Ohio faces a demographic reckoning. With 55 million Americans now over 65, including 2.2 million Ohioans, Ohio’s older adult population is expected to grow faster than the national average, while its population under 65 is projected to shrink. Nationally, by 2050, the number of individuals aged 85 and older is expected to double, creating an unprecedented demand for services as this population becomes more diverse and economically vulnerable. Innovation and collaboration will be especially critical in supporting those who won’t qualify for existing programs and in simplifying access to a complex system of providers and resources.
Fortunately, Ohio also boasts remarkable aging service innovators, from National Church Residences’ expertise in institutional transitions back to the community, to United Church Homes’ expanded service coordination beyond its affordable housing communities, to the Area Agencies on Aging serving as key partners to managed care organizations for the MyCare Ohio program. Success in Ohio’s aging future will hinge on building on these kinds of examples, mastering collaboration, and creating integrated systems that serve vulnerable populations effectively, irrespective of federal funding levels.
To that end, the following questions represent critical challenges reflecting conversations happening in boardrooms, county commissioner meetings, and strategic planning sessions across Ohio and the country.
Building Age-Ready Communities: Key Questions for Local Stakeholders
1. How can state and counties align their aging-in-place investments with those of payers, providers, and purchasers to increase the value of existing programs and resources?
As the aging population grows rapidly, states and counties can maximize aging-in-place investments by establishing unified visions that bring together public agencies, healthcare systems, and private sector partners under shared, evidence-based strategies. This requires deliberate alignment with state and local priorities while engaging private insurers, employers, and community organizations as strategic co-investors. Ohio exemplifies this approach through its remarkable growth in age-friendly communities—36 communities have now achieved age-friendly designation, including 10 new communities since early 2023, demonstrating accelerating momentum toward the development of systematic aging-in-place infrastructure.
Ensuring accountability and tracking progress are essential in demonstrating the effectiveness of public-private investments. Tools like data dashboards help maintain initiative momentum and adapt to needs. Additionally, strategically coordinating funding from various sources, such as Medicaid, Medicare, and private insurance, can enhance resource integration. The Westchester Public/Private Partnership for Aging Services exemplifies how shared resources can improve aging-in-place outcomes while serving as a replicable blueprint for creating age-friendly communities.
2. How can support for older adults in rural communities be increased?
While urban areas grapple with capacity, rural Ohio faces a different challenge: doing more with less. Nearly one in three rural Ohioans is now 60 or older—a concentration that’s both a testament to community strength and a preview of coming pressures. These challenges include limited access to healthcare specialists, transportation systems designed for different needs, and the risk of social isolation as neighbors and family members become more dispersed. Ohioans in rural and Appalachian regions are designated as priority populations in eight of the nineteen outcomes outlined in Ohio’s 2023-2026 State Plan on Aging.
Additionally, local leaders across health plans, hospitals, aging services organizations, and government are uniquely positioned to expand telehealth networks that bring care directly into homes, invest in the broadband and housing infrastructure that makes aging in place possible, and build homegrown training programs that keep caregivers rooted in their communities. Partnerships between Area Agencies on Aging, rural hospitals, and community organizations can create integrated care models that align multiple funding streams, including Medicare and Medicaid, as well as Older Americans Act and county resources. What is needed now is coordination to replicate or scale approaches that will be key to ensuring sustainable aging support for Ohio’s rural older adults and ensure the access required for the changes underway.
3. How can stakeholders reduce social isolation and increase access to age-friendly behavioral health services?
The National Academies of Sciences, Engineering, and Medicine report, “Addressing the Impact of COVID-19 on Social Isolation and Loneliness” documents the impact of COVID-19 on social isolation and loneliness among older adults. The report recommends five strategies to promote social connectedness and reduce social isolation, including:
- Community-based support: Using existing community infrastructure to leverage the resources of community service networks.
- Community leadership: Partnering with communities to design and deliver services, forcing inclusive, action-oriented alliances to enhance social connection and solutions tailored to each unique community.
- Digital environments: Utilizing online support groups to address loneliness and social isolation, being cognizant of cultural or generational preferences for electronic communication platforms.
- Social infrastructure: Designing inclusive and multifaceted public infrastructure and mixed-use planning, incorporating libraries, gardens, shops, cafes to promote social connectedness.
- Comprehensive policy initiatives: Proactive policymaking to aid in the enhancement of social connectedness through supportive programs that address older adults’ unique challenges.
In addition to trends in social isolation, depression and anxiety are frequently unreported and untreated in people age 65 and older; and people over the age of 65 are among those at the highest risk for suicide. Community and state agencies need to come together to expand access to age-friendly mental health and substance use disorder services and to engage older adults in preventive and supportive strategies. Healthy lifestyle programs like Healthy U are offered in communities statewide through the Ohio Department of Aging and local Area Agencies on Aging. These programs offer depression screenings and approaches to managing depression, anxiety, and chronic disease.
4. What are new and innovative approaches to expand affordable housing to prevent homelessness, unsafe living situations, and preventable healthcare costs?
According to the 2024 Ohio Housing Needs Assessment Executive Summary, the number of older Ohioans who live alone is increasing. One in eight Ohio households – or more than 613,000 – houses a single adult aged 65 or over. Aging householders living alone face unique challenges when it comes to maintaining the cost and upkeep of homes, especially among those who wish to age in place. Furthermore, one in eight mortgage holders aged 55 and over (13%) is severely housing cost burdened. Nineteen percent of mortgage holders aged 65 and over and 25% of those aged 75 and over are severely mortgage burdened.
Members of the Ohio General Assembly proposed a comprehensive solution to the housing crisis, including:
- Increase access to affordable housing for all Ohioans regardless of income by increasing the number of new units being built and helping local governments and for-profits and non-profits rehabilitate existing housing stock.
- Provide property tax relief that promotes tax fairness for all Ohioans with targeted assistance for veterans, seniors, first-time homebuyers, and low-income and middle-income renters.
- Update zoning laws and building inspection laws to reduce regulatory obstacles and allow for new housing developments; modernize real estate agency agreements; increase property conveyance transparency; and make changes to the eviction process.
Even for older adults who have affordable housing, most will need support at some point to age in place. The Age-Friendly Health Systems resources from the Institute for Healthcare Improvement provide a great framework for supporting older adults to age in place – the 4Ms of age-friendly organizations. These include (1) understanding what matters to older adults, (2) helping with medication issues, (3) preventing, identifying, and managing mental health conditions and dementia, and (4) ensuring mobility needs are met.
5. How can the state increase older adults, caregivers and communities access to information that is easy to understand about resources to support aging in place?
Currently, Ohio has a 29-year life expectancy gap by zip code, partly driven by unequal access to aging resources. With 99,484 older Ohioans speaking languages other than English, simply having services is not enough; information must be accessible and culturally relevant.
Older adults struggle to navigate complex systems to find housing assistance, healthcare options, transportation, and caregiver supports. Many give up before getting help. Research shows that nationally, 21% of Area Agencies on Aging employ Community Health Workers (CHWs), with 20% more seeking to add them. These trusted community members serve as cultural bridges, providing linguistically appropriate connections to care, accompanying older adults to appointments, and offering emotional support and companionship.
Gaps exist, but there are solutions where partnerships can accelerate progress.
- Community-Based Organizations: Expand CHW programs, host resource fairs in culturally familiar venues like faith centers and community halls, develop peer-to-peer information networks.
- Health Plans: Fund CHW positions, create simplified resource materials, and integrate aging services information into member communications.
- Local Government: Support broadband access in underserved areas, fund transportation to resource centers, and coordinate age-friendly community planning.
- Private Sector: Provide workplace caregiver supports and partner on innovative outreach methods.
Better access to information requires a coordinated effort. Communities are finding that reaching older adults requires innovative partnerships that meet them where they are, whether that’s at their church, community center, doctor’s office, or through a trusted neighbor who understands their language and culture.
