New aging, new generations : positioning Pima County in the 21st Century

              New Aging
New Generations
Positioning
Pima County
in the
21st Century
A Report to the
Pima Council on Aging
 
New Aging, New Generations:
Positioning Pima County in the 21st Century
A Report to the
Pima Council on Aging
From the
Commission on the New Aging
Prepared by
Scott G. Davis
The University of Arizona
Office of Economic Development
The University of Arizona
Dr. Peter Likins, President
Bruce A. Wright
Associate Vice President for Economic Development
September 2001
 
Pima Council on Aging 
Commission on the New Aging 
Judge Karen Adam Laura Almquist
Vicki Balentine, Ph.D. Don Chatfield, Ph.D.
Nance Crosby Mary Ann Dobras
Smithie Dunn Sheriff Clarence Dupnik
John R. Evans Celestino Fernández, Ph.D.
Robert Hom, M.D. Constance Howard
Evan Kligman, M.D. Carol Little
Attorney General Janet Napolitano Dimitri Petropolis
Representative Marion Pickens Reverend Dr. Andrew Ross
Ernest P. Schloss, Ph.D. Gladys Sorenson, Ph.D.
David Taylor Martha Vazquez
Cyndy Watson Marshall A.Worden, Chair
Allan Bogutz, Ex-Officio Marian Lupu, Ex-Officio
 
Contents
Foreword .......................................................................................................... i
Introduction.....................................................................................................................iii 
 
Executive Summary....................................................................................................... v
Part I: The Context of an Aging Population
Population
National Trends ........................................................................................... 1
Arizona and Pima County ........................................................................... 2
Longevity .................................................................................................... 3
Shifts in the Aging Population .................................................................... 5
New Aging in Pima County and Tucson..................................................... 6
Distinguishing the Aging Population by Race, Ethnicity and Sex.............. 7
Support Ratios............................................................................................. 7
Financial Security
Income Distribution................................................................................. …8
Poverty ........................................................................................................ 9
Social Security and Retirement Planning.................................................. 10
     
 Lifestyle  
Behavioral Characteristics of the New Aging........................................... 12
Volunteerism ............................................................................................. 13
Political Activity and Voting Behavior..................................................... 13
Maintaining Careers and Continuing Education ....................................... 14  
   
  Physical Community 
  Housing Characteristics.............................................................................15 
    Land Use and Urban Design...................................................................... 15 
  Transportation ...........................................................................................16 
    The Challenge of Driving.......................................................................... 17  
Society
Ageism and Discrimination....................................................................... 17
Elder Abuse ............................................................................................... 18 
  Law Enforcement ......................................................................................18 
   
Health Status
Personal Health Habits .............................................................................. 19
Disability ................................................................................................... 19
Mental Health............................................................................................ 20
Chronic Health Conditions........................................................................ 21
 
Health Care
Caregiving ................................................................................................. 22
Assisted Care Facilities ............................................................................. 23
Health Insurance and Medicare................................................................. 23 
    Prescription Drug Costs ............................................................................ 24
Rural Access to Health Care ..................................................................... 24
Part II: Imagining the Future for Tucson and Pima County
Vision One............................................................................................................. 27
Vision Two............................................................................................................ 28
Part III: Planning a Wise Course: Area Objectives
Framework ............................................................................................................ 31
Retirement Planning, Estate and Trust Management, Legal Services,  
    Financial Tools and Assistance ................................................................. 33
Continuing Education, Employment and Job-Training......................................... 34 
Volunteerism, Political Activism and Advocacy; Creative Contributions, 
Intergenerational Opportunities, Public Awareness and  
  Community Attitudes ................................................................................35 
  Medical and Non-Medical Home Services, Assisted Living, Caregiving,  
    Long-Term Care, Special Needs: Minority, Low-Income,  
    Rural, Frail................................................................................................ 36
Transportation ....................................................................................................... 39
Housing ................................................................................................................. 39
Elder Abuse ........................................................................................................... 40
Healthy Living, Disease Prevention and Treatment, Medical Insurance 
    and Savings Alternatives, Mental and Behavioral Health......................... 41 
 Technology............................................................................................................43 
 
 
Afterword ....................................................................................................................... 44 
 
 
List of Illustrations
Tables
Table 1 Number of Persons in U.S. by Age Group.............................................. 1
Table 2 Population by Age Group in 2000........................................................... 2 
   
  Table 3    Estimated and Projected Population in Arizona  
    by Age Group.......................................................................................... 3 
   
  Table 4    U.S. Life Expectancy in Years ................................................................ 4 
   
  Table 5   1990 and Projected Population Age 65 and Older  
    for Arizona and Pima County ................................................................. 6 
   
  Table 6   1990 and Projected Population in Pima County  
    by Age Group.......................................................................................... 6 
   
  Table 7    Persons Age 65 and Older in U.S. Living in Poverty.............................. 9 
   
  Table 8    U.S. Median Household Net Worth (in 1999 dollars)........................... 12
Table 9    Persons in U.S. Age 65 and Older Reporting  
    Good to Excellent Health...................................................................... 19 
   
  Table 10  Percentage of Persons in U.S. Age 65 and Older Who Are  
   Chronically Disabled ............................................................................20 
   
  Table 11  Percentage of Persons in U.S. Age 65 and Older with  
    Severe Depressive Symptoms, 1998..................................................... 20 
   
  Table 12  Percentage of Persons in U.S. Age 65 and Older with Moderate or  
    Severe Memory Impairment, 1998 ....................................................... 20 
 
  Table 13  Percentage of Persons in U.S. Age 70 and Older with  
   Chronic Conditions...............................................................................21 
 
Charts 
 
Chart 1 U.S. Average Life Expectancy and Percent
Age 65 and Older..................................................................................... 2
Chart 2 U.S. Average Life Expectancy (ALE) at Ages 65 and 85........................ 5
Chart 3   Income Distribution of U.S. Population Age 65 and Older ..................... 9 
 
i 
 
Foreword 
 
 
Having  reviewed  the  work  of  the  Commission on the New Aging and examined its 
findings and recommendations, there is no question that much work remains to be done to 
address the wide range of needs that the aging baby boomers have begun to present as its 
members reach age 55 in 2001.       
 
The report states:  
 
The recommendations suggested in this report are particularly concerned 
with positioning our community to address the challenges of older adults 
in the period 2010 to 2030.  While many ideas are relevant to the present, 
changes in cultural behavior and technological advances will significantly 
reshape the face of older America as we continue to redefine the process 
of aging. 
 
One always has to be careful about one asks for.  In establishing the Commission on the 
New Aging, Pima Council on Aging (PCOA) was, as usual, taking the lead in addressing 
the long term needs of the aging in our community.  It asked,  What needs to be done?  
and  Who needs to do it?   The answers that came back recommend 56 action items.   
The Commission recommended that PCOA be the primary entity to take the lead in 41 of 
the 56 action items.  As to the other 15 action items, PCOA s leadership and involvement 
are recognized as crucial. 
 
This  is  clearly  too  much  for  PCOA to shoulder alone. PCOA is the Area Agency on 
Aging, the umbrella agency responsible for aging issues under the United States  Older 
Americans  Act.    As  such  it  is  required  to  coordinate  programs  for  the  aging  in  its 
community, to develop and encourage new programs and to prepare an Area Plan for 
meeting the needs of the aging.  PCOA oversees many programs providing direct service, 
as well as provides direct services itself, and contracts with other organizations to provide 
services.   PCOA is also the primary advocate for the aging, presenting the needs of its 
constituency before governmental, community and corporate entities and advocating for 
appropriate  solutions  to  problems.  However,  meeting  all  of  the  goals  of  the 
Commission s Report is too much for PCOA to do alone. 
There is clearly a need for broader and more thorough consultation among service
providers, government and corporate citizens to determine who is best suited to pursue
the implementation of the action items. What is now needed is a coordinated, structured
plan involving the greater community to address the multiplicity of issues of aging.
Partnerships are certainly feasible for PCOA but only if financial resources are available
to provide the additional staffing necessary to carry out the coordinating role. Certainly
PCOA’s professional staff has the experience and expertise to enhance the success of any
plan.
 
 
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PCOA calls on the leaders of the Southern Arizona community at all levels--civic groups, 
individuals, aging organizations, government (city, county, state and  federal)  and 
corporations that enjoy and support our community--to work together to plan for  the 
elders among us.  The Sixth Commandment directs that we must  Honor Thy Father and 
Mother.  For too long, senior members of  our  culture  have  lived  without  adequate 
attention to their needs. As this population grows in size and proportion, we are presented 
with two choices: 1. attend to these critical needs, or 2. witness a growing number of our 
parents (and ourselves) share fewer and fewer resources. If we choose the latter, all our 
lives will be less fulfilled. 
 
This  excellent  report  is  being  circulated  to  all  of  the  leaders  in  our  community  and  the 
work that the Commission has done serves as a model for how communities throughout 
the United States should address the needs of their growing aging populations. Our 
sincere thanks go to the Commission members and to Marshall Worden, its chair. 
 
Allan D. Bogutz 
  Past President 
  Pima Council on Aging 
           
Marian Lupu   
  Executive Director    
  Pima Council on Aging 
 
 
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Introduction
Allan Bogutz, Past President of the Pima Council on Aging, appointed the Commission on the
New Aging in October 1998. The purpose of this blue-ribbon commission is to study the needs
that Pima County and Tucson will face as the baby boom generation approaches retirement age.
The Commission's membership represents a diverse group of individuals active in civic life and
includes persons involved in community planning, education, the media, health care, law
enforcement, the judiciary, politics and the provision of services to the aging. The Commission
continues with the support and encouragement of current president, The Honorable Katie
Dusenberry.
The new aging are today's baby boomers who will begin reaching retirement age in 2011. The
unique history and characteristics of this generation produce equally unique needs and benefits.
This report describes the challenges and opportunities that the Tucson metropolitan area will face
as baby boomers approach the traditional retirement age of 65. It identifies and recommends
policies and strategies that should be implemented in our community if the needs of this and
other aging populations are to be met.
With regard to terms, those persons among the baby boom population, currently age 37 to 55, are
referred to as the new aging. Those persons age 55 and older are referred to as older Americans
or older adults. More specific reference is made to individual sub-groups within the older adult
population, such as those age 65 and older and those age 85 and older.
This report is divided into three parts. Part I summarizes the context of the new aging and older
American populations at the local, regional and national levels. It looks at current and projected
characteristics regarding population, financial security, lifestyle, physical community, societal
perceptions, health status and health care. Part II is a fictional account that describes what life
for older residents in Tucson and Pima County might be like during the second and third decades
of this century. This section takes the form of two short stories depicting visions that could
occur under different scenarios. Part III suggests a variety of policy and program
recommendations and identifies which entities might champion those initiatives.
This is intended to be a forward-looking document, both suggestive and prescriptive. In painting
a picture of the present and the future, information has been gathered from a variety of sources.
Primary sources have been identified for tables and charts in order to provide an opportunity for
further investigation. However, ideas and facts that have come from books, newspapers,
magazines, journal articles and agency reports are not cited. The report aims to serve as a
catalyst to stimulate a public dialogue leading to political, economic and social action.
In order to consider a vision for the future, we first need an understanding of past and present
trends. Much of this report focuses on the current situation. The present condition provides the
backdrop from which to project and, in some cases, speculate about the needs of the future. The
other primary dimension to this report involves understanding the current needs and behaviors of
older adults and anticipating how those needs and behaviors will change as the baby boom
generation ages into their retirement years.
 
iv 
The beginning date for this change is 2011, the year the first baby boomer turns age 65. The
recommendations suggested in this report are particularly concerned with positioning
Pima County to address the challenges of older adults in the period 2010 to 2030. While
many of the ideas are relevant to present conditions, changes in cultural behavior and
technological advances will significantly reshape the face of older America as we continue to
redefine the process of aging.
 
v 
Executive Summary 
Population 
As the population of baby boomers approaches retirement, many forces are profoundly affecting 
and changing the demographics of the United States.  Since the end of the baby boom (the period 
1946 to 1964), breakthroughs in medical technology, healthier standards of living and a steady 
stream of net in-migration have produced the largest population over the age of 65 in the nation s 
history.  Currently, 35 million Americans are age 65 and older.  Not only is the absolute number 
of people in this population cohort the greatest this country has ever seen, but the relative share 
of the total population (12.7 percent) is also at its peak.  These trends are projected to continue.  
By the year 2030, the population age 65 and older is expected to double to over 70 million people 
representing 20 percent of the total population. 
 
Arizona is home to an ever-growing number of older adults.  The Arizona Department of 
Economic Security estimates that approximately 14.1 percent of Arizona s population is age 65 
and older.  This relative share of the total population is expected to increase to 21.3 percent by 
the year 2030. Currently, the percentage of those age 65 and older in Pima County (14.4 percent 
or 124,900 persons) is slightly greater than that of the State and 1.7 percentage points greater 
than that of the country as a whole. It is important to recognize that Arizona and Pima County far 
exceed the national average of older Americans.   
 
 
Population by Age Group in 2000
65 and Older 85 and Older
All Ages Number Percent Number Percent
United States 275,130,000 34,817,000 12.7 4,312,000 1.6
State of Arizona 4,961,953 700,461 14.1 83,381 1.7
Pima County 867,363 124,900 14.4 13,010 1.5
City of Tucson 485,790 59,752 12.3 7,773 1.6
Source: U.S. Census Bureau, Population Estimates Program; Arizona Department of Economic Security; American
Community Survey, City of Tucson Planning Department
 
 
The two great demographic shifts that are occurring nationally need to be considered in assessing 
the needs and opportunities of the new aging population in Pima County.  First, not only will the 
absolute number of persons 65 and older in Pima County continue to increase during the next 
several decades, but the relative share of older adults also will increase.  In 1990, 13.8 percent of 
Pima County s population was age 65 and older.  By 2010, that share is expected to be 16.2 
percent. 
 
Longevity
The primary influence behind this trend is a significant increase in longevity.  At the time Social 
Security benefits began in 1939, average life expectancy at birth was only 63 years.  Those age 
65 could expect to live roughly 13 more years. By 1997, average life expectancy was 76.5 years 
at birth and those age 65 could expect to live 18 more years.  Due to increasing longevity, the 
absolute and relative number of the oldest old will continue to grow.  In 1990, 1.2 percent of 
 
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Pima County s population was age 85 and older.  That proportion is expected to more than 
double to 2.6 percent by 2010.  The age 85 and older population has a unique set of needs that 
differ from that of the overall population of older adults.     
 
Ethnicity and Sex 
A significant shift in U.S. demographics is occurring with regard to ethnic makeup. Hispanics
represent an increasing share of the population across the nation and in Arizona. Hispanics
nationally represent 5.6 percent of the population age 65 years and older. This is expected to
increase to approximately 16.4 percent by the year 2050.   
 
Pima County has a much greater share of Hispanics than the nation in general.  Of the total 
population in Pima County, the relative share of Hispanics increased from 24.2 percent in 1990 
to 29.6 percent in 1999.  The concentration of Hispanics is much greater in the City of Tucson 
than in Pima County as a whole.  Hispanics accounted for 35.7 percent of the total population in 
the City of Tucson in 1999, compared to 29.6 percent in Pima County.  The trend toward greater 
ethnic and racial diversity will continue. 
 
Among the population age 65 and older, women represent an increasing share of the cohort as it
ages. A significant difference in longevity between men and women accounts for this
phenomenon.  
 
Support Ratios
One way to analyze how the population is growing older is through elderly support ratios.  The 
elderly support ratio is the ratio of the elderly population (those age 65 and older) to the working-
age population (those age 20 to 64).   
 
As  the  generation  of  baby boomers retires over the next three decades, there will be fewer 
working age adults paying into state and federal programs to support retirees.  According to the 
Arizona  Department  of  Economic  Security,  Arizona's elderly support ratio is currently .25, 
slightly higher than the national ratio of .22.  An elderly support  ratio  of  .27  illustrates  Pima 
County s relatively greater concentration of older adults.  This ratio of .27 equates to 3.7 people 
age 20 to 64 able to support each person age 65 and older.  
 
By the time baby boomers finish entering retirement in 2030, it is estimated that Pima County s 
elderly support ratio will be .45 (2.2 working age people able to support each older adult).  This 
ratio will be significantly higher than that of the state (.40) and the nation as a whole (.37).   
 
Poverty 
Nationally, over the period 1974 to 1998, the percentage of older adults in poverty  and  low-
income categories has declined while the percentage of those with medium and high income has 
increased  (Chart  3).  This  indicator  of  economic  health  illustrates  that  the  income  gap  among 
older  Americans  is  closing.    However, even with these improvements, more than one-third of 
older adults live in  poverty  and  low income  brackets and a disproportionate share of women 
and minority groups still are mired in poverty. 
 
 
 
 
vi i
The percentage of older Americans living in poverty has declined over the last forty years from 
35.2 percent to 10.5 percent.  Historically, older adults were much more inclined to live in 
poverty than the general population.  Today, the percentage of those living in poverty among 
older adults and working-age is roughly equivalent. 
 
Social Security and Retirement Planning 
The status of social security is one of the most significant issues facing the new aging population.  
Conflicting studies and political interests have caused much confusion and skepticism over the 
health and longevity of the social security system.  While the system is not in immediate danger, 
many question its ability to withstand the pressures of the oncoming surge of retiring baby 
boomers.   
 
Behavioral Characteristics of the New Aging
The behavioral characteristics that define the baby boomers are very different from those of their
parents. The new aging were the first to experience an age of abundance. They were also the first
to become a media generation. These two factors played a primary role in establishing a new
consumer culture. This group was also the first to experience widespread levels of high stress.
However, the generation of the new aging also holds a new respect for the environment. They are
more likely to question the status quo, speak out, and challenge authority. The new aging
experience a much greater rate of labor participation among women and redefined traditional
models of marriage and family. Seventy-five percent of the new aging are married, 75 percent
have children and 66 percent own homes.
As baby boomers age into retirement, they will continue the need for activity and social
involvement as part of their lifestyle as older adults. Past images of a leisurely retirement in
quiet isolation are now giving way to participatory and active lifestyles that engage the physical,
intellectual, spiritual and creative capacities of older adults.
Political Participation and Volunteerism
While rates of political participation are high among older adults, rates of volunteerism are lower 
than any other adult age-group. This is a disappointing characteristic of today s older adults, but 
one that has incredible potential for change. The volunteerism rate for those age 33 to 54 is 55 
percent. However, this rate drops to 46 percent after age 55.   
 
Older adults are typically more politically active than other adult age groups. Although they are 
diverse in their attitudes, interests and behaviors, they vote at high rates compared to younger 
persons and maintain a considerable interest in political affairs. 
 
Housing Characteristics 
The makeup of housing types inhabited by Arizona s older adults differs from that of the younger 
populace in a number of ways.  Single family detached and townhouse structures represent the 
bulk of housing for both age groups, with these one-unit structures comprising 62 percent of the 
housing for older adults and 63 percent of the housing  for  householders  under  age    65.  
Multifamily  units  with  two  or  more  units  per  structure  comprise  just  16  percent  of  the  senior 
housing, compared to 27 percent of the housing for younger householders.  Mobile homes house 
 
vi ii
22 percent of all older adults in Arizona, more than twice the percentage of younger householders 
(10 percent) who live in these structures.   
 
Transportation 
Sun Tran, Tucson’s Public Transit Authority, offers a number of services directed at increasing
the affordability and accessibility of transit for older adults. Four specific routes, servicing four
different areas of the city, have been developed under the Out and About program. These routes
are specifically designed to access senior centers, health care facilities, medical centers, banks,
grocery stores, shopping centers, libraries, municipal service centers and parks and recreation
centers. Public transit in Tucson s urban core has made the mobility of older adults much more 
affordable and accessible.  However, many aspects of traditional bus service remain inadequate 
in serving the transportation needs of older adults.   
 
Elder Abuse 
Elder abuse is a serious concern as a greater share of the population becomes a potential victim. 
The clinical history of elder abuse suggests that it gets worse, not better, in terms of frequency 
and severity.  Intervention is imperative.  Over ten percent of the cases in the Tucson Unit of the 
Arizona  Attorney  General s  Office  are  for fraud against older adults.  Cases of fraud against 
older adults have increased over the past three years and are expected to continue to do so.  
 
Forms of elder abuse include physical abuse, psychological abuse, caregiver neglect, self neglect 
and exploitation.  A nationwide report found two-thirds of the victims of elder abuse to be 
women, while abusers were equally inclined to be either male or female.   
 
Personal Health Habits
Personal health and nutrition habits among older adults have improved significantly over the last
century. Proper nutrition, sleep and exercise, combined with an increase in self-awareness and
continuing intellectual involvement, have resulted in a significant number of older Americans
rating their health as good or excellent However, even with the great majority of older adults
reporting to be in good health, many suffer from combinations of poor nutrition, chronic disease
and debilitating mental health conditions.  
 
Mental Health
Approximately 18 percent of older adults have some kind of mental health need.  As aging 
occurs, it is often accompanied by spousal and family loss as well as a loss of physical health, 
mobility and independence.  Among the most common mental health problems among older 
adults are isolation, loneliness and depression.  Women, because of their tendency to live longer, 
are at greater risk of suffering from severe depressive symptoms.  
 
 
Chronic Health Conditions
Increasing longevity over the last century has been accompanied by an increased risk for certain
diseases and disorders. Significant proportions of older adults suffer from a variety of chronic
health conditions such as arthritis and hypertension. The percentage of persons with chronic
health conditions increased for most conditions between 1984 and 1995, with the exception of
hypertension, which has remained roughly the same. 
 
 
ix 
  
Heart disease, cancer and stroke are the three leading causes of death for both sexes of every 
racial and ethnic group.  Five of the six leading causes of death among older Americans are 
chronic diseases.  Approximately 78,000 Arizonans suffer from Alzheimer s disease and other 
forms of dementia. The Arizona Department of Health Services estimates that approximately 
145,000 older adults in Arizona will have Alzheimer s disease by the year 2020.   
 
Caregiving
As chronic health conditions and longevity continue to increase, the number of older adults 
needing long-term care also will grow.  Caregiving provides assistance to those with limitations 
in activities of daily living and those who suffer from chronic diseases such as Alzheimer s.  
One-third of all people age 85 and older have Alzheimer s disease and three-quarters of their 
caregivers are surrounding friends and family. The majority of the caregiving community is made 
up of women and older adults.  Seventy-three percent of today s caregivers are women.   
 
Assisted Care Facilities
Assisted care facilities are facing major problems with financial stability and staffing.  Even 
though nursing home costs are out of reach for a large percentage of American families, they still 
suffer from underfunding.  Many facilities cannot staff or supply care services at adequate levels, 
leaving many residents at risk of being harmed.   
 
Health Insurance  
Arizona has the third highest percentage of older adults belonging to managed-care plans. This
percentage peaked in the early 1990s at 40 percent but has continued to decline since. There are a
number of insurance alternatives, such as long-term care (LTC) insurance and longevity
insurance, to help individuals prepare for increasing health care costs accompanied by older age.
Older Americans are paying twice as much for prescription drugs today as they did in 1992. The
increased costs are attributed to more advanced and effective drugs. According to a recent
Medicare beneficiary survey, prescription drugs account for ten percent of total out-of-pocket
health expenditures for those age 65 and older.
OBJECTIVES
Meeting  the  challenges  of older adults, today, and in the future, requires addressing a broad 
platform of issues. These issues are grouped into nine areas.   
 
1.  Retirement  Planning,  Estate and Trust Management, Legal Services, Financial Tools and 
Assistance 
2.  Continuing Education, Employment and Job Training 
3.  Volunteerism, Political Activism and Advocacy; Creative Contributions, Intergenerational 
Opportunities, Public Awareness and Community Attitudes 
4.   Medical and Non-Medical Home Services, Assisted Living,  Caregiving,  Long-Term  Care, 
Special Needs: Minority, Low-Income, Rural, Frail 
5.   Transportation 
6.   Housing 
 
x 
7.   Elder Abuse 
8.  Healthy Living, Disease Prevention and Treatment, Medical  Insurance  and  Savings 
Alternatives, Mental and Behavioral Health 
9.   Technology 
 
The following objectives serve to provide a framework for further consultation to occur. 
Retirement Planning, Estate and Trust Management, Legal Services, Financial Tools and 
Assistance 
 
1.  Provide increased retirement planning and investment management services to  help 
the new aging prepare for debt-free, late-life financial security. 
 
2.  Establish an advocacy task force to engage with the Presidential commission on social 
security reform. 
 
3.  Provide greater access and affordability to estate management and trust services for 
older adults. Offer discounted services as well as provide workshops and seminars for 
self-education. 
 
4.  Provide accessible home-equity loan programs for those  who  are   cash-poor   but 
 brick-rich  to draw cash from their homes. Promote reverse mortgages. 
 
Continuing Education, Employment and Job Training 
 
1.  Assist in the development of educational and job training opportunities  for  low-
income  older  adults  through  the  Workforce  Investment  Act  (WIA),  Title  V 
contractors, and other alternative funding sources. 
 
2.  Maintain a leadership role in the development of Arizona s One-Stop Career Centers 
that provides access for older workers to  choose  basic,  high  quality  employment, 
training and education services. 
 
3.  Educate businesses and organizations as to the benefits of employing older adults. 
 
4.  Promote the local network of nonprofit organizations such as the Service  Corps  of 
Retired Executives (SCORE) and Executive Service Corps (ESC). 
 
5.  Expand educational and training opportunities available to older adults. Provide low-
fee courses for older adults. 
 
Volunteerism, Political Activism and Advocacy; Creative Contributions, 
Intergenerational Opportunities, Public Awareness and Community Attitudes 
 
1.  Establish  a   resource  pool   where  the volunteer needs of organizations can easily 
come into contact with those wishing to get involved with volunteer activities. 
 
 
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2.  Develop a publicity program for reaching older adults who are not aware of existing 
opportunities for involvement. 
 
3.  Identify and monitor legislation affecting the older and vulnerable adult  population 
and track it through the legislative process. 
 
4.  Disseminate information and provide analysis of proposed legislation and the effects 
of budgetary requests to all interested parties. 
 
5.  Encourage the development of and participation in classes and workshops dealing 
with the arts. 
 
6.  Allocate space for exhibiting the creative work of older adults. 
 
7.  Identify agencies, organizations and special interest groups whose activities  include 
the  development of intergenerational programs, and work groups that support the 
needs of grandparents raising grandchildren. 
 
8.  Create, expand and promote awareness programs that educate  people  and  heighten 
understanding among our ethnically diverse population. 
 
Medical and Non-Medical Home Services, Assisted Living, Caregiving, Long-Term 
Care, Special Needs: Minority, Low-Income, Rural, Frail 
 
1.  Establish  community  based, home maintenance programs where individuals can 
receive the  assistance of  a  repair professional to fix or replace broken and worn out 
items as well as provide landscaping services. 
 
2.  Establish a single point of access to services  for management  of home  finances  as 
well as basic legal, medical, and nutritional consultation. 
 
3.  Support programs promoting the availability and accessibility of suitable housing for 
older adults, such as apartment and home finding services as well as housemate 
matching and placement services. 
 
4.  Provide for adequate assisted living options for low and middle-income older adults. 
 
5.  Promote higher standards for long-term care and expand the regulatory framework to 
ensure compliance. 
 
6.  Propose regulatory legislation requiring that referral fees be paid by families instead 
of adult-care homes. Legislation must also establish ethical, educational and business 
standards. 
 
7.  Increase the promotion and recognition of volunteer caregiving activities and expand 
the role of faith-based communities in volunteering. 
 
 
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8.  Enhance and expand training to assist caregivers with the administration of physical 
and occupational therapies, respite care and errand  running.  Provide  counseling  to 
help prevent burn out. 
 
9.  Establish  a  program  for  occupational  therapists  to  administer  in-home  assessments 
and teach individuals how to set up their home to better maintain their independence. 
 
10. Improve salary and benefits conditions for direct care workers to lower turnover rates 
and increase the quality of caregiving. 
 
11. Increase the number of  volunteer ombudsmen by recruiting, training, and retaining 
volunteers. 
 
12. Future  funding  should  support  the Long Term Ombudsman s Office at appropriate 
levels for staffing and empower the position with greater authority to mandate service. 
 
13. Develop methods that will enhance outreach efforts and increase participation of low 
income, minority and rural individuals. 
 
Transportation 
 
1.  Initiate a task force to develop strategies for improving access to transportation  for 
older and disabled persons. 
 
2.  Provide alternative transportation support systems to meet the needs  of  daily  living 
for older adults, such as vans and custom trip vehicles. 
 
3.  Expand telemedicine programs to decrease the need and frequency of physical doctor 
visits. 
 
Housing 
 
1.  Provide for a mixture of housing types within a neighborhood as well as promote the 
adaptability of the single family lot to accommodate building additions for aging 
family members. 
 
2.  Home design should be adaptable to making alterations for  aging in place.  Aging-
in-place adaptations are thoughtful design solutions by architects and developers such 
as: the substitution of door levers for doorknobs; easy to open drawers, windows and 
cabinets;  slip-resistant  flooring,  stairs and driveways; the addition of wall mounted 
railings for balance and guidance. 
 
3.  Provide workshops for older adults and family members to learn about the methods 
and options of home conversion for older adults. 
 
 
 
 
xi ii
Elder Abuse 
 
1.  Coordinate  with  aging network and adult advocacy groups to heighten public 
awareness of all types of elder abuse through the dissemination of  information  and 
presentations to agencies and organizations. 
 
2.  Cooperate with law enforcement agencies and prosecution offices to effectively carry 
out prosecution of perpetrators. 
 
3.  Promote an increase of emergency shelters and services that  address  the  needs  of 
abused older and vulnerable adults. 
 
4.  Identify and encourage the development of innovative intergenerational programs that 
prevent isolation and assist in the reduction of abuse of older and vulnerable adults. 
 
5.  Increase knowledge about elder abuse issues among local law enforcement agencies. 
 
Healthy Living, Disease Prevention and Treatment, Medical Insurance and Savings 
Alternatives, Mental and Behavioral Health 
 
1.  Coordinate with the Department of Health Services, County Departments of Health, 
the  Area  Agencies  on  Aging,  AHCCCS,  and  other  organizations  to  disseminate 
information on wellness, disease prevention, health care, and nutritional information. 
 
2.  Promote community-based efforts toward healthy living, such  as  exercise  paths, 
fitness courses, walkways and trails. 
 
3.  Provide  shopping-for-one  and cooking classes to meet the changing caloric and 
nutritional needs of older adults. 
 
4.  Support wellness clinics for physical, mental, and spiritual health. 
 
5.  Encourage  policy  and  programmatic  changes to enhance current service delivery 
systems that address the needs of persons with Alzheimer s or related disorders and 
their caregivers. 
 
6.  Assist organizations in disseminating information to increase public  understanding 
regarding the effects of and current research  into  Alzheimer s  disease  and  related 
disorders. 
 
7.  Promote making disease prevention and self care a national priority. Increase funding 
for preventing chronic diseases, not just treating them. 
 
8.  Support smoking cessation programs such as  Freedom  from Smoking Cessation 
Clinics offered by the American Lung Association  and  the  Arizona  Prevention 
Center s Tobacco Cessation Program. 
 
 
xi v
9.  Update information and increase assistance related to the application for  benefits, 
claims filing, purchasing supplemental and long-term care insurance,  comparison of 
Medicare+Choice plans, Medicare rights and protections,  and appeals processes. 
 
10. Provide  financing  alternatives to pay for the increasing demand for health care 
services, especially for those with late-life, chronic conditions. 
 
11. Medicare lacks coverage for optical and dental care. Provide alternatives for Medicare 
recipients to receive coverage for eyeglasses and dental work. 
 
12. Encourage the development of mental and behavioral health programs in community 
and residential settings that target the specific needs of older adults. 
 
Technology 
 
1.  Assess senior center participants  willingness to utilize information technology 
offered through a senior center. 
 
2.  In  cooperation with Area Agencies on Aging, identify and partner with private 
industry to provide senior centers with computers, software, phone line installations, 
internet access, technical assistance, and cost sharing. 
 
3.  Expand computer literacy and computer-based training for older persons. 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
  
 
 
 
 
 
 
1 
Part I
The Context of an Aging Arizona
POPULATION
National Trends
As the population of baby boomers approaches retirement, many forces are profoundly affecting
and changing the demographics of the United States. Since the end of the baby boom (the period
1946 to 1964), breakthroughs in medical technology, healthier standards of living and a steady
stream of net in-migration have produced the largest population over the age of 65 in the nation’s
history. Currently, 35 million Americans are age 65 and older. Not only is the absolute number
of people in this population cohort the greatest this country has ever seen, but the relative share
of the total population (12.7 percent) is also at its peak. These trends are projected to continue.
By the year 2030, the population age 65 and older is expected to double to over 70 million
people representing 20 percent of the total population (Table 1).
TABLE 1
Number of Persons in U.S. by Age Group
Year
65 or Older
(in millions)
Percent of
Total
Population
85 or Older
(in millions)
Percent of
Total
Population
1900 3.1 4.1 0.1 0.2
1920 4.9 4.7 0.2 0.2
1940 9.0 6.9 0.4 0.3
1960 16.6 9.2 0.9 0.5
1980 25.5 11.3 2.2 1.0
1990 31.2 12.6 3.1 1.2
2000* 34.8 12.7 4.3 1.6
2010* 39.7 13.2 5.8 1.9
2020* 53.7 16.5 6.8 2.1
2030* 70.3 20.0 8.9 2.5
* Projection
Source: Federal Interagency Forum on Aging-Related Statistics; U.S. Census Bureau.
The phenomenon most responsible for the rapid increase in population during the baby boom
was a significant increase in fertility rates. Fertility rates hit their peak during the 1950s at 3.8
children per woman. However, fertility rates have been in decline ever since and are stabilized at
2.1 children per woman, just above the replacement ratio. Another phenomenon that presents a
challenge as the generation of baby boomers matures is an increase in longevity. Average life
expectancy in the United States experienced significant increases through 1950 and has been
increasing steadily over the last half century. Efforts must be directed at ensuring a
corresponding increase in quality of life to go along with increases in quantity of life (Chart 1).
 
2 
Arizona and Pima County
Arizona is home to an ever-growing number of older adults. The Arizona Department of
Economic Security estimates that approximately 14.1 percent of Arizona’s population is age 65
and older. This relative share of the total population is expected to increase to 21.3 percent by
the year 2030. Currently, the percentage of those age 65 and older in Pima County (14.4 percent
or 124,900 persons) is slightly greater than that of the State and 1.7 percentage points greater
than that of the country as a whole (Table 2). The percentage of persons age 65 and older for the
City of Tucson is slightly below the national average. Urban metropolitan areas tend to consist
of younger, less wealthy populations. This phenomenon may account for the relatively low
presence of older adults within the Tucson city limits.
TABLE 2
Population by Age Group in 2000
65 and Older 85 and Older
All Ages Number Percent Number Percent
United States 275,130,000 34,817,000 12.7 4,312,000 1.6
State of Arizona 4,961,953 700,461 14.1 83,381 1.7
Pima County 867,363 124,900 14.4 13,010 1.5
City of Tucson 485,790 59,752 12.3 7,773 1.6
Source: U.S. Census Bureau, Population Estimates Program; Arizona Department of Economic Security; American
Community Survey, City of Tucson Planning Department.
Chart 1  U.S. Average Life Expectancy and Percent Age 65 and Older
0
10
20
30
40
50
60
70
80
90
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000
Year
Life
Expectancy
 in Years
0
2
4
6
8
10
12
14
Percent of
Population
 Age 65 and Older
Average Life Expectancy Percent Age 65 and Older
Source: National Center for Health Statistics; Federal Interagency Forum on Aging-Related Statistics.
 
3 
It is important to recognize that Arizona and Pima County far exceed the national average of
older Americans. Figures shown in Table 2 above do not include seasonal visitors, which further
adds to the population of older adults in Arizona. The relative difference in Arizona’s population
share of older adults is expected to increase as baby boomers approach retirement age and current
migration patterns among older adults continue. This is precisely the concern that will determine
Pima County’s needs as it plans for the next three decades. The most significant increase within
the older population is occurring among those 85 years and older. While the population of
Arizonans age 65 and older is expected to double over the next 30 years, the number of persons
age 85 and older is expected to do so in just 20 years. This will result in those age 85 and older
representing a greater share of the aging population (Table 3).
TABLE 3
Estimated and Projected Population in Arizona by Age Group
65 and Older 65 to 74 75 to 84 85 and Older
Year
Number
% of
Total
Number
% of
Total
Number
% of
Total
Number
% of
Total
1900 3,328 2.7 2,422 2.0 727 0.6 179 0.1
1920 9,977 3.0 7,133 2.1 2,305 0.7 539 0.2
1940 23,909 4.8 17,186 3.4 5,636 1.1 1,087 0.2
1960 90,225 6.9 63,634 4.9 22,499 1.7 4,092 0.3
1980 307,362 11.3 202,120 7.4 86,104 3.2 19,138 0.7
1990 480,587 13.1 290,044 7.9 151,013 4.1 37,846 1.0
2000 700,461 14.1 367,791 7.4 249,289 5.0 83,381 1.7
2010 908,554 14.8 465,855 7.6 309,749 5.0 132,950 2.2
2020 1,296,878 17.6 747,151 10.1 383,063 5.2 166,664 2.3
2030 1,836,177 21.3 1,017,301 11.8 612,245 7.1 206,631 2.4
2040 2,196,032 22.3 1,038,975 10.5 830,921 8.4 326,136 3.3
2050 2,361,831 21.1 1,060,880 9.5 845,120 7.6 455,831 4.1
Source: U.S. Bureau of the Census, Population Estimates Program; Arizona Department of Economic Security.
Longevity
The primary influence behind this trend is a significant increase in longevity. At the time Social
Security benefits began in 1939, average life expectancy at birth was only 63 years. Those age
65 could expect to live roughly 13 more years. By 1997, average life expectancy was 76.5 years
at birth and those age 65 could expect to live 18 more years (Table 4). Increasing longevity
presents significant challenges to future generations of older adults and their families, most
importantly with regards to financial security, caregiving and health maintenance. Increases in
life expectancy result in longer payment periods of social security benefits, a greater number of
years spent living with chronic disease and increased stress on family members and caregivers
who see the oldest through their last years. Significant advances have been made in the
effectiveness of treating chronic disease. However, greater advances regarding the prevention
and cure of such diseases remain critical.
 
4 
TABLE 4 
U.S. Life Expectancy in Years 
                     
  1900  1920 1940 1960 1980 1990  1997
                     
Life Expectancy At Birth 
Total  49.2  56.4 63.6 69.9 73.9 75.4  76.5
Men  47.9  55.5 61.6 66.8 70.1 71.8  73.6
Women  50.7  57.4 65.9 73.2 77.6 78.8  79.4
                     
Life Expectancy At Age 65 
Total  11.9  12.5 12.8 14.4 16.5 17.3  17.7
Men  11.5  12.2 12.1 13.0 14.2 15.1  15.9
Women  12.2  12.7 13.6 15.8 18.4 19.0  19.2
                     
Life Expectancy At Age 85 
Total  4.0  4.2 4.3 4.6 6.0 6.2  6.3
Men  3.8  4.1 4.1 4.4 5.1 5.3  5.5
Women  4.1  4.3 4.5 4.7 6.4 6.7  6.6
                     
Source: National Center for Health Statistics, National Vital Statistics System. 
During the first half of the twentieth century, America witnessed an incredible increase in
longevity. People were living longer at unprecedented rates. Breakthroughs in vaccinations and
antibiotics during the 1930s and 1940s resulted in increasing average life expectancy by over
four years for each ten-year period. From the period 1900 to 1950, average life expectancy
increased almost 19 years. This is in sharp contrast to an increase of less than half of that (8.4
years) over the period since.
Table 4 demonstrates not only that the share of older adults is getting larger but that it is getting
older as well. This trend can be identified since 1960. Average life expectancy in 1997 for those
at age 65 was 17.7 years. Those who were age 85 in 1997 are expected to live beyond the age of
91. Over the period 1900 to 1960, average life expectancy increased only 2.5 years (21 percent)
for those at age 65 and 0.6 years (15 percent) for those at age 85. Over the shorter 37-year period
since, average life expectancy increased 3.3 years (23 percent) for those at age 65 and 1.7 years
(37 percent) for those at age 85 (Chart 2).
The increase in longevity among older adults can be attributed to a number of factors. One of the
most important factors is an increase in awareness regarding the benefits of personal health and
wellness. This awareness has made its way into both the home and the workplace. “Lifestyle
medicine,” such as proper nutrition, routine exercise and increased self-assessment, has become
recognized as the most important factor contributing to optimal health. The discovery of more
effective medicine to treat chronic diseases such as cancer, heart disease, pneumonia and diabetes
has also increased longevity. In addition, advances in medical technology have enabled
procedures such as joint and organ replacement and arterial-bypass surgery to result in
significantly higher success rates with much less trauma.
 
5 
Chart 2: U.S. Average Life Expectancy (ALE) at Ages 65 and 85
0
2
4
6
8
10
12
14
16
18
20
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 1997
Year
ALE in Years
at age 65
0
1
2
3
4
5
6
7
Source: National Center for Health Statistics, National Vital Statistics System.
ALE in Years
at Age 85
at age 65 at age 85
Shifts in the Aging Population
Arizona ranks 21st nationally in terms of the percentage of persons over age 65. However, this
ranking does not reflect the influx of seasonal visitors from elsewhere in the country. According
to the Arizona Department of Economic Security, the state will experience a net migration of
over 11,000 people age 65 and older in the year 2000. Pima County is estimated to account for
22 percent of the state’s migrating seniors (approximately 2,500 people). The capture of
migrating seniors by Pima County is projected to increase to over 25 percent by 2030.
According to a 1999 study by economist Marshall Vest, the total economic impact of migrating
seniors in Pima County is nearly $37 million in direct spending.
 
Migrant retirees who relocate to other states typically have greater disposable incomes than those 
who stay in place; they move because they can afford to.  Rather than causing a net  drain  on 
public resources, relocating retirees provide a net  gain  for  their  newfound  locality  because 
wealthier  retirees  typically  do  not  draw  from public  aid.    As  the  need  for  public  aid increases, 
however, these retirees tend to take part in  a  counter-migration.    This  movement  takes  place 
among older adults who move from their new retirement locations after being widowed or falling 
ill, ultimately relocating nearer family members as their dependency increases.  
 
This pattern appears among older adults in Arizona.  The net migration of 2,500 people over age 
65 accounts for 18 percent of the total migration into Pima County.  For those migrants between 
ages  65  and  74,  2.25  people  will  enter Pima County for every one who leaves.  This ratio is 
slightly higher than that of the state (2.0:1) among this age group.  After age 80, an increase of 
 
6 
out-migration stabilizes net migration to a 1:1 ratio. Counter migration in Pima County, however, 
is not severe enough to result in a net loss of persons over age 80 beyond that which is caused by 
death.  The overall net migration ratio for Pima County among those age 65 and older is 1.8:1, 
slightly greater than that of Arizona at 1.6:1. 
New Aging in Pima County and Tucson
The two great demographic shifts that are occurring nationally need to be considered in assessing
the needs and opportunities of the new aging population in Pima County. First, not only will the
absolute number of persons 65 and older in Pima County continue to increase during the next
several decades, but the relative share of older adults also will increase. In 1990, 13.8 percent of
Pima County’s population was age 65 and older. By 2010, that share is expected to be 16.2
percent (Table 5).
TABLE 5
1990 and Projected Population Age 65 and Older for Arizona and Pima County
Arizona Pima County
Year
Number
% of Total
Population Number
% of Total
Population
1990 480,587 13.1 91,971 13.8
2000 700,461 14.1 124,900 14.4
2010 908,554 14.8 167,412 16.2
2020 1,296,878 17.6 237,052 19.7
2030 1,836,177 21.3 320,475 23.3
2040 2,196,032 22.3 356,418 23.4
2050 2,361,831 21.1 374,161 22.4
Source: U.S. Bureau of the Census, Population Estimates Program, 1990; Arizona Department of
Economic Security; American Community Survey; City of Tucson Planning Department.
Second, because of increasing longevity, the absolute and relative number of the oldest old will
continue to grow. In 1990, 1.2 percent of Pima County’s population was age 85 and older. That
proportion is expected to more than double to 2.6 percent by 2010 (Table 6).
TABLE 6
1990 and Projected Population in Pima County by Age Group
65 and Older 65 to 74 75 to 84 85 and Older
Year
Number
% of
Total
Number
% of
Total
Number
% of
Total
Number
% of
Total
1990 91,971 13.8 55,069 8.2 29,077 4.4 7,825 1.2
2000 124,900 14.4 67,109 7.9 49,279 5.8 16,737 2.0
2010 167,412 16.2 83,284 8.1 57,226 5.5 26,902 2.6
2020 237,052 19.7 133,874 11.1 71,697 5.9 31,481 2.6
2030 320,475 23.4 167,063 12.2 113,826 8.3 39,586 2.9
2040 356,418 23.4 153,894 10.1 140,559 9.2 61,965 4.1
2050 374,161 22.4 166,288 10.0 128,993 7.7 78,880 4.7
Source: U.S. Bureau of the Census, Population Estimates Program, 1990; Arizona Department of Economic
Security; American Community Survey; City of Tucson Planning Department.
 
7 
The projected increase in the age 85 and older population cohort also represents a relative
increase in the cohort’s share of the age 65 and older population, accounting for 9 percent in
1990 and 21 percent in 2050. The age 85 and older population has a unique set of needs that
differ from that of the overall population of older adults. Improvements in both human and
physical infrastructure should be considered to accommodate these oncoming changes.
Distinguishing the Aging Population by Race, Ethnicity and Sex
Another significant shift in U.S. demographics is occurring with regard to ethnic makeup.
Hispanics represent an increasing share of the population across the nation and in Arizona.
Persons of Hispanic origin are those who classify themselves as being Mexican, Puerto Rican,
Cuban, or of other Spanish, Hispanic, or Latino origin and may be of any race. Hispanics
nationally represent 5.6 percent of the population age 65 years and older. This is expected to
increase to approximately 16.4 percent by the year 2050.
Pima County has a much greater share of Hispanics than the nation in general. Of the total
population in Pima County, the relative share of Hispanics increased from 24.2 percent in 1990
to 29.6 percent in 1999. The concentration of Hispanics is much greater in the City of Tucson
than in Pima County as a whole. Hispanics accounted for 35.7 percent of the total population in
the City of Tucson in 1999, compared to 29.6 percent in Pima County. Hispanics account for
approximately 7 percent of Arizona’s population over age 65 and more than 10 percent of that
same cohort in Pima County. Over the period 1990 to 1999, the proportion of African-
Americans in Pima County increased from 3.1 percent to 3.6 percent while the share of Native
Americans grew from 3.0 percent to 3.2 percent. Asian and Pacific Islander populations
experienced no significant increase. The trend toward greater ethnic and racial diversity will
continue.
Among the population age 65 and older, women represent an increasing share of the cohort as it
ages. A significant difference in longevity between men and women accounts for this
phenomenon (Table 4). Combined with the historic tendency for women to marry men older
than themselves, married women age 65 and older can expect to outlive their husbands by
approximately ten years. This results in approximately one-half of all women age 70 and older
being widowed.
Support Ratios
One way to analyze how the population is growing older is through elderly support ratios.  The 
elderly support ratio is the ratio of the elderly population (those age 65 and older) to the working-
age population (those age 20 to 64).  It is acknowledged that not all of those in the working-age 
population are employed and that not all of those age 65 and older are retired. However, the use 
of  support  ratios  is  still valuable in illustrating a shift in population share and is used as a 
standard measure for social security support.  The concept of an age-based support ratio masks 
increasing  worker  participation  among  the age 20 to 64 year age group as more women have 
joined the work force.  Increased full and part-time worker participation in the age 65 and older 
age group could further erode the utility of the concept. 
 
As  the  generation  of  baby boomers retires over the next three decades, there will be fewer 
working age adults paying into state and federal programs to support retirees.  According to the 
 
8 
Arizona  Department  of  Economic  Security,  Arizona's elderly support ratio is currently .25, 
slightly higher than the national ratio of .22.  An elderly support  ratio  of  .27  illustrates  Pima 
County s relatively greater concentration of older adults.  This ratio of .27 equates to 3.7 people 
age 20 to 64 able to support each person age 65 and older.  
 
By the time baby boomers finish entering retirement in 2030, it is estimated that Pima County s 
elderly support ratio will be .45 (2.2 working age people able to support each older adult).  This 
ratio will be significantly higher than that of the state (.40) and the nation as a whole (.37).  As 
the percentage of the population acting as caregivers and supporting public assistance programs 
decreases over the coming decades, Pima County must position itself to creatively address this 
inevitable challenge.  Possible alternatives include decreasing the dependency of older adults on 
public assistance programs and program restructuring. 
 
By the year 2030, elderly support ratios will begin to decline due  to  a  stable  increase  in  the 
working age population as the generation of baby boomers thins out.  In 1997, the population of 
children in the United States finally rose above the  peak  level  previously  set  during  the  baby 
boom.    This population is referred to as the  millennium generation  and is driven by the 
offspring  of  baby  boomers  called  the  baby echo.   Support ratios will decrease as these two 
groups enter the labor force. 
As Pima County and Tucson continue to experience the pronounced demographic
transformations that are changing the face of the United States, our community is presented with
a complex set of challenges. These challenges, however, also hold much promise and
opportunity for us to grow into a healthier and more well-balanced community. In order to reach
this goal, planning for housing, health care, transportation, continuing education, community
integration and citizen participation needs to reflect the demographic and economic realities of
our community.
FINANCIAL SECURITY
Income Distribution
Analyzing the income distribution of the population age 65 and older provides important insights 
into  the  economic  well-being of older adults.  Nationally, over the period 1974 to 1998, the 
percentage  of  older  adults  in poverty and low-income categories has declined while the 
percentage of those with medium and high income  has  increased  (Chart  3).  This  indicator  of 
economic  health  illustrates  that  the  income  gap  among  older Americans  is  closing.   However, 
even  with  these improvements, more than one-third of older adults live in  poverty  and  low 
income  brackets and a disproportionate share of women and minority groups still are mired in 
poverty. 
 
 
9 
Chart 3 Income Distribution of U.S. Population Age 65 and Older 
 
Poverty 
The percentage of older Americans living in poverty has declined over the last forty years from 
35.2 percent to 10.5 percent.  Historically, older adults were much more inclined to live in 
poverty  than  the  general  population.    Today, the percentage of those living in poverty among 
older adults and working-age is roughly equivalent.  However, among older  Americans,  the 
poverty rate is higher at older ages and among minority groups (Table 7).   
 
TABLE  7 
Persons Age 65 and Older in U.S. Living in Poverty 
           Percent 
Age 65 and Older  10.5 
Age 65 to 74  9.1 
Age 75 to 84  11.6 
Age 85 and Older  14.2 
   
Women 12.8 
Men 7.2 
   
Non-married 17.4 
Married 4.9 
   
Non-Hispanic Black  26.4 
Hispanic 21.0 
Non-Hispanic Asian  16.0 
Non-Hispanic White  8.2 
Source: Federal Interagency Forum on Aging-Related Statistics; March Current Population Survey. 
Source: Federal Interagency Forum on Aging Related Statistics; March Current Population Survey.
1974
Medium Income
33%
High Income
18%
Extreme Poverty
2%
Low Income
34%
Poverty
13%
1998
Extreme Poverty
2%
Poverty
8%
Low Income
27%
Medium Income
35%
High Income
28%
 
1 0
Minority  women  age  65 years and older are the most economically disadvantaged.  In Pima 
County, Hispanic women account for more than 75 percent of the elderly poor.  Nationally, more
than one-third of all older adults live on less than $16,000 per year. 
Social Security and Retirement Planning
The status of social security is one of the most significant issues facing the new aging population.
Conflicting studies and political interests have caused much confusion and skepticism over the
health and longevity of the social security system. While the system is not in immediate danger,
many question its ability to withstand the pressures of the oncoming surge of retiring baby
boomers. As noted previously, support ratios are increasing with a greater percentage of the non-working
population dependent on the support of a relatively smaller working population.
About 27 percent or 370,000 of all households in Arizona received social security income in
1999. In Pima County, the number of households receiving social security income was 89,476 or
28.3 percent of all households. This share is expected to increase in conjunction with the
increasing population of aging adults. Average social security income for Pima County was
$11,538 (in 1999 dollars). By comparison, national poverty thresholds for 1999 were $7,990 for
an individual over age 65 and $10,070 for a couple. In 1999, the median gross rent for Pima
County was $554 per month accounting for well over half of the average monthly social security
payment of $962. It is clear that Pima County’s older adults who depend on social security as
their sole source of income can expect to live at near-poverty levels and, for many, inhabit sub-standard
housing.
Many of the commonly held myths of social security were addressed in the July 3, 2000 issue of
Newsweek magazine. The discussion pointed out some of the immediate challenges facing an
overhaul of the system and presented possible approaches to achieving financial solvency. Much
of that discussion is paraphrased here.
Myth #1 Social security is a pension plan.
Social security is actually an intergenerational transfer program. There is no pension fund to
handle the payments. Social security taxes are credited to what is commonly referred to as a
“trust fund.” Benefits received are ultimately charged against this fund. At its inception,
President Franklin Delano Roosevelt believed that having a trust fund pay out benefits, rather
than the U.S. Treasury, would make the program look more like a pension plan than a
government handout. The social security trust fund consists of Treasury bonds. When the time
comes to convert those bonds into cash, the government will have to cut expenses, increase
income, or borrow from private investors. This is exactly what would have to happen should the
money come from the Treasury. The trust fund should not be thought of in the actual sense but
only as an accounting framework. Benefits are in no way protected by this fund.
Money put into the system by an individual does not get set aside for that individual. Current
payments are used to send checks to current beneficiaries. Future benefits will be paid for by the
payments of future generations. These future benefits are only loosely related to how much an
individual has paid into the system.
 
1 1
Myth #2 Putting social security money into stocks will solve the problem.
The problem is not that the system is not investing its money well; it’s that too few workers will
be supporting too many beneficiaries. This trend is illustrated in the previous discussion of
support ratios. In 1945, there were 42 taxpayers for each social security recipient. Today, there
are only 3.4 with 2.8 projected in 2015. While the relative taxpayer base has decreased, overall
benefits have increased. Survivors and disabled people now receive more than one-third of social
security payments. This means that more than one-third of the money paid into social security
does not go to retirement at all.
Switching to a system in which most or all of an individual’s benefits are individual investment
accounts would change the program from “social security” to a “pension plan.” The current
system is progressive, which means that lower-paid people get a larger relative benefit than
higher-paid ones. Benefits range from 90 percent of covered wages for the lowest paid to 27
percent for the highest-paid. This feature is what hedges against increasing economic disparity
and widespread poverty. Allocating two percent of payroll taxes into investment accounts would
result in only $517 per year invested for the average worker and less than $200 per year for
nearly 40 million people in low-income brackets.
By 2038, social security’s cash income will fall below its cash outflow. When the cash shortfall
comes, the government will have to tap general revenues (i.e., income taxes) or the capital
markets to redeem the trust fund’s securities. This will alter the relationship between the benefits
received and the payments paid into the system.
The Newsweek discussion poses the following realities: Fixing social security will be painful and
expensive. The earlier we fix the problem, the less painful it will be. Small changes now can be
compounded over decades to right the system, rather than waiting for impending crisis. The
program will have to either take in more money or pay out fewer benefits. Changing the
retirement age and inflation adjustment are both forms of cutting benefits.
Social security has done a wonderful job of reducing poverty among older adults, the disabled
and the children of deceased workers. Poverty rates for older Americans have been in near
constant decline since 1959. When it was created 65 years ago, there were virtually no pensions
from employers, no 401(k) or IRA-type retirement plans and little stock market investment by
individuals. The long-term solution will be a balanced three-tier system of social security,
employer pensions and personal savings accounts.
The initial role of social security was to serve as a “security net” for America’s older adults and
was intended to be supplemented with personal retirement savings. It was never intended to be
the sole source of income for retirement as it currently is for 42 percent of older adults. That
social security allowances are relatively close to the poverty threshold illustrates that social
security continues to serve only as a financial net and not as the exclusive source of income.
However, today’s generation of aging adults are saving much less than those in the past. This
presents a real challenge to the financial security of retiring baby boomers. A lack of personal
retirement savings combined with growing income disparities among rich and poor boomers,
presents a looming threat that many of America’s aging may spend up to a third of their life in or
near poverty.
 
1 2
Although many baby boomers earn significantly more than those in previous generations, a
perilous number have accumulated high levels of debt and do not have established patterns of
voluntary retirement saving, investing or planning. The savings rate among individuals has
declined significantly in the last fifty years from 11.7 percent in 1950 and 10.8 percent in 1970 to
an incredibly low 4.9 percent in 1990. Excluding pension plans, the personal savings rate of
America is under two percent. The introduction of personal lines of credit since 1970 will
certainly have an effect on the retirement savings of America. Since 1984, the median household
net worth among those age 55 and older has increased. However, net worth among baby boomers
(ages 45 to 54) has decreased (Table 8).
TABLE 8
U.S. Median Household Net Worth (in 1999 dollars)
Age of Head of Household 1984 1989 1994 1999
45 to 54 $110,600 $98,500 $107,300 $85,000
55 to 64 $118,600 $149,800 $157,400 $145,000
65 to 74 $109,200 $126,300 $130,400 $190,000
65 and Older $93,000 $101,500 $112,400 $157,600
75 and Older $80,200 $84,000 $93,900 $132,900
Source: Federal Interagency Forum on Aging-Related Statistics; Panel Study of Income Dynamics.
Even as many older adults plan to continue working past age 65 to some degree, the trend toward
early retirement is growing. Seventy percent of today’s retirees left the workforce before age 65,
with forty percent leaving before age 60. On average, Americans in their mid-50s have saved
about $71,250 for their retirement. Two-thirds of boomers say they will need more than
$200,000 with the remaining one-third claiming to need more than $500,000 to retire
comfortably at the age of 65. The question remains: How will most find the money?
Those individuals who are currently age 65 and older lived through a very different time in
America when most could not purchase items with money they did not have. This consumer
behavior helped engender a propensity to learn to go without. Many of the baby boomers,
however, possess a very different consumer behavior and will not only want more but may very
well, after the payment of personal debt, have less.
Lifestyle 
Behavioral Characteristics of the New Aging
The behavioral characteristics that define the baby boomers are very different from those of their
parents. The new aging were the first to experience an age of abundance. They were also the first
to become a media generation. These two factors played a primary role in establishing a new
consumer culture. This group was also the first to experience widespread levels of high stress.
However, the generation of the new aging also holds a new respect for the environment. They are
more likely to question the status quo, speak out, and challenge authority. The new aging
experience a much greater rate of labor participation among women and redefined traditional
models of marriage and family. Seventy-five percent of the new aging are married, 75 percent
 
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have children and 66 percent own homes. Eighty-four percent of men among the new aging said
they spend more time with their children than their father spent with them.
As baby boomers age into retirement, they will continue the need for activity and social
involvement as part of their lifestyle as older adults. Past images of a leisurely retirement in
quiet isolation are now giving way to participatory and active lifestyles that engage the physical,
intellectual, spiritual and creative capacities of older adults. Currently, retirees spend an average
of 43 hours a week watching television. A future challenge is to provide older adults with places
and opportunities to meet in interest groups, a crucial element in the participation of a healthy
social and civic life.
Volunteerism
National statistics report that less than one-third of those over age 55 remain in the workforce.
However, much of the work done by older adults, such as volunteering, is not recognized in the
labor statistics. Among the population age 51 to 61, only 27 percent plan to stop working
entirely at the age of 65. This is partially a sign of the growing dissatisfaction with a sedentary
retirement lifestyle typically portrayed for older Americans. Community and political
involvement is high among the aging population, with over two-thirds of those age 65 and older
voting. This political power and influence has become known as “gray power” and will continue
to grow as the relative share of the aging population increases and an ethic of citizen involvement
remains strong.
While rates of political participation are high among older adults, rates of volunteerism are lower
than any other adult age-group. This is a disappointing characteristic of today’s older adults, but
one that has incredible potential for change. The volunteerism rate for those age 33 to 54 is 55
percent. However, this rate drops to 46 percent after age 55. The percentage of the entire adult
population volunteering has increased in recent years (reaching 56% in 1998), however, the
amount of hours spent volunteering has decreased (3.5 hours per week in 1998). This has
resulted in the net effect of fewer full-time equivalent (FTE) volunteer hours among all adults.
The role of the new aging in maintaining high levels of community participation and volunteer
activity is crucial. The unique behavioral characteristics of the generation of baby boomers have
the ability to positively change the face of older Americans. A melding of generational behaviors
can combine high rates of political activism with high rates of volunteerism to create some of our 
community s most valuable citizens. 
 
Political Activity and Voting Behavior 
Older adults are typically more politically active than other adult age groups. Although they are 
diverse in their attitudes, interests and behaviors, they  vote  at  high  rates  compared  to younger 
persons  and  maintain  a  considerable  interest in political affairs. Advocacy groups for older 
persons have achieved visible and often prominent roles in influencing  public  policies.  In 
addition, persons in late middle age and old age hold a disproportionate share of high political 
offices  world  wide,  especially  at the highest levels of national leadership. In 1975, the U.S. 
Congress consisted of 39 percent of senators and 21 percent of representatives age 60 and older. 
In 1993, there were fewer older senators (34 percent) and more older  representatives  (24 
percent). 
 
 
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Compared to younger people, older adults tend to engage in low-intensity  political  activities 
(such as voting) more than demanding and energetic forms  of  participation  (such  as  protest 
demonstrations and campaign work).  In Arizona, 75 percent of older adults are registered to vote 
with 82 percent of those registered voting. This equates to roughly two-thirds of those age 65 and 
older voting. 
 
Although older adults vote at a high rate, they are as diverse in their voting patterns as any other 
age group. Their votes divide along the same partisan, economic and social lines as those of the 
electorate  at  large.  Older  and  middle-aged  voters were never more than 10 percentage points 
apart in presidential elections from 1952 through 1980. Interestingly, the electoral  choices  of 
older voters are very rarely based on age-group interests. There appears to be little evidence that 
older voters base their votes on senior policy issues or a candidate s platform regarding support 
for  older adults.  Republicans represent 48 percent and Democrats 44 percent of all registered 
citizens in Arizona age 60 and older.  In Pima County, Democrats represent 44 percent and 
Republicans 38 percent of registered voters of all ages. 
 
Research indicates little evidence of intergenerational conflict over age-related policies. Support 
for spending increases on Social Security, Medicare and other age-specific benefits appears to be 
very  high  among  adults  of all ages. Rather than a unified front in favor of increased old age 
benefits, older adults are also divided over these issues. These divergences primarily run along 
party lines and economic status.  
 
Recent years have witnessed a tremendous expansion in the number, membership, visibility and 
political activity of old age interest groups in the United States.  Age-based interest groups have 
achieved great  influence and legitimacy  with policy makers  in  the  aging  field.  Policy  expertise 
and well-connected lobbyists give these groups easy access  to  public  officials.  Their  large and 
active memberships also enhance their access. Older members can be mobilized to contact policy 
makers  in  large  numbers  and  few  politicians  want  to  risk  alienating  such  a  large,  dispersed 
segment  of  the  electorate.  Furthermore, older Americans as a group possess a high degree of 
legitimacy as government beneficiaries among both political elites and the general public.  
 
Maintaining Careers and Continuing Education
Retirees are increasingly seeking some kind of work after formal retirement. They also are
seeking social and intellectual stimulation, often found in towns near college campuses.
Retirement communities associated with universities are already located, for example, at Iowa
State, Penn State, Stanford, Virginia, Ithaca College and the University of Arizona. According to
a Harvard University study, those over age 65 who eat out, play cards, go to movies and are
socially active live an average of 2.5 years longer than more reclusive people. Social integration
and involvement in the community not only serve to ameliorate commonly held stereotypes of
older adults but also help maintain mental and physical wellness.
Universities, community colleges and high schools are a valuable resource in educating people of
all ages. However, courses and programs directed specifically at older adults offer not only an
opportunity to remain intellectually stimulated but also would strive to develop new knowledge
and skills. Continued training and skill development of older adults is essential in meeting the
employment needs of the community. Participation in continuing education is also a valuable
social activity, as well as an opportunity to interact among generations. Twenty-five years ago,
 
1 5
the idea that people would spend their retirement involved in learning was exotic. Today,
hundreds of thousands of people over the age of 55 take Elderhostel classes. The success of
Elderhostel has spawned an entire industry of learning in retirement, involving universities,
corporations and travel groups.
PHYSICAL COMMUNITY
Housing Characteristics
The presence of the aging population in Pima County can be evidenced by the significant amount
of age-restricted housing. Since 1987, 14.8 percent of all single family housing construction in
the Tucson metropolitan area has been age restricted. This does not include manufactured
housing, a housing type preferred by many older adults for its affordability and ease of
maintenance. The aging community in Arizona tends to settle more in suburban and rural areas
than urban ones. The share of the population over age 65 in Pima County is 14.4 percent
compared to 12.3 percent within the city of Tucson.
In 1960, 40 percent of those age 65 and older lived in the home of an adult child. By 1999, this
number had dropped to 4 percent. Adult children, while for the most part no longer directly
house their aging parents, may be providing financial or other support for a variety of
independent housing options. The dissolution of intergenerational connections between young
and old at the household level can be identified as a factor leading to misunderstanding and
ageism among generations.
The makeup of housing types inhabited by Arizona s older adults differs from that of the younger 
populace in a number of ways.  Single family detached and townhouse structures represent the 
bulk of housing for both age groups, with these one-unit structures comprising 62 percent of the 
housing for older adults and 63 percent of the housing  for  householders  under  age    65.  
Multifamily  units  with  two  or  more  units  per  structure  comprise  just  16  percent  of  the  senior 
housing, compared to 27 percent of the housing for younger householders.  Mobile homes house 
22 percent of all older adults in Arizona, more than twice the percentage of younger householders 
(10 percent) who live in these structures.   
 
The nation s  older  population  is far more likely to own their own homes than are younger age 
groups.  This is especially true in Arizona where 81 percent of householders age 65 and older 
own their homes, higher than the nationwide average of 77 percent.  Just 59 percent of Arizona s 
younger householders own their own homes.  Home ownership does decline with advanced old 
age, however.  While 84 percent of householders between the ages of 65 and 74 own their own 
homes, this percentage slips to 77 percent for householders age 75 and older. 
Land Use and Urban Design
Contemporary housing types, such as the suburban single-family detached house and multi-story
apartment complex, do not meet the unique housing needs of many older adults. Many building
and land-use codes currently restrict the construction or addition of small studios or “granny
flats” on most properties. The large square footage of most new housing, for physical and
economic reasons, excludes many older adults who live on fixed incomes. Most housing that is
of a small, easily maintainable size, with access to transportation and services, can be found only
 
1 6
among older housing stock dating before 1960. The lack of good quality, affordable and
accessible housing alternatives often motivates many older adults to consider the appealing
amenities of age restricted communities.
Age-restricted communities provide a common ground where people of like values can live.
These communities provide a critical mass of older adults that can support and make feasible
many of the services required for various levels of assistance with daily living (for example,
shopping, transportation, home-maintenance services and health care needs). The concentration
of older adults also gathers enough people and resources to participate in the activities of a senior
center.
For all the benefits of age-restricted communities, there are drawbacks as well. While residents
are immediately surrounded by others somewhat like themselves, the physical and social
isolation that occurs often results in an overall exclusion from participation in the larger
community as a whole. Age-restricted communities also contribute to socioeconomic exclusion
within the older generation itself. With increasing pluralism in our society, inclusionary living
practices serve to increase awareness and understanding among generations. Integrated,
intergenerational living can help break down stereotypes and decrease the isolation where, for
instance, loneliness and elder abuse can occur.
The design of homes and neighborhoods needs to provide for and encourage the presence of
older adults. Homes should be adaptable to allow for “aging in place.” Planning and urban
design principles should encourage mixed-use communities with diverse housing types. Access
to commercial and public services should be within walkable distances and be accessible by
public transportation. Current specialty senior transportation services such as group vans and
individual trip carriers are inefficient and costly for the user.
Transportation
Sun Tran, Tucson’s Public Transit Authority, offers a number of services directed at increasing
the affordability and accessibility of transit for older adults. Sun Tran services 200 square miles--
an area that includes over 500,000 people. Individual fares for those age 65 and older are $0.40,
a 60 percent discount from the standard $1.00 fare. Monthly bus passes for older adults can be
purchased for $12.00. Bus routes also are designed to increase the mobility of older adults. Four
specific routes, servicing four different areas of the city, have been developed under the Out and
About program. These routes are specifically designed to access senior centers, health care
facilities, medical centers, banks, grocery stores, shopping centers, libraries, municipal service
centers and parks and recreation centers. All buses now have the ability to “lean” down to meet 
the curb, easing difficulties in entering and exiting the bus.  The majority of buses will also have 
wheelchair capabilities.   
 
Public transit in Tucson s urban core has made the mobility of older adults much more affordable 
and accessible.  However, many aspects of traditional bus service remain inadequate in serving 
the transportation needs of older adults.  Of the 2,150 bus stops in the Tucson area, only 639 are 
sheltered from the weather.  Over the next two years, the City of Tucson will continue their effort 
to  redesign new bus shelters and replace many of the existing bus stops with bus shelters.  In 
addition,  long  waiting  times  as  well  as  long  walking  distances  to  bus  stops  on  unimproved 
 
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roadways also present difficulties for many older adults.  Some portions of Pima County lack bus 
access entirely. 
 
The Challenge of Driving
As  the  aging  process  occurs,  both  physical  and  mental  faculties  become  less  acute.    The 
maintenance of health and safety standards among older adults is important for the driver of an 
automobile, its passengers, and others on the road.  In Arizona, drivers age 65 and older have to 
renew their license every five years. Since 1993, the  state  has  issued  a  lifetime  drivers  license 
that  is  valid  until  the  65th  birthday,  providing  that  the  motorist  passes  a  vision  screening  and 
updates the photo every 12 years. 
 
The Motor Vehicle Department (MVD) has instituted a number of methods to monitor driving 
abilities.  Any person who has multiple violations  and  convictions  can  be  sent  to   Traffic 
Survival  School.   In addition, the MVD has a Medical Review Board that reviews people s 
driving  abilities.  Referrals  to  the  Board  come  from  doctors,  family  members,  and  law 
enforcement  officers. However,  family members  and police officers must state specific reasons 
for their concerns and sign the letters they send. The Board can then ask someone to come in for 
a road test and for an additional vision screening. The most important thing to note, however, is 
that driving is an issue of ability, not age. 
SOCIETY
Ageism and Discrimination
Congress passed the Age Discrimination in Employment Act (ADEA) in 1967. As subsequently
amended, it forbids employers to discriminate on the grounds of age against any employee age
40 and older. Mandatory retirement at any age is now forbidden. Employers cannot treat people
over age 40 differently based on statistical discrimination, i.e., the thinking that a certain skill or
function cannot be executed because of an individual’s age or that it can be performed better by
someone younger. Employers can fire individuals, however, for poor job performance, even if
the lack of performance is due to the aging process.
When age discrimination in employment legislation was passed in 1967, age discrimination was
widely and openly practiced. Today, employers are more aware of the standards by which they
must abide as well as more savvy when ignoring those standards. While it is difficult to measure
just how prevalent age discrimination is, stereotyping among older adults, the new aging and
today’s youth remains a barrier between generations.
A lack of physical interaction among generations has resulted in a lack of or false understanding
of each other. As many older adults isolate themselves in age-restricted communities, their
depictions of the new aging and youth populations come mostly through the media. This
portrayal often heightens established stereotypes and even instills a sense of fear. As Ken
Dychtwald, author of Age Power, states:
Developing a philosophy and a new set of ground rules for intergenerational
relations presents a novel set of considerations. First, we must establish a basic
understanding of each generation’s composition, style and identity. Next, it’s
 
1 8
critical to take stock of the relative power and influence among the different
generations. Only then can we create programs that will bring each generation’s
needs, interests, contributions and demands into greater balance in the 21st
century.
Elder Abuse
Elder abuse is a serious concern as a greater share of the population becomes a potential victim.
The clinical history of elder abuse suggests that it gets worse, not better, in terms of frequency
and severity. Intervention is imperative. Over ten percent of the cases in the Tucson Unit of the
Arizona Attorney General’s Office are for fraud against older adults. Cases of fraud against
older adults have increased over the past three years and are expected to continue to do so.
Forms of elder abuse include physical abuse, psychological abuse, caregiver neglect, self neglect
and exploitation. A nationwide report found two-thirds of the victims of elder abuse to be
women, while abusers were equally inclined to be either male or female. The majority of abusers
are spouses or partners, followed by adult child caregivers and other family members. From 1984
to 1996, reported cases of domestic abuse among the elderly rose from 117,000 to 241,000, an
increase of over 100 percent. Although comprehensive data are not available to provide a
complete description of elder abuse, studies do indicate that instances of elder abuse are
increasing.
Amendments in 1987 to the Older Americans Act began funding services for elder abuse. These
services range from prevention to investigation and prosecution. Elder abuse in Arizona is
investigated by Adult Protective Services, which is administered by the Aging and Adult
Administration within the Arizona Department of Economic Security. There are six regional
offices statewide, of which Pima County constitutes Region II.
New legislation in 1999 increased reporting intake by Adult Protective Services to a 24-hour per
day operation. However, investigation of cases remains inadequate with only 70 percent of
reported cases being followed up. Investigative services only operate on a five day, 8 A.M. to 5
P.M. basis. The provision of emergency support facilities is an essential part of the protective
services system. Elder Shelter is an emergency care program for those age 60 and older who
suddenly find themselves with nowhere to go, due to the loss of a caregiver or because of fraud
or abuse. The program finds temporary placement for abused or neglected persons in one of 41
licensed care centers in Pima County for anywhere from one day to a couple of weeks. It is
funded primarily by an annual $50,000 grant from Pima County.
Law Enforcement
The prosecutorial response to elder abuse occurs through two divisions within the Arizona
Attorney General’s Office. The Elder Affairs Program in the Civil Division is an advocacy-oriented
program protecting the legal rights of older adults. This program maintains the Elder
Abuse Registry, which records all civil and criminal complaints against vulnerable adults. The
other division is the Arizona Health Care Cost Containment System (AHCCCS) Fraud Control
Unit. This division is a federally funded program that investigates and prosecutes medical
provider fraud and patient abuse affecting AHCCCS. It is imperative that coordinated
cooperation continues to exist among law enforcement and prosecutorial agencies.
 
1 9
HEALTH STATUS
Personal Health Habits
Personal health and nutrition habits among older adults have improved significantly over the last
century. Proper nutrition, sleep and exercise, combined with an increase in self-awareness and
continuing intellectual involvement, have resulted in a significant number of older Americans
rating their health as good or excellent (Table 9).
TABLE 9
Persons in U.S. Age 65 and Older Reporting Good to Excellent Health
Percent
65 and Older 72
65 to 74 74
75 to 84 69
85 and Older 65
Source: Federal Interagency Forum on Aging-Related Statistics; National Health Interview Survey 1994-1996.
However, even with the great majority of older adults reporting to be in good health, many suffer
from combinations of poor nutrition, chronic disease and debilitating mental health conditions.
Older adults are at increased nutritional risk due to factors associated with aging such as poverty,
physical inability to shop, cook and feed oneself, inadequate or monotonous diet, unintentional
weight loss or gain, alcoholism, poor appetite and depression. Meal programs such as home
delivered and congregate meals are a valuable service. Arizona’s Aging and Adult
Administration estimates a need to annually provide over 3.3 million meals for more than 38,000
individuals. Sixty-four percent of older adults receiving home delivered meals are unable to
grocery shop and 41 percent are unable to prepare their own meals. Nutrition programs serve to
ensure that older adults receive at least 33 percent of the recommended daily allowance of key
nutrients as well as provide social interaction to prevent isolation.
Disability
Even as longevity increases and chronic health conditions persist, disability among older adults
has decreased over the last two decades. The proportion of Americans age 65 and older with a
chronic disability declined from 24 percent in 1982 to 21 percent in 1994. However, despite the
decline in rates, the number of older Americans with chronic disabilities increased by about
600,000. This is due to the older population cohort, which is growing at a pace fast enough to
outweigh the decline in rates.
The ability to independently perform certain physical functions is extremely valuable in
contributing to one’s overall functional health. The desire to maintain functional independence is
prevalent across culturally diverse groups and is related to other concerns, such as fear and
anxiety, that contribute to one’s psychological health. The potential to suffer from chronic
disability is greater among women than men (Table 10).
 
2 0
TABLE 10
Percentage of Persons in U.S. Age 65 and Older Who Are Chronically Disabled
Year Total Men Women
1982 23.7 19.5 26.5
1984 23.7 18.4 27.2
1989 22.7 17.4 26.2
1994 21.1 15.5 24.9
Source: Federal Interagency Forum on Aging-Related Statistics; National Long Term Care Survey.
Mental Health
Approximately 18 percent of older adults have some kind of mental health need. As aging
occurs, it is often accompanied by spousal and family loss as well as a loss of physical health,
mobility and independence. Among the most common mental health problems among older
adults are isolation, loneliness and depression. Women, because of their tendency to live longer,
are at greater risk of suffering from severe depressive symptoms (Table 11). Roughly 15 percent
of older Americans age 65 to 84 had severe symptoms of depression in 1998. This increases
dramatically to 23 percent after the age of 85.
TABLE 11
Percentage of Persons in U.S. Age 65 and Older with Severe Depressive Symptoms, 1998
Age Group Total Men Women
65 to 69 15.4 12.1 18.0
70 to 74 14.3 10.3 17.2
75 to 79 14.6 10.4 17.4
80 to 84 20.5 17.1 22.4
85 and Older 22.8 22.5 23.0
Source: Federal Interagency Forum on Aging-Related Statistics; Health and Retirement Study.
Memory impairment, dementia and Alzheimer’s disease are all high-risk factors for needing
long-term care. In 1998, the percentage of older adults with moderate or severe memory
impairment ranged from 4 percent for those age 65 to 69, to 36 percent for those persons age 85
and older (Table 12).
TABLE 12
Percentage of Persons in U.S. Age 65 and Older with Moderate or Severe Memory Impairment, 1998
Age Group Total Men Women
65 to 69 4.4 5.3 3.8
70 to 74 8.3 10.1 6.9
75 to 79 13.5 16.2 11.7
80 to 84 20.1 22.8 18.5
85 and Older 35.8 37.3 35.0
Source: Federal Interagency Forum on Aging-Related Statistics; Health and Retirement Study.
 
2 1
Approximately 78,000 Arizonans suffer from Alzheimer’s disease and other forms of dementia.
The Arizona Department of Health Services estimates that approximately 145,000 older adults in
Arizona will have Alzheimer’s disease by the year 2020. This rapid increase is due to Arizona’s
significant senior migration, the state’s strong natural relative population growth and the
maturation of baby boomers into the years of increasing risk. Persons with Alzheimer’s disease
generally live at home until the end stage of the disease. Therefore, family and friends are
typically the front line of caregiving.
Caring for people afflicted with Alzheimer’s often has a devastating toll on the caregiver’s
family and personal life. According to the Alzheimer’s Association, 80 percent of caregivers
suffer from high levels of stress and nearly half suffer from depression. As the number of
persons afflicted with Alzheimer’s disease increases, it is very likely that there may be a
caregiving crunch. Contrary to the belief of many, long term and nursing home care for
Alzheimer’s patients is not covered under Medicare. Programs focusing on increasing awareness
about the impact of Alzheimer’s disease and teaching skilled treatment methods will help the
next generation of caregivers better prepare themselves for this reality.
Chronic Health Conditions
Increasing longevity over the last century has been accompanied by an increased risk for certain
diseases and disorders. Significant proportions of older adults suffer from a variety of chronic
health conditions such as arthritis and hypertension. The percentage of persons with chronic
health conditions increased for most conditions between 1984 and 1995, with the exception of
hypertension, which has remained roughly the same (Table 13).
TABLE 13
Percentage of Persons in U.S. Age 70 and Older with Chronic Conditions
Chronic Condition 1984 1995
Arthritis 55.0 58.1
Hypertension 45.6 45.0
Heart Disease 16.4 21.4
Cancer 12.4 19.4
Diabetes 9.9 12.0
Stroke 7.8 8.9
Source: Federal Interagency Forum on Aging-Related Statistics; Supplement on Aging and Second Supplement on Aging.
Heart disease, cancer and stroke are the three leading causes of death for both sexes of every
racial and ethnic group. Five of the six leading causes of death among older Americans are
chronic diseases. Arthritis and high blood pressure are the most common chronic health
conditions affecting older adults in Arizona. Men are at greater risk for becoming afflicted with
cancer and heart disease (23 percent and 25 percent, respectively) than are women (17 percent
and 19 percent). However, women are more inclined to suffer from arthritis and hypertension
(64 percent and 48 percent, respectively) than are men (50 percent and 40 percent).
Of more than 1.7 million hospital discharges attributed to cancer in 1997, 11 percent (or 192,000)
were attributed to lung cancer. This represents a 30 percent decrease in the number of attributable
discharges from 1988. The Center for Disease Control reports 430,000 deaths each year
attributable to cigarette smoking. Twenty-five percent of those age 45 to 64 smoke, with 12
 
2 2
percent of those age 65 and older smoking. Smoking rates, however, are greater for those
younger than age 45.
While a greater percentage of younger people smoke, a much greater percentage older adults are
hospitalized due to smoking-related illness. The greatest number of hospital discharges due to
smoking-related illness is experienced in the population age 65 and older. In 1997, death rates for
malignant neoplasms of the respiratory system were significantly greater for those age 65 and
older. However, the greatest decline in hospital discharge rates (51 percent) has occurred in the
45 to 64 year age group. Smoking prevention and cessation programs are widely offered by the
American Lung Association and should be supported.
HEALTH CARE 
Caregiving
As chronic health conditions and longevity continue to increase, the number of older adults
needing long-term care also will grow. Caregiving provides assistance to those with limitations
in activities of daily living and those who suffer from chronic diseases such as Alzheimer’s. Half
of those age 85 and older are expected to need help with personal care. Long-term care consists
of: 1) informal care, 2) home and community-based services, and 3) institutional care. An
estimated 72 percent of the care provided comes from spouses, adult children and other relatives
and friends. Smaller and more geographically dispersed families among the new aging will
result in fewer potential caregivers for older adults. In 1990, there were 11 potential caregivers
for each person needing care. By 2050, it is estimated that the ratio will be four persons for each
person needing care.
One-third of all people age 85 and older have Alzheimer’s disease and three-quarters of their
caregivers are surrounding friends and family. More than half of baby boomers mistakenly
believe that Medicare will cover long-term care costs should their parents become afflicted with
the disease. The financial, physical and mental burden associated with caregiving becomes very
exacting for many family members. The average nursing home in Tucson costs $149 per day,
slightly below the national average of $153 per day. This equates to roughly $55,000 per year.
The average cost of a home-health worker is $15 per hour. In 1999, average out-of-pocket costs
for long-term care were $40,000 per year. More than 60 percent of children caring for aging
parents suffer from depression. Decreasing fertility rates combined with increasing divorce and
re-marriage rates and increasing longevity will result in future caregivers having more parents
than children.
The majority of the caregiving community is made up of women and older adults. Seventy-three
percent of today’s caregivers are women. In 1999, 76 percent of women in their caregiving years
(age 45 to 54) were in the workforce. This is in sharp contrast to 38 percent in 1950. Women are
also having children at an older age. Forty-one percent of these women in their caregiving years
have children of their own under age 18 at home. This has created what is termed the sandwich
generation-- persons who find themselves caring for elderly parents while also caring for their
own children. With increasing longevity, 21st century Americans will most likely spend more
years caring for their parents than their children.
 
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Assisted Care Facilities
In anticipation of the increasing need for care among older adults, the number of assisted living
facilities in America has doubled since 1994. Construction has now slowed as it has reached a
saturation threshold. As a result of the influx of supply, national occupancy rates for nursing
homes have fallen from 88 percent in 1991 to 83 percent today. Over 1.6 million people receive
care in over 17,000 nursing homes nationwide.
Assisted care facilities are facing major problems with financial stability and staffing. Even
though nursing home costs are out of reach for a large percentage of American families, they still
suffer from underfunding. Many facilities cannot staff or supply care services at adequate levels,
leaving many residents at risk of being harmed. The General Accounting Office reports that
more than 25 percent of nursing homes in the United States had deficiencies that could cause
harm to residents or place them at risk of serious injury and death. Ninety-five percent of
nursing homes participate in Medicare or Medicaid. They cite the following reasons for
inadequate staffing: 1) insufficient payments and reimbursements from Medicare and Medicaid,
and 2) difficulty in attracting and retaining qualified workers within a healthy economy where
other industries offer less demanding and better paying jobs.
Working conditions and benefits for certified nursing assistants (CNAs) are a major concern
within the assisted care industry. Formal caregivers and other direct care workers staff nursing
homes, assisted living facilities, group homes and individual clients’ residences. These people
account for 20 percent of the health care workforce. Over 90 percent of direct care workers are
women age 22 to 45. Starting salary for a certified nursing assistant in the U.S. is $7.35/hour, a
salary belonging to the low-income wage bracket. Many are able to secure only part-time work,
and health insurance benefits are rarely offered. These conditions result in exceptionally high
annual turnover rates for direct care workers: 70 to 100 percent in nursing homes and 40 to 60
percent for in-home care.
Health Insurance and Medicare
In 1965, national legislation was passed establishing the Medicare and Medicaid programs.
While Medicare (Part A and Part B) covers physicians and hospitalization fees for those age 65
and older, Medicaid offers health care services for those of all ages who meet certain income and
eligibility requirements. As a result of 1997 legislation, Medicare beneficiaries have the option
of choosing from a variety of Medicare+Choice plans including health maintenance
organizations (HMOs), preferred provider organizations (PPOs) and private fee-for-service plans.
The only option for a drug coverage plan for Medicare beneficiaries in Arizona is through a
Health Maintenance Organization or employee retirement plan. Arizona has the third highest
percentage of older adults belonging to managed care plans. This percentage peaked in the early
1990s at 40 percent but has continued to decline since.
There are a number of insurance alternatives, such as long-term care (LTC) insurance and
longevity insurance, to help individuals prepare for increasing health care costs accompanied by
older age. Long-term care insurance provides for the services of assisted-care facilities, should
they be needed. This insurance should be purchased by both retirees and middle-aged workers
alike. In 1999, President Clinton proposed a measure to make private long-term care insurance
available to federal employees, retirees and relatives. Among current initiatives in legislation are
the Long-Term Care Insurance Act of 1999 that proposes an above-the-line tax deduction for
 
2 4
persons who purchase LTC insurance, and the Long-Term Care Advancement Act that permits
penalty-free withdrawals from IRAs and 401(k) plans to purchase qualified LTC plans.
Longevity insurance would, instead of paying an individual’s family in the case of early death,
provide financial support for the needs of living exceptionally long. One financing mechanism
for this kind of insurance is a reverse mortgage. Home equity is the single largest financial asset
of most older Americans, yet is seldom used as a source of financing for long-term care. With a
reverse mortgage, a bank or lending institution would allow contributions to be made to long-term
care insurance drawn from the equity value of the home. When the homeowner passes
away and/or the house is sold, the lending institution would receive back the principal and
interest.
Prescription Drug Costs
Older Americans are paying twice as much for prescription drugs today as they did in 1992. The
increased costs are attributed to more advanced and effective drugs. According to a recent
Medicare beneficiary survey, prescription drugs account for ten percent of total out-of-pocket
health expenditures for those age 65 and older. The burden of paying high prescription drug
costs falls disproportionately on the elderly. Older Americans account for only 13 percent of the
population but account for over 33 percent of prescription drug expenditures. Average cost per
subscription is $42.30, an increase from $28.50 in 1992. Older adults also are taking more drugs.
They purchased an average of 20 prescriptions per year in 1992 and 29 in 2000. It is estimated
that they will purchase approximately 39 prescriptions per year in 2010.
One-fourth of older adults pay more than $500 per year in out-of-pocket expenses for
prescription drugs. Approximately one-third pay 100 percent of retail prescription drug costs due
to a lack of supplemental drug coverage to enhance basic Medicare.
Rural Access to Health Care
The Federal Balanced Budget Act of 1997 reduced the HMO federal government reimbursement
rate from 95 percent in 1997 to 75 percent in 2004. As a result, more and more HMOs are
operating at net deficits and are rapidly withdrawing from rural parts of Arizona and the nation.
The overall withdrawal of Medicare HMOs from Arizona during the year 2000 is expected to
affect 4,700 rural older adults. Many will be forced to subscribe to more costly Medigap policies
to cover prescription drug benefits. The high cost of supplemental Medigap coverage is one of
the most pressing health care issues among the older population. With increasing numbers of
rural residents being abandoned by Medicare HMO providers, many older adults are forced to
turn to Medigap policies as their only alternative to retain similar levels of coverage. The cost of
these policies is rapidly on the rise.
Since 1999, 41,000 older adults in Arizona (4,900 in Pima County) have lost Medicare HMO
coverage. This totals more than 45,700 older adults who have lost coverage in Arizona. Only
Santa Cruz and Pinal Counties remain with one HMO serving the rural senior population. The
great majority of these people will switch over to original fee-for-service Medicare which has
higher premiums and no prescription drug plan. This trend by HMOs to drop coverage in rural
areas will affect 926,000 older adults nationwide, of which 151,000 will be left with no Medicare
HMO options. Health care options for older adults in Pima County are:
 
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(1) Traditional Medicare;
(2) Medicare+Choice HMOs – Health Net (offering one plan) and PacifiCare’s Secure Horizons
(offering three plans);
(3) Private Fee-for-Service – provided by Sterling Life Insurance Company; and
(4) Medigap Supplemental Insurance -- offered by 45 insurers serving Arizona.
Without a dramatic shift in health care skills and priorities, our society will continue to struggle
with acute illness, chronic disease, and disability. Longevity is increasing, but the afflictions of
chronic diseases such as arthritis, Alzheimer’s disease, osteoperosis, diabetes, heart-disease,
prostate and breast cancer still pervade.
 
 
 
2 6
 
 
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Part II 
Imagining the Future for Tucson and Pima County 
The reality of what Tucson might look like in 15 years is of course unknown. This section
provides two radically different visions of Tucson’s future in the year 2015 and beyond.
Vision One: Material Wealth for Some, Poverty of Spirit for All
Growth in Pima County has been mixed over the past 15 years, however, the economy is stable.
After the economic boom of the 1990s, there was a recession in the mid-2000s. Some people
who had gambled in the stock market lost much of their retirement savings. Others without
pension plans are now financially destitute after a lifetime of accruing personal debt. The tax
base has grown modestly, allowing basic human services to be met for most people. Social
Security and Medicare are solvent and pay at modest levels.
The trend toward gated communities for the well-off accelerated as baby boomers began to retire.
Professionals congregate with professionals. While some of this segregation is ethnically or
racially motivated, it is mostly a matter of economics and class. Those who had the good fortune
or foresight to secure adequate retirement income have the good life, but a large segment of
Tucson's retirees live near the poverty level. There is little mixing of the two groups.
The community's spirit and that of its residents has suffered. Residents of the more affluent
enclaves keep to themselves. While actively engaged in their own communities, their charitable
giving and volunteerism for the poor are at all-time lows. Older residents of lower class
neighborhoods live in isolation, with little help from neighbors or volunteers.
Katherine Jones picks up her paper and gazes down her well maintained, tree-lined
street. Her husband Jim has already left to play golf with his buddies.
Although Katherine and Jim moved to Tucson fifteen years ago, and most of their
neighbors in their gated foothills subdivision came from states other than Arizona.
Her book club will meet in an hour. The afternoon will be at the tennis court and
the lap pool. Jim and Katherine are trim, athletic sixty-year olds. Their children
and young grandchildren live in Illinois and California.
Katherine waves to her neighbor, Mr. Garcia. As Katherine glances in the
direction of the valley below, she has a fleeting memory of the announcement at
their church about the need for volunteers to deliver meals to shut-ins in
downtown neighborhoods. She brushes the thought aside and steps back inside,
closing the heavy wrought iron gate behind her.
Twenty years later…
Katherine shuffles out to the curb of her street and grabs her paper with an
extension stick. Her arthritis is bad this morning. She gazes down her street,
pieces of paper clinging to scraggly bushes in her neighbor's yard. She hasn't seen
Mr. Garcia in months. Since his wife died, he has become reclusive. Katherine
 
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would like to visit him, but it is all she can do to walk to the street for the paper
and the mail.
When Jim died five years ago after a long and expensive bout with cancer, his
modest pension from the printing company stopped. Their savings were wiped
out by Jim's illness because of the cost of the chemotherapy that Medicare didn't
cover. Katherine worked as a secretary for a social services agency in Illinois, but
they didn't have a retirement plan, and her Social Security barely covers the
mortgage and utilities. She now takes her arthritis medicine only every other day.
As Katherine looks around her neighborhood, an overwhelming loneliness
overtakes her. She sure misses Jim.
Vision Two: Prosperity From Within
The economy is doing well. The emphasis in Pima County has been placed on quality of life
issues rather than the aggressive growth of the new economy. People value the inherent richness
within their community. Their lives are less materialistic and more characteristic of a synergy
with the environment and the social life of the community. The transient nature of Arizona’s
residents has lessened as many have rediscovered an appreciation for family, place and
community.
River parks and walkways encourage walking and biking. The economy of internet commerce
and distance learning has made living and working at home a reality for a great number of
people. The telecommunications revolution of the 1990s has further evolved to make it possible
to be surrounded by extended families. Diverse ethnic traditions remain in this part of the state.
Neighborhood associations have evolved into social communities rather than regulatory bodies.
Most are intergenerational with few gated or age-restricted communities being built. Each
neighborhood association develops self-help programs to meet the needs of its residents.
There are still haves and have-nots, but few of the area's older adults live in poverty. Affordable
housing remains, but only with federal and state subsidies. Public expenditures for nursing
homes and assisted living facilities have decreased considerably. Finally, there is a national
health insurance plan encompassing Medicare and AHCCCS. Increasing life expectancy
continues, with better lifestyles being appreciated. New biotechnological interventions from
gene research are available and affordable. Concerns remain about how to keep the environment
clean and green. People continue to relocate to the Tucson area.
Planning for new aging begun 15 years ago by the Pima Council on Aging led to the
establishment of a joint commission of municipal officials, developers, educators, health care
practitioners and faith-based communities. The University of Arizona Center on Aging and the
College of Public Health continued the commission's work in developing policies and
functioning as a think tank for institutions, business and government.
Sara and Jeffrey never dreamed how comfortable and young they would feel once
reaching their early 70s. Age has brought them freedom and time to truly enjoy
the beauty, resources and prosperity of Tucson. Living along the Rillito River
Park, 6:30 a.m. is wake up time. Three times a week they make the five-minute
light walk to their health club for yoga class. Followed by a light aerobic work-out
and a healthy breakfast, they feel better than ever.
 
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Walking back home, they marvel at the city's foresight in developing two major
Riverwalks—the Rillito and the Santa Cruz. The multiple pathways between
neighborhoods connect a good portion of the community to the Sonoran
Ecosystem Park with wonderful outdoor sculpture and art. These parks are used
throughout the day by walkers, bikers and strollers and are free from noise and
vehicular traffic. These inter-connected parkways and community gardens, along
with the activism and growth of neighborhood associations, allow for a strong
sense of intergenerational spirit and community pride.
E-commerce and distance learning have allowed them to remain even more
productive in their "retirement," yet with very flexible hours. Sara is an interior
design consultant specializing in assisting older adults to redesign their homes to
accommodate their changing needs as they age. She prides herself in keeping a
log of all her clients who have been able to remain living at home and keep their
independence. Sara brings together human resource needs with the latest
technological innovations. Her background in nursing and social work has never
been put to greater use.
Jeffrey, a former Anthropology Professor at the University of Arizona, always
liked to teach and now finds his Internet classes as challenging and thought-provoking
as ever. His students sign up for his classes as fast as he creates them.
They range in age from 16 to 106 and are from all over the world. Jeffrey's area
of specialization is spiritual anthropology, a field that dawned with the turn of the
millennium and the growth in interest in the spiritual and religious traditions of
ancient and contemporary societies.
Sara and Jeffrey have two daughters. One is married with their first grandson and
is living in Europe where she works for the United Nations. The other, a "late
life" child adopted when they were in their mid-50s, is now finishing graduate
school in Exercise and Nutrition.
Most of life's daily chores can be done by computer when necessary: food
shopping, ordering medication and vitamin supplements and banking. They are
fortunate to feel healthy and function without physical limitations. 21st century
medicine is founded on self-management that begins in the home, not the
physician's office. Jeffrey's heart problems are managed quite efficiently with a
combination of home monitoring and the nutritional and yoga interventions his
health team helped him assemble.
Sara's medical problems also have not altered their lifestyle and quality of life.
Music therapy helps control her migraine headaches and the chronic fatigue she
suffered from has been "cured" by her enhanced nutritional protocol and exercise
program. Sara and Jeffrey spend one three-day weekend a year in their local
Health and Healing Center, a residential hybrid health spa and hospital. This
allows them the opportunity to explore new dietary, body work and meditation
interventions.
 
3 0
Tucson transportation has evolved into a comprehensive multi-modal system.
Still, most people try to arrange their outings at locations to which they can either
walk or bicycle. Such is the case for Sara and Jeffrey, as they can walk or bike to
restaurants, cinemas and shopping areas.
Despite good health and comfortable home living, Sara and Jeffrey are planning
ahead. Should either of them experience functional limitations in the future, both
are committed to continue living together at home. Their foresight meant building
a guest house in their backyard 15 years ago just in case live-in home aides might
be necessary. That guest house may just remain as the second home for their
children's families.
Which, if either, of these visions will become a reality? The commission is seeking to identify a
vision for the future of Tucson that will reflect wholeness and wholesomeness for the entire
community. Articulation of that vision will guide our policy recommendations.
 
3 1
Part III 
Planning a Wise Course: Area Objectives 
 
 
Framework 
The current generation of those age 37 through 55 has been described as the most powerful, most 
influential and largest generation in American history.  It has become known as the age wave -- a 
revolution that is crashing through our culture, reforming our expectations and changing the very 
meaning of aging. 
 
How  will  this age wave be experienced in Pima County?  The social, economic and political 
challenges of the coming decades will arise not only from  the  increasing  magnitude  and 
population share of older adults, but also from the fact that  this  future  generation  of  older 
Americans will come from an extraordinary age wave of individuals with a very different set of 
needs  and  expectations.    At  the  same  time,  there  is  uncertainty  as  to  the  attitudes,  values  and 
social orientations that younger generations will possess in the year 2015 and beyond.  Meeting 
the challenges will involve addressing numerous critical issues and societal questions.   
 
The Arizona Aging and Adult Administration released their Arizona State Plan in October 2000.  
The mission of the Aging and Adult Administration, under the Arizona Department of Economic 
Security, is to support older adults in meeting their needs to the maximum of their ability, choice 
and  benefit.    The  plan establishes statewide objectives and is the result of a cooperative effort 
involving input from Arizona s eight Area Agencies on Aging, the Governor s Advisory Council 
on  Aging,  the  general  public, and other concerned agencies and organizations throughout the 
state.   
 
The following recommendations are coordinated with the Arizona State Plan in order to maintain 
a consistent framework for meeting both area and statewide objectives.  An essential element to 
successful  regional  planning  is  to  maintain  a  consistent,  hierarchical  framework  for  policy 
development,  support  and  action.    The  challenges and opportunities of the new aging in Pima 
County are distinctive and require separate consideration.  Nevertheless, these proposals are 
inclusive, not exclusive, of the objectives set by the state.  Objectives are identified as State or 
Area.   
 
State Objectives  are  those  identified  by  the Aging  and  Adult  Administration  in  the  State  Plan.  
These objectives stop short of suggesting specific actions or coordinating entities to carry out the 
objective.   Area Objectives are those proposed by the local Area Agency on Aging,  the  Pima 
Council on Aging (PCOA).  Following both state and area objectives are suggested actions and 
coordinating  entities  that  are  identified  to  champion  the  objective  and  to  pursue  policy 
development and implementation strategies.   
 
Meeting  the  challenges  of older adults, today, and in the future