Prioritizing our Aging Population: A Conversation with Joyce Massey-Smith

Welcome to the Future of Caregiving, a leading caregiving podcast by CareYaya, America’s fastest-growing elder care platform.

In this conversation, Mark Kabai interviews Joyce Massey-Smith, the Director of the Division of Aging and Adult Services at the North Carolina Department of Health and Human Services.

Joyce discusses with Mark aging policy and the challenges and opportunities presented by the growing aging population. They discuss the need for policy focus on aging, the projected increase in the 65+ population, and the implications for North Carolina and the country as a whole. They also explore the shortage of caregivers, the importance of supporting family caregivers, and available resources for caregivers. The conversation concludes with a discussion on the need for federal government support and a reminder for caregivers to ask for help and take care of themselves.

Key Takeaways:

·      The aging population is growing rapidly, presenting both challenges and opportunities for policy makers.

·      There is a need for policy focus on aging and the unique needs of older adults.

·      The shortage of caregivers, particularly in long-term care facilities, is a pressing issue that needs to be addressed.

·      Supporting family caregivers is crucial, as they provide the majority of care for older adults.

·      There are resources available for caregivers, including online programs and respite options.

·      Federal government support, such as increased funding for caregiver support programs, is needed to address the growing needs of the aging population.


00:00 Introduction and Background

03:00 The Growing Aging Population

07:57 Policy Considerations

10:10 Shortage of Caregivers

13:18 Supporting Family Caregivers

17:39 Resources for Caregivers

21:03 Federal Government Support

22:20 Final Thoughts and Encouragement


Please find below the full episode transcript:


Mark Kabai (00:01.16)

So three, two, one. All right, Joyce, thank you so much for joining us. So just a first question here, we just wanted to learn a little bit more about you and how you arrived at the area of aging policy and in the related fields you might have worked in government.


So, you know, we can see you've worked in this kind of area for a long time, you know, even going back to 1995 White House Conference on Aging, working on policy since then. So what really brought you to this area of policy and why do you find it important?


Joyce Massey-Smith (00:38.51)

Absolutely. Thank you for that question. It's a pleasure to get to talk about it. I came to aging as a result of my own growing up around older people who were really the cornerstone of our family. And there was a lot of wisdom and knowledge and love and compassion. And really older women were at the heart of my family making sure that everybody was okay.


And when I thought about it as a career, I was interested in political science and social work and kind of helping people. And I was just naturally drawn to aging policy as something that I felt needed attention and needed work because older people are such a wonderful part of our fabric of life that I think sometimes we don't always realize that. And so that's what got me into this work. And


I've been doing it for a long time, as you said, and have really enjoyed and see lots of opportunities ahead. And with the growth in the population, it's just amazing what opportunities there are for us if we just take advantage of them.


Mark Kabai (01:54.276)

Yeah. And so did you kind of study this in school as you were kind of getting into the policy world? Or is this something you came to when you started working in government?


Joyce Massey-Smith (02:05.886)

Oh, absolutely. I studied social work as an undergraduate and majored in gerontology and was particularly interested in rural older adults because that's the community that I grew up in. Rural communities, particularly in North Carolina, struggle with access to services. And so you see a lot of informal caregiving going on. And so...


So I studied it in social work and then I got my master's in public administration and with a focus on gerontology and aging policy and really interested in, you know, how we think about particularly now and in the coming years how we think about this massive change in the demographic and what we propose to do about that.


how do we think about the fact that, you know, one in five of us are going to be 65 and older and most, there'll be most counties in the state of North Carolina will have more people over the age of 65 than between birth and 17. And so how do we take advantage of that? But also how do we prepare to serve that and those individuals who may need the help? And so


That's where my studies took me and I was able to do some internships and work around area agencies on aging and that really got me interested in working in the field and have a particular interest in adult protective services in terms of vulnerable people, vulnerable older adults, elder abuse. And so I've been really...


fortunate to have the career that I've had to be able to work in these spaces and try to make a difference in policy that will help older adults and their families.


Mark Kabai (04:06.376)

that's really amazing to hear because I'm a policy student myself and I really haven't heard of anybody getting into this area of policy so early on and there's some focus on like child and family policy but not so much on aging and as you said that's of increased importance in the next couple years. And so I want to kind of go to some of those statistics, one of them you cited, one in five people in the U.S. will be 65 or older in the coming years.


And so for our listeners here, I have some other statistics prepared here that are kind of relevant to both North Carolina and also the United States as a whole. So if it's OK, I'm going to read them out. And then the question I'd ask you is, in your role, what do you make of these numbers? And so I'm going to start with those numbers right now. So this report, this information comes from the DHHS state


Mark Kabai (05:03.688)

In 2020, North Carolina ranked ninth nationally in total population and eighth in people 65 and over. The state has on average more people 16 older than 18 and under. This is true of 85 of 100 counties currently and is expected to be true of 90 counties by 2040. By 2040, the 65 plus population will increase from 1.7 to 2.7 million, a 52% increase. And of adults 85 and older, that increase will be 116%.


Mark Kabai (05:33.608)

So yeah, just again, what do you make of these numbers and what does this mean for the future of North Carolina and the country as a whole?


Joyce Massey-Smith (05:41.142)

Well, there's a couple of messages in that data. One is with the growth of the population, this has never happened before in human history that we've had this number of older people on the planet. And it's happening all over the world, not just in North Carolina, not just in the United States. And so it's a time of recognizing the value and the wonderment of age and aging.


and the gifts that come with that. And we don't want people to think of this. We've heard the words aging tsunami or age wave. And really those are just negative connotations of what this means because not all older adults are gonna need help or need care. Most older adults live well into their old age without needing services or support. And so that.


That tells us that there's a golden opportunity to make sure that we are inclusive of older people in our planning, in our thinking, in our communities, in everything that we do. Older people can, you know, don't like to use the word retire, but maybe reinvest after their careers and, you know, reinvigorate, invest in their communities and their families and in themselves.


And then the other thing it does mean is that there with the 85 plus population, we do know that the incidence of chronic disease and other physical health problems increase beginning at age 85. And so our healthcare system has to be prepared to support and deal with and care for older adults who are going to need that care as they live into old age.


So it's a blessing in terms of the numbers and an exciting time to be an older person. But we also have to be mindful that we will have costs to deal with in terms of healthcare, particularly, and long-term services and supports.


Mark Kabai (07:57.004)

Yeah, that's when we'll get into that in a second for sure. I just wanted to touch on, you said, there are any speaker kind of policy focus on this in the next couple of years. So do you think, I know you think about this stuff all the time, but do you think folks maybe in the General Assembly and maybe in Congress are thinking about this? And how should they be thinking about it?


Joyce Massey-Smith (08:20.55)

I do, and I think that it's up to us to get the word out in terms of what those numbers look like and what the implications are, because we work in this space every day, and it's up to us to educate our leaders about the issues, and not only about the challenges, but about the opportunities and taking advantage of those. And so one of the things that


we're doing in North Carolina is a, it's called a multi-sector plan on aging. And it's really a cross sector plan across all sectors of government and industry to really think about this once in a lifetime event of having more people over the age of 60 or 65 than younger people. And what does that mean? And so what we're trying to do is work with


stakeholders and other individuals, elected officials, to make them aware first of the change and then begin to think about how do we address this and how do we engage older adults in addressing these issues? Not just older adults aren't waiting for us to do something for them. They wanna be part of the issue and part of the solutions that we move forward.


Mark Kabai (09:44.008)

Yeah, I think that's definitely really important, making sure everybody's voice is kind of accounted for and goes into this process. And so I did wanna continue on that thought as well. So, as this is the kind of future of caregiving podcast, I wanted to focus on kind of the caregiving needs, especially for those folks above 85, or gonna be above 85, and then also other folks who might need long-term supports earlier.


And so, you know, in 2021, the UNC Schepts Center released a report that by 2033, North Carolina will face a shortage of 12,500 registered nurses and 5,000 licensed practical nurses. And that's going to hit older adult care facilities harder than it will hit hospitals. And so what are, what are trends that, you know, your department might have seen that might've contributed to this growing shortage? And does that have anything to do with COVID and kind of related issues there?


Joyce Massey-Smith (10:38.75)

Yeah, yeah, I think that is an issue that's on a lot of people's minds is the shortage of direct care workers. And our department is working very hard to address that issue through a caregiving task force led by Secretary Kinsley and Secretary Sanders with the Department of Commerce, looking at how to retain, attract and retain


direct care workers so that those people are there to provide the care that's needed. It really is an issue of, I think COVID did have something to do with it. COVID was such a challenge to so many people in so many different ways, but those people on the front lines, providing healthcare, direct care, it was a tremendous challenge. And so we've got to make this work.


meaningful, attractive, and valuable to the people that we want to provide the care. And so we're committed at the department and Governor Cooper as well in terms of trying to make this a better opportunity for people to enter into the direct care workforce. And the other thing that's interesting to note is while we rely heavily on our paid


Most of the care that's done in North Carolina and across the country is done by informal family caregivers, friends, neighbors, church members. And there's no way we can really replace that with government resources. And so what our effort is about is trying to support those informal caregivers in the work that they're doing to care for their loved ones. And so there are several programs, and I'm sure we'll talk about those.


that we offer or support so that folks who are, there are some people who you would consider, maybe even in the sandwich generation that are caring for older loved ones or persons in their family with disabilities or other limitations and also caring for children.


Joyce Massey-Smith (12:58.67)

And so the strain on the informal caregiver is a heavy burden. And we're very committed to trying to support informal caregivers who may be family or maybe just neighbors. And sometimes that's the greatest support that we have is through our own small communities.


Mark Kabai (13:18.672)

Yeah, and that's really important. I think there was a report that estimated that it was like $600 billion was the worth of how much care that informal caregivers provide. And that definitely affects like incomes, as you said, and time spent on other tasks. So I was wondering, I wanted to kind of dig into, what is the kind of balance there between


providing or letting families do their own care, but also providing respite options, which are kind of, they're not so accessible to many people. I know there are some programs, but the funding for those is quite limited. So do you see a need for kind of greater respite options among for family caregivers in North Carolina and you know what can be done there.


Joyce Massey-Smith (14:10.546)

Absolutely, there is a need because sometimes families are facing choices around, do I go to work today or do I stay home and look after the situation with my mother and I'm, you know, sometimes people are anxious about leaving their loved ones alone. And that can lead to all kinds of stress and actually impact productivity in the workplace.


And so it's really important that our employers understand that there is a part of their workforce that has that responsibility and look at opportunities and options to support them as they provide that care. Because the alternative when you need to use public financing is much more expensive. And so when families can look after each other,


that's the best way to go. And families and loved ones prefer that. The other thing that we think about is the burden on caregivers, is that not everybody comes to this naturally. Family caregiving is a relationship between the caregiver and the care receiver. And one of the terms that I'm hearing a lot now


rather than caregiving is care partners. Because the person receiving the care has to be a partner in that caregiving. And sometimes as family members, we think we're supposed to do certain things. And if we don't, then we're not a good caregiver. And we've got to step away and think about our capacity to be a caregiver and whether or not it's the right place for us to be in.


Let's face it, families are messy, and it's not always easy to interact and to provide care to maybe perhaps to a parent when there's been a difficult or strained relationship. And so there's all kinds of dynamics that go into that. And much more research is needed on how to support family caregivers and alternatives such as respite.


Joyce Massey-Smith (16:35.066)

allowing that family member who's providing the care to be away from that situation, to take care of themselves, because absolutely, and I've heard this so many times, that if you're going to care for somebody else, you've got to care for yourself first. It's like that, you know, that we hear it and see it all the time when we fly. It's like you put your air mask on first.


Mark Kabai (16:52.329)



Joyce Massey-Smith (17:01.61)

before you do it for somebody else because you've got to be able to do and make sure you're in good shape before you're able to care for another person.


Mark Kabai (17:12.936)

Yeah, that's certainly really important. And, you know, I think one of the most beautiful efforts that has been done in this area is kind of, you know, the agency areas on sorry, area agencies on aging and kind of the resources that they're able to provide. So for, you know, part of our listener basis are caregivers themselves. So for individuals that might feel that this is a burden on them, or they might need to seek out more resources, what do you recommend that caregivers, you know, do first?


Joyce Massey-Smith (17:39.53)

Absolutely. There are several options and ways to receive support. One of the things that's really simple and for folks who like to go online and use technology, we have an online caregiver support program called TWALTA. And it's a program that individuals, they can go to our website,, go to slash aging, forward slash aging. And there are modules on caregiving. And a lot of those are very easy, quick. You do it at your own pace and you can ask, kind of key in on the issue that you're concerned about. There's a lot of information on.


caring for loved ones with dementia, which is a huge issue. And so that's an absolutely wonderful resource for those who just need some encouragement and need some information. And so going on that website is a good option. There are several modules there that help. We also have a program called Project CARE that's Caregivers Alternatives to Running on Empty.


And it's a respite voucher program for people caring for loved ones with dementia. And they can call our office at 919-855-3400. Again, that's 919-855-3400 and find out about the availability of that program in different parts of the state. And that provides support to those loved ones caring for someone with dementia.


We also have a family caregiver support program that's offered through the area agencies on aging, as you mentioned, and they can call our office to find out which area agency on aging serves their community, and we can make that connection. But they provide respite, they provide other services and supports for caregivers, and we wanna see that grow. There's so many things that caregivers do.


Joyce Massey-Smith (20:02.154)

without compensation or support. And it's our goal to improve and increase that. And we have a lot of folks, advocates and individuals who are concerned about this issue, who are working very hard to try to see that improve so that we have those supports available to people and they can continue their employment or continue the life that they have that they can still have a life.


while providing care.


Mark Kabai (20:31.58)



Yeah, I think thank you so much for highlighting those resources. And I think our listeners will really appreciate that. I have, you know, one final question kind of on more of the policy side of things. You know, beyond, I really appreciate, you know, kind of the things that the DHHS is doing, and also the North Carolina government on a general level. But, you know, if we were to encourage our listeners across kind of state lines,


to lobby the federal government for help. You know, what are some things that you might want to see happen that, you know, maybe North Carolina doesn't have the money for, but could get the money for from the federal government?


Joyce Massey-Smith (21:13.698)

Well, the Family Caregiver Support Program, which is federally funded under the Older Americans Act, certainly could use additional resources to support family caregivers. And the administration, the Biden administration, has been very supportive of that. And that is something certainly that increasing funding in that area would be...


a dramatic improvement for so many families across North Carolina.


Mark Kabai (21:45.588)

Mm-hmm. Great. Thank you so much. All right, Joyce, any last thoughts you might want to share with our listeners here?


Joyce Massey-Smith (21:53.738)

Well, I just want to say that, you know, for some people, caregiving comes very naturally. I'll give you an example. My sister is a nurse, and there is no better caregiver in the world. She can take care of everything. But me, not so much. And so what you have to think about, or what are your strengths, and where are you limited? And always, always ask for help.


This is not an easy task and sometimes, depending on the illness or the need of the person you're caring for, it can be extremely exhausting and draining and you've got to take care of yourself. And so I would just encourage people to reach out for help when they're in a caregiving situation and are struggling with it and need some support. And so that would be my, is don't feel like you have to do it on your own.


Mark Kabai (22:50.036)

All right, thank you so much, Joyce. Thank you so much for joining us today.


Joyce Massey-Smith (22:53.026)

Thank you.


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