Meeting the Needs of America’s Older Adults: Could State-Level Plans Better Inform Planning at the Federal Level?
Between 2022 and 2040, the number of people 85 or older in the US is projected to double. To support the nation’s growing older population, the Older Americans Act (OAA), the cornerstone of the federal aging services system, formed an interagency committee to develop a strategic framework for a national plan on aging. This national effort benefits from the long history of local and state planning efforts that have identified the need for affordable housing, accessible communities, and flexible home-based care for older adults.
Every three to five years, individual states outline their goals and objectives to meet the needs of older adults in a State Aging Plan, also required by the OAA. Recognizing the value of a participant-driven process, older residents and service providers inform the development of these state plans and, as a result, the plans reflect their priorities. Using a database of the fifty active plans approved between 2018 and 2023, we identified six areas of priority:
1) Aging in Community
Over three quarters of states emphasized the need for affordable, accessible housing to bolster the financial security of older residents. Many plans highlighted the importance of social inclusion through intergenerational programs and volunteerism. They highlighted the need for public infrastructure such as high-speed internet and transportation to facilitate active aging. Plans also established priorities related to safe, independent living such as abuse and fraud prevention and crisis services.
2) Care and Assistance at Home
Twenty-nine state plans emphasized the importance of in-home services and supports, with three in four states expressly identifying the value of high quality professional (paid) in-home assistance. Sixty percent of plans with a goal related to care work also described the need to support unpaid caregivers, and five noted that home-based care services should be better integrated into preventative healthcare systems.
3) Dimensions of Health
Seventy-five percent of state plans valued older residents’ ability to maintain an active, healthy lifestyle. These goals related to the management of disabilities and chronic conditions, health promotion, and minimizing falls. Access to nutritious food was frequently included, with multiple states prioritizing food delivery to homes.
4) Disasters and Emergencies
Interestingly, fewer than ten plans addressed disaster or emergency preparedness. Where goals existed, they called for more comprehensive planning and interagency coordination to improve responses, emergency infrastructure, and communication systems. We expect this topic to be increasingly important as climate-related disasters occur more frequently and as states comply with a new requirement to address emergency preparedness.
5) Organizational Work
Sixty percent of state plans included goals related to the network of services. Some called for collaboration between aging services and other public systems and others emphasized the need to coordinate with the private sector. Two thirds of these plans called for increased efficiency and accountability, and many prioritized workforce development for both direct care staff and coordinators.
6) Support for Vulnerable Groups
More than three quarters of plans specified a need to focus resources on older adults with dementia and cognitive impairment as well as those with disabilities. Twenty-five percent of states emphasized the need to increase equity for underserved and diverse groups, particularly those exhibiting the most economic and social need. Broadly, plans called for improved access to supportive services for these populations.
Despite the emphasis on affordable, accessible housing and access to care and assistance, federal funds are limited in these areas. For nearly sixty years, State Aging Plans have been used to allocate OAA resources, including food delivery to homes, congregate meal and recreation programs, transportation, elder abuse prevention, and caregiver support and referral resources. The OAA, however, does not directly fund a program to address housing costs. Yet the dual burden of unaffordable care and housing is a reality for older adults nationwide, and State Aging Plans underscore the importance of housing affordability to older adults living in the community. As federal plans examine opportunities to knit together a safety net from our disparate local, state, and federal programs, State Aging Plans bring a wealth of insight into local needs and priorities.