10 Years Ago

• Internet access as the source of timely information
• Growing awareness of wealth, race, equity and disparities
• Discrimination and marginalization of BIPOC communities
• Increased diversity in older adults
• Increased understanding of social determinants of health
• Increased value of HCBS outstrips investments in services
• People shift to work differently, longer, with changed expectations
• Living longer
• Growing focus on ageism, racism, homophobia, etc.
• Expansion of options; technology in care delivery and community supports
• Emergence of mental health discussions
• Limited access to affordable and accessible housing
• Later marriages, children
• Technology explosion - digital divide in access and experience
• Significant improvements in the designed environments for older adults
• People living longer with less money and family supports
• Emergence of workforce challenges as growing crisis
• Increase in respite and other "new" services coming online
• Growth and consolidations increased in aging service companies
• Strengths-based lens on aging grows

40 Years Ago

• Predominance of nursing homes (retirement homes) as the sole option; desire to age at home
• Policy: OBRA, Vulnerable Adult Act, AIDS, HMOs
• Shift away from "institutions" towards community-based settings
• Structure shifted to Skilled Nursing Facility; moratorium began
• Diversification of service lines: continuum model of care grew
• Increased diversity of older people; Grey Panthers
• Shift began towards deinstitutionalization of services
• Discrimination and marginalization of BIPOC communities
• Establishment of Adult Day Services - and hospice was on the horizon
• Increasing professionalization of the healthcare workforce
• Changes in family structures

     Beyond Coronavirus: The Path to the Next Normal (McKinsey, March 23, 2020)

Background Materials on Strategy and Our Operating Environment:

The Importance of Foresight to Imagine, Anticipate Change and Influence the Future

Before thinking in bigger, bolder ways about the future, we recognized we needed to have a clear picture of the current environment and the unique times we live in. Together, from various vantage points, we are positioned to meet the challenges and opportunities of today head on. Most notably, our opportunities to address in the future must include:

Additional detail provided by participants within each of these areas:

Resources

• Personal resources exist for individuals needing services today and tomorrow
• Needed funding for those without resources is in place to fund essential support net programs
• Sustainability is a focus - proactively addressing demographic shifts and the influx of short-term federal funds
• Age-Friendly Philanthropy leads the nation in a coordinated approach by foundations
• Grants, seed funding, and state programs are streamlined to support small and culturally-specific organizations
• Proactive, supportive collaboration exists with insurance companies and health plans

Justice

• Growing awareness and action across all systems to champion diversity, equity, and inclusion
• Closing disparity gaps for older adults, which can compound over the course of a lifetime
• Public leadership, acknowledgement and action on Ageism/Anti-ageism
• A positive narrative and perception of aging fights negative stigma and fears of aging
• Data is collected and research disseminated showing the assets and disparities of marginalized Minnesotans
• Culturally competent services grow - particularly for BIPOC and LGBTQ+ communities
• The public value, respect and contributions of older adults grows in time
• Intergenerational and holistic approaches to housing and care ensure culturally responsive services for all Minnesotans
• 
  

Housing

• Ensuring affordable options (truly affordable options)
• Expansion of the low and middle-market options
• Diversity of product moves away from one-size-fits-all big box offerings

Outdoor Spaces

• Community infrastructure across Minnesota cities and counties is enhanced to offer safe sidewalks, crosswalks, bike lanes, etc.
• Safe and engaging intergenerational convening spaces are available in all seasons

Communication & Information

• The "Digital Divide" is closed through in-person resources, digital literacy and universal access to phone/internet
• Complexities of the aging systems are reduced and a simple, accessible, easy-to-navigate partner is available
• Resources to plan for our aging at the individual level are robust, and well-utilized
• Regular public education builds awareness for older adults, families and organizations
• Collaboration and information sharing is easy and trusted across organizations

Social Participation

• Social isolation is reduced - particularly during pandemic as more people have grown empathetic
• Volunteerism is increased - particularly of older adults and for older adults
• Participation in dementia-friendly efforts at the community level are expanded
• Income disparities are not a barrier to meaningful community engagement
• Virtual communities are accessible, understood and inclusive of older adults

Health Services & Community Supports

• A variety of supportive services are accessible in communities across the state
• Effective community-based offerings like Adult Day are bolstered and become community hubs
• New models are launched, like partnerships with public libraries and community education
• Mental health needs of older adults are recognized and provided for in an integrated approach
• Resources, research, information and other supports address dementia, Alzheimer's
• Equitable opportunities for services is the expectation for all - particularly during the pandemic
• An immediate reduction in the closures of programs and organizations ensure communities have adequate options

Respect & Social Inclusion

• The value of older adults in the community are showcased - such as older adult performance groups; community education
• Social isolation is reduced; older adults become/stay an active part of their communities
• Families, friends and informal networks grow in their supportive skills and recognition as caregivers
• Faith communities focus on social connectivity and evolving needs of the older adults in their services

Civic Participation & Employment

• Policymakers look to older adults with great value to co-design any services - "nothing for us, without us"
• Minnesota harnesses and leverages the many skills and abilities of older adults willing to stay engaged
• Job sharing or creative employment models retain/re-engage a greater number of older people in the workforce

Transportation

• Trusted transportation options are available, reliable, and affordable across the state
• Programs are integrated thoughtfully into other systems and services
• Barriers to volunteer drivers are eliminated and community supports grow
• Operational processes are safe and easy to navigate
• 
  

Workforce

• The value of caring for older adults and professions across the aging sector are respected and valued
• Caregiving by families, friends and the community is recognized, respected and celebrated
• Caregiving careers are desired and sought-after by society eliminating staffing shortages
• Wage disparities are reduced in aging services - the lifetime of low-wage work is replaced with family-sustaining wages
• Statewide solutions - such as immigration - address underlying demographic shifts and lesson competition across all sectors
• A leadership development pipeline and succession planning are in place for all critical roles in the aging network
• 
  

Public Safety

• Ageism/Aging is viewed as a public health issue, elevating prevention and preparation initiatives for all Minnesotans
• Elder abuse in all forms is reduced: physical, sexual, emotional, financial/material exploitation, neglect, abandonment, and self-neglect
• Emergency preparedness planning expands to fully include older adults as a key audience and partner
• Future crisis management efforts understand the unique assets and needs of older adults

Technology

• Technology innovation and acceleration is focused on the aging sector
• Capacity of small organizations is bolstered by effective remote services, supplemental staff supports, etc.
• Breakthroughs begin to proactively address family genetics

Regulatory

• HIPAA and PHI are revised to ensure they are not barriers to continuity of care
• Starting with CMS, government partners incent, recognize and fund innovation
• Flexibility and creative approaches meet safety and compliance standards while streamlining bureaucracy
• At the human level, we see less paperwork; more client care
• At the community level, we see an aging lens applied to all services - such as zoning for intergenerational options

Access

• All rural communities have reasonable access to the various service lines needed to meet community needs
• Small home and community-based service organizations are viable and available

Other

• Leaders must think big and bold about change - this isn't the time for small moves
• Older adults without families or supportive structures are not forgotten
• Champion policymakers who understand aging systems in the Legislature and Congress emerge and are fostered
• Existing resources we have today are brought together in more intentional ways to maximize results
• As planning occurs, we should build on what works; not feel afraid to close down what doesn't
• Look at the full integration of financing and regulatory systems, from federal funding streams to local decisions
• Streamline and simplify this really complex system (set of systems)
• Leaders fully engage fully in collective policy and non-policy solutions
• Change is hard, crisis is painful, but a sector in crisis is prime for transformation
• We can't do this alone - leaders across silos must fully engage fully in collective policy and non-policy solutions 
• This work is best if co-designed, community-driven, and elder-informed at every stage
• What are our common definitions: what does it mean to age well?

Note: Many comments fall within the eight domains of an age-friendly state, listed below.

Challenges and Opportunities developed by Summit attendees on November 3, 2021.

Raw Data >

What follows are specific ideas generated by AGEnda participants in each of these five big themes of possibilities.

Aging and Equity

We seek a future where...

• The aging population is an essential asset with valuable knowledge and experience, worthy of respect and quality care.
• Human contact and community are central for health and life.
• A strength-based, person-centered approach across the continuum of care and throughout all life stages.
• Aging voices are integrated to best inform interventions and address needs.
• Diverse voices are reflected and co-design new policies for the future.
• Self-determination and individualized decision-making are advanced in safe, culturally sensitive environments.
• Cultural enrichment and engagement occur with a multi-generational lens.
• Discrimination, agism, and bias, are dismantled in current systems.
• Intergenerational interactions lead to basic needs being better met.
• Social determinants of health and social wellbeing are inclusive.
• Universal access to affordable broadband, Wi-Fi, and data are accessible (especially in rural).
• Intentional, multicultural, responsive and anti-ageist care is provide by medical personnel.
• Localized systems are encouraged to advance equitable education programs.
• Medicine and healthcare are equitably available and tailored for all communities.
  

To accomplish this, we could...

• Intentionally incorporate diverse voices in decision-making, co-designing policies, or other interventions.
• Learn from other cultures how to respectfully utilize older adults.
• Liaison more effectively at the Cabinet level.
• Foster champions in the Executive Branch.
• Elevate language on aging to raise awareness and strive for alignment.
• Promote utilization of intergenerational planning.
• Support structures that advance age-friendly communities.
• Require education aimed at combating ageism.
• Coordinate public information campaign efforts.
• Recreate social dependence between the generations.
• Actively work towards anti-ageism efforts and address crosswalk to generational poverty.
• Actively work towards anti-ageism efforts and address crosswalk to generational poverty.
• Show the important role and contributions of the older population in the workforce.
  

Economic Infrastructure and Policy

We seek a future where...

• Older adults are not a “budget burden” but drive policies and are prioritized in shared agendas across agencies.
• The costs of aging services are lessened.
• Fair reimbursement waivers offer benefits like healthcare via flexible service delivery options (i.e., telehealth or community-based services).
• The economic impact of an aging population is prioritized and addressed through policies.
• Pharmaceutical research/insurance is equitable and access to services is simplified.
• Universal healthcare and Medicare/Medicaid keep up with increasing costs and offer simplified enrollment.
• Financing information is clear and accessible to all people before they turn 65.
• Financing is flexible and scalable, removing the spend-down asset scrutiny.
• Funding better-serves rural, indigenous, and marginalized populations to close equity gaps.
  

To accomplish this, we could...

• Develop an infrastructure bill that includes universal broadband and data privacy.
• Adequately reimburse public programs.
• Invest in preventative technology.
• Engage cross-system partners to promote a shared financial responsibility of the community.
• Advocate for older adults as a Cabinet-level focus within the Executive Branch.
• Develop resources for securing basic livelihood, income, education, and home ownership by removing access barriers.
• Orchestrate a universal package of services where older adults can thrive with individualized care and support for a purpose post-retirement, (i.e.: skills, mentor, etc.).
• Direct funds to critical elements: family wellbeing, childcare, caregiving, rural and indigenous areas.
• Encourage CMS to approve new channels of care for supportive interventions.
• Create new intergenerational opportunities, like shared sites for older adults and childcare.
• Utilize the State of Washington model to help older adults not spend down their resources.
• Conduct outreach about future planning earlier in life so everyone understands micro-investment, insurance options, etc. and the public social contract in their LTSS.
• Address how insurance companies and payment are drivers for policy change and require baseline training to law makers to have consistent definitions and understanding related to equity and other “isms.”
  

Community Caregiving

We seek a future where...

• Caregiving is understood and highly valued.
• Family, friend and community caregivers receive the support they need to thrive in their roles.
• Employers respect the need for employees to care for others through flexibility, PTO, and respite.
• Family, friend and community caregivers are given fair compensation, support, and benefits.
• Isolation and issues of abuse, neglect, and/or exploitation are reduced/eliminated.
• Older adults are empowered with tools and resources to form their own caregiving team.
• Integrated families can have dinners without LTC shame.
• Caregiving is reframed as a lifespan issue.
• More families, friends and community caregivers have cultural competency training.
• SMART homes/communities offer a broad range of integrated, in-home services.
• Community-based PCA’s assist multiple individuals needing intermittent or light services.
• Individuals who are aging without supports (solo agers) have access to equivalent LTSS so they can age in place. 
• Paid family leave and in-home care with sustained support is enhanced.
• Access to trusted care is personal, equitable and inclusive.
  

To accomplish this, we could...

• Redefine caregiving as more than just care for an older adult (i.e.: Aging Consultant).
• Consider intergenerational caregiving and care through a “care exchange” or “co-care.”
• Guarantee workplaces are responsive to caregiver needs and supports.
• Provide supports within the community for those living alone.
• Identify assets before deficits.
• Learn from different cultural communities and replicate successful elements of living.
• Safely promote mobile services, e.g., clinics, personal care/beauty services, etc. in-person.
• Structure a paid-worker model that recognizes the caregiver.
• Develop a concierge of virtual social workers and ensure caregivers are trained for active engagement in the process of end of life.
• Promote technology and broadband in LTC and make it affordable and accessible for rural or underserved areas.
• Promote early interventions and prevention efforts, such as genetic innovations.
  

A Supported Workforce

We seek a future where...

• Career caregivers for older adults is understood and highly valued.
• Career caregivers receive the support they need to thrive in their roles.
• Livable wages and healthcare benefits for career caregiver roles or gig workers with flexible schedules are plentiful.
• Retired adults connect in new ways that contribute to the community.
• Organizations make accommodations for a diversity of older adult talents in voluntary, employment, or entrepreneurial roles to fill in workforce gaps.
  

To accomplish this, we could...

• Use an asset-based approach for livable wages, PTO, flexibility, incentivized recruitment, and removed penalties for older people earning more money.
• Establish immigration reforms - creating policies which facilitate the arrival of people with needed care skills.
• Create affordable and accessible education and training opportunities.
• Incorporate trained professionals from other countries to help design/implement services.
• Develop a forum or process to support older workers in finding relevant jobs.
• Expand the AmeriCorps and VISTA Program for college students to reduce loan debt and create a pipeline for careers in aging.
• Construct more flexible regulations to allow people at younger ages or with experience or skills to do partial pieces of jobs (high school students, Army medics, etc.).
• Promote aging services careers as valued professions.
  

Housing and Supportive Services

We seek a future where...

• Older adults have safe, affordable housing (rural and urban).
• Older adults stay in their homes for as long as they want.
• Inclusive policies and supports across a broad array of living situations (e.g. intergenerational homes, community-based living, etc.).
• Insurance companies pay for more and different supportive services (e.g. home delivered meals, transportation, all healthcare).
• Communities are multicultural and person-centered
• Isolation is reduced/eliminated.
• Builders avoid negative aging assumptions, and reflect considerations for varied location, full lifespan, and sustainability.
• The focus of a continuum is reframed around home and community-based services, not the nursing home.
• AI/SMART technology assists older adults as they age.
• Community centers serve all ages and are a hub to access respite, caregiving, and caregivers supports.
• Sustainable necessities and universal designs (i.e., stairs, doorways, etc.) within the home let people stay at home longer.
• Vulnerable adult laws protect older people.
  

To accomplish this, we could...

• Increase social interaction and inter-generational input in the built environment.
• Ensure rent control and affordable housing policies help stabilize the population.
• Make low-cost, mobile housing or retrofit homes available.
• Provide more support at the block level and create efficiencies in community-based supportive service dollars using targeted/localized programs/funding.
• Advance ownership equity programs and vouchers for supportive services (informal caregiving network payments).
• Promote a diversity of housing styles and different living models.
• Develop social services and an on-call tech support 24/7 to assist seniors with tech issues and assistive technologies (e.g. large print guides and resources to increase technology independence).
• Make housing and services culturally supportive with opportunities for healthy, active living and home delivery services for medicine or vaccines.
• Mobility support is readily available and accessible through safe transportation options (i.e. non-medical appointments).
• Design policies to ensure AI complies with HIPAA requirements.
  

What emerged from the workshop and Summit were two kinds of issues - policy priorities for 2023 and larger conversations where more detail was needed:

Immediate Shared Policy Topics

• LTSS/HCBS rate increases focused on workforce wages/benefits
• Senior nutrition funding
• Public information campaigns (focus on the value of older adults, ageism, underserved communities)
• Age-Friendly Council continuation
• A Legislative Task Force on Aging
• Phase 2 of the Vulnerable Adults Act work
• Closing the digital divide through broadband for all older adults
• Creation of a Native American Elders Office

Longer-Range Policy Conversations

• A lifespan approach to waivers
• Supporting family caregivers
• Affordable senior housing (homeless programs; multigeneratonal living)
• Live Well at Home reforms
• LTC Financing reforms
• Improving the workplace (enhanced pipeline, training and culture efforts)

Source: 2023 Legislation Workshop Jamboards

Raw Data >