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Local Aging & Disability Action Plan: A Blueprint to Improving Care for Older Californians

Over the next two decades, California’s over-65 population will nearly double, with those aged 85 and older being the fastest growing demographic group. 

While this change in demographics will introduce new opportunities for economic and community growth, it will simultaneously lead to an increased demand for health and support services.

In January 2021, the State of California began to implement a new Master Plan for Aging (MPA), a 10-year blueprint for state government, local government, the private sector, and philanthropy to prepare for these coming demographic changes. The plan was informed by a network of aging and disability providers, policy makers, advocates, and experts, and addressed topics such as housing, healthcare, community-based services, social isolation and loneliness, equity and inclusion, caregiver support, and financial security for older adults.

While many examples of age friendly planning initiatives exist in urban and suburban areas, these models often don’t translate to rural settings. In rural communities, local government leadership and civic engagement are pivotal to develop collaborative networks for community mobilization and collective impact. Local MPAs enable rural communities to tackle complex community challenges and drive population and systemic change by leveraging individual, community, and jurisdictional factors.

In January of 2022 the SCAN Foundation provided financial support to Agency on Aging Area 4 to focus on developing a regional Master Plan for Aging for Yuba and Sutter counties that will address the unique challenges of aging in a rural community.

Who does the plan benefit? 

The plan is for all Yuba and Sutter County residents but focuses on optimizing health and wellness of older adults, adults with disabilities, and caregivers. There are a wide range of needs amongst older adults, adults with disabilities, and caregivers in Yuba and Sutter Counties.

Overall, services and supports identified in the plan must be age and disability-friendly, aligning with the cultural needs and values of our diverse communities. The Yuba and Sutter County Master Plan for Aging (YSMPA) will address the unique challenges of aging in our geographically diverse region, encompassing rural and urban populations in Yuba and Sutter Counties.

Why is a local plan essential in rural communities? 

Planning for age-friendly communities for urban and suburban areas is very different from planning for rural settings. Engaging a wide variety of local community members and organizations is critical to ensure practices, policies, and programs are relevant to the community and is essential to understanding the specific challenges that many rural communities face, including:

  • An aging population: Across the globe, people are experiencing increased longevity, with adults aged 65 and above constituting the fastest growing demographic group. In the US, this trend is more pronounced in rural areas, where adults aged 65 and older make up a higher share of the population (19%) as compared to urban and suburban ones (15%). Furthermore, the proportion of older adults is expected to continue to grow by more than 40% by 2034.
  • Barriers to healthcare: Rural residents, particularly persons of color and those living on tribal lands, have lower access to health care as compared to urban and suburban areas. According to the US Congress Joint Economic Committee, 91% of all rural counties face a shortage of primary care physicians.  Nationally, there are only 10.9 physicians per 10,000 people in rural areas versus 31.7 in urban areas.  Additionally, between 2010 and 2021, a total of 136 rural hospitals and health systems closed, exacerbating shortages. Rural regions experience shortages in nurses, physician assistants, dentists, and dental hygienists. Almost one in four rural Americans is a person of color, and people of color and those living on Tribal lands are even more likely to feel the burden of lower access to health care in rural areas. Even when an adequate supply of healthcare services exists in the community, there are other factors that may impede healthcare access. For instance, to effectively access healthcare services, rural residents require financial means for healthcare coverage, access to transportation, language proficiency and health literacy, and confidence in the quality of care. All these factors can cause patients to delay care, leading to worse health outcomes and greater mortality.
  • Higher prevalence of disabilities:  Rural counties exhibit a higher prevalence of all types of disabilities as compared to urban counties, with older rural adults and racial/ethnic minorities experiencing particularly elevated disability rates compared to their urban counterparts. 
  • Lower access to long term services and supports (LTSS), including home and community-based services (HCBS): Rural areas face a severe shortage of direct service workers (DSWs), including personal care aides, home health aides, and nursing assistants. Rural Medicaid LTSS recipients are more likely to receive nursing facility care as compared to their suburban or urban counterparts. Another barrier to HCBS is affordability. Due to limited incomes, many older adults in rural areas struggle to afford LTSS. Once their personal finances are depleted, the majority of rural residents turn to Medicaid for funding to cover their essential care needs.
  • Greater reliance on informal caregivers: In many rural areas, family members, neighbors, and friends often fill gaps by providing informal HCBS. However, migration of younger family members to larger, more urban areas often reduces the number of family members available to provide care.
  • Transportation challenges: Long distances, road conditions, and seasonal variations in weather contribute to transportation challenges in rural regions, where residents must travel long distances to access groceries, opportunities for socialization, healthcare and other services. Over 20% of older adults do not drive, leading to a rising need for accessible transportation options. Rural older adults report an increased reliance on caregivers, friends and neighbors for transportation, though some report having no one they can reach out to for help.
  • Racial and ethnic disparities: Geographic disparities intersect with and exacerbate racial and ethnic disparities. These disparities are driven by many factors, including healthcare shortages, cultural and historic factors, weather-related vulnerabilities, underdeveloped public health infrastructure, barriers to qualifying for funding in rural areas, and more.
  • Digital divide: A third of Americans living in rural areas lack adequate access to broadband. This lack of access impacts access to online information and resources, telehealth, financial services, digital communication and social connection, and more.
  • Greater vulnerabilities to severe weather & climate related disasters: Disasters disproportionately effect older adults and individuals with disabilities. As climate change causes more frequent and severe weather fluctuations, rural communities bear the brunt of these impacts. Over 85% of the rural and unincorporated areas of California are situated in zones categorized as having "high" or "very high" severity for wildfire risk. Rural areas are also especially vulnerable to flooding due to inadequate investment in physical infrastructure, including poor maintenance of levees and irrigation channels.
What will the plan accomplish? 

The YSMPA will be designed to ensure older adults, adults with disabilities, and caregivers in the region can live with dignity, be engaged, feel safe, maintain good health and mobility, age in place, and can make choices.