Aging Across the United States: Matching Needs to States

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Aging Across the United States Matching Needs to
States Differing Opportunities and Services

• Charles Lockhart and Jean Giles-Sims

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Problem Micro-Level experiences
Parents vastly varying support in
different states during lengthy
declines. Macro-Level
Demographics a rapidly aging society
The challenges of a substantially larger
population of older citizens.
State capacities differ State
inclinations differ And state demographics
differ. Describe What policies/orientation
s help older citizens? Explain Why do
these policies/orientations appear more
thoroughly in some states than others?
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Existing theory for explaining cross state
policy/orientation differences We
use existing theory about state policy
differences as summarized by Karch
(2007) to explain cross-state variation. We draw
on the laboratory of federalism for isolating
particular state features helpful for
meeting the challenge of a substantially larger
population of older citizens. We pretty
much stepped into the void in terms of
describing and operationalizing
what we call the elderly-friendliness of the
American states
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Concepts state elderly friendliness, state
senior friendliness, state
age friendliness What
is it? Its not one thing, because Older
citizens form a heterogeneous group Individual
elders experience different needs across
sequential stages of aging. So, SEF is a
multi-dimensional concept built around five
primary objectives
since At any given time older citizens have
distinct priorities among these objectives, and
Across time, most elders experience several of
these objectives sequentially as their top
priority.
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Five dimensions of SEF Among younger,
healthier older citizens (the young-old) Fun
in the sun or the recreational lifestyle
dimension Finding meaning in life or the
meaningful contributions and supportive
communities dimension and the affordability
and safety dimension Among older, less
healthy citizens (the old-old) The health
and accessing high-quality medical care
dimension and the accessible, high-quality
long-term dimension. Each dimension is
measured with a four-item index using (with a few
exceptions) data coming from the period
1999-2005.
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Recreational lifestyle dimension
Elements State climate sunshine, temperature,
humidity averaged across state
zones Percentage of state 65 population who
do not live alone Percentage of state 65
population who are not disabled (average of
excessive criterion and understated
criterion) Percentage of SDP from a certain
type of tourism (100 miles and overnight).
Apples, oranges, lemons and limes dimensional
index formed from added z-scores (units
of standard deviation) to provide a common
metric. Cronbachs alpha for index .66.
(Several southeastern states with
encouraging climates also have relatively high
rates of disability.)
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Meaningful contributions and supportive
communities dimension. Elements Putnam
s state Social Capital II index (community
contributions and interaction with friends and
neighbors) State Gini index (reversed as an
index of income equality) Percentage of state
65 population voting in the 2004 presidential
election. Percentage of state 65 population
living above the federal poverty level
Two elements on state population generally and
two on state 65 population. Index
alpha .80.
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Affordability and safety dimension Slight
negative correlation (-.02) between these
two variables, so we measure affordability
first and then rank order the top third of the
states on affordability with respect to
property crime per 1,000 state residents. This
last statistic correlates positively (.31)
with homicides per 1,000 65 state
residents. Elements Percentage of
state population living outside metropolitan
areas (clusters of lt 50,000) States
median mortgage payment (reversed) States
Federal Medical Assistance Percentage (a
nonlinear inverse measure of state personal
income) States 65 median household income
(reversed). Alpha index .90.
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Health and high quality medical care dimension
Elements Centers for Disease Controls
state healthy aging index (average rank across
15 items) States score on the best
practices conception of the quality of medical
care delivered to Medicare patients (Jencks, Huff
Curedon, 2003) States score on the
coordination of care elements conception of
the quality of medical care delivered to Medicare
patients (Baicker and Chrandra,
2004) Percentage of state Medicare recipients
not in ICU/CCU during their last six months of
life. Alpha index .82.
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Accessible, high-quality long-term care
Elements Medicaid-certified nursing facility
beds per 1,000 65 state residents Percentage
of state Medicaid expenditures devoted to nursing
facilities State Medicaid nursing facility
expenditures per 1,000 65 state
residents Our quality of state nursing
facility processes scale (alpha index .78).
Alpha index .74.
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Highest, lowest states on SEF dimensions
Recreational lifestyle western, particularly
southwestern and some southeastern states top
five Nevada, Hawaii, Arizona, Utah
California bottom five Indiana, Ohio, North
Dakota, Kentucky West Virginia.
Meaning northern states top five Montana,
Minnesota, Utah, North Dakota South Dakota
bottom five Tennessee, Texas, Kentucky, New
York Mississippi. Affordability (and
safety) diagonal southeast to north
central/northwest top five Mississippi, West
Virginia, Arkansas, Kentucky Montana bottom
five Connecticut, Maryland, California, New
Jersey Hawaii. Among the top 17 states on
affordability, the top five on safety are
South Dakota, North Dakota, Maine, Kentucky
West Virginia. Health/medical care
northern states top five New Hampshire, Utah,
Oregon, Hawaii Colorado bottom five
Oklahoma, Illinois, Texas, Louisiana
Mississippi. Accessible, quality long-term
care Northeast and upper Midwest top five
Rhode Island, Connecticut, North Dakota,
Massachusetts Ohio bottom five Nevada,
California, Washington, Utah Arizona.
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• Relations among the five dimensions
• Table 6.1 Relations (Correlations) Among the
  Five Dimensions of SSF
• 1) 2) 3)
  4) 5)
• Recreational
  Contributions/ Affordability
  Health and Accessible,
  
• lifestyle
  community high quality
  quality long- medical care
  term care
• Recreational 1.00
• lifestyle
• Contributions/ -.11 1.00
• community
• Affordability -.42 -.07 1.00
• Health and -.02 .79 -.07
  1.00
• high quality
• medical care

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Consequences of these rankings social outcome
measures net state 65-74 in-migration (for
recreational lifestyle), index for
Elazars state political culture (meaning), state
cost of living reversed (affordability), state
life expectancy (quantity correlates with
qualityCDC index mentioned aboveat .79)
(health/medical care) and our state nursing
facility residents quality of life
outcomes scale (alpha index .83) (accessible,
quality long-term care). Table 6.3
Regression Coefficients on the Social Outcome or
So-What Variables for the Scales of
the Five SSF Dimensions a Independent
variables Net 65 -74 Index of
Elazars State cost of Life
State nursing in-migration
state political living (reversed)b
expectancy at facility residents
culture
birth
quality of life
outcomes Recreational lifestyle 9.10
-.37 .006
.08 -.05 (1.81)
(.20) (.004)
(.05)
(.14) Contributions/ -1.2 7
.72 .002
.05
.45 communities (1.79)
(.20) (.003)
(.05)
(.14) Affordability 4.51 -.39
-.018
-.14
.04 (1.21) (.14)
(.002) (.03)
(.09) Health and high
quality .07 .38 -.010
.26
.23 medical care (1.75) (.20)
(.003)
(.05)
(.13) Accessible, high quality -1.56
-.16 -.007
.03
.24 long-term care (1.53) (.17)
(.003)
(.04)
(.12) Adjusted R Square .56
.63 .71
.78
.61 Significant at lt .05 at lt .01
at lt .001 . a Standard errors are in
parentheses beneath the regression
coefficients. b More decimal places are necessary
to reveal the values in this column because we
are predicting small numbers with considerably
larger numbers.
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Explaining these rankings Basically state
inclination (), material capacity (),
percentage 65 minority (-). Table 6.4
Regression Coefficients on the Five SSF
Dimensions of Seven Prominent Explanatory
Factorsa Independent
Recreational Contributions/
Affordability
Health and high quality Accessible
High variables
lifestyle communities

medical care quality
long-term care Elazar-Douglas Wildavsky
state .01 .46
-.20
.40
-.05 political culture
(.10) (.09)
(.07)
(.11)
(.12) Ranneys index of
state -2.29 -1.81
-1.92
-2.75
-9.08 political party competition (4.19)
(3.87)
(3.06)
(4.61)
(5.06) State tax capacity -.80
-1.86
-13.47 -1.06
8.80
(1.92) (1.77)
(1.40)
(2.11)
(2.32) Median income of a
states .00044 .00037
-.00031
.00009
-.00044 65-or-older householdsb
(.00012) (.00011)
(.00009)
(.00013)
(.00015) Proportion of a states .22
.15
-.33 .20

.11 population that is 65 or older (.19)
(.18)
(.14) (.21)

(.23) Proportion of a states 65-or-older
population that .09 -.07
-.09
.01
-.02 is minority (.03)
(.03)
(.02) (.04)

(.04) Average senior residential property tax
abatement of .28 .11
.05
.43
.14 contiguous states (.16)
(.15)
(.12)
(.17)
(.19) Adjusted R Square .46
.64
.81 .50

.32 Significant at lt .05 at lt .01 , at
lt .001 . a Standard errors are in
parentheses beneath the regression
coefficients. b This variable is adjusted for
state cost of living. Additionally, more decimal
places are necessary in this row because we are
using relatively large numbers to predict small
numbers.
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Whats the central take home message here?
Many older citizens 1) either move to the
southwest or southeast early in retirement
for improved recreational opportunities, or 2)
move to southeastern or northwestern states early
in retirement for relative affordability
and safety. These elders should recognize
that these states may support their priorities
in later life only poorly and consider the
possibility of a second move to northeastern or
north-central states later in retirement in
order to 1) access better quality medical care
and find more accessible, high-quality long
term care, and/or 2) be closer to their
families for help in old age.