MT. ORAB, Ohio — It's winter, so Donna Robirds puts on two sweaters in the morning and keeps heavy blankets handy as she sets her thermostat low — 60 at night — and bundles up to keep her utility bill down.
At 67, with a fixed income and a $563-a-month mortgage, she lives on a tight budget. Food stamps help the retired state employee stretch her budget in this Appalachian village. So has the mild winter.
"We haven't had the extreme cold, so it hasn't been too bad," she said. "I really need to watch my money. It's going to be a struggle."
Robirds' daily battle is being played out across the Appalachian region, which stretches through 13 states from northeastern Mississippi to southern New York. A part of the country that has long lagged behind the rest of the U.S. economically finds itself on the leading edge of a national trend: The number of Americans 65 and older is increasing, and many are struggling as government services are being cut in a rough economy.
Nationally, with the aging of the baby boom generation, people 65 and over are expected to account for 1 of every 5 Americans by 2030. Some places in Appalachia have already reached that benchmark, such as southern Ohio's Brown County, where Robirds lives.
"These counties are like the canary in the coal mine," said Suzanne Kunkel, who heads the Scripps Gerontology Center at Miami University of Ohio. "This is a pretty dramatic change coming."
More than 15 percent of Appalachia's population is already at least 65, compared with 13 percent nationally, according to the 2010 Census. And projections show the number rising steadily in much of the region, as it is nationally.
The aging population means more demand for health care, economic help, transportation and home help, which are already in short supply in much of Appalachia.
"It's getting more urgent in the number of people needing those services and having those available to them," said Robert Roswall, commissioner of West Virginia's Bureau of Senior Services. "We have people waiting for all those type of programs."
Appalachia has long been plagued by isolation, poor roads, sewer systems and other infrastructure needs, lack of education and the decline of coal mining, manufacturing and other key industries. The region has low per-capita income (less than $30,000 in 2009, 18 percent lower than the nation's), low college graduation rates, an exodus of young working people, and high rates of heart disease, cancer and diabetes, along with poor access to health care.
Peggy Basham, 74, of Summersville, W.Va., is worried.
"I think most everybody in the area is," she said. "You've got baby boomers coming on. You've got so many seniors. ... Nothing stretches very far."
Basham helps craft quilts that are sold to support the Nicholas County Senior Citizens Center. The senior center feeds 500 people per month, and Basham said more would come if only they had transportation from their mountain homes. She said she sees elderly people regularly forced to choose whether to pay for prescription drugs, heat their homes or buy groceries.
West Virginia officials say their state has the country's highest concentration of older residents than anywhere but Florida. Sixteen percent of West Virginia's population is 65 or older, compared with 17.3 percent in Florida, according to census figures.
And unlike those who flock to Florida's retirement villages and condominium complexes, aging people in West Virginia and elsewhere in Appalachia have long been less likely to move, often because they can't afford it or they have a strong attachment to home.
Robirds doesn't have much choice: Her home's market value declined in the nation's housing crisis, and she is years away from paying it off. But the mother of three doesn't want to move anyway.
"I want to have a place for my grandchildren to stay when they visit," she said, "and to be able to have my passion for gardening."
Robirds got some vital help from Cincinnati-based People Working Cooperatively, a nonprofit organization that sent workers before winter to add insulation, clean vents, service her furnace, replace her refrigerator and perform other maintenance.
The organization, dedicated to helping poor people stay in their homes in the Ohio-Kentucky-Indiana region, is seeing demand for its services rocket over the last two years, from 40,000 calls for help in 2009 to 66,000 in 2011, according to president Jock Pitts.
Those in charge of dealing with the surging numbers of elderly people say such community-based help and other innovative solutions are especially important in struggling areas such as Appalachia.
"Given our state's limited resources — we're not going to hit the lottery — we are changing, in Ohio, our approach," said Bonnie Kantor-Burman, head of Ohio's Department of Aging. "There is a limit to what the state and federal governments are going to be able to do."
She sounds the alarm by often displaying a set of color-coded maps produced through Miami's Gerontology Center that show the projected aging of the population in eye-popping detail: In 2000, about one-fourth of the population in three of Ohio's 88 counties was 60 or older; in 2010, that was true of 16 counties, most of them in Appalachia. By 2020, it's projected to be 76 counties — with one-third of the population in six of those counties 60 or older.
Other community efforts to keep senior citizens in their homes include The Village concept, in which residents and volunteers help provide transportation, handyman work and home health care. Pioneered in Boston in the last decade, it is spreading into such states as North Carolina, Tennessee and Virginia.
The state of West Virginia, meanwhile, has designated six "retirement zones" where senior citizens can get access to affordable housing, health care, education, culture and recreation.
"We need to be talking about it and working together to find solutions," said Thomas Campbell, a state legislator from Greenbrier, W.Va., whose widowed mother is 89. "People in Appalachia tend to want to stay in their homes and have their family as close to them as they can, and I don't think those are bad things. I think we'll find a way to do it."