new stage of life

Why Aren’t We Investing In Our New Stage of Life?

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Have you noticed:

• When funding for programs for young people is debated, we talk about “investing in our children.”

• When the defense budget is under consideration, we talk about “investing in national security.”

• But when subsidies for long-term care and other benefits for older adults are part of a government spending debate, the word “investment” seems to vanish.

This is a key reason that it’s difficult to secure additional, much-needed funding to support older adults. The public doesn’t see that increased longevity has created a new stage of life, nor that investing in that stage offers benefits to all of us.

Instead, as I wrote in a previous post, older adults are viewed as “net takers” in society. Few people see the possibilities created as large numbers of older adults enter a new, uncharted stage of life.

Some key points about this stage of life (which has been described so well by Laura Carstensen and the Stanford Center on Longevity):

• On average, Americans are living significantly longer now. The premise that most of us will retire in our 60s and die five or 10 years later is no longer operable.

• That means many older Americans have additional decades of potentially useful life. Some want (or need) to use those years to continue to work, some want to volunteer, some want to be mentors.

• The older Americans who still want a job comprise the largest untapped workforce available to us right now. Adding them to (or keeping them in) the labor pool provides experience and wisdom, which makes a difference. Studies show that multigenerational workforces perform better than chronologically homogenous teams.

• As Ken Dychtwald has written, we have the chance to convert the older Americans interested in volunteering into an army working on the most pressing social problems we have.

• Our vision of life after 50 is flawed, as Jonathan Rauch wrote recently in The Atlantic. Reaching this new stage of life “brings gains, too: greater equanimity, more emotional resilience, and what Carstensen and others have called the positivity effect, a heightened appreciation of life’s blessings.”

If we don’t recognize these gains, we won’t grasp the full extent of benefits that older adults can bring to society.

(Rauch’s piece also correctly credits thinkers like Andrew J. Scott, Phyllis Moen, Chip Conley, Marc Freedman and Ashton Applewhite for their important work on this subject.)

• It’s important to remember that not every American can count on this new stage of life. We are not seeing uniform increases in longevity across socioeconomic, racial or ethnic lines.

Add it all up, and it’s clear that an investment in older Americans could produce immense dividends. Our economy, our social fabric and our sense of community would benefit.

But the investment in the new stage of life will only happen if the public starts seeing it through that lens — as an investment.

golden girls

Why the ‘Cultural Narrative of Old Age’ Needs to Change

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Our “cultural narrative of advanced age” has changed in recent decades, and that change may explain why we as a society don’t take better care of older Americans — that’s the thought-provoking case made in a recent New Yorker book review.

I was intrigued by the piece, which was written by Daniel Immerwahr and reviewed Duke historian James Chappel’s “Golden Years.” But I think the call for increased government spending devoted to the care and support of older Americans, while needed and well-intentioned, is both naive and doomed to fail.

I agree that long-term care and other benefits for older adults need more public funding. But what both Immerwahr and Chappel miss is that we’re never going to earn public support for these subsidies if older adults are seen as “net takers.”

Sadly, that’s a widely-held perception now. Older adults are seen as a drain on scarce societal resources while contributing little after age 65 or 75. Programs that could benefit us are framed as “handouts,” competing for dollars alongside programs for the needy and children — not to mention the military.

The New Yorker review frames the “narrative” of aging in the U.S. as having two parts. The first could be called the “Golden Girls” stage, named after the popular sitcom of the 1980s and 90s. We want our older citizens to live like the Golden Girls: acting youthful and finding fulfillment as they age in place, while not needing any form of government assistance.

The second half of the narrative, meanwhile, is “where the more disabling, restrictive stage of old age begins,” as Susan Jacoby is quoted as saying in the piece. This is where the “taker” perception kicks in, as the perception of older adults goes from “Golden Girls” to infirm and helpless burdens on the rest of us.

Obviously, aging is not so black and white. But if society continues to look at it this way, adequate support for older Americans will remain elusive, especially in periods where budget-cutting is prioritized.

What’s the answer? I think it starts with defining a new stage of life and all that it offers everyone in society. That is the topic of another post I wrote recently.

Older father with daughter

GUIDE: A Much-Needed Step in the Right Direction

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Our complex and fragmented system of long-term care and aging services became a little less confusing this summer with the launch of a Medicare pilot program called GUIDE. It’s fantastic news for older adults and their loved ones.

GUIDE, which stands for Guiding an Improved Dementia Experience, is a free program that aims to assist Americans who suffer from dementia and their family caregivers. As I told Richard Eisenberg when he interviewed me about it, GUIDE is the most prominent and promising thing the government is doing to recognize the need for meaningful care coordination and to pay for it.

Available to those with traditional Medicare (but not Medicare Advantage plans), GUIDE “offers free assistance in navigating benefits, caregiving alternatives and programs for people with dementia, along with respite care so caregivers can take a break. It has a goal of keeping people out of nursing homes, which Medicare typically doesn’t cover,” as Rich reports.

It’s an eight-year pilot, and it is expected to benefit around 80,000 Medicare beneficiaries and caregivers in its first two years.

It’s encouraging to see a program like this launch, given the call that Nexus Insights made in 2022 for “navigation hubs” for long-term care. In our report that year, the Nexus Insights fellows and I proposed the creation of hubs to support older Americans and their loved ones as they make critical decisions, usually under stressful conditions, about their care needs.

GUIDE is a welcome step in this direction.

ACL cites Nexus Insights report

ACL’s ‘Aging in the U.S.’ Framework Cites Nexus Insights Report

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The Administration for Community Living’s release of its new report on aging at the end of May was welcome news.

The agency, which is part of the Department of Health and Human Services, has created a framework that aims to build a more person-centered and accessible system of care for older adults, potentially allowing them to more easily connect with long-term supports and services.

It’s especially gratifying that the framework (Aging in the United States: A Strategic Framework for a National Plan on Aging) recognizes the report Nexus Insights published in 2022, which called for navigational hubs to help families negotiate our nation’s maze of long-term care and aging services.

Nexus Insights fellows Caroline Pearson, Anne Tumlinson, David Grabowski, Ryan Frederick, Dr. Bill Thomas and Sarah Thomas participated in the development of the report, from the initial “Nexus Voices” salon with long-term care providers, caregiver advocates, tech-driven startups and policy experts, to the writing and editing of the report.

They documented a key problem then, as the ACL does now: Every day, older adults and their families are facing tough questions about long-term care — often without the necessary resources to make informed choices. The ACL framework is another positive step toward addressing this problem.

ageism word cloud

The Greatest Challenge to Senior Housing and Aging Services: Our Own Ageism

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Having worked in senior housing and aging services for almost 40 years, I’m often asked, “What do you think is the greatest challenge we face in providing older adults with the housing, health care, supportive services and community that they need?”

The more I’ve reflected on this, and the longer I’ve been in the field, the more convinced I am that our greatest challenges are the ageist assumptions, prejudices and stereotypes that permeate our society.

If you’re like me, you’re disappointed but not surprised when those who don’t work in our industry use ageist phrases like the ones in the graphic above. And you’ve probably also seen how ageism can guide the actions of employers, policy-makers, regulators, researchers and others who don’t work in senior living and long-term care.

But sadly, many in our profession unconsciously fall prey to ageist stereotypes and language, too. It happens with well-meaning intentions, to be sure, but it can do real damage.

It diminishes the agency, identity and value of the older adults with whom we work.

One small example of this sort of ageism is the concept of a “continuum of care.” While on one hand, this concept can accurately describe the need for often-increasing levels of care and supportive services for older adults, it has an unfortunate and unintended consequence.

When we talk about a “continuum of care,” we frame our work around a declinist view of those we serve. It casts them as people who are beset by ever-increasing deficits, and that leads to further disempowering and devaluing them — discounting their desire and ability to contribute to their life, the lives of those close to them, and the issues that they care about most.

We need to offer a continuum of engagement, not a continuum of care. When we focus on engagement, we prioritize the things that give those we serve a sense of self-worth, identity, purpose and belonging — instead of diminishing the individual by making them a sum of their needs for care and functional support .

To be honest, I didn’t know this when I started my career. I have come to the realization over time.

But today, with experience, I’m certain that everything we do should start with engaging with the older adult, and asking what matters to them. Then we need to frame our work based on their responses.

That doesn’t mean we should ignore very real needs for care and support. But it does mean acknowledging that those we care for have a desire to stay meaningfully engaged in life. Or, more succinctly, acknowledging that there’s still a person there.

Dodgers

Ursula and the Dodgers: Cherished Memories and Memory Care

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I wouldn’t say that my mother-in-law, Ursula, loved baseball. But at this time of year, I am reminded of how a Brooklyn Dodgers story could make her happy — and truly helped bring her moments of joy as she struggled with dementia in the last years of her life.

In the late 1940s, Ursula worked as the manager of an Ebinger’s Bakery location near Ebbets Field, the Dodgers’ storied home until they left for Los Angeles in 1958. Dodger players would stop by the bakery after their games to pick up their favorite donuts or jelly rolls. Unfortunately, by the time their afternoon games ended, the bakery was often sold out of many of their favorites.

Seeing this, Ursula started to set aside each player’s favorite in the morning — even though it was against company policy. She made sure that Pee Wee Reese, Duke Snider, Jackie Robinson, Gil Hodges, Roy Campanella and their teammates always got the sweet they wanted.

Grateful and delighted, they were eager to offer her free tickets and other perks — which she would usually decline, because she really wasn’t a baseball fan. But she was incredibly proud that she had forged a relationship with the players and increased Ebinger’s customer loyalty at the same time.

In 2013, after moving from her home of 52 years on Long Island to Annapolis and losing her husband of more than 70 years, Sam, we helped her move into the dedicated memory care portion of a nearby assisted living community.

It quickly became apparent that she was agitated. She would act out at times, becoming quite upset. It was understandable — why shouldn’t she be upset? Dementia aside, she had undergone a series of huge, disorienting changes.

One way I tried to help was writing up five stories about Ursula’s life that were especially meaningful to her. I shared the stories with staff and suggested they ask her about them when she became upset. One of the stories was her interactions with the Dodgers at Ebinger’s.

“What did you do that endeared you to the Dodgers?” staff members would ask. It worked — she would calm down. She considered her work at the bakery and relationship with the Brooklyn players – ‘Dem Bums’ as they were affectionately called – to be core to her identity. It gave her great pride. And it was still there.

We didn’t know in 2013 that these sorts of memories stir the pleasure centers of the brain. We can see it when we look at the brainwaves of someone remembering a fond memory.

That’s why I love the work being done by John Zeisel and I’m Still Here and Kris Engskov and Rippl. Their work with those suffering with dementia recognizes that there’s still a human being there, and we can still connect with that person.

While their short-term memory may be limited or gone, they still have long-term memories. And reminding them of the things that gave them pride, a sense of purpose and belonging, or just joy makes a huge difference. I saw it first-hand with Ursula, the Dodgers and their donuts.

Presidential candidate speaking in front of crowd

When Will Political Campaigns Start Taking Long-Term Care Seriously?

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Prediction: In the 2028 presidential election, long-term care will become a mainstream campaign issue for the first time.

It seems clear that long-term care won’t be a major issue this year, for many reasons. But in 2026, the Medicare trust fund is projected to show a deficit. The oldest Boomers will turn 80 that year, as well. By 2028, those born in the Baby Boom’s peak years will have turned 65. Social Security will be just a few years from deficits, as well.

In other words, 2028 will be very different from 2024. And today, we already know the long-term care system is troubled. (Really, it is not a system at all, but a maze with lots of dead ends, as Anne Tumlinson, David Grabowski and I wrote in 2021.)

Whether a family is looking for home care or assisted living, the cost is steep. And Generation X and Millennials have become the first “triple mortgage” generations. Boomers like me only had to worry about paying off a home mortgage. But younger generations effectively are carrying two additional mortgages — their student loans and the long-term care bills of their parents.

For many, many families, the triple mortgage is an unbearable load. That’s why it’s not surprising to see increasing public support for the government shouldering some of the responsibilities of care payment (see this recent piece in McKnight’s Senior Living).

As pressure on families — and on the system — builds in the next four years, the issue will spill into politics. Candidates are going to be asked “What’s your solution?”

Up until now, politicians conveniently kicked the can down the road when asked about long-term care and funding. They would say “I’ll always support Social Security and Medicare,” and “I would never turn my back on seniors.” No one insisted they get more specific. They will soon.

Milken Future of Health Summit

Future of Health Summit: Reimagining Senior Housing and Integrated Care

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As the baby boom generation ages, expanding affordable housing and integrated long-term care options for our nation’s diverse older adult population has become increasingly urgent.

According to a National Investment Center for Seniors Housing and Care-funded study conducted by NORC at the University of Chicago, more than half of middle-income Americans aged 75 or older will not have the financial resources to access housing and care by 2029. Meeting the needs of this “Forgotten Middle”—an income group too wealthy to qualify for means-tested programs yet unable to afford private-pay senior living options—will require coordination from public and private sector stakeholders.

Recognizing the challenges of promoting and incentivizing innovation across sectors, this session hosted by the Milken Institute features industry leaders, providers, and policy experts discussing scalable housing and care solutions for this growing segment of the population.

Moderator:

  • Caitlin MacLean, Senior Director, Innovative Finance, Milken Institute

Speakers:

  • Lynne Katzmann, President and CEO, Juniper Communities
  • Bob Kramer, Co-Founder and Strategic Advisor, National Investment Center; Founder and Fellow, Nexus Insights
  • Nirav Shah, Senior Scholar, Stanford University
  • Elizabeth White, Founder, NUUage Coliving

Watch the recording: https://milkeninstitute.org/panel/14999/reimagining-senior-housing-and-integrated-care

Critical Resource for Older adults

Caregiving Navigation Hubs: A Critical Resource for Older Adults and their Families

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Coordinating caregiving for aging loved ones is a complicated and frustrating task for families. And the problem is growing.

According to a recent article in Next Avenue, “It generally starts with a crisis: Your parent shows signs of dementia…or is about to be discharged from a serious hospital stay…or requires help with daily activities of living. What do you do? Where do you turn? It’s the little-discussed part of long-term care that leaves many of the nation’s 22 million family caregivers for older loved ones bereft and befuddled.”

“We’re failing tens of thousands of older adults and their families,” said Bob Kramer, Founder and Fellow of Nexus Insights.

Nexus Insights is a think tank advancing the well-being of older adults through innovative models of housing, community and healthcare.

In early 2022, Nexus Insights brought together long-term care providers, caregiver advocates, tech-driven startups and policy experts in its first ‘Nexus Voices’ salon to discuss how to help older adults and their caregivers better navigate the complex and fragmented array of long-term care and aging services. The result was a report released in September 2022, “Where Am I, Where Do I Go: The Missing Entry Point to Long-Term Care Solutions for Older Adults and Their Caregivers.”

This report was the subject of the Next Avenue article, written by Richard Eisenberg.

Eisenberg spoke to several of the report’s authors, including Anne Tumlinson, CEO of ATI Advisory and a Nexus Fellow. “The primary challenge that most of my peers and friends and family were experiencing was entering into that phase of their lives when they were suddenly thrust into family caregiving roles and feeling like there’s no place to go,” Tumlinson said. “In the best-case scenario they’re getting a hospital discharge planner handing them a long list of organizations who are like, ‘Good luck. Here you go.'”

Caroline Pearson, another report author concurred. Pearson, formerly the Senior VP of Health Care Strategy at NORC at the University of Chicago, and now the Executive Director for The Peterson Center on Healthcare, and a Nexus Fellow. “Unfortunately, most people find themselves in these urgent scenarios that are sort of a call for help unexpectedly,” she said.

In fact, Nexus recently partnered with NORC to conduct a survey on this issue. The survey showed that 1 in 4 older adults needed long-term care services for themselves or a loved one in just the previous 12 months. It also echoed the report’s assertion that caregivers experience frustration and anxiety during the process.

The Nexus Voices report offers a powerful solution, according to the article, “A national, independent, trusted hub system of caregiving navigators who would be accessible to everyone and serve as a central doorway to long-term care services and supports.”

“For every single family to be creating a long-term care service delivery system is very inefficient from a societal standpoint and an economy standpoint,” said Tumlinson.

The solution would have to be national in scope. “There was broad-based agreement [among the salon participants] that creating the kind of awareness to make these hubs as visible as your local drugstore or post office was going to take a national effort, and a level of funding that was probably going to have to be federally driven,” said Kramer.

According to the article, a local example of such a hub was launched earlier this year in Ohio. The NaviGuide program, created by United Church Homes in Ohio, offers these types of services to its 166 clients. The program was inspired by a family crisis for its creator Terry Spitznagel, senior executive vice president and chief growth officer for United Church Homes. Spitnagel said, “I’ve been in senior services for three decades, but I just fell apart trying to help my father navigate the aging journey. I couldn’t manage it.”

The article sees the NaviGuide program as a positive step in the right direction. “If programs like United Church Homes’ NaviGuide are proven financially viable or federal or state governments earmark money for caregiving navigators, you may start seeing these experts pop up around the country.”

In fact, other recent reports echo the Nexus recommendations.

“There are real opportunities to move forward on this,” said Kramer. “But it’s going to take keeping the issue in the limelight and building momentum and seizing opportunities.”

And, the article suggests, “It may also require more people finding themselves thrust into becoming family caregivers or needing to coordinate care.”

Said Tumlinson: “You have to go through it and then be stunned. Then you say, ‘Why is this not being fixed? How is this possible?'”

Read the article at Next Avenue.

Read the Nexus Report
Read the Nexus Survey

Long Term Care Experience

NORC Study Shows Most Older Adults Experience Anxiety and Frustration While Selecting Long-Term Care

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Twenty-four percent of U.S. adults ages 50 and older say they, or a loved one needed long-term care in the past year, according to a new, national survey commissioned by Nexus Insights, a think tank focused on older adults. The research was conducted by the well-respected NORC at the University of Chicago. The findings illustrate the widespread need for information and guidance about long-term care services among an aging population and their caregivers, a need that experts say will grow exponentially in the future.

Nearly 1 in 4 older adults said they or a loved one needed long-term care in 2022

 

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Most older adults said the process of selecting long-term care caused anxiety (53%) and frustration (52%), while few said they felt confident (23%), at peace (23%), or happy (14%) while making a choice. Researchers say the survey findings suggest a need for more consumer-friendly resources to help families navigate care options.

Anxiety and frustration finding long-term care

 

“Making a decision about long-term care is a maze full of emotional twists and turns, dead ends, and setbacks,” said Bob Kramer, founder and fellow of Nexus Insights. “The lack of a consumer-friendly system to help families navigate the staggering array of decisions that must be made quickly during a healthcare crisis boosts families’ stress. It can result in making decisions that lead to poorly coordinated, lower-quality care.”

According to the survey, older adults said it was extremely important to have additional information about the cost of care and options to pay for it (69%) and the different types of long-term care services available (63%).

Nexus Insights released a report earlier this year detailing the often frustrating and confusing process facing many older adults when making decisions about long-term care for themselves or a loved one. It called for a national long-term care navigation hub to help older adults discover and assess options, educate them on available support and funding, select and connect with the option that is best for them, and continuously evaluate their needs as health and financial statuses change. Kramer said navigation resources are needed immediately to support the aging Baby Boomer population, many of whom not only serve as caregivers to older parents but will soon need long-term care themselves.

“Many families reckon with a long-term care system that’s nearly impossible to navigate and provides little-to-no support for families making life-and-death decisions,” said Caroline Pearson, senior vice president at NORC at the University of Chicago, who also serves as a Nexus Insights fellow. “Most people will eventually have to make decisions about long-term care for ourselves or a family member, so creating a consumer-friendly long-term care navigation system should be high up on the nation’s list of to-dos.”

People likely to turn to family for long-term care advice

 

The poll was conducted between November 11 and 14, 2022, during a monthly Omnibus survey. It included 1,014 interviews with a nationally representative sample of adults age 50 and older (margin of error +/- 4.34 percent points). The AARP and NORC’s Foresight 50+ probability-based panel is designed to be representative of U.S. adults age 50 and older.

DOWNLOAD THE SURVEY: One in Four U.S. Older Adults Needed Long-Term Care for Themselves or a Loved One in 2022

READ OUR REPORT: Where Am I, Where Do I Go: The Missing Entry Point to Long-Term Care Solutions for Older Adults and Their Caregivers

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