Money Makes the World Go Around

Having many candles on your birthday cake may be great for an Instagram post or a TikTok, but it falls short in capturing the complexity of how aging changes our capacities for engaging with life, and what resources are needed to adapt and accommodate to those changes. Based on my experience, individuals are better at making necessary changes that improve their quality of life than systems.

Average life expectancy around the world has been increasing steadily for decades. COVID put a temporary hiccup in the overall lengthening, but that aside, we are living longer than ever before. Here in the U.S., average life expectancy is 76 for men and 81 for women.

Where Systems Fall Short

Systems, by definition, are designed to address the needs of specific groups and/or problems. Systems of care involve collaboration and cooperation between provider groups and patient cohorts (e.g., infants, adults, aging adults). Banking systems provide funds for economic growth and credit among businesses and communities. Education systems funnel students through benchmarks for acquiring skills and knowledge. Each has strengths, and all fall short, not out of incompetence or outright failure, but by the inherent limitations of what it means to be a system.

When systems are no longer viable, they can be adjusted, replaced, adapted, or discarded. Railroads are a good example of this. Initially, they solved multiple problems. As the industrial age blossomed, they extended their reach, opened new areas, brought folks together, and dominated transportation. But as time wore on, spur lines went unused, passenger trains were replaced by airlines, and trucks and transport eventually dominated.

What Systems Are in Place to Meet the Needs of Aging Adults?

Aging adults group their concerns about aging into three broad categories:  health care costs, physical consequences of aging and running out of money. These concerns, however, have their roots in multiple systems. The problem is that each of these “systems” have overlapping and sometimes competing needs and goals that unintentionally duplicate processes and create barriers for aging adults.

For example, the healthcare system provides specific services related to prevention, treatment, and on-going care. Finding a healthcare provider who has experience or specializes in geriatrics is challenging because it does not pay as well as other specialties. Here the barrier is demand exceeding supply.

The financial system (bankers, investment advisors, and insurance brokers, and pension plans) provides the economic structure that insures sufficient funds to cover expenses of living, but the focus is on wealth-building, not on insuring that there are sufficient financial resources across the lifespan. Here the competing need is growth vs. maintenance.

The rest of people’s needs are met within what we call “community” which includes housing, transportation systems, and services that create the context where people can get where they need to go, obtain what they need to live, and be safely housed. Here again, the needs of aging adults are frequently not addressed from a community development model.

Drilling Down: Healthcare Systems in the U.S.

Most aging adults have their healthcare needs paid for by Medicare and/or Medicaid. Unlike other developed nations, the United States expects aging adults to pick up large portions of the costs of medical care. This is unrealistic given that costs are unregulated and many aging Americans are on fixed incomes.

Additionally, healthcare systems here are not designed in terms of population or need, but are designed in terms of specialty. This ranges from types of practice (e.g., surgery, cardiology, gastroenterology, diabetes, neurology, rheumatology), to locations of care (hospitals, skilled nursing facilities, memory care), to providers (e.g., geriatricians, palliative care doctors, care managers, nurse practitioners, psychologists, and social workers), to adjunctive services (e.g., physical therapists, medical suppliers, caregivers).

A Closer Look: When Systems Fail

Unlike in the past, where changes to health care systems would take generations, the pandemic forced us to shift how we delivered healthcare services across all segments of our population. We failed miserably for aging adults in long-term care. Patients, mostly older, flooded intensive care units. Outpatient care revealed huge gaps depending on whether you lived in urban areas, rural areas, on reservations, or off the grid.

Public health officials had difficulty navigating choppy waters. We needed leadership from the Federal government, which proved unstable and unreliable. States and local jurisdictions came up with their own plans, but still needed Federal funding to cover the costs of production and distribution of vaccines. The end result was a loss of trust across many systems that may take years to rebuild.

How Do We Change Systems to Meet the Needs of Aging Adults?

It’s one thing to identify where the holes are in the Swiss cheese. It’s entirely different to come up with a new cheese altogether. For decades we have seen the holes in the health care system, but have made only modest efforts to plug them. Still, the preference is to stick with the familiar, even though it isn’t working quite as well as it should.

How Can We Build on the Momentum of a Pandemic?

It is clear to me that we must not return to the “way things were”, especially in terms of meeting the needs of aging adults in this country. It is also clear to me that there is such a huge divide in the nation’s psyche that collaborating on a national level may be impossible for decades to come. My practical side concludes that local systems are left with defining needs and pulling together the essential elements that will make a given community elder-friendly. How is that accomplished? By recruiting key folks from the community and using available information to come up with a template that fits.

Available Templates for Elder-Friendly Communities

Good news is that these templates are being used and adapted around the world. Based on work being done in the UK, here are ten tips for making your community elder-friendly!

  1. Somebody’s Already Done It; No Need to Reinvent the Wheel!

There are lots of folks who are working to make where we live more elder-friendly. Check out Facebook groups, your local Senior Center, your local Council on Aging, and of course, faith-based communities. You can also take a look at what is being done around the world here: Global Networks of Age-friendly communities.

  1. Create a Narrative that Evokes Pride not Pity

There are lots of narratives about growing old in America that focus on decline, loss, anxiety, depression, and isolation. Based on my own experience and my experiences with folks I interact with daily, that is not the whole story!  We need to change the narrative!  So, when you go into a room, whether with your co-workers, your book group, your boss, or volunteers you work with, you need to be able to show why the position of older people and aging populations matters right now, and why it is imperative to plan for the future.

  1. Address the Elephant in the Room: Ageism

No doubt you will have to contend with explicit and implicit biases about aging – including your own! Words carry weight. Pay attention to how you talk about aging and help others to find new and better ways of talking about growing older.

  1. Build Relationships with All Age Groups

Invest in your relationships across the generations-spectrum. Learn to listen, inquire, and stay curious about what the world looks like from different vantage points of age. It is vital to find and connect with people of all ages who are invested in making the world livable. Make time to get out-and-about and make those personal connections.

  1. Find a Need then Fill It

Reaching across the table may be bad manners, but it opens up dialogue where common needs can be addressed in creative ways. Do elders in your community skip meals because of rising food costs? Then address their need for food security by partnering with local growers and your Senior Center. This creates a template that others can use to address needs in their community. There may be many different needs. Just start with one.

  1. Build Bridges – Locally and in Widening Circles

Working on aging can be lonely work. You may feel isolated and alone where you live, or there may be a small team if you’re particularly lucky. COVID opened up new ways of communicating that broke down distance barriers. Being able to connect with places and people outside of your area not only helps to boost morale, but it builds this thriving, vibrant, powerful community of people with a shared vision. And there are a lot of us out here!

  1. Sometimes the Pendulum Swings Away from You

There are times when people just aren’t interested in my agenda. When the pendulum swings away, find where the energy is in your community and show up there. Your being present with them is evidence of just how important it is to focus an age-friendly lens on local priorities that people are talking about. And, because it is a pendulum, when it swings back, make sure you invite your new buddies to join you and share their vision.

  1. Know More Than Everyone Else in the Room About Your Specialty (Or, If You Don’t – Find Somebody Else That Does) 

There is a wealth of information available on aging; but not everybody is interested in immersing themselves in it. If you like knowing things, you can be the messenger. Because our work is so wide ranging, we all need to know a little about lots of things like housing, insurance, and/or transportation. In this case, it really does take a village to keep each elder healthy and valued.

  1. Increase Visibility

What does aging look like in your community? Can’t call to mind an image? You are not alone! Many aging adults feel invisible, which is why it is important to increase the visuals. And not the negative ones! Positive images of aging are either stereotypical (wheelchairs, canes, and hearing aids) or absent altogether. We need to share ourselves doing what we are doing and flood Instagram, Facebook, and all other venues with images of what aging actually looks like!

  1. Come Together, Right Now Over Me

Your ability to bring people together to sit down and discuss why aging is a hot topic is so important. Your ability to engage the people, organizations, and elected officials in what it means to age in your community, is something that can be truly transformative. It is what is missing from so much of the dialogue we are submerged in. It just needs an invitation to discuss and a need to fill.

One response to “Best Time to Build Elder-Friendly Communities?  Right Now!”

  1. Rosalie Cushman Avatar
    Rosalie Cushman

    This is an excellent article. You should write for (or start your own??) magazine.

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