Few communities have started to think long term about how to plan and redesign services for aging baby boomers as they move out of the workforce and into retirement.
Even more troubling, dwindling budgets in a tight economy have pushed communities to cut spending on delivering meals to the homebound and shuttling folks who can no longer drive to grocery stores and doctor's offices.
These cuts, advocates for older Americans say, are coming when the services are needed more than ever. And those needs will grow tremendously over the next two decades.
The nation's population of those 65 and older will double between 2000 and 2030, according to the federal Administration on Aging. That adds up to one out of every five Americans — 72.1 million people.
Just eight years from now, researchers say, a quarter of all Ohio's residents in half of the state's counties will be 60 or older. Arizona and Pennsylvania project that one in four of its residents will be over the age of 60 by 2020.
"The bottom line is, the baby boomers are hitting," Chuck Gehring of LifeCare Alliance, an agency serving seniors in central Ohio, told The Columbus Dispatch. "Are communities prepared for this? No."
Six years ago, the National Association of Area Agencies on Aging said less than half of cities it surveyed at the time were preparing to deal with the needs of older folks. It said the results "should serve as a wake-up call for communities to begin planning now."
Five years later, the Washington, D.C.-based group revisited the survey and found little had changed. There was still a great need for transportation and housing for aging boomers, it said.
"There are a lot of communities that recognize they need to do something but haven't done it yet," Sandy Markwood, the group's chief executive officer, told The Associated Press.
Some of the changes cities can make include offering training to help older people drive more safely, installing road signs that are easier to read or creating ride-share programs, said Jo Reed, who oversaw the latest survey.
The biggest reason why cities have made little progress is the economy.
Nearly 21,000 times last year, drivers for the Licking County Aging Program in Ohio took elderly residents in communities east of Columbus to medical appointments. The gasoline bill has more than doubled in the past four years, topping $7,000 a month.
"With federal funding for these programs very flat, the burden is on local communities," Dave Bibler, the agency's executive director, told The Dispatch.
Transportation usually tops the list of unmet needs in local aging-agency surveys, advocates say. Public transit routes and stops sometimes aren't flexible enough; volunteer transportation networks are popping up in a few places but remain rare.
"How do we keep people involved in the community once they stop driving?" said Cindy Farson, executive director of the Central Ohio Area Agency on Aging. "It's one of those bottomless pits of need and demand. It's going to take a lot of creative thinking."
Home and apartments will need boomer makeovers, too.
Two Ohio lawmakers have proposed a tax credit to install bar handles, light switches and ramps to improve accessibility in homes. Supporters say it will save money because fall-related hospitalizations in Ohio cost $298 million a year in medical costs.
Communities can do some preparations on the cheap, said Henry Cisneros, the former mayor of San Antonio and the secretary of the U.S. Department of Housing and Urban Development in the Clinton administration.
Cisneros, now executive chairman of Los Angeles-based CityView, an institutional investment firm geared toward urban real estate, said communities can be creative with zoning for denser housing and what he called "granny flats" next to houses.
Although the task looms large, communities that address these issues now could reap benefits that reach beyond the boomer bubble. Creative planners like to envision neighborhoods that appeal to those who are young and old.
Young people actually have similar tastes to seniors when looking for a place to live, coveting walkable communities with easy access to shopping, entertainment and transit. And boomers want affordable and accessible housing, transportation, recreation options and, when the time comes, in-home care and services to help them avoid nursing homes.
Edward Elberfeld, a retired art teacher, and his wife, Barbara, plan to stay in their home near downtown Columbus as long as they can. Elberfeld, 63, has been working with neighborhood residents to form a group of volunteers to help other seniors do the same.
Their "aging in place" effort is based on similar projects in affluent neighborhoods of cities such as Boston and Washington, D.C., where private, nonprofit corporations formed to provide services and social activities so seniors don't have to move.
When residents are no longer able to drive, or walk down steep basement stairs, volunteers would ferry people around, check on a basement furnace, or help landscape the yard. Residents usually pay an annual membership fee, but far less than the cost of staying in a nursing-home.
Minnie Figart-Braden, 63, who oversees a meals-on-wheels kitchen in the city, said it's best for people to realize that good plans and quality care might call for sacrifice. "The boomers have to learn to give," she said. "They have to be responsible enough to give back to the community, to see what's going on."