The Missouri Department of Health & Senior Services unveiled its new “Aging with Dignity: Missouri’s Master Plan on Aging” last week. This ten-year plan is designed to help guide the state's priorities for seniors and adults with disabilities.
This plan has been in development since 2023, when former Governor Mike Parson issued an executive order identifying the need for such a report.
Mindy Ulstad, the Bureau Chief for Senior Programs at the DHSS, said the plan took years to develop because the process included input from more than 10,000 Missourians by way of committee involvement, public surveys and town halls throughout the state.
“Missouri, like the rest of the nation, is aging. By 2030 to 2034, older adults will outnumber children for the first time in our history,” Ulstad said. “And we knew there were not enough programs and services for the individuals we're trying to serve now, and if we didn't start preparing — we were going to be in trouble.”
The 115-page plan ended up being separated into seven main areas of focus. Each section identifies goals, gives recommendations and classifies individual action items as Lower Effort (L), Medium Effort (M) or Complex Effort (C).
Ulstad said it was important for the plan to be broken down in such a way because it provides guidance to stakeholders on how they can implement parts of the plan — especially while there’s no state funding attached to the Master Plan on Aging.
“We also developed that local implementation guide, and that was really important to us,” Ulstad said. “We wanted people at the local level to be able to take any pieces that they thought was important for their local area and be able to have the structure and resources to be able to do things on the local level.”
Ulstad admitted one thing that surprised her, as well as other state agencies involved in the process, was how much confusion existed about what resources were available to families.
She said, due to this, state agencies are refocusing attention on education and cross-agency coordination.
Daily Life & Employment
The first section of the plan focuses on how adults work and spend their time outside of the workplace, such as social gatherings and volunteer opportunities.
According to the plan, “As people age, social connectedness becomes increasingly essential. Studies have shown that loneliness can lead to declines in physical health, mental well-being, and overall quality of life.”
Ulstad said to think of this subsection in two ways — one being helping older adults and those with disabilities find meaningful employment and volunteer opportunities, and the second being to ensure that a rich, active social life is possible throughout the state.
“We really talked a lot about accessible park spaces and recreation spaces, and making sure that sidewalks are walkable for everyone, and making sure that communities are accessible to everybody,” Ulstad said.
One of the recommendations from the subcommittee is to increase access to online spaces and create more opportunities for continued education.
Some of the specific ideas for this section include working with universities and community colleges to create classes for older folks and developing the Geriatric Workforce Enhancement Program (GWEP) to get more young people working with older adults and adults with disabilities.
Family Caregivers
The plan also placed a significant focus on the well-being of caregivers — especially family members who often go unpaid.
According to the report, Missouri also has at least 800,000 family caregivers who provide care worth roughly $11 billion in economic value each year. But, as emphasized in the report, this work is stressful and can have adverse effects on the physical and mental health of caregivers.
Ulstad said individuals across the state identified the need for more support, training and resources for family caregivers — including better options for respite care, or short-term and temporary breaks for primary caregivers.
Columbia University’s Mailman School of Public Health determined in a 2025 analysis that Missouri is still considered “safe for now” when it comes to the number of family caregivers. But, Ulstad said, this could change as people age and younger individuals choose to have smaller families.
“We're seeing much more reliance on caregivers — whether that's a natural caregiver or relative, a neighbor, a church friend, someone along those lines, or a paid caregiver. We just really are seeing more and more reliance on that,” Ulstad said. “And we know that we've got to be able to support those individuals, for them to be able to stay healthy and be able to take care of their needs and anyone else they're caring for, too on top of the older adults or adults with disabilities.”
One of the specific recommendations set forth in the plan is to invest more in the professional caregiver workforce in the state through training, expanded benefits and opportunities for career advancement.
Housing & Aging in Place
The next section of the new master plan calls for more affordable and accessible housing throughout the state.
“We know from years and years and years' worth of surveys and town halls and different ways of collecting information that people want to be at home as long as they can, they're more comfortable at home. They have a better life quality at home,” Ulstad said.
She said this includes making sure more housing stock is available in the first place, but also making sure that Missourians have ways to modify their hopes to meet changing needs over time.
This could include waivers or financial assistance for the addition of walk-in showers, grab bars throughout a home, ramps at entryways and more.
The first recommendation in this section calls for the development of a state agency to oversee aging and housing. The report also calls for more overall investment in development, advocates for universal accessible design standards and recommends the creation of a centralized hub for information and resources related to affordable housing.
“So that people can age no matter what their ability is and not have to put a ton of additional funding into their homes to be able to do that,” Ulstad said.
Long-Term Services & Supports
One of the major concerns as Missourians continue to age is whether there are enough systems in place to support them.
This could include at-home services, such as meal preparation, personal care, transportation and housekeeping. But it could also include services outside the home, such as day centers for adults with disabilities and nursing homes.
“So, recognizing that that's necessary, and how we can best support people, not only to know what's available, but to help them through those processes,” Ulstad said.
According to the report, more than 68,000 Missourians are receiving home- and community-based services through Medicaid each month, more than 108,000 people are receiving home delivered or congregate meals and nearly 19,000 people are being served by local independent living centers.
Ulstad said the hope is that coordination between agencies could be improved, leading to a system that feels less difficult to navigate.
She added that more education about the system needs to be provided to Missourians, as well as more assistance with advanced care planning. This planning can help Missourians decide on the types of care they would prefer and figure out how to afford said care — ideally, before the need for it actually arises.
One of the ways they are already trying to help Missourians navigate the system is the “No Wrong Door” project, which is a collaboration ensuring that, no matter which agency a person enters, they can get cohesive answers to their questions and directed to appropriate resources.
“We want — no matter who is calling us — we want them to have information, to have access to the information they need when they need it,” Ulstad said. “So, a lot of work going into to that, along with the master plan, we're working on it together at the same time.”
Ulstad said the plan also addresses the need to maintain the resources that are available, while also working on increasing capacity for care throughout the state.
Safety & Security
Concerns about physical safety, as well as protections from scams and exploitation were other issues brought forth by Missourians during the town halls the state held as they developed the Master Plan on Aging.
“They really honed in on that abuse, neglect and exploitation, making sure that we're doing a lot of training on scams and AI,” Ulstad said.
She said it is also important to train more people on how to recognize abuse, neglect and exploitation among different groups — children, seniors and adults with disabilities.
Another of the plan's recommendations is to develop training for first responders so they are better prepared for interactions with adults with disabilities or dementia.
“They're often the first ones that are going to be called or interact with somebody if they are in an accident or if there is a situation going on,” Ulstad said. “And you don't want somebody getting hurt or getting arrested because they have a disability that the person didn't understand.”
Transportation & Mobility
“Housing and transportation are always one and two on access issues for older adults,” Ulstad said.
She added that transportation is a necessity for many older people and those with disabilities, who often have more regular medical appointments and, sometimes, are not able to drive themselves.
According to the report, transportation is also often one of the most common forms of caregiver support that is provided.
Ulstad said, through surveys and community town halls, it was found that many Missourians struggle with access to reliable transportation and, even more so, access to public transportation options.
“We're working really closely with MoDOT and Missourians for Responsible Transportation,” Ulstad said. “How can we help older adults and individuals with a disability have almost a one-shop call number or a one-shop website that they can go to and get the help they need because they don't always want to get on an app … It's great to have Uber and Lyft in the big cities, but if you can't use your smartphone or don't have a smartphone, what do you do?”
The report called for more investment in transportation infrastructure, as well as coordination between agencies offering similar services.
Ulstad added that since there is no state budget attached to the Master Plan on Aging, this section is one where local uptake — either by a local government or a community group — could be especially important.
Whole Person Health
Ulstad said the final section of the plan focuses on “whole person health,” the idea that a person’s overall well-being relates to more than just being “healthy” and accessing medical professionals.
The report identifies access to healthy food, physical activity opportunities, social connection and mental stimulation, as well as access to hearing, vision and dental care as components of whole person health.
“We know that if you're not taking care of those things, you're not truly taking care of your health,” Ulstad said.
The plan calls for more training for physicians in geriatric care, an increase in technological access to medical staff and more availability of programs that support health and wellness.
Ulstad said many of these programs help in combating isolation, which research has shown is deadly if left unaddressed.
“We've seen that the health impact of social isolation is the same as smoking 15 cigarettes a day,” Ulstad said. “It's very clear that people need to stay socially connected … for those that want to be involved with their community in any way, we are trying to do that through multiple different avenues.”
You can access a full transcript of the radio version of the story — here.
