One in five people in Hawaii are 65 and older, according to the latest data from the 2020 census — further evidence of the state’s fast-growing older population at a time when the birthrate continues to slide.

The U.S. Census Bureau’s demographic profile released Thursday shows there were 282,451 people age 65 and older in Hawaii, representing 19.4% of the state’s total population of 1.45 million. That’s a 45% increase from the number of residents in that age group who were counted in 2010, when they comprised 14.3% of the population, or 1 in 7 residents.

Meanwhile, the under-5 age group saw its numbers drop 11.5% during that same period, the data show. The under-18 population overall was down 1.5%.

The growing imbalance between Hawaii’s younger and older generations has far-reaching consequences, ranging from widening gaps in the taxpayer base and Social Security and Medicare contributions, to greater demands on health care systems, housing and the shrinking workforce for caregivers and service providers.

“Hawaii population aging is accelerating … ,” said State Chief Economist Eugene Tian with the state Department of Business, Economic Development and Tourism. “The impact of the aging population will be mainly on the demand for medical services and senior housing. Hawaii already has a shortage in medical professionals, and the situation might be worsening.”

The growth of the state’s older population, seen nationally as well, reflects the aging baby boomer cohort of those born between 1946 and 1964. Nationally, in 2020, there were 55.8 million people age 65 and over, or 16.8% of the total population, up 38.6% from 40.3 million in 2010, according to the census data.

Hawaii ranked seventh in terms of percentage of 65-and-older population; Maine had the highest share at 21.8%. And with a highest-in-the-nation life expectancy of 80.7 years, Hawaii had the highest percentage of residents age 85 and older at 2.6%, compared to 1.9% for the United States as a whole.

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The 37,839 local residents in that age group represent a 25% increase from the total in 2010, when they comprised 2.2% of Hawaii’s population. Going back even further, the 2000 census counted 17,564 residents age 85 and older, or a 1.4% share of the state’s population.

Although small in number, the population of centenarians jumped 111%, to 646 in 2020 from 306 in 2010, the data shows.

Housing is critical

As Hawaii grew older in the decade between the most recent censuses, with fewer keiki to offset the trend, so did the state’s median age. According to the latest census data, that age was calculated at 40.8 in 2020, up from 38.6 in 2010, ranking Hawaii ninth nationally in terms of oldest median age.

Hawaii County, with the oldest median age of the state’s four main counties at 44.3 years, also had the highest share of the 65-plus population at 22.7%. Honolulu had the youngest median age at 39.8 and lowest share of 65-plus, at 18.7%.

Housing remains a crucial concern for older renters especially, said Diane Terada, division administrator for Catholic Charities of Hawaii’s Community and Senior Services Division. She said some of the folks the agency has assisted reported that their landlord decided to renovate and then raised the rent to a point that they can no longer afford it, or their landlord died and family members decided to sell the property.

“It’s not good to be poor and old,” Terada said. “Many seniors can afford to pay only $500 and not more than that for rent, and that’s a real struggle for folks. It’s getting worse in terms of housing and the population at risk for homelessness. People have been on waitlists for years in order to get into a place they can afford for the rest of their lives.”

A 2021 DBEDT report on living circumstances and housing options for Hawaii’s older population estimated that about 22,000 older residents were living in poverty in 2020, based on federal poverty measures. The report noted an inventory of only 8,135 affordable rental units statewide reserved for older residents, many with years-long waitlists, along with 2,619 licensed beds in adult residential care homes, 2,743 beds in skilled nursing facilities and 2,367 units in assisted living facilities.

Terada also said the tight labor pool across the economy is making it more difficult to find caregivers at a time when more older residents are “aging in place” at home. And a smaller workforce overall means a declining tax base for programs for older residents who lack adequate savings to pay for support services on their own.

Workforce shortages

The state’s Executive Office on Aging, under the Department of Health, is currently updating its four-year State Plan on Aging to address conditions affecting older residents, including increasing social isolation and mental health issues made worse by the pandemic.

Executive Director Caroline Cadirao said other critical concerns are Hawaii’s high cost of living, especially for those on a fixed income and no longer in the workforce; escalating rent as property owners face increased costs of their own; and a shortage of medical doctors and specialists. With long-term care insurance out of reach for most people, many are forced to rely on publicly funded care, she added.

“I think, No. 1, all these issues I brought up can’t really be addressed without a strong workforce, so that’s an indirect issue that’s facing not just the aging population but our whole population,” Cadirao said. “How do we increase our workforce so that we can support our kupuna with the needs that they have?”

The University of Hawaii John A. Burns School of Medicine is one of the few medical schools in the country with a geriatric medicine department, yet it often can’t fill the handful of fellowships offered in the specialty, according to Dr. Kamal Masaki, who heads the department.

Geriatric medicine is a federally designated critical shortage specialty, she said, with fewer than 7,000 geriatricians practicing nationwide and a need for 30,000 more.

“It’s kind of ironic that the older population is going up in the U.S. each year and the number of geriatricians is decreasing,” Masaki said.

With a more holistic approach to their patients’ physical, psychological and social needs, Masaki said the specialists can play key roles as primary care physicians and in hospital settings, outpatient clinics, medical directorship positions at care facilities, and in making house calls for the homebound, enabling more residents to age in place.

“It’s not a high-glamour field for sure, and it’s not a highly paid field either, but I wish people didn’t make that decision based on that,” Masaki said. “Job satisfaction is highest among geriatricians. It’s a very gratifying field to be in.”

Where’s the keiki?

The latest batch of demographic data from the 2020 census indicates the 299,366 children in Hawaii under the age of 18 represent 20.6% of the state’s population. That total includes 77,352 keiki under the age of 5, down 10,055 from the 2010 census.

The cohort of Hawaii’s youngest residents comprised 5.3% of the population in the 2020 census, compared to 6.4% in 2010 and 6.5% from 2000, a trend consistent with lower number of births and declining birthrate in recent years.

Tian said the reasons include more young people deciding to stay single and more couples “selecting a lifestyle without children.” The struggle to find stable employment and affordable housing and child care, coupled with Hawaii’s high cost of living, also contributed by driving many families to relocate to mainland states.

The shrinking population of younger residents will have long-term effects on the demand for school facilities and workforce numbers, he said. In fact, at the start of the 2022-23 school year, the state Department of Education reported that enrollment had dropped 1.9% from the previous year to 156,518 students, continuing a downward trend over the four previous years.

Tian said Hawaii’s population dynamic resulted in an increase in its “dependency ratio,” or the number of dependent-age people — children under age 18 and adults age 65 and older — for every 100 working-age people. In 2020, the Hawaii ratio was 66.6 dependent-­age people for every 100 working-age people, up from 57.9, according to the census data.

Nationally, the ratio was 63.6 in 2020.

Retirement support

AARP, with about 140,000 members in Hawaii, has prioritized efforts to boost financial security for older residents so they can better afford retirement and decrease the demand for social services.

AARP Hawaii State Director Keali‘i Lopez was a staunch advocate for legislation last year that resulted in the Hawaii Retirement Savings Act, which established a state-run individual retirement savings program starting July 1, 2024. A study commissioned by the Hawaii Retirement Savings Task Force to look at the issue estimated taxpayers would be on the hook for $1.72 billion over 20 years for the state’s share of social service programs to support workers and their families reaching retirement age who lack adequate savings.

Lopez said the trends revealed in the latest census data are “extremely concerning and I don’t think our decision-makers and policy folks out there are paying close enough attention to that.”

Cadirao called the 2023 legislative session “a banner year” for bills supporting the aging population, including funding for the Executive Office on Aging to implement a public health campaign for Alzheimer’s disease and other forms of dementia; temporary expansion of the State Rent Supplement Program for qualified persons age 62 or older who are homeless or at imminent risk of becoming homeless; an amendment to the Kupuna Care Program that ensures unpaid caregivers also receive support services; and a major boost in Medicaid reimbursements aimed at improving access to medical care.

Additionally, six new positions were funded for the Executive Office on Aging’s Hawaii State Health Insurance Assistance Program that provides free health insurance information, counseling and referrals for people with Medicare, and the volunteer-based Senior Medicare Patrol Hawaii that works to prevent Medicare fraud.

“A lot of what was passed this legislative session regarding aging and supporting our kupuna either directly or indirectly really will help us as we’re coming out of the pandemic,” Cadirao said, “because I think the pandemic exposed a lot of needs that were already there, it just exacerbated it as far as the social isolation, the food insecurity, the access to services and support.

“And it just helped identify and bring to light where we need to address those gaps and services, and how to really create new partnerships as far as workforce development and really pushing forward a lot of the long-term care issues that our state’s faced for a very long time.”