HHSC updates Aging Texas Well Strategic Plan, identifies policy priorities for caregivers


Soraya Marashi


On Dec. 3, the Texas Health and Human Services Commission (HHSC) published its 2022-2023 Strategic Plan for the Aging Texas Well (ATW) initiative. The plan is meant to serve as a guide for HHSC and other state agencies to support strategic planning to serve the approximately 9,245,560 adults aged 50 and older in Texas. 


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HHSC conducted a statewide survey in 2021 to identify the current and future needs of three groups of individuals: older adults, informal caregivers of older adults, and social service providers supporting older adults. The 2022-2023 ATW Strategic Plan presents the top priorities reported by each group, supports them with data, and identifies strategies for addressing them. 

The top three priorities among older adults were physical health, access to social engagement opportunities, and access to services and supports in the community.

Image: Texas Health and Human Services Commission

The plan states only 23.6% of Texans aged 65 and older met the federal guidelines for regular physical activity, citing the fact that 43.2% of Texas Medicare beneficiaries aged 65 and older have four or more chronic conditions which may influence their ability to be physically active.

HHSC also emphasizes the loneliness and isolation older adults experienced due to the COVID-19 pandemic, resulting in a myriad of negative mental health effects including anxiety, depression, poor sleep quality and physical inactivity.

The agency acknowledges that community services and supports are critical for helping older adults age safely in their own homes. Additionally, many older adults experience increased financial distress as they age, with approximately 11% of Texans aged 65 and older living below the federal poverty level. 

HHSC identifies some preliminary strategies to address these priorities, including:

    • “Enhanced efforts to promote access to available services, and increased awareness of resources related to physical health, nutrition, and more.”
    • “Efforts to raise awareness of services, connect older adults on fixed incomes to free or low-cost services, and initiatives to help local organizations expand access to services.”
    • “Promoting awareness of virtual social groups, multigenerational programs, and other social engagement resources.”

The top three priorities among informal caregivers of older Texans were mental health concerns, physical health concerns, work strains/issues, resources and eligibility for services, and financial strains.

Image: Texas Health and Human Services Commission

The plan notes that, according to another recent HHSC report, 65.7% of informal caregivers said providing care while meeting other family and work responsibilities was stressful. HHSC emphasizes that while informal caregivers often feel great satisfaction in caring for their loved ones, their responsibilities can also negatively impact their mental health.

Regarding physical health, HHSC also notes the common tendency of informal caregivers to put their loved ones’ needs ahead of their own. The plan cites that over half of caregivers reported that their health affects their ability to provide care, according to the 2020 HHSC report on informal caregiving

The 61% of informal caregivers who are employed nationwide experience major work strains and issues, with the majority of caregivers reporting at least one impact to their employment as a result of their caregiving responsibilities, according to AARP. HHSC says 10% of these employed caregivers have had to give up work entirely or retire early in order to continue their caregiving duties. Additionally, 42% of all informal caregivers reported that providing care has strained their finances.

HHSC identifies some preliminary strategies to address these priorities, including:

    • “Promoting awareness of informal caregiver support services, education focused on specific conditions, such as Alzheimer’s, and efforts to expand informal caregiver support.”
    • “Promoting education and awareness of physical health resources for informal caregivers and efforts to expand informal caregiver support.”
    • “Efforts to expand local informal caregiver support and promoting awareness of informal caregiver challenges through education and training resources.”

The agency asked aging services providers about both their administrative priorities and their priorities concerning policies and program implementation. The top three administrative priorities among aging services providers were coordination and collaboration, funding, and staffing.

Image: Texas Health and Human Services Commission

HHSC emphasizes that coordination and collaboration help make the aging network stronger, stating: 

“Providing organizations with the opportunity to work together can help stretch strained budgets, increase their reach in the community, and enable them to provide needed services as well as create a sense of shared social capital.”

HHSC also emphasizes the importance of accessible and reliable funding that allows local organizations to expand their services, as well as maintain the quality and availability of social services for older Texans. 

The plan notes that a sustainable workforce of trained and reliable staff is necessary to ensure quality care without disruption of services, and that adequate funding is needed to hire, train, and compensate this workforce in order to meet the growing demand for services.

HHSC identifies two preliminary strategies to address these priorities.

    • “Promoting education, training, and opportunities for collaboration.”
    • “Efforts to increase awareness of funding sources.”

Service providers’ top three priorities related to policy and program implementation were addressing social isolation, supporting caregivers, and addressing food insecurity.

Image: Texas Health and Human Services Commission

The plan says older adults were at an increased risk for social isolation and loneliness even before the pandemic, and though many organizations have been exploring strategies to decrease social isolation in their communities, barriers such as transportation access and access to broadband prevent many older adults from engaging with the community. 

The plan also notes that many older adults in Texas struggle to obtain healthy food and are often forced to make difficult decisions between food or medical care due to its rising costs. The plan asserts that a lack of nutritious food can lead to a myriad of negative health outcomes for these older adults, often putting them at risk for chronic conditions. 

Service providers also prioritized supporting informal caregivers. The plan states:

“The availability of locally accessible, reliable informal caregiver support is essential to these long-distance informal caregivers and their loved ones.”

HHSC identifies some preliminary strategies to address these policy priorities, including:

    • “Promoting social engagement and volunteer opportunities, as well as developing and sharing training on social isolation.”
    • “Promoting education and training on food resources for program specialists, expanding food resources, and promoting malnutrition awareness.”
    • “Promoting education and training on supporting informal caregivers.”