A national mental health advocacy organization called Inseparable has released a report on the rollout of the 988 crisis line for people going through a mental health emergency.

Iowa scored well but there are still questions over how to pay for the service. The report called for Iowa and other states to expand 988 call-center capacity, increase the number and availability of mobile mental-health response units, create more crisis stabilization centers, and find ways to pay for it all.

Iowa came close to its goal of answering 90% of its calls in a timely manner, and is working on creating more than two-dozen mobile response teams.

Angela Kimball, chief advocacy officer for Inseparable, said the 988 mental health services need to be available to everyone who needs them, 24/7.

"Regardless of their ability to pay, just like we expect fire trucks to come if there's a fire," Kimball explained. "We don't ask for insurance information first. Police come. They don't ask whether or not there is an insurance card or payer first."

Iowa is considering several ways to pay for the 988 service, including a surcharge, billing commercial insurance or by asking for money from the federal Medicaid program.

Kimball said the 988 system needs effective communication between mental health, emergency first responders and police, and added given the high stakes in mental health emergencies, a botched response is not an option.

"One in five fatal police shootings involve someone with mental illness," Kimball pointed out. "Too often we see really a tragic outcome when people don't get the right help."

A 98-cent surcharge on Iowans' phone service would generate more than 3 million dollars a year, according to Inseparable's data and the report is looking at ways to keep the service accountable no matter how it is paid for.

By Judith Graham for KFF Health News.
Broadcast version by Mike Moen for Minnesota News Connection reporting for the KFF Health News-Public News Service Collaboration

Donald Hammen, 80, and his longtime next-door neighbor in south Minneapolis, Julie McMahon, have an understanding. Every morning, she checks to see whether he's raised the blinds in his dining room window. If not, she'll call Hammen or let herself into his house to see what's going on.

Should McMahon find Hammen in a bad way, she plans to contact his sister-in-law, who lives in a suburb of Des Moines. That's his closest relative. Hammen never married or had children, and his younger brother died in 2022.

Although Hammen lives alone, a web of relationships binds him to his city and his community - neighbors, friends, former co-workers, fellow volunteers with an advocacy group for seniors, and fellow members of a group of solo agers. McMahon is an emergency contact, as is a former co-worker. When Hammen was hit by a car in February 2019, another neighbor did his laundry. A friend came over to keep him company. Other people went on walks with Hammen as he got back on his feet.

Those connections are certainly sustaining. Yet Hammen has no idea who might care for him should he become unable to care for himself.

"I'll cross that bridge when I come to it," he told me.

These are fundamental questions for older adults who live alone: Who will be there for them, for matters large and small? Who will help them navigate the ever more complex health care system and advocate on their behalf? Who will take out the garbage if it becomes too difficult to carry? Who will shovel the snow if a winter storm blows through?

American society rests on an assumption that families take care of their own. But 15 million Americans 50 and older didn't have any close family - spouses, partners, or children - in 2015, the latest year for which reliable estimates are available. Most lived alone. By 2060, that number is expected to swell to 21 million.

Beyond that, millions of seniors living on their own aren't geographically close to adult children or other family members. Or they have difficult, strained relationships that keep them from asking for support.

These older adults must seek assistance from other quarters when they need it. Often they turn to neighbors, friends, church members, or community groups - or paid help, if they can afford it.

And often, they simply go without, leaving them vulnerable to isolation, depression, and deteriorating health.

When seniors living alone have no close family, can nonfamily helpers be an adequate substitute? This hasn't been well studied.

"We're just beginning to do a better job of understanding that people have a multiplicity of connections outside their families that are essential to their well-being," said Sarah Patterson, a demographer and sociologist at the Institute for Social Research at the University of Michigan.

The takeaway from a noteworthy study published by researchers at Emory University, Johns Hopkins University, and the Icahn School of Medicine at Mount Sinai was this: Many seniors adapt to living solo by weaving together local social networks of friends, neighbors, nieces and nephews, and siblings (if they're available) to support their independence.

Still, finding reliable local connections isn't always easy. And nonfamily helpers may not be willing or able to provide consistent, intense hands-on care if that becomes necessary.

When AARP surveyed people it calls "solo agers" in 2022, only 25% said they could count on someone to help them cook, clean, get groceries, or perform other household tasks if needed. Just 38% said they knew someone who could help manage ongoing care needs. (AARP defined solo agers as people 50 and older who aren't married, don't have living children, and live alone.)

Linda Camp, 73, a former administrator with the city of St. Paul, Minnesota, who never married or had children, has written several reports for the Citizens League in St. Paul about growing old alone. Yet she was still surprised by how much help she required this summer when she had cataract surgery on both eyes.

A former co-worker accompanied Camp to the surgery center twice and waited there until the procedures were finished. A relatively new friend took her to a follow-up appointment. An 81-year-old downstairs neighbor agreed to come up if Camp needed something. Other friends and neighbors also chipped in.

Camp was fortunate - she has a sizable network of former co-workers, neighbors, and friends. "What I tell people when I talk about solos is all kinds of connections have value," she said.

Michelle Wallace, 75, a former technology project manager, lives alone in a single-family home in Broomfield, Colorado. She has worked hard to assemble a local network of support. Wallace has been divorced for nearly three decades and doesn't have children. Though she has two sisters and a brother, they live far away.

Wallace describes herself as happily unpartnered. "Coupling isn't for me," she told me when we first talked. "I need my space and my privacy too much."

Instead, she's cultivated relationships with several people she met through local groups for solo agers. Many have become her close friends. Two of them, both in their 70s, are "like sisters," Wallace said. Another, who lives just a few blocks away, has agreed to become a "we'll help each other out when needed" partner.

"In our 70s, solo agers are looking for support systems. And the scariest thing is not having friends close by," Wallace told me. "It's the local network that's really important."

Gardner Stern, 96, who lives alone on the 24th floor of the Carl Sandburg Village condominium complex just north of downtown Chicago, has been far less deliberate. He never planned for his care needs in older age. He just figured things would work out.

They have, but not as Stern predicted.

The person who helps him the most is his third wife, Jobie Stern, 75. The couple went through an acrimonious divorce in 1985, but now she goes to all his doctor appointments, takes him grocery shopping, drives him to physical therapy twice a week and stops in every afternoon to chat for about an hour.

She's also Gardner's neighbor - she lives 10 floors above him in the same building.

Why does she do it? "I guess because I moved into the building and he's very old and he's a really good guy and we have a child together," she told me. "I get happiness knowing he's doing as well as possible."

Over many years, she said, she and Gardner have put their differences aside.

"Never would I have expected this of Jobie," Gardner told me. "I guess time heals all wounds."

Gardner's other main local connections are Joy Loverde, 72, an author of elder-care books, and her 79-year-old husband, who live on the 28th floor. Gardner calls Loverde his "tell it like it is" friend - the one who helped him decide it was time to stop driving, the one who persuaded him to have a walk-in shower with a bench installed in his bathroom, the one who plays Scrabble with him every week and offers practical advice whenever he has a problem.

"I think I would be in an assisted living facility without her," Gardner said.

There's also family: four children, all based in Los Angeles, eight grandchildren, mostly in L.A., and nine great-grandchildren. Gardner sees most of this extended clan about once a year and speaks to them often, but he can't depend on them for his day-to-day needs.

For that, Loverde and Jobie are an elevator ride away. "I've got these wonderful people who are monitoring my existence, and a big-screen TV, and a freezer full of good frozen dinners," Gardner said. "It's all that I need."


Judith Graham wrote this story for KFF Health News.

Churches are often seen as cornerstones of their communities in North Carolina and elsewhere, but Swansboro United Methodist Church in Onslow County has elevated that role to a critical lifeline for disaster response and recovery.

Combining faith, preparation and strategic partnerships, the church has become a hub of support for both its local community and regions far beyond.

Since launching its mission during the devastation of Hurricane Florence in 2018, leaders say their efforts demonstrate how faith-based leadership can help mobilize resources and rebuild lives.

Layne Harpine, D.M. - Swansboro's director of community life - said the church continues to rise to meet these challenges.

"It could be the immediate response of people that are certified to get out there and do assessments in homes, in communities," said Harpine, "whether it's putting tarps on roofs, whether it's providing shelters, food, and support, clothing."

Swansboro UMC's Disaster Recovery Center operated for 18 months after Hurricane Florence, staffed by a team managing everything from construction to casework. Harpine said these efforts not only provided immediate relief, but also laid the groundwork for longer-term recovery in the region.

Harpine said the church has also become a hub for disaster training, partnering with United Methodist organizations and local agencies to equip volunteers.

He said this ensures teams are ready to respond when disasters strike.

"The Emergency Response Training Certification gives you a badge that you can go out and be the first people out and about doing these assessments, doing responses and then getting people to plug in," said Harpine. "We just didn't do it for ourselves. Through partnerships, Swansboro United Methodist Church should be the hub for that type of initiative, that type of training."

Lead Pastor Laura Thompson said disaster relief is all about teamwork, requiring collaboration and resilience, and the belief that no one should have to face the challenges of disaster recovery alone.

The church recently stepped in to help western North Carolina, sending essential items to support those recovering from devastating storms there.

"It's something that takes all of us, and you know, the proverb stands - if you want to go fast, go alone, and if you want to go far, go together," said Thompson. "So, we're learning that this is not something that we can do alone, and it is not something that is efficient and speedy work."

Their efforts reflect a recent Duke Endowment report, highlighting how rural Methodist churches play a critical community role by mobilizing resources, delivering essential services and acting as trusted pillars of support in times of need.




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AARP Connecticut is awarding funds to seven groups through its Livable Community Grants program.

Some projects awarded funding include the new internet café at the West Haven Senior Center, shade sails for the outdoor seating at Thrive 55's Active Learning Center and outdoor benches for the Flanders Nature Center and Land Trust's new pavilion.

Kelli Lefler, associate state director of community outreach for AARP Connecticut, said deciding which projects will receive funding is challenging.

"Part of what we look at is how is it impacting the community," Lefler explained. "For a community to really be livable, we want it to be livable whether you're 8 years old or 80 years old. So, if it's just helping one piece of that population, that might not make the cut."

Other considerations are how much impact a project will have, specifically if it benefits a niche audience or the broader community. This year, there were 80 submissions for projects, which Lefler noted all had merits. Once the organizations receive the funding, they have a year to complete the projects with a follow-up report due to AARP Connecticut to see how the project is being used.

Since beginning in 2018, 45 projects in the state have received funding through the program. Typically, the group sees 50 to 75 applications annually, although some are disqualified for not being filled out properly. Lefler added many projects submitted this year were grant-worthy, although they did not make the final cut.

"There was a request for basically like a ramp that a wheelchair can use," Lefler observed. "They place it on the beach and it goes into the water so that wheelchair users have more access to get over the sand and to actually enjoy the water."

She added projects receiving funding can help municipalities make spaces accessible for seniors to age in place.