New York State recently released a Master Plan for Aging to prepare the aging of its population. Within a few years, older adults will make up a quarter to a third of the population in some New York counties.
The plan recognizes the challenges faced by an aging population with words that could have just as easily be applied to Massachusetts:
Many systems that support the needs of aging New Yorkers are siloed, the growth in aging New Yorkers often leaves in-demand services out of reach, and the direct care workforce is not large enough to meet increasing demands. Additional challenges include infrastructure that is not designed for the volume, nor current preferences, of the people it will serve in coming years.
The New York Plan
The New York plan, which was developed through the combined efforts of 430 people who participated in working groups and subcommittees, outlines more than 100 proposals to “address the built environment and infrastructure, transportation and transit, financing of care and services, recruitment and retention of the long term care workforce, licensing and training, pilot initiatives that can bring together providers and community services, innovations in care and service delivery, public-private partnerships.” It coalesces around these nine “pillars”:
- Affordability of Basic Necessities
- Informal Caregiver and Workforce Support and Modernization of Community-Based Aging Network Service
- Modernization and Financial Sustainability of Healthcare, Residential Facilities and Community-Based Aging Network Service Providers
- Prevention, Wellness Promotion and Access
- Housing Access and Community Development
- Access to Services in and Engagement with Historically Underserved Communities
- Social Engagement of Older Adults
- Combating Elder Abuse, Ageism, Ableism and Stigma
- Technology Access and Development
One of the focuses of the New York plan is to support informal caregivers who “are an essential component
of the health and long-term care systems” given the shortage of paid caregivers. It calls on employers to “recognize and adopt policies and practices that allow for caregivers to work and continue their responsibilities” and for “aging service providers, and health service provider systems [to] work to align resources, including respite care and both social adult day and adult day health care programs.”
While it remains to be seen how well the New York plan will be implemented, it’s an admirable step towards preparing for the aging of its population, one that Massachusetts might well emulate.
What About Massachusetts?
It’s not that Massachusetts has not been preparing at all. It has its own plan, ReiMAgine Aging 2030, which I recently discussed with Bonnie-May Shantz, Policy Manager of the Executive Office of Aging and Independence, on my Risking Old Age in America podcast. But my sense is that the Massachusetts plan focuses on the admirable goal of keeping older Massachusetts residents healthy and independent while largely ignoring planning for when they need assistance.
One reason for this, I believe, is the short-term nature of the plan — just the next five years. It’s a year after that when the oldest baby boomers will turn 85 and it’s after this age when the rate of cognitive and physical decline accelerates leading many more people to need assistance. Through 2030, the vast majority of baby boomers will benefit from initiatives that make the state more “age friendly.” But after that date, a rapidly increasing number — and their caregivers — will need more.
To some extent, this is addressed in a separate Massachusetts State Plan on Alzheimer’s Disease and Related Dementias adopted in 2021, but it does not seem to be coordinated with ReiMAgine Aging 2030. And its recommendations seem a bit anodyne. For instance, to increase caregiver support and public awareness of services, it recommends creating videos in several languages, adding information to the Executive Office of Aging and Independence website, and implementing “changes at the Aging Services Access Points (ASAPs) to ensure that stressed caregivers get what they need in an effective
and consistent manner.” To improve the quality of care, it recommends developing “a person-directed care plan framework and template” and “a plan that ensures staff receive training and support needed to build and retain interprofessional teams with expertise in dementia.”
These are all good steps to take and, according to the annual report of the Advisory Council on Alzheimer’s Disease and All Other Dementias for 2023, significant strides have been made in implementing them, but they seem inadequate to meet the huge coming need for caregivers and for up-to-date facilities in which to provide care. We need a multi-sector planning process that brings together all the different providers of care to develop better coordinated systems to provide the necessary assistance to seniors and their families in a cost effective way. If we don’t start preparing now, we will face an elder care crisis in just a few years. The New York process and plan can be a model for Massachusetts.