Organized by the indefatigable Tim Driver, founder of RetirementJobs.com, the Age Friendly Foundation, and AgeFriendly.com, hundreds of aging professionals, academics, medical providers, journalists and government leaders met at the Seaport Hotel on October 23rd to discuss the future of aging in Massachusetts. Driver's incredible slate of presenters included Mayor Marty Walsh, Governor Charlie Baker, industry leaders, Boston Red Sox President Sam Kennedy, and Alexander Kalache, MD, Co-President of the International Longevity Centres Global Alliance.
There were a few common themes about the challenges of our increasingly older population voiced by speakers from many different perspectives:
- Inequity is a big problem; the wealthy can buy the care they need, there are some programs for the poor, and not much for the vast majority of Americans.
- We have over-medicalized elder care and invested too little in social supports; this is a very expensive approach.
- We operate too much in silos, health care professionals not talking to social service providers, who are not talking to private industry.
- Social isolation versus participation in community is a big determinant of our welfare as we age.
- Any solution will have to come through public-private partnerships.
- Workforce -- If we don't expand and better train and compensate the workforce that provides care to seniors, nothing else will work.
Here are some of the highlights:
Urbanization Hits the Aging World
The Brazilian gerontologist, Dr. Alexandre Kalache, described how his neighborhood of Copacabana in Rio De Janeiro was built during the 1950s and 1960s and at the time many younger adults moved in. Now, according to Kalache, they're still there, aging in place. And the most important person for their well being is the doorman, of which there are 6,500 in the Copacabana neighborhood. They help care for the residents of their buildings, in some cases just being to reach and change light bulbs, and act as early warning eyes and ears for their families. Kalache's organization has provided training to doormen to help them better recognize when residents need assistance and where help might be available.
When Kalache worked as a director of the World Health Organization's global aging program he helped found its Global Age-Friendly Cities Project which is working with cities to help them provide better living environments for their older citizens. This is especially important because the world is both aging and urbanizing at a very fast rate. In addition, as evidenced by the Copacabana experience, cities can be much more efficient places to provide assistance than suburban and rural areas where people must depend on automobiles, social and community supports are less easily available, seniors can become very isolated, and delivery of services is more expensive.
Industry and Health Care System Struggling for Answers
Boston Globe reporter Rob Weisman moderated a panel of industry leaders and one gerontologist in what was billed as a "reverse pitch." The idea was that instead of start-up companies pitching their concepts, the panel members would state problems they face that they would like start ups to solve. It didn't really work out that way. Most of the panel members instead talked about the problems they were seeking to solve themselves, but they still had some interesting things to say.
Terence O'Malley, MD, a gerontologist at Massachusetts General Hospital, spoke about the lack of social supports for his older patients, many of whom need assistance with their activities of daily living. The result, he said, is that problems that could be resolved through social support become medicalized, which means that many seniors deteriorate until they end up in emergency rooms, which is a very expensive way of providing care. Europe is way ahead of us. For every dollar they spend on health care, they spend $1.76 on social services. In contrast, in the U.S., we spend 56 cents on social services for every dollar we spend on health care -- no wonder our health care expenses are so much higher.
O'Malley also pointed out that without the care provided by family members, the whole system would collapse. He recommended that we provide more support to family caregivers. He also advised not looking to the medical profession to solve the problem of how we're going to care for the growing number of seniors in our population -- it's too big a problem and it's not just a medical issue.
Sanjay Pathak, the chief operating officer of CVS's 1,100 Minute Clinics in 33 states, is working to expand their services to make them available to seniors, especially those with chronic conditions. He feels that the convenience of the clinics can help such seniors to stay healthy at a much lower cost than care provided in hospital settings.
What Do Family Caregivers Need?
Marc Bernica of Bright Horizons reported on a study of the challenges family caregivers face, including:
- Elder care is hard to plan for since the need for assistance can happen at any time.
- It's also hard to plan for because family members can't know in advance how long the need for care will last or how those needs will change over time.
- Coordination among family members and with care providers and financial and legal advisors can be very difficult.
- Communication can be difficult, in part due to information overload. Information about health care, caregiving arrangements, finances and legal issues can be hard to organize and to share at the same time the family member is trying to provide assistance and keep his or her own life moving forward.
Alice Bonner, a former Secretary of Elder Affairs for Massachusetts who now works at the Center for Innovative Aging at the Johns Hopkins School of Nursing, reported on a program developed at Johns Hopkins called Community Aging in Place -- Advancing Better Living for Elders, which provides supportive services to help low-income seniors stay at home through teams that include social workers, nurses, occupational therapists and handy-workers. Massachusetts is the only state so far that provides a Medicaid waiver for this service.
I came away from the program both encouraged and discouraged. There was a lot of agreement among the speakers about the challenges we face as our population ages. This is especially important given their many different backgrounds and perspectives. It was a great achievement of the conference and Tim Driver, in particular, to bring such a diverse group together. Unfortunately, the solutions are less clear.
There's agreement that we need to move from a medicalized view of the problem to one that focuses on social supports, that this must be guided largely by government, and that it should be community-based. But how we will raise more money for these purposes or move the flow of money from the health care industrial complex to more cost-effective supports was not discussed. Another issue that was mentioned, but only in passing, is that most care these days is provided by immigrants. What happens when we close our doors to them?