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State of the States Survey 2011: State Aging and Disability Agencies in Times of Change


This 2011 report is an update to the 2009 State of the States report. The National Association of States United for Aging and Disabilities (NASUAD) created this report to highlight the roles and responsibilities of state aging and disabilities agencies, and uncover underlying themes related to long-term service and support systems transformation.

Key Points

NASUAD surveyed 56 states and territories, and 55 member state agencies responded. It was stated that NASUAD member state agency operations are impacted by a variety of factors, including aging and disability trends, state budgets, and the LTSS provider marketplace. With this in mind, it was concluded that agency restructuring is common because states are reorganizing how they conduct business and deliver services, state agencies are experiencing an increase in new leadership that is resulting in loss of historical knowledge, Medicaid managed long-term care is expanding rapidly, a number of states are interested in state-level health reform activities even though a number of states noted lack of involvement in Affordable Care Act options, and the majority of agencies are mainly concerned about balancing budgets with the growing demand for services. 

Based on these conclusions, report highlights include:

  1. In the 2011 survey, it was noted that 76 percent of state directors had served for five years or less.
  2. The main reasons for agency restructuring are administrative simplification, comprehensive vision, consistent policymaking, and budget and personnel reductions.
  3. Beyond budget concerns and the increasing need for services, state agencies face challenges associated with insufficient state staff to operate and oversee a larger and more diverse array of services and supports.

How to Use

State aging and disability services are essential due to the economic downturn coupled with the rapidly expanding older adult population, making it all the more pertinent for officials and planners to discover agency needs, challenges and opportunities. This document is particularly helpful for local planners and officials when considering state budget needs for supplying sufficient resources to meet the growing demand for state agency services and staffing because it provides both a snapshot of agency roles and responsibilities, but also detailed information about the growing demand for and restructuring of these agencies.

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