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APRIL | 2021
Comprehensive Policy Approaches to Support the Aging Population
HEALTH
iii NATIONAL CONFERENCE OF STATE LEGISLATURES
NATIONAL CONFERENCE OF STATE LEGISLATURES © 2021
The National Conference of State Legislatures is the bipartisan organization dedicated to serving the lawmakers and staffs of the nation’s 50 states, its commonwealths and territories.
NCSL provides research, technical assistance and opportunities for policymakers to exchange ideas on the most pressing state issues, and is an effective and respected advocate for the interests of the states in the American federal system. Its objectives are:
• Improve the quality and effectiveness of state legislatures.
• Promote policy innovation and communication among state legislatures.
• Ensure state legislatures a strong, cohesive voice in the federal system.
The conference operates from offices in Denver, Colorado and Washington, D.C.
Comprehensive Policy Approaches to Support the Aging Population
BY SAMANTHA SCOTTI
1 NATIONAL CONFERENCE OF STATE LEGISLATURES
Introduction For the first time in the nation’s history, older adults—those 65 and older—are expected to outnumber children by 2034. The shifting demographics arise from factors including a declining birth rate and rising life expectancies.
Roughly 1 in 6 Americans are 65 and over, and this is projected to rise to 1 in 5 by 2030. Resources to support older adults, including the number of caregivers, have not kept pace with population growth. In fact, the ratio of potential caregivers for each older person is sharply declining. According to AARP, “by 2030, the ratio is projected to decline sharply to 4 to 1; and it is expected to further fall to less than 3 to 1 in 2050.”
Source: U.S. Census Bureau
Population Age 65 and Over; Age 85 and OverSelected years, 1900-2018, and projected years, 2020-2060
100
80
60
40
20
01900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2012 2020 2030 2040 2050 2060
Y E A R
MI
LL
IO
NS
PR
OJ
EC
TE
D
Age 65 and over
Age 85 and over
Older adults experience unique social, physical and economic challenges that other segments of the population may not. For example, roughly half of Americans over 65 are predicted to need some level of long-term services and supports (LTSS). These services include a range of health, health-related and social services that assist individuals with limited physical or cognitive abilities.
Some older adults also face economic constraints due to limited financial resources in retirement. In-creased age is associated with higher rates of poverty: from 9% for ages 65 to 74 to 14% for ages 85 and older.
Older adults may also face more transportation barriers than other age groups as people tend to drive less frequently, or not at all, as they age. According to the Federal Interagency Forum on Aging-Relat-ed Statistics, “13% of the noninstitutionalized Medicare population age 65 and over had given up driv-ing altogether, about 18% had trouble getting places, and 27% had reduced their travel because of a health or physical problem.”
The coronavirus pandemic also underscored the importance of strengthening the systems that support older adults who are more susceptible to severe illness or death. Given the multiple challenges older adults face during the pandemic, such as increased health risks and social isolation, states are consid-ering integrated approaches to address these challenges.
NATIONAL CONFERENCE OF STATE LEGISLATURES 2
Creating a Master Plan for Aging Given these unique challenges, lawmakers may consider a variety of comprehensive approaches that span a number of policy areas supporting older adults’ social, physical and economic wellbeing. Some states have adopted Master Plans for Aging—a framework developed to guide restructuring of state and local policies, programs and funding geared toward meeting the needs of older adults and their caregivers. To date, four states have developed or implemented “master plans” that outline long-term, comprehensive approaches to support various aspects of aging across health, human services, housing, transportation, employment and income security, and business development.
The term “Master Plan for Aging” was coined by The SCAN Foundation, which aims to transform care for older adults, and refers to a comprehensive planning process that delves deep into policy issues and solutions, calling out proposed investments and connections ranging across housing, transportation, work-force, health care, LTSS, economic security and safety, among others. However, each state may call its com-prehensive plan something a little different, like strategic action plans, statewide policies or blueprints.
The SCAN Foundation identifies five key elements of Master Plans for Aging. By their definition, a Master Plan for Aging:
• Is generally led by a governor with other executive and legislative leaders.
• Uses data to inform priorities.
• Includes comprehensive approaches to addressing issues that impact aging populations (e.g., financ-ing, infrastructure, health and social services, workforce, housing and transportation) and engages rel-evant state agencies and departments from these sectors in the planning process.
• Involves active stakeholder engagement—including consumers, providers and advocates—in plan creation and implementation.
• Includes objectives with clear reporting timelines to measure progress, with annual updates to reflect needs and emerging issues.
Source: U.S. Census Bureau
Percentage of Population Age 65 and OverBy state, 2018
HI
AS GU MP PR VI
AK
UT
ID
ND
NE
OK
KS
TX
LA
IL
MS
IN
GA
DC
WA
CA
NV CO
MN
VA
MD
MT
WY SD
NM
IA
WI
MO
AR
KY
TN
MI
AL
OH
NC SC
MA
CT
NHVT
OR
AZ
WV
PA
NY
NJ
DE
RI
FL
ME
20% or more
16%–19.9%
12%–15.9%
Less than 12%
3 NATIONAL CONFERENCE OF STATE LEGISLATURES
Other State Actions Focused Toward Older AdultsStates may consider other plans or actions with elements similar to those identified in a Master Plan for Aging. For example, Title III of the Older Americans Act (OAA) requires states to have an approved state plan on aging that indicates how OAA funds will be allocated to various service areas, such as nutrition pro-grams like Meals on Wheels or other community-based service programs.
A handful of states are working towards the goal of becoming an age-friendly state by joining AARP’s Age-Friendly Network. This network is comprised of states and jurisdictions (e.g., counties, cities) that have a demonstrated commitment to work toward making communities a supportive place to age. This work can create a strong foundation for building out a more comprehensive master plan that communicates the state’s long-term vision for an aging population. For example, Minnesota Executive Order 19-38 (2019) established the Governor’s Council for an Age-Friendly Minnesota and ordered collaborative work across sectors including state government, nonprofits, communities, businesses and others. To support the goal of becoming an age-friendly state, the order states that the council will submit an action plan and legisla-tive recommendations to the governor by Dec. 31, 2021.
While not all states have created a plan or framework to outline long-term, comprehensive approaches, some states have enacted legislation aiming to support various services for older adults—and this type of legislative action could serve as a stepping stone to creating a master plan. South Carolina HB 3998 (2019) enacted the “Workforce and Senior Affordable Housing Act,” which allows a taxpayer eligible for a feder-al housing tax credit to also claim a state housing tax credit. New Jersey SB 2785 (2020) creates the Isola-tion Prevention Project, which requires long-term care facilities to implement policies to prevent social iso-lation of residents. And, in 2011, Florida HB 7107 established the Managed Medical Assistance program which includes non-emergency medical transportation (NEMT) as a covered service. NEMT can be instru-mental in getting older adults who don’t have access to transportation to their various health care services.
NATIONAL CONFERENCE OF STATE LEGISLATURES 4
Master Plans for Aging: State ExamplesThis brief highlights four examples of states—California, Colorado, Massachusetts, and Texas—that have implemented or developed comprehensive strategies to support aging.
California California Executive Order N-14-19 (2019) seeks to elevate the health and wellbeing of older Californians as a priority for the state. The executive order calls for the creation of a Master Plan for Aging to serve as a blueprint for state government, local communities, private organizations and philanthropy to prepare the state for an increasingly aging population.
Creating the plan included over a year of collaboration through public engagement, stakeholder outreach, community roundtables, and coordination with existing state efforts. The executive order specifically out-lined this process by calling for the creation of a Stakeholder Advisory Committee, a Long-Term Services and Supports (LTSS) Subcommittee, and a Research Subcommittee. These three committees comprise 78 members from local government, health care providers, health plans, employers, community-based orga-nizations, academia, researchers and consumers.
California’s Master Plan for Aging, released in January 2021, outlines five goals and 23 strategies to build an “age-friendly” California by 2030. Goals include: “1) housing for all stages and ages, 2) health reimag-ined, 3) inclusion and equity, not isolation, 4) caregiving that works and 5) affording aging.” For each strate-gy, the plan identifies indicators to measure progress. The Data Dashboard for Aging captures progress and shows how these indicators change over time. For example, “dementia in focus” is one of many strategies to achieve goal #2: “health reimagined.” As one of the handful of indicators to measure progress within this strategy, the dashboard details the number of dementia-related deaths per 100,000 adults age 65 or older.
ColoradoColorado House Bill 1033 (2015) created a multi-disciplinary private and public sector stakeholder group to develop a comprehensive strategic action plan on aging in Colorado through the year 2030. The bill sets out requirements for the planning group membership and duties. The group released an original Strategic Action Plan on Aging in 2016, and issued updates to the plan in 2018, 2019 and 2020 (forthcoming).
Colorado’s Strategic Action Plan on Aging was crafted through collaboration among community organiza-tions, public agencies and others to create a vision, goals and recommendations for aging in the state. The plan’s goals address various areas such as workforce, affordable housing, transportation, health and hu-man services. Specifically, one goal relating to economic stability states, “Colorado seniors and their fami-lies will be more financially secure and prepared to meet the challenges of aging.”
The plan also identifies concrete recommendations to achieve its goals. For example, a recommenda-tion from the 2016 plan lays out steps that the Colorado General Assembly could take to increase retire-ment savings by Coloradoans. The planning group identifies Senate Bill 200 (2018) as one of many of the plan’s “successes to date.” This legislation relates to Public Employees Retirement Association (PERA) reforms aimed to reduce the overall risk of the retirement plan and fully fund the program over the com-ing decades.
5 NATIONAL CONFERENCE OF STATE LEGISLATURES
Massachusetts Massachusetts Executive Order 576 (2017) established the Governor’s Council to Address Aging, charged with developing a plan to improve public and private efforts to support healthy aging in communities. In 2018, the council released its plan, the Governor’s Council to Address Aging in Massachusetts Blueprint Recommendations, which outlined 28 recommendations and 67 action steps. The recommendations were put forth by five workgroups examining housing, transportation, caregiving, employment, and inno-vation and technology. The blueprint suggests community input is integral, as “all recommendations will be implemented with input and support from older adults and family caregivers, and from economically, racially, and culturally diverse communities.”
The Governor’s Council Blueprint indicated that while 19 of the 28 recommendations may be implement-ed without additional funding or legislation, at least nine recommendations may require state legislation or budget support. One of the nine recommendations potentially requiring legislation addresses afford-able housing and economic security for older adults through increased awareness and use of property tax deferral programs.
Texas Texas Executive Order R.P. 42 (2005) created the Aging Texas Well Advisory Committee and strategic plan, which is updated every two years. The strategic plan “is a comprehensive proposal to identify and discuss aging policy issues, guide state government readiness and promote increased community preparedness for an aging Texas.” The advisory committee identifies policy areas affecting older adults such as caregiv-ing, community support, employment, health and long-term care, housing, transportation and spirituality. The first Aging Texas Well plan was released in 2015, with periodic updates issued every couple of years.
The Texas Department of Aging and Disability Services staff developed strategic plan mandates with input from the Aging Texas Well Advisory Committee. Each mandate is accompanied by various activities to be carried out by Aging Texas Well partners, including other state agencies, educational institutions, non-gov-ernmental organizations and private organizations. For example, mandate #3 requires a review of state policy, specifically directing the state health and human services agency to review state policies affecting the lives of older Texans. Aligning with this mandate, Texas Senate Bill 1693 (2017) charged the Aging Tex-as Well Advisory Committee with facilitating a study on the prevalence of vision loss among older Texans and providing recommendations for improving and expanding vision loss services.
Looking ForwardImproving services and supports for older adults has long been a priority for state legislatures. As the pro-portion of older adults grows and the pandemic exposes vulnerabilities of this group, states are exploring cross-cutting, comprehensive approaches to better support America’s aging population. Legislators have an opportunity to lead their state in a comprehensive planning process with coordinated efforts across sectors—like health, housing, transportation and social services—and to engage a multitude of experts and community members to achieve long-term success.
Tim Storey, Executive Director
7700 East First Place, Denver, Colorado 80230, 303-364-7700 | 444 North Capitol Street, N.W., Suite 515, Washington, D.C. 20001, 202-624-5400
ncsl.org© 2021 by the National Conference of State Legislatures. All rights reserved.
NCSL Contact:
Samantha Scotti Senior Policy Specialist, Health Program
303-856-1440 [email protected]
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.
