Healthy & Fulfilling Aging Systems of Washtenaw County by AAACF

AAACF Washtenaw County HEALTHY & FUlFilling AGING SYSTEMS Research Report 2020 Analysis of the Local Senior Ecosystem & Opportunities

To document and analyze the daily lived experiences of older adults in Washtenaw County and the systems intended to support healthy aging, the Ann Arbor Area Community Foundation (AAACF) commissioned the AAACF Washtenaw County Healthy & Fulfilling Aging Research Report, the first research of its kind to establish an independent and objective understanding of what healthy aging could be in Washtenaw County and how to improve the quality of life for all local seniors. AAACF contracted Root Cause of Cambridge, Massachusetts, to map existing programs and services using both quantitative and qualitative expertise to produce a comprehensive analysis of Washtenaw County’s current senior demographics, documentation of the lived experiences of older adults, and how to improve the senior ecosystem.

R ES EA RCH SYNOPSIS

AAACF Washtenaw County Healthy & Fulfilling Aging Systems Research Report: 2020 Analysis of the Local Senior Ecosystem & Opportunities New Research to Advance a More Just Approach to Growing Older Since 1963, the Ann Arbor Area Community Foundation (AAACF) has provided community capital to Washtenaw County, distributing proceeds from endowed funds made possible by 15,000 donors. Providing support for local older adults has been a focus area of AAACF since the establishment of The Anna Botsford Bach Fund for Seniors in 2003, which built upon the Phoebe Davis and Oscar Reimold funds. The addition of the Glacier Hills Legacy Fund in 2018 transformed the impact of funding for vulnerable seniors in Washtenaw County and their caregivers.

The Impact of Older Adults in Washtenaw County As the largest grantmaker for older adult needs among Michigan’s 60 community foundations, AAACF sought to better understand the current status of local seniors and the systems designed to serve them, as well as to identify opportunities to promote a more just aging “ecosystem”: the spectrum of private and public resources to support healthy and fulfilling lives of seniors.

By 2040, the number of Washtenaw County seniors in poverty will more than double to approximately 9,000 as the senior refugee population annually increases by nearly 3%.

To document and analyze the daily lived experiences of older adults in Washtenaw County and existing services to support healthy aging, AAACF commissioned the AAACF Washtenaw County Healthy & Fulfilling Aging Systems Research Report, the first research of its kind to establish an independent and objective understanding of the local ecosystem for seniors. AAACF contracted Root Cause to conduct a broad analysis of the county using both quantitative and qualitative methods.

The comprehensive research project began in November 2019 with a thorough analysis of demographics for the older adult population in Washtenaw County. Interviews with more than 70 local older adults from all walks of life then yielded significant insights to complement the quantitative data and service mapping. In addition to the interviews, researchers conducted focus groups and trained older adults to conduct interviews with other older adults in their own communities and to act as photo/video journalists capturing daily lives digitally. This research report summary provides (1) a concise demographic snapshot of the local senior population and (2) firsthand perspectives from older adults (70+ interviews plus focus groups) about their experiences aging in Washtenaw County. It concludes with recommendations for action and partnership.

Life for everyone in 2040 will be shaped by our response now toward aging. The county must prepare to fully and justly support all seniors to have healthy and fulfilling lives as older adults.

AAACF Washtenaw County Healthy & Fulfilling Aging Systems Research Report

Contextual Background

Throughout the research project, AAACF and Root Cause consulted with a local working group comprising representatives from governmental agencies, foundations, nonprofit service providers, and community members experienced in working with older adults and accessing systems. In keeping with its mission to serve the entire community and foster collaborations, AAACF intentionally sought diversity of perspectives and representation in every aspect of the research project. Research Report Working Group Participant Representatives Aging for Life Chelsea Senior Services Glacier Hills Legacy Fund Jewish Family Services Michigan Health Endowment Fund Washtenaw County Office of Community & Economic Development

United Way of Washtenaw County

This is such a massive opportunity. We have great momentum and I hope we don’t lose that.”

Washtenaw County Health Department Washtenaw Health Initiative’s Senior Services Work Group Community members experienced in working with older adults and accessing systems

—Working group member

SNAPSHOT: Demographics of Older Adults in Washtenaw County* Of Washtenaw County’s estimated 371,000 residents, more than 72,000 (20%) are 60 years or older. The majority are White, with 15% identifying as people of color.

AGE DISTRIBUTION OF OLDER ADULTS IN WASHTENAW COUNTY

Ages 60-64 [28.3%]

Ages 65-69 [24.1%]

Ages 70-74 [19.7%]

Ages 75-79 [12.7%]

Ages 80-84 [7%] Ages 85+ [8.2%]

Because 79% of adults 65+ locally are not employed, understanding their annual income is critical.

HOUSEHOLD INCOME SOURCES IN PAST 12 MONTHS, 65+ YEAR OLD LED HOUSEHOLDS

Social security

90% $24,026

Retirement

56.8% $30,750

Earnings

41% $71,410

Food Stamp / SNAP Benefits

6.1% N/A

Supplemental Security

4.6% $11,728

Cash Public Assistance

1.6% $1,684

% Households Mean income $

* The full report contains more comprehensive demographic data.

AAACF Washtenaw County Healthy & Fulfilling Aging Systems Research Report

A primary cost for seniors is housing. Adults 65+ account for 30,000 total housing units locally. While most older adults in Washtenaw County own their homes, more than one quarter may have trouble paying for heat.

HOUSING COST BURDEN, HOUSEHOLDS 65+ YEARS OLD

% Housing cost-burdened (>30% household income spent on housing costs) Median $ housing costs

Renter occupied

18% 5,413

Renter occupied

53.3% (rent) $867

Owner occupied

82% 24,514

Owner occupied

26.5% (select monthly owner costs) $1,547 (with a mortgage) $670 (without a mortgage)

% Housing units # Housing units

Other Important Demographic Consideration of Local Adults 65+ Differing Abilities Of the 50,000 local adults 65+ who are not institutionalized, more than one in four (29%) have a disability.

TOTAL Seniors

Seniors with a Disability

TOTAL

Ages 65-74

Ages 75+

TOTAL

Ages 65-74

Ages 75+

50,706

31,161

19,545

28.6% 15,154

21.6% 6,745

43% 8,409

Ambulatory TOTAL 18.5% 9,393

Ages 65-74 13.3% 4,146

Ages 75+ 26.8% 5,247

Hearing TOTAL 13.7% 6,930

Cognitive TOTAL 6.7% 3,407

Ages 65-74 3.5% 1,079

Ages 75+ 11.9% 2,328

Ages 65-74 8.3% 2,574

Independent Living Ages 75+ 22.3% 4,356

TOTAL 12.2% 6,208

Self-Care TOTAL 6.9% 3,509

Ages 65-74 4.6% 1,434

Ages 75+ 10.6% 2,075

Ages 65-74 6.9% 2,163

Ages 75+ 20.7% 4,045

Vision TOTAL 3.4% 1,712

Ages 65-74 1.9% 577

Ages 75+ 5.8% 1,135

AAACF Washtenaw County Healthy & Fulfilling Aging Systems Research Report

Differing Abilities (continued)

Language

10% speak a language other than English. 5% are challenged in speaking English.

Veteran Status

15% of all seniors are U.S. military veterans.

Caregiving Role

3% live with their grandchildren, and 1% of seniors serve as caregivers.

Solo Households

44% live alone. The Washtenaw County Older Adults 60+ Survey results say “living alone does not seem to be a significant indicator of lower quality of life.”

Geographic Disparities

Those near the urban areas of Ann Arbor and Ypsilanti, along with the northern border and southwest corner of the county, have greater economic security. Two zip codes, 48197 and 49198, are typically highlighted when viewing Washtenaw’s “vulnerable” older adults.

The Demographic Data Reveals: Service accessibility, availability, and quality can differ for older adults based on geographic location, race, class, socioeconomic status, and other characteristics.

Healthy and fulfilling aging requires an interconnected web of services that accounts for these differences.

AAACF Washtenaw County Healthy & Fulfilling Aging Systems Research Report

Older Adults’ Views on Aging in Washtenaw County To build upon the demographic analysis and to understand how older adults access and use available programs/ services, any challenges they have encountered, and how their aging experiences could be improved, the research study included 71 interviews as well as focus groups with Washtenaw County seniors about their aging experiences (before and during the pandemic), conducted by phone and via Zoom. Root Cause researchers conducted 32 interviews and focus groups and then trained Community Research Partners—older adults in Washtenaw County—to conduct 39 more interviews. These older adult researchers were paid for their services and some also acted as photo/video journalists to capture their daily lives digitally.

Snapshot: Demographics of the Interview Population

21%

LOW INCOME

28%

[33%]

Chelsea

18%

Ann Arbor 1%

Sharon Township

Ypsilanti

7% 1%

PLACE OF RESIDENCE

Pittsfield Township

Ypsilanti Township 1%

DISABLED

Willis

Saline

Manchester

[14%]

UNKNOWN

Milan

White [78.5%]

50s [4%]

Male [25.7%]

80s [20%] 60s [19%]

AGE

90s [1%] Unknown [7%]

Black [16.9%]

RACE

GENDER Asian [3.1%]

70s [48%]

Other/ Unknown [1.5%]

Female [74.3%]

AAACF Washtenaw County Healthy & Fulfilling Aging Systems Research Report

Most Common Barriers to Healthy and Fulfilling Aging From 70+ interviews and focus groups with older adults from all walks of life across Washtenaw County, four areas were repeatedly cited as the most common barriers to healthy and fulfilling aging: Housing, Transportation, Social Connection, and Technology and Access to Information/Services.

Housing

For homeowners, maintaining one’s home (yard work, repairs, etc.) becomes a challenge with increasingly restricted physical mobility and income in older adulthood. Many wish to downsize, but find Washtenaw County (particularly Ann Arbor) cost prohibitive. For renters, affordable, senior-friendly apartments are difficult to find in Washtenaw County. Rent makes up a significant percentage of the monthly budget. Across economic brackets, many respondents cited lack of affordable, seniorfriendly housing options in Washtenaw County, as well as the need for a central resource for affordable, vetted housing services, including repair contractors, real estate brokers, affordable housing programs, etc. Respondents cited a desire to “live in my own home for as long as I can” and avoid being confined to a nursing home.

Transportation

Many residents expressed that getting around without a car is very difficult in Washtenaw County. Older adults who cannot drive anymore, or who cannot afford car payments/maintenance, are made especially vulnerable by a lack of public transportation options in the county. One major theme that emerged was that of transportation as a connector. Many people rely on transportation to access healthcare, food, social activities, jobs, etc. There is a strong need for a coordinated transportation system in the county, which offers door-to-door and affordable options for older adult residents. Many public transportation options have been shuttered during the pandemic, including A-Ride and bus routes, isolating older adults in their homes. Subsidized cab options like A-Ride cannot be used for entertainment or leisure activities, or to take advantage of senior discounts offered at local establishments. Other private cabs such as Uber or Lyft have a limited range within the county and are expensive.

Social Connection

Older adults overwhelmingly spoke of the negative impact of social isolation during the pandemic on their mental and emotional well-being. Many are trying to stay connected through phone calls and Zoom calls with friends and family. Senior centers play a significant role in many respondents’ social lives, serving as a central place for social and physical activity pre-pandemic, and helping to connect older adults to resources and virtual community during Covid-19. However, the type and quality of programming and services can vary among senior centers. Some older respondents expressed that their local senior centers are “geared towards the 70-75 crowd,” with limited options for adults over 80. Increasingly, access to high-speed internet and comfort with using a computer are critical to socialization during the pandemic. In pre- and post-pandemic times, built-in spaces near housing, such as parks or community rooms, can also encourage natural socialization.

AAACF Washtenaw County Healthy & Fulfilling Aging Systems Research Report

Most Common Barriers to Healthy and Fulfilling Aging (continued)

Technology and Access to Information/ Services

Technology: Overwhelmingly, older adult respondents reported using technology to adapt during the pandemic, utilizing video calling, online grocery delivery, telehealth, and other online platforms, many for the first time. Many senior centers, faith organizations, and community groups have taken social activities online; our respondents reported using Zoom to play cards, take classes, connect with family, and participate in civic meetings, among other activities. However, some older adults also cited barriers in accessing the internet and troubleshooting their devices. Many of our interviewees who are struggling economically use only their smartphone for all of their tech and online connectivity needs, which is remarkably sufficient in most cases. These interviewees did not have access to either a computer (laptop or desktop) or wifi/ broadband. However, some remarked on the slow speed or data limits of their wireless plan data connection as limiting their ability to share photos/video or use video chat platforms. Access to Information/Services: A significant number of respondents reported that information on services and resources for older adults is difficult to find, and that “you need to know where to look.” Many cited the need for a centralized agency to help people plan for older adulthood, find resources, navigate health and financial benefits, and access reliable information. Several respondents also reported not knowing what to believe during the pandemic, citing conflicting and confusing media reports about Covid-19. Many older adults interviewed reported getting their news from a single media source, usually television. Some reported a mix of sources, including online and print media, as well as television. Those older adults who are connected to senior centers or programs (such as Washtenaw County’s Foster Grandparents Program) lauded those entities for calling to provide reliable information about pandemic safety and resources such as meal delivery programs.

Another consistent theme across interviewees was the notion that older adults do not have sufficient political or economic power to positively influence aging systems. Despite high levels of civic and political engagement, seniors stressed the need for new, better, and expanded program interventions (e.g., better transportation or senior center availability) as a potential objective of greater advocacy for an aging population.

AAACF Washtenaw County Healthy & Fulfilling Aging Systems Research Report

Recommendations for Action

In reviewing the demographic and qualitative data, working group members agreed that healthy aging has traditionally been defined with an emphasis on health, such as minimizing the risk of disease and disability, effectively managing chronic conditions, and maintaining a high level of physical and mental functioning. Based on the report, Aging with Health & Fulfillment must also encompass economic security, affordable housing, transportation, food security and nutrition, social connections to one’s community, a sense of purpose, and access to all needed programs.

I’m glad you are doing this [research] and somebody cares about how seniors are doing.”

It is also essential to promote “Aging Justice,” viewing older adults as community assets, valuing seniors as a priority, and ensuring a healthy & fulfilling aging experience regardless of class, race, or gender. The opportunity to reach this “high bar” is illustrated below.

THE (HIGH) BAR FOR HEALTHY & FULFILLING AGING Aging-Related Transitions (Health, Finances, Family/Relationships, Independence) AGE 55

• Social Connection

• Economic Security

• Health & Wellness • Sense of Purpose

CLASS, RACE, GENDER

100+

• Ages-Friendliness & Narrative GAP

• Affordable Housing (ages-friendliness, downsizing) • Transportation (can’t drive)

• Affordable Housing (% of budget)

GAP

• Transportation (no car) • Food Security & Nutrition • Access to Programs

AGING JUSTICE = CLOSING THE GAPS

AAACF Washtenaw County Healthy & Fulfilling Aging Systems Research Report

Based on the review of Washtenaw County’s demographics and learnings from interviews with local older adults, the following actions are recommended:

Action Strategy for Impact

Intended Results for Community Transformation

Solidify a more robust field around Healthy & Fulfilling Aging and Aging Justice

A cross-sector, collaborative stakeholder group serves as an anchor to develop and own a county-wide aging strategy, expand partnerships and solidarity with other groups, spread an aging justice lens across other fields, and promote agesfriendly practices.

Champion older adult capacity to influence systems change

Older adults are empowered and organized to expand civic engagement, generate new leaders, and work in solidarity with allies, in order to build political and economic power that drives improvements to aging systems.

Shift mindsets to prioritize aging, older adults, and systems change

Key stakeholders value older adults as a priority stakeholder group for engagement and investment, and understand and prioritize systems change as a strategy to support healthy & fulfilling aging and aging justice.

Advance targeted solutions in priority aging areas

Systemic and programmatic solutions are defined, prioritized, and make implementation progress in the prioritized aging areas of transportation, housing, community connections, and equitable access, which also generate data and inform policy.

AAACF Washtenaw County Healthy & Fulfilling Aging Systems Research Report

AAACF is committed to advancing these strategic actions—through funding and collaborative partnerships—to create a more equitable ecosystem for healthy and fulfilling aging in Washtenaw County. Funding for older adults has not been a priority area of focus for philanthropy in general—despite the certainty of aging for all. With our significant funds for seniors, AAACF has embraced our ability to convene groups across sectors and to encourage a collaborative approach toward serving older adults and their caregivers. We look forward to working with individuals and organizations across the sectors and across the county to seize the opportunity we all have to shape a more just present and future for seniors.

Beyond creatively granting funds and catalyzing resources, AAACF is urging a more just approach to aging. We want to help shift the mindset around growing older from focusing on declining abilities to celebrating the continuation of lives well lived and promoting the contributions seniors make to our community. Our county’s future will be shaped by our current response toward an aging population. Together, we can fully and justly support all seniors to have healthy and fulfilling lives that enrich our entire community.

AAACF Washtenaw County Healthy & Fulfilling Aging Systems Research Report

The mission of the Glacier Hills Legacy Fund is to benefit senior adults in Washtenaw County—especially those at-risk and with low incomes—in perpetuity. Through this fund, AAACF directs more than $650,000 annually toward senior initiatives in Washtenaw County.

301 North Main St., Suite 300, Ann Arbor, Michigan 48104

734.663.0401 | info@aaacf.org | aaacf.org

Healthy & Fulfilling Aging Systems: Washtenaw County, MI Systems Mapping Outline

Table of Contents I. A Project Recap II. Reimagining Healthy & Fulfilling Aging and Aging Justice III.Key Aging Systems

rootcause.org

I. A PROJECT RECAP

rootcause.org

A 2019-2020 Retrospective Journey Fall 2019

Feb 2020

Spring 2020 COVID...

Healthy Aging Contextual Overview Washtenaw County Gemographic Review

WG Launch, Framing Healthy/Fulfilling Aging, TSL Setup

2021...

Fall 2020

WG and TSL Go Virtual

Summer 2020

Polished Investment Recommendations Aging Experience rootcause.org

The CRP Team + Focus Group

Systems Mapping TSL Interviews

Investment Hypothesis

Latest Progress: Virtual TSL Total Washtenaw Older Adults Engaged: 70 TSL Interviewees

CRP Interviewees

Community Research Partners (CRPs)

8 TSL Focus Group Participants

rootcause.org

37 Photo/Video Journalers

II. REIMAGINING HEALTHY & FULFILLING AGING AND AGING JUSTICE

rootcause.org

Where We Started: What is ‘Healthy Aging’? A More Traditional Definition 1. Promoting health, minimizing risk of disease and disability and effectively managing chronic conditions, 2. Maintaining a high level of physical and mental functioning 3. Active social and civic engagement rootcause.org

What is ‘Healthy & Fulfilling Aging’?

Older Adulthood

Food Housing Vulnerability Family/Relationships Child Care

rootcause.org

Basic Needs

Physical & Mental Health

Health & Transportation Wellness Care Community

Healthy & Fulfilling Aging gradually begins as another stage in life, building on previous stages and with many similar wants and needs.

What is ‘Healthy & Fulfilling Aging’?

Life Expectancy: 79 yrs

100+

Healthy & Fulfilling Aging Years = 20 to 40 years. Longer than the first three to four life stages combined. rootcause.org

With 25% of the attention.

What is ‘Healthy & Fulfilling Aging’?

●

We are all aging. All the time.

●

As we all age, we build momentum and experience. ○

●

rootcause.org

"I want to be 100 years old so I can touch the sky." - Khelan

As we all age, we experience shifts and transitions, which can lead to gaps in economic security, housing, social connection, health, and more. ○

“None of us have been 74 before, it’s a learning process” - Sue Jackson

○

"How do we make sure people are not just alive as we get older, but actually living?" - Linda Bennett

ReimaginingHealthy & Fulfilling Aging and Aging Justice

Healthy & Fulfilling Aging An aging experience in which all people can thrive as we all age and navigate older adulthood, tapping our greatest assets and building momentum to live our fullest lives.

Aging Justice A lens that recognizes people as community assets as we all age, values older adults as a priority, and ensures a healthy & fulfilling aging experience regardless of class, race, or gender.

Overlaps Across Stages of Life

rootcause.org

Overlaps Across Issue Areas

What is ‘Healthy & Fulfilling Aging’?

● Health ● Economic Security ● Housing ● Food Security & Hunger ● Environment ● Community Development

The (High) Bar for Healthy & Fulfilling Aging 55

100+

Aging-Related Transitions: Health, Finances, Family/Relationships, Independence

Gap Gap

Class Race Gender Gap

● Social Connection ● Sense of Purpose ● Health & Wellness ● Ages-Friendliness & Narrative ● Affordable Housing (ages-friendliness, downsizing) ● Transportation (can’t drive)

● Economic Security ● Affordable Housing (% of budget) ● Transportation (no car) ● Food Security & Nutrition ● Access to Programs

Aging Justice: Closing the gaps 13

III. KEY AGING SYSTEMS

rootcause.org

Ages-Friendly Features & Livability Domains Infrastructure

Community

Economic Security • Equity

Health, Support, Info

Healthy & Fulfilling Aging Key Systems Planning & Development Shaping infrastructure, use of space, proximity

Community Faith-Based

Nonprofit

Religion-based and service oriented communities

Volunteer-based engagement and communities

Employers Work-based engagement and communities

Infrastructure Housing Safe, comfortable home to live

Transportation Connections from home to and between all else.

Commercial & Parks Green/outdoor, social shared spaces

Health & Wellness Food Fresh, healthy food for nutrition and wellness

Health Care Screening and care for acute and chronic conditions

The Roles of Systems and Programs Systems: Individual and groups of institutions, laws and policies, across sectors, that collectively shape the broader conditions and environments that people live in.

System s Programs Programs: Direct services, supports, benefits working within systems to help compensate, fill gaps, increase access, address challenges, add soul. 17

How Place Shapes the Aging Experience Economic Security

Food Security

Criminal Justice Neighborhood Poverty Rate

Health

Education

The Roles of Systems and Programs Planning & Development Housing

FaithBased

Senior Centers Employers Food Pantries Senior Shuttles Meals on Wheels Home Retrofitting Health Care Public Benefits

Food

Transportation 19

Systems + Programs/Services A (Real-Life) Case Study ● Housing in walkable neighborhoods is increasingly expensive ● Residential and commercial development distances homes from businesses, services, and community spaces ● Many older adults have limited income with limited lifetime assets, or are houserich, cash-poor ● Health/mobility challenges require particular accommodations ● Lower transport options, only have smartphone with email ● Older adult lives in high-rise, relies on bus and food pantries rootcause.org

Ages-Friendly Domains: Community Domain

Domain Elements

Relevant Systems

Relevant Programs

Civic Participation and Employment

● ● ● ● ● ●

Flexible employment and volunteer options Job/volunteer training Encouraging civic participation Entrepreneurial opportunities for older people Lifelong learning opportunities Valuing older people’s contributions

● Employers ● Economic Development: Workforce, Small Business, Neighborhood ● Nonprofit sector ● Faith-based institutions

● Senior center volunteering ● Faith-based volunteering ● Inter-generational programs ● Nursing homes, LT care facilities

Social Participation

● ● ● ● ●

Accessible opportunities Affordable activities Range of opportunities Encouraging participation and addressing isolation Integrating generations, cultures and communities

● Planning and development ● Residential real estate ● Commercial real estate

● ● ● ●

Respect and Social Inclusion

● ● ● ●

Respectful behavior towards older people Appreciation of older people Intergenerational interactions and public education Role within the family

● All

rootcause.org

Senior centers Group classes Intergenerational programs Faith-based group activities

Ages-Friendly Domains: Infrastructure Domain

Domain Elements

Relevant Systems

Relevant Programs

Availability Affordability Reliability and frequency Age-friendly vehicles Specialized services for older people Priority seating and courtesy to older passengers Age-friendly transportation stops and stations Access to taxis, ride-shares and community-run transportation Courtesy towards older drivers Age-friendly parking

● ● ● ●

Public transit Private taxis Ride sharing Planning and development

● Paratransit services ● Senior shuttles ● Senior discounts

Transportation

● ● ● ● ● ● ● ● ● ●

Housing

● ● ● ● ●

Affordability Age-friendly design Home modifications Support in maintaining one’s home Safe, uncrowded living environment

● ● ● ● ●

Planning and development Residential real estate Commercial real estate Lenders Home improvement

● Homeless shelters ● Home ownership programs ● Home maintenance services

Outdoor Spaces and Buildings

● ● ● ● ● ● ● ●

Green spaces Public seating areas Age-friendly pavements Safe pedestrian crossings Accessibility and safety Walkways and cycle paths Age-friendly buildings Accomodations for older customers

● Planning and development ● Residential real estate ● Commercial real estate

rootcause.org

Ages-Friendly Domains: Health & Info Domain

Community Support and Health Services

Domain Elements ● ● ● ● ● ● ● ●

Accessible care A wider range of health services, including prevention Home care Residential facilities for people unable to live at home A network of volunteers and community services Emergency planning and care Affordable, accessible food and nutrition Wellness and prevention opportunities

Relevant Systems Health Care ● Health Systems ● Community Health Centers ● Private Practices ● Health Insurance

Relevant Programs ● Meal delivery services ● In-home care programs ● Fitness, wellness classes

Long-Term Residential Institutions Food

Communication and Information

rootcause.org

● ● ● ●

Access to relevant and timely information Opportunities for interpersonal communication Age-friendly formats and design Inclusion in information technology

● Telecommunications/ internet providers ● Faith-based institutions ● All

● Tech training programs

The Importance of Place

rootcause.org

The Importance of Place

rootcause.org

The Importance of Place

rootcause.org

The Importance of Place

rootcause.org

What Shapes Systems Decisions Public Transit

Policy, laws, regulations

$ Budget

Roads

Practice

Decision Makers County Council County Admin City Councils Mayor’s Offices Transit Authorities Developers ● Key Businesses Providing Older Adult Services and/or Employment ● ● ● ● ● ●

(e.g. grocery, financial svcs, health care) 28

REFERENCE

rootcause.org

What is ‘Healthy Aging’? Systems – laws, policies, and institutional entities that provide (or constrain) access to opportunities and eliminate (or create) barriers to achieving core milestones Program & Service Supports – programs and services that enable (or constrain) individuals’ ability to achieve core milestones Family & Community Supports – families, friends, communities who provide individuals with the support through relationships that enable them to achieve core milestones Individuals – knowledge, skills, and conditions that enable (or constrain) core milestone achievement

Prenatal-5 Ready to Learn

rootcause.org

6-14 yrs Build personal & academic competencies

15-19 yrs Deepen competencies & prepare for adulthood

20-29 yrs Transition into adulthood

30-64 yrs ~ 65+ yrs Solidify family, career, assets

Sustain healthy aging 30

Healthy & Fulfilling Aging Systems: Washtenaw County, MI Investment Recommendations

Table of Contents I. Investment Summary II. Investment Goal Details III. An Implementation Plan

II. INVESTMENT SUMMARY ● ● ● ●

rootcause.org

Investment Goals and Intended Results Strategic Investment Areas Aging Ecosystem Roles AAACF Roles and Capacity Building

Investment Goals and Intended Results Investment Goal

Intended Results

I) Solidify a more robust field around Healthy & Fulfilling Aging and Aging Justice

II) Champion older adult capacity to influence systems change

III) Shift mindsets to prioritize aging, older adults, and systems change

IV) Advance targeted solutions in priority aging areas

Investment Goals: Strategic Investment Areas Investment Goal

Strategic Investment Areas

I) Solidify a more robust field around Healthy & Fulfilling Aging and Aging Justice

A. Backbone support: Core operating support to backbone organization(s) to perform functions including framing, coordination, convening, information sharing, partnership development, data, advocacy, other B. Strategy development: Process to define a collective, county-wide aging strategy C. Capacity building: Technical assistance (TA) and other resources to strengthen field-building organizational and leadership capacities among aging stakeholders, including distributed leadership, collaboration, embracing an aging justice lens D. Measurement: Process and tools to measure performance across investment goals

II) Champion older adult capacity to influence systems change

A. Empowerment: Integrate older adult representation into all Investment Goals B. Organizing and mobilization: Support of targeted organizations to build an older adult, diverse and representative grassroots base - building off Virtual TSL C. Leadership development: Program offerings to grow older adult community leaders D. Capacity building: TA to build organizing capacity among targeted aging stakeholders, and to strengthen capacity across the aging ecosystem to better empower and organize older adults

rootcause.org

Investment Goals: Strategic Investment Areas Investment Goal

Strategic Investment Areas

III) Shift mindsets to prioritize aging, older adults, and systems change

A. Messaging and narrative: Expert guidance, community voice, and collaborative process to develop asset-based aging and systems change messaging language and tools B. Strategic communications: Develop communications strategy, promote messaging/narrative via priority channels (e.g. op-eds, media, field publications, etc.) to reach target audiences (e.g. policy makers, foundations, service providers) C. Capacity building: TA to strengthen aging stakeholder capacity to incorporate/expand messaging and systems change approaches within their work

IV) Advance targeted solutions in priority aging areas Transportation, Housing, Community Connections, Easy Access rootcause.org

A. Solution research, benchmarking, expert guidance: Focused research and consultation to document existing evidence, designs, best practices, learning, and success stories in other communities B. Solution planning and development: Co-prioritize, define and design solutions C. Solution implementation and advocacy: Support for identified aging stakeholders to implement programmatic and advocate for policy aspects of defined solutions 6

Roles in the Aging Ecosystem Policymaker

Convener

The “aging ecosystem” in Washtenaw County comprises a number of distinct roles. Individual stakeholders across sectors will be required to play any number of existing and/or new roles as part of supporting the investment areas.

Communications

Data/ Research

Funding

Technical Assistance

Service Provision rootcause.org

Community Engagement

Advocacy 7

AAACF Roles and Capacity Building Foundation Roles

Practices and Internal Capacity

● Grantmaker ● Convener: Supplement convening by backbone role ● “Champion”: Communications, data/research, advocacy, other

● Strengthen equitable grantmaking practices ● Expand older resident, other community member representation (e.g. in grant review) ● Embed systems change approach

Align with foundation-wide values, strategy, etc. rootcause.org

III. INVESTMENT GOAL DETAILS

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Details: Investment Goal I Investment Goal

Intended Results

I) Solidify a more robust field around Healthy & Fulfilling Aging and Aging Justice

1. This is the core of the overall work 2. Build around a “backbone” role, integrated with older adult community empowerment and key partnerships, e.g. the Aging Commission 3. Solidify a holistic healthy & fulfilling aging and aging justice lens 4. Connect the dots, spread an aging justice lens, and build solidarity with other local efforts and momentum with shared interests, across demographic groups and issue/topic areas 5. Develop countywide aging strategy informed by: community, research/benchmarking, incentive structure analysis, levers for impact, mapping local aging program/field ecosystem rootcause.org

6. Compile and track countywide aging data based on leading indicators/metrics, including defining “quality of life” metrics (building on data collected via this project)

Details: Investment Goal I Investment Goal

Intended Results

I) Solidify a more robust field around Healthy & Fulfilling Aging and Aging Justice

Example strategic frameworks to incorporate into an aging strategy:

Details: Investment Goal II Investment Goal

Intended Results

II) Champion older adult capacity to influence systems change

1. Build on TSL to date, particularly the team of Community Research Partners 2. Identify and support grassroots/grasstops aging leaders 3. Integrate older adult representation and capacity into other three Investment Goals 4. Infuse organizing, civic engagement, empowerment into all possible venues, e.g. senior centers, political/electoral engagement, faith-based institutions, central older adult resource hub, neighborhood associations, senior housing, etc. (connect older adults to civic engagement, volunteer, advocacy and other opportunities along with connecting to services) 5. Partner with other community empowerment efforts, demographic groups with shared interests

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6. Potential programmatic partnership with UofM, other higher ed institutions around collaborative advocacy between older adults and college students, young professionals: tap into alumni associations, course work, research, student clubs, etc., e.g. program partnership between senior centers and colleges/universities

Details: Investment Goal III Investment Goal

Intended Results

III) Shift mindsets to prioritize aging, older adults, and systems change

1. Promote more asset-based, accurate narrative around aging and older adults 2. Spread concept of aging justice 3. Educate policy makers, other systems leaders, community leaders 4. Document shared interests with all demographic groups 5. Emphasize role of systems in driving, and reducing, disparities, and priority of a systems change approach 6. Use to reinforce advocacy strategy/tactics toward influencing systems change rootcause.org

Details: Investment Goal IV Investment Goal

Intended Results

IV) Advance targeted solutions in priority aging areas

1. Initial priority areas: transport as a connector, community connections, affordable/supportive housing, equitable access (priority areas will evolve over time) 2. Co-design the solutions with the aging field and community members 3. Align other Investment Goals to promote these targeted solutions, while also leverage these solutions to reinforce the other Investment Goals 4. Apply systemic approach to support these programmatic solutions 5. Ensure dynamic evolution, continuous learning and improvement of these solutions over time (“moving models”) rootcause.org

Details: Investment Goal IV Investment Goal

Intended Results

IV) Advance targeted solutions in priority aging areas

Transportation as a Connector ● Enables choice, incl. grocery/medication AND social activity access ● Ensure older adult knowledge/comfort around various transport options ● Strong need for a coordinated, systemic transportation effort ● Door-to-door is ideal ● Don’t forget the suburbs/rural areas

Community & Connection Spaces ● Physical/virtual gathering places ● Good examples include high speed internet, senior millage, JFS Wise ● Aging Commission, City and County governments all have roles to play ● Built-in spaces around housing ● Invest in tech access as a means to increase virtual connections

Affordable Housing ● Need one-stop shop for seniors to find affordable, vetted housing/services ● Need for multi-generational, affordable housing ● Pandemic, elder abuse concerns and lack of developer incentives pose barriers ● Easier transition to lowermaintenance options

All solutions ideally tied together

Equitable Access ● Streamlined, coordinated access to benefits, programs, services (e.g. service coordinators, “senior advocates,” central resource hub, automatic benefits enrollment, supported by tech access)

IV. AN IMPLEMENTATION PLAN*

*Assumes continuous measurement, learning, dynamic evolution, and improvement of all work over time *A county-wide aging strategy as part of Investment Goal I would revisit this implementation plan rootcause.org

An Implementation Plan: Phased Objectives Year 1 (2021)

I) Solidify a Robust Field

● Solidify backbone role, collaborative structure, aging field parameters ● Recruit allies, build partnerships ● Develop 5-yr county aging strategy ● Build capacity-building offerings

II) Champion Older Adult Capacity

● Solidify engagement of core group of older adult community members ● Identify, recruit organizing partners ● Build capacity-building offerings

III) Shift Mindsets

IV) Advance Targeted Solutions

● Develop messaging/narrative language and tools ● Define communications strategy, launch early pilot communications ● Educate policy makers, systems ● Build capacity-building offerings ● ● ● ● ●

Recruit implementation partners Set up solution working groups Conduct solution research Co-shape and prioritize solutions Pilot short-term solution elements

Years 2-3 (2022-2023)

● ● ● ●

Expand cross-field partnerships Develop formal policy/program agenda Launch capacity-building offerings Secure local funding partnerships

Years 4-5 (2024-2025)

● Secure national funding partnerships ● Evaluate overall results and refine approach ● Develop refreshed 5-yr strategy

● Integrate older adult empowerment into existing settings ● Set up and launch community leadership development offerings ● Expand pool of organizing partners ● Launch capacity-building offerings ● Build out messaging/narrative partners ● Formalize messaging/narrative content and community training ● Launch capacity-building offerings ● Secure natl communication partnership (field leader, publication, media) to reinforce local momentum

● Accelerate communications content production ● Expand local and natl communications partnerships ● Evaluate overall results and refine approach

● Develop longer-term solution plans and details ● Implement/refine prioritized solutions ● Track progress and integrate with field building, older adult engagement,

● Formally document solution models, social and economic value ● Articulate value to key stakeholders ● Evaluate overall results and refine approach

● Formalize community organizing, mobilization structure ● Strengthen and expand leadership development, capacity-building ● Evaluate overall results and refine approach

Healthy Aging: A National Contextual Overview INTRODUCTION As more of us live longer and healthier lives, we have the powerful opportunity to rethink the future of our society. So many of us accumulate knowledge, skills and wisdom as we get older, yet our current policies and cultural beliefs fail to create space for the advantages that age brings. In 2011, there were 41.4 million adults over the age of 65 in the United States, 12.5% of the total population. i Thanks to advances in medicine, public health and lifestyle choices, these values are expected to nearly double by 2050. ii i.e. in 30 years, one in four U.S. residents will be over age 65. However, the environments in which many of us live are not engineered to help us stay active, healthy, and connected to our communities as we age, nor do they tap into the tremendous potential of an expanded population of older Americans. It is up to us to find creative new solutions to ensure we all thrive as we age. Aging is a dynamic process, and we are all constantly aging -- our social systems and programs should reflect the contexts in which we live, the assets we bring, and the support we require at every point throughout our lifespan. THE PURPOSE OF THIS DOCUMENT This National Contextual Overview has been developed as a starting reference to inform Root Cause’s work on mapping healthy aging systems in Washtenaw County. The term “systems” refers to the individual and groups of institutions, across sectors, that collectively shape the broader conditions and environments that people live in. In the case of aging, these systems include (but are not limited to) those responsible for medical and health care, transportation services, housing, food and nutrition, community spaces, financial services, and public benefits. Systems can be complemented by “programs”, which provide the direct services and resources that help people succeed in their given environment by meeting basic needs, filling gaps, facilitating access, subsidizing costs, and combating challenges. Examples of healthy aging programs include home-delivered meal services, intergenerational community centers, and home health services. This evolving document examines various frameworks for understanding and defining the elements needed to ensure healthy aging for all. We draw on existing research to outline the ways in which our current systems fail to support older Americans, and how this affects all of us. We also present high-level data on the current state of aging nationally, as well as in the State of Michigan and Washtenaw County, and cite nationally recommended areas of investment to strengthen healthy aging systems and programs. We will continue to update this document as new insights emerge from our ongoing research and local stakeholder engagement. DEFINING HEALTHY AGING Broadly, healthy aging can be holistically defined by a combination of three core criteria: 1. Promoting health, minimizing risk of disease and disability and effectively managing chronic conditions, 2. Maintaining a high level of physical and mental functioning, and 3. Active social and civic engagement. iii,iv ,

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HEALTHY AGING: A NATIONAL CONTEXTUAL OVERVIEW

However, individual experiences in the later years of life can vary tremendously based on employment status, health conditions, personal wealth, family demands, and other factors. Unlike some other stages of life, there is no single indicator that effectively defines healthy aging for all of us, including when it needs to begin. v Despite the historical and commonly accepted age-65 threshold, as illustrated in our life course pathway diagram below, aging is an ongoing process that begins at birth and continues until death.

While the term “older adulthood” is generally associated with age 65 (the age at which individuals become eligible for Social Security in the US), individuals may find themselves identifying as an older adult at earlier or later ages, depending on their personal experiences of age-related changes. A more holistic definition of healthy aging might be: An aging experience in which all people can thrive and live our fullest lives, as we all age, build momentum, and navigate older adulthood over time.

The continuous nature of aging means that investments to ensure all of us can reach our full potential in later life may occur ‘upstream’ earlier in the lifespan (similar to investments made in early childhood to ensure young adult success). The World Health Organization (WHO) has outlined a framework for these investments, articulating the following eight core components of age-friendly environments: outdoor spaces and buildings; transportation; housing; social participation; respect and social inclusion; civic participation and employment; communication and information; and community and health services. vi Like every life-stage, older adulthood is marked by unique experiences, transitions, and challenges. The process of aging, however, is continuous across the lifespan, and our needs as we age -- access to healthcare, social connection, mobility and financial stability -- are largely related to our needs earlier in life. Systems and programs which meet the needs of older adults, therefore, provide those same supports to people in other stages of life and should be understood as related to broader efforts around community wellbeing. HALLMARKS OF OLDER ADULTHOOD The gradual transition into older adulthood can be considered to happen around a set of common milestones or transitions during which one’s life circumstances undergo distinct changes. These milestones or transitions include, but are not limited to, changes in: ●

Health As the body and mind age, we begin to experience changes in our physical and/or cognitive functioning. Some older adults may experience one or several chronic or acute health conditions in later life, and find ourselves adjusting to manage chronic pain, disability or decreased mobility. Others of us may continue to

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HEALTHY AGING: A NATIONAL CONTEXTUAL OVERVIEW

enjoy vigorous health throughout later life, and may experience only minor adjustments to our lifestyle as we age. ●

Independence As our physical and cognitive health changes, we may find ourselves relying on support from others to complete some daily tasks or activities. Requiring assistance for personal care or activities of daily living, vii adjusting to illness or assistive devices, relocating to a new home or facility, and engaging hospice services for end-of-life care are often hallmarks of the transition to older adulthood. viii The need for human assistance, however, can also create a site for connection and intergenerational relationships, as well as an opportunity for increased care-based training and employment.

●

Finances and Employment Retirement, second careers or transitioning to a fixed income (such as Social Security) can prompt significant lifestyle changes around discretionary spending and daily activities. For some of us, this may allow for increased leisure time and adoption of new hobbies, while others may remain in the workforce or experience financial insecurity in trying to make ends meet.

●

Family and Relationships Shifts in family dynamics, such as moving in with a child, losing a spouse or loved one, or becoming a family caregiver, are not uncommon in older adulthood. These changes can be challenging to adjust to for everyone involved, particularly in times of loss. However, the changes we make to accommodate our needs in later life can also bring positive impacts, such as proximity and strengthened ties to children, family and community.

●

Perspective In older adulthood, our perspectives become a resource. We accumulate experience throughout our lives, and consequently emerge into older adulthood with decades of knowledge, wisdom and lessons from our younger years. Each of us is also witness to the shared experiences of our generation, including social, political and environmental changes; as we get older and the years pass, we become living stewards of that history.

●

Vulnerability The changes that we experience in health and income as older adults are often unaccounted for in our built environments. As a consequence, as we age we face heightened vulnerability to minor injuries, harsh weather, and similar incidents, having fewer resources than we once had. Knowledge of this vulnerability can create additional emotional and psychological stress -- the risk of falling, for example, can lead us to self-restrict our movement, out of fear of the consequences of an injury which could compound existing physical or financial challenges.

KEY GAPS BETWEEN OLDER ADULTHOOD AND HEALTHY AGING SYSTEMS Current approaches to how we work, live and build our communities have been shown to be insufficient in providing equity and opportunity for all, contributing to racial, social and economic inequality and holding many of us back from safety and security. These same patterns continue as we age, and must be reimagined in order to ensure success and well-being for each and every one of us. Many of our present systems are not set up to help us navigate the changes that occur in older adulthood described in the previous section. This includes the systems which govern transportation and mobility, public benefits, employment, housing, healthcare and community spaces. These systems play significant roles in ensuring our health, security and social connection as we age; however, key gaps in these systems have resulted in the many of us experiencing challenges in the following areas of life: rootcause.org

HEALTHY AGING: A NATIONAL CONTEXTUAL OVERVIEW

Financial Security Income levels vary widely among older Americans, causing high poverty rates among a subsection of seniors to be underreported nationally. About 1 in 5 older Americans has an income below half of the median population income, with 38% of income among those 65 years or older in the United States coming from Social Security and 32% coming from current earnings. ix 43% of single senior Social Security recipients depend on Social Security for 90% or more of their income, and one-third of all senior households are either in debt or have no money left over each month after meeting essential expenses. x The baby boom generation -- defined as Americans born between 1946 and 1964 -- faces particular financial challenges as they rapidly approach and surpass 65. Projections of the entire older population (including the babyboom population and their predecessors) indicate that there will be 71.4 million adults over 65 in 2029, a 6% increase from 2012. xi However, 45% of boomers reported having no money saved for retirement in 2019, and 29% of Boomers ages 65 to 72 were working or looking for work in 2018, the highest proportion of any generation in fifty years. xii In 2017, only 31% of adults over 65 received pension benefits, while 84% received income from Social Security. xiii Financial insecurity creates physical and emotional stress, can exacerbate existing health conditions, and often leaves us unable to access the care and resources we need to thrive. This is true for people of all ages -- our current systems do not guarantee us shelter, food, or medical care, leaving us vulnerable to preventable disease and conflict. Our communities are stronger and healthier when all of us have our basic needs met -- without financial security, older adults remain unable to contribute the full scope of their energy, expertise and experience to their communities. The Responsibility of Caregiving In 2011, more than 2.7 million grandparents were serving as the primary caregiver to their grandchildren, with 55% having been in this role for three years or longer. While grandparents can often provide much needed care and stability to children, ‘grandfamilies’ are often not able to benefit from the financial assistance offered to foster families, and can lack the formal legal guardianship rights required to make medical and school decisions for their grandchildren. xiv The financial challenges experienced by grandfamilies is illustrated by the fact that 22% of grandparent caregivers are living below the poverty line, while just 10% does so among the full population ages 50 and older. xv The financial burden of caregiving is heightened for Black seniors, as 1 in every 25 Black children are being raised by a grandparent (versus 1 in 50 in the general population), and one-third of Black seniors live below the poverty line. xvi Grandparents raising grandchildren also fall into a service gap, as social assistance programs for seniors rarely account for the needs of seniors raising children, while children and family programs are often not built to meet the unique needs of children being raised by grandparents. xvii Many of us may also find ourselves in caregiver roles for other older adults, including older senior parents, spouses, siblings, or other relatives. In these roles, older adults face the dual burden of caring for dependent relatives, while managing their own health, emotional, and financial needs in later life. As with primary grandparenting, few social programs account for older caregivers, leaving a significant gap in services and support. Systems and programs that fill these gaps would allow us to provide quality care for our loved ones even as we age. With support, those of us who serve as caregivers for family members in our older age can also benefit from a renewed sense of purpose in later life, and strengthened relationships with family members. A reimagined rootcause.org

HEALTHY AGING: A NATIONAL CONTEXTUAL OVERVIEW

support system for caregivers would also allow all of us to reap the benefits, including reduced loneliness, improved health, and higher developmental skills for children. xviii Loneliness and Social Isolation Many of us may also face the challenge of feeling lonely or being apart from family and community in our later years, which can have negative effects on our physical and mental health. Social isolation is the objective physical separation from other people (i.e. living alone), while loneliness is the subjective distress of feeling alone. The two are not always linked -- some may live alone without experiencing loneliness, while others may feel lonely while surrounded by others. While both social isolation and loneliness can result from experiences common in older age (such as the death of a spouse, retirement, separation from friends and family, or loss of mobility), researchers also believe that there some people may have a stronger genetic risk for loneliness than others. Chronic loneliness can activate a biological defense mechanism in the body, inflaming immune cells and increasing the risk of conditions like high blood pressure, heart disease, obesity, anxiety, depression, and Alzheimer’s disease. However, there are a number of things we can do to avert the risks of loneliness. Feeling a sense of purpose is linked to better immune health, and helping others through volunteering or caregiving can decrease feelings of loneliness. xix Our relationships with others also have a significant impact on our quality of life, and even our longevity; in fact, one study found that people with strong social relationships have a 50% increased chance of survival. xx Intergenerational gatherings, age-friendly public spaces and access to transportation can facilitate these connections on a daily basis, and volunteer programs can provide opportunities for older people to contribute to their communities in meaningful ways. Our communities are richer with our full scope of energy, and investing in systems and programs which facilitate social connection and engagement can help enhance life for all of us. THE CURRENT STATE OF HEALTHY AGING A high-level summary of the state of aging across the US, in the State of Michigan, and in Washtenaw County is illustrated in the table below. Healthy Aging by the Numbers US National

State of Michigan

Washtenaw County

Total Population (2018) xxi

327,167,434

9,995,915

370,963

Median Age (2017) xxii

37.8

39.6

33.4

Percent Over Age 65

16.0%

17.2%

13.8%

Population 65+, White

34,809,526 xxiii

1,198,320

39,860 xxiv

Population 65+, Black

3,487,236

133,698

4,393 xxv

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HEALTHY AGING: A NATIONAL CONTEXTUAL OVERVIEW

Population 65+, Asian

1,410,380

16,267

2,228 xxvi

Percent of 65+ Living in Poverty xxvii

9.28%

8.34%

6.43%

Percent of 65+ and 60+ Adults Living Alone*

26% (65+) xxviii

29% (65+) xxix

52% (60+) xxx

*Data not available for percent of adults 65+ living alone in Washtenaw County. However, the high percent of adults over 60 living alone in Washtenaw indicates this should be an area of further research during the local mapping stage.

The US National Context Baby Boomers constitute approximately one-fifth of the US population and expected to outlive previous generations. xxxi In 1950, the average U.S. life expectancy at birth was about 69 years -- in 2018, life expectancy was 78.7. xxxii This value is expected to increase even more, to about 84 by 2050. An old-age dependency ratio provides an estimate of the number of older people in a country, compared with the number of those who are working age -- The American old-age dependency ratio currently stands at 19.5 -- meaning that there are about 20 people ages 65 and older for every 100 people ages 15-64. xxxiii The Michigan State Context Michigan is currently the 12th oldest state in the country, with a median age of 40 years. As the number of baby boomers reaching retirement swells, the state’s social service programs have come under strain. Although some counties with substantial college-aged populations tend to skew younger, the median age of residents reaches 50 in 21 of the state’s counties. xxxiv A rapidly aging population reduces the ratio of workers to Social Security beneficiaries, posing a risk to those in retirement as well as the state’s overall economic growth. NATIONAL RECOMMENDED AREAS FOR INVESTMENT All sectors must be engaged in planning for the opportunities of a growing population of older adults. The U.S. Centers for Disease Control and Prevention (CDC) recommends ‘aging-in-all’ policies, by which the impact on healthy aging is considered for all policy, program and infrastructure changes. These aging-in-all policies provide a multi-dimensional view of healthy aging, which can improve the quality of life for everyone. xxxv Similarly, healthy aging is strengthened and enabled by investments that occur upstream, enabling healthy lifestyle choices, economic security, social connection and other social determinants of health throughout the lifespan, not simply once a person has turned 65. Age-Friendly Communities As America’s older adult population continues to grow, there is an increased focus on the concept of “agefriendly” environments and communities. Similar to baby- and family-friendly communities, age-friendly communities meet the needs of its senior members by providing the infrastructure and support for older people to continue to participate in their communities. xxxvi Age-friendly initiatives involve multiple sectors, and include initiatives like accessible transportation, curb cuts, neighborhood access to groceries, and age-appropriate recreational and social activities. At their core, agefriendly communities address the social determinants of health for older adults, including nutrition, healthcare, mobility, financial security, social connection and civic engagement. rootcause.org

HEALTHY AGING: A NATIONAL CONTEXTUAL OVERVIEW

The AARP's model of healthy aging in the US echoes the WHO framework introduced earlier in this document. Both organizations use a similar framework, alternately described as the eight domains of livability (AARP) and core features of an age-friendly city (WHO), which include: 1. 2. 3. 4. 5. 6. 7. 8.

Outdoor spaces and buildings Transportation Housing Social Participation Respect and Social Inclusion Civic Participation and Employment Communication and Information, as well as Community and Health Services. xxxvii

Both organizations assert that these community features “help make communities livable for people of all ages”, using terms such as “livability” and “age-friendliness” to describe the combination of physical, social, economic, and infrastructural support that enables well-being across the lifespan. There are many such frameworks for defining and supporting our well-being in later life, which can (and should) be customized to fit different geographies, cultures, economies and populations. Holistic frameworks such as this that employ a broad view of healthy aging provide a useful umbrella for efforts to map local aging systems and programs, identify assets and gaps, and prioritize areas for improvement. Such frameworks also offer an umbrella to identify who and what is required to implement priority improvements, including multi-stakeholder collaborations, government commitment, inclusion of older persons, and policies that tackle both physical and social environments. xxxviii xxxix

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REFERENCES i Anderson, L. A., & Prohaska, T. R. (2014). Fostering Engagement and Independence: Opportunities and Challenges for an

Aging Society. Health Education & Behavior, 41(1). doi: 10.1177/1090198114547818 ii Pew Research Center. (2015, May 21). Family Support in Older Societies. Retrieved from https://www.pewsocialtrends.org/2015/05/21/family-support-in-graying-societies/ iii Anderson, L. A., & Prohaska, T. R. (2014). Fostering Engagement and Independence: Opportunities and Challenges for an Aging Society. Health Education & Behavior, 41(1). doi: 10.1177/1090198114547818 iv Centers for Disease Control and Prevention. (2013). The State of Aging and Health in America Centers for Disease Control and Prevention, US Dept of Health and Human Services. Retrieved from https://www.cdc.gov/aging/pdf/State-Aging-Healthin-America-2013.pdf v Stanzler, C., & Bercaw, L. E. (2011). Healthy Aging. Root Cause. Retrieved from http://rootcause.org/insights/publication/healthy-aging/ viAARP. (n.d.). The 8 Domains of Livability. Retrieved from https://www.aarp.org/content/dam/aarp/livablecommunities/livable-documents/documents-2019/8-Domains-of-Livability-102019.pdf vii SeniorLiving.org. (2018, August 16). Activities of Daily Living (ADLs). Retrieved from https://www.seniorliving.org/caregiving/activities-of-daily-living/ viii University of Cincinnati. Center for Aging and Dignity. Retrieved from https://nursing.uc.edu/content/dam/nursing/docs/CFAWD/LookCloserSeeMe/Module%203_GDST_Reference%20Guide.pd f ixPew Research Center. (2015, May 21). Family Support in Older Societies: Demographic and Financial Profiles of People in the U.S., Germany and Italy. Retrieved from https://www.pewsocialtrends.org/2015/05/21/1-demographic-and-financialprofiles-of-people-in-the-u-s-germany-and-italy/ x Elderly Poverty Statistics. National Council on Aging. (2019, December 3). Retrieved from https://www.ncoa.org/news/resources-for-reporters/get-the-facts/economic-security-facts/ xi Pollard, K. M., & Scommegna, P. (2014, April 16). Just How Many Baby Boomers Are There? Retrieved from https://www.prb.org/justhowmanybabyboomersarethere/ xii Insured Retirement Institute. (2019 April). Boomer Expectations for Retirement 2019. Retrieved from https://www.myirionline.org/docs/default-source/default-documentlibrary/iri_babyboomers_whitepaper_2019_final.pdf?sfvrsn=0 xiii Pension Rights Center. (2011, January 6). Sources of Income for Older Adults. Retrieved from http://www.pensionrights.org/publications/statistic/sources-income-older-adults xiv Dunifon, R. (2017, March 15). The Challenges Faced by Grandparents Who Raise Grandchildren Alone. Retrieved from https://scholars.org/brief/challenges-faced-grandparents-who-raise-grandchildren-alone xv Pew Research Center. (2013, September 4). At Grandmother's House We Stay. Retrieved from https://www.pewsocialtrends.org/2013/09/04/at-grandmothers-house-we-stay/ xvi Dunifon, R. (2017, March 15). The Challenges Faced by Grandparents Who Raise Grandchildren Alone. Retrieved from https://scholars.org/brief/challenges-faced-grandparents-who-raise-grandchildren-alone xvii Ibid. xviii McGuire, A. (2019, March 27). Toddlers and Seniors Together: The Benefits of Intergenerational Care. Retrieved from https://ifstudies.org/blog/toddlers-and-seniors-together-the-benefits-of-intergenerational-care xix National Institute on Aging. (2019, April 23). Social isolation, loneliness in older people pose health risks. Retrieved from https://www.nia.nih.gov/news/social-isolation-loneliness-older-people-pose-health-risks xx Holt-Lunstad, J., & Smith, T. (2010). Social Relationships and Mortality Risk: A Meta-analytic Review. PLoS Medicine, 7(7). doi: 10.4016/19911.01 rootcause.org

HEALTHY AGING: A NATIONAL CONTEXTUAL OVERVIEW

xxi U.S. Census Bureau. (n.d.). QuickFacts: Washtenaw County, Michigan; Michigan; United States. Retrieved from

https://www.census.gov/quickfacts/fact/table/washtenawcountymichigan,MI,US/PST045219

xxii United States Census Bureau. (2010, October 5). American FactFinder. Retrieved from https://factfinder.census.gov/ xxiii United States Census Bureau. (2010, October 5). Annual Estimates of the Resident Population by Sex, Age, Race, and

Hispanic Origin for the United States and States: April 1, 2010 to July 1, 2018. Retrieved from https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk xxiv CARES Engagement Network. (n.d.). ACS (2014-2018) 5 Year Estimate. Retrieved February 2, 2020, from https://engagementnetwork.org/map-room/ xxv Ibid.

xxvi Ibid. xxviiPolicyMap. (n.d.). Online GIS Maps. Retrieved February 2, 2020, from https://www.policymap.com/maps xxviii Stepler, R. (2016 February). Smaller share of women ages 65 and older are living alone: More are living with spouse or

children. Washington, DC: Pew Research Center. xxix Coffey-Carney, K. (n.d.). Vital Stats About Michigan Seniors: Many Live Alone but Need Assistance. Retrieved from http://secondfamilyseniorcare.com/2017/12/05/vital-stats-about-michigan-seniors-many-live-alone-but-need-assistance/ xxxUnited Way of Washtenaw County. (n.d.). Older Adults. Retrieved from https://www.uwwashtenaw.org/older-adults http://blueprintforaging.org/wp-content/uploads/2015/12/60-Survey-Presentation_revised_12_8_15.pdf xxxi Stanzler, C., & Bercaw, L. E. (2011). Healthy Aging. Root Cause. Retrieved from http://rootcause.org/insights/publication/healthy-aging/ xxxii Kochanek KD, Anderson RN, Arias E. (2010–2018). Changes in life expectancy at birth. NCHS Health E-Stat. 2020. Retrieved from https://www.cdc.gov/nchs/data/hestat/life-expectancy/lifeexpectancy-H.pdf xxxiii Pew Research Center. (2015, May 21). Family Support in Older Societies: Demographic and Financial Profiles of People in the U.S., Germany and Italy. Retrieved from https://www.pewsocialtrends.org/2015/05/21/1-demographic-and-financialprofiles-of-people-in-the-u-s-germany-and-italy/ xxxiv Noble, B. (2019, June 24). Services strained as census shows Michigan is now 12th oldest state in nation. Retrieved from https://www.detroitnews.com/story/news/local/michigan/2019/06/24/michigan-ages-faster-than-nation-census-showsservices-strained/1514838001/ xxxv National Prevention Council. (2016 November). Healthy Aging in Action. U.S. Department of Health and Human Services, Office of the Surgeon General. Retrieved from https://www.cdc.gov/aging/pdf/healthy-aging-in-action508.pdf xxxvi Key Characteristics of Age-Friendly Cities and Communities: A Review. (2018). Cities, 47, 45–52. doi: 10.1332/policypress/9781447331315.001.0001 xxxvii AARP. (n.d.). The 8 Domains of Livability. Retrieved from https://www.aarp.org/content/dam/aarp/livablecommunities/livable-documents/documents-2019/8-Domains-of-Livability-102019.pdf xxxviii Key Characteristics of Age-Friendly Cities and Communities: A Review. (2018). Cities, 47, 45–52. doi: 10.1332/policypress/9781447331315.001.0001 xxxix Smith, R. J., Lehning, A. J., & Dunkle, R. E. (2013). Conceptualizing Age-Friendly Community Characteristics in a Sample of Urban Elders: An Exploratory Factor Analysis. Journal of Gerontological Social Work, 56(2), 90–111. doi: 10.1080/01634372.2012.739267

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HEALTHY AGING: A NATIONAL CONTEXTUAL OVERVIEW

Healthy Aging Systems Mapping in Washtenaw County Washtenaw County-Level Demographic and Geographic Review (Gemographic Review ™) Introduction The effectiveness of Washtenaw County’s healthy aging systems is directly related to the profile of the older adults they are in the role of supporting. We know that as we age, we represent a wide spectrum of attributes and experiences. This spectrum also reflects patterns based on geographic location, which can vary greatly when examining an entire county. Washtenaw County includes urban, suburban, and rural areas across its 722 square miles, forming a ~27 mile square roughly 40 miles/45-minute drive west of Detroit.

The Purpose of This Document This Demographic and Geographic Review, i.e. Gemographic Review™, captures key data points about Washtenaw’s older adult residents to inform the systems mapping process. This document reviews the overall scale and scope of the older adult population. The mapping project also aims to capture a range of older adult experiences as they vary based on the factors listed below, as highlighted by the Healthy Aging Working Group. This document focuses on data points related to these factors. Older Adult Experience Factors ● ● ● ● ● ●

Age Range Within Older Adulthood Economic Security Physical Ability Medical Needs (Physical and Mental) Language Technology Access

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● ● ● ● ●

Immigration Status Faith Community Membership Caregiver Role Social Isolation Veteran/Spouse Status

WASHTENAW COUNUTY-LEVEL GEMOGRAPHIC™ REVIEW

TOP-LEVEL DEMOGRAPHICS Washtenaw County has an estimated 370,963 residents, 72,194 of whom are 60 years and older (19.5%) and 51,775 of whom are 65 years of age and older (13.9%)1 This includes the following age distribution. 60 to 64

65 to 69

70 to 74

75 to 79

80 to 84

85+

20,419

17,429

14,221

9,179

5,011

5,935

Adults 65 years and older are majority White, with approximately 15.7% identifying as of color.

These adults represent 29,927 households, 43.7% of which represent householders living alone.

U.S. Census Bureau. ACS 2018 1-Yr Estimates, Washtenaw County, Age and Sex Table.

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WASHTENAW COUNUTY-LEVEL GEMOGRAPHIC™ REVIEW

Economic Security An important contextual factor to note around economic security is that 78.9% of adults 65+ years old in Washtenaw County are not in the labor force. Of the 21.1% in the labor force, 20.4% are employed. The income sources and levels of 65+ year old adult-led households are outlined in the table below. Household Income Sources in Past 12 Months, 65+ Year Old Led Households 2 Household Income Source

% of Households

Mean Income $

Earnings

41.0%

$71,410

Social Security

90.0%

$24,026

Supplementary Security

4.6%

$11,728

Cash Public Assistance

1.6%

$1,684

56.8%

$30,750

6.1%

Retirement Food Stamp/SNAP Benefits

The above income sources are associated with the prevalence of 65+ year old adults with an income below 100% of the Federal poverty level (6.4%) and at 100 to 149% of the poverty level (5.7%), for a total of 12.1% or estimated 6,265 adults living under 150% of poverty level. 3 If considering 200% of the FPL, often considered a more accurate indicator of economic hardship, this number increases to 18.9% or 9,785 adults ages 65 and older 4. Housing costs are one major component of cost of living, and can provide a complementary indicator of economic security. Adults 65+ years old accounted for 29,927 total housing units. The distribution of owner-occupied and renter-occupied units, and the share of households spending more than 30% of their household income on housing costs (as an indicator of burden), is outlined in the table below. One implication suggested by the data in the table is that, while most older adults in Washtenaw County own their homes, more than one quarter may have trouble paying for heat. Housing Cost Burden Households 65+ Years Old 5 Owner Occupied

Renter Occupied

# Housing Units

24,514

5,413

% Housing Units

82%

18%

U.S. Census Bureau, ACS 2018 5-Yr Estimates, Table SO103 U.S. Census Bureau, ACS 2018 5-Yr Estimates, Table SO103 4 CARES Engagement Network, Population Below 200% Poverty Level, Adult (65+), Percent by County, ACS 2012-2016, Washtenaw County Map 5 U.S. Census Bureau, ACS 2018 5-Yr Estimates, Table SO103 2 3

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WASHTENAW COUNUTY-LEVEL GEMOGRAPHIC™ REVIEW

Housing Cost-Burdened (>30% Household Income Spent on Housing Costs) Median $ Housing Costs

26.5%

53.3%

(select monthly owner costs)

(rent)

$1,547 (with a mortgage) $670 (without a mortgage)

$867

Differing Abilities 6 Of the approximately 66,954 non-institutionalized Washtenaw County adults 65+ years old, more than one in four (28.6%) have a disability according to federal data. The table below shows the types of disability reported, and as might be expected, an increase in prevalence when comparing older adults 65-74 years old and those who are 75 years and older. For both age groups, an ambulatory difficulty is most common, followed by difficulties with hearing and independent living.

Total

65 to 74 Years

31,161

75 Years and Over

19,545

Total Seniors

50,706

With a Disability

15,154

28.6%

6,745

21.6%

8,409

43.0%

Ambulatory

9,393

18.5%

4,146

13.3%

5,247

26.8%

Hearing

6,930

13.70%

2,574

8.3%

4,356

22.3%

Independent Living

6,208

12.2%

2,163

6.9%

4,045

20.7%

Cognitive

3,407

6.7%

1,079

3.5%

2,328

11.9%

Self-Care

3,509

6.9%

1,434

4.6%

2,075

10.6%

Vision

1,712

3.4%

577

1.9%

1,135

5.8%

U.S. Census Bureau, ACS 2018 1-Yr Estimates, Table S1810

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WASHTENAW COUNUTY-LEVEL GEMOGRAPHIC™ REVIEW

Language 7 9.9% of Washtenaw County adults 65+ years old report speaking a language other than English, with 4.8% speaking English less than “very well.” Caregiving Role 8 3.2% of Washtenaw County adults 65+ years old live with their grandchildren, with 0.8% reporting responsibility for their grandchildren. Veteran Status 9 14.8% of Washtenaw County adults 65+ years old are civilian veterans. Social Isolation As noted above, federal census data indicates that nearly 44% of 65+ year old led households represent older adults living alone. While this can be considered as a factor in social isolation, the Washtenaw County Older Adults 60+ Survey results do cite “living alone does not seem to be a significant indicator of lower quality of life.” A Washtenaw County senior need survey commissioned by the Area Agency on Aging 1-B in 2019 showed that: ● ● ●

12% of older adults ages 60+ (~6,000 seniors) cite loneliness or isolation as the top hardship faced by older adults in community 1 in 4 (~13,000) want more contact with friends/neighbors/relatives 8% (4,000) cite social involvement as a serious challenge (ranked 8th on a list of 12 challenges)

Technology Access 10 The vast majority of older adults in Washtenaw County live in a household with a computer and high-speed internet access, as shown in the table below. Nearly 10% do not have a computer present in the household. However, the presence of a computer and high-speed internet may not necessarily indicate comfort with accessing technology. Older Adult 65+ Years Presence of Computer/Internet in Household #

Total 65+ Years

49,883

100.0%

Has a Computer

44,938

90.1%

With Broadband

42,588

85.4%

0.1%

2,316

4.6%

With Dial-Up Without Internet

U.S. Census Bureau, ACS 2018 5-Yr Estimates, Table SO103 U.S. Census Bureau, ACS 2018 5-Yr Estimates, Table SO103 9 U.S. Census Bureau, ACS 2018 5-Yr Estimates, Table SO103 10 U.S. Census Bureau, ACS 2018 1-Yr Estimates, Table B28005 7

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WASHTENAW COUNUTY-LEVEL GEMOGRAPHIC™ REVIEW

No Computer

4,945

9.9%

Geographic Variation in Older Adult Experience Across Washtenaw County All of the above indicators can be found to vary based on where older adults engage in life experiences across the expanse of Washtenaw County. This variation is driven by a number of geography-associated factors including where people tend to live, local availability of resources, physical access to destinations, and others. The maps below provide a high-level indication of this variation. Together, the maps show a clear picture of a square county with a population concentrated around the largest urban center and county seat of Ann Arbor, along with a network of smaller cities, towns, and villages, including Ypsilanti, Chelsea, Saline, Manchester, Dexter, and others that are woven together by suburban and rural areas. Washtenaw County, MI

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WASHTENAW COUNUTY-LEVEL GEMOGRAPHIC™ REVIEW

% Population 65+

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WASHTENAW COUNUTY-LEVEL GEMOGRAPHIC™ REVIEW

# Population 65+

Economic Security The maps also show concentrated areas in which older adults are facing greater economic security, including urban pockets around Ann Arbor and Ypsilanti and also the more rural northern border and southwest corner of the county. The following two maps show areas with concentrations of older adults with an income below the poverty level and below 200% of the poverty level (often considered a more reliable indicator of economic insecurity).

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WASHTENAW COUNUTY-LEVEL GEMOGRAPHIC™ REVIEW

The areas noted above include two zip codes - 48197 and 49198 - that are typically highlighted when looking at Washtenaw’s older adult populations considered to be “vulnerable.” Washtenaw County Zip Codes 11

Washtenaw County - Michigan Zip Code Boundary Map (MI), www.zipmap.net/Michigan/Washtenaw_County.htm.

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WASHTENAW COUNUTY-LEVEL GEMOGRAPHIC™ REVIEW

These areas also align with areas that have been noted as having low overall opportunity based on the Washtenaw County Equity and Opportunity Map, a product of the Washtenaw Opportunity Index. Led by the Washtenaw County Office of Community and Economic Development (OCED) via the One Community equity initiative, the index reflects the county’s being ranked 80th out of Michigan's 83 counties for income inequality in 2015. The Index speaks to opportunity in the areas of health, job access, economic well-being, education & training, and neighborhood safety and stability. The results of this reflect a 2015 Martin Prosperity Institute report indicating that Ann Arbor is the eighth-most economically segregated metro area out of 380 studied in the United States, the second most segregated city in the nation in service class segregation, and the fifth in working class segregation. This is on a list that includes a number of smaller metro areas that are almost all other college towns. Washtenaw County Equity and Opportunity Map 12

Washtenaw County Equity and Opportunity Map, http://arcg.is/0iyOiu

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WASHTENAW COUNUTY-LEVEL GEMOGRAPHIC™ REVIEW 10

Additional complementary indicators of economic security present a similar geographic picture, including the financial burden of the cost of housing (selected monthly housing costs are 30% or more of household income), either renting or homeownership. The below maps show the prevalence of cost burden for older adults living in areas across Washtenaw County. Most areas with a higher cost burden align with the higher-poverty areas shown above, with a few exceptions where a higher-poverty area shows low cost burden or vice versa. For example, the southwest corner of Manchester shows both higher poverty with high rent cost burden but low homeownership cost burden, and suggests the need for further investigation.

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WASHTENAW COUNUTY-LEVEL GEMOGRAPHIC™ REVIEW

Cost-Burdened Renters 65+ 13

“Map of Washtenaw with Estimated Percent of All Renters 65+ Who Are Cost Burdened, between 2014-2018. “ PolicyMap, https://plcy.mp/n7HQprY

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Cost-Burdened Homeowners 65+ 14

Healthy Aging and Racial Equity As shown in the map below, the higher-poverty, lower-opportunity areas again align with areas in which communities of color more commonly reside in Washtenaw County, including older adults.

14 “Map of Washtenaw with Estimated Percent of All Homeowners 65+ Who Are Cost Burdened, between 2014-2018.” PolicyMap, https://plcy.mp/YVFD3wc

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Social Isolation While living alone is not necessarily directly correlated with experiencing social isolation or lower quality of life, the map below shows geographic variation in older adults living alone across Washtenaw County. Certain higher concentration pockets, including neighborhoods in Chelsea, Ann Arbor, Ypsilanti, and Saline, may reflect residential and family dynamics in more urban areas, but suggest the need for further investigation.

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Healthy Aging and Political Environment As one indicator of the political environment in different areas of the county, which may affect future systems efforts, the below maps show 2020 and 2016 presidential election results by precinct. 2020 Washtenaw Election Results 15

2016 Washtenaw Election Results 16

”Washtenaw County Election Results: November 3rd, 2020.” Washtenaw County, webmapssecure.ewashtenaw.org/ElectionRedirect/WebMap/nov2020/results.html#. 16 Washtenaw County Election Results: November 8th, 2016.” Washtenaw County https://webmapssecure.ewashtenaw.org/ElectionRedirect/WebMap/nov2016/results.html?entry=1 15

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WASHTENAW COUNUTY-LEVEL GEMOGRAPHIC™ REVIEW 15