| Creating healthier, more inclusive environments for older adults

| Shalini Kathuria Narang

| In a recent article in the Gerontologist, researchers Claire Wickersham and Caitlin Coyle at the LeadingAge LTSS Center at U Mass, Boston highlight that age-friendly states are an anchor in age-friendly ecosystems. States can establish policy, cross-agency alignment, and finances necessary to scale and sustain local efforts and can translate community-level innovation into durable systems change that shapes how transportation, housing, health, social services and other agencies operate and help create healthier, more inclusive environments for older adults. 

The researchers examined age-friendly state plans and multisector plans on aging in 18 states and one U.S. territory to identify strategies for systems change across public sectors and to determine how states design and implement healthy aging programs. Twelve had AARP Age-Friendly State designations, eight had multisector plans for aging (MPAs) in development or implementation, and four had MPAs supported by legislation or executive orders. 

“State MPAs can provide a helpful structure to support age-friendly ecosystems. These plans bring together relevant state agencies and their constituencies across healthcare, public health, housing, transportation and other sectors to plan proactively for their aging populations,” says Scott Bane, senior program officer at The John A. Hartford Foundation. 

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The research identified transferable models, enabling conditions, and actionable lessons that can direct future state and local efforts to embed age-friendly principles to support long-term, equitable change. The authors emphasize that state involvement is vital in advancing age-friendly ecosystems.  

“California was one of the first states to develop a multisector plan for aging,” states Bane.  “The state is notable for having its aging and disability services working closely together and they developed a dashboard to track initiatives under the plan. The state also developed relationships with foundations in the state, which were able to provide pilot funding for projects.”

Bane adds, “Pennsylvania is another state leading the way. Its plan, called Aging Our Way, PA, also brought funders together to partner with the state. They engaged Grantmakers in Aging, the membership organization for funders in aging, to serve as a hub for that work. Very importantly, the state dedicated funding towards their plan. The state also worked with the National Center to Reframe Aging so that messages about the plan are effective and help promote the existing resources, such as its network of senior centers.”  

How the age-friendly movement started

Initially championed by the World Health Organization’s Age-Friendly Cities and Communities initiative in 1991, the age-friendly movement encourages communities globally to adapt infrastructure, services, and policies that promote active aging and social inclusion. 

A 2022 article points out that since states have the statutory authority, financing mechanisms, and cross-agency coordination capacity to translate age-friendly principles into durable systems change, they can scale these efforts, acting as intermediaries between federal and local governments. As demographic shifts intensify, the imperative for state leadership in fostering inclusive, age-friendly societies has become urgent.

MPAs are now underway in more than half of U.S. states. Although the AARP Age-Friendly State framework has been a catalyst in community-level participation, MPAs are formal state-level planning processes with direct legislative authority, built-in accountability mechanisms, and dedicated funding streams.

Together, these frameworks highlight the opportunities and the challenges for scaling at the state level. Alongside the AARP effort, the national MPA movement has introduced a complementary pathway for states to embed aging-related goals across various sectors.

The age-friendly state model emphasizes the need for sustained, coordinated efforts across multiple systems. It facilitates alignment between grassroots initiatives and statewide frameworks, ensuring consistent goals, metrics, and resource allocation. By standardizing age-friendly policies, promoting innovation, and fostering partnerships among aging, health, housing, and transportation systems, states can reduce barriers to local implementation and enhance the overall quality of life for older adults.

Pathways that only states can forge

States have adopted a variety of strategies, each yielding tangible outcomes that highlight the potential of state-led interventions to influence aging policy and practice across domains. The key contributions to long-term improvements in aging policy and practice include:

• Financing and coverage infrastructure to improve long-term care access, states are reforming public financing, insurance eligibility, and income supports. Restructuring these fiscal tools lowers costs and removes barriers, making affordable care central to age-friendly infrastructure.
• Housing and land use reform-housing policy is a central structural domain of state-level aging reform. Across states, land use regulations and zoning laws are being revisited to expand housing flexibility, increasing supply, and reducing regulatory barriers that limit aging in place. Accessory dwelling unit reforms represent a recurring strategy and primarily alter the regulatory framework governing housing markets.
• States are using labor policy, targeted wage investments, and caregiver-focused supports to address shortages in direct care occupations and reduce strain on unpaid caregivers.
• A distinct set of state actions involves institutional restructuring and formal governance adjustments that elevate aging within administrative systems. These governance reforms alter institutional architecture and policy coordination, embedding aging considerations within the state administration.
• States are also advancing age-friendly goals through structured stakeholder engagement and cross-sector collaboration. Universities play a role in engagement infrastructure.

Across these five domains, states are employing varied but convergent policies to respond to demographic aging.

State pathways as infrastructure for sustaining age-friendly ecosystems

Across states, successful strategies differ not by any single policy or program, but by governance pathways that align local innovation, healthcare transformation, and broader inclusion-oriented systems change related to age and disability. These pathways create the infrastructure that embeds age-friendly principles into the routine functions of government and public systems. States with meaningful progress share three interrelated characteristics. 

• They demonstrate strong multisector coordination that bridges aging services, healthcare, housing, transportation, labor, and public health. 
• Effective states move beyond symbolic commitments by institutionalizing accountability. 
• Leadership and stakeholder engagement emerge as foundational elements of infrastructure-building. 

According to research by Emily Greenfield and Natalie Pope, these pathways allow states to connect local age-friendly initiatives, healthcare delivery systems, and broader efforts to advance inclusion. Rather than operating as standalone programs, age-friendly principles become embedded within budgeting processes, workforce strategies, land-use policy, and emergency preparedness planning. This shift reflects a deeper cultural transformation within government, one that reframes aging as a universal experience rather than a niche population issue.

States that blend top–down authority with bottom–up engagement are well positioned to build durable age-friendly ecosystems. Legislative and administrative actions establish an enabling environment by signaling political commitment, resource allocation, and mandating coordination, while community-led efforts foster legitimacy and responsiveness. 

Finally, emerging federal momentum, including proposed legislation such as the Strategic Plan for Aging Act (S.3827), underscores the opportunity to further align state and federal aging policy. Federal support for state planning and implementation could accelerate the diffusion of best practices and reinforce states’ role as intermediaries between national priorities and local action. Positioned within this evolving policy landscape, state-level age-friendly pathways have the capacity to sustain, scale, and normalize age-friendly principles as a core feature of public systems rather than a time-limited initiative.s real work to be done in how we structure and incentivize safety.”

Shalini Kathuria Narang is a Bay Area-based independent writer and software professional. She writes about health, wellness, education and technology.