The State Plan Context sets the stage for the State Plan and describes the issues to be addressed in the rest of the document. The Context conveys a clear understanding of the current and future service and support needs of the state's older residents, and the issues, challenges and opportunities facing the Aging Network.

This section of the State Plan identifies the mission and values that will guide the Plan. The Administration on Aging's strategic goals should be acknowledged up front, and there should be a brief discussion about how the state and federal visions interrelate.

    DECISION POINT: Mission and Values  See also AoA Strategic Action Plan 2007-2012

The Context should consider history, current conditions, and the future, and should answer these questions:

• Who are the current and future older persons? What are their needs?
• How are the Aging Network and Long-Term Care system organized to support older persons? What is the role of the SUA in long-term care?
• What are the critical issues/trends? What are the future implications?
• What are the strategic opportunities to leverage to improve the state system?
• What are the challenges?
• What are the resources?

Q-1  Who are current and future older persons? What are their needs?

The Aging Network operates in both internal and external environments, or contexts. State demographic trends and service utilization patterns are one of the keys to understanding these contexts. Data and statistics in the State Plan should focus on factors most applicable to the state. The State Plan Context provides an excellent opportunity to discuss targeting services to under-served population(s). For example, a targeted population may include specific racial and ethnic minorities, people living in rural areas, and/or people on waiting lists.

    DECISION POINTS: Environmental Scans; Needs Identification. See also Strategic Planning Process

• State population figures, including numbers of oldest old
• State rankings compared to national data
• Special populations (e.g., Alzheimer's and related dementias; caregivers; persons with disabilities)
• Underserved populations, private pay, persons with life long disabilities who are aging, other future populations

• Persons served by Medicaid; Medicare; state general revenues; Older Americans Act; Social Services Block Grant; other funding sources
• HCBS utilization versus institutional care (expenditures, utilization rates)
• Waiting lists
• Persons who are under-served by HCBS and other aging programs

Q-2  How are the Aging Network and long-term care system organized? What is the role of the state agency on aging in long-term care?

The State Plan Context should include detailed information about the State Aging Network and the state long-term care system. The State Aging Network's pivotal role in addressing the needs of older individuals living at home and in institutions must be considered. The state agency's capacity to play a key role in long-term care reform depends, at least in part, upon its placement within state government and current administrative responsibilities.

    DECISION POINT: Environmental Scans

• SUA location in state government
• Organization of the Aging Network
• Administrative responsibilities of the state agency on aging and the area agencies on aging

• Who administers HCBS (Medicaid, state-funded, SSBG, other) for the elderly?
• Role of the SUA in setting policy and direction for HCBS and other long term care services
• Role of the Aging Network in serving persons with disabilities

Q-3  What are the critical issues/trends? What are the future implications? What are the challenges?

The political and economic conditions that support or hinder the SUA's influence are important considerations for the future development of the Aging Network. Historical state trends, such as the degree to which spending for nursing facility care dominates the Medicaid budget or a priority on serving populations other than older adults in the community, must be considered. Such developments may challenge the Aging Network's ability to move toward a community based service system for older people.

Conversely, a trend such as the emergence of a strong advocacy voice on behalf of home and community long term care options for older people may enable the SUA to develop ambitious goals in the coming planning cycle.

The focus of the State Plan is on the activities to be undertaken during the current planning cycle, as well as anticipated trends impacting the Aging Network and the state's older residents in the future. The Plan laid out should not focus solely only current conditions and challenges. A future orientation will ensure that the Aging Network is positioned to seize opportunities and respond to future challenges.

• Long-term care services available to older people
• Funding patterns for institutional and home and community based services
• The degree of integration between long-term care programs and the SUA (i.e., access, program policies and practices, and administration)
• New/anticipated initiatives at the state and federal levels
• Funding opportunities
• Significant research findings related to aging and long-term care
• Trends in Medicare, Medicaid, Social Security, housing, transportation, health care, prevention and chronic care, long-term care
• The emergence of advocacy/interest groups
• Disasters
• Major economic, social, political events

• Long-term care reform/rebalancing efforts in the state
• Vulnerable populations
• Gubernatorial and state legislative Initiatives
• State strategic goals
• 2006 Amendments to the Older Americans Act
• AoA Strategic Action Plan
• CMS Strategic Plan, HHS Annual Plan
• Program and regulatory directives

National trends and developments likely to influence the Aging Network (e.g., Money Follows the Person,Choices for Independence) and state developments and initiatives (e.g., legislative study of the long-term care workforce, hearings on nursing home quality, gubernatorial directives to reorganize long-term care) must be considered in the Plan.

The State Plan Context responds to Questions 1-3 listed above and lays the groundwork for responding to the following Questions 4-7 in the rest of the Plan.

• To what extent are older people in the state able to access home and community services responsive to their needs and preferences?
• To what extent do we have an integrated elder rights system to ensure the state is able to quickly and effectively protect seniors from threats to independence, well-being and financial security? (focus area: elder rights)
• How has the Aging Network worked to address this issue in the past?
• What is the overall direction in which the Network is moving?
• What opportunities will support older people and the Aging Network moving toward a community based long term care system?
• What challenges need to be addressed to achieve the overall goal of balanced long term care in the state?
• How will the Network's planned activities for the coming 2 to 4 years provide greater access for older people to community long term care options?
• How will the Network's planned activities for the coming 2 to 4 years provide for a stronger, more visible role for the network in long term care?

The State Plan on Aging may need to address a number of side issues related to the critical questions listed above. Additional questions may also need to be answered related to state-specific issues, such as new initiatives of the Governor or State Legislature, or priorities identified by a master comprehensive state plan.