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Inside The Senior Alliance: Trends in Aging – Part 1 (Ep 43)

Jason Maciejewski (00:00):
Welcome to Inside The Senior Alliance, a podcast exploring resources and issues in the field of aging. I’m Jason Maciejewski, CEO at The Senior Alliance, the Area Agency on Aging, serving Western Wayne in the downriver area. Joining me today is Sandy Markwood, CEO of USAging. Sandy has been USAging CEO since 2002. Prior to that, she worked at NACO, the National League of Cities, and for Albemarle County, Virginia in policy and programming roles impacting issues such as aging, health, housing, transportation, community development, land use, environmental quality, and workforce development. She’s a graduate of the University of Virginia and holds a bachelor’s degree in history and a master’s degree in urban and environmental policy. Sandy, thank you for joining me today on the podcast.

Sandy Markwood (00:45):
I’m so thrilled to be here, Jason. Thank you for having me.

Jason Maciejewski (00:48):
So Sandy, I have a really quick question to start because I’m not always sure of the number, but how many area agencies on aging are there in the US?

Sandy Markwood (00:57):
Like The Senior Alliance, there are 614 area agencies on aging across the country, serving every community in the United States.

Jason Maciejewski (01:07):
Okay. 614. So that’s the number I’m going go with from here on out. And for our listeners who may not know what USAging is or what you do, tell us about your mission and vision.

Sandy Markwood (01:17):
Well, USAging represents and supports the National Network of Area Agencies on Aging – those 614 agencies. And we also have the privilege of advocating for the Title Six Native American Aging Programs. And our mission is to ensure that older adults, people with disabilities can live with optimal health, wellbeing, independence, and dignity in their homes and communities. That’s a really important mission, but our real vision of aging in this country is to ensure that we can build a society that values and supports people across their lifespan.

Jason Maciejewski (01:58):
What are some examples of the work that USAging does as the National Association for Area Agencies on Aging?

Sandy Markwood (02:04):
We do really important work that really supports our members and also supports older adults and caregivers across the country. First, we advocate, we advocate in Washington DC with the folks on the Hill, members of Congress, as well as the administration, but also key stakeholders that are important to ensuring that older adults can meet that mission of optimal health, independence and wellbeing. And so from a public policy perspective, recently there have been older Americans Act regulations that have come out first time since the 1980s that really drive how the Older Americans Act is going to be operated across the country. We were integral in advocating for that. This year in 2024, we’ll be advocating for the reauthorization of that important Older Americans Act that really is the Safety Net program for older adults in this country. So advocacy is key, but so is helping to build the capacity of our members to respond to the changing needs of older adults, caregivers, and people with disabilities.

Sandy Markwood (03:09):
So we operate a range of programming that really supports our members, whether it be around social engagement, addressing social isolation, transportation services, caregiver support, housing. Also during Covid and beyond, we are working on a vaccine project to ensure that older adults who are most vulnerable to Covid and also influenza get their important vaccines. We’re also looking at working at ways to ensure that we can partner with healthcare to ensure that the social needs of people get supported by healthcare as well as their medical needs. So there’s a range of programs that we do there. And we also provide training and technical assistance to our members and do important leadership and research in this arena. And we operate a national call center, both the Elder Care locator on the aging side, and Dial the Disability information access line on the disability side to ensure that consumers can connect with area agencies on aging and other aging and disability community-based organizations across the country to meet their important and critical needs.

Jason Maciejewski (04:20):
That’s certainly a lot of important work that USAging does. And I want to highlight the advocacy piece. And for anybody that might be listening from the Area on Aging Network, I want to encourage you to attend the Capitol Hill Days and policy briefing that occurs every spring in Washington, a really important event for those of us in the Area Agency on Aging Network to join with our colleagues at USAging and talk to legislators on the hill and get updated on what’s going on. So many of those things that you just covered, Sandy though, those different topics from the Older Americans Act to different policy bills and budget issues, really an important event for people to go and attend and I hope that people in the Area Agency on Aging Network take advantage of that, not only in 2024, but in subsequent years. But it really is a depth of work that you do at USAging and one of the aspects is this national survey of area agencies on aging that you’ve been working on since 2007, typically completed by the vast majority of area agencies on aging. What are some of the key findings from the most recent survey that you did?

Sandy Markwood (05:24):
Well, Jason, we’ve done this survey, as you said, for a number of years, and it really helps us track the trends and the new directions of what’s happening in the world of aging. What do older adults need, and how are area agencies on aging responding to meet those needs? So for the 2022 survey that came out, we found some startling information. 90% of area agencies on aging are serving consumers under the age of 60, often with a chronic or serious illness. So the vast majority of area agency on aging programs are targeted to older adults over 60. But it really, that number really hits us hard because it really shows that area agencies on aging are operating as really the home and community based services hub for people across the lifespan that need that level of service and support. Also, 98% of AAAs are providing programming to address social isolation.

Sandy Markwood (06:25):
And as we all know, older adults were more apt to be socially isolated and lonely before Covid. But Covid really shined a spotlight on those important needs for older adults to get socially engaged. And so 98% of area agencies on aging are responding to that need by developing and providing programming in that arena. 97% of AAAs are offering evidence-based. Evidence-based means they’re proven programs to address issues such as chronic disease self-management, false prevention, diabetes self-management, promoting safe physical activities, and even tackling depression. 75% we found of AAAs from the survey are serving caregivers of all ages. 72% are developing programs specifically targeted to meet the needs of people living with dementia. And again, on that vaccination issue, 60% of AAAs are offering vaccination support and the list goes on. What we’re finding out through these surveys is the breadth of the programs and services that are being provided at the area agency on aging level to meet the varied and critical needs of older adults, people with disabilities, and also caregivers in this country.

Sandy Markwood (07:46):
And they’re doing this with an eye on equity on recognizing the diversity of the aging population and being able to meet people in a very person-centered way. And doing this through creating partnerships. The survey found a growing list of partnerships in public health, in food banks, hospitals, healthcare systems that were developed and are essential to the Area Agency on Aging Network. But it also really surfaced some major challenges for area agencies. And those include funding, you know, recognizing that during Covid, more area agencies on aging were experiencing a higher volume of people coming to them for aging services. And that the needs of those individuals were more complex than they had been pre Covid. Well, those individuals, even though the public health emergency is officially over, those people who came, those older adults who came to area agencies during the Covid crisis are still there and their needs are still there. However, the funding that area agencies received, the increased funding during Covid is no longer there. So funding is a critical issue, as is workforce. It’s recognizing that as the numbers of older adults grow, that we need to have and invest in a workforce to be able to meet their needs.

Jason Maciejewski (09:08):
I’m glad you mentioned the equity piece of the work that we do. We put a huge focus on trying to reach communities that maybe struggle with access to healthcare services and include those voices in our advisory council and the work that we’re doing is an important focus for us to make sure that we are reaching out to those hard to reach populations through programs like we have with community-based services. You mentioned the under 18 population that we serve. You know, we do the My Choice Medicaid Waiver program, which is our, in Michigan, the 1915C waiver. And that is a population that includes people that are 18 and 19 years old that we serve at The Senior Alliance. So that partnership in that healthcare space is really important to what we do as an agency as well. So I appreciate you mentioning those things. Let’s talk about demographics for a minute. And the Census Bureau, you know, the number of Americans that are age 65 and older is projected to be about 82 million by the time we reach the year 2050. And with that comes a greater need for services and diversity of services. What needs are prevalent today that maybe we didn’t see 25 years ago in the older adult population?

Sandy Markwood (10:20):
Jason, I’m so glad that you raised the issue of the numbers of the demographics of the aging population, but also the diversity of the aging population. And to be honest, as a nation, as communities, as individuals, we need to celebrate this. The fact that there are more older adults, the fact that we’re living longer, and also the fact that historically we’re going to have the most diverse population of older adults this country has ever seen. In saying that we need to respond to that. And because of the growing numbers of older adults, the fact that by 2034 there are going to be more people over the age of 65 than under 18 in this country, the fact that we have this growing diversity of our aging population means that we need to invest in services and supports that really meet people’s needs that are person-centered and meet people where they are.

Sandy Markwood (11:11):
And in saying that, I think your AAA has done an amazing job of prioritizing that. And the successes in your area of really meeting people where they are are tremendous. But as a nation, as we look across the diversity of the aging population, it’s really being able to ensure that our programs and services really reflect the people that we’re serving, reflect the communities that we’re serving, whether they are a racially diverse community, a community that is low income, a community that is primarily LGBTQ+ a community that is primarily people living with dementia or also a community of people who have lived with disabilities their entire life and now are going from the disability community and transitioning into the aging community. This, I think is again, something to be celebrated, but it’s something that the aging network is working really hard to respond to.

Sandy Markwood (12:10):
Whether it’s being able to tailor culturally appropriate meals for meal programs to a diverse group of older adults for whom a traditional meal in a senior center, for instance, would not be appropriate. Whether it is really looking and ensuring that people who are older adults who are LGBTQ+ feel that they are welcomed into the aging community and aging services, whether that be at a senior center, community center, any type of evidence-based programming, looking at ensuring people with limited English proficiency also feel and understand the breadth of programming that is offered through the aging network because of translations and the opportunity for staff who are working in area agencies actually to reflect the communities that they’re serving. And also, you know, Jason, one of the growing area that I am also seeing is looking at people with disabilities who, again, we need to celebrate that so many of them are living longer.

Sandy Markwood (13:14):
You know, people with Down Syndrome and IDD are living longer, but transitioning from a disability network support to an aging network support and how we are going to ensure that that’s a seamless transition for them. So there’s lots of challenges out there as we look at meeting the needs of a diverse, older population. But I want to underline the fact that we really need to celebrate the fact that we have such a growing population of older adults in this country with huge assets to be able to contribute to their community. But we also know that as we age, there is a point where we need services and supports from our friends, from our family, from our community, and it’s so wonderful that the aging network is there to help provide that.

Jason Maciejewski (14:01):
I want to applaud USAging for the attention that you bring to diverse communities and high risk populations. I think having USAging as a forum and a place where the Area Agency on Aging Network can discuss these issues and learn from each other, different approaches and different strategies is an incredible value. And I really appreciate the work that you’ve led there. I want to turn to another aspect of the survey. The most recent survey found that 85% of area agencies on aging identify affordable housing for older adults is a major concern. What are some of the challenges older adults are facing when it comes to housing and what are the trends that you’re seeing out there?

Sandy Markwood (14:42):
Well, what we know, Jason, is that most older adults want to age in place in their home and in their community. And in doing that, for those people who want to age in their existing home, you know, their existing home may, they may face challenges in doing that over time. That most people’s homes were not constructed for home modifications that will be needed to ensure that people over their lifespan can safely live there. Very few homes are what is called visitable that have, you know, the wider entrances that have ramps or limited stairs that have grab bars in the bathroom that really, you know, as people age, maybe a necessary component to help them age safely in their home. So from an older adult’s perspective, you face in your home modifications and repairs that may need to be made to be able to ensure that you can live safely there.

Sandy Markwood (15:40):
For renters, older renters, there has been a vast increase in rental rates that have really kind of forced people to, in some cases, to move out of long existing rental properties because of those rent increases. So when you’re looking at across the board at the housing issue, this is really percolated up in US aging, what we’ve heard from older adults themselves and from our members as one of the biggest priority issues for ensuring that older adults can age safely at home and in the community. So as we’re looking at this, the Aging Network is looking at ways to respond to this housing challenge, but it’s a hard one because building new housing in a community takes years and it takes a lot of funding and, you know, responding to rental rates, the Biden administration has done a lot in this area, but it’s still difficult to meet everybody’s needs. And unfortunately, Jason, as a result of this, the other really, I think, horrible statistic that we’re seeing is that the fastest growing segment of the homeless population are older adults. You know, people who are becoming unhoused because either their housing, they’re being cost out of their housing, their housing is inappropriate for them, they can find no other housing, and financially they are finding themselves in a position where they can’t afford housing in their community.

Jason Maciejewski (17:15):
It really is a perplexing issue for those of us who work in the aging field about how do you deal with housing shortage and housing challenges. There are no easy answers. You know, local governments play a huge role in zoning rules and things of that nature. And one of the things that we’ve done at The Senior Alliance is we tried to partner with Veterans Associations to try and address homelessness among veterans and try and get them access to vouchers for housing. Really trying to be a resource connector for people on the housing front. But there’s no real easy solution here. You know, we were involved at one point with a project that would’ve developed a hundred units of affordable housing for older adults and just putting the financing together for that kind of project proved to be overwhelming for it. So it really is something that doesn’t have an easy answer, but something we have to keep paying attention to.

Jason Maciejewski (18:03):
And sometimes it’s not just the actual availability of the housing, sometimes it’s home modifications or minor home repairs that allow people to stay in the housing they’re already in so that they don’t get themselves into a worse situation or need a facility setting because they have some issues with repairs at their own homes. Definitely a complex issue that you explored in that survey. There are a lot more questions that we want to get to, but those will be heard along with Sandy’s answers in part two of this interview, which will be Episode 44. And if anyone has questions about services or programs The Senior Alliance offers, you can call us at (734) 722-2830 or email us at Information about our agency or the programs and services we offer can be found on our website at On Facebook, we can be located by searching for The Senior Alliance. And finally, our X, formerly known as Twitter handle, is @AAA1C. I’m Jason Maciejewski. Thank you for listening to this episode of Inside the Senior Alliance.

Speaker 3 (19:06):
Inside The Senior Alliance is a production of The Senior Alliance and Blazing Kiss Media.

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