Positive Approaches Journal, Volume 12, Issue 4

Volume 12 ► Issue 4 ► February 2024

Aging Our Way, PA: Paths to Independence

Nathan Lampenfeld, Jessie Pierce, Gabrielle Szymanski and Kevin Hancock

On May 25, 2023, Governor Shapiro signed Executive Order (EO) 2023-09. This EO directed the Pennsylvania Department of Aging (PDA) and partners to evaluate issues facing older Pennsylvanians to support the development of a ten-year strategic plan. Recognizing that Pennsylvania has a larger than average older adult population, and that this population is growing faster than any other demographic, Governor Shapiro initiated this planning process to address the concerns of older adults across the commonwealth. To begin this planning process, stakeholders - including Pennsylvanians over the age of 60, caregivers, care partners, individuals engaged in supporting these populations - were asked to identify barriers that inhibit independence and opportunities to improve community living for older adults. Comments were organized by eight Domains of Community Living, created by the World Health Organization, and adapted for the United States by AARP. These domains are: Housing, Outdoor Spaces and Buildings, Transportation, Civic Engagement and Employment, Communication and Information, Respect and Social Inclusion, Social Participation, and Health Services and Community Supports. [i] According to many community members and service providers, Pennsylvania’s service system and infrastructure are not currently able to support these large and growing numbers of older adults. Extensive quantitative and qualitative data was shared with the Steering Committee and Subject Matter Experts, who provided recommendations within the eight Domains of Community Living. This plan, now known as Aging Our Way, PA, includes priorities, strategies, and tactics that promote the health, well-being, and quality of life of older Pennsylvanians and prepare the Commonwealth for a larger, longer-living older adult population. The plan is designed for adaptability, to respond to changing needs, shifting priorities, and available resources.

The development of Aging Our Way, PA is critical as demographic changes place a heavier burden on Pennsylvania’s service and infrastructure future. By 2030, the population of older adults, aged 60 and above, is projected to surpass 3.8 million (29% of the total population) and will outnumber every other demographic age group. [ii] Currently, nearly 14% of Pennsylvanians have a disability. [iii]  With increased age, there's a heightened risk of acquiring physical disabilities and cognitive decline, both of which have impacted our activities of daily life. Estimates suggest that 50% or more of people with Down syndrome will develop dementia due to Alzheimer’s disease as they age. [iv] Additionally, the number of people with disabilities reaching older age groups and caregivers of people with disabilities becoming older adults are increasing. Older age, compounded with a physical or cognitive disability, presents new and different challenges. Anticipating and preparing for these intersecting trends is essential, as many people will have unique desires and needs as they age and will need specialized support for their journey.

Governor Josh Shapiro recognized that these distinct and overlapping trends are a call to action to build more inclusive, supportive communities for Pennsylvania’s older adults and adults with disabilities. A Master Plan for Older Adults (MPA) is a general term for a state-led planning process that convenes multiple departments and agencies designed to foster cross-sector collaboration and improve the infrastructure and coordination of services for older adult populations. [v] This term originated through the collaboration of a collective of organizations and funders that are working to mobilize financial, social, and intellectual capital, to restructure state and local policies and convene a wide range of cross-sector stakeholders to address the needs of Pennsylvanians as we age. The latter collective includes the Center for Health Care Strategies (CHCS), The SCAN Foundation, West Health, the May & Stanley Smith Charitable Trust, and the John A. Hartford Foundation, among others. MPAs allow states to plan for the rapidly growing population of older adults and people with disabilities, as well as the various compounding demographic shifts like increasing racial and ethnic diversity, increasing rates of solo-aging, and greater longevity among the oldest of the older adult cohort. MPAs consider the entirety of state, county, local and federal policies and programs, and private industry practices that directly or indirectly affect older adults and residents with a disability. A ten-year strategic plan is optimal for stable and mature organizations like state governments, to articulate a long-term vision and to ensure that the goals of the plan are in line with that vision. Several states are actively developing and implementing MPAs. The Pennsylvania Department of Aging (PDA) began this effort immediately after the executive order was signed, using the guidelines set by the Center for Health Care Strategies (CHCS) toolkit along with recommendations from the SCAN foundation and AARP.

PDA began and will continue this effort anchored by five core tenets:

Guided by these tenets, PDA began an extensive community engagement series to understand the barriers that older adults and people with disabilities face in accessing community life and enjoying the journey. PDA, in partnership with the statewide network of Area Agencies on Aging (AAAs) and the Pennsylvania Association of Area Agencies on Aging (P4A), sponsored over 200 virtual and in-person listening sessions, to gather more input from an individual or group either engaged with or affected by older adult and disability related services, programs, and infrastructure. Stakeholders were also invited to submit comments by mail, an online form, or e-mail. This complementary, multi-pronged approach to stakeholder engagement provided over 10,000 constructive points to engagement that allowed the PDA staff to understand the needs and perspectives provided.

PDA also collected data through a Community Needs Assessment, developed and distributed through academic and community partners, including the University of Pittsburgh and AARP Pennsylvania. This Needs Assessment was issued to document the baseline for older adult and disability services, infrastructure, and programming, and to identify clear gaps or barriers that need to be addressed by the plan. The Needs Assessment included a randomized, representative sample of older adults and older adults with disabilities, to present a more objective understanding of perspectives and barriers related to older adult quality of life. The Needs Assessment survey was also available to stakeholders to complete at their discretion. This survey was made publicly available in digital and printed forms in multiple languages and distributed to community partners and their networks, to broaden the understanding of perceived barriers to older adults in accessing services and infrastructure.

Both the Needs Assessment and listening sessions were structured through framework developed by the World Health Organization (WHO) and adapted by AARP for the United States to support the advancement of livable communities for older adults and adults with disabilities. [vi] This framework uses eight domains of livability to assess the characteristics of a geographic area, such as a municipality, city, or state, that make it more accessible to the 60+ population (with benefits for all residents.) The availability and quality of these domains are known to positively impact the well-being of older adults and help make communities more livable for people of all ages across the world. These eight domains include:

Responses to the community engagement and the Needs Assessment survey clearly identified gaps and opportunities for improvement in each of these domain areas. Many of the comments presented by community members overlap in multiple domains, which emphasizes the purpose of this effort: to transform our infrastructure so that all Pennsylvanians are living in and experiencing the support of a holistically age- and disability-friendly community.

Stakeholders highlighted many barriers they face as areas of concern as they age:

These themes and more, were included in qualitative summary reports for each domain and shared with the Steering Committee led by the Pennsylvania Long-term Care Council (LTCC) per EO 2023-09. This committee was supported by Subject Matter Experts (SMEs) who were recruited from state government agencies and organizations that specialize in the domain areas mentioned above. They reviewed the data and spent October and November 2023 crafting recommendation reports for each of the eight domains. These reports outlined priorities, strategies, and actionable tactics, forming the basis of the Aging Our Way, PA plan. The recommendations are intended to build upon the existing infrastructure of public and private policies and programs.

These recommendation reports informed Aging Our Way, PA’s, 5 priorities of concern:

Each priority includes several strategic approaches to address barriers presented by community members and numerous actionable and measurable tactics actions to direct resources, including policy proposals, new programs or program changes, research proposals, proposed new and changed legislation, or funding requests, to support each strategy.

Aging Our Way, PA will provide a unified and realistic plan to guide every older adult, family, and stakeholder through a shared vision of how we, as individuals, determine to age our way with dignity, self-determination, and the supports and services we need to remain independent. In drafting this plan, Pennsylvania is committing to a future in which Pennsylvanians of all abilities have the resources we need to age with dignity and respect and continue to be vital, active members of our communities.

In this vision for the future, Pennsylvania will serve as a model for the nation, and prove that a community is only as strong as its commitment to inclusivity, respect, equity, and support for all its residents. By embracing the AARP's eight Domains of Community Livability, we commit to creating a state where every Pennsylvanian, especially older adults and adults with disabilities, can experience happiness, dignity, and fulfillment.

Aging Our Way, PA is a living document that is designed to be refreshed and advanced as priorities shift, and tactics are executed over the next ten years and beyond. The plan that we publish in 2024 will likely be different from the plan we have in 2034. PDA will continue to engage community members, coordinate efforts with other agencies, formalize collaborative partnerships, elevate common goals, and align the execution of strategies.