More and more these days, when Fairfax County paramedics respond to emergency calls, they find an older person who has fallen, broken a bone or suffered a heart attack.
In Maryland's most populous jurisdiction, Montgomery County, authorities are investigating an increasing number of elder-abuse cases and crimes targeting senior citizens. In Chicago, New York City and elsewhere, more money is being allotted to government buses that take seniors to exercise classes and social workers who help families at a loss for how to care for aging loved ones.
Rising demand for services for the elderly is taking a toll on local governments, as communities nationwide seek to accommodate a growing senior citizen population while still tending to schools, roads, parks and other needs.
By 2030, 1 out of 5 U.S. residents — a total of 70 million people — will be 65 or older, according to population estimates. At the same time, federal funding for senior citizen programs has decreased by about 19 percent since 2010, to just less than $8 billion, according to the National Association of Area Agencies on Aging. It is expected to shrink further under President Trump.
Policy experts say battles over spending, services and zoning will only worsen as baby boomers enter into stages of greater dependency, creating a headache for local budget officials whose constituents already feel taxed to the limit.
"If you have to build schools and you also have to add more transportation and senior centers for older adults, where does the money come from?" said Howard Gleckman, a senior fellow at the Urban Institute who writes about tax policy and elder care. "It's a very hard question to answer."
Fairfax County, Virginia's largest and most economically powerful jurisdiction, embodies the challenge many local governments face. The two fastest-growing age groups in the county of 1.1 million are schoolchildren and people older than 65. The elderly population is expected to grow from 135,000 to 172,000 over the next eight years.
A Washington Post review of 13 agency budget reports showed that services for seniors has helped drive up spending by about $43.8 million since 2014 — nearly 10 percent of the county's overall spending growth during that period. Some of that money went to initiatives created through the Fairfax 50-plus Community Action Plan, which focuses on transportation improvements, affordable housing and social programs to help elderly residents age in place.
At the same time, the County Board of Supervisors denied or trimmed funding requests for employee raises, police reforms and education, and voters resoundingly rejected a meals tax to generate new revenue for the fast-growing school system.
"We need to make sure that folks can continue to live within the community where they raised their families," said Sharon Bulova (D), the board's chairman. "But we're also doing so at a time when we've had the Great Recession and have had to make reductions across the board in all the services we provide."
The Fairfax County Fire and Rescue Department is on pace to exceed 100,000 emergency calls this year — 10,000 more than in 2014. People age 65 or older represent 40 percent of the volume. The agency's budget has grown nearly 19 percent in the past four years.
In 2016, the department began staffing a paramedic on every fire engine and ambulance, to better deal with severe emergencies such as cardiac arrest or car crashes. It also launched a program to encourage elderly residents to keep their medical histories readily accessible inside vehicle glove compartments or posted on their fridge.
Dorothy Carter, 83, had not done so when county firefighters and paramedics showed up outside her Annandale apartment one morning this past summer. The former nurse's aide had been gardening when she tripped and fell. By the time her roommate found her, she'd been laying in the hot sun for more than five hours, with bits of mulch clinging to her hair.
"I'm sorry," Carter muttered while emergency workers helped her sit up.
"No, ma'am," paramedic Steve Urban replied. "Don't be sorry. I'm here for you."
Carter was loaded into an ambulance and taken to a hospital, where she was treated for high blood pressure.
Elderly slip-and-fall cases are a huge concern as senior citizens become less mobile, officials say. That has contributed to a rising demand for assisted-living centers and nursing homes. In Fairfax and elsewhere, proposals for new or expanded facilities have sparked major zoning battles and concerns over the cost of and effect on roads, sewers and other services.
"The vast majority of people want to stay in their communities as they age, but many of those communities weren't designed for that," said Rodney Harrell, a public policy director at AARP. "We've spent decades, and maybe even centuries, not planning for aging and designing for aging."
Paramedics have seen some extreme cases, such as the 66-year-old man they found dead near his bed in Springfield earlier this year, apparently of cardiac arrest. His bedroom was filled with paperwork and junk-food cartons. On the bureau were three large plastic cups of urine — a sign that the home's occupant had not left the room in days.
John J. Kenney, chief of Montgomery County's Aging and Disability Services program, said officials there are worried about a rise in financial crimes against seniors and a lack of affordable housing for them in an era of shrinking resources.
"There is always this competition in trying to establish what our priorities are," Kenney said.
Fairfax's Division of Adult and Aging Services, which connects elderly residents to county programs and operates a hotline for seniors and their caregivers, has increased its budget by $986,000 since 2014.
Last year, the hotline took in nearly 17,000 calls, up from 15,400 in 2013. They varied from pleas for Medicaid assistance to arranging rides to doctor's appointments and setting up in-home care. Calls to the hotline led social workers to open 2,714 cases for adult protective services, which applies to people who are no longer able to function independently.
"He was drinking and cut his foot?" social worker Bonita Stokes calmly asked one harried apartment manager whose tenant, age 69, had stepped on a broken wine bottle.
Karen Hannigan, the division supervisor, said the county walks a fine line in deciding whether to merely counsel a caller on how an elderly person might live more safely at home, or recommend that they move somewhere they can get health- and life-care services.
"When they get the gray hair or are on walkers or in wheelchairs, people immediately want to put that label on them of lacking capacity," she said. "When you can see they're completely out of it, that's easy. Or when they're completely sharp as a tack, that's easy. Most of our clients are in between, so we have to figure it out."
The county is also dealing more with the deteriorating effects of Alzheimer's disease. Social workers help patients find support groups, long-term care and transportation. Police and fire agencies respond to domestic violence and missing-persons investigations that can be linked to the disease.
Judith Branagan turned to aging services for help with her husband, Tom, 73, who was diagnosed with Alzheimer's in 2007. Three years ago, she enrolled him in a day program near their home in Burke that relies on volunteers trained to help Alzheimer's patients with physical and mental exercises. As the elderly population continues to grow, more programs — and volunteers — will be needed, she said.
"That's going to have to be the Plan B," she said. "The government funding isn't always going to be there."
Last year, Fairfax voters approved $37 million in bonds to replace an aging senior center in Chantilly and build a new one in Lorton, where senior programs currently take place in leased space inside a neighborhood strip mall.
Officials decided to wait at least until 2024 to ask voters to approve a $16 million bond for another senior center in Springfield, however. In the meantime, the county wants to secure funds to upgrade its sewer system, fix deteriorating parks and tend to other infrastructure needs.
The shortage of space for recreation programs led to the creation in 2009 of the county's Senior Center Without Walls program, where libraries and local houses of worship host discussion groups and classes. On a recent day, the line-dancing class in a Pohick Regional Library community room in Burke was so crowded the dancers had little room to maneuver.
"When we started this program, we only had 75 people. Now, we have 1,000 members and a growing waiting list," said co-founder Corazon Foley. "Some of the facilities that helped us are dropping out. They figured they would be helping us for only one or two years. It is a scramble."
Frank Shafroth, director of George Mason University's Center for State and Local Government Leadership, said the needs of the nation's aging population is something most local governments "haven't adequately prepared for."
"This generation is living longer lives than previous generations," Shafroth said. "You're going to get this huge tension over taxes and what people are willing to pay for older people who can no longer take care of themselves."