A survey released by Age Wave and The John A. Hartford Foundation reveals widespread dissatisfaction among older adults with the U.S. health care system.

Four in five older adults (82%) say the U.S. health care system is not prepared for the growing and changing needs of America’s aging population. Just one in 10 (11%) give the health care system an ‘A’ grade. Instead of the status quo, older adults say they want solutions that will maximize their golden years, like interventions that make care more affordable, innovations to reduce or prevent cognitive decline and health care providers who understand what matters most to them when assessing care options.

Today, America ranks 50th in terms of lifespan and 68th in the world in terms of healthspan, according to the Institute for Health Metrics.

Other findings from the survey include:

• NEED FOR AGE-FRIENDLY CARE. Most older adults (94%) say it is more important to maintain quality of life than it is to live as long as possible. Only three in five older adults with a health care provider (58%) report that their providers currently ask about what matters to them. Though older adults fear Alzheimer’s and dementia more than any other health condition, for example, less than half (40%) say their health care providers routinely evaluate their cognitive health and brain functioning. Similarly, less than half of older adults (45%) say their health care providers evaluate their mental health, and although the ability to walk freely without pain is top of mind for older adults, just 55% say their medical care providers evaluate their mobility and physical fitness.
• NOT ENOUGH QUALIFIED CARE PROVIDERS. Experts say health care organizations have struggled to meet people’s needs in part because of workforce and talent shortages. Nearly all older adults (94%) say that health care providers should be trained on the unique health issues of people 65 or older, but only 10% of medical schools require a rotation in geriatric care, compared to 96% that require a rotation in pediatric care. Between 2000 and 2022, the U.S. population of adults aged 65 and older rose 60%, while the number of geriatricians dropped 28%.
• UNAFFORDABLE CARE. The poll shows health care costs are a bigger concern to older adults than living expenses, inflation, tax increases and an economic downturn or recession. Just 16%, for example, give an ‘A’ grade to satisfaction with their out-of-pocket costs. Older adults are especially concerned with the cost of long-term care, saying that one of their greatest concerns is not being able to afford future health and long-term care needs (68%), and that the government should prioritize having Medicare cover long-term care (80%).
• LOW-QUALITY NURSING HOMES. An estimated 36 million Americans have a family member or friend living in a nursing home or memory care facility today, according to the survey. Just 37% of those adults ages 18+ say their family member or friend living in a nursing home or memory care facility receives high-quality care. Only half (50%) say these facilities are the safest place for them.
• LACK OF COORDINATION. While 52% of Medicare beneficiaries see more than three physicians per year, half of older adults from the survey say their primary care provider does not coordinate their treatment with their other health care providers. This may be attributed to the increasing shortage of primary care providers, which makes it less likely for people to have a usual source of primary care or long-term relationship with a primary care provider.
• CONFUSION OVER COVERAGE. More than half of older adults (56%) say it is difficult and stressful to navigate the current health care system, while nearly two in three (62%) say health insurance plans provide too many confusing choices. Research has shown that more than half (55%) mistakenly believe Medicare will cover a long-term stay in a nursing home.

Recommendations from John A. Hartford Foundation and its partners include:

1. Promote age-friendly care that helps older adults maintain their health, ability to function and independence—focusing on wellness and quality of life rather than treating diseases.
2. Pursue scientific breakthroughs that could bring an end to diseases like Alzheimer’s.
3. Address social isolation in older adults by supporting tools for empathetic and respectful mental health care and support, tailored to individual needs.
4. Assist family caregivers with skill-building tools, flexibility in taking paid leave and ensuring care providers coordinate among multiple providers—making care easier to navigate.
5. Support a ‘national master plan for aging’ that is centered on the needs of older adults and identifies and addresses barriers that contribute to inequities—specifically a plan for financing long-term care and reform of nursing homes, including systems to provide health care in people’s homes rather than in acute and congregate settings.

Aside from the National Plan on Aging, the report recommendations appear to leave out a direct tie to encouraging connection and collaboration with age and dementia friendly communities. The Massachusetts Healthy Aging Collaborative supports those connections and partnerships between community and healthcare that can support the Age-Friendly Health System framework. A resource to help build this connection is available by contacting James Fuccione at MHAC (James.Fuccione@mahealthyaging.org).