Charles Lockhart - Aging across the United States : Matching needs to states differing opportunities and services

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Aging Across the United States

Library of Congress
Cataloging-in-Publication Data

Lockhart, Charles, 1944 .

Aging across the United States : matching need to states differing opportunities and services / Charles Lockhart and Jean Giles-Sims.

p. cm.

Includes bibliographical references and index.

Summary: Compares services and opportunities for older Americans by region and state. Examines the criteria of recreational lifestyle, meaningful contributions and supportive communities, affordability and safety, health and high-quality medical care, and accessible, high-quality long-term careProvided by publisher.

ISBN 978-0-271-03756-1 (alk. paper)

1. Older personsUnited StatesStates.

2. AgingUnited StatesStates.

I. Giles-Sims, Jean.

II. Title. HQ1064.U5L63 2010

305.260973dc22 2010021723

Copyright 2010
The Pennsylvania State University

All rights reserved

Printed in the United States of America

Published by
The Pennsylvania State University Press,
University Park, PA 16802-1003

The Pennsylvania State University Press
is a member of the
Association of American University Presses.

It is the policy of The Pennsylvania State University Press to use acid-free paper. Publications on uncoated stock satisfy the minimum requirements of American National Standard for Information SciencesPermanence of Paper for Printed Library Material, ANSI Z39.481992.

This book is printed on Natures Natural, which contains 50% post-consumer waste.

In Loving Memory of Our Parents:
Wilbur and Dorothy Grindell
Charles H., Gertrude, and Elizabeth Lockhart

CONTENTS

The state ranking appear in the Appendix

This study grew out of recent troubling and often sad experiences with our parents, to whom we dedicate this book. Across something more than a decade we watched, initially from the sidelines, but increasingly over time from the field of action, as they became progressively more physically frail, cognitively limited, or both. Lengthy portions of this process occurred in different states, and we were repeatedly surprised by how much the experiences in one state differed from those in another.

We decided to learn more about the underlying reasons for these differences. So academics happily engaged in research on comparative public social policy and aspects of family sociology involving much younger persons became gerontologists with the encouragement and assistance of others.

So, whatin briefhave we learned? First, older citizens form a heterogeneous population with different priorities associated with successive stages of aging. Second, the American states turn out to be specialists, rather than generalists, with regard to supporting these various priorities. So, third, sequentially realizing the shifting priorities of an older couple often entails a pair of cross-state moves as they age, moves designed to match their current priorities to different states distinctive strengths.

In developing this book from these three fundamental points, we have enjoyed the assistance of a number of persons. While we each found the process of learning and, particularly, writing as spouses to pose numerous unanticipated challenges to our relationship, each of us grew to appreciate more fully the others talents and capacities. Neither of us could have produced this book on her or his own.

Murray A. Straus encouraged us to examine cross-state differences in what he called state elderly-friendliness systematically. An early version of our thinking on this topic appeared in Publius: The Journal of Federalism 35, no. 3 (2005): 42547. This terminology has gradually morphed into the state senior friendliness found in this book. Some authors are now using the term age-friendly states to express a similar concept. The late Marc Miringoff provided a wonderful example for us to loosely emulate in his The Social Health of the Nation: How America Is Really Doing (with Marque-Luisa Miringoff) (New York: Oxford University Press, 1999). Frank Caro, Christine L. Day, and Sandy Thatcher read the manuscript and made numerous helpful suggestions, prompting improvements.

This book centers on state rankings on forty indicators (eight for each of five dimensions) of state senior friendliness. We are grateful to a number of institutions, such as the U.S. Census Bureau and the Inter-University Consortium for Political and Social Research at the University of Michigan, which either create or maintain the data on which these rankings are based. We cite these and a number of other institutions that provided data frequently throughout the text. Here we wish to express our gratitude to persons at various institutions who have been particularly helpful in making data available. Thanks especially to Gretchen Straw, AARP; Elizabeth Gough, American Foundation for Suicide Prevention; Gina Flores and Alan Schafer, Arizona Health Care Cost Containment System; Robert Clair, U.S. Census Bureau; Tara Balsey, Centers for Disease Control; Lori Anderson, Deborah Kidd, and especially Janet G. Freeze, Centers for Medicare and Medicaid; Bob Mollica, National Academy for State Health Policy; and Steve Eiken, Thomson Medstatt.

Sanford G. Thatcher, director of Penn State University Press, expressed an interest in our research and provided crucial support as the book developed. Erin Greb, a cartographer at the Gould Center for Geography Education and Outreach at Penn State, created the maps scattered throughout the text from our tables. Kathryn Yahner ably managed the transformation of our manuscript into a book.

Born in 1944 and 1945, we often find ourselves thinking about the questions in the book with respect to our own lives. Unsurprisingly, given our generation, we sometimes need help with the computers that younger generations find intuitive. Trey Ivy, Jason Packer, Amanda Giles, and Andrea Sims provided this help with extraordinary good humor when we faced the limits of our computer savvy. Each of us had previously worked with qualitative methodologies, and the current project required us to update and deepen our statistical analysis skills. Kristen Klopfenstein and Cathy Coghlan helped us immensely in overcoming data analysis problems and provided us with the skills to manage the data analysis for this book ourselves.

Ralph Carter, Pat Kinkaid, Mary Volcansek, and Nowell R. Donovan at TCU all supported an academic leave in the spring term of 2007 that facilitated our completing the manuscript in a timely fashion.

During the writing of this book, Jeans good friend Dee Sharlip became ill and required extensive medical care. All of us face these risks in the short or long term, and we hope that we all will find a graceful way to face them. The humor of Gregg Franzwa, Richard Galvin, and other members of the optimists has, thankfully, enabled Charles to survive the stresses of shifting trends in academic management for decades. Our three childrenAndrea, Gregory, and Johnand our whole family motivate us to make the world a better place for future generations in whatever small way we can.

Garrison Keillors amusing stories about the residents of an imaginary small northern Minnesota town who fantasize in February, not about sex, but about living in Florida remind us of one way in which where we live influences our well-being as we grow older. Indeed, once they retire, many Minnesotans spend their winters in Florida or other states with milder winter climates and a range of outdoor recreational opportunities. Some Minnesotans move entirely to these other states, at least during their early retirement years. But later in retirement they develop different needs, and among persons eighty-five or older, Minnesota actually has net

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