Aging in Missouri 2025

Abstract

In 1950, the US population stood at 152 million and was considered relatively “young” due to historically higher fertility rates, declining infant and childhood mortality, and a greater influx of young immigrant workers.¹ Between 1946 and 1964, the Baby Boom era saw an accelerated number of births, further shaping the country’s demographics. However, in the decades that followed, birth rates declined while advances in healthcare led to improved survival rates and reduced mortality at older ages.² This demographic shift has contributed to a significant aging of the population.

The graying of America….the silver tsunami….the age wave. Ready or not, here we come!

US Aging Trends

By the year 2000, adults over age 65 had risen to 35.1 million, making up 12.4% of the total US population, compared to just 8.1% in 1950. Currently, seniors account for about 17% of the population (Figure 1).³ By 2035, the entire baby boomer generation will be older than 65 and there will be more adults over age 65 than children younger than 18. By 2050, the older population will reach 88.5 million, representing 20% of the US census.^1,2 In 2060, nearly 25% will be over age 65. Historically women greatly outnumbered men in the population over age 65. With the improvements in health care, this gender gap is narrowing.

Figure 1.

Age >65 as % of MO/US Population

The US will also see an increase in the oldest-old age groups. Currently 12% of older women and 9% of older men are over age 85 (Figure 2).⁴ By 2050, it is projected that 1 in 5 older women and 1 in 7 older men will be over age 85. This shift is significant as the oldest old will experience the highest rates of disability, chronic disease, and dependency, adding pressure to the health care system at both state and federal levels.²

Figure 2.

US Population over age 65 yrs: % by age category

Missouri’s Aging Population

Missouri’s aging population projections are nearly identical to national trends. In 2000, the older adult population in Missouri numbered 756,000 (13%) and was predicted to surpass one million by 2020.⁵ We exceeded that number, and currently 1.3 million (19%) of the 6.8 million Missouri residents are 65 or older. About 2% are over age 85.

Life expectancy as of 2023 is 74.6 years in Missouri, compared to 76.3 nationally. This is the lowest in over 40 years and is attributed to COVID-19-related deaths and record high opioid overdose deaths.⁶ Due to declining birth rates, for the past three years the death rate of 1.16% is higher than the birth rate.

Heart disease and cancer contribute to about 40% of Missouri deaths over age 65 with Alzheimers disease being the third highest cause of death in those over age 95. Approximately 130,000 Missouri residents have the diagnosis of Alzheimer’s dementia and 17% of those are enrolled in hospice care.^7,8

Economic Impacts of an Aging Population

The financial impact of an aging society is in part driven by greater healthcare utilization and the rising complexity of care among older adults. Research indicates that individuals aged 65 and older visit physicians 20% more frequently than younger adults and have hospitalization rates nearly three times higher. A 2019 Kaiser Family Foundation study found that Medicare spending per beneficiary averages $7,566 for those aged 65 to 74 but nearly doubles to $16,145 for individuals aged 85 and older.⁹

The demographic shift will impact the healthcare infrastructure and long-term care resources for Missouri’s aging residents.⁵ For sustainability, our healthcare system will require adaptations in service delivery, workforce expansion, and policy reform to accommodate the needs of our older adults. Government spending on Social Security and Medicare is projected to rise, and state and local governments will need to allocate more resources toward healthcare and pensions for retirees. According to the Congressional Budget Office, federal expenditures on major health programs for older adults, including Medicare and Medicaid, are expected to increase from 6.6% of the gross domestic product (GDP) in 2020 to 9.2% by 2050.¹⁰

About 30% of the Missouri population lives in rural areas. Rural Missourians face higher health disparities than their urban counterparts.¹¹ These disparities include higher rates of chronic diseases including arthritis, asthma, cardiovascular disease, and diabetes. Since 2005, Missouri has lost eight rural hospitals with a total loss of 351 beds.¹² According to a review by the Chartis Group, 42% or 26 of Missouri’s remaining rural hospitals are at risk of closing.¹³ Missouri has recently approved the expansion of Medicaid eligibility which should significantly increase the need for rural hospitals.

In 2023, Missouri had a per capita personal income of $61,302 (compared with the national per capita of $68,531), ranking it thirty-fourth in the nation. The average retirement income in Missouri is $51,254, with $28,204 from retirement and $23,050 from Social Security income.¹⁴ Housing costs for older Missourians consume around 29% of monthly income compared to the national average of 34%. Although Missouri ranked the sixth lowest state in cost of living, 9% of residents over age 65 live in poverty.⁸

Health care costs contribute to the financial burden faced by older adults. Overall, 31% of Missourians have over $1,000 and 10% have more than $5,000 in medical debt. About three-quarters report that debt was due to a single or recent medical expense. Almost 46% of the elderly reported that dental care contributed to their medical debt.¹⁵ About 3% of Missourians reported an inability to see a doctor due to financial limitations.¹⁶

Aging Vulnerabilities

Cost of care is a major concern for older adults. More than 75 percent of health care costs are due to chronic conditions.¹⁷ We know that poverty is associated with increased exposure to environmental risks, poorer health related behaviors, increased risk of chronic disease and mortality, poor health outcomes, disabilities, homelessness, and physical and cognitive decline.

An increased life expectancy has resulted in a higher prevalence of chronic and degenerative diseases.⁹ The CDC reports that 80% of older adults nationwide have at least one chronic condition and 50% have at least two.¹⁸ In a survey of older Missourians, 95% were found to have one chronic condition, more than 80% had at least two, and about 65% had at least three.¹⁷ Among chronic comorbidities, obesity is a coexisting risk factor to many other health conditions. Missouri has an obesity rate of 37% in adults and continues to outpace the national average of 34%. According to the United Health Foundation’s Senior Report, Missouri ranks thirty-third overall on measures of health determinants and outcomes.¹⁹

The number of Missourians over 65 with Alzheimer’s disease will increase between 2010 and 2025, from 110,000 to 130,000.¹⁹ Cognitive impairment can heighten financial vulnerabilities. Older adults may face difficulties in managing money and making investment decisions, increasing the risk of financial exploitation. Conversely, many older individuals provide care and financial support for younger generations, creating a complex dynamic within multigenerational households.

Despite more family involvement in elderly caregiving, older adults remain at high risk for abuse. As physical and cognitive abilities decline and dependence increases, the risk of elder abuse rises. In 2011, there were 17,571 reports of elder abuse in Missouri. Ten years later there were 29,000 reports and in 2025 DHSS predicts 33,000 reports.²⁰ Of these reports, nearly 75% were substantiated after investigation.¹⁹

Aging Workforce Challenges

Adults over age 65 account for 6% of the Missouri labor force with roughly 14% in this age group being employed.²¹ Employers will need to adapt to an aging workforce by addressing increased labor costs, which include salaries, health benefits, and retirement contributions. Additionally, as older workers retire, labor shortages in key industries may emerge, requiring workforce development strategies to ensure economic stability.

As older adults become too ill, frail, or cognitively impaired to care for themselves, the need for direct caregiving grows. As the population of Missouri ages, so do our caregivers. Currently about 60% of Missouri caregivers are over 60 years old. Predominantly, these caregivers are family members who may also be managing their own health care needs.¹¹

Unpaid family caregivers are an essential and often unrecognized workforce. The demands of caregiving can take a serious toll on physical and mental health, as well as financial stability. In the United States, many working-age caregivers, especially women, reduce their paid work hours, leading to diminished earnings and retirement benefits. According to the American Association of Retired Persons, caregivers in the US lose an average of $5,000 in income annually, with women disproportionately affected.¹⁸ Additionally, caregivers bear direct costs such as home modifications, food, cleaning supplies, and other necessities for care recipients.

As part of the federal American Rescue Plan under the Older Americans Acts, funding has been allocated to the National Family Caregiver Support Program (NFCSP) to assist family and informal caregivers in covering costs for in-home support services, including respite care and training. The NFCSP provides grants to states to fund caregiver services, including respite care, to help family and informal caregivers keep older adults in their homes for as long as possible.

Geriatrics Workforce in Missouri

A shortage of healthcare workers, especially nurses and physicians will impact an increasing number of older adults as their medical requirements grow. There is an increasing need for medical providers who are trained to care for the complexities of the aging population. The demand for professional caregivers is also rising. According to the Bureau of Labor Statistics, home health aides and personal care workers are among the fastest-growing occupations, with more than one million new job openings projected by 2029.²³ Home health agencies rely on Medicaid and Medicare to cover roughly three-quarters of their workers’ wages.

Geriatricians are specialists in the care of older adults. These physicians may be board certified in geriatric medicine following internal medicine or family medicine residency or board certified in geriatric psychiatry following general psychiatry residency training. There are 164 geriatric medicine and 61 geriatric psychiatry fellowships nationally. These fellowship programs are one year in duration. In Missouri there are three geriatric medicine fellowships with a total of nine positions and in Kansas City, Kansas, one program with four positions.²⁴ There is one geriatric psychiatry fellowship in Missouri offering three positions each year. Unfortunately, many of these positions remain unfilled both locally and nationally.

Currently, Missouri has 109 board certified geriatricians and 21 board certified geriatric psychiatrists.²⁵ In addition, there are 118 certified gerontological nurse practitioners in Missouri and 336 advance practice nurses identified as working in the field of gerontology.²⁶ Clearly there are not enough specialty trained providers in the field for the growing older population. National and regional efforts have thus focused on educating the health care workforce in aging-related care, as it is expected that most elderly will see non-geriatrician physicians or nurse practitioners.

Missouri Senior Living and Support Services

In 2024, Governor Parson signed an executive order to establish a Master Plan on Aging by December 2025 to reduce age and disability discrimination, eliminate barriers to safe and healthy aging, and help Missourians age with dignity.²⁷ A statewide needs assessment was conducted via 12 Town Hall sessions with input from more than 1,700 individuals to develop this Plan. The resulting Aging with Dignity report outlines its seven broad goals: Daily Life and Employment, Family Caregivers, Housing and Aging In Place, Long-Term Services and Supports, Safety and Security, Transportation and Mobility, and Whole Person Health (Figure 3).

Figure 3.

Aging with Dignity report outlines its seven broad goals: Daily Life and Employment, Family Caregivers, Housing and Aging In Place, Long-Term Services and Supports, Safety and Security, Transportation and Mobility, and Whole Person Health

Services for older adults in Missouri are largely under the authority of the Missouri Department of Health and Senior Services (DHSS) which oversees the Senior & Disability Services and the Area Agencies on Aging (AAAs). Missouri’s 10 AAAs provide senior programs and services such as legal, caregiver, transportation, and home modification assistance in their local areas. Information is available through the Missouri Senior Resource Line (Table 1).²⁸

Table 1.

Department of Health and Senior Services Resources

MO DHSS Senior Resource	Contact	Phone
Division of Senior and Disability Services	health.mo.gov/seniors/hcbs/	866-835-3505
Missouri Senior Resource Line	https://health.mo.gov/seniors/senior-resource-line.php	800-235-5503
Adult Protective Services	health.mo.gov/abuse	800-392-0210
Alzheimers State Plan	MOAIzStatePlan@health.mo.gov	573-526-4542
Office of Long-Term Care Ombudsman	LTCOmbudsman@health.mo.gov	800-309-3282
Bureau of Senior Programs	info@health.mo.gov	573-526-4542
Silver Haired Legislature	SHL@health.mo.gov	573-751-2413
Area Agencies on Aging	info@health.mo.gov	573-526-4542
Home and Community Based Services	LTSS@health.mo.gov	866-835-3505
Nursing Homes and Other Care	info@health.mo.gov	573-751-6400
Missouri Caregiver Program	https://cabllc.com/caregiver-training-and-relief-program/	573-415-7343
State Health Insurance Assistance Program	missouriship.org	800-390-3330
Senior Community Service Employment Program	scsepemployment@health.mo.gov	573-526-4542

The Senior and Disability Services manages concerns about elder abuse and neglect through Adult Protective Services. Reports can be made to the Adult Abuse and Neglect Hotline. Since 1975, DHSS also oversees The Long-Term Care Ombudsman Program to investigate and respond to complaints in long-term care facilities. Volunteers provide advocacy and assistance to residents and families with their concerns. DHSS supports the Silver Haired Legislature (SHL), a body of formally elected but voluntary citizens over age 60 who support each AAA in identifying legislation of importance to the aging community. SHL focuses on policy priority areas that affect seniors in their communities.²⁹

Missouri has approximately 1,100 licensed chronic care facilities with a capacity of 80,000 beds. The state’s 300 long-term care, 208 adult day care, 361 memory care, eight long-term acute care, 134 hospice, 126 home health care, and 33 acute rehab centers provide Medicare and/or Medicaid services, largely to the older adult population.^30,31 Missouri is also home to three PACE (Program for the All-Inclusive Care of the Elderly) sites located in St. Louis, Kansas City, and Springfield. PACE is a comprehensive health and social care model administered to Medicare/Medicaid dual eligible adults over age 55. PACE provides services utilizing an adult day center structure with the goal of maintaining independent home living.

Missouri Medicare and Medicaid Services

Medicare Parts A and B cover health care services such as inpatient hospital, nursing home care, hospice care, medical tests, surgery, outpatient visits and home care services for homebound beneficiaries. Part C, also known as Medicare Advantage, expands traditional benefits with coverage for items such as hearing aids, dentures, and glasses. Part D provides prescription drug coverage, and in 2025 will eliminate the “donut hole,” by capping the out-of-pocket annual prescription drug costs at $2,000 per person.

In 2022, 19% of the Missouri population received Medicare or a combination of Medicare and private insurance.³² Eleven percent had Medicaid alone or Medicaid plus private insurance and 1% of Missouri residents were “dual eligible” meaning they qualified for both Medicare and Medicaid coverage.

Missouri SHIP (previously Missouri CLAIM) is the official Missouri State Health Insurance Assistance Program (MO SHIP) and has been providing free and confidential Medicare coverage counseling for the past 30 years. Over 200 volunteers provide information on Medicare, Medicaid (MO HealthNet), Medicare Advantage Plans, Part D Drug Plans, Medigap, and supplemental insurance programs for seniors. Missouri HealthNet offers three managed care health plans for income qualifying older adults: Healthy Blue, United Healthcare, and Home State Health.

There are 134 Medicare Advantage plans and 10 Medigap plans offered in Missouri for 2025. Medicare Advantage Plans come in five forms: Health Maintenance Organizations (HMO), Preferred Provider Organization (PPO), Private Fee For Service (PFFS), Special Needs Plans (SNP), and Medical Savings Account Plans. Medicare Advantage plans have grown in popularity, with over 30.8 million enrollees in 2023, covering more than 50% of all Medicare recipients³². There are eight companies offering Medicare Advantage programs in Missouri with varying plan options based on geography within the state: Aetna Medicare, Anthem Blue Cross and Blue Shield, Anthem HealthKeepers, Cigna, Essence Healthcare, Humana, UnitedHealthcare and WellFirst Health.³³

Special Needs Plans (SNPs) provide supplemental benefits and services to those with specific chronic diseases or care needs. There are three groups served by SNPs: Dual Medicare/Medicaid Eligible SNP (D-SNP), those with a qualifying Chronic Condition SNP (C-SNP), and those who reside in Institutional care (I-SNP)

To be eligible for Medicaid, older adults must have an income below 85% of the federal poverty level ($15,650 in 2025 for a household of one). Of Missourians who receive Medicaid, 10% (about 91,000), are over age 65 but consume 19% of the Medicaid spending budget.^19,34 In 2023, Missouri Medicaid expenditures for older adults were $1.73 billion ($1,600 per month per beneficiary) and accounted for 35% of the Missouri state budget. Two-thirds of that funding was provided via federal subsidies.³⁴

Medicaid beneficiaries are eligible for the Home and Community-Based Services (HCBS) program which provides financial assistance for household chores, shopping, transportation, and personal care services, and other services within their own homes or communities. This is more cost-effective than care in institutional settings. Medicaid supports this assistance through their community-based long-term services and supports (LTSS) program.

Missouri Veterans Population

In Missouri, 2% of the population receives health insurance via the military or Veterans Affairs systems.³⁴ Missouri has the sixteenth highest veteran population in the nation with over 340,000 residents, about 7% of the adult population. This is 1% higher than the US average of 8%.³⁵ Nationally and in Missouri, about half of veterans are over age 65. Although the veteran population is declining, veterans will be utilizing greater health care services as they age.

Veterans have access to a range of benefits and services provided by the Department of Veterans Affairs (VA) to address their healthcare, social, and financial needs. There are four VA medical centers and over 40 Community-Based Outpatient Centers (CBOCs) and other community healthcare facilities in Missouri. Longterm care services, including nursing homes, residential care, and home-based community services, are available for eligible veterans who require ongoing care. Missouri hosts seven Veterans Homes, with a total 1,238 long term care beds, that are located in Cameron, Cape Girardeau, Mexico, Mount Vernon, St. James, St. Louis, and Warrensburg.³⁶

The VA Aid and Attendance (A&A) benefit provides additional financial assistance to veterans receiving a pension who require help with daily activities such as bathing, dressing, or feeding, while the Housebound Benefit supports those confined to their homes due to a permanent disability. The VA also conducts geriatric research and offers specialized programs to address the unique health challenges faced by aging veterans.

The Non-Service-Connected Pension provides financial aid to veterans with limited income who are permanently disabled or aged 65 and older, even if their disabilities are not related to military service. Veterans supporting a dependent parent may qualify for the Dependent Parent Benefit, which offers financial assistance for their care. For those unable to maintain substantially gainful employment due to service-connected disabilities, the Total Disability Individual Unemployability (TDIU) program compensates them at the 100% disabled rate, regardless of age. To access these benefits, elderly veterans or their families would apply through a local VA office.

Conclusion

As Missouri’s population ages, we must be ready for the health care and financial impact of this demographic change. The complex social and medical needs of our older adults will benefit from coordinated state and federal services. Resources and support for older adults through the Missouri Department of Health and Senior Services, the Senior & Disability Services and the Area Agencies on Aging will be needed to successfully implement the Master Plan on Aging in our state. These efforts will reduce age and disability discrimination and eliminate barriers to safe and healthy aging, and help Missourians age with dignity.