Roanoke isn’t just getting older. It is growing older while the workforce, caregivers, and family networks that support older adults are becoming smaller.

Roanoke, VA

Author: Roanoke Rambler Staff, Tina Charisma

Published: 12:07 AM EST July 1, 2026

Edited: 12:07 AM EST July 1, 2026

Since 2020, the city’s population has steadily declined. By 2026, Roanoke had lost more than 1,000 residents, with its largest single-year decline — more than 1,200 people, occurring in 2021 alone, according to U.S. Census Bureau estimates.

But the story isn’t simply one of population loss. It’s a story of demographic change.

Younger adults are leaving while the population left behind is growing older. Today, about 17,900 Roanoke City residents — 18.3% of the population — are 65 or older. In neighboring Roanoke County, nearly one in four residents is 65 or older. Across the Valley, the Local Office on Aging estimates that one in four residents is already over the age of 60 — a figure projected to reach one in three by the early 2030s.

That shift is quietly reshaping almost every part of community life, increasing demand for affordable housing, transportation, healthcare, and caregivers at the same time the pool of workers and family members available to provide those services is shrinking.

The question facing Roanoke is no longer whether its population is aging. The data show that it is. The question is whether the Valley is prepared for what comes next.

“The wave is not coming. It is here.”

And Washington, at this particular moment, is moving to pull back the programs that help the oldest residents stay afloat.

“Funding and services are not keeping up,” said Ron Boyd, President and CEO of the Local Office on Aging, which has served Roanoke, Salem, Covington, and the counties of Roanoke, Botetourt, Craig, and Alleghany since 1972. “We are already one out of four over the age of sixty. And local, state, and federal leaders are not paying adequate attention.”

THE MISCONCEPTION THAT COULD COST EVERYTHING

Ask Boyd what frustrates him most, and he doesn’t hesitate.

“The biggest misconception is that Medicare is free,” he said. For families watching an aging parent navigate co-pays, premiums, and coverage gaps, that misconception can be devastating — a collision between expectation and reality that arrives at the worst possible time. People plan for retirement. They rarely plan for the cost of growing old inside it.

There is a second misconception, Boyd says, that cuts deeper: the idea that older residents are a drain.

“Younger populations perceive seniors as a strain on the economy, not recognizing that many — especially currently retiring baby boomers — still help drive the economy. The majority of volunteers are seniors, which contribute significantly to our economy and community supports.”

Steve Jones, Market President for InnovAge in Virginia and Florida, sees the same blind spot from a different angle. InnovAge operates the Roanoke Valley PACE center — the Program of All-inclusive Care for the Elderly — which provides coordinated healthcare and social services to seniors who would otherwise qualify for nursing home placement but choose to remain home. The center, which joined the InnovAge network in 2017 and opened an expanded facility in 2021, now includes five clinical exam rooms, four day rooms, a dining room, a dental suite, and two patios.

“The biggest misconception is that aging is only a healthcare issue,” Jones said. “Aging affects housing, transportation, caregiving, workforce participation, and social connection.”

That framing aging as a systems problem, not a medical one runs through every conversation happening right now among the people who work closest to Roanoke’s oldest residents. It also explains why the current moment feels so precarious.

THE MATH IS UNFORGIVING

The city now has just under 99,000 residents, a decline from nearly 100,000 in 2020, and almost one in five residents — about 17,900 people — is now 65 or older, according to World Population Review analysis of Census Bureau data. At the same time, Virginia itself is rapidly aging: the UVA Weldon Cooper Center projects that by 2030, one in five Virginians will be over 65.

For leaders working with older adults every day, those numbers are less a forecast than a warning.

“We are already one out of four over the age of sixty,” said Boyd. “By the early 2030s, we’ll be one out of three. Funding and services are not keeping up.”

The demographic shift reaches far beyond healthcare. It affects housing, transportation, caregiving, workforce participation, and the local economy.

“There will be fewer people available to offer the services the aging community will need,” Boyd said. “Need will become greater; availability of services will diminish.”

Family caregiving is already showing signs of strain. “We are being advised that family members are becoming less available to assist our clients,” Boyd said. “Our clients are saying their caregivers don’t have as much time to donate to assist them.”

Jones sees the same trend. “Many caregivers are balancing careers, children, and aging parents simultaneously,” he said. “Demand continues to exceed workforce supply across the healthcare continuum.”

Home care costs roughly $46,000 per year on average. Nursing home care runs between $82,000 and $92,000 annually — nearly twice as much. Community-based services, the kind the Local Office on Aging provides, cost a fraction of either. The case for keeping people home is not simply humanitarian. It is fiscal.

Yet the One Big Beautiful Bill Act — signed into federal law this year — is projected to strip Medicaid coverage from an estimated 260,000 Virginians through funding cuts and stricter eligibility rules, according to Kaiser Family Foundation data. Home and community-based services, the programs that fund in-home aides, adult day care, transportation, and caregiver support, are among the most vulnerable. Nationally, the legislation could affect roughly one million older adults enrolled in both Medicare and Medicaid who need help with basic daily tasks: bathing, dressing, eating.

The structural problem is worth naming plainly: nursing home care is mandatory Medicaid coverage. Home and community-based services are not. When states face budget pressure, they cut home care first — even though it costs less — because they have no legal obligation to protect it.

At the same time, the Older Americans Act — the 60-year-old law that funds everything from Meals on Wheels to transportation assistance to caregiver support — received $392 million less than its authorized funding level in FY 2025, according to the National Association of Counties. It has not been reauthorized since 2020. The Trump administration’s proposed FY 2026 budget called for dissolving the Administration for Community Living, which has administered OAA programs. The Alzheimer’s disease program faces a proposed cut from $32 million to $17 million. Chronic disease self-management education would be eliminated entirely.

It is in this environment that Boyd runs an organization people in the Roanoke Valley depend on to stay in their homes.

“More people in nursing homes,” Boyd said plainly. “Due to the inability to afford services and supports in their home. Lack of caregivers and caregiver supports.”

Jones put it this way: “Demand for aging services may outpace community capacity.”

Both men are describing the same future, arriving from different directions.

CAN PEOPLE ACTUALLY AGE IN PLACE?

Ninety-three percent of seniors want to age in place. Boyd cited the figure not as a talking point but as a baseline reality that shapes everything the LOA does.

“They are happier, live longer, and live more fulfilled lives if they are in their choice environment,” he said.

But wanting to stay home and being able to stay home are increasingly different things.

The barriers are familiar and compounding. Affordable housing is scarce. Accessible housing is scarcer. Jones was direct: “The market continues to face a shortage of accessible housing designed to meet the needs of older adults with mobility limitations.” Boyd agreed. Asked whether there are enough accessible homes in the Valley: “No,” he said.

Roanoke has taken steps. Zoning amendments adopted in 2021 now permit accessory dwelling units, and a City-funded design contest produced four pre-approved ADU architectural plans that residents can use for free — creating new pathways for multigenerational living. The Trinity Commons development, supported through federal Community Development Block Grant funding and the Home Safe program, converted a former church annex into apartments with units reserved for low-income seniors.

These are real efforts. They are also, by the account of those working in this space daily, not enough to absorb what is coming.

What surprises people most, Jones said, is how quietly independence disappears. “Independence is often lost gradually through small setbacks — missed appointments, transportation barriers, medication management challenges, or caregiver fatigue.” It is not one crisis. It is a series of small erosions, each one narrowing the options, until the only remaining option is institutional care that everyone agreed was the last resort.

The City of Roanoke’s written statement pointed to programming at Historic Fishburn Mansion — a Senior Club for adults 55 and older with monthly social activities, arts programming, and outings — and Senior Summits, an easy-to-moderate hiking series for adults over 50. The Roanoke Public Libraries offer Senior Movie Nights, dementia education programs, and the Talking Book Service, which provides free audiobooks and magazines for residents who are blind or have print disabilities.

These programs matter. Boyd would not dispute that. But they sit upstream of the crisis his office navigates daily: the gap between what people need to remain independent and what the community can actually provide.

THE CAREGIVING CLIFF

The people who hold this system together are mostly invisible. They are adult children driving parents to dialysis appointments before logging into morning meetings. They are spouses managing medication schedules while managing their own health. They are neighbors checking in because no one else does.

And they are running out of time.

“Family members are becoming less available to assist our clients,” Boyd said. “Our clients are saying that their caregivers don’t have as much time to donate to assist them.” That shrinking availability has produced a measurable increase in transportation requests to the LOA — people who once relied on a daughter or son to take them to the doctor now need the organization to step in.

The workforce behind professional caregiving is no more stable. Boyd flagged staffing shortages in assisted living facilities and nursing homes as among his primary concerns, warning that over-reliance on agency staff — contractors cycling through facilities with little continuity — “creates a lack of care and compassion to those receiving the care.”

Jones was direct: “No. Demand continues to exceed workforce supply.” He listed the roles hardest to fill: direct-care professionals, home health aides, CNAs, nurses, drivers.

The national data deepens the concern. As of 2025, 59 million Americans were caring for an adult family member at home — up from 48 million in 2020, a 23% increase in five years. The Bureau of Labor Statistics projects nearly 740,000 new home health and personal care aide jobs will be needed between 2025 and 2034 — a 17% growth rate, compared to a 3% average across all occupations. Yet PHI, the workforce research organization, estimates 9.7 million total job openings in direct care from 2024 to 2034 when transfers and labor force exits are included. Demand is outrunning supply by a margin that is difficult to close.

By 2040, the Census Bureau projects there will be just three potential family caregivers per person aged 80 or older — down from six in 2025. A 50% decline in fifteen years.

In Roanoke, where younger adults are already leaving, that arithmetic is not theoretical. “There will be fewer people available to offer the services and supports the aging community will need,” Boyd said. “Need will become greater; availability of services will diminish.”

He offered one example that rarely makes it into policy discussions: “Our senior population sometimes depends on younger family members to transport them to appointments. With a reduction of younger residents, it places additional burdens on our senior population to secure transportation.”

TRANSPORTATION HAS BECOME HEALTHCARE

When someone can no longer drive in Roanoke, a cascade begins.

“There is a loss of independence,” Boyd said. “They become socially isolated and miss their medical appointments and obtaining prescriptions, which leads to declining health.”

Social isolation among older adults is not a soft concern. It is a clinical one. Jones cited its association with “poorer health outcomes, depression, and increased healthcare utilization.” Boyd is blunter: “Seniors are the most commonly isolated population. Social isolation is detrimental to their health.”

Transportation to medical appointments is already strained. Boyd noted that Medicaid-contracted transportation companies serving long-term care residents are “unreliable, at best.” Clients have told him directly: without the LOA’s own transportation program, they may not be able to reach the care they need at all.

For Jones and InnovAge, transportation is not an add-on. It is embedded in the PACE model as a medical necessity — a structural acknowledgment that getting to the doctor is inseparable from getting better. “Transportation is now a major social determinant of health,” he said. Rural and geographically dispersed communities, he noted, face the greatest exposure.

WHAT THE CITY IS DOING — AND WHAT IT ISN’T

The City of Roanoke’s statement reflected genuine investment in programming and housing. The Healthy Homes and Lead Safe initiatives improve housing conditions. ADU zoning creates options for multigenerational families. Library programming and Senior Summits reach residents who might otherwise have few points of connection.

But the statement is also notable for what it does not address: workforce shortages, federal funding cuts, the mounting pressure on family caregivers, or the widening gap between available services and the scale of the demographic change already underway.

Boyd was asked directly whether local leaders are paying adequate attention to the aging trend. “No,” he said. “Local, state, and federal.”

He is not dismissing what exists. The LOA has been operating since 1972. InnovAge’s Roanoke Valley PACE center provides a model of integrated care that its advocates believe should be far more widely available. But model programs running on constrained and threatened funding, in a region whose demographics are shifting faster than its infrastructure, can only do so much.

2035: TWO CITIES

Both Boyd and Jones were asked the same question at the close of their interviews: Imagine it is 2035. What would need to happen for Roanoke to become a great place to grow old? And what happens if it doesn’t?

Jones’s answer was specific. “Roanoke can become a model age-friendly community by expanding accessible housing, strengthening transportation infrastructure, investing in caregivers, and supporting integrated care models such as PACE. If we do these things, more older adults will remain independent, healthier, and connected to their communities.”

The alternative, he said: “Greater caregiver burnout, increased healthcare costs, workforce shortages, and more individuals entering institutional care earlier than necessary.”

Boyd’s answer was pointed. The Older Americans Act needs to be reauthorized with meaningfully increased funding. Policy must change for respite care and caregiver support. Without both, the projected wave of people aging into the 60-plus demographic will simply outpace the community’s capacity to serve them.

“Lack of federal and state funding to assist seniors to age in place,” Boyd said, when asked what concerns him most about the next decade. “The numbers are coming. The question is whether we are ready.”

By the early 2030s, one in three Roanoke Valley residents could be over the age of 60. Whether that becomes a crisis or a success story may depend less on medicine than on decisions being made right now — about housing, transportation, caregiving, workforce, and the political will to fund the infrastructure that holds it all together.

Growing old, it turns out, is not simply about living longer.

It is about whether a city chooses to grow old alongside its residents.

The Roanoke Rambler