Circumstances & Trends

An important trend in the field of aging is growth in the older adult population. “The number of people ages 65 and older in the United States has increased steadily during the past century, and growth has accelerated since 2011, when baby boomers first started to turn 65” (Mather and Kilduff, 2020). This growth is expected to continue and “between 2020 and 2060, the number of older adults is projected to increase by 69 percent, from 56.0 million to 94.7 million” (2020). The Center for Community Solutions in Cleveland reports that 26.3% of the Ohio population will be 60 years or older by 2030 and “Cuyahoga County’s population will have almost 30 percent (28.7) of the total population” 60 or older (Tarter, Jr., 2021, p. 5). This is both a challenge and an opportunity because older adults are already the largest voting bloc, so organizations such can use these numbers to their advantage when seeking resources and support for programs serving this population.

Another key trend is the older adult population is becoming more diverse. “In 2015, roughly 8 out of 10 people age 65-plus (78 percent) in the U.S. were white non-Hispanic” (Fox-Grage, 2016). However, “in the 2030s, the number of white older adults will level off while the other racial and ethnic groups will increase,” and by 2060 “less than 6 out of 10 older Americans” will be white (2016). Meeting needs for older adults will require addressing existing disparities that make racially marginalized older adults more vulnerable to circumstances such as low-income. While older adults in general face insufficient incomes – “half of people ages 65 or older who live alone do not have enough income to afford a basic budget in their home communities, and nearly one in four older couples” deal with the same challenge – “far higher percentages of Black, Latino, and Asian older adults live on incomes that fall short of what it takes to get by relative to their White counterparts” (Mutchler et al., 2021, p. 1).

Related to economic inequity, there has been growth in food insecurity for older adults:

Before COVID-19, 26 percent of older adults in Cuyahoga County had to choose between food and at least one other necessity, such as housing, medical care or utilities […] During COVID-19, two-thirds of Ohioans age 65 and older said they used their stimulus payments to pay mostly for those same basic expenses — the most of any age group”

(Tarter, Jr., 2021, p. 3)

There are opportunities related to food security for older adults, however. Meals on Wheels America reports that in March 2022 “the President signed into law a final Fiscal Year (FY) 2022 appropriations bill that included an increase of $15 million for the OAA Title III-C Nutrition Program, for a total of $966,753,000” (2022, p. 1). The Older Americans Act (OAA) Nutrition Program includes three sub-programs including congregate meals, home-delivered meals, and the Nutrition Services Incentive Program that “incentivizes states to serve more OAA-eligible congregate and home-delivered meals by providing additional funds based on the relative number of meals served the year prior to cover the cost of domestically produced foods” (2020, p. 1). This increase in nutrition funding opens the door to maintain or increase nutrition services to older adults. It may also indicate a widening of a policy window for those in the field to advocate for more along with Meals on Wheels as they “urge Congress to do more and double funding for the program to $1,933,506,000 in FY 2023” (2022, p. 1).

Entwined with each of these circumstances are the rising costs of goods challenging access to resources. One dollar in June 2022 had the same buying power as 87 cents in January 2020, and over the 12-month period ending in June 2022, the Consumer Price Index rose 10.4% for food and 41.6% for energy (including electricity, natural gas, fuel oil, and gasoline). Rising food costs are intensifying food insecurity already exacerbated by the pandemic, while rising costs for electricity and fuel contribute to higher utility bills and gasoline prices (for clients and human service agencies). Additionally, “demand for cars stayed relatively strong” while supply has decreased which has caused an increase in prices for new and used vehicles while “car repairs are getting more expensive” (Gailey & Stauffer, 2022).

The relationship between foundations and nonprofits also changed during the pandemic. Building on momentum established in late 2019 “when presidents from five of the nation’s largest foundations announced a plan to stop underfunding grantees’ indirect costs,” many funders offered more flexibility to their grant recipients (Eckhart Queenan & Bradach, 2021).

Most say that at least some of their staffed foundation funders have allowed goals of current grants to shift, extended the deadline for completing the work funded by current grants, waived reporting deadlines or made them flexible, proactively converted restricted grant funds to unrestricted funding, provided supplemental grants, and offered to discuss converting restricted grant funds to unrestricted funding […] the most helpful actions […] are reaching out to them – especially to ask what they need – providing more funding, and providing unrestricted funding” (Martin et al., 2020, pp. 13-14)

This signaled more openness and partnership-style relationships between funders and those funded. Writing for Salesforce in late 2020, David Ragones predicted, “We can anticipate a less transactional, more collaborative relationship between grantors and grantees, with more efficient processes, more transparency and a greater emphasis on feedback loops” (Ragones, 2020).

Implications

The increase in the older adult population suggests that organizations in the field of aging should be preparing to expand the workforce and programs serving this population to meet the growing demand for services. For service providers in the field of aging, the trend of increasing diversity “has enormous implications for meeting diverse personal and family caregiver preferences, providing services with cultural sensitivity, and training the paid health care workforce in cultural competence” (2016). Players in the sector cannot wait until 2030 to begin thoroughly weaving racial equity into their work; if they do, they will already be contributing to clients and communities falling into gaps and being underserved.

Inflation and rising costs of goods will affect organizations in the field in multiple ways. Regarding payroll, they could face choices to keep wages the same and risk losing workers or decrease worker satisfaction, pay more to maintain their workforces while providing wages that rise with the cost of living, or make strategic pay cuts/lay-offs/position eliminations that could jeopardize organizational morale and accomplishment of goals. Cost increases for goods and services organizations need – such as food, office supplies, technology, medical supplies, staff, etc. – may be passed on to clients or cause the organization to scale back on programs and services offered. As an example, food and fuel prices increasing coupled with the cost of acquiring or repairing a vehicle could strain availability of food, working vehicles, and fuel for meal delivery programs. Without funding increases to match rising costs, organizations may choose to serve smaller areas or fewer clients or increase client pay rates to improve program service revenue – potentially pricing some clients out of service or raising costs for more economically stable clients to subsidize services for low-income clients.

Rising costs also directly impact clients. The federal government declared a Public Health Emergency (PHE) due to the pandemic, and they have extended the PHE several times, most recently in July 2022 until October 13, 2022. This emergency declaration and its extensions have allowed for states like Ohio to provide many households temporary increases to Supplemental Nutrition Assistance Program (SNAP) benefits over the base amounts. Monthly benefits in Ohio increased by as much as $218 for a single older adult to $497 for an older adult with two grandchildren. When the PHE ends and SNAP benefits return to base amounts, “federal food assistance will undeniably hurt everyone who relies on the program to meet their nutritional needs,” but “older adults, a population that already disproportionately struggles with food security, will face the most severe impacts (Hudacek & Lane Gavin, 2022).

Today vulnerable individuals and communities choose which necessities to meet or forego based on income and cost. As prices continue to rise and benefits drop to pre-pandemic levels, more people may become vulnerable and be forced to scale back further on meeting their needs – for instance, food insecure seniors will go without meals more often or poor seniors will skip medications more often because they cannot afford them. This will lead to increased demand for services as well as clients being in more dire circumstances by the time, they come in contact with service providers. “Prevention is the key to both better health and lower health-care costs over the long haul,” so a reactive stance will cost more in multiple ways (Schimpff, 2010).

Funding could help mitigate the negative implications; however, challenges arise there, too. Though governments have stepped into the gap since 2020 with ARPA funds,nonprofits may compete with each other, a government’s own initiatives, small businesses, or impacted industries to get a slice of the billions of dollars governments will either dole out directly (via grants or budgets) or through foundations. A positive note is that since 2020 governments and foundations have embraced increasing collaboration and flexibility with nonprofits – including offering more unrestricted funding and support for capacity building – while seeking the most impact which implies a better environment for organizations to pursue missions with fewer compromises. The National Council of Nonprofits advises that as governments seek high-impact programs to fund, they should expect to prioritize equity, invest in nonprofits that act as economic multipliers, hold nonprofits accountable while working with them to avoid overly burdensome requirements, and look to new and existing systems (such as community foundations) to quickly and fairly distribute funds (2022, p. 11).

Nonprofits should be prepared to engage in relationships with funders (whether direct funder or an intermediary arrangement) that are more open and reciprocal. Organizations in the field will need to evaluate their achievements and goals to see how they fit with funders’ current priorities – equity, sustainable development, making the dollar go the farthest for the biggest impact, and addressing systemic challenges – while navigating funders’ preconceived notions and apprehensions as “foundations’ quest for greater impact is not usually accompanied by an increased tolerance for conflict or risk” (Brown et al., 2003, p. 20). As suggested previously by the “economic multiplier effect,” nonprofits will also likely need to be in collaboration with other organizations with related or complimentary missions and services to achieve the biggest impact. Collaboration will necessarily include collective advocacy as organizations pool their resources and power to pursue mission-driven systemic change – such as the increased funding for nutrition programs for older adults championed by Meals on Wheels America.

Organizational Adaptation

Even before COVID-19, the field was adapting to funding shortfalls and resource challenges. In 2019, the Minnesota nonprofit Senior Community Services “which provides senior outreach and caregiver services, such as support groups, household maintenance and social workers” hired a development director to attract more donations and got “pro bono help to market a program” in response to a drop in grant funding to senior-serving organizations (Smith, 2019). Many organizations expanded collaborative efforts to make an impact, and “in Nevada, there’s now a ‘Delivering with Dignity’ consortium comprised of six groups delivering 4,000 meals to the doorsteps of the most vulnerable older adults in their community” (Blancato & Whitmire, 2020). Collaboration between governments and the nonprofit sector also increased. “Governments at all levels are partnering even more with charitable organizations to put [ARPA funds] to use in ways that address longstanding challenges and improve conditions in communities” (National Council of Nonprofits 2022, p. 1). Growing collaborations contribute to enthusiasm for supporting nonprofits in new ways with some government officials considering using state budgets or leveraging other funding for nonprofits because “they’re all of a sudden seeing nonprofits as part of future solutions, not just immediate needs” (Queram, 2021).

The American Society on Aging realized a challenge to getting necessary funding was the stereotype that older adults are either “people who deserve pity, services and help” and have little value to society or “energetic white upper middle-class people” (Morris, 2021). To make its public image reflect the reality of aging and how it wanted to be seen, the nonprofit hired a branding company for “a full rebrand of ASA’s image, which included our logo, publications and corporate website, as well as all the materials that we distribute” (Morris, 2021). The rebranding sought to address diversity in the population and support the goal “to be inclusive in our imagery, showing aging in a realistic way, with people of different races and ethnicities and socioeconomic, ability and health status” (Morris, 2021). To show its commitment, ASA launched its ASA RISE program to provide training and mentorship to a BIPOC pool of new leaders in the field of aging. ASA also established a standing board committee, DEI Upstanders, to set a strategic vision for its DEI principles and “ensure that ASA promotes equity, combats racism and other systemic inequalities, and fosters inclusion in all of its advocacy work, programming and in the employee lifecycle at ASA” (American Society on Aging, 2022).

Recommendations

Based on this assessment, I recommend more inclusive strategic planning, enhanced internal and external collaboration, evaluation of funding sources and strategy, enhanced advocacy efforts, and resources dedicated to racial equity at every level of [the organization’s] work. Specific action steps include:

• Develop cross-departmental groups including all types of staff (program implementation, budgeting, research, plant management, housekeeping, etc.) as well as intra/extra-organizational groups to work on strategic planning and to review [the organization’s] brand/reputation (internally and externally) to make sure it engages all stakeholders and accurately reflects the service population and [the organization’s] goals and desired impact
• Collaborate with area health schools, management, and training programs to support development of leaders and service providers – with specific initiatives for BIPOC individuals in these areas – who are well-equipped to serve in the field of aging
• Promote and encourage recruitment, training, professional development, research, and program changes related to better serving different racial groups of older adults/families
• Review Medicaid/Medicare reimbursement levels and continue to pursue diversified funding (such as remaining ARPA funding and nongovernmental funds) that anticipates government underpayment while advocating for improved reimbursement
• Seek more open and reciprocal relationships with partners (including funders) in support of work that 1) is preventative and 2) is an economic multiplier for the community by providing needed services that have positive economic ripple effects
• Advocate with others in the field and across subsectors/sectors for policy related to relieving burdens (such as decreased housing and prescription costs) and more funding for older adults’ that is also flexible enough for organizations to use for maximum impact

These recommendations require programming to have the will and freedom to prospect. They also require strategic development (responsible for new resource acquisition and leading special projects and analyses), institutional advancement (marketing/communication and development), research, and finance and administration departments to have a healthy embrace of the prospector type – even while blending with strong defender and analyzer approaches to maintain efficiency and mission focus. This will allow [the organization] to avoid hyperfocus on government funding and “the risk of overemphasizing a single factor in the development of their strategy” while attaining the capacity and position to continue as a leader in the field and help older adults age well (Akingbola, 2006, p. 278).