Aging brings with it new questions on how we can live our best lives and a new book could help people answer some of those questions.

One of the most important focuses is on caregiving.

Debra Whitman is author of "The Second Fifty: Answers to the Seven Big Questions of Midlife and Beyond." She's originally from Electric City, Washington, and is an alumna of Gonzaga University. Whitman said when she reached age 50, she had a lot of questions. She noted caregiving is one of the tricky questions, especially for caregivers.

"Many people have to hire somebody in but that's extremely expensive," Whitman pointed out. "Nursing homes and long-term care facilities are extremely expensive. So, far too many people have to quit their job in order to care for somebody that they love."

Whitman noted there are more than 820,000 caregivers assisting a loved one in Washington state, more than one in 10 residents. Whitman is also chief policy officer for AARP. The organization has resources for caregiving on its website.

Whitman acknowledged Washington state is excelling in the caregiving arena in part because of the program WA Cares, which recently survived a ballot measure that would have gutted it. She said WA Cares lets people age at home.

"It offers some resources in order to pay either for the family member who has to take time off of work, to buy things to make their homes more accessible, or to pay a paid caregiver," Whitman outlined. "This is an incredible program that you have in Washington."

Whitman stressed caregivers need time off too, and people who are not caregivers can help with that.

"Sometimes just giving somebody an hour off to go get a haircut for themselves or to go to the doctor for themselves," Whitman added. "How can we as a community step in, give somebody a ride to a doctor's office? Lots of the different things that people need as they age."

What is the quality of Virginia's nursing homes? If you ask one advocate, he says "bad."

Jared Calfee, state advocacy director for AARP Virginia, said nursing home inspectors are "woefully" behind.

A possible legislative fix is a bill that would update what Calfee called the outdated fee structure for medical facilities.

The Virginia Department of Health would use those extra funds to increase recruitment and retention of inspectors. Calfee added understaffing can lead to worsening health for nursing home residents.

"What we know is that understaffing leads to negative outcomes, like pressure sores, falls, and ultimately sickness, and even death in a lot of cases," said Calfee. "And so the best thing that we can do for nursing home residents is ensure that there is adequate staff to provide quality care in our facilities."

The Virginia Joint Legislative Audit and Review Commission finds that nearly 40% of nursing homes are in need of their biennial state licensing inspection.

And the Commonwealth has the sixth highest proportion of nursing homes that have not been inspected within two years.

Another budget proposal would include $3.5 million to train Virginians as certified nurse aides, or CNAs.

CNAs provide the bulk of assistance within nursing facilities. Calfee said this small budget ask could have big impacts for nursing home staff.

"This is a high-demand area where we badly need staff," said Calfee, "so a program like this could take a relatively small amount of money, and hopefully infuse the workforce with badly needed staff - to make sure that our nursing homes can staff adequately."

A Virginia Health Care Association survey in 2022 found that 93% of facilities in the Commonwealth have openings for CNAs.

A number of bills in the Maryland legislature are looking to increase the quality and accountability of the state's nursing homes and assisted living facilities.

Advocates for seniors are supporting a bill that would require facilities to install video surveillance systems in common areas.

That way, there would be video evidence to monitor any neglect, abuse or exploitation of residents.
Another bill would increase the number of inspections of assisted living facilities.

Tammy Bresnahan the senior director of advocacy for AARP Maryland.

She said a lot of her focus this legislative session is on assisted living facilities, because of how many high-care individuals they take in.

"We've been looking at assisted living, because they're systematically taking more chronically health-needed individuals," said Bresnahan. "So they look a lot like what's in a nursing home, but people are privately paid for that."

Bresnahan explained that nursing homes have many layers of accountability, given the state and federal medicare dollars flowing into the facilities.

Assisted living centers, on the other hand, usually only receive funds from private customers - with little oversight.

Data from the Center for Medicare and Medicaid Services found Maryland has some of the longest wait times for nursing home inspections, at nearly three years.

Bresnahan added that it's important to have more inspections for assisted living facilities.

"The regulations really only require initially for the licensure to have the inspection - and if there's a problem, they have to go out," said Bresnahan. "So, they really want their assisted living to be inspected more often. "

Bresnahan said any Maryland senior considering a nursing home or assisted living facility should call the Maryland Office of Healthcare Quality.

That office can let seniors know if a facility has a history of issues.

Increasing housing options for the state's seniors is at the top of AARP Iowa's priority list for the new legislative session and the group is pushing for a tax credit for Iowa's growing number of family caregivers.

A lack of housing reduces options for Iowa seniors who want to age in place. Accessory Dwelling Units can help address the problem, from a small house or cottage on the property of an existing home, or even a garage apartment.

Paige Yontz, state advocacy manager for AARP Iowa, said smaller housing units can be the difference between an older person staying in their home or having to find another place to live.

"Currently, those are not allowed in all communities across the state of Iowa," Yontz pointed out. "We are looking to expand access to this housing option by championing a statewide ADU law that would give all Iowans the right to build an ADU on their property, which would reduce unnecessary regulations and red tape."

AARP Iowa will also push for a tax break for the caregivers in the state who provide billions of dollars in unpaid services, mostly to family members.

The tax credit for family caregivers is designed to help offset the costs of services and care they provide, which is often more than $7,000 out of their own pockets.

"It would be a nonrefundable income tax credit that would allow working caregivers to claim up to 50% of eligible expenses when caring for a relative," Yontz outlined. "This would be capped at $2,000 per year, with an additional $1,000 available for individuals caring for veterans or those with a dementia-related diagnosis."

As the group has done in years past, she added AARP Iowa is working to help reduce fraud among the state's aging population, a target for a growing number of phishing and other information scams.