Virginia's coalfields are losing residents at an alarming rate

The population in Virginia’s coalfield's region is dropping at an alarming rate, with Buchanan County down 51% from its peak in 1980, writes Jim Branscome at Cardinal News, which covers Southwest Virginia.

Virginia’s seven Central Appalachian coalfield counties collectively lost 7,208 residents between 2020 and 2025, according to the U.S. Census Bureau.

Buchanan County had the biggest five-year loss of them all at 9.1%, among the worst in the entire 60-county Central Appalachian area, Branscome adds.

Buchanan County had the largest five-year change in population of the seven Virginia coalfield counties. (Chart via Cardinal News, data from the U.S. Census Bureau, Click to enlarge)

The two main factors working together to create the alarming trajectory for Virginia’s coalfields are people leaving the region and the number of deaths exceeding the birth rates, Branscome writes. 

The median age in Buchanan County has almost doubled since 1980, from 26 to 47, Branscome reports. While the county is projected to lose 48% of its current population by 2050, its current annual rate of decline shows this loss occurring closer to the late 2030s, adds Branscome.

A 'Nursery to Nursing Home' campaign for a rural Wisconsin community could help the well-being of children, older adults

Members of Groundswell Collective advocate for their 
'Nursery to Nursing Home' campaign (Photo The Yonder)

In Walworth County, Wisconsin, a local community group called Groundswell Collective proposed to turn a vacant wing of the county’s nursing home into a combined childcare center and senior-living space, reports Madeline de Figueiredo for The Daily Yonder.

Like many rural communities, this county has faced challenges such as a lack of child care and senior care, as well as the loneliness and isolation that can come with living in a rural area with long winters.

Abriana Krause, who lives and works in the area as a childcare provider, told the Yonder, "In Walworth County, all 2,240 licensed childcare slots, spread across the 35 active centers listed on the DCF [Department of Children and Families] website, are already full. That leaves nearly 2,680 children without stable care." Similarly, Wisconsin is projected to need 33,000 long-term care beds by 2030.

To support their proposal, the Groundswell Collective has relied on research that shows the benefits of intergenerational care, such as "boosting the well-being of both children and older people, reducing isolation, improving cognitive and physical health for older people, and cultivating empathy and connection in young children," Figueiredo explains. Intergenerational care has also been linked to dispelling age stereotypes and a renewed sense of care that affects entire communities and fosters lasting relationships.

Research also shows that the benefits intergenerational spaces offer can "extend to the caregiving staff," Figueiredo reports. "Daily interaction with both children and older adults can enhance the work environment and make intergenerational centers more rewarding for staff." There’s hope that this initiative will help the county retain nursing staff.

After almost a year of the community organizing around the proposal, the Walworth County Board approved funding in November for a feasibility study on the intergenerational care center.

Analysis: Nursing home patient capacities have shrunk, with rural areas posting the greatest decreases

Rural areas had the greatest declines in available nursing
home beds since 2019. (Pixabay photo via Medical Express) 

Despite the rapidly aging U.S. population, nursing home capacity has shrunk nationwide since 2019. According to Sadie Harley for the University of Rochester Medical Center, a recently published study in JAMA Internal Medicine showed that 25% of U.S. counties "experienced decreases in the number of supported nursing home spots by 15% or more," with rural areas reporting the greatest declines.

The dwindling number of nursing home placements for older Americans translates into "nearly 4,000 fewer beds available for new patients each day," Harley writes. "But this decline was not felt by all communities equally. It varied widely across geographic regions, with rural counties more likely to face declines of 25% or more."

Rural communities are already grappling with fewer physicians, hospital closures and strained emergency medical services. The loss of nursing home spots presents another challenge, leaving more rural residents with few other options than to travel farther for ongoing care.

Within the U.S. medical system, nursing homes provide vital care to seniors who need regular medical treatment but don't require the expertise of hospital services. They also offer interim care for patients leaving the hospital who aren't yet ready to care for themselves at home. Harley explains, "The reduction in nursing home capacity was linked to longer hospital stays, especially extended stays of 28 days or more."

The decline in nursing home care spots isn't a reflection of the number of beds a facility has. Harley adds, "This study estimated nursing homes' operating capacity by taking other resource constraints into account." Study author Brian McGarry, told Harley, "The facility may not have the staff or other resources to fill every bed."

Flora & Fauna: Masked bandits evolve; 2-purpose turkeys; foraging stats; whales' aging secrets; birds can help farmers

Perhaps one day, urban raccoons will be pets.
(Adobe Stock photo)

Racoons are masked, cute, and affectionately known as "trash pandas," and they are proving to have a real knack for evolving to live alongside humans, reports Axios. "The same evolutionary forces that turned wolves into domesticated dogs over thousands of years may now be reshaping urban raccoons, recent studies suggest." Marcie Logsdon, who works closely with wildlife rehabbers, told Axios, "Raccoons have adapted incredibly well to our presence. . . [They are] bold enough to raid garbage cans but polite enough" to avoid altercations with people.

An agrivoltaic 'trial flock' enjoys solar panel shade.
(Photo by Evan Carpenter, Offrange)

These turkeys have it made in the shade as they peck and strut under solar panels, unwittingly being prepared as a holiday dinner while also participating in a "dual-use agrivoltaic system," reports Jake Zajkowski for Offrange. Evan Carpenter, who is raising the "trial flock," will share bird and energy outcomes with "project collaborators United Agrivoltaics and Cornell University, to study the feasibility and business model of Carpenter’s project to scale dual-use income land."

In the Mid-Atlantic forests of the U.S., researchers Amy Wrobleski and Eric Burkhart explored regional fungi foraging and shared some of their findings with The Conversation. "We learned that harvesters use the mushrooms primarily for food and medicinal purposes. . . . Over 800 harvesters reported that, collectively, they foraged 160 species of wild mushrooms. . . . Morels and chicken of the woods were the two most popular. . . .Other popular species were hen of the woods, oysters, lion’s mane, black trumpet, honey mushroom, turkey tail, bolete, reishi, puffball, chaga, shrimp of the woods and Dryad’s saddle." Mid-Atlantic fungi can be found here. 

Bowhead whale and calf (NOAA Fisheries photo)

At full-grown, a bowhead whale can weigh 88 tons, which is roughly the weight of 15 elephants. But that's not the only outrageous bowhead fact -- the whale can live to be 268 years old. "Some whales caught in the late 1900s had old harpoon points lodged in their blubber that dated to the mid-1800s," reports Carl Zimmer of The New York Times. "A study published in the journal Nature offers a clue to how the animals manage to live so long: They are extraordinarily good at fixing damaged DNA."

K4 Ranches photo

When it comes to raising cattle, a horse is a rancher's best friend. "Using horses to check and gather cattle is typically the only option with rugged terrain," reports Maddy Rohr for Drovers. Diamond A Ranch, a division of K4 Ranch in Arizona, employs a large crew with seasonal cowboys and eight camps with full-time cowboys." Sarah Kieckhefer of K4 told Rohr, "A good horse can go where a pickup, ATV or side-by-side can’t. Horses can cover long distances and a horse allows you to move quietly, ease cattle along and reduce stress, which leads to fewer wrecks and better weight retention.”

Photo by Mike Wagner via Reasons to be Cheerful

American rice grower Mike Wagner welcomes thousands of migratory ducks, geese and shorebirds that "arrive on his farmland after harvest every autumn," writes Elizabeth Hewitt for Reasons to be Cheerful. "Over winter and early spring, the birds clean up leftovers from the growing season. Thousands of webbed feet mix up soil and water, leaving the fields ready for planting when they depart in the spring. And their droppings are so rich that Wagner has cut how much synthetic fertilizer he needs for his crop by more than a third."  

Long-term care facilities face immigration crackdown and looming Medicaid cuts

Jackline Conteh is a nursing assistant in Va. She emigrated 
to the U.S. from war-torn Liberia. (KFF News photo)

Long-term care facilities call for immigration reform and push against Medicaid cuts as the sector faces "a double whammy from President Donald Trump’s crackdown on immigrants and the GOP’s proposals to reduce Medicaid spending," reports Jordan Rau of KFF Health News. "More than 800,000 immigrants and naturalized citizens comprise 28% of direct care employees at home care agencies, nursing homes, assisted living facilities, and other long-term care companies."

While labor shortages are not new to the eldercare sector, once the Trump administration canceled the industry's "protected" status in January and allowed Immigration and Customs Enforcement to raid health care facilities, the dynamics changed. Katie Smith Sloan, president of LeadingAge, an association of nonprofits that care for older adults, told Rau, “People may be here on a green card, and they are afraid ICE is going to show up."

The long-term and senior care industries are "urging the federal government to expand legal immigration channels for essential workers in healthcare and other sectors," reports Kimberly Bonvissuto of McKnights. "The Essential Worker Immigration Coalition sent a letter to Homeland Security Secretary Kristi Noem that [said] the shortage of legal immigration channels for essential workers 'threatens the stability of our supply chains, the viability of small businesses and the strength of the American economy.'"

Besides additional staffing shortages brought on by immigration issues, long-term care facilities continue to lobby against the Republican party's Medicaid spending cuts, which passed the House and are under Senate review. Rau writes, "Federal spending cuts under negotiation may strip nursing homes of some of their largest revenue sources by limiting ways states leverage Medicaid money and making it harder for new nursing home residents to retroactively qualify for Medicaid."

Given the current issues, providers, patients and employees all have reasons to be concerned. "The long-term care industry expects demand for direct care workers to burgeon with an influx of aging baby boomers needing professional care," Rau writes. Jackline Conteh, a U.S. nursing assistant originally from Liberia, told him, "If all these people leave the United States, they go back to Africa or to their various countries, what will become of our residents? What will become of our old people that we’re taking care of?"

Report: Social Security trust fund needs attention now if it's going to stay viable past 2034

If changes aren't made, the Social Security trust fund 
will run out of money by 2034.  (Adobe Stock photo) 

Social Security benefits play a vital role in communities nationwide; however, rural areas may be more dependent on the program because their populations skew older. Regardless of region, 73 million Americans currently depend on the program’s monthly payments; however, its 2025 Trustee Report indicates that the program needs attention to meet its expenses, reports Gopi Shah Goda for Brookings.

The report outlines how the Social Security trust fund will run out of money by 2034, and will "no longer be able to make all of its promised benefit payments," Goda explains. According to the report, the shortfall will continue to grow since the program lacks sufficient payroll taxes to cover its ongoing and predicted future costs.

"The shortfall amounts to 3.82% of taxable payroll, meaning that the payroll tax rate would have to be raised immediately—and permanently—from the current rate of 12.4% of taxable earnings to 16.1% in order for the program to be able to pay all promised benefits through 2099," Goda writes. "In 2025, that increase would have amounted to an extra $374 billion in program revenue."

Even if the Trump administration were able to eliminate all Social Security fraud, overpayments and any other human error costs, it would not compensate for the billions needed. "Even this unrealistic, pie-in-the-sky scenario would only yield 'savings' of $10.2 billion per year, barely moving the needle in terms of the program’s $1.48 trillion annual cost," Goda adds. "Social Security is already a lean operation."

Cutting more Social Security staff members would likely result in reduced services and even longer wait times for disability determinations. Goda writes, "It is very likely that any additional cuts in staffing will make it harder for Americans — particularly the most vulnerable — to access benefits they have earned, with dire consequences."

While there are solutions, few are likely to be popular. "There is no free lunch. . .changes would involve difficult tradeoffs between beneficiaries and workers as well as current and future generations," Goda writes. "Policy options that raise revenues include increasing the payroll tax rate or broadening the income base to which that the payroll tax is applied. . . . .Cutting benefits across the board, raising the retirement age at which a beneficiary is eligible for full benefits, reducing benefits disproportionately for higher earners. . . .Some action will be necessary within the next decade."

Quick hits: A 'new' Robert Frost poem; the penny's top advocate; the little farmer from the Super Bowl ad

The newly discovered poem by Robert Frost was written
in Amherst, Massachusetts, in 1918. (Adobe Stock photo)

Laced with nature, deep and succinct -- Robert Frost's poems are a rich read. And it so happens, there's a previously unpublished poem by Frost to enjoy, reports Jay Parini for The New Yorker. "I opened “Nothing New” and saw at once that it was indeed something new. It was originally inscribed inside a copy of Frost’s second collection. . . that was found in a retired educator’s home library. . . It’s a good poem, short and aphoristic, from a period when Frost, writing at the height of his powers, had a special affection for poems of this kind: brief, rueful, tight, focused."

Taking truckloads of books to rural hither and thither after Hurricane Helene became this traveling librarian's mission. "In the 1930s, women employed by the Works Progress Administration rode pack horses through the mountains of eastern Kentucky, bringing books to rural residents in hard-to-reach places," reports Anya Petrone Slepyan of The Daily Yonder. "Nearly a century later, Kirsten Crawford Turner is carrying on that tradition, with the help of a truck and a U-Haul rather than a horse and saddle bags." Turner told Slepyan, "It started with one box of books on my porch. Now I have thousands." 

Weller would like to give every American
a penny for their thoughts. (A.S. photo)

 

Almost everyone despises pennies. "Except this guy," writes Joseph Pisani of The Wall Street Journal. "Mark Weller has been on a roll for three decades, arguing for the one-cent coin’s existence every chance he gets. When the penny is slighted in newspapers, it’s Weller who writes letters to the editor." Weller runs a pro-penny group and he keeps Congress abreast of all the benefits the penny affords. "He’s been to Capitol Hill countless times to convince Congress to keep the penny, which the U.S. Mint has been producing since 1793."

Fake meat is made of plants, which people are encouraged to eat. But it's also an ultra-processed food, which people should avoid. What's the low-down? Alice Callahan of The New York Times reports, "Here’s what we do — and don’t — know. . . . While it’s clear that eating red meat and processed meat is associated with health risks like heart disease, some types of cancer and earlier death, we really don’t yet know how fake-meat alternatives might affect our health in the long term."

Else M. Rike still uses a calculator
to do taxes. (Adobe Stock photo)

Even if you love your job, would you do it if you lived to be 100? Probably not. But that's not true for everyone. "Else M. Rike will be 101 years old on March 24 but doesn’t expect to take a day off to celebrate. She will be too busy preparing tax returns," reports James R. Hagerty for The Wall Street Journal. "Active tax professionals over 90 years old are rare but can be found here and there. . . .William D. Brew, who lives in Henderson, Nev., and will be 102 in March, continues to prepare taxes for a handful of clients. . . Wes Cobb, 94, a retired IRS agent in Keene, N.H., invites clients to spread out their tax materials on his kitchen table."

She's the Little Potato Farmer who could. She's also a little famous after a Super Bowl ad spotlighted her family's potato farm, which grows potatoes for Lay's potato chips. Her father, Jeremy Pavelski, is a fifth-generation farmer from Hancock, Wisconsin, reports Tyne Morgan of Farm Journal. "The Super Bowl commercial . . . was inspired by Pavelski’s story, after he hosted a farm tour for Frito Lay one day." Morgan adds, "The group was especially touched by Pavelski’s 7-year-old daughter, who is passionate about the potatoes her family produces."

Quick hits: Small-town murder mysteries; slower mail for rural residents; a new hearing aid; Halloween night skies

Rossif Sutherland and Kristin Kreuk star in the new Global/FOX series 'Murder in a Small Town.' (Global TVvia IMDb photo/The Daily Yonder)

There's nothing quite like small-town murder tales to get people glued to their television screens week after week. "The latest TV series on FOX puts its own spin on a genre that has stood the test of time," reports Keith Roysdon of The Daily Yonder. "We haven’t yet reached the point where it’s become obvious that something is very, very wrong in the town of Gibsons . . . . 'Murder in a Small Town' is good, dependable murder-of-the-week television, probably not dissimilar to how 'Murder, She Wrote' was perceived for most of its run."

In Lancaster County, Penn., Democrats see an opportunity even though the county typically votes Republican, "the demographics are shifting here and throughout the state," report Campbell Robertson and Robert Gebeloff of The New York Times. "Pennsylvania is arguably the most pivotal state in the election, carrying 19 electoral votes, the most of the so-called swing states. After voting for the Democrat in every presidential election going back to 1992, the state went for Donald J. Trump in 2016 by less than a percentage point. Joe Biden won in 2020, by a little over a percentage point."

Jim and Sharon Erwin enjoy the natural beauty of
 Gunnison, Colo. (Photo by Jim Erwin via WSJ)

As baby boomers head into retirement, some choose to resettle in rural places for reasons that range from cutting costs to living closer to natural attractions. "The move to remote mountain and lake areas is helping reverse a long decline in the rural population. From April 2020 to July 2023, the rural counties retirees flocked to grew 4% versus less than 1% for rural America as a whole," report Anne Tergesen and Veronica Dagher of The Wall Street Journal. 

If slower is cheaper, is that OK? That depends. "The U.S. Postal Service is moving forward with a plan to slow down delivery for a relatively small portion of mail, telling its regulator the changes would save nearly $4 billion annually and better reflect the evolving nature of mail usage," reports Eric Katz of Route Fifty. Advocates for rural residents say the change will disproportionately affect mail delivery and pickup in more remote areas. Liz Carey of The Daily Yonder reports, "The plan would eliminate evening mail pickup in rural and remote areas, which could affect delivery times for areas that are more than 50 miles from a large USPS regional processing facility."

Apple's AirPods Pro 2 with hearing aid feature
(Apple photo via Wired)

Over-the-counter hearing aids seemed like a "cheaper and more accessible [solution] for people with mild to moderate hearing loss. Instead, people are returning them at high rates," reports Julie Jargon of The Wall Street Journal. "Doctors lauded the move as a solution for over 20 million American adults who have hearing loss that isn’t severe enough to warrant expensive prescription devices. In reality, many go for $1,500 to $2,000 . . . . The struggles come as Apple prepares to release a potential game-changer — a software update that will turn its popular, $249 AirPods Pro 2 into hearing aids."

This year's spooky season will be topped off by rarely-seen cosmic visitors. "In the days leading up to Halloween, Tsuchinshan-ATLAS, also known as Comet C/2023 A3, will be at its brightest, and likely visible to the naked eye. . . just look to the western sky shortly after sunset. As the days pass, the comet will get fainter and move to a higher part of the sky," reports James Wray for The Conversation. "The second comet, C/2024 S1 (ATLAS), should be visible around the end of October. The comet will pass closest to Earth on Oct. 24 – look low in the eastern sky just before sunrise. Then, after swinging around the Sun, the comet may reappear in the western night sky right around Halloween."

In rural towns with shrinking populations, residents can help seniors age at home by teaming together to serve

Kyla Sanders wears many hats serving Glen Ullin's
aging population. (Photo by Tim Evans, NPR)

Glen Ullin, North Dakota, was once a bustling railway town, but as the town aged, its population steadily declined, leaving many older residents in need of extra help from fewer people. "Adults age 65 and older make up a third of Glen Ullin's roughly 700 residents," report Juliana Kim and Tim Evans of NPR. "The town's retired teachers, accountants and health care workers are making every effort to age at home, but one big obstacle for them is the ability to access medical care — without it, they are often forced to move to a larger city."

While rural populations skew older, the number of citizens available to help each other varies. Glen Ullin residents are working together, so the town's seniors get care without moving. Kim and Evans explain, "Each person plays a separate role — from keeping lonely older adults company to springing into action when a health emergency arises. In rural towns experiencing a loss of people, jobs and resources, this network of support can make a big difference."

The state's new pilot program "Aging in Community" is helping Glen Ullin and other towns address seniors' needs. Kyla Sanders is the program coordinator and her job is actually a lot of jobs. NPR reports, "Her list of responsibilities changes every day — from setting up internet at an older person's home to leading a flower arrangement class for a group of seniors to helping an older adult apply for Medicaid."

Location of Glen Ullin, N.D.
(Wikipedia map)

Glen Ullin's local nurse practitioner, Rhonda Schmidt, and EMT volunteers are also dedicated to helping the town's older residents live healthy, full lives at home. "On a regular day, Schmidt sees somewhere between 15 and 20 patients," Kim and Evans write. Lori Kottre "may work 9 to 5 as the office manager at Glen Ullin's nursing home, but she serves around the clock as the town's emergency responder."

For rural areas, having enough medical workers isn't the only barrier to helping seniors thrive at home. "Loneliness can have detrimental effects on physical health, including increased risk of heart disease, stroke and dementia, according to a report from the U.S. surgeon general," NPR reports. In Glen Ullin, the Rev. Gary Benz "spends his weekdays traveling to the homes of his aging parishioners who are too ill or weak to attend services. . . . Initially, the purpose was to bring them Holy Communion, but he quickly learned that they needed something else — connection."

Some of rural Virginia is getting younger; three years of Census data supports a steady trend

This map shows where age 25-45 population has increased from
2020 to 2023. (Map by H. Lombard, from Census Bureau data)

As more younger people move into Virginia, communities that were once watching young people leave or avoid their regions are seeing population growth. "The net in-migration of younger adults has been significant enough that the median age has now fallen in 35 Virginia localities," reports Dwayne Yancey of Cardinal News. "Most of them are rural, and most of them are in Southwest and Southside."

A longitudinal review of U.S. Census data reveals who is moving in, and in this case, it's not retirees. "In much of rural Virginia, we’re seeing an increase in the number of young adults, part of what appears nationally to be a post-pandemic trend to move out of bigger cities," Yancey explains. Three years of data support this shift. "In 1980, there wasn’t much difference in the median ages among localities in Virginia. . . . By 2019, every locality had gotten older but. . .new data that shows since the 2020 census, some localities have gotten younger."

While the shift in numbers isn't huge, it's significant because the overall net shows a trend of younger people making rural Virginia home. Yancey reports, "Virtually every locality is seeing its 65 and older population grow. . . as the huge baby boom generation ages. . . [And] most places have seen their population of ages 25 to 45 grow. . . . working-age adults in the main years for getting married and having families. Overall, though, the state is gaining people in the 25-45 cohort; it’s just not gaining them in the biggest metros. Instead, they’re going to rural areas."

 These communities are getting younger.
(Map by H. Lombard, from Census Bureau data)

Rural Virginia is still aging and remains the oldest in the state; however, "The state's two biggest metro areas, Northern Virginia and Hampton Roads, are facing unprecedented demographic challenges that should concern all of us," Yancey adds. "Rural areas depend on our state's metro areas to generate the revenue that subsidizes rural schools, for instance. . . . Much of rural Virginia is now seeing a demographic renaissance." Danville and Martinsville, Virginia, were "given up for dead when textiles, tobacco and furniture collapsed," but have had surprising recoveries.

The U.S. is in the middle of a 'silver tsunami' as the country is becoming 'the land of the senior citizen'

As America ages, more citizens will require unique
care from multiple sectors. (Adobe Stock photo)

As millions of Americans enter their mid-60s, the country is fast becoming "the land of the senior citizen," where government agencies and systems are busy working to accommodate an aging population. "More Americans are about to be 65 years old than ever before. A record number will hit the milestone this year—about 4.1 million. But it's just one of many waves in the 'silver tsunami,' a metaphor often used to describe the aging of America," reports Susan Miller of Route Fifty. "Since 2011, 10,000 Americans have been turning 65 every day, a trend that the Pew Research Center says will continue through 2030." The need for aging accommodations for rural residents may be particularly needed since its population already skews older.

As the number of older residents increases throughout the United States, health care, housing and transportation systems will need additional resources to meet senior needs. To help states support the transition, the Department of Health and Human Services issued a report outlining supportive measures for aging Americans. Miller explains, "It details the web of services an aging society will need beyond financial security, safe housing and adequate health care. . . . The framework comes as several states have also started planning for their aging populations."

Some states have already created programs aimed at helping aging Americans. "New Jersey released its 'age-friendly blueprint,' which provides strategies and best practices to improve the state’s communities for older adults and enable people to remain in their homes and communities as they age," Miller reports. "The state is also putting some funding behind its plan. . . . [Its] Human Services Department is dedicating $5.5 million to launch an age-friendly community grant program later this year."

Other states are developing 10-year plans, also known as "multisector plans for aging," which outline "restructuring state and local government to address the needs of older adult populations," Miller writes. "According to the federal strategic framework, four states have legislation or an executive order to develop an MPA, and seven are in varying stages of implementing plans."

When relatives want to age at home, family caretakers struggle with two jobs. It's more difficult for rural residents.

Responsibility for aging family members can take a toll
on home caretakers. (Adobe Stock photo)

A growing number of Americans are working two jobs: one to pay the bills and a second unpaid job caring for an aging family member. "The double shift can come at a career cost. Caregivers who are also working full-time report turning down promotions or seeking less-demanding assignments," reports Clare Ansberry of The Wall Street Journal. "Some switch companies or say they've had to choose care duties over their careers." Even if the older relative still lives independently, the juggling still can be taxing.

In rural communities, aging residents prefer to have family members care for them, but they have additional challenges. "Like older adults across the country, rural seniors tend to want to age in their communities, amid familiar people and places," report Martha Hostetter and Sarah Klein for The Commonwealth Fund. "But with fewer health care providers, fewer professional caregivers, and fewer young people than in urban areas, rural communities struggle to care for aging residents."

Both rural and urban families struggle to balance elderly care with life's other duties. "An estimated 29 million workers, from senior managers to retail clerks, work while also caring for an adult family member, according to research by AARP and the National Alliance for Caregiving," Ansberry writes. "Care demands on workers are growing because people are living longer with chronic illness. . . . A large share of people want to age at home but need lots of help from family members to do so."

Many companies don't offer eldercare options, so employees often have to sandwich in a loved one's medical appointments during breaks and use vacation time. "Some working caregivers have been called in to talk with their bosses about performance. Others say they haven't used a vacation day for an actual vacation in years," Ansberry reports. "Tensions can run high between employees and employers over caregiving."

Rural communities are working on ways to help residents get to appointments and social events without solely relying on family members. "St. John's United, a member of the Rural Aging Action Network, provides senior housing in and around Billings, Montana," Hostetter and Klein report. "In 2019, St. John's launched 'At Home' services for clients living in their own homes. This monthly subscription service is offered on a sliding scale and provides seniors with rides to medical appointments, help with household tasks, social outings, and other supports."

For information on aging in place and what creative solutions and resources exist or can be cultivated, click here. 

These centers offer specialized care for aging adults that allows them to live at home instead of in nursing homes

PACE centers offer multiple types of care under one
roof. (National PACE Association photo)

As people age, most don't want to live in nursing homes. But when faced with extensive medical needs, many older adults end up in institutionalized care. While some older adults may need that degree of attention, a lesser-known option known as PACE (Program of All-Inclusive Care for the Elderly) is gaining popularity as a cheaper, healthier alternative to nursing homes. "PACE has long flown under the national radar as an elder care option," reports Anna Claire Vollers of Stateline. "PACE centers provide government-funded medical care and social services to people older than 55 whose complex medical needs qualify them for nursing home care, but who can live at home with the right sort of help."

Given the preference of most individuals and their families to avoid nursing homes, considering a PACE center is a logical step. Vollers writes, "By 2030, one in five Americans will be over age 65, and most older adults say they would prefer to remain living in their homes for as long as possible. . . . . [The program has] recently attracted significant interest from lawmakers because it can keep people at home and may cost less than nursing home care."

The PACE model offers companies and health care systems a way to meet clients' health needs without lengthy inpatient stays. Each center provides a range of medical treatments, including physical therapy, vision and dental care, counseling and lab work. Centers also offer opportunities to get out of the house and socialize by providing a dining hall for meals and gathering areas for puzzles and games. Vollers reports, "Center social workers can help clients obtain needed items such as walkers and at-home wheelchair ramps."

Robert Greenwood, senior vice president for communications and member engagement at the National PACE Association, told Vollers, "It's definitely gaining momentum. In the last couple of years, we've had maybe six or seven new PACE programs open a year. In the last couple of months, we've had about four PACE programs open each month. There are 50 organizations in the pipeline for the next two years."

So far, PACE centers have had bipartisan support. Vollers reports, "Tennessee state Rep. Caleb Hemmer, a Democrat representing Nashville, and state Sen. Bo Watson, a Republican representing Hamilton County (which includes Chattanooga), are cosponsoring legislation that would expand PACE across the state." Hemmer told Stateline, "Even I was amazed when I visited. You walk in, and it’s nice and clean, it smells good, and there are activities for people. It’s a place I would want to send a loved one.”

For examples of PACE care in rural communities, click here and here.  To discover more about PACE, click here.

Private equity-owned health care is guided by expansion and profits; many are calling for more regulation

As Americans age, the home health care sector will
continue to grow. (Photo by G.A. Pflueger, Unsplash)

Home health care businesses may go by nurturing names, such as "Senior Helpers" or "At Home Angels," but the much industry is funded by private equity investors looking to make hefty profits, reports Anna Claire Vollers of Stateline. "Proponents of private equity investment in health care say the infusion of capital helps smaller companies expand into new markets." But skeptics point to places where care companies suddenly pulled out of entire regions when profits waned, leaving elderly people at home with no care.

Private equity-owned health care companies exist to make money for investors. "Private equity firms pool investments from pension funds, endowments, sovereign wealth funds and wealthy individuals to buy controlling stakes in companies," Voller explains. "In health care, critics say, that business model can diminish the quality of care, increase costs and narrow access for patients — particularly in more lightly regulated industries such as home care and hospice care."

Home health care is an appealing business venture because it doesn't face the same level of scrutiny as hospitals and nursing homes, the profit margins are robust, and there's an aging population where "around 10,000 baby boomers turn 65 every day," Voller reports. There will be "millions of people who will need care in the coming years," which will guarantee strong business growth. Plus, insurance companies encourage their customers to use home health care, which again, bolsters profits.

Even with all those benefits, private equity firms tend to pile debt on their companies to fund expansion. "Private equity firms typically aim to acquire a company and boost profits before selling it within five to seven years," Voller reports. "They often purchase companies with borrowed money, using the company's assets as collateral for the loans."

Mary Bugbee, senior research and campaign coordinator for health care at the Private Equity Stakeholder Project, a research and advocacy group, told Voller, "We leave a lot to the whims of the market and allow private players to dictate access to and quality of health care."

State policy and lawmakers are looking at home health care companies as businesses needing more regulatory oversight. "Improving transparency, requiring certain health care staff-to-patient ratios and boosting wages for health care workers can also help protect patients and communities," Voller reports. 

Opinion: To prevent holiday loneliness from setting in, follow this 5-step 'prescription'

Intergenerational contact helps lessen loneliness.
(Washington Post illustration, iStock)

The holidays can be a source of joy and celebration, but for many people the time is marked by severe loneliness and depression. With some inspiration from the U.S. Surgeon General's 5-for-5 connection challenge, Dr. Trisha Pasricha gives her 5-step "prescription to combat loneliness during the holidays" in her medical opinion for The Washington Post.

Day 1: Reach out to a former mentor and thank them.
I was recently at a wedding reflecting with others about all the teachers, friends and colleagues who have no idea how much they meant to us. Would they find it strange that we messaged them simply to express gratitude? I called my high school French teacher. She was as delighted as she was delightful. I found out she had retired but still loved to volunteer at my old school. She couldn't believe I was a physician. Today, thank someone. . .  .and tell them how they influenced your life for the better.

Day 2: Join a group activity.
Whether you go into it with a friend or alone, sign up for a group activity to do for a few weeks. Get a ClassPass for aqua aerobics, plan a month of yoga in the park, or find a neighborhood book club. Choose something that gets you outside the house for part of your day. And if you're debating what to give someone this holiday, consider gifting an activity you'll do with them. It opens the door to a new community and is more valuable than any pair of cozy socks.

Day 3: Call a relative or friend you haven't spoken to in a while.
On my last birthday, a widowed uncle I've honestly never had much contact with called out of the blue to wish me happy birthday. It became one of the loveliest conversations I had that day as he asked all about my kids, and I learned he had an adorable new dog. Now, he and I text every month. Today, think about someone you've drifted away from and wish them a happy holiday season.

Day 4: Ask for help.
Reflect on some of the areas in your life where you could use more support. Ask your grandmother to walk you through your favorite recipe and teach you tricks in the kitchen one-on-one. Or ask the neighbor's kids to help you walk or play with your dog. You get bonus points if you make a bridge with someone from another generation. There have been many studies on intergenerational contact to improve loneliness. For children, such opportunities lead to higher self-esteem, better academic performance and improved social skills. For adults, they reaffirm value and lead to greater life satisfaction in addition to other mental health benefits.

Day 5: Tackle screen time.
It's hard to give up screens entirely. But at your next meal, try this compromise. Put all the phones in a basket on the table and schedule a 30-second phone check for later in the meal. Using your phone during a face-to-face gathering not only reduces conversation quality but lowers your own enjoyment of time spent together.

What I want my patients to know.
The public health costs of loneliness are clear. In one meta-analysis, loneliness increased the odds of early mortality by 26 percent. Depression as a consequence of loneliness is linked to heart failure and even getting a cold. Loneliness modulates stress hormones, contributing to low-level inflammation and gene expression.

The people at greatest risk of loneliness are adolescents and older adults, those with poor physical or mental health, people living alone and single parents. Seek help if you are struggling during the holiday season and talk to a trusted friend, family member or physician, or call or text the 988 crisis line, which provides 24/7, free and confidential support for people in distress.

Opinion: Growing old includes the good, the bad and the unexpected

Illustration by Lauren Martin, The New York Times

Aging can be filled with experiences you never wanted to have, often failing to live up to past expectations, muses 83-year-old Roger Rosenblatt in his opinion piece for The New York Times. Humorous highlights are condensed below.

"Old age isn’t what the books promised it would be. Literature is littered with old people for whom the years have brought some combination of wisdom, serenity, authority and power — King Lear, the ageless priest in Shangri-La, Miss Marple, Mr. Chips, Mrs. Chips (I made that up), Dickens’s Aged P, crazy Mrs. Danvers. In fiction, old folks are usually impressive and in control. In life, something less.

"I can’t think of anyone who has come to me for wisdom, serenity, authority or power. People do come to sell me life insurance for $9 a month and medicines such as Prevagen, which is advertised on TV as making one sharper and improving one’s memory. Of course, that is beneficial only to those who have more things they wish to remember than to forget.

"One thing I need to remember is which day for which doctor. . . . On one day last week, I had a vascular sonogram in the morning, consulted my ophthalmologist in the afternoon, made an appointment with a retina specialist, spoke to my primary care physician about test results and put off my dentist. As a result of such activities, my vocabulary has increased. I now can say 'occlusion' — and mean it.

"I wrote a book called Rules for Aging 25 years ago. . . .The rules were less about aging than about living generally, one of the first being 'Nobody’s thinking about you.' . . . In old age that’s true in spades. . . . You disappear from the culture, or rather, it disappears from you.

"To be sure, old age has compensations. Grandchildren. Their company is delightful, partly because they think you have something useful to impart, if you could remember to impart it. Waitresses tend to treat you sweetly. Doormen and maintenance crews show respect. And there are positive or harmless activities for the over the hill. Women take up watercolors and form book clubs. Men find loud, if pointless, camaraderie in diners and on village benches all over the country. Hey, old-timer.

"My point is: Who ever expected to spend time wondering if Madison Beer is a beverage honoring a founding father? Who ever expected that one’s social circle would consist of Marie, who does blood work, and an M.R.I. technician named Lou? Who ever expected old age?"

American farmers are getting old, and there aren't enough younger farmers to replace them

Lack of younger farms means aging farmers have to work
  harder. (Photo by KT Kanazawich, The Washington Post)

American farming has a problem -- its labor force is aging, and there's no clear pipeline to fill the eventual need. "The average American farmer is 57 and a half years old, according to the most recent data from the Department of Agriculture. That's up sharply from 1978, when the figure was just a smidge over 50, report David R. Buys, John J. Green and Mary Nelson Robertson for The Conversation, a platform for journalism by academics. "As researchers who study well-being in rural areas, we wanted to understand this trend and its implications. So we dug into the data."

"We found that the average age of farmers was fairly consistent across the country, even though the general population's age varies quite a bit from place to place," the researchers write. "For example, the average Maine farmer is just a few months older than the average farmer in Utah, even though the average Maine resident is more than a decade older than the average Utahn." Their data also showed a countrywide trend of "amber waves of gray" and noted that if farmer recruitment or industry adaptations aren't implemented, America's food supply could be at risk.

Buys, Green and Robertson asked, "Why is this happening?" They cite several barriers younger would-be farmers face, including how much money it takes to start a farm, agricultural consolidation, and the profession's overall stresses from weather to politics.

The lack of younger farmers increases workloads for current farmers. Researchers explain, "Without younger people to leave the work to, farmers are left with intense labor — physically and mentally – to accomplish, on top of the ordinary challenges of aging. . . . The U.S. needs to increase opportunities for younger farmers while also supporting farmers as they age."

The good news is that the USDA already has some programs within the Farm Bill designed to "aid new farmers, as well as farmers of color and female farmers, and those who operate small farms," Buys, Green and Robertson explain. The upcoming Farm Bill could expand those programs to "help bring new talent into the field. . . . The farm bill also includes nutrition aid and funds for telehealth training and educational outreach for farmers, all of which could help meet the needs of young and aging farmers alike. Notably, the Cooperative Extension Service offers programs that range from 4-H and youth development, including introduction to agriculture, to providing on-site technical help."

Researchers point to the 2024 Census of Agriculture, which will provide "new insight into America's farming workforce. We expect it will show that the average age of U.S. farmers has reached a new all-time high." 

Aging populations and too few skilled workers has 42 states offering 'stay and we'll help you pay' student loan options

Mandy Dwinell opted to stay in Vermont.
(Photo by Oliver Parini, Hechinger)

States with aging populations are enticing skilled workers to stay in their state by paying down their student loans. "At least 42 states have enacted student loan repayment or forgiveness programs since 2018, according to the National Conference of State Legislatures," reports Jon Marcus for The Hechinger Report, which covers education. "Almost all of them are for professionals in specific areas of shortages — mostly teaching and healthcare — or who agree to work in underserved areas.

Jamie Kohn, senior research director for the human resources practice of the Gartner consulting firm, told Marcus: "Generally, there is a massive shortage of talent, particularly in certain skilled talent areas. Student loan repayment may be a way for states to mitigate some of the loss of wage growth that people are feeling, so they not only stay, but can afford to start families and buy houses."

Using student loan repayment options gives states latitude in targeting the types of skilled workers they need. For instance, in Utah, "Doctors, dentists and pharmacists who work for at least three years in underserved areas can get up to $75,000 of their student loans paid off," Marcus reports. "South Carolina will pay off up to $5,000 per year of student loans for teachers. Illinois will help repay the student loan debt of school social workers."

Maine and Vermont are states with some of the nation's oldest populations. Vermont has had a series of private colleges close that were once reliable conduits bringing in "young people there who put down roots and stayed," Marcus explains. "That leaves a smaller population of graduates, a decline that's beginning to happen nationwide and that can result in labor shortages, slower economic growth and declines in state tax revenues. Unemployment in Vermont is just 1.8 percent, third lowest in the country after New Hampshire and Maryland. Maine has projected a need for 75,000 more workers in the 10 years ending 2029."

"Two years didn't seem too much to ask from recent grad Mandy Dwinell, either — especially in exchange for help repaying the $20,000 student loan debt she racked up in a college career interrupted by family obligations. She now works for the Vermont Association of Snow Travelers. She told Marcus: "When I was in high school, I'm, like, as soon as I graduate, I'm out of here, I'm not looking back. . . . [But now] I absolutely love it here!"

Opinion: In a country obsessed with youth, how can America face old age?

New York Times illustration

In a little over a decade, America won't be a beacon of youth and strappy upstarts. It will be old. "By 2034, there will be more Americans over the age of 65 than children. . . . It's time to prepare," advises The New York Times editorial board in its opinion piece, "Can America age gracefully?"

"Thanks to falling birthrates, longer life expectancy and the graying of the baby boomer cohort, our society is being transformed. This is a demographic change that will affect every part of society. Already, in about half the country, more people are dying than being born, even as more Americans live into their 80s, 90s and beyond. In 2020, the share of people 65 or older reached 17 percent, according to the Census Bureau. By 2034, there will be more Americans past retirement age than children.

"The challenge the country faces transcends ideology, geography and ethnic or racial category, and American leaders, regardless of their party, need to confront it with the appropriate urgency. . . . Places like Japan, with the highest proportion of people 65 or older in the world, offer a hint of what the near future might look like for America. In Japan, especially in rural areas, schools shut their doors because there are no longer enough children to fill them; births fell below 800,000 in 2022, and about 450 schools close every year. With fewer young people working, revenue for retirement programs is shrinking, and there is a chronic labor shortage. Japanese people increasingly work into their 60s, 70s and beyond, often in physically demanding but low-paid jobs such as making deliveries and cleaning offices."

A country with a significant aged population has particular needs, but American politicians and policy writers need to be faster to address the shift. The Board writes, "The strains are showing in everything from health care and housing to employment and transportation. With an average of 10,000 boomers turning 65 each day, these pressures are steadily intensifying and will continue to do so, especially if current immigration policies hold. . . . By 2053, more than 40 percent of the federal budget will go toward programs for seniors, primarily Social Security and Medicare . . . .

"A demographic shift this significant calls for a broad-based response, and the longer the challenges go unaddressed, the more formidable they become. . . . There are many pieces to this puzzle, including who will care for older people, where they will live, how our cities are designed and how businesses will adapt. Many older people in the United States say they feel invisible in a country that has long been obsessed with youth, avoiding the inevitability—and possibilities—of old age."

Ageism is one form of bigotry that doesn't seem to get old

OPINION by Gary Abernathy, for The Washington Post

Because of my online Post photo — which I try to keep current — it has become increasingly common for people annoyed by my views to respond not by addressing the merits, but by simply calling me an “old white guy,” as if that made their point. Just recently, a reader emailed and referred to me as “an elderly white boy.” Elderly? Yikes.

Gary Abernathy (PBS image)

In fact, I’m thrilled to be the age I am. I’ve never enjoyed life more. Society’s change in attitude toward me — based strictly on the passage of time — is noticeable and striking, but not too personally disturbing. I’m glad I was young when I was and not now; I worry about my children and grandchildren navigating their way through this contentious world.

I realize that while I’m more fortunate than many — still able to pursue a career and enjoy a rewarding life with loving family and friends — in too many cases, the United States, compared with other cultures, holds its aging population in contempt. Too often, “old people” here are regarded as useless, helpless or a nuisance, left to wind down the clock as they stare out the window, a lifetime of experiences, work, achievement and sacrifice forgotten.

While we rightly ostracize, deplatform or even “cancel” people for their racism, antisemitism, xenophobia, homophobia and other prejudices, ageism is openly practiced, and ageist stereotypes thrive. Examples in the news abound. A TV crime story from April involving a 74-year-old North Carolina woman reported that “a grandmother” was the victim of a carjacking and also referred to her as “elderly.” In a more tragic case, ABC News recently reported on the fatal stabbing of an Atlanta woman whom it pegged as a “77-year-old grandmother.”

Both women most likely adored their grandchildren, but in neither case were those offspring part of the story. Maybe these women could have been defined by other, more pertinent life achievements. But because they were over a certain age and apparently their children had borne children, their status as “grandmothers” became their primary identifier.

Many of the most common insults leveled against President Biden are age-related. Granted, as president his mental acuity will be scrutinized, as was that of other older presidents such as Donald Trump and Ronald Reagan. But the mocking tone underscoring many of the jokes and memes is nothing short of cruel.

How should we respectfully refer to old people? I’ve seen people 60-plus still refer to themselves as “middle aged,” but let’s be a little more realistic and cut that off at least by 59. The word “old,” however, is such a pejorative that it should not be used alone. “Older person” is preferable. I hesitate to use “elderly” at all, which implies not just old age but a feeble condition. I’ve always despised “senior citizen” and references to the “golden years.” How ‘bout “best people ever?” That’s good.

But more important than terminology is how we regard older Americans in general. We should all be able to take a good-natured joke, whether about our age, our appearance, our background or our beliefs. But the rampant practice of ageist bigotry should join all the other “isms” and “phobias” as unacceptable, especially when it crosses the line from friendly ribbing to cruel attacks.

I’m going to add that to my list of causes. Right now, though, this 66-year-old grandfather is going to hit the couch for an afternoon nap — an “old person” stereotype I happily embrace.

Gary Abernathy is a retired rural newspaper editor from southern Ohio.