For those people who have had a chance to visit any senior housing, nursing homes or assisted living in the entire US, few will agree that the services or environment are ideal for the aging population. Those offering their services in the care setting are forced to struggle with the motive to transform their delivery system and environment while meeting the constraints and demands of the bulging elderly population ( National League for Nursing (NLN), 2014) . On the other hand, the authority struggles to fulfill their duties to the public and provide systems that guarantee minimum levels of care standards and safety measures. The players view the current issues that could have answers but are hindered by the demerits of the laws they are bound to enforce.
According to the Census conducted in 2010 in the US, the population aged 65, and above is rapidly growing compared to the other population that is below 65. It implies that the elderly proportion (65 and above) of the total population is increasing. By 2011 the first baby boomers- people born between 1946 and 1964- started to turn 65. As of now, at least 30 million individuals in the U.S are 65 and above. Also, this number is expected to double and reach up to 79 million by 2050 (Jacobsen, Kent, Lee & Mather, 2011).
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Age Structure and Median- Age
Patterns of geographical distribution and redistribution of the aging population in the United States at the national level is dynamic. As the older population grows more widely in the US, the population as a whole is getting older. The median age divides the population into two groups, the younger half, and the older half. Due to decline in fertility during most of the first half of the twentieth century the, the U.S population progressively became older. As a result the median age has progressively risen to 37.5 years in 2010 from 30.5years in 1950s and is projected to increase to 39.5 years in 2030. On the other hand population structure is affected by three factors; births, migration and deaths. Until recently the age structure resembled a pyramid attributable to the large number of birth cohorts at the base of the pyramid and rapid narrowing as people aged. In the past these deaths were caused by diseases that nowadays are treatable hence the pyramid shaped age structure (West, Cole, Goodkind & He, 2014). However, due to decline in fertility and mortality the age structure shape has shifted from a pyramid shape to a more rectangular shape.
Today as much as the population grows older it is also predominantly becoming dominated by the female. U.S Census Bureau in 2010 has reported that the U.S population is split into two, 49.2% male and 50.8% female. Consequently the ratio is drastically changing, for every 100 females in the age bracket of 65-74 there are only 86 males (West, Cole, Goodkind & He, 2014). Further the number of males continue to drop to 72 as the age increases from 74- 85 and it further drops to 49 males for every 100 females as they grow older and above the age group of 85. In a nutshell, mortality between men and women narrows progressively, in other words there is conclusive evidence that indicate that there is a higher mortality rate for men compared to women, beginning birth all through their life course. These results to fewer men compared to females ( Echenberg, Gauthier & Leonard, 2011) .
From the federal population data, older people tend to migrate to less populated areas away from towns. The South had the largest number of people who are 65 years and above and the Midwest. When comparing the older population in regions, the west had least elderly population of 11.9%, followed by the South, which had 13%, and then, the Midwest came in third with 13.5 percent in descending order. The Northeast had the biggest percentage of older people at 14% ( Echenberg, Gauthier & Leonard, 2011) .
The elderly population is increasingly turning out to be ethnically and racially diverse since the minority are growing and experiencing low mortality rates (West, Cole, Goodkind & He, 2014). Although it is people may think that the elderly persons are uniformly distributed between race and ethnicity; this is not the case because out of every five Americans there is one that is from a minority race and ethnicity. They break down in the following way:
The Hispanic race is one of the main dominating minority races in the U.S. Its population growing faster as compared to other minority groups, and makes up 15 percent of the total U.S population. Hispanics have a life expectancy of 81 years and they live two years longer than whites and eight years more than the blacks (West, Cole, Goodkind & He, 2014). It appears that by the year 2019 the Hispanic will be the largest racial/ ethnic minority in the age group of 65-85. From 2.7 million Hispanics in 2008, 6.8 percent of the population, they are projected to reach over 17 million by 2050 and account for 19.8 percent of the older American population.
Black or African American
In 2008, there were 3.2 million African Americans who represented 8.3 percent of the older population. By 2050 their number is projected to swell over 9.9 million and account for 11 percent of the most elderly population.
Asian, Hawaii and Pacific Islanders
In this group, there are over 1.3 million persons, giving a percentage of 3.4 of Americans aged 65 and above. The figures are projected rise to over 7.6 million by 20150, which will translate to 8.6 percent of the older population.
American Indian and Native Alaskan
The 2007 demography of Native Alaskan and American-Indian elderly persons were found to be 212,605, translating to 0.6 percent of the aging population. Also their figures are expected to grow to at least 918, 000 by 2050. The American population distribution by sub-group shows disparity that can be attributed to the changing birth rates, immigration rates, socio-economic factors, and inaccuracies characterized by enumeration difficulties of census. Therefore in the coming four decades there should be a change in percentages; increased percentage in minority elderly and decreased white majority elderly (West, Cole, Goodkind & He, 2014).
Need for Health Service provision
Health care services are core for any community, to maintain and lower the death rates among the old and the whole population. In 2013, 70 percent of children between the ages of 19- 35 months had concluded their childhood vaccinations requirements. Equally, 41% of persons aged 18 years and above were given influenza vaccination in the same year 59.7 percent of non-institutionalized adults of 65 and above years had the pneumococcal vaccination (NLN, 2014) .
Further, two- thirds of women who were above 40 years had had a mammogram in the past two years. This is an indication that there is a vital need for a healthy population for an overall prosperity of the state. Also, the prevalence of most chronic conditions and impairments has increased in older adults. A large number of 65 years and more elderly population in the U.S suffer from chronic conditions, and their numbers may continue to grow. Therefore, this growth demands from the healthcare system more checkups (NLN, 2014) .
Social Security and Pension plans
Several religious, private and governmental organizations across the country offer compassionate services to the elderly population. Like most individuals, older people also require good life. Medicare and Medicaid are two social security bodies of the government that ensure people of 65 years and above are catered for health wise. Old-Age, Survivors and Disability Insurance (OASDI) The program issues monthly benefits in place of lost earnings due to retirement, death and disability.
Factors such as age and earning history are the primary basis of an amount of claim that one may ask. OASDI enables the old population to at least have a source of income that would allow them to acquire and take care of basic needs. Medicaid focuses on providing care for people with specific diseases such as Alzheimer’s disease and forms of dementia. These are mental and cognitive conditions that recreational activities have proven effective improving and maintaining cognitive and physical functions. These services are provided by George G, Glenner Alzheimer’s and Family Center, Inc. This is an Alzheimer’s Adult day care and family care.
There is uncertainty when forecasts of income and cost for the OASDI program are done. Trustees have attempted to demonstrate the degree of the uncertainty in annual reports but have not succeeded. Alternatives have provided and shown how assumptions and principles of the ultimate nature of funding differ. Due to the progressive increase of the old age population, benefit reductions of around 25 percent will be witnessed while payroll tax will increase. It is in line with the old American Act of the OAA that seeks to uphold the dignity of older adults through the provision of services that enable them to remain independent and be indulging citizens to the socio-economic level of the society.
Major Barriers to Providing Appropriate Services to the Elderly in the Current
Despite the growing population of older Americans each year, funding on the national level is being held at low levels and in some situations funding declines from previous years’ levels. The Congress seems not to notice the importance of the services offered through aging networks. This makes the organization to be too inward looking and therefore they need a more outside look. This makes the group be too inward looking and therefore they need a more outside look to reach out and ask for more support and recognition. This shows that aging networks are missing the required number of clientele which can be attributable to the poor or lack of promotion that will make them recognizable ( Rantz et al, 2015) . For example, older people who are poor are struggling with old age in their communities without any help from either state or federal. Therefore, the National Association of Area Agencies on Aging and the National Association of State Units on Aging should push the Congress to increase elderly funding by at least 25% to existing aging programs (Echenberg, Gauthier & Leonard, 2011).
Secondly, there is the need for simplification in the aging networks. This entails recommendations that will streamline rules and eliminate time-consuming procedures as well as overextended planning processes. This is because most developing systems have the Congress include more and more language and more programs which are unique to the various race and ethnicity of older Americans. As per 2010 census data, the Missouri population was estimated at 5,988,927. Out of this number, 82.8% were whites, 3.5% Hispanic/Latino, 11.6% were African-Americans, 1.6% Asian, 0.5% American-Indian/Native Alaskan and 0.1% are Native Hawaiian and Pacific Islander.
Poverty in Missouri is one of the setbacks to proper health care acquisition. Local health care systems like the aging networks strive to provide and make health care available and accessible to the citizens but hindrances such as limited resources in rural Missouri. Also, according to the U.S. Bureau of Economic Analysis, 82 of the 89 Missouri’s counties have poverty rates that have poverty rates that are greater than the overall state ( Rantz et al, 2015) .
The Missouri Department of Health and Senior Services’ Community Data Profiles of 2011 have profiled the number of persons who lack health insurance. Health Insurance is a core determinant is a core of health status; it also correlates with income levels and health care awareness and access. County level studies show that a mere 15.3 percent of Missouri populations are not insured. This is a significant barrier to aging networks success in caring for the old.
Public Policy Proposal for Services/Programs
There are approximately 1.5 million elderly populations currently living in nursing homes in the whole of U.S. Professionals have pointed out that most nursing homes lack the capacity the required capacity for early ailment prevention and detection. There is the necessity to increase the current and the future supply care workforce in both urban and rural Missouri. Paraprofessional staffs and nurses like certified nurse assistants, personal care attendants and home health aides have to be increased from the current numbers ( Corazinni et al, 2013) . Currently, Missouri has huge number of unskilled paraprofessionals offering long-term care services. Majority of them are women derived from different ethnicity and race of minorities. This can be said to have been contributed by the low wages paid, hard working conditions and heavy workloads have made employee retention and recruitment to be difficult. Due to the ever increasing number of the old age individuals, there should be a greater number of recruitment and potential hiring of long-term health caregivers both in a public and private sector. This will ensure proper caring of the old at every household (Vogelsmeier et al., 2015). Also, advanced practice registered nurses (APRNs) should be deployed in nursing homes because the evidence shows that they have the ability to lower avoidable hospitalizations.
Further, major cost savings in medical care have been reported when APRNs work in nursing homes. The reason behind this squarely lies in their expertise in the clinical health management, early illness detection, and solving problem with other supervisors to offer the required care to establish clinical environments within Nursing homes (Vogelsmeier et al., 2015). Although evidence has emerged showing the abilities of APRNs to boost resident outcome, few evidence has discussed the ability APRNs to incorporate their innovative practice duty into nursing homes to impact on care delivery ( Corazinni et al, 2013) .
Adequate funding for projects mend to benefit the elderly are in the initial stages of ensuring that the old are being catered for. While a majority of public policies emphasizes on the federal and state expenditures on the elderly, the size of the economy is yet to be given attention. According to the vision 20150 of the Social Security Actuaries, the US economy will expand up to $111 trillion in nominal GDP (Echenberg, Gauthier & Leonard, 2011). Therefore, public programs’ financial burden will be determined by pace at which the economy grows. The implication of this is that in formulating long-term goals for elderly care expenditure, the 20148 expenditure from the GDP percentage could be three times that of 2010 if the economy grows at 1.5% per annum (Vogelsmeier et al., 2015). A number of workers could also increase due to increased labor force participation and immigration which will enable improved tax collection by the government that could bring about the creation of more nursing homes and increased hiring of caregivers like nurses (Lane, K.et. al.2015).
There is clear evidence that suggests the future population structure will comprise of senior citizens of 65 years and above. This is because of the improved medical care that has reduced the mortality rate. Most of the elderly are women who are of the same age as men, but they are predominant at the age of 65 and progressively beyond 65 years. Government intervention is needed to create a better health care system for the old and welfare is important to improve the standards of living of the elderly.
Corazinni, K. N, Anderson, R. A., Mueller, J. M. & McConell, E. S. (2013). Licensed practical nurse scope of practice and quality of nursing home care. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23995465
Echenberg, H., Gauthier, J. & Leonard, A. (2011). Some Public Policy Implications of an Aging Population. Retrieved from http://www.lop.parl.gc.ca/content/lop/researchpublications/cei-07-e.htm.
National League for Nursing (NLN). (2014). A Vision for Recognition of the Role of Licensed Practical/Vocational Nurses in Advancing the Nation’s Health. Retrieved from http://www.nln.org/docs/default-source/about/nln-vision-series-(position-statements)/nlnvision_7.pdf?sfvrsn=4
Rantz, M.J., Lane, K.R., Phillips, L.J., Despins, L.A., Galambos, C., Alexander, G.L., Koopman, R.J., Skubic, M., & Miller, S.J. (2015). Enhanced RN care coordination with sensor technology: impact on length of stay and cost in Aging in Place housing. Nursing Outlook, 63 , 650-655.
Vogelsmeier, A., Popejoy, L., Rantz, M., Flesner, M., Lueckenotte, A., & Alexander, G. (2015). Integrating advanced practice registered nurses into nursing homes: The Missouri Quality Initiative experience. Journal of Nursing Care Quality, 30 (2), 93-98.
West, L. A. Cole S., Goodkind, D. and He, W. (2014). 65+ in the United States: 2010. Current Population Reports. Retrieved from https://www.census.gov/content/dam/Census/library/publications/2014/demo/p23-212.pdf