PIKEVILLE — Even as population trickled out of many rural and Appalachian counties in Kentucky, the numbers of people 65 and older kept growing, according to 2010 U.S. Census data released Thursday. The aging of baby boomers is not a trend that's new or unique to rural Kentucky, but the fact that the overall population has shrunk in many rural counties makes the trend more pronounced.
In 12 of the 36 counties whose overall population declined since the last census in 2000, the 65-and-older population increased by double digits. In Menifee County, for example, the overall population declined by 3.8 percent to 6,306, but the number of people 65 and older grew by 30.2 percent, to 1,005.
That differs from urban counties such as Fayette, which saw growth in all age categories. Fayette County still saw the most growth in 65-and-older, at 18.9 percent, but the 5-and-younger group was right behind, at 18.6 percent growth.
"What you're seeing is the population loss in East Kentucky was basically the population under age 45," said Ron Crouch, statistics and research director for the Kentucky Education and Workforce Development Cabinet.
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Migration of the working population in search of jobs is a factor, but a lower birthrate in Eastern Kentucky is an equal force, Crouch said, as well as the birth boom between the Great Depression and World War II.
"What you'll find is ... it's really that 75-plus group that is growing," he said.
Crouch said he saw the trend as an opportunity for growth in health care employment. He said his office has analyzed data that shows increasing average wages in the Eastern Kentucky health care industry.
Hospitals and health care providers have planned and invested for that aging population, said Chris Hoffman, chief operating officer for Floyd County's Highlands Regional Medical Center.
Many Eastern Kentucky hospitals, including Highlands, have recognized that access to care is a problem for older people, so satellite clinics away from the home county help funnel people into the hospital system. And the mix of services has changed as there is less demand for birthing and obstetrics, for example, and more demand for cardiology and other age-related chronic disease care.
Nearly half of Highlands' in-patient population is 65 and older, Hoffman said.
As the working-age population in rural Kentucky counties has shrunk, it has become harder to recruit medical providers, especially for specialized fields, Hoffman said. And as the government pressures Medicare to cut costs, getting payment for services for the aged is difficult.
"We're treating more but getting less," Hoffman said.
"It's harder for health care organizations to survive. It creates a much tougher environment for a rural hospital than for an urban health care system," he said.
To the Frenchburg-Menifee County Chamber of Commerce, an aging population means building up tourism to keep the local economy going.
"I know we are becoming more of a retirement community," said chamber Executive Director Lola Thomas whose business is a cabin rental called Pine Tree.
The chamber has received a grant to refurbish and build trails and a bridge at Broke Leg Falls, which used to be a state park. The county is about halfway between Cave Run Lake and Red River Gorge National Recreation Area.
There is no hospital in the county; the closest are in Morehead or Mount Sterling.
"Most of the people have to go out of the county to work. The board of education would be the largest employer," Thomas said.
"It would be nice to have a hospital in the county. I can't see that happening any time soon," she said. "We would greatly benefit if we had a new road coming into the county."
Frenchburg is about 18 miles on a small winding road from Interstate 64.
The population changes are hitting not only counties in Appalachia but also in rural Western Kentucky. Hickman County lost 6.8 percent of its population over the past 10 years but its 65-and-older number grew by 4.8 percent.
It makes it harder to recruit employers to the county, said Judge-Execuitve Greg Pruitt. The number of available workers is reported by county, so when a prospective employer looks at the numbers, it appears Hickman County doesn't have a pool of available workers.
"Creating jobs and recruiting industry, it's a major factor there," he said.
Another challenge: Most rural counties have volunteer fire departments. As the population ages, it becomes more difficult to keep those staffed.
There also is an issue with the so-called "homestead exemption," which gives people over 65 a break on their property taxes. The state sets a tax rate for each county that allows them to raise the same amount of money as the year before, but with more older people getting the exemption, the remaining taxpayers pay a greater share.
The growth in the elderly population could mean some opportunities to provide health care, but there are fewer doctors in rural areas. In many places, health services are concentrated in regional centers such as Paducah. Hickman County has a clinic and two full-time doctors, but no hospital.
There also is a concern over adequate funding for services for senior citizens, such as meal deliveries. Most funding for that comes from the state and federal governments. The concern is that those funds could be cut because of the state and federal budget problems, even as the population ages in many places.
A few years ago, when gas prices spiked, the program to deliver meals to older people in the Hickman County region switched from delivering five hot meals a week to delivering four and one frozen meal. The drivers would leave the frozen meal on a day when they took a hot meal (so the recipient could prepare it later), dropping one day from the delivery schedule to save money.
The downside of that was that in some cases, it probably meant no one checked on those people on the day the driver didn't come.
"We've got to be careful with the senior citizens programs," Pruitt said.