Get ready for some sticker shock at cost of Tri-Cities elder care

Remember the numbers recently used to illustrate the contrast between the emergence of GenZ and the Tri-Cities Baby Boomers on the front porch of old age? A 2018 study by Genworth Financial Inc. adds another level of context – and some sticker shock – to current and future costs challenges as the local population ages.

$120 a day for home health aide services; $100 a day for adult day care; $130 a day for assisted living. Nursing home costs head toward $100,000 a year.

According to the study, Johnson City Metropolitan Statistical Area (MSA) elders who are in semi-private nursing home care are now paying a median cost of $76,833 a year. In a decade, when the local elderly population will balloon, the median cost is expected to be to $103,257 a year.

In the Kingsport-Bristol area, the current median price for a semi-private nursing home room is $73,000, and it’s expected to increase to $98,106 in 2028.

Of course, nursing home care is at the top of the elder care cost pyramid. Some elders live at home or with family caregivers. Others contract for homemaker services, home health aides and assisted living. And the use of and need for adult day care is growing just as fast as the aging population.

Current estimates show 18 Tri-Cities residents a day are turning 70. Census data show there are about 45,000 who are 75 or older. And, there’s a projection that the 75+ group will increase by 36% in the coming decade. The bottom line is the Tri-Cities is five or six years ahead of the national aging trend – a tsunami that will impose many new challenges as well as providing additional opportunities for some elders. But many of those opportunities are muted by the reality of aging and the cost that come with it. Some elders continue to be active and living at home. Many are in or rejoining the labor force. The opportunity and needs level is a highly individual condition.

The cost of elder care comes with some sticker shocks. Long-term health care insurance is available, but it’s expensive and out of reach for many nearing old age. As pointed out in many studies, few age groups are even saving enough for retirement much less worrying about long-term elder care.

Here’s a local look at this facet of the Tri-Cities aging story


Folks in the Kingsport-Bristol Metropolitan Statistical Area (MSA) who use Homemaker Services or a Home Health Aide are paying a median daily cost of $119 for those services that make it possible for them to live in their own homes by having someone to take care of household cores they can’t manage. Things like cleaning house, cooking meals or running areas.

Those services and folks who make it possible for the elderly to live at home run $122 a day in the Johnson City MSA.


Adult Day Care gives caregivers a break that in concept is similar to Child Day Care. Centers may provide health care services, therapeutic services, and social activities. In the Johnson City MSA, the median tab is $50 a day. It’s $96 a day in Kingsport-Bristol.


The cost of aging begins to increase when assisted living facilities come into the picture. Assisted living is not an alternative to a nursing home. It’s an intermediate level of long-term care that offers personal and health services for elders. The median cost in Kingsport-Bristol is $137 a day and $127 a day in the Johnson City metro area


The cost goes up substantially when nursing home care is involved. Residents at these facilities need a higher level of supervision and care than what assisted living facilities can offer. Services include personal care, room, and board, supervision of medications, therapists and rehab as well as skilled nursing care on a 24-hour basis.

Semi-private rooms in the Johnson City metro have a median price of $211 a day while it $226 a day for a private room.

The median for a semi-private room in Kingsport-Bristol is $200 a day and $210 a day for a private room.

Here’s how Genworth thinks the median price for those items will cost in 2028. The median is the number where half is higher, and half is lower.


Homemaker services and home health aide services are expected to increase to $160 a day.

Adult day care increased from $96 a day to $129.

Assisted living increases to $184 from $137.

Semi-private nursing cost increase to $269 a day and a private room goes up to $282.


Homemaker service $164 a day. Home health aides $171 a day.

Adult Daycare $67 a day.

Assisted living facilities $171 a day.

Nursing home semi-private room $284 and $304 for a private room.

For 15 years, Genworth has developed the Cost of Care Survey to help families understand the costs of varying types of care across the U.S. Since 2004, the Cost of Care survey has become the foundation for long-term care planning. The 2018 survey, conducted by Carescout®, covering  449 regions is based on data collected from more than 15,500 completed surveys.

According to the report, the annual median cost of care now ranges from $18,720 for adult care services to $100,375 for a private nursing home room. Since 2017, assisted living facilities increased the most at 6.67%, followed by a semi-private nursing home room at 4.1%.

The press release and a breakdown of the national costs can be found at

Tri-Cities employers add 1,000 jobs, unemployment rate down, private sector wages up

Tri-Cities employers added 1,000 nonfarm jobs in October, the unemployment was unchanged at 3.8%, and the average hourly wages for private-sector workers was up in both of the region’s two Metropolitan Statistical Areas.

So far this year, nonfarm jobs have increased at an average of 200 per month and the jobs growth trend plateaued at 1% year-over-year growth in August. That’s the best trend growth since June 2016.

October was the third straight month of monthly nonfarm job gains according to preliminary, unadjusted number from the Bureau of Labor Statistics Payroll Report. Although it was the weakest monthly report for new jobs since August, the total number of jobs was better than the pre-recession benchmark for the second time this year.

Private sector job growth lagged the nonfarm sector. Private sector employers added 100 jobs. It was the weakest month-over-month report for that sector’s seven months of growth this year. So far this year it added new jobs at the rate of 170 per month.

The BLS employment report shows employment in the seven-county region was 9,852 better than September and the labor force increased by 972 people. It was also the sixth month that the unemployment rate has been below 4%.

Unlike the jobs report, neither employment nor the labor force is anywhere near pre-recession highs. In October there were 20,176 fewer people in the labor force, and 15,988 fewer area residents were employed. Much of the labor force participation decline can be attributed to the region’s rapidly aging population. Back-of-the-envelope calculations based on the most current Census population data show about 25 area residents turn 65 every day while 18 a day celebrate their 70th birthday.


The three-county Johnson City Metropolitan Statistical Area (MSA) labor market added 1,000 nonfarm jobs in October, the unemployment rate dropped to 4% and the average weekly per hour wage increased 1.9% from September to $20.31. That was the best monthly pay increase since April.

Johnson City has recovered from a six-month nonfarm job creation slump that began December last year. Currently, the labor market is growing at an average of 80 new nonfarm jobs a month. The private sector job growth rate is currently averaging 56 a month.

Employment grew by 1,023 people in October, and the labor force was 987 more than it was in September.

Sectors with the best year-over-year nonfarm job growth last month were: Trade, transportation and utilities; financial activities; professional and business services; leisure and hospitality; and government. Manufacturing was the only sector with a year-over-year job loss.


October preliminary, unadjusted totals for nonfarm jobs in the seven-county Tri-Cities Consolidated Metropolitan Statistical District.

The four-county Kingsport Bristol MSA’s nonfarm job level was unchanged from September and is at the highest level this year. So far this year, the labor market has added an average of 120 new jobs a month. October’s unemployment rate was 3.6%, and the average hourly private sector wage increased 0.5% to $18.32. The average hourly wage has seen seven month-over-month increases this year.

Kingsport-Bristol’s private sector added 100 jobs in October, and the stood at its highest level this year. So far this year, the private sector has been adding jobs at the rate of 170 a month.

Employment in Kingsport-Bristol increased by five in October, and the labor force was down by 15 workers from September level.

Sectors with year-over-year job growth were other services; government; and trade, transportation, and utilities. Sectors with year-over-year job losses were: Mining, logging and construction; manufacturing; information; professional and business services; and leisure and hospitality.


Here comes Gen Z, but what about the 68,000 Tri-Cities residents on the front porch of old age

There’s a new generational group grabbing the fancy of writers who offer advice to employers and businesses. Can you believe it? The oldest Millennials are turning 40, and many are weary of the hype about them. So, here comes Gen Z.

Here’s a snapshot of the current Tri-Cities breakdown of generations. Remember Gen Z still has two more birth years and don’t have the mortality factor weighing on them as much as the elders. The area’s current birth-to-death ratio is 10-to-14. Clicking on chart renders a larger file.

The oldest of Gen Z is 23, and as a group, they outnumber the Baby Boomers, but most are too young to flex their consumer and cultural muscles. We do know they’ve tech-savvy, goal-oriented and promise to make some major shifts in consumerism and politics. Researchers peg 1995 as the beginning of the nation’s largest demographic cohort. And the ending year is 2020.

And estimating the size of each generation from the way the Census treats its population by age numbers is a chore. You must do some fudging because Census uses a four-year age spread that doesn’t lend itself to the beginning and ending generation birth years. But that doesn’t mean you can’t get a pretty good grip on the ranks of each generation.

For instance, the seven-county Tri-Cities region had about 142,516 Gen Zers in its latest count. That’s 28% of the region’s population, and they’ve got another two years of pending births to go.

Compare that to the 139,463 Baby Boomer’s 27% share of the population, and you can see why Gen Zers are going to get a lot of attention.

While I don’t want to throw cold water on the quest of “Marketing to Gen Z: The Rules for Reaching This Vast – and Very Different Generation of Influencers” and the other works that focus on the what, when and why of cropping on the market there just might be a bigger issue at play.

There are currently 68,000 Tri-Cities residents on the front doorstep of old age. And just over that threshold, there are another 72,286 already there.

Here’s an approximation of how the Tri-Cities generations look. The Silent and Greatest Generations were combined.

Just for the sake of argument let’s set 70 as the benchmark for old age. Look at it this way. There will be an average of 18 area residents a day turning 70 for the next 10 years. And if you count the 50 and overpopulation, you’re looking at over 211,749 people. That’s about 42% of the region’s population, and it’s this group that has most of the money and will continue to dominate the politics and marketplace for the next decade or so even if their dominance is diminishing. They’ll retain some dominance because many of the Gen Zers will leave the area for college or better job opportunities.

The stage is set for a big young tech-savvy generation entering the workforce and flexing its influence on the business community at the same time an almost equally large part of the demographic is entering old age and exerting their own unique influences on the economy. Some of those demands have a defined downside for services, but these elders also offer some opportunities if they not looked at as just problems that need to be dealt with.

The demands they will make on the region’s housing market is just one example of what’s coming.

For those elders with enough money options like five-star accommodations at The Blake are available. But check out its status. It’s not ready for move-ins just yet, and it’s already just about filled up.

The area also has a variety of nursing homes. Some better than others and some are always being ordered to clean up their act by state officials. But many seniors – and their families – put nursing homes and funeral parlors on the same level. The big financial difference is the funeral home doesn’t get the deed to the elder’s property.

You can’t put a precise number on them, but the number of seniors who have moved or been moved into apartments or other rentals is increasing. Many get daily visits from the relatives who couldn’t or wouldn’t move them into their homes. Others have the tell-tale lock box that gives home health care access.

There’s also an increase in multi-generational households. And there’s a growing interest in granny pods. But that may be a heavy planning and zoning lift before it would meet the needs that are just around the corner.

There are also some examples that cohabitation is a coming trend for older folks. Think of the Golden Girls TV series. Who would have thought it was ahead of its time? And have you heard of the Beacon Hill Villages concept? As we get deeper and deeper into the aging trend, you probably will.

Housing is just the tip of the iceberg. Elder abuse has the potential to become a rival in numbers to child abuse.

Some of the unique challenges – and yes real-time capitalism opportunities – also come with the rising tide of older folks. Joseph Coughlin, head of the Aging Lab at MIT, lays the groundwork and offers some solutions in “The Longevity Economy: Unlocking the World’s Fastest Growing, Most Misunderstood Market” It’s a highly recommended read for local government officials and business people.

And then there’s Gen Z knocking at the labor market and economy’s front door. Fasten your seatbelt and hang on.




Local equity-rich properties decline, seriously underwater count see a big increase

Tri-Cities properties with mortgages have fallen behind the national equity rich benchmark for the first time since the recession. At the same time, all 10 local markets in the Attom Data Solution’s Equity & Underwater Report had a higher share of properties that were seriously underwater.

Attom’s report shows 8.8% of mortgaged U.S. properties were seriously underwater at the end of Q3. Seriously underwater is defined as a property with loans at least 25% higher than the property’s estimated value.

Local underwater properties spiked in Q2 this year at 17,096 properties. Three months later it had dropped to 16,691. Both quarters were the highest in five years. The lowest local number in Attom’s current report was Q4 2013 – 7,884 properties.

CoreLogic’s Loan Performance report shows the most current 30-day or more delinquency rate in the Kingsport-Bristol metro area was 4.8% compared to 0.4% last year. It was 4.5% in the Johnson City MSA, up from 0.3%.

The delinquency rate and share of underwater properties don’t necessarily point to a big increase in foreclosures since some of those homeowners will resolve their issue. Attom’s Q3 foreclosure report listed 213 new foreclosure filings in the Tri-Cities area counties compared to 195 last year. That’s lower than spikes reported earlier in the year. And while the region’s foreclosure rate is running a little north of the normal, but under one percent. Still, the increase of underwater properties is an economic stress red flag for both the local economy and housing market.

Locally there were 16,691 mortgaged properties that were seriously underwater. During the same period last year, the number was 10,206. The two SW VA counties in the Tri-Cities region were the exception to NE Tenn.’s uptrend. Their share of underwater properties decreased.

Here’s how that underwater share of properties looked in the Q3 report compared to Q3 last year.

Carter Co. – 18.9%, 10.3%

Hawkins Co. – 19.8%, 11%

Johnson Co. – 28.1%, 20.2%

Sullivan Co. – 12/5%, 8.4%

Unicoi Co. – 13.1%, 9.4%

Washington Co. TN – 15.9%, 9%

Greene Co. – 20.9%, 12.9%

Bristol VA – 19%, 17.1%

Scott Co. – 20.6%, 27.7%.

Washington Co. VA – 18%, 23.8%

Last year all the NE Tenn. counties in the report had a share of equity-rich properties in the mid and upper 20% range. This year only three of those seven counties had more than 20%. The only jurisdiction that improved its equity rich share was Bristol, VA.

Equity-rich properties are defined as those where the property was 50% or less of the estimated market value.

There were 19,583 equity-rich properties at the end of Q3 compared to 23,699 last year.

“As homeowners stay put longer, they continue to build more equity in their homes despite the recent slowing in rates of home price appreciation,” said Daren Blomquist, senior vice president with ATTOM Data Solutions. “West coast markets along with New York have the highest share of equity-rich homeowners while markets in the Mississippi Valley and Rust Belt continue to have stubbornly high rates of seriously underwater homeowners when it comes to home equity.”


There are several reasons for the drop in local equity-rich properties. Some owners tapped their equity for a new home. The region has seen record single-family resales for 38 of the past 47 months. Other owners tapped their equity with Home Equity Lines of Equity.

Attom’s most recent loan origination report shows a big increase in the number of HELOC originations in the Kingsport-Bristol MSA beginning late last year. The much smaller spike in the number of HELOCs can be seen in the Johnson City MSA.

Here’s the share of equity-rich mortgaged properties in Q3 compared to Q3 2017.

Carter Co. 19.2%, 28.2%

Hawkins Co. – 18.7%, 26.4%

Johnson Co. – 23.3%, 29.7%

Sullivan Co. – 23.3%, 28.3%

Unicoi Co. – 24.5%, 25.7%

Washington Co. TN – 17.2%, 24.4%

Greene Co. – 19.2%, 28.2%

Bristol VA – 11.6%, 15.2%

Scott Co. – 22%, 18.7%

Washington Co. VA – 18.3%, 19.3%


Report methodology

Attom’s U.S. Home Equity & Underwater report provides counts of properties based on several categories of equity — or loan to value (LTV) — at the state, metro, county and zip code level, along with the percentage of total properties with a mortgage that each equity category represents. The equity/LTV is calculated based on record-level loan model estimating position and amount of loans secured by a property and a record-level automated valuation model (AVM) derived from publicly recorded mortgage and deed of trust data for more than 155 million U.S. properties.



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