Next Avenue: The number of older Americans is growing, and many states are unprepared

While several other states also have developed or are developing similar long-term proposals, which typically address aging issues over a 10-year period, most states do not have a plan, despite clear data showing the need for additional aging services and support — from more accessible public transportation to community-based long term care options.

Master Plans for Aging, or MPAs, take a look at the entirety of state, county, local and federal policies and programs that directly or indirectly affect aging residents in each state. That might include health, transportation, housing, workforce, nutrition, home and community services, as well as specific projects such as age-friendly communities.

By developing a master plan, state officials can more readily make sure these diverse programs and agencies coordinate to keep the needs of aging adults at the forefront.

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Five states lead the way

Currently, only five states — California, Colorado, Texas, Minnesota and Massachusetts — have fully developed and started implementing their plans. Vermont is developing a plan but has not yet rolled it out.

In addition to New York, nine other states — Oregon, Washington, Hawaii, Michigan, Illinois, Florida, New Jersey, Connecticut, and Maine, along with the District of Columbia, are in the early stages of strategizing and developing ideas.

The remaining states have yet to begin the process, according to The Scan Foundation, which is helping support master plan initiatives for interested states.

States that delay or ignore the coming demographic shift will not make it any easier to address the fact that the U.S. population is rapidly getting older.

Aging by the numbers

The median age of people in the U.S. — the point at which half the population is older and half younger — rose to 38.8 years in 2021 from 30.2 years in 1950. By 2030, some 73 million boomers — people born in the two decades after World War II — will be 65 or older. About 13 million people in the U.S. have already celebrated their 80th birthdays.

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Older adults prefer to age at home or in their community rather than assisted-living facilities or other institutional settings. But experts on aging say that could be difficult or impossible if states do not prepare comprehensive, integrated long-term strategies and policies to help them.

“A master plan can organize people around the need to make home and community-based services and long-term care more accessible to people,” said Carrie Graham, director of long-term services and supports at the Center for Health Care Strategies (CHCS) in Hamilton, New Jersey.

A master plan gathers information and recommendations from groups and individuals with a stake in the process, such as social service and government agencies, county aging offices, nonprofit agencies, elected representatives and older adults themselves, and arranges it under one umbrella, tying all of the pieces and priorities together, she explained.

Complex documents

In addition to input from various interest groups, a viable master plan must also take into account economic, racial and ethnic disparities, said Graham, who is overseeing an initiative to help interested states develop their own master plans for aging. MPAs also define how to measure results.

Ten states — Colorado, Illinois, Indiana, Minnesota, North Carolina, North Dakota, Oregon, South Carolina, Tennessee and Vermont— currently participate in CHCS’ voluntary Master Plan for Aging Learning Collaborative. The 12-month program helps the participating states move forward on their proposals by offering peer interaction, technical support and access to a network of aging experts.

While plan specifics will vary from state to state, three key principles span all steps in the development process, Graham said: transparency and inclusion, equity and person-centered planning.

State policy makers across the U.S. are aware of the demographic changes of our aging society, but “the infrastructure, policies and programs for older adults continue to be fragmented, uncoordinated, and inequitable,” said Dr. Sarita Mohanty, president and CEO of The Scan Foundation. Scan helps fund the CHCS effort and supported California’s Master Plan initiative.

“A plan is essential for aging the way individuals want to — in or near their home and supported by their community. Having a strategy that has broad appeal and is properly implemented means that people can age well and with choices,” she said.

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Different plans, different priorities

California was the first state to develop this type of road map, beginning work on its plan in 2019 by talking with a range of participants across the state. Ensuring that policies and programs aligned with the state’s diversity — both in geography and population — was a key component of the California plan, said Jennie Chin Hansen, former CEO of the American Geriatrics Society and a member of the state MPA stakeholder advisory committee.

Gov. Gavin Newsom released California’s Master Plan for Aging, including local playbooks and data dashboard, in January 2021.

Master plans not only address the current needs of older people, they also prepare for the future, said Bob Blancato of Matz, Blancato & Associates, a strategic consulting and government relations firm in Washington, D.C., and a coalition coordinator for the New York State Master Plan on Aging Coalition.

“This is not a master plan for the aged,” he said, “it’s a master plan for aging—which we all are.”

In a New York Academy of Medicine summit, Creating an Age-Friendly Plan for the New York State Master Plan for Aging, participants from across the state — individuals, organizations, state and county representatives and agencies — looked at New York’s current aging initiatives, such as age-friendly health systems and age-friendly communities, as a jumping off point for a new master plan.

Participants also highlighted the need to address aging New Yorkers’ future housing, caregiving, social connection and rural aging. These recommendations will lay the groundwork for a comprehensive, statewide initiative, Blancato said.

For New York’s master plan to be as effective as California’s, there must be continuous, concentrated input by all interested parties.

“As long as they stay true to that commitment, you will see ideas that have never been thought of by the state,” Blancato said. “And that’s what makes the process interesting and exciting. There are a lot of ideas out there that are not inside the walls of Albany.”

Because it addresses issues such as healthcare, transportation and climate change, a master plan must involve partners in all levels of government. And challenges like expanding broadband access to rural areas affect everyone in the state, not just older people, said Graham.

Pursue every view

Graham suggested that states interested in developing a long-term aging plan should involve groups from which they don’t typically hear. Maybe they’re non-English speakers, or new Americans. Or they may come from communities of color, which may not typically get involved in broad initiatives.

“Making sure that you’re engaging the people in your state — that you’re really making an effort to engage people who maybe are not the ones you typically do — is really important,” she said.

Another important component is to include policy makers early in the planning process, said Hansen. In California, state and local officials were invited to sit in on focus groups with a variety of different participants when the state began putting its program together. It allowed officials to really hear the voices of their voters.

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A big-tent issue

Aging is a bipartisan issue, and a good master plan, whether it’s New York’s or North Dakota’s, will bring government, nonprofits, private and public organizations, community groups, and individuals together to rethink how services are designed, financed and delivered to all older adults equitably, said Mohanty.

“Aging is less about a numerical value as much as it is a continuum and an ecosystem,” she added.

If your state has not begun planning for its future aging population, Graham suggested residents write to their state legislature and governor to ask why and urge them to start. Give examples of other states that have done it and some things that you would like to see addressed in the plan.

She also recommended that disability groups get involved early to make sure they have an equal voice and are not fighting for scarce resources.

A master plan should embrace all ages and stages, Graham added. It should ensure that communities are inclusive and equitable places for people of every age and ability to age with dignity.

Liz Seegert is a veteran independent health journalist covering aging, health policy, social determinants of health, and other key healthcare issues. 

This article is reprinted by permission from NextAvenue.org, ©2023 Twin Cities Public Television, Inc. All rights reserved.

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