| Q&A with Claire Wickersham of the LeadingAge LTSS Center

| Shalini Kathuria Narang

| A recent article in The Gerontologist reviews the progress states are making toward age-friendliness. (Read our exploration.) Article author and senior research associate Claire Wickersham of the LeadingAge LTSS Center at U Mass, Boston spoke to Shalini Kathuria Narang about the study’s findings.

What is the main takeaway of the study?

It highlights the role that states can play in the age-friendly movement. The article covers different levers that states have to push to take ecosystems forward. We highlighted two things that some states have done to scale age-friendly progress—one is the master plan on aging, and the other is the AARP age-friendly state model. 

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Can you tell me more about those two levers? How are they different?

A multisector plan for aging (sometimes called a master plan for aging) is a long-term state blueprint across agencies and sectors, usually around ten years for preparing for population aging. It brings together healthcare, housing, transportation, public health, long-term services and supports in a state. It has clear goals, outcomes, and sustained engagement from older adults and stakeholders. It should be used as a plan for aging policy and implementation and requires responsibilities across agencies, with clear goals and measurable outcomes. 

The AARP age-friendly state framework is complementary. It connects states to broader national and international age-friendly movements and encourages attention to specific domains. There are eight of them, like housing, social participation, civic engagement, etc. States voluntarily join this network, through a commitment from their governor. They participate in these ongoing cycles of planning, implementation, evaluation and progress reporting. The network can provide technical assistance or peer learning and connections. 

The AARP framer provides an age-friendly vision, structure, and network, and multisector plans for aging can provide the state policy architecture for carrying that vision across agencies and systems. 

Can you give me examples of some state-led initiatives that have stood out to you?

Massachusetts and Washington adopted policies that allow accessory dwelling units to be easier to build, and they are supportive of multigenerational living, as well as aging in place. In Massachusetts, they’ve built a coalition to build community, and end loneliness. It’s a coalition of different organizations, state, and local governments including nonprofits, academic institutions, advocacy groups, thought leaders, and partners—bringing more people to the table and to discuss aging issues.

In 2017 in New York, Governor Andrew Cuomo’s office announced the first statewide mobile app to connect older adults to resources and services in their communities about benefits, programs, health and wellness, housing and transportation. 

In Texas, there was a state law for law enforcement officers to receive training and how to interact with individuals who have Alzheimer’s and other forms of dementia. The law requires instruction on techniques for recognizing symptoms, communicating more effectively and employing alternatives for physical restraints. Also, identifying signs of abuse or neglect. 

Utah developed a series of short videos that portray different types of fraud to educate older adults about scams and how to go about recording it. 

In Michigan, they rolled back the retirement tax to save half a million households an average of $1,000 a year. They also signed a budget to increase wages for direct care workers, other staff assisting seniors, and people with disabilities that require home-based care and nursing care services. That’s another way that states can help financially. 

In Colorado, there is a career advance initiative. It was funded through the house bill, which dedicated $38.6 million to cover enrollment costs for training programs in sectors that have significant workforce shortages. That bill was signed by the governor. It builds on the success of their age-friendly movement. They’ve trained thousands of people in Colorado for entry-level healthcare positions. 

Which initiatives and programs are most successful?

Housing, improving transportation and workforce or caregiver support and anything that has to do with modernizing property tax- or rent-relief programs are really important for older adults. Like caregiver tax credits or changing zoning policies and paid family leave, or it could be a statewide education program. So many different avenues. 

States can remove different regulatory barriers and establish common standards or provide technical assistance. They also control funding, and can help communities adapt approaches to their own circumstances. They can connect to priorities, for specific domains, like housing or transportation workforce, caregiving, health equity. 

California seems to be leading the way in terms of their master plan on aging, and they have a specific focus on long-term services and supports, and specifically looking at the needs of the overlooked middle population. Another thing that they have done, which is different from other states that other states could definitely replicate is a dashboard for measuring progress on all domains. 

What were some learnings from other nations?

We also looked at some other countries because this can also be expanded at the federal level. In the United Kingdom, they did this age-friendly employer pledge that was a nationwide program for employers who recognize the importance of older workers. Employers commit to improving work for people in their 50s and 60s. They also provided free bus passes to older adults.

Ireland has age-friendly stadiums with age-friendly inclusive seating fitted with more comfortable seating options, including areas designated for older spectators that offer easier access and better views, age-friendly toilets, concessions, transportation and parking. They have age-friendly airports, making them more accessible and comfortable. They had their staff go through awareness training. We have a long way to go, but there’s a lot of interesting things that states in the U.S. could look at to replicate, or even that could be replicated nationally. 

Can you share about scaling successful state initiatives?

Different states have their master plans on aging. Many times people are secluded to just their own initiative. Having space for learning from other people as they’re going through this blueprint is interesting. They do publish a lot of resources.

The AARP network of age-friendly states and communities provides a common planning place, and they’re more focused on eight domains of livability, but they also provide technical assistance, peer learning and reporting, which is helpful. There’s also this whole age-friendly health systems movement that’s focused on hospitals growing throughout the states.  At the national level, it’s still fragmented. There’s so much that could be done. Nationally, that just hasn’t been done yet.  

What policies or practices make a state program successful?

What distinguishes states as being successful or not is visible, sustained leadership, and coordination across agencies and meaningful engagement from older adults and caregivers. And then there’s accountability. The strongest plans assign responsibility for specific actions and establish timelines and have specific measurable goals and public progress reporting. They also embed aging priorities into budgeting and routine operations, because it can’t entirely depend on one governor or agency. 

Many different people from different sectors have to come together and make the change on all the domains to really have a stronger impact. Sometimes government agencies act in silos. When a plan calls for coordination, agencies may lack the authority or staff and funding to actually implement it. There’s also political turnover. Even though there are executive orders and voluntary coalitions that people build, priorities also change under a new administration. That’s difficult. States need to have more durable governance structures and shared performance measures or responsibilities that are more institutionalized rather than tied to one specific leader. There’s also considerable variation in state and local capacity. Rural areas and smaller communities may not have the dedicated staff or data expertise.

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