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Government Plans for Aging Must Consider the Lived Experiences & Identities of All Older Adults 

Three older Latina women dance joyfully in an indoor hall or recreation room. In the background, a man is playing the guitar.

“Hold the button and count slowly to ten,” I ordered, sternly but kindly, leaning into her right ear. At 90 years old, Grandma was almost completely hard of hearing in her left ear. She nodded and firmly pressed the life alert. We were practicing in case she needed help. Despite robust Medicaid home and community-based services allowing her to live independently in the community and receive culturally appropriate care, it reassured our whole family knowing that help was just one press of a button away. 

Except in this case, it turned out to be more complicated than we initially thought. In our practice session with Grandma’s life alert – despite being set to the highest volume – she could not hear the dispatcher and therefore was unable to answer their basic questions. The dispatcher did not speak Cantonese, either, rendering the entire exercise even more futile. That help now seemed more distant than ever.

Just as ageism renders older adults invisible, other forms of systemic discrimination erase people like Grandma as older adults. This is despite the fact that according to some estimates, by 2060, older adults of color will comprise almost 50 percent of the 65+ population, or 95 million people.

Grandma’s experience trying to use her life alert, paid for by health insurance, represents a failure of systems. These systems and actors, including policymakers, government, and the private sector, failed to think broadly about who is aging and therefore would likely be using services like a life alert. Just as ageism renders older adults invisible, other forms of systemic discrimination erase people like Grandma as older adults. This is despite the fact that according to some estimates, by 2060, older adults of color will comprise almost 50 percent of the 65+ population, or 95 million people.

We as aging and disability advocates can help states and communities see the broad range of older adults in this country. One critical opportunity is in the multisector plans for aging. Dozens of states across the country are launching, developing, and implementing these plans that seek to coordinate services and create solutions that touch on many different facets of aging, including health care, housing, economic security, and more. In response to these efforts, earlier this year, Senators Gillibrand and Casey introduced the Strategic Plan for Aging Act, a bill that would create a grant program opportunity under the Older Americans Act to incentivize and support states with their own plans for aging.

The success of these plans will depend on many factors, one of which is whether plans center equity in their work by expanding perceptions of who older adults are in a particular state, region, or across the country. As state and federal governments are developing and implementing their multisector plans, equity should be centered in at least three different dimensions: (1) outreach and engagement, (2) substantive goals and initiatives, and (3) measurement and evaluation. 

The success of these plans will depend on many factors, one of which is whether plans center equity in their work by expanding perceptions of who older adults are in a particular state, region, or across the country.

As states develop and implement plans, they must focus outreach and engagement to as broad and diverse of an older adult community as possible. Diversity with respect to age (e.g. 50+ versus 85+ years old), race, ethnicity, gender, sexual orientation, disability, immigration status, language ability, and more, is key. To build relationships with diverse communities, states can employ a range of strategies such as listening sessions, townhalls, and stakeholder committees.

Second, the actual substance of a multisector plan on aging’s goals and initiatives should also center and prioritize equity. This includes both goals and initiatives that center equity on their face, usually by targeting a policy toward a specific group of older adults (e.g. expanding Medicaid to undocumented older adults), and those that are neutral on their face but are prioritized because of disproportionate impact (e.g. improving access to and quality of home and community-based services). For policies that are more universal, states and advocates should assess a proposed policy’s impact on an inclusive group of older adults, prioritizing goals and initiatives that would most advance equity for specific groups of older adults. Tools such as Justice in Aging’s Home and Community-Based Services Equity Framework can help with this process. 

As states develop their plans, progress should be measured in real-time with equity and a focus on equitable data collection in mind. Are policies equitably improving the lives of all older adults, or some more than others? The creation and maintenance of equity indices, such as what California has proposed and is developing for its Master Plan for Aging (MPA), can be one way to operationalize this goal. 

In addition to state-level efforts, the Interagency Coordinating Committee on Healthy Aging and Age-Friendly Communities, authorized under the Older Americans Act and compromised of agencies from across the federal government, is engaged in developing a strategic framework for a national plan on aging. In order to advance equity for older adults, the development of such a framework should also operationalize equity in outreach and engagement, substance, and measurement and evaluation. The framework should also connect with other federal efforts to advance equity, like the federal equity action plans and the equitable data working group report under Executive Order 13985, in order to situate aging as a part of equity and expanding perceptions of who older adults are.

State multisector plans for aging and a federal framework for a national plan on aging are an opportunity to ensure that programs and services are available, accessible, and coordinated for all older adults. If policymakers create them inclusively, we can create a world where someone like Grandma’s experiences aging in this country are not fraught with barriers, frustration, and invisibility, but rather recognition, dignity, and celebration.

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