This chapter helps the reader to understand what a needs assessment is and be acquainted with a framework within which to conduct a needs assessment. and to be familiar with the core concepts of a needs assessment. It helps the reader to be familiar with strategies that encompass a needs assessment. Needs assessments can be carried out by a wide cast of people. Social workers and public health workers, as well as city planners, can carry out needs assessments, as can government organizations. Local citizens or groups of people can also be responsible for carrying out a needs assessment. The chapter provides an overview of strategies to develop a needs assessment. When used in combination with a health behavior framework, a needs assessment can help one determine the needs of a community and attempt to build community support for this resource or policy change through media advocacy and coalition building.

This chapter highlights some of the current health programs and policies in place and changes in demographic trends for older adults living within American society. In addition, substantial changes within the social, political, and cultural expectations of communities over the past century pose challenges for policies and programs serving older adults. The chapter presents several issues emerge as realities within the context of policy development and program planning for older adults. These issues include changes in living arrangements, education levels, economic well-being, and rural population settings; trends in morbidity and mortality; and changes within the social, political, and cultural expectations of communities. Despite the availability of programs and services resulting from health policies, many programs have focused upon “medically necessary” services and have lacked a health promotion, health education, or community-based focus.

This chapter discusses the history of the Medicare in the United States; specific components of Medicare Parts A, B, C, and D; and how Medicare provides healthcare resources to older adults and people with disabilities. Medicare, a healthcare program perceived to be a universal program rather than one based upon a needs test, currently provides healthcare to people who reach the age of 64. Comprised of four parts, it can provide hospital care, general healthcare, hospice care, home healthcare, and prescription drug coverage. The chapter provides an overview of the Medicare program, its various components, and aspects of healthcare that are covered through its component parts. Although there are currently no needs tests or limitations as to who qualifies for services, the chapter concludes with some dilemmas for the future of healthcare coverage, including “an empty pot at the end of the rainbow” and rationing of healthcare services and procedures.