By the end of the decade, 1 in 5 Americans will be 65 or older. In just seven years, all baby boomers will have crossed this age threshold, marking a long-anticipated demographic milestone.
This change coincides with a significant shift in the ratio of people of retirement age—65 and over—to those of working age, with some estimates expecting a decline from 3.5-to-1 to 2.5-to-1 working-age adults for every older person by 2060. This might create challenges with state and federal resources to support older adults, such as the number of caregivers or funds for home- and community-based services.
Older adults experience unique social, physical and economic challenges that affect a wide range of health and quality-of-life outcomes, often referred to as “social drivers of health.” Social factors, such as access to food, economic opportunity, transportation, housing and health service, can impact the ability of older adults to independently age in place.
Recognizing these challenges, lawmakers are considering a variety of programs to support older adults. Several states have acted to ensure older adults can access the services necessary to thrive independently in their communities.
Food security can play an important role in helping older adults sustain good health and manage chronic disease. Arkansas provided funds to support the state’s meals-on-wheels program. Texas simplified the Supplemental Nutrition Assistance Program, or SNAP, certification process for older adults and people with disabilities by shortening the application form and enabling phone registration. New Jersey recently appropriated funding for electronic benefit transfer cards in the Senior Farmers’ Market Nutrition Program.
Some older adults may also face economic constraints due to limited retirement resources. Alaska’s Senior Benefits Program pays monthly cash benefits to Alaskans 65 or older and have low to moderate income. The Massachusetts Emergency Aid to the Elderly Disabled and Children program provides cash and medical assistance, including to those who are over 65 and applying for Supplemental Security Income. Because financial exploitation is the most prevalent form of elder abuse, at least 41 states and Washington, D.C., have enacted tougher criminal penalties to combat it.
Because people tend to drive less frequently, or not at all, as they age, older adults may face more transportation barriers than other age groups. Hawaii requested that its transportation department prioritize projects to create safe routes for senior citizens living in housing units, rentals, hotels and condominiums statewide. Maryland required its transportation department to set aside funding in the annual budget for elderly and handicapped transportation services.
A recent survey suggests that 88% of adults ages 50 and older want to stay in their homes and communities as they age. Compared with institutional care, aging in place has also been shown to have health and emotional benefits and can be relatively cost-effective. Delaware created a working group to develop a plan to guide policies designed to promote successful aging in place for seniors in the state, and a corresponding report outlining 11 recommendations to the General Assembly. Florida established the Low-income Emergency Home Repair Program to assist low-income people, particularly older adults and those with physical disabilities, in making emergency repairs.
Direct Care Workforce
About half of Americans over 65 are predicted to need some level of long-term services and supports, including a range of health-related services. Studies suggest that between 2018 and 2028, the direct care industry will need to fill nearly 8.2 million jobs due to increased demand for services. Tennessee formed a public-private partnership to address direct care workforce shortages. The Direct Support Professionals Apprenticeship Program compensates individuals for on-the-job training, increases wages by $3.50 per hour upon completion of the program and partners with community colleges and universities to train students in direct care work. Indiana implemented a 14% rate increase for direct support professional wages.
Some states are exploring new ways to engage older adults to reduce the likelihood of social isolation. Illinois established the Senior Housing Residents’ Advisory Council within the Department on Aging to identify ways to keep seniors feeling supported by and connected to their communities and evaluate available resources and services for seniors, including state outreach.
While a number of states have enacted legislation targeting specific factors related to aging, a handful have taken a comprehensive approach, with strategies that address various aspects of aging, including health, human services, housing, transportation, employment and income security, and business development. These strategies aim to bring together the stakeholders working across these issue areas to support policies to meet the needs of older adults and their caregivers.
Vermont recently enacted the Older Vermonters Act, which created a set of principles for a comprehensive and coordinated system of services for seniors and directed the state to create an “action plan for aging well.” Principles focus on:
- Financial security.
- Optimal health and wellness.
- Social connection and engagement.
- Housing, transportation and community design.
- Family caregiver support.
The state budgeted a half-time state employee for development of the plan and leveraged health department funds for needs assessment activities.
Similarly, New York issued an executive order in November declaring that the state’s master plan for aging “shall coordinate existing and new state policy and programs creating a blueprint of strategies to be implemented to ensure older New Yorkers can live fulfilling lives, in good health, with freedom, dignity and independence to age in place for as long as possible.” The order calls for the health department, in coordination with the state Office for the Aging, to convene a council to advise in developing the plan.
Vermont and New York joined a handful of states with initiatives underway. Most of the plans are established by executive action, though legislators are important partners in crafting the plans and funding initiatives. California, Massachusetts and Texas called for the creation of master plans for aging through executive orders, while Colorado enacted legislation creating a multidisciplinary group to develop a plan.
Other states have indicated interest in developing or building on their plans by participating in a recently formed learning community called the Multisector Plan for Aging Learning Collaborative. Participating states include Colorado, Illinois, Indiana, Minnesota, North Carolina, North Dakota, Oregon, South Carolina, Tennessee and Vermont.
Many factors affect the health and well-being of older adults. State legislators have an opportunity to play a key role in coordinating efforts across sectors and creating approaches that span policy areas and improve the lives of older adults.
Samantha Scotti is a program manager in NCSL’s Health Program.
Supported by a grant from The SCAN Foundation, advancing a coordinated and easily navigated system of high-quality services for older adults that preserve dignity and independence. For more information, visit www.TheSCANFoundation.org.