Driving slowly down a suburban block on the outskirts of Casper, Renee Penton Jones, a local hotelier, grips the wheel and counts the numbers of the pastel-colored homes that line the street.
Without breaking her gaze, she parleys with her co-pilot, Karin East, and confirms the address — No. 91 — and pulls the SUV to the curb, arriving at roughly the same time that every driver on the Paradise Valley Meals on Wheels route has every morning, every weekday, for years.
With the repetitive nature of the route, some get very used to drivers arriving at a certain time. And if you’re late, said Penton Jones, a six-year veteran of the program, “they’ll let you know.”
“We had a couple, they’re usually one of our first stops,” she said. “They seemed pretty independent — they just ordered the food as a convenience for themselves. Then, one year, the wife died. And so you see him deteriorating, now that she’s not there anymore. He’s one of the ones who gets very frustrated if we’re late.”
With years of experience in the neighborhood, they know the characters, and all of their quirks, but the neighborhood is always changing. With every stop, they consult the map — a black-and-white printout with their route drawn up in pink highlighter — and match the meals to the names on a chart, each with a distinct description of the homes they’re going to hit. One woman is on oxygen and is slow to answer the door. Another man has a dog, though the chart doesn’t say whether the dog is aggressive or nice, big or small. Some people would prefer you don’t bother them at all and drop the food off in a cooler in the garage.
Today, there are just nine stops on the route. At times, though, there have been as many as 26 houses in the neighborhood listed on their chart. They’ve delivered meals on Christmas Eve together, pushing down the route through driving snow to deliver a holiday meal, pre-packaged and prepared several miles away. Some of the people they deliver to are just looking for convenience, maybe an elderly couple who no longer want to drive or cook. Others live alone and receive meals not just for nutrition, but peace of mind.
For many of the people they’ve checked in on over the years, the arrival of Meals on Wheels is the only visit from another human being they’ll get all day. And in that narrow window of time where volunteers deliver meals, they can see snippets of lives that are slowly but steadily deteriorating. In the worst cases of diminishing health or neglect, volunteers can call their supervisors, who can then call professionals to help them out. But many sit alone, waiting for their delivery before waiting out the day in solitude.
What the folks on the Meals on Wheels routes see only hints at a greater social issue that has been fermenting for decades across rural communities like those in Wyoming: social isolation among senior citizens.
Loneliness: a public health issue?
Across the United States, senior citizens are increasingly having to face their golden years in isolation. Of the nearly 33 million Americans living alone today, more than one-third of them — 12.5 million individuals — are over the age of 65, an 18 percent increase over 2010, according to 2017 U.S. Census Data.
While of universal concern, this issue is particularly heightened in Wyoming, where an aging population and a sparsely populated landscape present their own set of problems. Across the state, many senior citizens — far-flung from population centers — can go days without quality human contact. With nobody to rely on for transportation, doctor’s appointments get missed and nutrition and personal hygiene go neglected.
“One of the things we’re really beginning to understand is that social isolation is different from just being alone — it’s a lack of meaningful contact,” said Dr. James Bush, medical director for the Wyoming Medicaid system. “You can have someone come and just drop off a meal and leave, but if you don’t feel like you have a means of connection, that can have a significant effect. We really try and talk about the quality of social interaction as well as the quantity of social interaction.”
The impacts of senior isolation have the potential to create a serious liability to the state’s public health. A study by professors Julianne Holt-Lunstad and Timothy Smith of Brigham Young University found that prolonged social isolation is as harmful to health as smoking 15 cigarettes a day and has been linked to higher blood pressure, greater susceptibility to infectious diseases and earlier onset of dementia.
Isolation also means increased vulnerability. Senior citizens, particularly those with nobody to rely on, are more susceptible to abuse or exploitation. According to the National Council on Aging, one in 10 Americans over the age of 60 can expect to experience some sort of elder abuse, potentially increasing their risk of death by 300 percent.
“When people become isolated and vulnerable, they can then be exploited by younger people — like their adult children, sadly,” said Bush.
Aging alone on the frontier
It’s not difficult to find solitude in Wyoming, a state defined by vast, empty plains and dotted by isolated communities. Many towns count populations in the triple digits. Some might even have a dozen or fewer people, their name on the map established years ago more or less as a means to get the mail.
Almost all of these communities — particularly in the most rural parts of the state — are growing older.
According to figures released last month by the Wyoming Department of Administration and Information’s Economic Analysis Division, the proportion of the population older than 65 in the state’s most rural counties were significantly higher than the state average: around 15.8 percent. In Niobrara and Goshen Counties, nearly 22 percent of the county’s population is over the age of 65. One in four residents of Platte County are over the age of 65, and in Hot Springs County nearly 26 percent of its residents are senior citizens — a number that is expected to grow with the 17 percent of its population currently between the ages of 55 and 64.
In a state where geographic isolation often clashes with the fierce independence of its people, the risks of going it alone become particularly sharpened. Long in possession of one of the nation’s highest suicide rates, Wyoming’s suicide rate among those aged 65 and older is alarmingly high, making up 20 percent of all suicides in the state and coinciding with the phenomenon of increasing suicide rates seen in rural areas throughout the country.
According to the most recent figures from the Wyoming Department of Health, while suicide rates among people aged 65 to 69 were among the lowest across the state — 20.1 per 100,000 people — the rate of suicide increases sharply as people age. For ages 70 to 74, the suicide rate jump to 25.6 per 100,000 people, rising to a rate of 30.8 at the ages of 75 to 79.
The highest suicide rate in the entire state is for those between the ages of 80 and 84, where it goes up to 42 cases per 100,000. At 85-plus, the rate again decreases — to 36.2, just under the rate of 36.8 seen between those ages 40 and 44.
Broken down by county, the rates are often significantly highest in the state’s most “frontier” counties like Platte, Niobrara, Crook, Converse, Sublette and Fremont, said Bush, the Wyoming Medicaid medical director. However, those rates vary widely; frontier Goshen County, for instance, has one of the state’s lowest rates for senior suicide.
“It’s a real problem,” Bush said. “A lot of it has to do with isolation — you talk to physicians and they always talk about the old rancher, all by himself on the ranch and his physical ability has gone down, and then one day he goes out to the barn and shoots himself. They’re too proud to seek help; they’re too afraid of feeling like a burden ... the manifestations are isolation and increased frailty.”
Bridges to the outside world
Across Wyoming, the main combatants of isolation for seniors are oftentimes volunteers — like drivers for Meals and Wheels and workers at the local senior centers, said Tom Lacock, associate state director for communications and state advocacy at AARP Wyoming.
In Casper, Barb Summers presents the perfect example of the type of volunteer relied upon by groups like the AARP and Meals on Wheels. Eternally cheerful and energetic for 76 years of age, Summers volunteers roughly 40 hours a week for a number of groups in the community, including a local Rotary Club, Meals on Wheels and Casper’s AARP Community Action Team, a group responsible for all of the group’s local outreach efforts.
Every once in a while, Summers helps to host a program called “Movies For Grownups,” where anyone 50 years of age or older can see a movie for free and meet other people their age. The Community Action Team has done events with the local minor league baseball team as well, hosting free tickets, brats and beer for anyone looking to get out of the house. Then there’s the local senior center, which offers a multitude of activities from games to educational sessions on topics like personal health to computer literacy.
While effective, there are still swaths of people the programs cannot reach, either by a lack of access, a lack of transportation or other issues, such as medical problems. Physical appearance can be another limitation, Summers said, remembering several members of the community she works with who are self-conscious about the way they look — be it a scar, missing teeth or an amputation — and do not want to be seen out in public. Many on the fringe might not even have the means to engage with the community, lacking a phone, computer or even a newspaper, which some might find too costly, making them even more difficult to reach.
“Even getting the word out to some of those folks is nearly impossible unless it’s one on one,” Summers said.
The Hot Springs County Senior Center in Thermopolis, the seat of Wyoming’s most senior county, serves a critical civic function with a client base that is countywide. Many older adults who come in for the first time are often greeted by familiar faces once they come in, said Trenda Moore, the center’s director, and once they see what the place has to offer, they often come back.
“If you can get them in here, you’re friendly and glad to see them and let them know what we can do for them, then they’re more likely to come back,” she explained. “But that’s a hard nut to crack. You’ve got to earn their trust, and show them we don’t just serve you a hamburger; we take care of you.”
When isolation is so ingrained in the identity of a place, tracking down and identifying those in need of help is often the most difficult piece of the equation. While programs like Meals on Wheels can provide a point of contact to the outside world for many people, a lack of resources and an abundance of demand make those programs insufficient to address loneliness on their own.
The biggest barrier, Summers said, is trust — something not easily earned by strangers.
“I think the families have the best shot at getting people out,” she said. “Or close friends. But strangers… I guess we have to rely on those people (families and friends) more than outsiders. They trust them. You have to have trust.”
“We also have to know if they want us to help,” Summers added. “To say I’ve got the answer — ‘I’m government and I’m here to help’ — that’s a joke I’ve always heard, but when you’re imposing on people, even though you’re going to offer them something, it’s still an imposition. Some people just don’t want to answer the door. I guess when you have a meal for them, they’ll answer it more readily.”
On the back end, funding problems are a major part of the equation, both in terms of social and medical need.
Federal grants — which finance a substantial share of local senior centers’ budgets — are often prohibitively onerous, with so many requirements and regulations attached to them that some agencies may choose to forego the money.
“Some providers — there’s a lot of strings attached to federal dollars — and a few centers don’t take those dollars so they don’t have to adhere to those requirements,” said Lisa Osvold, director of the Aging Division of the Wyoming Department of Health. “Quite frankly, they may not just have the staff and support to administer the requirements of those.”
In places like Hot Springs County, where resources are limited and the need is significant, this means a situation where donations, not federal money, can be the most sustainable source of revenue, and the best way to get people in.
“I don’t know how you say it, but bigger and better donations are appreciated,” Moore said. “It’s crucial we reach everybody out there who cannot come in, because we don’t know their needs until they do come in.”
Funding cuts from lawmakers at the state and local level have further limited in-home services across the state. During the 2017-18 legislative session, the Wyoming Home Services program — a state-funded grant program that provided in-home services to nearly 2,000 at-risk seniors last year — had its budget cut by roughly $931,000. Meanwhile, local funding for the program — which accounts for one-fifth of the total cost — has fallen about 113 percent since 2016, further straining services.
Conversely, there’s the potential that a significant number of the state’s neediest are currently not being served. According to statistics from the Wyoming Department of Health, roughly 28,000 unique individuals received some form of services through state and federally funded programs last year — approximately 21 percent of all citizens aged 60 and older.
Even if the reach of programming is extended, many organizations may be unable to meet the need.
“One of the providers once told me it’s a double-edged sword,” Osvold said. “We want to get people in, but because of the lack of funding for the feds and the state budget cuts, it’s a challenge, because you also know you need the funding and resources to support them. You want to do outreach and you want them to come in, but you have to know you don’t have the resources you need to serve.”
In the long term, the lack of preventative care could result in an unpredictably high cost to the state. With populations at their current levels, Wyoming paid $138 million last year for long-term care. By the year 2030, that number will be between $312 million and $380 million per year, a figure that could be exacerbated by the increasing number of young people leaving the state.
“Between now and 2050, we’re looking at a 277 percent increase in the number of people aged 80 and over,” Lacock said. “But we’re also anticipating a 5 percent decrease in the number of people under 65. And that’s a huge deal for any number of reasons, not for the least of which that 45 to 65 year age span tends to, most commonly, be the family caretaker for grandpa, grandma and their neighbor or loved one who is 80 and over. So if we’re losing that population under 65 that’s generally providing those caregiving services ... that has big implications for the state going forward.”
“There’s no silver bullet here,” he added. “Obviously, more money wouldn’t hurt, but that’s no silver bullet.”
In many communities, volunteers are the glue that holds the state’s senior services together.
“It takes the help of a lot of local, involved people to make things happen,” said Tanya Johnson, Associate State Director for Outreach at AARP Wyoming. “They’re going to be the ones doing the lifting and the advocating to help make this change happen.”
But many of the volunteers are on the precipice of needing those services themselves. In Casper, considered one of the state’s best communities for seniors, many of the roughly two dozen volunteers in the AARP community action team are senior citizens, while Meals on Wheels has a significant number of elderly drivers. One daily volunteer, executive director Jamie Loveall said, is pushing 80 years old and still completes regular shifts for the organization.
Summers, meanwhile, has tried to recruit more members to the group, but has had difficulty. She said only about half of them are reliable, and new members are difficult to attract. While her group holds a meeting every month, retaining members has also been difficult. She’ll often bake something “to try and keep ‘em coming back,” she says, but that hasn’t always been effective.
“Maybe next time we’ll have pizza and beer,” she jokes. “Maybe that’ll bring ‘em back.”
“It’s kind of difficult,” she said. “I think that’s true everywhere. Like Kiwanis, our group is dwindling, and we can’t find anybody to replace them. We’ve heard that from Rotary, we’ve heard that from all volunteer places. It’s almost like volunteering is a lost art, and we’re so sad.”
Senior care is expected to be among the most significant topics addressed by state lawmakers in the 2019 interim session, with lawmakers expected to examine everything from the high cost of caring for the state’s seniors to the diminishing number of home health aides across the state, who are often overworked and underpaid for the demands of the job.
“We have some numbers on it, but we are anticipating the state will actually lose population of those 40 and under in the next several years, while we see the age 85 and over rising dramatically,” Lacock said. “This is a perfect storm for increased long-term care costs because the family caregivers who have, in past generations, taken care of their family members simply aren’t in Wyoming anymore. That will put a huge burden on the state to step in and support those who are at the tipping point of either needing institutionalization or would ordinarily live with family.”
The state has suggested telehealth could be an option to meet some of the gaps, solving the problem of Wyoming’s remoteness — a “small town with long roads” — by turning the physical community into a metaphysical one. In Cody, neurologist Alan Gee has been working on potential remote care options through his facility called Wyoming Living Labs, a place for companies across the country to test telehealth technology in small sample sizes.
“If it works in Wyoming, it’ll work anywhere else in the world,” Gee said. “With the remote nature of the state and the challenges that come with it, it’s a great test bed for innovation. So right now, I’m working on building a way to find out what works.”
Technology, however, has its limits. Human connections are important, Lacock said, and ultimately, it’s human beings — not just funding or innovation — that are needed to solve the problem.
“We can throw money at this all we want,” Lacock said. “But if there’s nobody to do the job, that’s a big problem.”