Former S.C. Lt. Gov. Glenn McConnell, in an address before the S.C. General Assembly in March 2014, said: “The issue of aging is the central public health challenge of our lifetime.”



That challenge is becoming clear. 2030 will mark a demographic turning point as all baby boomers will be older than 65. By 2035, older adults are projected to outnumber children for the first time in U.S. history, a trend that will be reflected in South Carolina. In 2017, there were 795,265 South Carolinians over the age of 65 in South Carolina; by 2030 this will increase to more than 1 million, or almost one in five residents.

These statistics from the U.S. Census and the S.C. Revenue and Fiscal Affairs office are sobering but do not tell the entire story of the impact on the state and what can be done proactively to prepare. As shared by the U.S. Administration on Aging, nearly 70% of the elderly need long-term care services and supports (LTC) at some time during their lives. The effect of this demographic shift on the needs of residents, their caregivers and the state of South Carolina will be significant.



Public and private requests for LTC services will increase and our current system will be overwhelmed. Anyone with limitations caused by physical, cognitive or chronic health conditions may need regular assistance with various activities of daily living. The system also serves people with disabilities under age 65, many of whom need daily care to live as independently as possible.

Families, service providers, government agencies, advocates and people in the long-term care continuum envision an integrated, fiscally sustainable system of high-quality, accessible services. Recognizing the need to proactively prepare South Carolina for the coming “silver tsunami,” the S.C. Institute of Medicine and Public Health established an LTC Taskforce in 2014. The taskforce included 65 service providers, researchers, advocates and agency representatives from across the state. Members explored a range of issues facing our statewide LTC system and worked to develop actionable recommendations to address some of the most critical needs.

In June 2015, IMPH released Creating Direction: A Guide for Improving Long-Term Care in South Carolina, a report that highlighted the urgency of addressing growing demands on family caregivers, public and private service providers, and government agencies over the next five years.

The taskforce’s 30 recommendations are grouped into six crucial areas for improvement: promoting system efficiency and coordination; strengthening the full spectrum of long-term services and supports; ensuring an adequate and trained workforce; protecting vulnerable adults; supporting family caregivers; and promoting choice and independence through education. The envisioned health services system will continually promote choice and independence to the fullest extent possible, enabling people to choose the most appropriate care in the least restrictive setting.

To build on the momentum of the taskforce’s work, IMPH implemented the capstone recommendation and facilitated a formal Implementation Leadership Council of key stakeholders to maintain focused attention on recommendations, minimize or eliminate barriers to implementation, connect and mobilize the many stakeholders across public agencies, family caregivers and LTC service providers throughout South Carolina, and promote and track progress toward implementation.

Since the report’s release three years ago, committed partners have come together to advance additional recommendations and themes. While the full progress report will be released later this spring, highlights include:

  • Progress has been made to develop a Vulnerable Adult Abuse Registry (Recommendation 14). In coordination with the Implementation Council, IMPH brought together a workgroup to discuss the challenges and possible solutions to develop a registry in South Carolina, which resulted in “Protecting Vulnerable Adults from Potentially Abusive Workers: An Issue Paper.” Currently, House Bill 3273 to enact the “Vulnerable Adult Maltreatment Act” resides in the House Judiciary committee.
  • Recommendation 23 would develop and market a comprehensive, user-friendly online information and referral resource for long-term services and supports, including resources for caregivers. The South Carolina Department on Aging manages this resource at
  • A current IMPH initiative, the Workforce for Health Taskforce, is addressing system-wide changes in South Carolina’s healthcare workforce and incorporates the taskforce’s goal of strengthening the long-term care continuum and supporting caregivers. The recommendations from this taskforce will be released in June.
  • Recommendation 26 calls for support and enhanced awareness about statewide public education efforts regarding advance care planning based on the needs and values of individuals. The South Carolina Coalition for the Care of the Seriously Ill and its partner organizations have engaged in multiple projects to educate families, community organizations, health care professionals and the public about advance care planning.

Significant efforts have been undertaken by public and private stakeholders and IMPH to improve options for older adults, people with disabilities and family caregivers across our state. Implementation efforts face serious barriers, including lack of resources, competing priorities and the need for greater coordination.

As IMPH and the members of the Implementation Council continue to address the full array of recommendations from the LTC Taskforce, the support of key public and private-sector partners remains vital. Collaboration is essential to improving access, quality, caregiving strategies and education for the benefit of all people who enter a more robust LTC system in the coming years.

Kester Freeman is the executive director of the S.C. Institute of Medicine and Public Health and Megan Weis in the senior director of strategic engagement. Weis can be reached at [email protected]. IMPH is an independent organization with the mission to inform policy to improve health and health care.

This column first appeared in the March 11 print edition of the Columbia Regional Business Report.