This article is part of State of Health, a series examining health disparities, how they affect Michigan's children and seniors, and the innovative solutions being developed to address them. It is made possible with funding from the Michigan Health Endowment Fund.

Senior citizenhood presents new challenges for everyone, but for Lansing resident Dave Devinney those challenges were almost insurmountable.

Devinney has bad teeth. ("If I were a horse you wouldn't get very much money for me," he cracks.) He was shocked when his dentist told him he needed $60,000 to $80,000 worth of dental work done, even with Medicare coverage.

"I kept waiting for him to go on, (to) maybe tell me what my other options were or what else was available out there for me, but he had nothing," Devinney says.

Through his own research, Devinney eventually found Care Free Medical, a Lansing clinic providing low-cost care to uninsured and financially constrained patients, where he says he got the work done "practically for free."

"For us older people, who live on fixed incomes and have health issues that seem to get bigger every day, places like that can literally be a lifesaver," he says.

Lansing and many other cities across Michigan are taking steps to better connect older residents like Devinney to infrastructure, policies, and resources that address their unique needs. In 2015 Lansing joined the AARP network of Age-Friendly Communities, which establishes standards for improving older residents' quality of life. Over 300 other American communities have joined the network, including Auburn Hills, East Lansing, Grand Rapids, Highland Park, Lansing, and Southfield in Michigan.

Age-friendly communities are becoming increasingly important as lifespans and senior populations have increased, but they also benefit more than just seniors. Karen Kafantaris, associate state director for livable communities at AARP Michigan, says "an age-friendly community is a community for all ages."

"Whether you're 8 or 88, it's a place where you can get where you need to go and do what you need to do, a place where you can live your life, no matter how old you are," she says.

The long road to age-friendly status

Inspired by the World Health Organization's Global Network for Age-Friendly Cities and Communities, AARP has identified eight domains of livability as being critical for all age-friendly communities. They include:

• outdoor spaces and buildings;

• public transportation;

• affordable and accessible housing;

• opportunities for social participation;

• opportunities for civic participation and employment;

• respect and social inclusion;

• accessible methods of communication and information access;

• and community and health services.

Achieving age-friendliness in all eight domains is a years-long process for most cities. For example, while Lansing joined AARP's age-friendly network in 2015, it's only beginning to implement its age-friendly action plan, developed last year. In all communities the process starts with community conversations, where people of all ages can share what they believe would make their community more age-friendly.

When Southfield began its community conversations after joining the AARP's age-friendly community network last year, city staff learned some surprising things about aging Southfield residents' needs.

"We discovered that most of the seniors in our community don't have access to cable or internet," says Karen Schrock, chair of the Southfield Commission on Senior Adults. "So the assumptions that are made about how much information is available are incorrect. Online info is no good to someone who can't go online. We need a much more grassroots approach."

Attendees at Southfield's community conversations were invited to contribute ideas either in discussion or by writing them down on a sticky note and posting them on a wall. Schrock and her colleagues read and cataloged every suggestion afterwards.

"There are so many barriers to healthcare that people encounter," she says. "The catch is listening to what they are. You won't know what people need until you listen."

Similar efforts have taken place in Auburn Hills.

"In putting together our community conversations, we wanted to hear not just from the current aging population, but also from younger people who would be seniors in the future," says Karen Adcock, Auburn Hills' director of senior services.

Healthcare was a priority for Auburn Hills seniors, and it's one of the major issues city staff have worked to address. Adcock says the city has added a wide variety of health-related services including cooking, fitness, and safe driving classes; a tech class that teaches participants how to access their healthcare records; and affordable public transit to and from doctor's visits for seniors. Adcock says the city has tried to prioritize social, mental, and physical health.

"If you want a healthy community, you have to make all of those things available, and you have to make sure they're available to people of all ages," she says.

Beyond the AARP

Other Michigan cities are making strides toward becoming age-friendly outside the AARP's formal structure. Ann Arbor is one such community, with places like the Turner Senior Resource Center (TSRC) contributing to a vital, age-friendly community by offering a variety of health and wellness programs for seniors.

Paul Clark leads an enhanced fitness class at Turner Senior Resource Center.

"We believe strongly in the fact that social needs and medical needs are all part of the greater whole, that quality of life and wellness are integrated, and social connection is vital to health," says TSRC director Rachel Dewees. "So while people are coming here for specific reasons, the underlying thing that draws everyone is the connections and relationship."

Turner Senior Resource Center director Rachel Dewees.

Some TSRC clients have even created their own programming. Concerned about the documented links between social isolation and failing health, one TSRC client pitched the idea of a group encouraging better socialization between men. The group, known as the "Wise Guys," has been going strong for four years.

Clients' notes on a bulletin board at Turner Senior Resource Center.

Other Ann Arbor organizations focus more specifically on seniors' unique medical needs, like the Senior E.R. at St. Joseph Mercy Hospital. Where the usual emergency room experience is loud and chaotic, a senior E.R. focuses on safety and comfort for older adults. The facility offers softer lighting, non-skid floors, hearing assistive devices, reading glasses, pressure-reducing mattresses, and staff trained to connect seniors to appropriate resources in the community.

St. Joseph Mercy Health System was the first to create a senior E.R. in Michigan, and it now has five senior E.R.s in the state. However, it isn't the only organization looking to provide Michigan's aging population with a more age-friendly healthcare experience.

"We've had hospitals around the state reach out to us because they're interested in starting their own senior E.R.s, or because they want to provide a more age-friendly experience for the fast-growing number of seniors in their communities," says Joanne Grosh, regional director of senior services for St. Joseph. "Sparrow in Lansing is one of a growing number of health care systems that's genuinely interested in providing age-friendly health care access."

Whether under the AARP's formalized umbrella or not, providers agree that developing age-friendly communities requires coming together to take a holistic approach to ensuring older residents' wellbeing.

"We look at health in a really broad way," Schrock says. "You can't really address health-related issues without also addressing a host of other concerns as well. ... Health means so much more than just the state of your body."

Sarah Hillman is the news editor at Capital Gains and has been writing stories about issues that impact people's lives for years. She is also the writer and illustrator of a children's book about leadership qualities.

All photos by Doug Coombe.