Saturday, May 4, 2013

Richard Adler's Seven Grand Challenges of an Aging Society

Richard Adler, Distinguished Fellow, Institute for the Future
Researcher, technologist, gadfly Richard Adler has been laser focused on the intersection of aging and technology for more than two decades. In the 1990's, he pioneered research on the use of computers by older Americans while working at SeniorNet, a nonprofit that teaches computer skills to millions of seniors worldwide. 

Today as an independent consultant and "Distinguished Fellow" at the Institute for the Future, Richard evangelizes the concept that the aging of our population is not just an economic burden but also provides exciting opportunities for innovation.

Headlining a panel discussion in front of a packed audience at the UC Berkeley School of Social Welfare library recently, Richard entertainingly summarized the demographic trends that brought about the aging dilemma and presented what he calls the "7 Challenges of an Aging Society,"--along with some of the potential solutions to these problems. 

"One place demographically in the U.S. where the action is going to be," he says, "is in the older population." 

Up to age 64 there is going to be slow population growth over the next 40 years, while the number of people 65 plus is going to double and the number of people over 85 is going to increase over 200%.

"No matter what business you are in, if you don't think about older people, you're missing out," he continues.

Baby boomers are of course responsible for this trend. 

While there could not possibly have been a person in the room who didn't already know the 72 million American born between 1946-1962 represent an aging population bulge that now threatens to bankrupt the whole country, Richard's retelling of it was still insightful.

One of his slides showed 4 Newsweek magazine covers. The first, published in 1948, is one of the earliest recognitions of the baby boomer phenomenon. It's headline reads, "Boom in Babies. What it Means for America."

By 1964, the focus was on "The Teen-Agers." It is subtitled, "A Newsweek Survey of What They're Really Like." 

In 1992, the magazine presented a "Boomer's Guide to Health, Wealth and Happiness," important information for boomers who then represented "The New Middle Age."  

Fast-forwarding to 2005, Newsweek proclaimed, "Ready or Not, Boomer's Turn 60."

"Like this was a big surprise," Richard quips.

Life Expectancy Continues to Increase

Despite predictions that the increase in life expectancy would level off, he points out, "it never has and it never will, people are living a lot longer."

"People say boomers are the best educated, the most affluent segment of the population, but a large part of them are not," he continues. 10% of boomer households have a "net worth of zero of negative," and over 50%, have a "quite low" net worth.

Reality is inescapable. A huge number of people are going to need social and medical services and these are going to be impossible to support.  The current system of Social Security, Medicare, and related services such as congregate care retirement housing, senior centers, meals on wheels, and the like, just isn't up to the task. 

"The whole canopy of programs that truly have made a marked difference in the lives of older people," Richard says, "as good as they've been, they will not scale up adequately for this population which is going to double."

"Clearly the resources are going to be restricted. I believe we need to see a wave of entrepreneurial innovation, both in public and private sectors, mainly on the local, grassroots level instead of the top-down, bottom-up," he proclaims.

Challenge 1 
Reinvent Healthcare

There are 7 major challenges Americans need to face and find creative solutions for if we are going to "navigate our way" through the aging crisis. The first of these is "Reinventing Healthcare."

As the above slide shows, the annual healthcare cost in the U.S., Germany, UK, Sweden and Spain are similar until age 50, and then "suddenly, the U.S. breaks out." 

If life expectancy in the United States was much higher than these other countries, then our healthcare costs might be justified, but our life expectancy is in the middle.
Just Going to the Doctor is Not Enough

"More high tech procedures, more gadgets, just isn't going to dictate the help we need," Richard claims. "What we need is a broader view of health that includes social economics, the context of people's lives."

As a "great example" of what he means, he point to Kaiser Permanente's program of integrating social workers into its primary care practice. By addressing the social needs of patients, Kaiser has been able to better control costs and at the same time provide better care.

An expanded view of someone' health has to involve much more than the typical medical measurements, cholesterol levels and blood sugar counts. It needs to look at all the things on the chart shown above--lifestyle factors, living and working conditions, education, environmental standards, and the like. 

Challenge 2
Reinventing Senior Services

The next challenge on Richard's list is "Reinventing Senior Services." He shows us a photograph of a typical "nice senior center" where seniors can get a subsidized meal and points out, "most baby boomers don't want to go there."

I think to myself, wow, can I ever relate to this! Sitting around a ceramic card table, sipping hot tea through a straw, and sharing photos of the grandkids is not the way I invision my "golden years" and I'm surely not alone in this feeling.

One answer, Richard says, is to "package" senior centers in a more "comfortable way." 
Mather's Cafe Plus
An example of this better packaging is Mather's Cafe Plus, a senior center in Chicago disguised as a neighborhood restaurant.    
From outside, the cafe looks more like a "Starbucks for Seniors," than the typical, institutional based senior center. And inside is different too. More like a "nice restaurant" with the services for seniors hidden away in the back. 

At Mather's, the initial draw is the food, but benefits include classes and programs that provide older people with the information they need to age well, and opportunities to meet new people, to learn new things.

Richard's "favorite new example" however, is a Seattle based social service called  "Aging Your Way."  This program began its existence by spending an "entire year having dozens of neighborhood meetings," asking people about the ideal way they see themselves living as they age, the things they want to do and the people they want to associate with. 

Among its many activities, Aging Your Way organizes action teams that produce neighborhood walking maps and clean up neglected parks. A sub-program called "Timebank" encourages older people to exchange services through an online database that keeps track of everyone's hours--all services from dog walking to electrical work are valued the same. You earn credits by helping your neighbors. 

Aging Your Way reinvents senior services by making it easier for seniors to care for each other and this, in turn, reduces their need for government social services. 

Challenge 3
Reinventing Senior Housing and Long Term Care

Aegis Gardens Photos by Augie Chang
"All across the country we are developing culturally relevant senior housing for people who were probably born outside of the U.S. and want to age within their culture, but don't want to go back home," Richard continues.

A great example of this is Aegis Gardens in Fremont, California, where the focus is on Chinese culture. Here, residents can participate in activities such as tai-chi, mahjong, and calligraphy (shown above.) The staff speaks multiple Chinese dialects, the food is Chinese, and they even celebrate Chinese holidays.

A completely different example is the Burbank Senior Artist Colony, an "apartment rental community," for people who want to paint, participate in plays, write poetry, practice photography and other artistic pursuits. There is a community theater, art gallery, organized readings, art classes and related activities. 

And a "more dramatic example" is co-housing, where residents get together to create their own housing community. 

Co-housing communities are usually designed as attached or single-family homes along one or more pedestrian streets or clustered around a courtyard. They range in size from a few up to 50 households, where there are opportunities 
for casual meetings between neighbors, as well as for deliberate gatherings such as celebrations, clubs and business meetings.

The private homes contain all the feature of conventional homes, but residents also have access to extensive common facilities such as open space, playgrounds and a common house. 

Residents make all the decisions and can pool their resources to hire shared outside services. 

One such co-housing project that Richard cites is under construction in Mountain View, California, just a few blocks for the main downtown area. Here, they have an acre of land and an old farm house that will serve at the common house. 

Challenge 4
Reinventing Community

Richard points out the obvious--a lot of people simply do not want to move out of their homes at all. 

In 1999, a group of friends who live in Boston on Beacon Hill got together to discuss how life would be for them as they age. Each realized the time was coming when they would need caregiving support, but none of them wanted to move out of the neighborhood, which they love. 

The Beacon Hill friends were of a common mind--they didn't want to be "taken care of." So they decided to take steps to create the groundwork that would allow them to take care of themselves. They formed a nonprofit organization called Beacon Hill Village, which hires its own staff of service providers, and recruited volunteers.

Today, the residents of Beacon Hill Village take care of each other. They self-govern, make all their own decisions and live in their own houses and apartments, a true example of "aging in place." 

This idea has been so successful it has been replicated in Palo Alto, California and in at least 100 other locations. 

Challenge 5
Reinventing Retirement 

Retirement was "sold for decades," Richard says, "as this wonderful, endless vacation where you go sit on a beach somewhere and have a good time."

Because people are living longer and staying more engaged, this classic concept has lost its appeal, in fact, the very word "retirement" seems dated.

For myself, I hate it when some asks me, "Are you retired?" I feel like I want to punch them out, but I usually just say, "Retired? That word is not part of my vocabulary." 

Instead of doing less, older people want to do more, only they want to do the things they care about. Many pursue dreams they had to defer while working at a career and raising a family. Now they have the time, they get busy and often work harder than ever. 

No one really wants to sit on a rocking chair and do nothing. 

Challenge 6
Reinventing Life Stages

The old model of infancy, childhood, adulthood and old age has broken down. 

Citing the books, "The Big Shift," by Marc Freedman and "Composing a Further Life" by Mary Catherine Bateson, Richard notes that both authors write about an additional stage of life between adulthood and old age. Freedman calls it the "third age," while Bateson refers to a "Adult II." 

Adult II is a time when you are still healthy and engaged, but don't want to devote your life to a career. It is generally the 20 years from the mid-60's to the mid-80's.

"This idea has actually helped me," Richard says, "I celebrated my 70th birthday last year and was getting confused, was I 'old' or wasn't I 'old.' When I heard about Adult II, I thought 'oh, I'm in Adulthood II, problem solved."

Challenge 7
Reinvent Social Work

Projected # of Social Workers Need in Long Term Care
The challenge for many of the people in the audience is to reinvent social work to meet all the needs of the above.

Obviously the demand is real. It is growing, but there is a question about whether funding for the jobs will be there. 

Richard cites a government report that found the majority of social work students complete their studies with no courses in aging, no knowledge of services available for elders, or any understanding of the diversity of the aging population.

Social work students perceive that all work with the elderly involves caring for demented and bed-bound clients in unpleasant settings that inevitably leads to a poor outcome.

"Doesn't sound like a great job," he cracks, which evokes a nervous laugh. I wonder how many in the audience actually share this perception, or at least did before they came today. 

Despite an increasing needs for social workers trained to work with older adults, government sponsored training programs have declined. No significant national resource presently exists for supporting social work students interested in aging. 

"This is a truly grand challenge," Richard concludes.

Following his presentation, there were other speakers and a robust question and answer session. At this point, though, I felt I had a lot of information to think about and I hope anyone reading this agrees. There are big decisions ahead. 

--David Bunnell

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