The aging effect: As population grows older, Boulder County-area hospitals develop new ways of delivering care – The Daily Camera

Boulder County continues to grow at a rapid rate, and as its population gets older, the health care system will feel the crunch. That’s why many of the hospital systems that serve the area are taking steps now to change the way health care is delivered in the hopes that they won’t have to build new hospitals in the future.

Boulder’s demographics look fairly stable when students at the University of Colorado Boulder are included, said Elizabeth Garner, state demographer for the Colorado Department of Local Affairs. But when those younger people are taken out of the equation, the numbers show that the city doesn’t have a lot of 30- and 40-year-olds. They can’t afford to live there, so there aren’t a lot of children there as a result.

The U.S. Census Bureau puts the city of Boulder’s under-18 population at just 12.5%.

“This is their second decade in a row of absolute decline in the under 18 population, and it’s primarily because their parents can’t afford to be there,” Garner said.

For Longmont, the under-18 population stands at 23.8%, according to U.S. Census Bureau data.

Broomfield is different. Younger families can afford to live there, and there’s a lot more 30-year-olds than there are 70-year-olds, she said. The U.S. Census Bureau records Broomfield’s under-18 population at 22.1%.

With both Boulder and Broomfield counties, the over-65 population is some of the fastest-growing in the country. For Broomfield, the 75- to 84-year-old population increased 53% over the past decade, while the 85 and older population grew by 75%.

“Boulder is one of the slowest-growing counties in the Front Range,” Garner said. But if its population is looked at by age group, the 75- to 84-year-old population is expected to increase 88%, while the 85 and older group is expected to grow by 60% over the next decade.

There aren’t a lot of nursing homes being built in the area, but there is a demand for assisted-living facilities.

“I think they’ve realized that people can make it with assisted living. You don’t have to be hospitalized if you can’t perform self-care yourself,” she said.

A recent report by the Boulder County Area Agency on Aging — Aging in Boulder County: Past, Present, Future — found that “the proportion of older adult residents (people age 60 and older) is greater and growing faster than ever before. Between 2020 and 2050, the county’s overall population increase is projected to be 33%. Compare that against the older adult population increase of 58% and the 80-plus population increase of 244%.”

The report also found that the proportion of older adults in Boulder County is dramatically increasing relative to all other age groups but will stabilize by 2040.

Boulder County is known for its healthy and active senior population, with 86% of that population engaging in moderate or vigorous physical activity compared with the state average of 76%. But even with a healthier lifestyle and mindset, the leading cause of death in the county is chronic diseases, such as cancer, heart disease, chronic lower respiratory diseases and Alzheimer’s.

One of the big problems in Boulder County and across the country is that “a quarter (23%) of adults ages 45 to 64 are serving as a caregiver to an aging adult, making them the most likely age group to provide informal caregiving. The number of county residents who are 45 to 64 years old is expected to decrease compared to those 65-plus in the community, creating a greater need for stronger formal and informal support systems for older adults,” according to the report.

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Boulder Community Health President and CEO Robert Vissers, pictured in 2019, said advances in technology such as the pandemic-accelerated shift toward telehealth appointments, are helping the hospital system find new ways to deliver care as more patients need it as they age. (Jeremy Papasso/File photo)

“We’ve been navigating the aging population for 10 to 20 years,” said Robert Vissers, president and CEO of Boulder Community Health. “It certainly has occurred more rapidly in Boulder County because of the shift in demographics and the challenge around affordability.”

Advances in technology, shifting higher acuity care out of a hospital setting and advances in the way the system takes care of people should help alleviate the pressure on local hospital systems as they find new ways to serve their patients, he said.

One segment of health care that has seen significant changes is how quickly hospitals are able to care for patients in an acute-care setting and then transition them to their home or an outpatient setting. In the past, a patient getting a joint replacement would spend a week in the hospital. Now, that patient may go home the same day instead of transferring to an outpatient rehabilitation center.

Boulder Community Health’s Foothills Hospital has been doing more of its joint-replacement surgeries at its surgery center.

“That is a reflection of our expertise, of the staff and team involved, but also reflects the health of our population,” Vissers said. “A 70-year-old in Boulder is not the same health status of a 70-year-old 10 to 20 years ago or in most areas of the country.”

Some advances, such as telehealth and the ability to engage with people remotely, were already in the works before the pandemic hit but have ramped up as a response to it. Being able to connect with a physician or medical provider remotely “affords efficiencies,” he said. It can be inconvenient for someone living in the mountains to drive down to town to get a second opinion. Telehealth has “created capacity for change and providing more care,” he added.

“Hospital at home” is the next big advancement.

“There are so many things we are able to do in the hospital that we can do potentially remotely in the right setting,” Vissers said, such as monitoring vital signs with a cell phone. For most patients, being at home is safer and more comfortable.

“There is optimism this will become more of the norm in the next decade. All of these things create capacity in our hospital to bring more people in and care for them,” he said.

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UCHealth Longs Peak Hospital is prioritizing better screening and partnerships aimed at keeping people healthier for longer and hopefully out of the hospital. The hospital system, UCHealth, also is expanding primary care clinics because those are easier and more financially feasible to get operating quickly. (Timothy Hurst/File)

With the advent of surgery centers and outpatient medications, even for cancer care, the amount of time patients spend in the hospital recovering has gone way down.

Christine Vogel, division manager of the Boulder County Area Agency on Aging, says that ageism is a real problem that impacts older adults in the workplace and in health care. Many times, when an older patient visits their doctor and complains about a specific malady, they are told that it is just a result of them getting older.

There “could be additional aspects of treatment and options that could extend my life and/or my experience or my capacities. If my capacity goes down, it makes it harder for me to live in my own home; I need to be somewhere else. That has impacts on the long-term care system that is not ready for everybody. Not everybody needs to be in long-term care but we don’t have community options that are affordable and attainable,” she said.

Her agency focuses on ways to keep people in their homes and manage their conditions at home, but “that is a challenge the way the system is set up.”

Lindsay Parsons, aging policy advocate and planner for the BCAAA, said that her organization wants to see people live well and longer. “Within our AAA, we focus on healthy aging, looking upstream so we can help people address these issues at an earlier time,” she said.

That means creating programming around conditions such as diabetes and pre-diabetes to manage those conditions that can really take a toll on someone’s ability to live well in their home and community, “which is what we know most adults want to do,” she said.

The population demographics of the county pose a challenge. In the past, many older people were cared for by an adult in their own family, but as the older population increases and the younger populations decrease, that system of care is turned upside down.

There is a real need for assisted-living facilities and skilled nursing facilities, but there also is a real shortage of workers for these facilities because many of the workers can’t afford to live in the area.

Good Samaritan Medical Center President Dawn Anuszkiewicz said the hospital is learning to consider the whole community when approaching health and wellness concerns. (Matthew Jonas/Staff Photographer)

Dawn Anuszkiewicz, president of Good Samaritan Medical Center in Lafayette, said her hospital’s parent company, SCL Health, tries to stay two steps ahead of the curve by “making sure folks can get the health care they need, at the right level of care, and in the right location.”

Expanding access to care is important. Many of the hospitals serving Boulder and Broomfield counties are opening primary care physician offices in their communities.

The goal is to make sure that the “community hospital isn’t the sole purveyor or provider of health care,” she said. Good Samaritan has partnered with Luna to offer at-home physical therapy, making it easier for an elderly person who was injured to get access to care, and it “removes barriers to finishing that course of care and regaining functionality after their illness,” Anuszkiewicz said.

The hospital also partners with the BCAAA to offer classes that help older adults age better, offering peer-to[peer conversations and online activities so that they can learn how to master their health as they age.

It is hard to predict when new hospital beds will need to be built in the next five years because “we don’t know how many patients we will have in five years and what diseases they will have. We know that every single hospital bed we build is costly in terms of resources and financially, and they take an environmental toll,” Anuszkiewicz said.

Lonnie Cramer, president of UCHealth Broomfield Hospital and UCHealth Longs Peak Hospital in Longmont, said that his organization is trying to keep people healthy and out of the hospital when and where possible. That means better screening and partnerships that help keep people from having to come to the hospital to get treatment.

Its Aspen Club is a partnership in Northern Colorado and Fort Collins that provides its members with health education, screenings, hospital discounts and social opportunities as a way of catching problems early and keeping those patients outside of a hospital setting.

Its Healthy Hearts program in Longmont works with schools to teach children the importance of making good choices with diet and exercise. If people are taught to make better choices early on, it benefits their health as they age.

Longmont conducts a community needs assessment every year, working with 40 independent groups to determine what the community’s needs are.

“As a nonprofit, we do that to see what is changing and what is coming. My work on Longmont Economic Development is also important so we understand that businesses are growing and where development is growing around Longmont,” he said. “That helps us understand what to do as an organization to keep those people out of the hospital.”

When The J.M. Smucker Co. came to town, UCHealth partnered with the company for an onsite care facility. Having access to health care at their workplace means that more employees are likely to take advantage of those services rather than immediately visit an emergency room or urgent care when they experience a health problem.

Expanding primary care is “key to keeping people out of the hospital,” Cramer said. UCHealth recently opened a new primary-care location in Longmont, adding four more primary-care doctors. The health system is looking to add even more in other areas it serves.

Hospital systems are getting away from urgent cares and trying to build up primary-care locations that are integrated with behavioral health components. Another benefit of opening up these types of locations is that they are smaller and can get up and running more quickly. It is easier to lease a small location than to buy land and build one, “which is a struggle in Boulder County,” he said.

UCHealth also saw its virtual telehealth visits expand dramatically through the pandemic.

“UC Health has done a fabulous job in investing in telehealth and technology to drive patient care and results,” he said. “Patients respond better to health care when they are engaged in health care.”

The hope is that by offering more accessibility to primary care physicians, it will decrease the level of emergency needs.

“The population will grow so there will always be a need for emergency care. That will never go away,” Cramer said. “But if we can get less acute care treated elsewhere, focus more on acute care in the [emergency department], we will not grow emergency rooms at the same rate as primary-care treatment facilities.”

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Hospital systems like Boulder Community Health also are facing obstacles with funding: As patients age, they rely more on Medicare and Medicaid, which do not reimburse hospitals for the entire cost of most health care. (Cliff Grassmick/Staff Photographer)

BCH’s Vissers said that one of the biggest challenges in health care is how to pay for it.

“Right now, the way we pay for health care in the U.S. is incredibly complex, and at best fragmented. And, as we have said for many years now, (it) seems to be unsustainable,” he said.

The majority of the care provided at BCH is paid for through Medicare and Medicaid, neither of which pays enough to cover the care provided, he said.

“We hope these efficiencies create cost effectiveness to provide this care at a lesser cost,” he said. “Many technological advances can improve efficiencies and reduce costs but it takes more upfront to do those things.”

He added that most hospital systems are struggling to afford all of the new technologies under the current reimbursement structure. Right now, those with private insurance and their employers end up paying more for their care to help cover the people who don’t have private insurance.

“At some point, employers at the end of the day who are footing that bill can no longer sustain that,” Vissers said.

The pandemic made Good Samaritan realize that it couldn’t do everything itself.

“We are learning we need to take a whole community approach to maintain wellness and health and safety,” Anuszkiewicz said.

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SCL Health Good Samaritan Medical Center partners with the Boulder County Area Agency on Aging to offer peer mentoring and activities to help community members age well. (Cliff Grassmick/Staff Photographer)