As Delaware’s population gets older, a significant question emerges: Will the state get wiser in how it confronts the demographics of aging?
“We’re losing ground, and we’re not keeping pace with the growth in aging,” said Melissa Smith, a planner with the state Division of Services for the Aging and Adults with Physical Disabilities, during a recent online workshop on demographics hosted by the Delaware Population Consortium and the University of Delaware’s Institute for Public Administration.
The program, titled “Delaware in 2040 – Demographic Changes and the Impacts on Infrastructure,” was designed more to provoke thought than to provide answers, with many of the questions raised focused on healthcare for the state’s growing senior population and housing, both for seniors and for those who will have to care for them.
Ed Ratledge, director of the university’s Center for Applied Demography and Survey Research, offered a succinct synopsis for why the workshop was important. “People are living longer, and there are a lot of them,” he said.
But the issues raised during the two-hour session referenced age groups other than seniors – primarily younger adults and even students who will have to step up to fill an increasing number of healthcare jobs needed to serve individuals who will need even more care with every additional year that they live.
Understanding the concerns starts with a look at Delaware’s population basics, and even that requires a bit of caution. Birth and death rates change every year and so do migration patterns, Ratledge said. The state’s Latino population is growing two to three times as fast as its African-American population, while the White population is slowly declining. “What these groups will look like in 10 years is hard to deal with,” he said.
Aging, by the numbers
While the estimates are subject to change, the numbers used for planning purposes are the ones published by the Consortium last October. Here are some comparisons of the state’s 2040 population projections with actual figures from 2020.
Total state population is projected to increase by 9 percent, from 992,508 in 2020 to 1,081,837 in 2040.
The most significant increases show up in the older age groups. The 85 and up population would more than double, from 23,196 to 48,565. The 65 and up population would increase by more than 41 percent, from 190,427 to 269,248.
But the picture is significantly different in the lower age brackets. The population in the 25 to 54 group – people in their prime working years – would increase by a little more than 6 percent, from 374,257 in 2020 to 397,899 in 2040. And there would be no population growth at all among Delawareans aged 24 and under, holding steady at just under 290,000.
This creates a problem for the labor force and for healthcare, Ratledge says. As people age and leave the labor force, there aren’t enough people in the lower age groups to replace them.
“This will go on for the next 20 years,” Ratledge says. “When we say that the labor market is tight, it’s not because of the economy. The demographics are driving this.”
Healthcare demographics
Aging is a topic that many people don’t want to face head on, said Smith, the Division of Aging planner. “Aging is not death and dying. Aging is the next phase of your life.”
The statistics show the changing face of Delaware’s population, and Delawareans must realize that “the same old services are not going to [adequately] serve the people who need them,” she said.
The impact of aging on that tight labor market creates a double whammy in the healthcare industry, with the pool of older individuals needing more healthcare increasing much more rapidly than the size of the workforce needed to provide those services.
Going into the COVID-19 pandemic three years ago, the state was already facing a shortage of healthcare workers, and burnout, illness and stress experienced during the pandemic reduced their numbers even more, said Tim Gibbs, executive director of the Delaware Academy of Medicine and the Delaware Public Health Association. Both nationally and locally, those numbers are starting to return to pre-pandemic levels, but that’s still short of current and future needs, he said.
And today’s healthcare workers will continue to experience the stresses that led them to quit during the pandemic. “The exhaustion of the healthcare workforce is real,” he said. “They’re dealing with chronic diseases, with cancer, with death.”
"The exhaustion of the healthcare workforce is real. They’re dealing with chronic diseases, with cancer, with death.”Tim Gibbs, executive director of the Delaware Academy of Medicine and the Delaware Public Health Association
Delaware has been taking steps – some for many years – to attempt to build a viable healthcare workforce.
“If you want to have a new doctor in 2040, that person was probably born in 2013 and would now be in the fifth grade,” Gibbs said. That puts these young people on track to graduate from college in 2034, then moving on to medical school and internships.
“The educational process is lengthy. What we do now [to promote careers in the health professions] will impact what we have in 2040,” he said. “It’s not like we can call Amazon and have them [new doctors] delivered to us.”
A report issued last year by the Delaware Academy of Medicine and the Delaware Public Health Association gives reason for concern. A table in that report looks at the birth years of licensed physicians in the state. It shows, on average, that there are about 140 M.D.s born each year in the 1960s, indicating, roughly speaking, that there will be about 140 retirements per year in the next decade. For M.D.s born in the 1970s – likely retirees at some point in the 2030s or early 2040s – it’s about 150 M.D.s per year. However, for birth years after 1986, there are fewer than 120 licensed M.D.s born in those years. In other words, there will be more doctors retiring than starting to practice medicine in the state at a time when an aging population will need more frequent care.
However, Gibbs notes, the situation is less traumatic than those numbers suggest. The healthcare workforce has been changing dramatically in recent years, with nurse practitioners and physician assistants stepping into the gatekeeping roles (and sometimes specialty areas) once handled by family and primary care physicians. That trend is likely to continue, Gibbs says.
Promoting healthcare professions
Delaware has a variety of programs that encourage or steer its students into the health professions.
Since 2009 the Delaware Academy of Medicine and the Delaware Public Health Association have offered the Delaware Mini Medical School, a program for middle and high school students (and adults as well) consisting of six sessions discussing trends in medicine. The sessions went virtual in 2021 and are now offered six times a year.
The 20-plus Career Pathways programs in the state’s public schools include three with healthcare themes: Allied Health, Nurse Assisting and Public and Community Health. Each program offers a sequenced curriculum that enables high school students to earn professional certifications, up to nine college credits and experience in work settings. The college credits help students transition into healthcare majors at Delaware Technical Community College, Delaware State University and Wilmington University. Vocational-technical high schools in the state also offer healthcare career programs.
At the post-college level, the Delaware Institute for Medical Education and Research (DIMER) and the Delaware Institute for Dental Education and Research (DIDER) have agreements to reserve seats for Delaware students at two medical schools and one dental school in Philadelphia. Currently those schools admit 54 Delawareans a year – 49 to medical school and five to dental school.
While DIMER and DIDER increase the odds of Delawareans being accepted at the participating schools, the programs do not require Delawareans to return to the state to practice. However, the schools have created branch campuses and residency sites in Delaware, helping to create a pipeline that brings new doctors and dentists to the state, Gibbs said.
Also, for 30 years, the Delaware Academy of Medicine has administered a loan program for medical and dental students from the state. The loans – $4,000 to $15,000 per year – are interest-free until the student graduates. An expanded program, added this year using funding through the American Rescue Plan Act (ARPA), provides loans of up to $15,000 per year for Delawareans studying at Delaware institutions of higher education to become nursing and physician assistants, medical and dental assistants, and various behavioral health professionals. These loans remain interest-free if the students work in an approved Delaware healthcare position after graduation.
Housing concerns
The continuing construction of communities serving the age 55-and-up population raises another set of questions for planners to consider, participants in the online workshop said.
A related point, especially as it refers to healthcare, Gibbs said, is the need for affordable housing for workers in hospitals and clinics, especially in eastern Sussex County, a popular destination for recent retirees moving from other states.
The county’s 65-plus population is projected to grow from nearly 66,000 in 2020 to more than 91,000 in 2040, a 40 percent increase. As Ratledge and Gibbs noted, the growing aging population will need more healthcare, which translates to more workers who will want to live near their jobs.
“Affordable housing for the healthcare workforce is essential,” he said. “There are a lot of people working at Beebe [Healthcare, in Lewes, and its satellite campuses] who are living in Kent County or in Maryland.”
David Carter, a New Castle County councilman who represents the Middletown area, raised a similar concern relating to his community during and after the workshop. Much of the new housing being built near Middletown consists of 55-plus communities and subdivisions of larger homes – residences that he says are often out of the price range of the teachers, police officers, paramedics and healthcare workers needed to provide essential services.
Carter’s concern goes beyond the short-term need for more affordable housing for younger workers in these service occupations.
What happens, he wonders, when the residents of today’s 55-plus communities die? In many cases, homeowners’ association rules restrict the ages of who can live there. What if the resident doesn’t have an heir age 55 or older, or if that heir doesn’t want to live in that community? Will there be vacancies? Will market values decrease?
“When we segregate portions of the population with intentionality, there can be unintended consequences,” Gibbs said. He suggests that developers of these communities, as well as the government agencies that must approve their construction, review their policies with an eye toward preventing unintended consequences from having a negative impact.
With their smaller footprint and smaller yards, vacant units in 55-plus communities might work well as starter homes for couples and small families without significantly changing the neighborhood’s overall ambiance, Carter said.
“We’ve got to look at the changes in housing, changes in the number of one-person households. These are concerns that could be explained in much more detail,” Carter said. “It’s something we have to start talking about.”
