In California, the ability to move safely and confidently is often treated as a personal responsibility rather than a public health issue. For many older adults, especially those with low incomes, mobility is not a luxury. It is the foundation of independence, emotional well-being and dignity. Yet access to basic mobility support varies widely across the state. That gap has serious consequences.
As a physical therapist working in post-acute and long-term care, I see this divide every day. Two older adults with similar health profiles can experience vastly different outcomes depending solely on whether they receive early mobility support. One regains strength, returns home and stays engaged. The other grows sedentary, dependent and declines not from lack of motivation, but from lack of access.
Low-income older adults face systemic barriers. Many rely on Medicaid, which often delays therapy and limits follow-up. Some live-in neighborhoods without safe places to walk. Others depend on family caregivers who haven’t been trained to assist safely. Too often, patients are discharged from hospitals or Skilled Nursing Facilities with no guidance for staying mobile. This neglect turns a preventable risk into a predictable decline.
Mobility loss is not inevitable. It is a result of systems that fail to intervene early.
But there are models that work. In Sacramento County, the StopFalls Sacramento coalition provides in-home fall-prevention assessments, mobility education, workshops and caregiver training — reaching people who might otherwise be overlooked. Their model doesn’t require a physician referral or private insurance. It leverages partnerships with home-based providers and services for the aging to meet older adults where they are.
This approach is simple, cost-effective and scalable. It treats mobility as a shared community responsibility, not a service reserved for those who can afford it.
California has the infrastructure to replicate this model statewide. We already have aging-services networks, home health agencies, community health workers and caregiver training programs. With better integration and modest funding, we can make early mobility coaching, screenings and fall-prevention a routine part of aging support.
Imagine a California where every older adult regardless of ZIP code or income has access to timely mobility support. Where we intervene before decline sets in. Where movement is viewed as medicine, and mobility is a right, not a privilege.
We do not need more studies to prove this. We need action. We need a statewide commitment to treat mobility as a public health priority.
California can lead the nation in closing the mobility divide. But it starts with reimagining how we care for people before they fall, not after.
Neha Sabharwal is the director of Rehabilitation at Vintage Faire Nursing and Rehabilitation in Modesto, and a certified clinical instructor and stroke rehabilitation specialist.
