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

Preface

PREFACE 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, what—in brief—have 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 other’s 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): 425–47. This terminology has gradually morphed into the “state senior friendliness” found in this book. Some authors are now using the term “agefriendly 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...