Each day, more than 11,000 Americans turn 65, according to the National Council On Aging. Ask them who pays if they need help bathing, cooking, or getting to a doctor’s appointment, and most will answer incorrectly.
That confusion — and the complete lack of a coordinated national safety net — was the focus of a July 28 panel hosted by the Bipartisan Policy Center. The session launched a three-year initiative called The Aging of America: Forging a National Consensus.
Bob Blancato, executive director of the National Association of Nutrition and Aging Services Programs, moderated the conversation with panelists Alison Barkoff, director of the Hirsh Health Law & Policy Program; Tim Getty, regional nutrition coordinator at the Heritage Area Agency on Aging; Kim Fitzgerald, CEO of Cathedral Square; and Beth Kowalczyk, CEO of the Ohio Association of Area Agencies on Aging.
The experts discussed current policy obstacles and highlighted working models already operating in Iowa, Vermont, and Ohio that are immersed in the day-to-day challenges of helping older adults. Panelists also discussed the recent bipartisan reauthorization for the Older Americans Act (OAA) and strong cross-aisle support for a national family caregiver strategy.
Why this matters
While the Senate passed the OAA reauthorization unanimously, the House has not taken it up. Reporters can ask their local representatives where they stand on the legislation and what is delaying action. Journalists may also want to offer explainers describing the many OAA-funded programs and services, and the importance of everyone — not just older people — reaching out to their legislators. Speak with older adults and find out whether supportive services and aging-related programs are making a difference.
The lack of reauthorization could create uncertainty for many of the nation’s older adults and their family caregivers. Millions of seniors rely on the services, programs, and supports provided by the OAA.
“We do not have a long-term care system in this country,” Barkoff said. Many people don’t know that Medicare does not cover long-term personal care, and find out only when a crisis hits.
Medicaid fills part of the gap, but eligibility generally requires people to meet income and asset requirements, which vary by state and program. to meet strict asset caps. Even then, the system leans heavily toward institutional care over the home-based support people prefer. Barkoff called it an “institutional bias.” The result is years-long waiting lists for home- and community-based services (HCBS), leaving some people waiting for services that could help keep people in their homes.
Local health reporters should check their state’s current Medicaid HCBS waiver wait times — and find out who is stuck in limbo.
A meal program that’s scalable
Getty, who manages nutrition programs in the eastern part of the Hawkeye state, brought up a piece of the puzzle some reporters miss: home-delivered meals are often an older adult’s single point of contact with any social safety net.
“One of the significant challenges that older adults are currently facing is access to available resources, especially for those of older adults and specifically in rural communities, but also throughout our entire state and also the nation,” he said.
The OAA programs serve as an entry point to services such as housing, transportation, nutrition assistance, and care management. Heritage’s Home-delivered and congregate meal programs also help identify problems such as malnutrition, isolation, and elder abuse: 71% of home-delivered-meal recipients and 29% of congregate diners were at high nutritional risk in FY26, while social isolation can worsen physical and mental health, Getty said.
To reach isolated seniors, Heritage built Encore Café — pop-up dining sites operating out of churches, libraries, and parks. Some sites now host up to 90 people a day. It is an inexpensive, scalable model that any local area agency could adapt.
Affordability and fragmentation are key obstacles
Cathedral Square’s Kim Fitzgerald had a simple message for webinar attendees: housing is healthcare. “Accessible, affordable housing with services would allow older adults, especially those aging with disabilities, to stay housed, stay healthy, and age with dignity in their community,” she said.
Cathedral Square runs Support and Services at Home (SASH), a program pairing affordable housing with care coordination and on-site nursing. A peer-reviewed evaluation showed the program reduced Medicare spending and cut ER visits.
More than 1,300 people remain on Cathedral Square’s waitlist. The issue is not whether the model works — it is that funding constraints keep it out of reach for thousands, Fitzgerald said.
Beth Kowalczyk, CEO of the Ohio Association of Area Agencies on Aging, emphasized the invisible infrastructure holding this fragmented network together. Area Agencies on Aging (AAAs) help families navigate Medicaid waivers, OAA programs and local resources.
“The area agencies on aging are the glue that really holds all of these supports together,” Kowalczyk said. Ohio’s 12 AAAs face the greatest demands in rural counties, where care options remain exceptionally sparse.
What happens if the funding disappears?
Every dollar invested in OAA services saves three dollars down the line — primarily by delaying or preventing costly hospitalizations and nursing home admissions, according to Barkoff. The Senate Special Committee on Aging reported that every $1 invested in the OAA generates $3 to help older adults remain at home and avoid hospitalization through low-cost, community-based services. States typically leverage $2 to $3 from state, local, and other sources for every federal dollar invested through the OAA, according to the Administration for Community Living.
Barkoff also flagged proposed Medicaid cuts tied to H.R. 1, which could reach $1 trillion over the next decade. When state budgets tighten, optional home- and community-based care services are often vulnerable to cuts.
The panelists agreed that the aging-services and supports system faces a crisis with potential solutions, whether it’s an Iowa pop-up cafe, a Vermont apartment building or an Ohio AAA office. The real concern is whether lawmakers will fund these other models at scale before tens of thousands of additional Americans turn 65 this year.
The BPC initiative is funded by the John A. Hartford Foundation, which also supports AHCJ’s aging health beat.
Resources
- What to know about the Older Americans Act and the services it provides to older adults, KFF
- Meals on Wheels America
- The cost of aging in place: what older adults should know, National Council on Aging
- State aging units and Area Agencies on Aging, National Planning Council
- What older Americans want policymakers to know, Bipartisan Policy Center
