhance caring skills and continuity of care, and increase job satisfaction. The program recently received honorable mention in a national recognition competition from the Rosalynn Carter Foundation. The Study Commission on Aging recommended (Recommendation 16, 2007 session of the General Assembly, p.7) “that the General Assembly appropriate to the Department of Health and Human Services, Division of Facility Services (now the Division of Health Service Regulation), $200,000 for FY 07-08 and $200,000 for FY 08-09 to develop and pilot a WIN A STEP UP (Workforce Improvement for Nursing Assistants: Supporting Training, Education, and Payment for Upgrading Performance) Program for nurse aides employed by home care agencies; to appropriate $200,000 for FY 07-08 and $325,000 for FY 08-09, in addition to fine and penalties collections provided by the Division, to continue the program in nursing homes; and to direct the WIN A STEP UP Program to study the feasibility of becoming a self-sustaining program and to report to the House and Senate Appropriations Subcommittees on Health and Human Services by May 1, 2008. The WIN A STEP UP program shall continue to enhance and enrich curriculum components with information and exercises involving appropriate care for individuals with dementia, anxiety, depression, and other severe mental health problems.” This recommendation was not adopted, and the program has continued with reduced financial support. Legislation that is consistent with Recommendation Number 16 of the 2007 North Carolina' Study Commission's report would allow the IOA, which houses and conducts this award-winning program, to develop and pilot a WIN A STEP UP Program for nurse aides employed by home care agencies; to continue the program in nursing homes with support from fines and penalties collections provided by the Division of Health Service Regulation; to allow the WIN A STEP UP Program to continue its study of the feasibility of becoming a self-sustaining program across all types of long term care; and to enhance and enrich the curriculum with information and exercises involving appropriate care for individuals with dementia, anxiety, depression, and other severe mental health problems.


• Aging Workforce Initiatives
  The Institute on Aging has agreed to be provide administrative support for a Forum on North Carolina’s Aging Workforce. The forum was initiated by the Governor’s Advisory Council on Aging, and the Workforce Development Board of the Department of Commerce will also play an important role in developing the conference. This will be a two-day conference, September 23-24 in Raleigh, and we expect to find additional partnership support from the corporate sector and non-governmental organizations. With the leading edge of the baby boomers now eligible for early retirement at age 63, and the average retirement age 62 in fact, North Carolina faces severe labor force shortages in the future. Throughout the developed world, nations and corporations are in the process of a huge policy shift– from encouraging early retirement to fostering retention of workers to later ages. We simply cannot afford to lose the talent of older workers; however, if we are to encourage them to delay their retirement, we need to make work more flexible, more rewarding, and more healthy, and to make adjustments to pension and health care provisions to facilitate things like phased retirement. I have no doubts that the legislature will, at some point in the near future, be wishing to consider legislation to make work more flexible and to increase our ability to use the talents of workers to later ages. All members of the legislature will be invited to attend this forum, but we are particularly hopeful that you, as members of the Aging Study Commission, will mark your calendars for this event.