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Senior Community Engagement

Needs Assessment

2016-2017 SENIOR COMMUNITY PROFILE

SUBMITTED BY

April 2017

Westminster Canterbury Richmond - Senior Community Profile 2016 - 2017

TABLE OF CONTENTS

Executive Summary I

Community and Household Demographics 1

Economy and Education 18

Health Care Access 22

Older Adult Health Indicators 26

Chronic Conditions 32

Mortality 36

Medicare Fee-for-Service Beneficiaries 39

Key Informant Conclusions 43

Older Adult Conclusions 49

Appendix A: Secondary Data Profile References 52

Appendix B: Secondary Data Terminology 53

Appendix C: Key Informant Participants 54

Appendix D: Demographics of Older Adult Survey Participants 57


I

EXECUTIVE SUMMARY

Study Background

Westminster Canterbury Richmond is dedicated to improving the lives of older adults living in the

service area by serving them outside of their established walls. As part of their ongoing commitment to

older adults, Westminster Canterbury Richmond initiated a Senior Community Profile to evaluate the

health and social service needs of older adults. The Senior Community Profile, conducted from August

2016 to April 2017, assesses key indicators of health and well-being, including socioeconomic status,

morbidity and mortality, and the physical environment.

The Senior Community Profile offers a broad, but rich overview of the current status of older adults, and

is a compilation of secondary data, key informant testimony, and older adult feedback from the

community. Secondary data are comprised of data obtained from existing reputable resources,

including the U.S. Census Bureau and Centers for Disease Control and Prevention (CDC). For all

demographic and health indicator statistics, data from Richmond City, VA and Henrico County, VA were

incorporated. Sources for secondary data are included in a full reference in Appendix A. In addition,

definitions for statistical terms used in the report are included in Appendix B. Secondary data represent

a point in time study using the most recent data possible. When available, state and national

comparisons are provided as benchmarks.

Key informant testimony was gathered from 77 individuals living in and/or working in the Greater

Richmond Area. Their testimony will be found under “Community Perspective” within the report. The

following table is a detailed summary of the community sectors represented by key informants. It is

important to note that key informant testimony reflects the perceptions of some community leaders,

but may not necessarily represent all community leaders within the service area. Additionally, nearly

64% work in organizations that serve 500 or more older adults.

Count Percent

Senior/Aging Services 18 23.7%

Non-Profit/Social Services 11 14.5%

Faith-Based 10 13.2%

Government 8 10.5%

Health Care/Public Health Organization 7 9.2%

Other 6 7.9%

Business Sector 5 6.6%

Education 4 5.3%

Cultural Organization 2 2.6%

Finance/Law 2 2.6%

Mental/Behavioral Health Organization 1 1.3%

Housing 1 1.3%

Community Member 1 1.3%

Additional community sectors, referred to as “Other” in the table above, include Architect/Design,

Funder, and Philanthropic Leader.


II

Lastly, older adult feedback was gathered from 338 individuals in the Greater Richmond Area. Their

feedback will also be found under “Community Perspective” in the report. Of those responses, 47%

were from Richmond City, 34% from Henrico County, 13% from Chesterfield County, 1% from

Goochland County, 2% from Hanover County, 1% from Powhatan County, and 2% from Other locations.

Westminster Canterbury Richmond expanded the scope of this component of the study to include

additional counties in an attempt to glean information from a broader range of residents in the Greater

Richmond Area.

While the older adult survey provides valuable insights, particularly when used in conjunction with the

other components of the research, the demographic information may not particularly mirror the actual

population due to non-random recruiting techniques. The demographic profile of the respondents who

completed the online survey is depicted in full in Appendix D.

In general, approximately three quarters of respondents were female (76.3%). The majority of

respondents were between the ages of 65 - 84 with 38.1% between the ages of 65 - 74 and 28.5%

between the ages of 75 - 84. Approximately 38% of respondents are married and another 21.5% are

widowed. In terms of health insurance, 65.9% of respondents have Medicare or Medicaid or any kind of

government assistance plan, 26.6% have insurance through their own or their spouse’s current

employer, and 23.3% have insurance purchased directly from an insurance company. Nearly 28% of

respondents reported having a disability. Approximately 63% of respondents were White, while about

33% were Black or African American. In terms of education level, about 46% of respondents have a 4-

year college degree or higher. Lastly, 33.7% of respondents reported their income between $20,000 and

$49,999 and another 29.4% reported their income between $50,000 and $99,999.

The completion of the Senior Community Profile enables Westminster Canterbury Richmond to take an

in-depth look at the issues facing older adults. The findings from the profile will be used to both inform

and engage the greater community in a collective initiative to improve the quality of life of older adults.

Westminster Canterbury Richmond’s Mission Statement:

As a faith-based charitable organization, we will provide services, specific to need, in a compassionate,

professional, holistic manner, through an inspiring environment and dynamic leadership for our residents,

employees and others we serve.

Key Findings

The following section provides key takeaways derived from data highlights found throughout the

Community Profile as noted by the Holleran consulting team. While many opportunities exist

throughout the report to improve the lives of older adults in the Greater Richmond Area, or more

specifically in Richmond City or Henrico County, four key themes have risen to the forefront. Another

point of reference in reviewing the key findings can be found in the 2016 - 2017 Older Adult Report

Card immediately following the Key Findings.


III

1. Housing

Older adults have an enormous need for affordable housing options as they often struggle to maintain

a sustainable household income as they age. Thirty-percent of a household’s total income is considered

the cut-off for housing-cost burdens and avoiding financial hardship. Approximately 60% of adults who

rent in Richmond City and 58% in Henrico County spend more than 30% of their household income on

rent. Additionally, in Richmond City, nearly 38% of older adult homeowners are spending 30% or more

on their mortgage and housing expenses, which is higher than Henrico County, the state and the nation.

Richmond City has a higher percentage of older adults spending 30% or more of their income on both

rent or mortgage/housing expenses when compared to Henrico County. Furthermore, Richmond City

also has a much higher percentage of older adults living below 150% poverty level. Approximately 15%

of older adults in Richmond City have an income below 100% federal poverty level and another 13%

have an income 100% to 149% of the federal poverty level. This equates to nearly 6,500 older adults.

Nearly three quarters of key informants felt that there is high need for affordable housing for seniors in

the community. However, only 20% of key informants “agreed” or “strongly agreed” that there is a

variety of appropriate affordable housing options available in the area for older people. Additionally,

while 47% of older adult survey respondents feel there are affordable housing options in the

community for older adults, 31% feel there aren’t and nearly 22% weren’t sure. With nearly a quarter of

survey respondents unsure of the availability of affordable housing options in the area, this may indicate

a lack of information about available housing options in the community.

2. Transportation and Walkability

Transportation was frequently mentioned as an issue in the community by both key informants and

older adults themselves. Nearly three quarters of key informants felt that public transportation is not

available for older people to reach destinations such as hospitals, health centers, grocery stores,

shopping centers, banks, senior centers and parks. Additionally, only 14% of key informants agreed with

the statement, “In areas where public transportation is limited, community transport services, including

volunteer drivers and shuttle services, are available to older people.” Even less felt that there are sufficient

specialized transportation services for people with disabilities (12.2%). This may be a particular concern

in Richmond City where nearly 39% of the older adult population has a disability, which is higher than

the percentage in Henrico County, the state, and the nation. One key informant in particular explained

the transportation issue best. When asked what is needed to improve the community for older adults,

this key informant said, “A good public transportation system. Resources are not resources until they are

accessible. It’s like having a building with no light bulbs. Transportation is an instant multiplier of

opportunity.” Older adult survey respondents further emphasized the transportation issues in the

community. Approximately half of respondents did not feel public transportation was easy to use or

reliable or that public transportation stops are safe.

Walkability was another aspect of transportation that was a concern for both key informants and older

adult survey respondents. Only 17% of key informants were able to “strongly agree” or “agree” that safe

and well-maintained green spaces and pedestrian-friendly walkways are easily accessible for older

adults. For survey respondents, 40% felt there are well-lit safe streets and intersections as well as

countdown or beeping crosswalks at intersections. However, nearly an equivalent percentage did not

feel that they are accessible in the community. Consequently, when asked about the biggest challenge


IV

faced when traveling, nearly half of respondents said they don’t feel safe walking where they need to

go. This can be a hindrance for older adults in both accessing services as well as engaging in physical

activity.

3. Aging in Place/Access to Services

Across the nation, more and more older adults and their families are searching for opportunities to

safely age in place. In 2016, the older adult population in Henrico County was 46,506 and accounted for

14.3% of the total population, and Richmond City had 27,424 older adults and accounted for 12.4%. By

2021, the older adult population is expected to grow to 55,955 and account for 16.4% in Henrico

County and to 34,226 in Richmond City, which will account for 14.6% of the total population. In

addition, of those older adults who live in non-family households, nearly 59% of older adults in

Richmond City are living alone and 49% in Henrico County. Both of these percentages are higher than

the state and the nation.

The desire to age in place is further emphasized by both key informants and older adult survey

respondents. According to key informants, the top transition decisions impacting individuals in the

community is providing caregiving services to aging parents. This was followed by retiring and

downsizing to a smaller home with less home/yard maintenance. While key informants felt services and

options to support life transitions are widely available in the community, the information about these

services is lacking. Only 30% of key informants felt older adults are able to easily find information on

services and options related to life transitions.

Additionally, over half of older adult survey respondents said that it was extremely or very important to

remain in their community as they age. Furthermore, while nearly half of respondents said it was

somewhat or very likely that they would move to a different home during their retirement years,

approximately a quarter still indicated that it was not likely that they would move and 18% weren’t sure.

According to survey respondents, the top two factors that would influence their decision to move were

looking for a home that will help them live independently and maintaining the outside of their home.

The ability to access health care and social services is another aspect of aging in place. Despite provider

to population ratios that are often better than the state and National Benchmark, it is well known that

the sheer number of providers does not always give the full picture of access. Key informants identified

navigating/accessing health care and social services as the top most pressing issue facing older adults in

the community. Inability to navigate the health care system was also identified by key informants as the

most significant barrier that keeps seniors from accessing health care when they need it. Inability to pay

out of pocket expenses was another top barrier along with lack of transportation. The cost of health

care services appears to be a particular issue in Richmond City as, according to 2013-2014 BRFSS data,

12.6% of adults aged 55 and older were unable to see a doctor due to cost.

4. Chronic Disease Management

Chronic disease management was identified by key informants as the second most pressing issue in the

community facing older adults. According to Medicare data, while older adult residents in Henrico

County are slightly more likely to be burdened by multiple chronic conditions (4 or more) when

compared to Richmond City, still more than a third of older adults in both areas have 4 or more chronic


V

conditions. Managing multiple chronic illnesses can be challenging and costly, particularly when not

managed appropriately.

Health behaviors, such as tobacco use, diet, and exercise, and obesity are often correlated with certain

chronic health conditions. The percentage of older adults who are current smokers is higher in both

Henrico County (17.7%) and Richmond City (22.6%) when compared to the state and the nation.

Additionally, approximately 69% of older adults in both Henrico County and Richmond City are

considered overweight or obese. While this number is similar to the percentage in the state and the

nation, it is still concerning that over a third of older adults in the area are struggling with maintaining a

healthy weight.

While smoking and obesity are impacting older adults in both Henrico County and Richmond City, these

are manifesting themselves differently in the types of chronic conditions affecting older adults in each

area. In Richmond City, older adults are more likely to be burdened by colon/rectal cancer,

lung/bronchus cancer, prostate cancer, asthma, and chronic obstructive pulmonary disorder (COPD).

However, older adults in Henrico County are more likely to suffer from breast cancer, melanoma of the

skin, and heart disease. Henrico County also has a higher percentage of older adults who have been

diagnosed with a depressive disorder.

VI

2016-2017 Older Adult Health Report Card

Richmond City and Henrico County, Virginia

DOMAIN INDICATOR MEASURE RICHMOND

CITY

HENRICO

COUNTY VA U.S.

Socio-

Economic

Factors

Language Older adults who speak English less than very well 1.9% 4.5% 4.5% 8.5%

Income

Older adults living below 100% the poverty level 15.1% 6.2% 7.6% 9.4%

Older adults relying on food stamp/SNAP benefits 11.3% 4.6% 6.9% 8.5%

% of unemployed older adults (55-64 years) 6.0% 3.9% 4.5% 6.6%

Education Older adults with a bachelor’s degree or higher 28.6% 28.4% 27.0% 23.2%

Affordable Housing

Older adult renters spending more than 30% of their income on

housing 60.4% 58.1% 52.4% 54.7%

Older adult home owners spending more than 30% of their income

on housing 37.9% 24.5% 25.4% 27.8%

Social Support

Older adults living alone 59.0% 49.1% 42.3% 43.6%

Most prevalent transition need cited by key informants: Providing

caregiving services to aging parentsa 74.0% of key informants --

Health Care Access

% of older adults without health insurance coverage 0.4% 0.6% 1.0% 1.0%

Older adults unable to receive care due to cost 12.6% 8.4% 8.7% 9.0%

Older adults receiving a routine checkup within the past year 86.7% 84.1% 85.5% 82.5%

Physician to population ratio 990:1 1,020:1 1,330:1 1,040:1*

Mental health provider to population ratio 370:1 410:1 680:1 370:1*

Dentist to population ratio 790:1 1,450:1 1,570:1 1,340:1*

Most prevalent barrier to accessing care cited by key informants:

Inability to navigate the health care systemb 81.8% of key informants -- --

Most needed resource in the community cited by key informants:

Free/low cost dental carec 63.6% of key informants -- --

Built Environment

Key informants that agree the local community is an age-friendly

communityd 19.7% of key informants -- --

Food access and insecurity (Ranking from 1 (worst) to 10 (best)) 5.8 7.9 8.3 8.3*

Recreation/Exercise opportunities 88% 94% 81% 91%

= Areas of Strength = Areas of Moderate Need = Areas of Greatest Need

VII

2016-2017 Older Adult Health Report Card

Richmond City and Henrico County, Virginia (Cont’d.)

DOMAIN INDICATOR MEASURE RICHMOND

CITY

HENRICO

COUNTY VA U.S.

Health

Behaviors

Physical and Mental

Health

Older adults reporting fair or poor health 20.2% 21.4% 24.2% 25.4%

Older adults limited in activity due to poor physical or mental health 27.3% 26.5% 27.0% 29.8%

Older adults with a disability 38.9% 32.7% 34.2% 36.3%

Overweight or obese older adults 69.0% 68.6% 69.0% 68.8%

Tobacco Use Older adults who currently smoke 22.6% 17.7% 14.1% 12.9%

Preventative

Screenings

Older adults who received a flu vaccine in the past year 56.2% 58.6% 56.5% 53.2%

Older adult women who had a breast exam/mammogram/Pap test in

the past 2 years

84.3%; 88.9%;

69.4%

81.4%; 71.7%;

64.0%

81.2%;

80.9%;

58.1%

78.3%;

78.8%;

51.7%

Older adult men who had a PSA test in the past 2 years 79.7% 82.7% 82.0% 79.3%

Older adults who had a sigmoid/colonoscopy in the past 2 years 44.4% 36.2% 38.7% 38.0%

Health

Outcomes

Chronic Conditions

Older adults with arthritis 41.0% 44.6% 48.1% 47.0%

Total cancer incidence rate per 100,000 older adults 2,046.7 1,901.0 1,900.0 2,002.1

Older adults with diabetes 22.9% 19.5% 19.3% 20.2%

Older adults with coronary heart disease 9.7% 12.3% 9.2% 9.7%

Older adults diagnosed with asthma who still have a diagnosis 83.1% 64.4% 76.3% 73.0%

Older adults with COPD 13.7% 7.5% 11.5% 11.2%

Premature Death Years of potential life lost (death before age 75) per 100,000 people 9,700 5,700 6,100 5,200*

Death Rates Total cancer mortality rates per 100,000 older adults 1,099.1 986.8 979.4 963.3

Alzheimer’s death rate per 100,000 adults age 65 years and over 169.7 221.3 163.2 199.6

= Areas of Strength = Areas of Moderate Need = Areas of Greatest Need

* Represents the 90th percentile across the nation

a Only 30% of key informants felt information on available services to support a life transition (e.g., retiring older adults) is easily accessible. b Additional barriers included the inability to pay out-of-pocket expenses (co-pays, prescriptions, etc.) and lack of transportation. c Additional missing resources or services included Geriatricians/Gerontologists and free/low cost vision care. d Services or resources cited as missing included, affordable housing, affordable services to age in place, transportation, safe and well-maintained

green spaces and walkways, and an effective communication system.

Westminster Canterbury Richmond – Senior Community Profile 2016 - 2017

Page 1

COMMUNITY AND HOUSEHOLD DEMOGRAPHICS

In this section:

Overall Population Housing Tenure and Value

Population Estimates Household Status

Veteran and Disability Status Community Perspective

Overall Population

Henrico County and Richmond City are both located in the western part of Virginia. Henrico County

comprises one of the 95 counties in the state. With an estimated population of 325,197, Henrico County

is the fifth most populated county in the state as of 2016. Since 2010, the population in Henrico County

increased by nearly six percent. By 2021, it is estimated the county will experience an additional growth

of almost 5%, making it home to 341,218 residents.

Henrico County curves around Richmond City surrounding it to the west, north, and east. An

independent city in Virginia, Richmond City is home for an estimated 220,653 residents making it the

fourth most populated city in the state of Virginia out of 593 cities. In 2016, the population increased by

8% from 2010, and it is estimated the city will experience an additional growth of 6% by 2021 and will

be home to 233,821 residents.

Map of Henrico County Map of Richmond City


Page 2

Table 1. Total Population Estimates (2016; 2021)

Henrico County Richmond City

2016 Estimate 325,197 220,653

Growth 2010 – 2016 6.0% 8.1%

2021 Projection 341,218 233,821

Growth 2016 - 2021 4.9% 6.0%

Older Adult Population Estimates

The population in Richmond City is notably younger when compared to Henrico County, Virginia,

and the nation. According to the 2010-2014 census, the median age of residents in Richmond City was

32.6; whereas residents in Henrico County had a median age of 37.8, 37.6 in Virginia, and 37.4 across

the nation.

In 2016, the older adult population (aged 65 years and over) in Henrico County was 46,506 and

accounted for 14.3% of the total population and Richmond City had 27,424 older adults and accounted

for 12.4%. By 2021, the older adult population in Henrico County is projected to grow to 55,955

and account for 16.4% of the total population, an increase of nearly 9,500 people. By the same

token, the older adult population in Richmond City is projected to grow to 34,226 and account for

14.6% of the total population, which is equivalent to about 6,800 people.

Racial Composition among Older Adult Population

The older adult population aged 65 years and over in Henrico County is predominantly White

(74.1%). The racial composition in Richmond City is nearly equal between the proportion of the

population that is White (47.6%) and the proportion of the population that is Black/African

American (50.0%). In Henrico County, the Black/African American and Asian populations will grow

slightly by 2021. In Richmond City, the racial composition will change slightly by 2021 with decreases in

the White and Black/African American populations and small increases in other racial groups.

Table 2. Older Adult Population by Race/Ethnicity, Population 65 Years and Over (2016; 2021)


2016 Estimate

N=46,506

2021 Projection

N=55,955

2016 Estimate

N=27,424

2021 Projection

N=34,226

White 74.1% 71.5% 47.6% 47.2%

Black or African American 20.9% 22.2% 50.0% 49.7%

American Indian and Alaska Native 0.3% 0.3% 0.4% 0.4%

Asian 3.5% 4.5% 0.8% 0.8%

Native Hawaiian and Other Pacific

Islander 0.0% 0.0% 0.0% 0.0%

Some Other Race 0.3% 0.4% 0.4% 0.7%

Two or More Races 0.8% 1.1% 0.9% 1.2%

Hispanic or Latino 1.5% 1.9% 1.3% 1.6%

*Hispanic/Latino residents can be of any race, for example, White Hispanic or Black/African American Hispanic


Page 3

Over 90% of older adults aged 65 and over in Henrico County and Richmond City speak English as their

primary language. This figure is similar to that of the state but is greater than the nation.

Table 3. Language Other than English Spoken at Home, Population 65 Years and Over (2010 - 2014)

United States Virginia

Henrico

County

Richmond

City

Spoken language other than English 14.5% 8.5% 7.9% 3.9%

Speak English less than “very well” 8.5% 4.5% 4.5% 1.9%

Figure 1. Percentage of older adults speaking English less than “very well”

Veteran and Disability Status

Nearly 22% of older adults in Henrico County and 19% in Richmond City are veterans. The percentage in

Richmond City is lower than Henrico County, Virginia (23.3%) and the nation (21.6%). The percentage

of disabled older adults in Richmond City (38.9%) is higher than the percentage in Henrico

County (32.7%), the state (34.2%) and the nation (36.3%). The disabilities that affect older adults

the most in Henrico County are ambulatory disabilities, independent living disabilities, and

hearing disabilities. This is similar in Richmond City in regard to ambulatory disabilities and

independent living disabilities, but cognitive disabilities also affect older adults in this area.

Table 4. Veteran Population, Population 65 Years and Over (2010 - 2014)

United States Virginia Henrico County Richmond City

21.6% 23.3% 21.5% 19.2%

8.5%

4.5%

4.5%

1.9%

0.0% 2.0% 4.0% 6.0% 8.0% 10.0%

U.S.

Virginia

Henrico County

Richmond City


Page 4

Table 5. Disabled Population, Population 65 Years and Over (2010 - 2014)


Henrico

County

Richmond

City

Population with a Disability 36.3% 34.2% 32.7% 38.9%

Hearing Disability 15.0% 13.6% 12.4% 10.1%

Vision Disability 6.7% 6.1% 5.5% 7.5%

Cognitive Disability 9.3% 8.9% 8.0% 10.7%

Ambulatory Disability 23.3% 21.9% 20.7% 27.3%

Self-Care Disability 8.6% 8.3% 9.2% 9.7%

Independent Living Disability 15.7% 15.0% 17.0% 20.3%

Housing Tenure and Value

The majority of older adults in both Henrico County and Richmond City own their residence (75% and

63% respectively). However, the percentage of those older adults that own their residence in Henrico

County is much higher than Richmond City. Owner costs without a mortgage are substantially higher in

Richmond City when compared to Henrico County, the state and the nation. In addition, the percentage

of older adult homeowners spending more than 30% of their income on their mortgage/owner

costs is much higher in Richmond City (37.9%) when compared to Henrico County (24.5%),

Virginia (25.4%) and the nation (27.8%). Thirty-percent of a household’s total income is considered

the cut off for housing-cost burden and avoiding financial hardship.

The median rent in Henrico County is $958, which is notably higher when compared to Richmond City

($777), the state ($848) and the nation ($757). However, a greater percentage of older adult renters in

Richmond City spend 30% or more of their income on rent when compared to older adults in

Henrico County, the state and the nation. Specifically, this figure comprises 60% of older adults in

Richmond City as opposed to 58% in Henrico County, 52% in Virginia, and 55% across the nation.

Table 6. Housing Tenure, Population 65 Years and Over (2010 - 2014)

United States Virginia Henrico

County

Richmond

City

Older Adults Who Own Their Residence 78.5% 81.7% 75.4% 63.2%

Older Adults Who Rent Their Residence 21.5% 18.3% 24.6% 36.8%

Table 7. Housing Value and Costs, Population 65 Years and Over (2010 - 2014)

United

States Virginia

Henrico

County

Richmond

City

Median Home Value $164,900 $217,700 $200,500 $176,400

Median Monthly Owner Costs With a Mortgage $1,295 $1,414 $1,247 $1,281

Median Monthly Owner Costs Without a Mortgage $449 $429 $438 $575

Median Rent $757 $848 $958 $777

Older adults spending more than 30% of income on

mortgage/owner costs 27.8% 25.4% 24.5% 37.9%

Older adults spending more than 30% of income on rent 54.7% 52.4% 58.1% 60.4%


Page 5

Figure 2. Housing costs greater than or equal to 30% of income, 2010 - 2014

Household Status

Households are identified as either family households or non-family households. In Richmond City, 62%

of older adults live in non-family households. This percentage is much higher when compared to older

adults in Henrico County (51%), Virginia (44%), and the nation’s figure of 46%. Furthermore, 59% of

Richmond City older adults living in non-family households live alone. The percentage equates to

nearly 6,000 older adults. In Henrico County, about 49% of older adults live in single-person

households, which is equivalent to nearly 6,500 older adults. Richmond City’s figure is notably

higher when compared to the percentage of older adults who live alone in Henrico County, the state,

and across the nation. However, the percentage in Henrico County is still worse than the state and the

nation as well. Living alone generally entails a higher risk for social isolation and this figure may warrant

attention.

Table 8. Households by Type, Population 65 Years and Over (2010 - 2014)


County

Richmond

City

Family Households 53.9% 55.6% 49.4% 38.5%

Non-family Households 46.1% 44.4% 50.6% 61.5%

Householder Living Alone 43.6% 42.3% 49.1% 59.0%

54.7%

27.8%

52.4%

25.4%

58.1%

24.5%

60.4%

37.9%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0%

Older adults spending ≥

30% of income on rent

Older adults spending ≥

30% of income on

mortgage/owner costs

Richmond City Henrico County Virginia U.S.


Page 6

43.6%

42.3%

49.1%

59.0%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0%

U.S.

Virginia

Henrico County

Richmond City

Figure 3. Percentage of older adults living alone, 2010 - 2014

In regard to marital status, only 33% of older adults in Richmond City are currently married, which is

much less than older adults in Henrico County (49.9%), the state (56.2%), and across the nation (54.6%).

However, nearly 34% of older adults in Richmond City and 30% in Henrico County are widowed. These

figures are comparable to the state and the nation. Notably, Richmond City has a higher percentage of

older adults who were never married compared to older adults in Henrico County, Virginia, and the

nation.

Table 9. Marital Status, Population 65 Years and Over (2010 - 2014)


County

Richmond

City

Now Married, except separated 54.6% 56.2% 49.9% 33.3%

Widowed 27.1% 27.0% 30.2% 33.5%

Divorced 12.2% 11.2% 14.0% 20.0%

Separated 1.2% 1.2% 0.9% 2.8%

Never Married 4.9% 4.2% 5.0% 10.4%

Approximately 5% of older adults in Henrico County and 4% in Richmond City live with 1 or more

grandchildren under 18 years. However, only 1% of these older adults are responsible for grandchildren.

Table 10. Population 65 Years and Over Responsible for Grandchildren Under 18 Years (2010 - 2014)


County

Richmond

City

Living with Grandchild(ren)

5.0% 5.3% 5.1% 3.6%

Responsible for Grandchild(ren) 1.2% 1.3% 1.3% 1.4%


Page 7

Community Perspective

Key Informant Perspective

Key informants were asked to comment on individuals facing life transitions, such as retirement or

moving to a personal care home, and the services available to assist with transitions. The following table

represents the types of transition decisions that individuals in the community face, according to key

informants. The most common transition decisions in the community are providing caregiving

services to aging parents, retiring, and downsizing to smaller home with less home/yard

maintenance.

Table 11. Life Transition Decisions According to Key Informants

Count Percent

Providing caregiving services to aging

parents

57 74.0%

Retiring

47 61.0%

Downsizing to smaller home with less

home/yard maintenance

45 58.4%

Changes in employment status

42 54.5%

Seeking Home & Community-Based Services

to support aging in place

39 50.6%

Moving to Independent Living Community or

Continuing Care Retirement Community

(CCRC)

37 48.1%

Changes in available income

36 46.8%

Receiving Hospice or Palliative Care

33 42.9%

Elderly parents moving into their adult child's

home

31 40.3%

Moving to a Personal Care Home, Assisted

Living Facility, or Nursing Home

29 37.7%

Grief Counseling

20 26.0%

Attending an Adult Daycare

15 19.5%

No/Not Applicable

4 5.2%

Other

3 3.9%

Only 23 key informants or 30.3% felt older adults are able to easily find information on available

services and options related to life transitions. While the majority of key informants seemed to feel

that services and options related to life transitions are available in the community, they seemed to feel

the awareness and knowledge of available services is seriously lacking. Many felt that information about

these services is not easy to find and that older adults may lack the motivation to reach out and seek

the information. Compounding this issue is that there is not enough support and outreach in the


Page 8

community to assist older adults in finding this information either. Along these lines, one key informant

stated, “It seems like given the number of people who are faced with these transitions that there would

be more guidance available. Or more tools for helping to make decisions. I don't think that there is

acknowledgement among the business community that there is an opportunity to provide services

throughout a continuum of needs as people age. It's not really linear, but I believe that the perception is

that it's an ever downward spiral. More general education about aging, retirement, choices to be made,

etc., would be really helpful.”

Other Select Comments Related to Life Transitions

“Each of these services requires significant research, usually online. This can be difficult for

seniors and busy adult children, who may not be living in the same region.”

“I think the silent generation is just that--suffering in silence and social isolation and being

preyed on by family and fraud scams. This population needs greater outreach. I also have

concern for vulnerable elderly is less than adequate care settings--both homes and

institutional settings.”

“In light of the fact that for many older or disabled individuals, the preferred option would

be to remain independent in their own homes with 'wrap-around' services. There is often a

daunting challenge to be faced in trying to find, arrange, and finance available options

among an assortment of provider sources. Coordination of service providers can require

energy and capacity beyond what many of those needing services can consistently muster.

For the majority continuing care settings - while offering in many ways the simpler and

more secure/sustainable solution - are not affordable. More and more of today's seniors are

wary of entering what they fear may tend to be a paternalistic environment; others find no

appeal in living within an age-segregated environment.”

“It seems there are many resources, but they are not well known. Also, some people seem

to need help yet are reluctant to seek or accept it.”

“It would be great to have a comprehensive listing for all of the items listed about in the

Richmond metropolitan area.”

“Most of the information is available online. However, there are a large number of seniors,

in particular, that are intimidated or unaware of the online search capabilities available to

them.”

“There needs to be a single, TRUSTED source of information for seniors. It needs to be

unbiased and safe.”

“This "system" is almost impossible for people to navigate. And most folks wait until a

catastrophic event before educating themselves about available services.”

Creating environments that are truly age-friendly requires action in many sectors including housing,

transportation, health and social services. Most older adults want to age in place. Doing so is possible if

homes are appropriately designed or modified and if a community includes affordable housing options

for varying life stages. On the other hand, frequent, reliable and specialized transportation options need

to be in place to support older adults to manage their day-to-day lives and enhance their quality of life

as they age. With this in mind, key informants were asked to rate the age-friendliness of the community.


Page 9

Housing and Transportation

Key informants first rated statements related to age-friendly housing and transportation. Housing and

transportation statements addressed the availability of affordable housing options, affordable support

services to age in place, public transportation, community transport services, and specialized

transportation services for people with disabilities. Approximately 60% or more of key informants either

“disagreed” or “strongly disagreed” that these services are available in the community. The availability of

affordable housing and public transportation seemed to be of particular concern in the area.

Specifically, 69.5% of key informants stated there are not a variety of appropriate, affordable

housing options available in the area for older people. Additionally, 72.8% felt public

transportation is not available for older people to reach key destinations such as hospitals, health

centers, grocery stores, shopping centers, banks, senior centers, and parks.

Statement Strongly

Disagree Disagree

Neither

Agree nor

Disagree

Agree Strongly

Agree Mean

There are a variety of appropriate,

affordable housing options available in

the area for older people.

16.7% 52.8% 11.1% 18.1% 1.4% 2.3

Affordable support services are available

to enable older people to remain at

home, to “age in place.”

13.9% 51.4% 18.1% 15.3% 1.4% 2.4

Public transportation is available for

older people to reach key destinations

such as hospitals, health centers, grocery

stores, shopping centers, banks, senior

centers, and parks.

42.9% 29.9% 13.0% 14.3% 0.0% 2.0

In areas where public transportation is

limited, community transport services,

including volunteer drivers and shuttle

services, are available to older people.

23.9% 38.0% 23.9% 14.1% 0.0% 2.3

Sufficient specialized transportation

services are available for people with

disabilities.

28.4% 35.1% 24.3% 12.2% 0.0% 2.2

Social and Civic Participation

Key informants then rated statements related to age-friendly social and civic participation opportunities.

Social and civic participation statements addressed the availability of suitable community activities, well-

maintained green spaces and pedestrian-friendly walkways, volunteer opportunities, employment

opportunities, and opportunities for inter-generational activities. Volunteering was the only opportunity

that was positively rated by over half of key informants (55.4%) as being readily available within the

community to older adults. Approximately 51% of key informants either “disagreed” or “strongly

disagreed” that there are a wide variety of community activities available to appeal to a diverse

population of older people. Additionally, over 40% also “disagreed” or “strongly disagreed” that


Page 10

there are flexible employment opportunities for older people and that older people are provided

opportunities to share their knowledge and experiences with other generations. However, notably,

key informants may not be as well informed on the availability of these opportunities as over 30%

selected “neither agree nor disagree.” Accessibility of safe and well-maintained green spaces and

pedestrian-friendly walkways to seniors particularly garnered the lowest rating as nearly 68% of

key informants indicated they “disagreed” or “strongly disagreed” with the statement.

Statement Strongly

Disagree Disagree

Neither

Agree nor

Disagree

Agree Strongly

Agree Mean

A wide variety of community activities is

available to appeal to a diverse population

of older people.

4.2% 46.5% 19.7% 21.1% 8.5% 2.8

Safe and well-maintained green spaces and

pedestrian-friendly walkways are easily

accessible to older people.

20.8% 46.8% 15.6% 15.6% 1.3% 2.3

There are flexible volunteer opportunities

for older people available in the community. 4.1% 14.9% 25.7% 48.6% 6.8% 3.4

There are flexible employment opportunities

for older people available in the community. 19.2% 26.0% 38.4% 15.1% 1.4% 2.5

Older people are provided opportunities to

share their knowledge, history and expertise

with other generations.

13.7% 27.4% 31.5% 27.4% 0.0% 2.7

Community and Health Services

Key informants then rated statements related to the availability of age-friendly community and health

services. Community and health services statements addressed the availability of support services to

promote and maintain health, home care services, community emergency planning, and an effective

communication system. Over 50% of key informants “agreed” or “strongly agreed” that both health and

community support services, as well as home care services, are available in the community. However,

57% said that there is not an effective communication system that reaches residents of all ages in

the community. Another nearly 44% of key informants also “disagreed” or “strongly disagreed” that

community emergency planning takes into account the vulnerabilities and capacities of older people.

Lastly, key informants rated the overall age-friendliness of the community. Only approximately 20% of

key informants “agreed” or “strongly agreed” that the local community is an age-friendly

community overall.


Page 11

Statement Strongly

Disagree Disagree

Neither

Agree nor

Disagree

Agree Strongly

Agree Mean

A range of health and community support

services is offered for promoting and

maintaining health.

6.7% 20.0% 22.7% 48.0% 2.7% 3.2

Home care services are offered that

include health services, personal care, and

housekeeping.

5.5% 12.3% 26.0% 49.3% 6.8% 3.4

Community emergency planning takes

into account the vulnerabilities and

capacities of older people. 6.1% 37.9% 30.3% 25.8% 0.0% 2.8

The community has an effective

communication system that reaches

residents of all ages.

13.7% 43.8% 23.3% 19.2% 0.0% 2.5

Overall, I believe the local community is an

Age-Friendly community. 9.2% 36.8% 34.2% 19.7% 0.0% 2.6

Key informants provided several comments related to what is needed in the community to make it a

better place for older adults. The key themes among the comments were affordable housing and

affordable health/support services, better public transportation system and transportation options,

increased opportunities for socialization and intergenerational activities, and improve walkability.

Additionally, key informants thought increased education is needed of both seniors on available

services as well as the public on the benefit of older adults in the community. Select verbatim comments

are provided below.

Select Comments Related to Improving the Community for Older Adults

“A good public transportation system. Resources are not resources until they are accessible.

It's like having a building with no light bulbs. Transportation is an instant multiplier of

opportunity.

“Affordable housing is the number one issue that leads to many other problems, including

poverty and homelessness. The projects in Richmond have created pockets of poverty and

increased crime and they are not the answer for those with low income. Many older citizens

are living in blighted conditions in our community that are not visible to the general public.

We need to continue the movement that AARP and VCU Gerontology and the AAA

agencies are doing to encourage people to age in place safely and with proper supports in

place.”

“I would like for everyone in our community to realize what a large and diverse cohort of

older persons we have. And, what a resource they are for us! Their wants and needs are as

individual as they are. There is always a lot of attention and passion devoted to supporting

children -- let's recognize that there are older adults here who have contributed to our

neighborhoods, and worked and raised families, who deserve safe, resourceful,

communities they can thrive in.”

“More focus on consumer education of services and who pays for them.”


Page 12

“The issue of transportation continues to be the number one concern of the seniors we have

spoken to. There are a variety of opportunities and organizations that provide

transportation services, but there is a cost for these services - in spite of organizations such

as Senior Connections providing free vouchers for some of these services. The County can

do better with education on this subject, as well as consideration of providing some EMS

services to seniors differently - particularly in the case of seniors calling "911" to receive

their medications.”

“Better options to live outside of age-restricted developments in a broader community with

decent transportation and improved walkability”

“Intergenerational programs and activities to reduce social isolation.”

Senior Living, Life Planning and Senior Needs

Lastly, key informants answered questions pertaining to senior living options, life planning services, and

specific senior needs. First, key informants were asked several questions about senior living options in

the Greater Richmond area regarding need, availability, amount of information, and consumer

understanding. Looking across all topics, key informants seemed most concerned about affordable

housing for seniors and adult day care. Nearly three quarters of key informants felt there is a high level

of need for affordable senior housing in the Richmond area. Unfortunately, an equivalent percentage of

key informants’ also felt affordable senior housing isn’t readily available in the area. Furthermore,

approximately 41% feel there is no information about affordable senior housing and nearly 60% feel

their older adult consumers have a low level of understanding of it. In terms of adult day care, over half

of key informants feel there is only a moderate need for adult day care and that it is moderately

available in the community. However, nearly a quarter of key informants said there is no information

about it and about 50% say their older adult consumers have a limited understanding of it.

Key informants also rated how critical they felt certain life planning services are for the seniors they

serve. These services include medical directives/end of life decisions, transitions through stages of

aging, financial/retirement planning, legal planning, and memorial service and arrangement planning.

With the exception of memorial service and arrangement planning, the majority of key informants felt

that all of the aforementioned life planning services are very critical for seniors. Medical directives and

end of life decisions was the most critical with 89% of key informants feeling this service is very critical.

Although only approximately a third of key informants thought memorial service and arrangement

planning is very critical for seniors, nearly half thought it was at least somewhat critical.

Finally, keeping in mind the whole person, including mind, body, and spirit, key informants were asked

whether they felt certain needs of seniors are being met in the community. These needs included access

to regularly attend worship services, access to spiritual counseling, regular interaction with a supportive

community, spiritual support during crisis or transition, and opportunities to volunteer. As a whole,

approximately 60% of key informants believed all previously mentioned needs were at least somewhat

being met in the community. However, nearly 28% of key informants felt seniors do not have regular

interaction with a supportive community.


Page 13

Older Adult Perspective

In addition to feedback provided by key informants, older adults in the community also completed a

survey in order to provide their perspective. Survey respondents were asked similar, but more pointed,

questions about their community, housing, transportation, community engagement/civic participation,

and the availability of information.

Community and Housing

In terms of community and housing, survey respondents were asked about the importance and

likelihood of remaining in their community and their home as well as the factors that would influence

their decision to move. Over half of respondents (56.8%) felt it was extremely or very important to

remain in their community as they age. When asked about their likelihood to move to a different home

outside of their community, nearly half (49%) of respondents said it was somewhat or very likely that

they would move. However, still approximately a quarter of respondents indicated that it was not likely

that they would move during their retirement years and another 18% said they weren’t sure. According

to survey respondents, the top factors that would influence their decision to move were looking

for a home that will help you live independently, maintaining the outside of your home,

providing peace of mind for themselves and their children, and wanting to live near amenities.

Table 12. Factors Influencing Decision to Move According to Survey Respondents

Count Percent

Looking for a home that will help you live

independently as you age

188 56.8%

Maintaining the outside of your home

(lawn/snow removal, etc.) will be very tiring as

you age

147 44.4%

Provide peace of mind for me and my children

142 42.9%

Wanting to live near the amenities (shopping,

medical facilities, restaurants, parks, etc.) that I

need and want

137 41.4%

Opportunity to socialize with my peers

125 37.8%

Looking for a different home size that meets your

needs

118 35.6%

Maintaining your current home will be too

expensive

101 30.5%

Wanting to move to an area that has better

health care facilities

93 28.1%

Wanting to be closer to family

92 27.8%

Looking for an area that has a lower cost of living

91 27.5%

Needing more access to public transportation

67 20.2%

Wanting to live in a different climate

60 18.1%

Other

11 3.3%


Page 14

Additionally, survey respondents were asked if they have access to certain home repair and seasonal

services, affordable housing options, and accessible features such as no-step entry and wider doorways.

For the most part, respondents felt they have access to services, housing, and accessible features.

However, nearly 51% do not feel they have access to a low-cost or free home repair service in the

community. Additionally, while 47% of respondents felt there are affordable housing options in

the community, nearly 22% weren’t sure. This may indicate a lack of information about housing in

the community.

Table 13. Access to Housing-Related Services According to Survey Respondents

Yes No Not sure

Affordable home repair contractors who are

trustworthy and do quality work 57.6% 27.6% 14.8%

A low-cost or free home repair service 30.3% 50.8% 19.0%

Seasonal services (lawn work or snow

removal) which are affordable 57.2% 27.8% 15.0%

Affordable housing options (such as active

adult communities, assisted living and

communities with meal plans or shared

outdoor spaces)

47.2% 30.9% 21.9%

Features such as no-step entry, wider

doorways, first floor bedroom and bath, grab

bars in bathrooms

51.2% 36.6% 12.2%

Transportation

Respondents also provided their perspective on transportation in the community including access,

challenges, and their personal needs. Survey respondents were asked about their ability to access

several transportation related services and features in the community. Public transportation was of

most concern to respondents as approximately half did not feel it was easy to use or reliable or

that public transportation stops are safe. However, pedestrian safety in the community was split

among respondents. Over 40% of respondents felt there are well-lit, safe streets and intersections as

well as countdown or beeping crosswalks at intersections. However, nearly an equivalent percentage did

not feel these are accessible in the community. Consequently, when asked about the biggest

challenge faced when traveling, nearly half of respondents (49.4%) said that they don’t feel safe

walking where they need to go. This is a serious concern because when respondents were asked what

they do to stay physically active, nearly 80% said walking.


Page 15

Table 14. Access to Transportation-Related Services According to Survey Respondents

Yes No Not Sure

Special transportation for older adults or

individuals with disabilities 47.7% 25.1% 27.2%

Easy-to-read traffic signs 67.2% 24.4% 8.4%

Affordable and easy to use public parking

lots, spaces and areas to park 52.0% 36.4% 11.6%

Well-lit, safe streets and intersections for

pedestrians, bicyclists and drivers 47.6% 43.6% 8.8%

Pedestrian crossing with countdown or

beeping crosswalks 41.7% 45.7% 12.7%

Public transportation that is easy to use and

reliable 37.7% 50.3% 12.0%

Safe public transportation stops or areas 33.8% 50.0% 16.3%

Community Engagement and Civic Participation

Next, respondents discussed community engagement and civic participation. Survey respondents were

asked how often they engage in social interactions, types of social interaction, and what makes them

feel connected to their community. The majority of respondents engage in social/community events

multiple times per week or a few times a month (63.6%). Additionally, respondents appear to

have regular social interactions with their friends, family, or neighbors, as over a third of

respondents (36.8%) said they interact at least once a day or more. Another 39% of respondents

interact several times a week. The top three frequent means of social interaction chosen by

respondents were in-person visits (68.8%), telephone (68.0%), and church or other organizational events

(57%).

Even though respondents seem to have regular social interactions and participate frequently in

community events, they were still asked what would make them feel more connected to the community.

Not surprisingly, 38% of respondents state that they already feel connected to their community.

Regardless, over 41% of respondents felt activities specifically geared towards older adults

(41.9%) and activities and events that are affordable for older adults (48.2%) would help them

feel more connected.


Page 16

Table 15. Connection to the Community According to Survey Respondents

Count Percent

Activities and events that are affordable for

older adults

161 48.2%

Activities specifically geared to older adults

140 41.9%

Conveniently located venues for entertainment

132 39.5%

Opportunities that involve both younger and

older people to socialize together

128 38.3%

I already feel connected to my community

127 38.0%

Continuing education classes

117 35.0%

A variety of cultural activities for diverse

populations

112 33.5%

Social clubs such as for books, gardening, crafts

or hobbies

91 27.2%

Visits or call from community members

60 18.0%

Respondents were also asked their current or future participation in social/community activities,

volunteering, and connection to a worshipping community. Over 60% of respondents said that they

currently participate in family gatherings (66.1%), church activities (62.4%), and going to restaurants

(62.2%). These were the top three activities that respondents currently participate. Notably, while only

36% of respondents currently participate in lifetime learning opportunities, nearly 54% stated

that they would like to participate in these types of opportunities. This was the top activity in which

respondents would like to participate. When asked about volunteering, 61% of respondents

currently volunteer. Only 6% of respondents have no interest in volunteering. Additionally, over

three-quarters of respondents are connected to a worshipping community (76.9%). Nearly 83% rely

on their congregation for spiritual guidance. Over half also rely on their congregation for social

interaction (54.0%) as well as peace of mind (55.5%).


Page 17

Table 16. Participation in Social/Community Events According to Survey Respondents

I currently

participate

I would like to

participate

I have no

interest

Community events (resource fairs,

holiday parties, etc.) 40.0% 41.6% 18.4%

Physical recreation activities, like walking

groups 44.0% 38.1% 17.9%

Church activities 62.4% 22.5% 15.1%

Movies 54.7% 36.6% 8.7%

Family gatherings 66.1% 22.1% 11.7%

Shopping for fun 45.3% 28.6% 26.1%

Live theatre 45.0% 34.6% 20.4%

Concerts/musical performances 50.5% 38.1% 11.4%

Sporting events 34.8% 25.1% 40.1%

Lifetime learning opportunities 36.1% 53.6% 10.4%

Restaurants 62.2% 32.4% 5.4%

Other 61.5% 33.3% 5.1%

Information Source

Lastly, survey respondents provided input on the availability of information in the community.

Respondents were asked several questions related to their primary source of information as well as

access to the internet. According to respondents, the top three sources of information for services,

such as health care, housing, home care, transportation, or social activities, were family or friends

(65.3%), doctor or health care professional (61.7%), and the internet (59.9%).


Page 18

Table 17. Primary Source of Information According to Survey Respondents

Count Percent

Family or friends

218 65.3%

Your doctor or other health care professional

206 61.7%

Internet

200 59.9%

Local senior centers

121 36.2%

Faith-based organizations

110 32.9%

Local Area Agency on Aging (AAA)

109 32.6%

AARP

104 31.1%

Local government offices such as the

Department of Health

82 24.6%

Local non-profit organizations

68 20.4%

Phone book

60 18.0%

Local library

47 14.1%

Other

8 2.4%

The majority of respondents have access to the internet (87.2%). Additionally, 82% of respondents

use their computer mostly at home, while 50% use it on their smart phone/tablet. Over 10% chose

“Other” as a response, and the majority of these respondents specified using the internet at work.

Approximately sixty-two percent of respondents use the internet at least once a day or more.

ECONOMY AND EDUCATION

In this section:

Income and Earnings Employment

Poverty Status Education

Income and Earnings

The following table depicts the percentage of older adult households earning an income and/or

collecting from secondary sources, like Social Security or retirement savings. Henrico County older

adults are slightly more likely to earn an income when compared to older adults in Richmond City

and the nation but comparable to the state. However, the mean earnings are lower among older

adults in Henrico County ($46,239) when compared to their counterparts in Richmond City

($56,134), Virginia ($57,104), and the nation ($50,291). The percentage of older adult households in

both Henrico County and Richmond City with a secondary source of income is generally consistent with

the state and the nation. However, over 11% of older adults in Richmond City rely on Food

Stamp/SNAP Benefits, and this figure is higher when compared to Henrico County, the state and

the nation.


Page 19

Table 18. Household Earnings, Population 65 Years and Over (2010 - 2014)

United

States Virginia

Henrico

County

Richmond

City

Households with Earnings 35.3% 38.4% 38.3% 34.5%

Mean Earnings $50,291 $57,104 $46,239 $56,134

Households with Social Security Income 90.8% 90.1% 91.5% 88.6%

Mean Income $19,195 $19,293 $20,004 $16,552

Households with Supplemental Security Income 6.4% 5.1% 3.8% 7.6%

Mean Income $9,019 $8,726 $10,120 $8,669

Households with Cash Public Assistance Income 1.8% 1.5% 0.9% 1.6%

Mean Income $3,451 $3,054 $3,455 $3,693

Households with Retirement Income 48.3% 54.6% 52.9% 47.0%

Mean Income $24,069 $30,009 $25,034 $25,473

Households with Food Stamp/SNAP Benefits 8.5% 6.9% 4.6% 11.3%

Figure 4. Population 65 years and over mean household earnings, 2010 - 2014

The median household income for older adults is estimated to increase by more than $2,800 in both

Henrico County and Richmond City between 2016 and 2021. Additionally, older adults aged 55 to 64

years in Henrico County will see the highest increase in their median earnings in 2021 by approximately

$4,600. In Richmond City, the highest increase in median earnings occurs with older adults aged 65 to

74 with earnings increasing by approximately $2,700.

$50,291

$57,104

$46,239

$56,134

$0 $10,000 $20,000 $30,000 $40,000 $50,000 $60,000

U.S.

Virginia

Henrico County

Richmond City


Page 20

Table 19. Older Adult Median Household Income Estimates and Projections (2016; 2021)


2016 Estimate 2021 Projection 2016 Estimate 2021 Projection

Householder Age 55 – 64 $70,376 $75,038 $43,657 $45,928

Householder Age 65 – 74 $55,070 $57,838 $47,942 $50,733

Householder Age 75 – 84 $37,075 $38,974 $29,103 $30,563

Householder Age 85 and Over $29,332 $30,435 $20,600 $21,004

Median Household Income $62,674 $65,630 $41,763 $44,624

Poverty Status

In general, older adults across Richmond City are more likely to live in poverty when compared to older

adults across Henrico County, Virginia, and the nation, as determined by the federal poverty level. The

federal poverty level represents the dollar amount below which a household has insufficient income to

meet minimal basic needs. The federal poverty level may also be reported as a percentage. Households

that are below 100% of the poverty level have an income less than the amount deemed necessary to

sustain basic needs. Households at 100% to 149% of the poverty level have an income 1.0 to 1.49 times

the necessary amount. In Richmond City, approximately 15% of older adults have an income below

100% of the federal poverty level and another 13% have an income 1.0 to 1.49 times the federal

poverty level. The combined percentage equates to nearly 6,500 older adults.

Table 20. Poverty Status in the Past 12 Months, Population 65 Years and Over (2010 - 2014)

United

States Virginia

Henrico

County

Richmond

City

Population Below 100% of the Poverty Level 9.4% 7.6% 6.2% 15.1%

Population At 100% to 149% of the Poverty Level 10.9% 9.4% 8.5% 13.2%

Population At or Above 150% of the Poverty Level 79.7% 82.9% 85.2% 71.7%

Figure 5. Older adult population receiving food stamp/SNAP benefits by poverty status, 2010 - 2014

9.4%

7.6% 6.2%

15.1%

8.5%

6.9%

4.6%

11.3%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

U.S. Virginia Henrico County Richmond City

Population living below 100% poverty level

Households receiving food stamps/SNAP benefits


Page 21

Employment

The following table depicts the employment status of older adults in Henrico County and Richmond

City. Among older adults who are actively seeking employment, Richmond City has a higher

unemployment rate for older adults aged 55 to 64 years (6%) and aged 65 to 74 years (5%) when

compared to Henrico County and the state but similar or better than the nation.

Table 21. Employment Status, Population 55 Years and Over (2010 – 2014)


County

Richmond

City

Age 55 to 64 Years in Labor Force 64.3% 67.1% 70.6% 61.8%

Unemployed Civilian Labor Force 6.6% 4.5% 3.9% 6.0%

Age 65 to 74 Years in Labor Force 25.3% 27.6% 30.7% 28.9%


Age 75 Years and Over In Labor Force 6.0% 6.5% 5.6% 6.5%


Education

The percentage of Henrico County older adults with a high school diploma is notably higher when

compared to older adults across Richmond City, Virginia, and the nation. However, the

percentage of older adults with a bachelor’s degree or higher is similar in Henrico County and

Richmond City. Both percentages are higher than the state and the nation. Specifically, about 83%

of older adults residing in Henrico County and 75% in Richmond City have at least a high school degree,

whereas around 28% of older adults in both areas have a bachelor’s degree or higher.

Table 22. Educational Attainment, Population 65 Years and Over (2010 – 2014)


County

Richmond

City

High school graduate or higher 79.9% 78.6% 82.8% 74.8%

Bachelor’s degree or higher 23.2% 27.0% 28.4% 28.6%


Page 22

Figure 6. Educational attainment, Population 65 years and over, 2010 - 2014

HEALTH CARE ACCESS

In this section:

Health Insurance Coverage Community Perspective

Health Care Provider Access

Health Insurance Coverage

Henrico County older adults are slightly more likely to be uninsured (0.6%) when compared to

Richmond City older adults (0.4%), but less likely to be uninsured when compared to the state and

the nation (both 1%). The percentage of uninsured disabled older adults in both Henrico County and

Richmond City are generally low, and the figures are both less than the state and the nation.

Table 23. Uninsured Population Aged 65 Years and Over (2010 - 2014)


1.0% 1.0% 0.6% 0.4%

Table 24. Health Insurance Coverage by Disability Status, Population 65 Years and Over (2010 - 2014)


County

Richmond

City

Population 65 Years and Over With a Disability 36.3% 34.2% 32.7% 38.9%

With Health Insurance 99.3% 99.2% 99.6% 99.7%

Without Health Insurance 0.7% 0.8% 0.4% 0.3%

79.9%

23.2%

78.6%

27.0%

82.8%

28.4%

74.8%

28.6%

0.0% 20.0% 40.0% 60.0% 80.0%

Percent high school

graduate or higher

Percent bachelor's

degree or higher



Page 23

Health Care Provider Access

Health care provider density or the provider to population ratio is a measure of overall health care

access. In Richmond City, the ratio of primary care providers to residents and dentists to residents

is substantially better than Henrico County, the state and the National Benchmark. The ratio of

mental health providers to residents is also better in Richmond City when compared to Henrico County

and the state and closely mirrors the National Benchmark. In general, provider to population ratio is

better or within reach in both Henrico County and Richmond City when compared to the National

Benchmark. The National Benchmark represents the 90th percentile, i.e., only 10% of locations are better.

Table 25. Health Care Provider Density (2016)

National Benchmark

(90th

Percentile) Virginia

Henrico

County

Richmond

City

Physician to Population Ratio 1,040:1 1,330:1 1,020:1 990:1

Dentist to Population Ratio 1,340:1 1,570:1 1,450:1 790:1

Mental Health Providers to

Population Ratio 370:1 680:1 410:1 370:1

The following tables depict the ability of older adults to afford health care when needed and receive

routine checkups. Approximately 13% of older adults in Richmond City consider cost a barrier to

seeing a doctor, which is higher than Henrico County, Virginia, and the nation. Additionally, older

adults in Richmond City are more likely to have received a routine checkup in the past year when

compared to older adults across Henrico County, the state, and the nation.

Table 26. Population 55 Years and Over Unable to See a Doctor Due to Cost (2013 - 2014)


9.0% 8.7% 8.4% 12.6%

Table 27. Population 55 Years and Over Receiving a Routine Checkup in the Past Year (2013 - 2014)


County

Richmond

City

Within the past year (anytime less than 12

months ago) 82.5% 85.5% 84.1% 86.7%

Community Perspective

Key Informant Perspective

Key informants were asked to identify the most significant barriers that keep seniors/elderly in the

community from accessing health care when they need it. The inability to navigate the health care

system was identified as the top barrier to seniors/elderly accessing health care. Additional barriers

to older adults accessing health care included inability to pay out of pocket expenses such as co-pays

and prescriptions as well as lack of transportation. The “other” responses included fear of going into the

hospital and never coming home, hesitancy to ask for help or have people in their home, and

recognizing that they need care.


Page 24

Table 28. Most Significant Barriers Accessing Health Care According to Key Informants

Count Percent

Inability to Navigate Health Care System

63 81.8%

Inability to Pay Out of Pocket Expenses (Co-

pays, Prescriptions, etc.)

58 75.3%

Lack of Transportation

57 74.0%

Availability of Providers/Appointments

35 45.5%

Lack of Providers accepting

Medicare/Medicaid

32 41.6%

Lack of Trust

26 33.8%

Time Limitations (Long Wait Times, Limited

Office Hours, Time off Work)

23 29.9%

Lack of Health Insurance Coverage

23 29.9%

Language/Cultural Barriers

22 28.6%

Basic Needs Not Met (Food/Shelter)

21 27.3%

Other

4 5.2%

None/No Barriers

2 2.6%

Key informants were then asked to identify health-related resources or services that are missing or

lacking in the community to support seniors/elderly. The top resources or services identified as

missing or lacking in the community are free/low cost dental care, geriatricians/gerontologists,

free/low cost vision care, and memory care specialists. The “other” responses included caregiver

supports and education, coordination of care/review of meds when multiple specialists are involved,

and good habit building.


Page 25

Table 29. Missing Health-Related Resources/Services According to Key Informants

Count Percent

Free/Low Cost Dental Care

49 63.6%

Geriatricians/Gerontologists

48 62.3%

Free/Low Cost Vision Care

45 58.4%

Memory Care Specialists

40 51.9%

Health Education/Information/Outreach

39 50.6%

Mental Health/Behavioral Health/Substance

Abuse Services

38 49.4%

Free/Low Cost Medical Care

37 48.1%

Prescription Assistance

33 42.9%

Health Screenings

21 27.3%

Primary Care Providers

14 18.2%

Immunization/Vaccination Programs

13 16.9%

Other

6 7.8%

Medical Specialists (Cardiologist,

Dermatologist, Neurologist)

5 6.5%

None

4 5.2%

Older Adult Perspective

Like the key informants, survey respondents were also asked about the barriers they encounter

accessing health care as well as the health care services that are available and accessible in the

community. Nearly 47% of respondents stated that they do not encounter any barriers when trying to

access health care. However, for those respondents that do experience barriers, the top barriers selected

are similar to the responses given by key informants. Difficulty understanding/navigating the health care

system and inability to afford medical bills or medication/prescriptions topped the list with

approximately 31% and 23% of respondents selecting these barriers respectively. Additionally, 21% of

respondents said they had difficulty getting a ride to appointments.


Page 26

Table 30. Most Significant Barriers Accessing Health Care According to Survey Respondents

Count Percent

None/No Barriers

154 46.8%

Difficulty understanding/navigating the

health care system

101 30.7%

You can’t afford your medical bills or

medications/prescriptions

75 22.8%

Cannot get a ride to appointments

68 20.7%

You can’t afford your insurance co-pays

56 17.0%

You can't get an appointment

56 17.0%

Not enough time

47 14.3%

Lack of health insurance coverage

43 13.1%

You can't find a primary care physician

30 9.1%

Language/Cultural issues

21 6.4%

Other

11 3.3%

Key informants felt free low/cost dental and vision care as well as geriatricians/gerontologists were the

top health care services lacking in the community. However, when survey respondents were asked what

health care services are available in the community, home health and home care services received the

lowest percentage of responses. Only about a third of respondents said they had access to affordable,

well-trained, certified home health care providers (33.4%) and home care services including health,

personal care and housekeeping (35.9%). Additionally, only 41% feel they have access to affordable

medical equipment.

OLDER ADULT HEALTH INDICATORS

In this section:

General Health Status: Physical & Mental Substance Abuse

Body Mass Index

Nutrition

Vaccinations

Smoking

General Health Status

General self-rated health status provides a strong predictive measure for overall health outcomes.

Richmond City older adults are less likely to report fair or poor health when compared to older

adults in Henrico County, Virginia, and the nation. Compared to older adults across the nation,

older adults in both Henrico County and Richmond City are less likely to report poor or fair

health. Twenty percent of Richmond City older adults report fair or poor health compared to 21% of

older adults in Henrico County.


Page 27

Table 31. Population 55 Years and Over Reporting Fair or Poor Overall Health (2013 - 2014)


25.4% 24.2% 21.4% 20.2%

Figure 7. Population 55 years and over reporting fair or poor health, 2013 - 2014

Adults in poor physical or mental health are defined as having reported 14 or more days for which their

mental or physical health was “not good” within the past 30 days. Contrary to the self-rated general

health status finding noted in the previous section, 19% of Henrico County older adults report

experiencing 14 or more days of poor physical health and 9% experienced 14 or more days of

poor mental health in the previous month. The physical health rates are higher when compared to

the rates for Richmond City, the state, and the nation. The mental health rates are also higher than the

rates for Richmond City and the state, but are equitable to the nation.

Table 32. Population 55 Years and Over with Poor Physical and Mental Health

Days in the Past Month (2013 - 2014)

Poor Physical Health Days United States Virginia Henrico County Richmond City

1 – 13 days 21.4% 20.0% 22.2% 21.5%

14 – 30 days 16.9% 16.4% 19.1% 16.6%

Poor Mental Health Days

1 – 13 days 16.1% 13.5% 19.0% 15.3%

14 – 30 days 9.5% 8.4% 9.2% 8.1%

The likelihood of being diagnosed with a depressive disorder increases as one experiences more

physical or mental health days. Twenty-two percent of older adults in Henrico County have been

7.8%

17.6%

7.9%

16.3%

6.2%

15.2%

4.3%

15.9%

0.0% 5.0% 10.0% 15.0% 20.0%

Poor Health

Fair Health



Page 28

diagnosed with a depressive disorder. This figure is much higher when compared to the rates of

Richmond City, the state and the nation.

Table 33. Mental Health Status of Population 55 Years and Over (2013 - 2014)


Population Diagnosed with a

Depressive Disorder 18.0% 16.4% 22.0% 15.2%

The combination of poor physical and mental health can often inhibit daily activity. Twenty-seven

percent of Richmond City older adults report having activity limitations due to poor physical or

mental health. This percentage is similar to the figures in Henrico County and Virginia, but lower when

compared to the nation.

Figure 8. Limitations in activity due to poor physical or mental health, 2013 - 2014

Food Environment

The ability to maintain a healthy weight through diet and physical activity is influenced by both

behavioral and environmental indicators. Environmental indicators include, but are not limited to, access

to healthy foods and access to exercise opportunities.

The food environment index measures overall food access based on 2 indicators, limited access to

healthy foods and food insecurity. The index is based on a score of 0 (worst) to 10 (best). The first factor,

limited access to healthy foods, measures the proportion of the population that is low income and does

not live close to a grocery store. The second factor, food insecurity, measures the percentage of the

population that did not have access to a reliable source of food during the past year. The food

environment index in Richmond City (5.8) is much worse when compared to the index in Henrico

County (7.9), Virginia (8.3), and the National Benchmark of 8.3.

21.0% 21.3% 23.5%

18.4%

29.8% 27.0% 26.5% 27.3%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

U.S. Virginia Henrico County Richmond City

14 or More Poor Physical or Mental Health Days

Activity Limitations Due to Poor Physical or Mental Health


Page 29

Table 34. Food Environment Index (2016)

National Benchmark

(90th

Percentile) Virginia Henrico County Richmond City

8.3 8.3 7.9 5.8

Grocery Store Access

Access to grocery stores can have a profound influence on the overall health of a community. The

United States Department of Agriculture (USDA) defines grocery stores as supermarkets and smaller

grocery stores primarily engaged in retailing a general line of food, such as canned and frozen foods,

fresh fruits and vegetables, fresh and prepared meats, fish, and poultry. Grocery store access provides a

measure of healthy food access and environmental influences on dietary behaviors. Grocery store

access rates per 100,000 are much higher in Richmond City when compared to the rates in

Henrico County, Virginia, and across the nation.

Figure 9. Grocery store access per 100,000, 2014

A community’s health and overall quality of life is also affected by access to exercise opportunities. The

measure is based on the proportion of residents who live reasonably close to a physical activity location.

Physical activity locations may include parks (local, state, and national) or facilities identified by the

NAICS code 713940 (gyms, community centers, YMCAs, pools, etc.). The percentage of residents who

have access to exercise opportunities is higher in Henrico County (94%) when compared,

Richmond City (88%), the state (81%) and the National Benchmark of 91%. The high percentage of

residents with access to exercise opportunities did not necessarily translate into a substantial

percentage of older adults who exercise. Specifically, 71% of older adults in Henrico County

reported exercising in the past month compared to 74% in Richmond City. However, both of these

percentages are still higher than the state and nation.

21.1

18.7

20.5

29.4

5.0 10.0 15.0 20.0 25.0 30.0

U.S.

Virginia

Henrico County

Richmond City


Page 30

Table 35. Access to Exercise Opportunities (2016)

National Benchmark

(90th


91% 81% 94% 88%

Table 36. Population 55 and Over that Exercised in the Past Month (2013 - 2014)


69.6% 69.0% 70.8% 74.0%

Body Mass Index

Body Mass Index (BMI) is a factor of diet and physical activity and is correlated with chronic health

conditions. It is calculated based on the height and weight of an individual. The following table depicts

the percentage of older adults who are overweight or obese. The percentage of older adults who are

overweight or obese is 69% across Richmond City, Henrico County, the state, and the nation.

Table 37. Overweight or Obese, Population 55 Years and Over (2013 - 2014)


68.8% 69.0% 68.6% 69.0%

Figure 10. Overweight or obese older adult population, 2013 - 2014

Smoking

Smoking is detrimental to nearly every organ in the body and is often correlated with poorer health

outcomes and chronic health conditions such as lung cancer, stroke and heart disease. Richmond City

and Henrico County older adults are much more likely to currently smoke when compared to

68.8%

69.0%

68.6%

69.0%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0%

U.S.

Virginia

Henrico County

Richmond City


Page 31

older adults in the state and the nation. Nearly 23% of older adults in Richmond City currently smoke

compared to 18% in Henrico County, 14% in Virginia and 13% across the nation.

Table 38. Smoking Status, Population 55 Years and Over (2013 - 2014)


Current Smoker (Every day or

Some days) 12.9% 14.1% 17.7% 22.6%

Former Smoker 37.8% 36.3% 32.6% 29.6%

Substance Abuse

Binge drinking is defined as males having 5 or more alcoholic drinks and females having 4 or more

drinks on 1 occasion. Heavy drinking is defined as males having more than 2 alcoholic drinks and

females having more than 1 drink per day. About 6% of older adults across the state, Henrico County

and Richmond City participate in binge drinking, which is less than the nation’s figure of 7.4%. In

Richmond City, 5% of older adults are heavy or chronic drinkers. This figure is higher when

compared to Henrico County and Virginia, but comparable to the nation.

Table 39. Binge or Heavy Alcohol Consumption, Population 55 Years and Over (2013 - 2014)


Binge Drinkers 7.4% 6.1% 6.3% 6.6%

Heavy or Chronic Drinkers 4.8% 4.3% 3.1% 5.2%

Vaccinations

The flu vaccine is recommended as an annual prevention measure, particularly for older adults. Henrico

County older adults are slightly more likely to receive a flu vaccine when compared to their

counterparts in Richmond City (56.2%), the state (56.5%) and the nation (53%).

Table 40. Population 55 Years and Over Receiving a Seasonal Flu Vaccine in the Past Year (2013 - 2014)


53.2% 56.5% 58.6% 56.2%

The pneumonia vaccine is typically recommended for older adults as a means to prevent more serious

illness. Older adults in Henrico County, Richmond City, and Virginia more likely to receive a

Pneumonia vaccine in their lifetime (between 52% and 53%) when compared to older adults

across the nation.

Table 41. Population 55 Years and Over that Has Ever Had a Pneumonia Vaccine (2013 - 2014)


50.7% 52.4% 52.9% 53.5%


Page 32

CHRONIC CONDITIONS

In this section:

Arthritis

Cancer

Diabetes

Heart Disease

Respiratory Disease

Asthma

Arthritis

Arthritis is defined as inflammation of the joints. In Henrico County, 45% of older adults have been

diagnosed with arthritis. The percentage of arthritis patients is higher than Richmond City but less

than the state and nation.

Table 42. Population 55 Years and Over Diagnosed with Arthritis (2013 - 2014)


47.0% 48.1% 44.6% 41.0%

Cancer

The overall cancer incidence rate in Richmond City is higher when compared to Henrico County,

Virginia, and the nation. However, Richmond City and Henrico County are burdened by different cancer

types. Richmond City has a substantially higher cancer incidence rate for colon and rectal, lung

and bronchus, and prostate cancer; whereas in Henrico County, the incidence rates for breast

cancer and melanoma of the skin are higher when compared to Richmond City, the state and the

nation. Both Richmond City and Henrico County have lower pancreas cancer incidence rates than the

state and the nation.

Table 43. Older Adults Ages 65+ Cancer Incidence Rates per Age-Adjusted 100,000 by Site (2009 - 2013)


Henrico

County

Richmond

City

Breast, Female 419.7 421.9 431.9 410.3

Colon and Rectum 199.3 181.5 200.7 221.8

Lung and Bronchus 356.6 354.3 327.5 432.1

Melanoma of the Skin 77.6 75.8 100.0 60.5

Pancreas 76.5 75.5 64.6 67.0

Prostate 621.8 567.7 609.4 711.9

Total Cancer Incidence 2002.1 1900.0 1901.0 2046.7


Page 33

Figure 11. Total cancer incidence rate among older adults ages 65 and over, 2009 - 2013

Cancer screenings are important for the early detection and treatment of cancer. For women, clinical

breast exams, mammograms, and Pap smears are recommended. In general, older adult women in

Richmond City are slightly less likely to have ever received breast cancer screening exams and

mammograms when compared to older adult women in Henrico County, the state, and the nation.

However, Richmond City older adult women are more likely to have received a breast exam as

well as a mammogram within the past two years. In particular, 84% of Richmond City older adult

women had a breast exam in the past 2 years and 89% of older adult women had a mammogram in the

past 2 years.

Table 44. Breast Cancer Screening among Population 55 Years and Over (2013 - 2014)

Breast Exam United States Virginia* Henrico County* Richmond City*

Ever 91.0% 89.9% 88.8% 86.5%

In the Past 2 Years 78.3% 81.2% 81.4% 84.3%

Mammogram

Ever 96.0% 95.4% 97.7% 94.6%

In the Past 2 Years 78.8% 80.9% 71.7% 88.9%

*Data only available for 2014

Again, older adult women in Richmond City are less likely to have ever received a Pap Test when

compared to Henrico County, the state, and the nation. However, they are more likely to have

received a Pap Test within the past 2 years. Nearly 91% of older adult women in Richmond City have

ever received a Pap Test and approximately 69% have received one within the past 2 years.

2,002.1

1,900.0

1,901.0

2,046.7

1,000 1,200 1,400 1,600 1,800 2,000

U.S.

Virginia

Henrico County

Richmond City


Page 34

Table 45. Cervical Cancer Screening among Population 55 Years and Over (2013 - 2014)

Pap Test United States Virginia* Henrico County* Richmond City*

Ever 95.4% 95.5% 97.1% 90.8%

In the Past 2 Years 51.7% 58.1% 64.0% 69.4%


Prostate-Specific Antigen (PSA) tests are recommended for men to detect prostate cancer. Older adult

men in Richmond City are much more likely than older adult men in Henrico County, across

Virginia and the nation to ever receive PSA tests. Eighty-six percent of men in Richmond City had a

PSA test in their lifetime compared to 75% in Henrico County and across Virginia and 73% across the

nation.

Table 46. Prostate Cancer Screening among Population 55 Years and Over (2013 - 2014)

PSA Test United States Virginia* Henrico County* Richmond City*

Ever 72.7% 74.5% 74.7% 86.3%

In the Past 2 Years 79.3% 82.0% 82.7% 79.7%


Sigmoidoscopies/Colonoscopies are used to detect the presence of colorectal cancer. In general,

Richmond City older adults are slightly more likely than older adults in Henrico County, Virginia

and across the nation to receive a sigmoidoscopy or colonoscopy screening in their lifetime.

Table 47. Colorectal Cancer Screening among Population 55 Years and Over (2013 - 2014)

Sigmoidoscopy/

Colonoscopy United States Virginia* Henrico County* Richmond City*

Ever 74.8% 76.2% 75.5% 79.4%

In the Past 2 Years 38.0% 38.7% 36.2% 44.4%


Diabetes

Diabetes is caused either by the body’s inability to produce insulin or effectively use the insulin that is

produced. Richmond City older adults are slightly more likely to be diagnosed with diabetes (23%)

when compared to older adults in Henrico County (20%), across Virginia (19%) and the nation

(20%).

Table 48. Older Adults Diagnosed with Diabetes, Excluding Gestational Diabetes (2013 - 2014)


20.2% 19.3% 19.5% 22.9%


Page 35

Heart Disease

In general, Henrico County older adults are more likely to have heart disease when compared to

older adults in Richmond City, the state, and the nation. In particular, 11% of Henrico County older

adults have been diagnosed with heart attack, 12% with angina or coronary heart disease, and 7% with

stroke.

Table 49. Population 55 Years and Over Diagnosed with Heart Disease (2013 - 2014)


Heart Attack 9.5% 9.0% 10.6% 6.5%

Angina or Coronary Heart Disease 9.7% 9.2% 12.3% 9.7%

Stroke 6.1% 5.8% 7.3% 4.8%

Figure 12. Heart Disease among older adults ages 55 years and over, 2013 - 2014

Respiratory Disease

Air pollution is often associated with higher rates of respiratory diseases like asthma and COPD. Fine

particulate matter is a form of air pollution and is a measure of the overall outdoor air quality. It is

measured as an average daily amount in micrograms per cubic meter. The National Benchmark for daily

fine particulate matter is 9.5. The particulate matter is much higher across Richmond City (12.4), Henrico

County (12.4) and the state (12.7) when compared to the National Benchmark. Another measure of air

quality is the frequency of high ozone days. According to the American Lung Association, Henrico

County received a “D” grade for a weighted average of 3.2 ozone days per year. Data was not

collected in Richmond City. The grading system is based on a weighted grading system of A to F.

Weighted averages are calculated based on the number of poor air quality days and the severity of

pollution present.

6.1%

9.7%

9.5%

5.8%

9.2%

9.0%

7.3%

12.3%

10.6%

4.8%

9.7%

6.5%

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0%

Stroke

Coronary Heart

Disease

Heart Attack



Page 36

Table 50. Daily Fine Particulate Matter (2016)

National Benchmark

(90th


9.5 12.7 12.4 12.4

Asthma

Asthma is reported as the percentage of individuals who have ever had asthma (lifetime diagnosis) and

the percentage of individuals who currently have asthma. Richmond City older adults are more likely

to ever be diagnosed with asthma as well as still have the condition if diagnosed when compared

to Henrico County, Virginia, and the nation. Specifically, 20% of Richmond City older adults have

been diagnosed with asthma compared to 11% in Henrico County, 12% across the state and 13%

nationwide. About 14% of older adults in Richmond City have also been diagnosed with COPD,

which is higher when compared to COPD diagnosis rates for older adults in Henrico County, the

state, and the nation.

Table 51. Population 55 Years and Over Diagnosed with Asthma (2013 - 2014)


Ever diagnosed with Asthma 12.5% 11.9% 11.2% 20.1%

Still have Asthma 73.0% 76.3% 64.4% 83.1%

Table 52. Population 55 Years and Over Diagnosed with COPD (2013 - 2014)


11.2% 11.5% 7.5% 13.7%

MORTALITY

In this section:

Overall Mortality and Premature Death Cancer Mortality

Leading Causes of Mortality

Overall Mortality and Premature Death

The following table depicts the overall mortality rate for older adults. Richmond City has a much

higher death rate for older adults in the “55 – 64” age category as well as a slightly higher death

rate in the “65 years and over” age category when compared to Henrico County, Virginia, and the

nation. The data corresponds to the higher number of premature deaths that is reported in Richmond

City when compared to Henrico County, the state, and the National Benchmark (Table 54).


Page 37

Table 53. Multiple Cause of Death Rate per 100,000 (2014)


Deaths Death

Rate Deaths

Death

Rate Deaths

Death

Rate Deaths

Death

Rate

Population Age 55 – 64* 348,808 870.3 8,597 826.3 299 740.4 346 1,316.4

Population Age 65 and

Over 1,922,271 4,198.0 46,424 4,266.0 2,034 4,385.6 1,153 4,525.8

*Crude rate provided since rate only includes one age category.

Figure 13. Mortality rate among population 55 years and over, 2014

Table 54. Premature Mortality: Years of Potential Life Lost Before Age 75 per 100,000 (2016)

National Benchmark

(90th


5,200 6,100 5,700 9,700

Leading Causes of Mortality

The following table depicts age-adjusted mortality rates for the 8 leading causes of death in the nation.

Richmond City has a higher mortality rate for heart disease and stroke when compared to Henrico

County, the state, and the nation. However, older adults in Henrico County are far more likely to

die from Alzheimer’s disease and influenza and pneumonia compared to their counterparts in

Richmond City, Virginia, and the nation. Other mortality rates are comparable to the state and

nation.

4,198.0

870.3

4,266.0

826.3

4,385.6

740.4

4,525.8

1,316.4

400.0 1,400.0 2,400.0 3,400.0 4,400.0

65 years and over

55 - 64 years



Page 38

Table 55. Population 65 and Over Mortality Rate per 100,000 by Leading Cause of Death (2014)


County

Richmond

City

Heart Disease 1,062.1 993.6 961.6 1109.8

Cancer 915.0 921.8 987 949.7

Chronic Lower Respiratory Disease

(CLRD) 276.6 245 272.7 264

Stroke 247.3 257.4 262.9 318.6

Alzheimer’s Disease 199.6 163.2 221.3 169.7

Accidents 105.0 111.7 93.7 Unreliable

Diabetes 119.3 104.2 94.4 104.4

Influenza and Pneumonia 97.1 113.1 154.8 73

Cancer Mortality

The 5 deadliest types of cancer nationally, in ranking order, are lung and bronchial cancer, colon and

rectal cancer, breast cancer, pancreatic cancer, and prostate cancer. The following table depicts

mortality rates for each of these types for older adults ages 65 and over in Henrico County and

Richmond City. The overall cancer mortality rate in Richmond City and Henrico County are higher

than both the state and nation. With the exception of breast cancer, Richmond City has a higher

mortality rate than Henrico County, the state, and the nation for all reported cancer types.

However, Henrico County does have a slightly higher breast cancer mortality rate than Richmond City.

Table 56. Older Adults ages 65 and Over Cancer Mortality per 100,000 by Site (2009 - 2013)


Henrico

County

Richmond

City

Breast, Female 97.4 99.9 126.4 106.4

Colon and Rectum 85.8 82.4 84.3 113.5

Lung and Bronchus 275.5 283.4 284.7 325.2

Pancreatic 64.5 64.4 59.3 71.0

Prostate 151.7 164.6 145.0 199.7

All Cancer Sites Mortality Rate 963.3 979.4 986.8 1,099.10


Page 39

Figure 14. Cancer mortality rate among population 65 years and over, 2014

MEDICARE FEE-FOR-SERVICE BENEFICIARIES

In this section:

Common Chronic Conditions Emergency Department Visits and Per

Presence of Multiple Chronic Conditions

Hospital Readmissions

Capita Costs

Preventable Hospitalizations

Common Chronic Conditions

The following table depicts the percentage of Medicare beneficiaries aged 65 years and over affected by

chronic conditions. The percentage of Medicare beneficiaries in Henrico County with a given

chronic condition is generally higher when compared to Richmond City, Virginia, and the nation.

However, Alzheimer’s disease/dementia and asthma appear to be more prevalent among older adults in

Richmond City when compared to their peers in Henrico County, the state, and across the nation.

963.3

979.4

986.8

1,099.1

500 600 700 800 900 1,000 1,100

U.S.

Virginia

Henrico County

Richmond City


Page 40

Table 57. Chronic Conditions among Medicare Beneficiaries 65 Years and Over (2014)


County

Richmond

City

Alzheimer’s Disease/Dementia 11.5% 10.4% 11.8% 11.9%

Arthritis 30.7% 29.2% 31.5% 29.1%

Asthma 4.5% 4.6% 4.7% 5.0%

Atrial Fibrillation 9.3% 8.9% 9.7% 7.8%

COPD 11.0% 9.5% 9.3% 8.4%

Cancer 8.9% 8.9% 10.4% 9.2%

Chronic Kidney Disease 17.3% 16.2% 16.0% 17.2%

Depression 13.6% 12.6% 14.0% 13.2%

Diabetes 27.1% 26.7% 25.0% 26.7%

Heart Failure 14.6% 12.0% 12.2% 12.6%

Hyperlipidemia 47.9% 50.5% 50.3% 43.9%

Hypertension 58.4% 59.5% 60.2% 58.7%

Ischemic Heart Disease 29.3% 24.8% 27.2% 24.5%

Osteoporosis 6.7% 5.9% 7.3% 5.6%

Schizophrenia/Other Psychotic

Disorders 2.6% 2.0% 1.9% 2.4%

Stroke 4.0% 3.7% 4.6% 4.0%

Note: Bold font indicates the percentage is higher when compared to the county, state, and nation.

Presence of Multiple Chronic Conditions

In general, Henrico County Medicare beneficiaries aged 65 years and over are more likely to have

4 or more chronic conditions when compared to older adults in Richmond City and the state but

are similar to the nation. However, Henrico County has a lower percentage for 0 to 1 multiple chronic

conditions when compared to Richmond City, Virginia, and the nation.

Table 58. Chronic Conditions per 100,000 Medicare Beneficiaries 65 Years and Over (2014)


County

Richmond

City

0 – 1 Chronic Condition 32.1% 31.9% 30.1% 34.2%

2 – 3 Chronic Conditions 30.6% 33.3% 33.5% 31.2%


6 or More Chronic Conditions 15.4% 13.0% 13.9% 13.3%


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Figure 15. Chronic conditions among Medicare beneficiary population, 2014

Hospital Readmissions

The percentage of hospital readmissions for Richmond City Medicare beneficiaries ranges from 7% for

residents with 2 to 3 chronic conditions to 24% for residents with 6 or more chronic conditions.

Hospital readmission percentages are generally higher in Richmond City when compared to

Henrico County, the state and the nation, with the exception of the percentage for beneficiaries

with 2-3 chronic conditions, which is similar across all four locations.

Table 59. Hospital Readmissions for Chronic Conditions 65 Years and Over (2014)


County

Richmond

City

0 – 1 Chronic Condition 5.8% 6.3% * *



6 or More Chronic Conditions 21.7% 22.3% 21.7% 23.6%

* Data suppressed because there are fewer than 11 Medicare beneficiaries in the cell.

Emergency Department Visits and Per Capita Cost

With the exception of Medicare beneficiaries with 0 to 1 chronic condition, the rate of Emergency

Department visits for Medicare beneficiaries in Richmond City is notably higher when compared

to Henrico County, the state and the nation. In Richmond City, Emergency Department rates per

1,000 beneficiaries range from 112.2 for residents with 0 or 1 chronic condition to 2,044.3 for residents

with 6 or more chronic conditions. However, the per capita cost for chronic conditions in Richmond City

is lower or comparable to the cost in Henrico County, Virginia, and the nation with the exception of

beneficiaries with 6 or more chronic conditions in which the cost is slightly higher. The highest per

15.4%

21.9%

30.6%

13.0%

21.8%

33.3%

13.9%

22.5%

33.5%

13.3%

21.4%

31.2%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0%

6 or more conditions

4 - 5 conditions

2 - 3 conditions



Page 42

capita cost in Henrico County is among beneficiaries with 6 or more chronic conditions and

equates to approximately $32,103.

Table 60. Emergency Department Visits for Chronic Conditions per 1,000 Beneficiaries 65 Years and Over

(2014)


County

Richmond

City

0 – 1 Chronic Condition 117.5 116.9 115.2 112.1

2 – 3 Chronic Conditions 318.7 318.6 306.2 359.0

4 – 5 Chronic Conditions 647.3 691.3 654.2 748.4

6 or More Chronic Conditions 1,767.5 1,938.1 1,796.6 2,044.3

Table 61. Per Capita Cost for Chronic Conditions 65 Years and Over (2014)


County

Richmond

City

0 – 1 Chronic Condition $1,698.9 $1,639.9 $1,881.3 $1,561.4

2 – 3 Chronic Conditions $5,206.8 $4,723.2 $4,986.0 $4,992.0

4 – 5 Chronic Conditions $10,880.5 $10,184.1 $11,025.2 $11,052.1

6 or More Chronic Conditions $31,238.2 $28,981.7 $29,793.0 $32,102.7

Figure 16. Per capita costs for 65 years and older beneficiaries, 2014

$31,238.2

$10,880.5

$5,206.8

$1,698.9

$28,981.7

$10,184.1

$4,723.2

$1,639.9

$29,793.0

$11,025.2

$4,986.0

$1,881.3

$32,102.7

$11,052.1

$4,992.0

$1,561.4

$0.0 $5,000.0 $10,000.0 $15,000.0 $20,000.0 $25,000.0 $30,000.0 $35,000.0

6 or more conditions

4 - 5 conditions

2 - 3 conditions

0 - 1 condition



Page 43

KEY INFORMATION CONCLUSIONS

In this section:

Most Pressing Issues Missing or Lacking Resources/Services

Anxiety about Aging and Ageism Open-Ended Feedback

Most Pressing Issues

Key informants were asked to identify the 5 most pressing issues facing seniors/elderly in the

community. The most pressing issues identified were navigating/accessing health care and social

services, chronic disease management, Alzheimer’s disease/dementia/memory loss, social

isolation, and poverty/financial insecurity.

Table 62. Most Pressing Issues According to Key Informants

Count Percent

Navigating/Accessing Health Care & Social

Services

52 67.5%

Chronic Disease Management (Heart Disease,

Stroke, Diabetes, Cancer, Arthritis)

46 59.7%

Alzheimer’s Disease/Dementia/Memory Loss

44 57.1%

Social Isolation

42 54.5%

Poverty/Financial Insecurity

36 46.8%

Transportation

34 44.2%

Affordable Housing/Homelessness

26 33.8%

Injuries/Falls

26 33.8%

Mental/Behavioral Health Issues

21 27.3%

Financial Scams/Fraud

18 23.4%

Elder Abuse/Neglect

10 13.0%

Hunger/Food Insecurity

9 11.7%

Other

5 6.5%

Overweight/Obesity

2 2.6%

One key informant emphasized the complexity of the health care system, “The health care system and

services to support elders are increasing(ly) complex and difficult to navigate for those not working

within the system. The complexity of services, eligibility, and insurances are overwhelming for both

elders and those that care for them.”

Another key informant explained the effect of transportation on social isolation, “Only 5% of the

metropolitan city is covered by full-service public transportation. If you don’t have a car or can’t drive,


Page 44

either anytime or at night, you are isolated. City and county can provide specialized transportation only

a little. No shopping. No wandering. Just isolation. No other major city in the world has this situation. It

is an artifact of deliberate racial segregation, now fully in place and no longer labeled as such. But now

and over the next decades, its victims will increase exponentially.” In addition, “Other” responses

included ageism, assistance with daily living activities, lack of knowledge of resources/activities, re-

hospitalization, and reliable/affordable long-term care.

Key informants were also asked to provide additional information regarding issues facing seniors in

their community and their reasons for ranking the aforementioned issues the way they did. The

following textbox summarizes select verbatim comments.

Select Comments Regarding the Most Pressing Issues Facing Seniors/Elderly

“A growing number of seniors have difficulty managing their finances to include appropriate

housing, insurance needs, and medical coverage- including prescription drug coverage.

Unfortunately, many seniors have to choose what area they spend their money; healthcare

associated costs continue to rise. Access to social services is likely limited for many, as some

seniors may not qualify for Medicaid or live in a setting where social services are offered.

Also, signing up for many medical services (insurance plans, Part D coverage) is online-

something that not all seniors are comfortable with at this time.”

“Chronic disease can lead to unemployment, social isolation, limited income, lack of food,

housing and financial concerns. Transportation to and from medical appointments and

errands is critical for those who do not have a vehicle or cannot drive due to health or other

reasons. Navigating the health care and social service system is a complaint that I hear often

in my work and is so complex for older adults, whether you are educated or not. It seems that

the five issues I chose all feed into each other and are most prevalent.”

“Seniors are afraid of memory loss/dementia in any form and want to know much more

about how they can sharpen their own brains and avoid deterioration. They also need and

want help in dealing with the intricacies of Dementia/Alzheimer’s when it confronts them in

themselves or in their family.”

“Transportation is a problem for seniors who cannot drive or whose comfortable driving

territory is shrinking. We have limited regional transportation and inadequate transportation

resources. This is a problem at all economic levels.”

“Chronic Disease Management is an issue when it impacts a senior or family member, and it

can often prevent engagement and social networking. We try to work with the issue of

chronic disease management in a supportive social environment and also introduce the

senior to other opportunities and activities as a part of management and rehabilitation.”

“Social Isolation is a real "fear" of some of our seniors, but mostly of those of us who know

what social isolation can do. It is not first in their minds, but it increases the risk of declining

health, increased dependency and decreased living skills.”

“Most of my members have pensions but are struggling with health issues and with not

wanting to leave their homes to move into assisted living facilities. They are isolated in their

homes but they don't want to move.”


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“Lack of knowledge and lack of someone offering solutions/resources keep many seniors at

home. They don't know where to start and after a while, they give up trying. Many don't use

the internet, our most flexible resource about what is possible. Many may not want to do an

activity that they know about but don't know what else might be available. Others don't

have a clue and finally stop thinking about it.”

“The Age Wave will present issues that we have never seen before. If quality is inconsistent,

adding more needy people could tip over the care system. Too many people are unprepared

and those that are still have to master a complex maze of providers where there's a wide gap

between quality and inadequate service. Living beyond your means is a major threat for

those who are living longer.”

“The impact of Alzheimer's Disease and other dementias on not only the person suffering

with the disease but the caregiver and family unit can be devastating - costly in both

individual personal suffering as well as economic and social costs overall. This issue

intersects with the lack of affordable housing as the assisted living end of that continuum in

that so many persons needing a supportive living environment but not yet requiring nursing

facility level care have few affordable options of dependable quality. Similarly, the lack of

easily accessible and affordable transportation options intersects with the problem of social

isolation as individuals get 'marooned in areas underserved by good aging/disability-friendly

public transportation. With rapid changes and increasing complexity in the health and

social service delivery network- with confusing options and obstacles - many older adults

struggle with finding clear dependable pathways to ensure continuity, quality, and

accessibility in care and support services to maintain maximum independence and quality of

life.”

Missing or Lacking Resources/Services

Key informants were asked to identify any resources or services that are missing or lacking in the

community to support seniors/elderly. The top three resources or services identified as missing or

lacking in the community are transportation, respite care, and caregiver support services. This

finding is consistent with other research findings in the field that older adults want to grow old in their

present residence, provided that the home and social environment supports the unique changes that

come along with aging. “Other” responses included affordability of services and housing, aging in place

options, navigating health care between numerous specialists, mental health services, more home

visiting and check-in services for the homebound. Many key informants acknowledge that there are a

number of these services available in the community. However, they questioned the affordability,

quality, and awareness of these services. One key informant explained, “There is a specific lack of

resources for people in the middle market - those who don’t qualify for subsidies and don’t have the

funds for private pay.”


Page 46

Table 63. Missing or Lacking Resources/Services According to Key Informants

Count Percent

Transportation

44 57.9%

Respite Care (Short-Term, Temporary Care

to Provide Relief to Caregivers)

39 51.3%

Caregiver Support Services

38 50.0%

Home Care Services (Assistance with

Bathing, Dressing, Eating)

31 40.8%

Intergenerational Programs (Interactive

Activities for Seniors & Children)

30 39.5%

Financial Management/Counseling Services

26 34.2%

Home Modification/Repair Services

25 32.9%

Home Health Care Services (Assistance with

Medical Needs)

22 28.9%

Adult Day Programs/Adult Daycare Centers

21 27.6%

Fitness and Wellness Programs

20 26.3%

Elder Fraud Prevention

20 26.3%

Social/Recreational Programs

19 25.0%

Legal Services

19 25.0%

Meal Preparation/Meal Delivery Services

18 23.7%

Lifelong Learning Opportunities

17 22.4%

Yard Maintenance Services

17 22.4%

Housekeeping Services (Cleaning, Laundry)

13 17.1%

Security

11 14.5%

Hospice/Palliative Care/Grief Counseling

10 13.2%

Other

9 11.8%

None

1 1.3%

Key informants were also asked to provide additional information regarding missing or lacking

resources/services for seniors in their community. Select verbatim comments from key informants are

provided in the box on the following page.

Select Comments Regarding Missing or Lacking Resources/Services

“All of these services and resources are available, maybe more will be needed, but they are

available. They aren't always affordable even for middle income seniors (or at least they

don't think they are affordable). They may be there, but THEY DON'T KNOW HOW TO FIND

THEM OR WHAT TO LOOK FOR. Transportation and respite care are both in short supply.

Yes we need more, but MORE won't help, if no one knows what is available.”


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“I believe the most important need is home care services provided by personal care assistants

or CNAs. These individuals lack proper training, adequate salary, health care insurance and

child care benefits. As a result, the health care field is lacking qualified individuals to provide

care for older adults who choose to remain living in their homes. Although this continues to

arise as a problem in Virginia, not enough is being done to improve the opportunities for

these assistants and the people they serve. As baby boomers age, this will be an ongoing

concern, as baby boomers will not want to live in a nursing facility to get care for activities of

daily living. They will want to live in their own homes.”

“In the above list, I would like to emphasize transportation. There also needs to be more

programming related to positive views on aging. Negative views on aging relates to physical

health outcomes as well as psychological. Stigma around aging and older people contributes

to isolation.”

“The older the person gets, the more centralized all these services need to be. I think the

retirement communities do a good job of providing the needed services, but these

communities are expensive. A more affordable (equivalent to their Medicare monthly

payment) and accessible option would serve the community and the aging well.”

“While I am not sure there is a 'shortage' of home health care or home care services, there

may be more specifically a lack of affordable home health care or home care services. There

is tremendous variation in terms of availability of certain services, depending on whether one

is examining urban, rural, or suburban areas. For example, while it does not appear that

there is an overall shortage of home health care, some rural areas experience home health

care shortage in terms of a lack of choice of providers.”

Anxiety about Aging and Ageism

Lastly, key informants also answered questions regarding their own anxiety about aging as well as the

prevalence of ageism, discrimination or prejudice on the basis of a person’s age, in the community.

Approximately 62% of key informants expressed mild to moderate anxiety about their own personal

anxiety. In terms of ageism, about 95% felt that ageism was somewhat or very prevalent in the

community. Only 5% believe that ageism is not present at all in the community. The prevalence of

ageism in a community can present many challenges for older adults. It can affect their choice,

independence, dignity, and negatively impact their overall quality of life.

Open-Ended Feedback

To conclude the survey, key informants were asked to provide open-ended feedback on what is being

done well in the community in terms of quality of life. The majority of key informants agreed quality

programs, services, and providers are available in the area. However, they are concerned with whether

older adults can access and/or afford these services. Transportation is still a big concern. Key informants

felt there is an adequate amount of volunteer opportunities available in the community as well. Both

Age Wave and Senior Connections were recognized as organizations trying to make an impact on the

quality of life of older adults. Below are select comments that were provided by key informants.


Page 48

In your opinion, what is being done well in the community in terms of quality of life?

(Community Assets/Strengths/Successes)

“A lot of volunteer opportunities.”

“As is probably the case in most communities, those that can afford to live well, do live

well. Lower income individuals often do not have needed services and supports. Faith-based

communities often do a better job of serving all individuals, regardless of income level.”

“Collaboration, prevention programs, intergenerational, person-centered approaches.”

“Excellent aging network between VCU Gerontology, Senior Navigator, Alzheimer's

Association, and other key organizations.”

“Henrico County has an advocate for the aging person who offers services to the elder

population. Henrico County also offers an EngAGE program.”

“I think that Senior Connections is doing a good job with trying their programs and there

are many other community agencies that are doing good things. I think there is an issue

with coordinating programs & with awareness of what is available.”

“Numerous support services and service providers are well informed of what they do/do not

do and how to refer to other appropriate services.”

“Overall, the city and surrounding counties in the Richmond area are age-friendly and offer

a wide variety of services and opportunities for their older residents. However, the city and

counties have pockets of poverty where folks do not have the same privileges as those who

are financially stable. In rural areas of Virginia, there is a significant lack of community

senior services, and social and medical services.”

“People at Westminster Canterbury and many other places from Senior Connections to the

Age Wave Coalition are addressing the good things. We have the beginnings of a good

bud/paratransit system but it is not complete. We have good services but many people do

not realize they need help until they cannot make the decision to reach out for them.

Affordable services is an issue.”

“Region wide Age Wave Plan, which collects assets and informs community.”

“Senior Connections is engaged in care planning for the community, but planning is in its

infancy and the governing bodies of localities are not engaged as they should be.”

“Special provisions to make the arts accessible and affordable to older adults. Some

opportunities for intergenerational sharing/support.”

“There are many people and organizations who are identifying specific needs in our

community. There is some overlap, but intentions are generally good and hopefully these

inquiries will result in direct, person-centered care for individuals.”

“Things appear better in the city, but skews toward the more affluent elderly. I may be less

aware of many programs, but I am very connected and active with social media and web

searches, which would not be the case with the elderly. I did a web search and it is better

than I thought. Transportation remains a critical issue.”

“Through work of the Age Wave Coalition, livable communities are being addressed.”


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Is there any additional information that you would like to provide regarding the needs of older

people or other populations in your community?

“Affordability with quality option.”

“I would like to emphasize the need for increased social connectedness. Also the need for

transportation options.”

“I would encourage Westminster Canterbury to work within their tether to the church and

its principles. As such, there should be some mechanisms to assist some individuals with

less resources. There should be flexibility in its services to meet the needs of the people.”

“The Age Wave planning group has done a good job of developing a plan and are working

hard to implement it. It would be great if there was more attention focused on the fact that

there is a plan and to further engagement in the business community and integrate efforts

between service providers, academia, and most notably governmental agencies.”

“The need to experience where they live as they would at home - Free to live and worship

according to their convictions, have privacy, direct how they are approached and receive

honor and deference from care providers and staff, which is not condescending or

patronizing, treating older adults as children.”

“There is a subset of older adults that seem to fall through the cracks and for whom there is

no niche: limited to moderate income, capacity for self-care in all ADLs including meals,

limited ability to drive and no public transportation.”

“Those who can afford to reside at WCR have the opportunity to reach out to other older

adults in their community who cannot afford to reside in a CCRC. I would encourage them

to continue to be a part of their community and offer their skills and services to those less

fortunate.”

“To say it again and another way: The absence of transportation is the great hidden factor

in metro Richmond's resources. Studies of available resources may make Richmond appear

well resourced -- in fact it is in many ways -- but because there is no normal accessibility

to these resources the studies are invalid.”

OLDER ADULT CONCLUSIONS Caregiving Services Age-Friendliness of Community

Open-Ended Feedback

Caregiving Services

Approximately 61% of survey respondents have personally had experience providing caregiving services

to a loved one. Those respondents that provided caregiving services to a loved one offered further

insight into the resources that were most important to supporting their care. Ninety-one comments

were provided. Of those 91 comments, the two most frequently mentioned resources were doctor or

other health care professional and family. Nearly 33% of the comments mentioned doctor while about

34% discussed family. Additional resources that were frequently mentioned included in home care or

home health (25%), church (16%), friends (16%), and hospice (15%). Still others occasionally mentioned

retirement communities, specifically assisted living, support groups, and the internet/information about

services.


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Age Discrimination and Age-Friendliness

Survey respondents were asked about both age discrimination as well as the age-friendliness of the

community. The majority of survey respondents have not experienced any discrimination due to their

age (69.4%). Yet still, nearly 31% of respondents say that they have experienced some form of age

discrimination. Despite this, nearly half of survey respondents (49.1%) feel the community is either

extremely or very age-friendly. Additionally, another 39% feel the community is at least somewhat age-

friendly. Only 12% feel it is not very or not at all age-friendly.

Open-Ended Feedback

Lastly, survey respondents were invited to provide open-ended feedback on their age-friendliness rating

and/or additional information to better understand their needs. Not surprisingly, given survey

respondents positive ratings for age-friendliness, many of the comments were positive. A number of

respondents feel they live in neighborhoods that are diverse in regard to age, regularly interact socially

with their neighbors, and that those they encounter are, for the most part, very helpful. Many feel they

have easy access to activities and that there is plenty to do in the area.

However, given this, there are a few concerns that came to light. While many respondents felt activities

and entertainment are plentiful in the area, it was acknowledged that this may be difficult for those

older to access if they don’t have good financial resources, have mobility issues, or don’t have

transportation. This may be why some did say they feel socially isolated. Furthermore, a few did feel that

there aren’t always activities available that are specifically targeted at older adults.

Transportation and employment were the most frequently mentioned concerns within the open-ended

feedback. Respondents feel there is a lack of transportation in the area particularly for those who may

live in more rural areas. This can be a challenge in trying to access the entertainment venues and

activities in the area. Employment was another concern mentioned by some respondents. Those who

expressed concern for employment did not feel jobs were readily available in the community. However,

some also did feel that they experience discrimination due to their age at work but not necessarily in

other aspects of their lives. Below are select comments that were provided by survey respondents.

Select Comments Regarding Age-Friendliness or Additional Needs

“Accessibility to public transportation and non ADA compliance.”

“As we take walks we see neighbors and our neighborhood has numerous social events.”

“Diverse neighborhood Middle aged as well as older adults helping one another.”

“Downtown isn't safe or easy to navigate regardless of age, but is of more concern as I get

older.”

“Employment field difficult.”

“Great young neighbors who are available and willing to help with things like shoveling

snow and changing light bulbs high up.”

“I am a professional who wishes to continue my career and grow--in the workplace; I find a

bias against women who are older. The community is otherwise age-friendly.”

“I am isolated in the country and only go into the city when it requires a doctor's

appointment or business.”


Page 51

“I don't feel like I'm treated differently at my church, at the gym or in the community due

to my age.”

“I don't know of a lot of events/activities going on throughout the community that are

specifically targeted towards aging and older adults.”

“I live in a more rural area so it is not possible to walk to any stores/services.”

“I participate in my local country club which has several age friendly opportunities. My

church also offers the same opportunities. Plus my neighborhood has a good mix of age

groups.”

“I'm not familiar with many of the resources available throughout the community for older

adults.”

“In restaurants & other convenience-type shopping places, I am very often referred to as

"Honey", "Dear", etc. which is not respectful to the elderly.”

“Lack of transportation. Also rural environment makes it difficult to make seniors aware of

resources that are local.”

“Living independently requires mental and physical agility. At some point those begin to

fail, and changes will need to be made. We would prefer to be independent, of course, but

need to be realistic.”

“Most of my current needs are available to me within a 10-15 mile radius. I still drive so

can get to most anything I care to be at. It would be a different matter if I could not drive

myself.”

“No multicultural activities or help in the community for older adults who speak English as

a second language.”

“Some resources, but limited. Resources can be difficult to identify & access can be limited

to low income. Middle income or limited income w/o impoverishment have few resources

to assist.”

“The community I live in has many people of many age group and we have several

community groups that bring us together.”

“There many civic, churches and independent people that are willing to help. Senior

discounts at restaurants and adult day care also available. My biggest problem is

transportation. There is very little transportation here.”

“This is a small community where many of us have "aged" together and know each other.

There are several communities that are designated 55 or older in the community. The

county Parks and Recreation has programs geared toward older citizens. Senior

Connections opened a friendship Café here within the last 2 years. Many churches in the

area have Senior Groups and/or activities.”


Page 52

Appendix A. Secondary Data Profile References

American Lung Association. (2016). State of the air. Retrieved from

http://www.lung.org/our-initiatives/healthy-air/sota/city-rankings/states/virginia/

CDC Wonder (2014). Leading causes of death by state and county. Retrieved from

http://wonder.cdc.gov/

Centers for Disease Control and Prevention. (n.d.). Behavioral risk factor surveillance system.

http://www.cdc.gov/brfss/

Centers for Medicare & Medicaid Services. (2014). County reports. Retrieved from

http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-

Reports/Chronic-Conditions/MCC_Main.html

Community Commons. Community Health Needs Assessment. Retrieved from

http://www.communitycommons.org/

County Health Rankings & Roadmaps. (2016). Virginia. Retrieved from

http://www.countyhealthrankings.org/app/virginia/2016/overview

National Cancer Institute (2009-2013). Cancer incidence and mortality. Retrieved from

http://www.statecancerprofiles.cancer.gov/index.html

The Nielsen Company. (2016). Senior life 2016. Retrieved from

https://answers.nielsen.com/

U.S. Census Bureau. (n.d.). American fact finder. Retrieved from

http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml

U.S. Department of Health and Human Services. (2014). Healthy people 2020. Retrieved from

http://www.healthypeople.gov/2020/default.aspx

Virginia Department of Health. (n.d.). Behavioral risk factor surveillance system. Retrieved from

http://www.vdh.virginia.gov/brfss/


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Appendix B. Secondary Data Terminology

Age-Specific Rate – Age-specific rates are calculated in the same manner as crude rates, but the

number of cases or deaths and the population are based on a specific age group.

Crude Rate - Generally defined as the total number of cases or deaths divided by the total population

at risk. Crude rate is generally presented as per populations of 1,000, 10,000 or 100,000. It is based on

raw data and does not account for characteristics such as age, race, and gender.

Family - Defined as more than one person living together, either as relations or as a married couple.

Frequency - Often denoted by the symbol “N,” frequency is the number of occurrences of an event.

Household - Defined as one or more people sharing a residence. Examples include college students

sharing an apartment or a single male living alone.

Incidence Rate - Indicates the number of new disease cases in a specified amount of time. Time is

determined by the number of years candidates for the disease are observed before they are diagnosed.

Poverty Guidelines - A version of the federal poverty measure. They are issued each year by the

Department of Health and Human Services. The guidelines are a simplification of the poverty thresholds

for use for administrative purposes (determining financial eligibility for federal programs).


Page 54

Appendix C. Key Informant Participants

Name Agency

Heidi Abbott, Esq. Hunton & Williams LLP

Gigi Amateau United Way

Melissa Andrews Leading Age Virginia

Beth Barber Commonwealth Council on Aging

Joann Bawiec Bon Secours Memorial College of Nursing

Mr. and Mrs. Gregg Beck Thalhimer Commercial Realty

Will Blackwell Westminster Canterbury Richmond

Devin Bowers Virginia Department for Aging and

Rehabilitative Services

Susan Brown Davis The Community Foundation Serving Richmond

and Central VA

Amy Burkett Department of Medical Assistance Services

(DMAS)

Rev. Ben Campbell Richmond Hill

Chief Humberto I. Carsounel, Jr. Henrico County Police Division

Anne Chan Sheltering Arms Rehab Center

Eileen Ciccotelli Virginia Business Coalition on Health

Carolyn Comerford Senior Center of Greater Richmond

Constance Coogle, Ph.D. Virginia Center on Aging

Bob Cox Westminster Canterbury Richmond

Jeff Cribbs Richmond Memorial Health Foundation

David DeBiasi, RN AARP

Rev. Dr. Alex Evans Second Presbyterian Church

Vicki Fowler Westminster Canterbury Richmond

Russel Gardner Westminster Canterbury Richmond

Tracey Gendron VCU Department of Gerontology

Rob Goodall NET 30

Suzanne Hall St. James's Episcopal Church

Mary Hawley Westminster Canterbury Richmond

Jay Holdren VCU Department of Internal Medicine

Lee Householder project_HOMES

Rev. Bobby Humle-Lippert Grace Covenant Presbyterian Church

Debra Jacobsen Westminster Canterbury Richmond

Christine Jensen Riverside Center for Excellence in Aging and

Lifelong Health (CEALH)

Adrienne Johnson SeniorNavigator

Rev. Gary Jones St. Stephens Episcopal Church

Brint Keyes Overbrook Presbyterian


Page 55

Name Agency

Marie Kolendo Greater Richmond Chapter of the Alzheimer's

Association

Emily Krause Westminster Canterbury Richmond

Joani Latimer Virginia Department for Aging and


The Rev. Larry E. Lenow Trinity United Methodist Church

Sloan Lindsey Westminster Canterbury Richmond

Teri Lovelace Virginia Community Capital

Beth Ludden Genworth Financial Inc.

Amy Marschean, J.D. Virginia Department for Aging and


Lynn McClintock Westminster Canterbury Richmond

Karen Moeller VCU Department of Gerontology

Andrew Moore Glave & Holmes Architecture

Angie Phelon Senior Connections

Sharon Poznanczyk Westminster Canterbury Richmond

Katherine Ramsey, Esq. Virginia Estate and Trust Law

Susan Revere R.A.M.P.S: Ramp Access Made Possible by

Students

Rev. Phoebe Roaf St. Phillips Episcopal Church

Ramona Schaeffer Centers for Disease Control and Prevention

Tom Silverstri Richmond Times-Dispatch

John Swierczewski Covenant Home Care

The Rev. Dr. Alexander Tartaglia Virginia Commonwealth University

Beth Travis Westminster Canterbury Richmond

John Vithoulkas Henrico County

Marilyn West M.H. West & Co., Inc.

Jay White A Grace Place Adult Care Center

Debbie Whitmore Westminster Canterbury Richmond

Colleen Wilhelm Family Lifeline

Jonathan Zur The Virginia Center for Inclusive Communities

Unidentified Participant N/A











Page 56

Name Agency








Page 57

Appendix D. Demographics of Older Adult Survey Participants

Demographics

Location

Richmond City 47.0%

Henrico County 34.0%

Chesterfield County 13.6%

Goochland County 0.6%

Hanover County 2.1%

Powhatan County 0.6%

Other 2.1%

Gender

Male (N=79) 23.7%

Female (N=254) 76.3%

Age

55 – 64 (N=71) 21.3%

65 – 74 (N=127) 38.1%

75 – 84 (N=95) 28.5%

85 or older (N=40) 12.0%

Marital Status

Single (never married) (N=34) 10.3%

Married (N=124) 37.5%

Not married, living with partner (N=20) 6.0%

Separated (N=24) 7.3%

Divorced (N=58) 17.5%

Widowed (N=71) 21.5%

Health Insurance*

Insurance through a current employer of yours or your spouse

(N=88) 26.6%

Insurance purchased directly from an insurance company (not

through an employer) (N=77) 23.3%

Medicare or Medicaid or any kind of government assistance plan

(N=218) 65.9%

Veterans Administration or other military health care (N=33) 10.0%

Any other insurance coverage (N=89) 26.9%

Disability

Yes (N=91) 27.7%

No (N=237) 72.3%

* Respondents could select more than one option, therefore the percentages may sum to more than 100.0%.


Page 58

Demographics, (Cont’d)

Race/Ethnicity*

White (N=205) 62.5%

Black or African American (N=109) 33.2%

American Indian or Alaska Native (N=5) 1.5%

Native Hawaiian or other Pacific Islander (N=2) 0.6%

Asian (N=6) 1.8%

Hispanic or Latino (N=17) 5.2%

Other (N=4) 1.2%

Education Level

Never attended school (N=2) 0.6%

Grades 1 – 8 (elementary school) (N=0) 0.0%

Grades 9 – 11 (some high school, but no diploma) (N=15) 4.5%

Grade 12 (High school diploma or GED) (N=53) 16.1%

Some college, technical or vocation school (N=51) 15.5%

Associate’s degree (N=51) 15.5%

4-year college degree (N=89) 27.0%

Graduate or professional-level degree (N=63) 19.1%

Other (N=6) 1.8%

Income

Less than $10,000 (N=25) 7.8%

$10,000 to $19,999 (N=25) 7.8%

$20,000 to $29,999 (N=50) 15.6%

$30,000 to $49,999 (N=58) 18.1%

$50,000 to $74,999 (N=57) 17.8%

$75,000 to $99,999 (N=37) 11.6%

$100,000 to $149,999 (N=29) 9.1%

$150,000 or more (N=39) 12.2%

* Respondents could select more than one option, therefore the percentages may sum to more than 100.0%.


Page 59

Demographics (Cont’d)

Zip Code Representation

Zip Code % Zip Code %

23220 10.7% 23236 0.9%

23227 9.8% 23838 0.9%

23219 8.3% 23173 0.6%

23231 5.0% 23232 0.6%

23222 4.5% 23282 0.6%

23229 4.2% 23284 0.6%

23233 3.9% 23297 0.6%

23218 3.3% 23288 0.6%

23226 3.3% 23059 0.6%

23221 3.0% 23063 0.6%

23075 3.0% 23111 0.6%

23225 2.7% 23241 0.3%

23060 2.7% 23260 0.3%

23223 2.4% 23286 0.3%

23230 2.4% 23295 0.3%

23113 2.4% 23238 0.3%

23235 2.1% 23242 0.3%

23237 2.1% 23255 0.3%

23832 2.1% 23069 0.3%

23294 1.8% 23103 0.3%

23224 1.5% 23114 0.3%

23150 1.5% 23139 0.3%

23112 1.5% 23803 0.3%

23234 1.5% 23831 0.3%

23116 1.2% 23875 0.3%

23228 0.9% 23894 0.3%

23141 0.9% 24529 0.3%

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