Within the next two decades, Utah's baby boomers will be Utah's elderly. If you want a shorthand way to understand the ramifications, says Shauna O'Neil, look at garbage cans.

Right now, notes the Salt Lake County Aging Services director, on every garbage route in the county there are at least a couple of houses where an elderly resident can't maneuver the unwieldy cans out to the curb.

So the garbage man gets out of the truck, pushes the cans out to the street, empties them and returns them back down the driveway. It's time-intensive help — which is OK if there are only a few elderly residents per route.

"But what happens," O'Neil asks, "when there are 15 or 20?"

From garbage cans to home health to bus routes, the graying of Utah will mean an increased need for infrastructure and services, because even though many of those seniors will still be vital and independent — many still working past traditional retirement age or providing crucial volunteer help in schools and other institutions — the sheer numbers of those baby boomers also mean there will be more people with needs. And boomers, say aging experts only half jokingly, will expect services in ways that their less-demanding parents haven't.

"I think, as a state, we're in denial about the problems that are coming," says Bill Farley, director of the W.D. Goodwill Initiatives on Aging, part of the University of Utah's College of Social Work. "I don't think our state Legislature has taken the responsibility for dealing with this problem" — including funding programs that help seniors stay in their homes as they become more frail. Already there are long waiting lists for several of these programs, including Salt Lake County's Caregiver Support Services.

Utah's boomer stats are daunting: In Utah, the number of residents 65 and older will increase 51 percent from 2010 to 2020. In 2028, just 20 years from now, a Utahn will turn 75 every 22 minutes. By 2038, 25 percent of the population of Salt Lake County will be over 60 years old. The fastest growth is among people 85 and older. By 2050, it's predicted, there will be 103,000 in that age group in Salt Lake County alone.

At the same time, because the fertility rate has declined, there will be fewer adult children to take care of each aging parent. More single women have arrived at old age without children to take care of them. While need increases, the number of women between the ages of 25 and 54 — the average age of paid caregivers, the majority of whom are female — will remain flat.

Certified nursing assistants, aides and even nurses, the groups that provide most of the professional hands-on care, are already in short supply. There is also a serious shortage of geriatric physicians, here and across the country. Of 145 medical schools, only 11 have geriatrics programs. All 30 of Utah's geriatricians are near the Wasatch Front. Even St. George, Utah's retirement hub, doesn't have one.

But caregiving is only part of the problem. More aging boomers means more people who need road signs with bigger lettering, improved intersection design, more visible striping, maybe even roads with wider lanes. When they give up their car keys, they'll need buses within walking distance, and after they can no longer walk very far, buses that come door-to-door.

Currently, Salt Lake County Aging's transportation program provides rides primarily to medical appointments. Not all counties even provide that service. Transportation is, in fact, the biggest challenge for people growing old in rural areas. That's one reason telemedicine is becoming a hot topic away from the Wasatch Front.

The county's suburban communities, with their cul-de-sacs and lack of access to walkable shopping, are largely designed for automobiles rather than an 85-year-old woman on foot. If they don't have someone to take them places, the frail elderly are effectively trapped in their yards.

"If we don't make changes to those communities, those who can afford it will move, and those who are left behind will be those who are the greatest burden to the community," cautions Sheldon Elman, associate director of Salt Lake County Aging Services.

Salt Lake County will be hardest hit. Predictions say 46 percent of Utahns 85 and older will live in Salt Lake County by 2050.

On a personal basis, too, Utahns are often in a state of confusion, says Utah Commission on Aging director Maureen Henry. "For the boomer generation, there are huge gaps between what they think they need and what they actually need. Twenty percent think they have pensions they don't have."

Not only that, but "many think Medicare offers long-term care," and are counting on it, adds Dr. Mark Supiano, executive director of the University of Utah Center on Aging. And very few have purchased long-term care insurance.

Although there are more frail people overall, most of them are that way for a relatively short time. But that may change, experts warn. The so-called obesity epidemic bodes ill because it carries so many health problems, from increased risk of Alzheimer's to diabetes and heart disease.

"We're all going to be dealing with more and more frail people. We're going to have to prioritize the most frail with the dollars we have," says Peter Hebertson, director of outreach for Salt Lake County Aging Services.

About 50,000 Utahns have some type of dementia, including 30,000 with Alzheimer's, according to a 2004 study in the journal Neurology. Barring the arrival of miracle drugs, Utah is predicted to see the largest increase in the nation —127 percent between 2000 and 2025.

Three factors combine to create that number: a faster increase in the number who are old-old, in-migration of the elderly to places like St. George that some states are not seeing, and a younger population that has room to age.

States like North Dakota have more old-old residents, but they're already old as a population, so the percentage is not increasing, says Dr. Norman Foster, professor of neurology at the U. and director of the Alzheimer's care and research center.

As a state, Utah doesn't even have the data it needs to plan for its aging population, says Henry. We don't know, for example, what percentage of Utahns over 80 end up in long-term care in a nursing home. We don't know what kind of care is being provided by families. And some of the data we do have about "seniors" lumps 60-year-olds together with 90-year-olds, not differentiating whether someone is healthy or not. "Our attempts to plan very quickly come to a halt because of a lack of data."

That may change. One hopeful sign locally is the brand new Wilford W. and Dorothy P. Goodwill Humanitarian Building that opened last month at the U. In the College of Social Work, it will house several agencies serving the elderly.

Senior centers are already trying to change to meet the future. They've been caught between serving the older meat-and-potatoes crowd and the younger olds who prefer a salad bar, and food is just one of the generational differences.

The "old-old" love ceramics and craft classes, while the younger-olds are more interested in tai chi and computer classes. Hard as it is to stay relevant now, administrators agree that if they don't change with the populations they're serving, they may not even exist in 2028.

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