The Crossroads of Aging in the United States: Will we encounter challenges or lag behind?
The United States is on the verge of a massive demographic shift that will transform health care, labor, housing and economy for future generations. By 2040, one in five Americans will be over 65 years old. It's not just a future issue – it's happening now, it's changing our perspective on aging, caring and quality of life.
We have faced such moments of change before. After World War II, the infant boom sparked unprecedented expansion of public education, suburban development and employer-based health care. In the 1960s, we saw the creation of Medicare and Medicaid, and the safety net transformed the opportunity to provide health care for older and low-income Americans. Today, we are facing similar estimate moments. Will we redesign our aging policies and systems to reflect modern needs, or do we allow outdated structures to bend under the pressure of demographic reality?
Aging is a national challenge, but the solution must be local
While more and more seniors are a national problem, the reality is that aging occurs in communities – in homes, communities, workplaces and healthcare settings, which are often not sufficient to meet changing needs. Addressing this shift will require coordination at all levels: federal, state and local governments must work together, while also attracting businesses, nonprofits and communities.
At the federal level, Medicare and Medicaid remain the main forces in funding long-term care. Recent efforts to expand Family and Community Services (HCB) in Medicaid and new reimbursement models for Medicare Advantage are promising steps – but they require ongoing funding, bipartisan commitment and regulatory stability. Without a long-term strategy, states will struggle to meet the needs of aging population.
The state recognizes that aging policies involve not only health care, but also infrastructure, labor and economic stability, and are in their own hands. New York, California and Massachusetts have developed a Master Aging Plan (MPA) that takes a broad approach – integrating health care, workforce policy, housing and transportation into a comprehensive vision for aging. These efforts laid the foundation for aging policies nationwide.
But while federal and state policies create frameworks, real changes happen at the local level. Cities and towns are places where housing access, transportation networks, caregiver support and social participation programs, either succeed or fail. Local governments, community organizations and businesses must be on the desktop – develop services that suit their reality for the people. If local services do not meet the real community needs, there is no amount of federal funding to solve the problem.
What can we learn from other countries
Although the United States is still working through its aging approach, other countries have tested and implemented models that can be used as inspiration.
Japan faces one of the world's oldest populations and has embraced technology and intergenerational housing. Robots provide caregivers with long-term care facilities, while aiming to reduce isolation and promote community engagement.
Scandinavian countries prioritize infrastructure and preventive health care for aging to ensure access to housing and integrated social services for older people, thus reducing the need for institutional care.
Germany has taken a different approach, providing long-term care insurance, providing universal coverage for services related to aging. The model integrates public funding with private innovation, ensuring that long-term care needs do not become an overwhelming financial burden for families.
There is no need to directly replicate any model in the United States, but we should take a closer look at these approaches, especially how other countries fund services, integrate technology and create sustainable long-term care models.
Aging is not just a government issue – it’s a problem for everyone
It is a mistake to assume that aging is a problem that the government solves separately. Businesses, philanthropy and local communities all play an important role in shaping the future where older people can thrive.
The private sector has begun innovating in home care technologies, financial planning for lifespan, and workplace policies suitable for older workers and caregivers. Employers need to rethink retirement policies, establish flexible work arrangements for older employees, and support home care workers who are taking up an increasing number of their workforce.
Charity and nonprofits are also stepping up, filling gaps in government plans. These organizations have tested new models of care, funds for aging programs, and advocate for policies that reflect the real needs of older Americans.
From a basic point of view, the community itself must be engaged. Aging should not occur in isolation. Faith-based organizations, neighborhood groups and volunteer networks can all play a role in ensuring older people stay connected and supported.
Now is the time to act
Aging is not a crisis, but evolution. This is a transition, if handled well, to create a society that values experience, supports independence and builds systems that make future generations. But if ignored, it would constitute public resources, deepen labor shortages, and create a fragmented and unequal system that would fail millions of dollars.
We know what to do. States must continue to develop overall plans for aging and investment in community-based services, workforce development and housing solutions. Federal policymakers must support these efforts through ongoing Medicaid funding, expanded HCBS selection and workforce incentives for caregivers. The private sector must establish workplaces for aging and drive innovation in home care and financial planning.
This is not only related to the elderly today, but it is about the next 50 years. If we now design a smarter and more sustainable system, then our time will benefit.
Now is the time to take action. Writing in the United States today the Future of Aging. What we choose to do next will define the health, safety, and dignity of generations.
Photos: izusek, Getty Images
Adam S. Herbst is a health care partner for Sheppard Mullin, New York, providing advice on health care policies, regulations and strategies to government agencies, hospitals, health systems, acute care post-providers and private equity firms. He specializes in reimbursement reform, regulatory compliance, value-based care and medical innovation. Previously, Adam served as deputy commissioner at the New York State Department of Health and two special counsel for the New York governor, shaping policies for one of the largest health care systems in the country. He leads modernization programs for the aging and disabled population, overseeing hospitals, nursing homes, family services and Medicaid programs.
Adam is an adjunct professor of health law and bioethics and is a recognized thought leader, often speaking and writing about health care visits, Medicaid policies and regulatory trends. His expertise helps clients browse emerging care models, Medicaid transformation, and strategic plans to initiate policies and practices.
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