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Increases in the availability and use of home-based and other support services may help seniors remain in their homes and communities.

Food insecurity is the percentage of adults aged 60 and older who faced the threat of hunger in the past 12 months. Since 2017, food insecurity decreased from 15.8 percent to 13.6 percent in 2019. This 14 percent drop reversed an upward trend between 2013 and 2017 (Figure 8). Despite recent progress, food insecurity among seniors is expected to increase through 2050 as baby boomers age, according to Feeding America, a nonprofit focused on fighting food insecurity. Seniors experiencing food insecurity may have reduced intake of vital nutrients, which could have negative implications for overall health. Studies indicate food insecurity is associated with increases in heart attack, diabetes, high blood pressure, asthma and depression.
In Louisiana, the least healthy state for this measure at 21.7 percent, food insecurity is 3.7 times higher than in Colorado, the healthiest state for this measure at 5.8 percent. Figure 9 shows that since 2017, food insecurity among seniors decreased in Colorado (-7.9 percentage points), Arkansas (-7.4 percentage points), Kansas (-5.5 percentage points), New York (-5.3 percentage points) and Vermont (-5.0 percentage points). It increased in New Mexico (+9.4 percentage points), Alaska (+4.4 percentage points) and West Virginia (+4.2 percentage points). Another 11 states, including New Hampshire and Pennsylvania, had increases in food insecurity over this same period.

Supplemental Nutrition Assistance Program (SNAP) reach is the number of adults aged 60 and older who participate in SNAP per 100 adults aged 60 and older living in poverty. SNAP is the largest federal nutrition program, helping millions of low-income Americans access food and improve their economic security and health. While program eligibility requirements vary by state, the majority of SNAP participants are living in poverty. Since 2015, SNAP reach increased 13 percent from 71.8 to 80.9 participants per 100 adults aged 60 and older living in poverty, or an estimated 5.4 million seniors (Figure 10).
Connecticut, the District of Columbia, Massachusetts, New York, Oregon, Pennsylvania, Rhode Island, Vermont, and Washington all have a SNAP reach of 100 participants per 100 adults aged 60 and older living in poverty. This is 3.6 times higher than in Wyoming (27.5 participants per 100 adults aged 60 and older living in poverty), the least healthy state for this measure. Figure 11 shows that since 2015, the largest improvements occurred in California (+19.2 percentage points), North Carolina (+18.3 percentage points), Nevada (+17.4 percentage points), Louisiana and Montana (+16.8 percentage points), Pennsylvania (+16.3 percentage points) and Maine (+15.3 percentage points). The largest declines occurred in Alaska (-25.0 percentage points), New Hampshire (-12.5 percentage points), Tennessee (-11.7 percentage points), Hawaii (-10.9 percentage points) and Kentucky (-10.4 percentage points).

Home health care workers is the number of personal care and home health aides per 1,000 adults aged 75 and older. Home health care workers increased 21 percent in the past year from 112.3 to 135.5 workers per 1,000 adults aged 75 and older and 44 percent in the past six years from 93.8 workers per 1,000 adults aged 75 and older (Figure 12). The number of home health care workers grew more than 550,000 from 2018 to 2019. Home health and personal care aides enable seniors to remain in their homes by providing short-term, skilled nursing services for seniors with functional decline or chronic illness. According to the Bureau of Labor Statistics, the need for long-term support and services — including home health care — is expected to increase 41 percent over the next decade to accommodate the growing senior population.
The number of home health care workers per 1,000 adults aged 75 and older varies widely across states. There are 8.2 times more home health care workers in the healthiest state for this measure, Minnesota at 263.9 workers per 1,000 adults aged 75 and older, than in the least healthy state for this measure, Florida at 32.2 workers per 1,000 adults aged 75 and older (Figure 13).

Hospice care is the percentage of Medicare decedents aged 65 and older who were enrolled in hospice during the last six months of life after diagnosis of a condition with a high probability of death. Hospice care increased 5 percent in the past year from 52.0 percent to 54.4 percent, and 48 percent in the past six years from 36.7 percent (Figure 14). Hospice care is for terminally ill patients; it emphasizes pain control and emotional support, as opposed to focusing on a cure, for patients and families. According to a report funded by the Medicare Payment Advisory Commission, Medicare hospice use has nearly doubled over the past decade.
Hospice care is 2.3 times higher in Utah, the healthiest state for this measure at 67.1 percent, compared with the least healthy state, North Dakota at 29.2 percent. Since 2013, there have been increases in hospice care use in all 50 states and the District of Columbia. Figure 15 shows the largest increases occurred in Hawaii (+29.3 percentage points), Maine (+28.2 percentage points), Arkansas (+26.6 percentage points), South Carolina (+24.9 percentage points), and Rhode Island and Wisconsin (+23.4 percentage points). The smallest increases were in North Dakota (+5.4 percentage points), Colorado (+10.6 percentage points), New York (+10.9 percentage points), Nevada (+11.6 percentage points) and Arizona (+11.9 percentage points).

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