The number of seniors in El Paso County is expected to grow by 39% this decade. As this so-called senior tsunami hits the Pikes Peak region, eventually, some will likely move into nursing homes. But more and more nursing home residents are actually under the age of 65.
Joe Fisher is not a typical nursing home resident, not white-haired or wrinkled.
He's in his forties.
In the summer of 2016, he'd been living at the Cripple Creek Care Center for two months. The previous year, Fisher says he suffered a traumatic brain injury while living on the streets in Amarillo, Texas.
"I head-butted a car," he says. "Scrambled the old brain bucket."
Fisher's speech is labored. He has cropped, dark hair and wears a camouflage t-shirt and sweatpants.
He says he grew up in Denver, more than two hours from where he lives now.
Fisher is one of a handful of residents under the age of 65 at the Cripple Creek Care Center, and part of a growing number in the region.
In 2016, more than 15% of nursing home residents in Teller and El Paso Counties receiving government assistance were under the age of 65. That number has risen each year since 2012, according to the federal Center for Medicare and Medicaid Services.
Scott Bartlett is the area ombudsman for the Pikes Peak Region, working for the Pikes Peak Area Council of Governments as a liaison between nursing homes and the people who live there.
"What I hope the general public would understand is that this isn't your grandma's nursing home anymore," he says.
He says nursing homes in the area can struggle to care for people of different ages.
"The issue with younger residents in long-term care facilities, specifically nursing homes, is that they have different needs and wants than elderly populations. Lots of them want to spend a lot of time away from the facility. They want to be young people."
According to Bartlett, these residents often wind up in nursing homes because they need around-the-clock care for substance abuse issues, major mental illness, or, like Fisher, a traumatic brain injury. Many of them, Bartlett says, have experienced homelessness.
"Long-term care was designed to serve the elderly," he says. "But, more and more, because they are the highest level of care, by default we're seeing a lot of people in long-term care because they can't be served anywhere else."
Linda Rosenberg directs the National Council for Behavioral Health, an advocacy group for mental health and addiction treatment organizations across the U.S. She says nationally, it's not a new issue, and attributes it to a gap in the system.
"It is certainly a far from ideal place for these people to be living," she says. "But often, it's a combination of the lack of affordable housing and the not being able to advocate for yourself to get the in-home services you need to be able to live on your own."
The Cripple Creek Care Center has about 10% younger residents, according to administrator Lawrence Cohen. He says the facility's small size and history with substance abuse programs helps it to serve that group appropriately.
"Several of our residents were people that had come here for the drug and alcohol treatment, and then stayed when the facility discontinued that program," Cohen says.
He emphasizes trips to go shopping, to the casino, or to the theater as examples of ways the facility strives to entertain younger residents.
As for Joe Fisher, he says after being homeless for three years, he's thankful to be living at the center.
"I was eating dog food for breakfast, lunch, and dinner," he says. "Now I'm so glad I'm here. I got good meals coming. Oh yeah. Nothing bad about this place. This is a good place."
But he says it's not his first choice.
Linda Rosenberg says finding appropriate care for those in need is becoming national conversation. And she says she thinks Medicare and Medicaid are beginning to prioritize keeping people at home.
Locally, Scott Bartlett has created a group called the Behavioral Health Ethics Committee.
The group brings representatives from nursing homes, assisted living facilities, and hospitals together into one room, in part, to discuss how best to care for non-traditional residents.
Bartlett says they've tried other versions of this meeting in the past, but this time around, it seems to be taking root.
"First thing we needed to get over I think was, is getting people to the table. Getting the right people to the table. In fact, we're still struggling with that," he says.
The committee meets once a month.