Administration for Community Living

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

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.

Milken Future of Health Summit

Future of Health Summit: Reimagining Senior Housing and Integrated Care

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

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NIC Awards $3M to Milken Institute to Establish Groundbreaking Aging Innovation Collaborative

NIC Awards $3M to Milken Institute to Establish Groundbreaking Aging Innovation Collaborative

New Collaborative will reimagine aging, leveraging nationally renowned experts from different economic sectors to collaborate to improve the lives of older adults.

The National Investment Center for Seniors Housing & Care (NIC) awarded the Santa Monica, Calif.-based Milken Institute $3 million to establish the Aging Innovation Collaborative (AIC) within the Institute’s Center for the Future of Aging, which advances healthy longevity and financial security through policy, research, convenings, and multisector partnerships.

As part of the creation of the AIC, Nexus Insights will share intellectual and human capital with AIC, and merge with the new collaborative. Its fellows — including its founder, NIC strategic advisor Bob Kramer — will contribute to its day-to-day work, becoming AIC fellows.

The AIC will engage experts to develop bold new models of housing, healthcare, and community that meet the needs of a growing U.S. population of older adults. By removing silos between industries and incorporating innovations in housing, healthcare, technology, and more, the AIC will identify and scale comprehensive solutions that improve the lives of older adults.

“Housing and long-term care stand at a crossroads as millions of Baby Boomers think about how they want to live their best life after retirement,” said Raymond Braun, president and CEO of NIC. “This commitment to the Milken Institute brings talented individuals from diverse backgrounds together to transform how we think about aging in the United States. The Aging Innovation Collaborative will become a font of ideas for consumer advocates, real estate developers, senior housing operators, healthcare providers and payers, policymakers, and others.”

The AIC will initially focus on three core offerings:

  • A Landmark Tracking Study. This research study will track attitudes and preferences of older adults aged 50-80 over time. It will be conducted in collaboration with a nationally recognized research partner and leading experts in the field. Initial results are expected in 2024.
  • Aging Innovation Council. This advisory council will include leaders from consumer goods and retailers, housing, government, healthcare providers and payers, technology, and capital markets. By removing silos across industries to share ideas and technologies, the Council will create new housing, healthcare, and community solutions for the aging population.
  • Advisory Services. The AIC will provide advisory services to organizations wanting to enhance the health and housing of older adults but that lack the capacity or expertise for innovative solutions. Advisors will help companies navigate the complexities of the aging sector, identify opportunities for innovation, and accelerate time to market.

“It’s an exciting time to join forces with the Milken Institute to help people meet their expectations for aging,” said Kramer. “Older adults have diverse backgrounds, interests, healthcare, and social needs, and they want and expect housing and care that is as unique as they are. Aging is a good thing, and we need disruptive innovation to create housing and care that supports older adults’ ability to not just age but thrive.”

“I am honored to work with NIC in the establishment of the AIC at the Milken Institute,” said Diane Ty, senior director of the Institute’s Center for the Future of Aging. “I look forward to bringing in outside entrepreneurial experience to lead the AIC and examine the intersection of sectors to create new solutions and platforms that benefit older adults. The Milken Institute’s core maxim is ‘turning ideas into action,’ and that is exactly what the AIC plans to do.”

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Longevity expert Ryan Frederick

Longevity Expert Ryan Frederick

Ryan Frederick, Founder & CEO of Here and a Nexus Fellow, is an internationally recognized thought leader, speaker, author, innovator, developer, and strategy consultant specializing in the intersection of place and healthy longevity. He has educated tens of thousands of consumers through keynote talks, workshops, videos, blogs, online assessments and his book, Right Place, Right Time.

Healthy longevity is challenging in modern times. We are less likely to have a support team in close proximity.

“We have more people living longer without this infrastructure or support of extended families. People are having fewer kids, and those kids are less likely to be geographically approximate to where they are.”

Living longer better is more than just genetics. Where you live matters significantly.

“We need to find a way to successfully age. Your genetics only account for 30% of your longevity. It’s more about those social determinants of health we hear about. It’s lifestyle, it’s environment, it’s social connection, it’s physical wellbeing, it’s financial wellbeing, it’s being engaged in your community.”

Ryan has worked with Johns Hopkins University, Stanford University, AARP, LeadingAge, and more, and has been featured on CBS News, Forbes, The Washington Post and more. If you’d like to learn more about Ryan, visit Here.

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Group of Senior Friends

8 Reasons to Be Optimistic About the Fight Against Ageism

American popular culture worships youth, and our governmental policies aimed at supporting older adults are far from perfect. But there’s still good news when it comes to society’s attitudes toward aging. We asked Nexus Insights Fellows to name one reason to be encouraged about the fight against ageism in the U.S.

8 Reasons to Be Optimistic About the Fight Against Ageism

  1. “I am encouraged that ageism is now part of the national conversation. That wasn’t the case even five or ten years ago. Now we see universities including ageism in their aging services curriculum, multiple books being published on the topic, and even female celebrities embracing their gray hair and aging process. We have a long way to go in driving real change, but awareness is the first step.” – Jill Vitale-Aussem
  2. “Aging is one of the most unifying human experiences we have. I find hope in the elevated value of intergenerational engagement: the parent who returns to a new career after raising their children and is embraced by the team; the college student who chooses to live in a senior living apartment instead of the dorms. We have more opportunities now than ever to engage with people of all ages.” – Sarah Thomas
  3. “As young people are becoming increasingly aware of the probability of longer lives — century-long lives in some cases — more young people are seeing the ways in which our society needs to be redesigned to help them thrive over their life course. In such cases, these young people are acting in their self-interest but to the betterment of society more broadly.” – Ryan Frederick
  4. “I love what Julia Louis-Dreyfus has been doing to uplift aging. Brava!” – Jacquelyn Kung, PhD
  5. “Following the pandemic, I am encouraged by the interest in taking on challenges related to older adults that we have ignored for decades.” – David Grabowski, PhD
  6. “A decade ago at a White House Correspondents dinner, actress Helen Mirren lamented to me that there were no good roles for women over 50 in Hollywood. It’s been heartening to see a proliferation of smart, savvy films and TV shows featuring people over 50. Maybe Hollywood can save D.C. and do a film about a smart, savvy older politician?” – Jay Newton-Small
  7. “What I find encouraging today is that people of all ages are speaking out about ageism; not just older people. It’s that intergenerational effort that will ultimately extinguish ageism in our culture.” – Sara Zeff Geber, PhD
  8. “I am encouraged whenever I see people admit and own their age. That act helps others recognize that the person speaking is much more than a number (age).” – Dr. Bill Thomas

We also asked our Fellows to name what they think is the most damaging example of ageism in the U.S.

8 Ways Ageism Damages Our Society

  1. “Most damaging to the fight against ageism is our language. Our language reflects how we think, so when we can extinguish terms like ‘little old lady,’ ‘geezer,’ ‘over the hill,’ and ‘granny,’ we will have made a worthy start on changing the images people hold in their minds about older adults.” – Sara Zeff Geber, PhD
  2. “Ageism leads many to believe that caring for older adults is not everyone’s responsibility. Caregiving will always be a family issue, but it is also a policy issue. We should prioritize policies that improve housing, long-term care, and health care for older adults.” – David Grabowski, PhD
  3. “The most damaging example is the assumption that as we age, we have nothing left to contribute to our communities and society. The term ‘silver tsunami,’ for example, frames our growing cohort of older adults as a disaster, assuming that older people are nothing more than a drain on society. This messaging seeps into the minds of policy makers, aging services providers, and each of us as aging human beings.” – Jill Vitale-Aussem
  4. “Equating aging with decline creates a perverse, self-fulfilling prophecy that cuts older people off from their full developmental potential.” – Dr. Bill Thomas
  5. “I believe that the weaponization of age — particularly accusations of cognitive impairment as political cudgels — was incredibly damaging and stigmatizing for anyone grappling with that diagnosis.” – Jay Newton-Small
  6. “Ageism has limited our ability to design places — from metropolitan areas to neighborhood blocks to housing — that are welcoming and inclusive to people of all ages and abilities. The result is that there are fewer intergenerational relationships and older people may need to move away from their ‘home.’” – Ryan Frederick
  7. “Aging is not a disease. All too often we succumb to society’s ageist pressures to attempt to halt or reverse the aging process. The anti-aging movement that applies unnatural filters to every photo we take and pushes a definition of beauty that revolts against nature is dangerous. This unhealthy view of aging begins to damage society in our youth and we carry the burden of these unhealthy pressures for decades.” – Sarah Thomas
  8. “When I hear older adults described as ‘cute,’ I cringe.” – Jaquelyn Kung, PhD

 

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ATI Advisory Launches New State Resource Center

ATI Advisory has launched a new State Resource Center which supports states in their efforts across Medicaid, Medicare, long-term services and supports (LTSS), behavioral health, and health-related social needs (HRSN).

“I am grateful to the talented team at ATI that makes this possible,” said ATI Advisory CEO, and Nexus Fellow, Anne Tumlinson, in a LinkedIn post announcing the new center.

Current resources include: tips sheets focusing on Medicare-Medicaid Plan (MMPT) transitions, key programs serving dual eligible individuals, and state approaches to increased home and community-based service (HCBS) provider capacity.

ATI Advisory will continue to add tools, data, and tip sheets to the State Resource Center in the coming months.

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Disrupting Aging Services Through Citizenship

The Citizenship Approach to Community Living

Health, community and housing are three vital and intertwined components associated with healthy longevity. For community to be achieved, Nexus Insights believes we need to shift from the current primary focus on what is done ‘for’ and ‘to’ older adults, to a focus on what is done ‘by’ and ‘with’ older adults.

Nexus Fellow and President & CEO of Christian Living Communities, Jill Vitale-Aussem, recently led a discussion on the importance of community. CLC’s citizenship model is rooted in the belief that each individual, at every age and level of abilities, has gifts, passions, talents and experience that make the community stronger and better.

She was joined by Maddy Chapman, the Associate Executive Director at Holly Creek, and Andrew Sharp, the Community Life Director at Clermont Park, to discuss how citizenship helps to revolutionize aging services.

“Citizenship is the ultimate goal of a person-directed culture.” Jill Vitale-Aussem.

Continuum of Person-Directedness

Previously, the traditional framework was provider-driven, where management made decisions for elders and staff, but organizations like Christian Living Communities have moved a new model – one that CLC calls the citizenship model – where elders contribute to their community and play important roles.

Provider Directed – Management makes most of the decisions with little conscious consideration of the impact on elders or staff. Elders are expected to follow existing routines.

Staff Centered – Staff consults elders or put themselves in elders’ place while making the decisions. Elders have some choices within existing routines and options.

Person Centered – Elder preferences or past patterns form the basis of decision-making about some routines. Staff begin to organize routines in order to accommodate elder preferences, either articulated or observed.

Person Directed – Elders make decisions every day about their individual routines. When not capable of articulating needs, staff honor observed preferences and habits. Staff organize their hours, patterns and assignments to meet elder preferences.

Citizenship – Elders influence their community, they are problem solvers, share responsibility for each other and are expected to contribute. The organization, leadership, management and staff support others to exercise autonomy, connection and well-being, and work to remove systemic barriers.

(Source: Pioneer Network, Continuum of Person Directed Culture, modified by Christian Living Communities to include the Citizenship model.)

During the presentation, Sharp shared a video, “I am”, from Clermont Park where residents explain their roles. “It’s ‘I am’ because it’s right now. Not I was or back in the day I did. It’s ‘I am’,” said Sharp. Examples of residents’ roles included Gallery Committee Chair, Conversation Connections, Campus Gardner, Chronicle Editor, Ambassador, and Researcher.

The Five Rs of Citizenship

The Five Rs of Citizenship published by the Journal of Community Psychology are Rights, Responsibilities, Roles, Resources and Relationships. In reference to community living, rights refer to the Rights of the residents that need to be upheld. Responsibilities are the duties residents are responsible for. Roles are the titles the residents hold. Resources are time, money and training that need to be given to residents. Relationships are people getting to know one another.

“We need a life with purpose. We need true belonging. We need roles to play. There’s not been one study that says to live a long and healthy life you should live a life of leisure and have everything done for you.” Jill Vitale-Aussem

Disrupting Aging Services Through Citizenship

Watch the full discussion:

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Unpacking the Future of Senior Living with Bob Kramer

Unpacking the Future of Senior Living – Positive Aging Community Interviews Bob Kramer

Founder and Nexus Fellow, Bob Kramer joined Steve Gurney on the Positive Aging Community podcast to discuss the future of aging and aging services in America.

Kramer kicked off the conversation stating that at this moment we are in a very key transitional shift as we move from the ‘Greatest Generation’ to a new customer, the ‘Boomer’. The Boomer population is looking for something different.

“I could spend our whole hour, Steve, just unpacking [this]…The sort of what I’ll call, frankly at times, condescending, patronizing and, and also ageist view that older adults lack independent agency and lack the ability to continue to make a difference in the broader community. I don’t buy any of that. Increasingly, older adults are not willing to settle for whatever society provides for them as they live longer than anyone anticipated. What they want is purposeful longevity.”

“Older adults want not just to add years to their life, they want to add life to their years.” – Bob Kramer

“In the past, senior living and aging services has been about what we do for and to older adults. In the future, it will be about what is done by and with older adults. And that is a huge shift.”

Kramer also noted that the seniors housing and care industry has gone through three shockwaves. The first was COVID, where staff scrambled to keep residents alive. The second crisis is the staffing shortages. The third challenge is the financial crisis, “not just the capital markets, but inflation, interest rates rising and now real capital market turmoil where investors are very much on the sidelines and concerned about preserving their capital.”

But Kramer isn’t ready to throw up his hands in despair.

“One of the things that I look for in each of those is, what’s the silver lining that enables us to emerge stronger and with a better product, with better services, and doing better with and for older adults?”

You can listen to the full discussion at Positive Aging Community’s website.

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LeadingAge Releases Report on the Failures of Medicare Advantage in Post-Acute Services

LeadingAge Releases Report on the Failures of Medicare Advantage in Post-Acute Services

LeadingAge recently released a report, “Fulfilling the Promise: Medicare Advantage”, describing problems and policy recommendations for Medicare Advantage in long term care. According to the report, “one in five Medicare beneficiaries discharged from a hospital will need post-acute care. Those with Medicare Advantage plans may run into significant challenges in trying to access post-acute care.”

ATI Advisory CEO, and Nexus Fellow, Anne Tumlinson, told McKnight’s Senior Living that “[i]t’s simply a matter of Medicare Advantage plans waking up to the opportunity to design plan products that offer supplemental benefits and quality improvement programming — as well as value-based contracts with in-house primary care organizations — to reduce the cost of senior living services to the residents, and to offer a higher-value, more comprehensive aging-in-place option.”

The LeadingAge report includes recommendations such as:

  • Make payment rates adequate and predictable.
  • Understand and address challenges with prior authorization.
  • Bring the vision of high-quality care closure to routine practice by making value-based payments workable.
  • Ensure beneficiaries have a true choice of high-quality providers by addressing MA plan network adequacy.
  • Address transparency concerns by improving data collection and sharing.
  • Actively support beneficiaries’ needs and rights.

Tumlinson said that “[i]f policymakers are looking for a road map to improve Medicare Advantage for populations with complex care needs, LeadingAge’s recommendations provide an excellent one.”

Read the full story at McKnight’s Senior Living.
Read the LeadingAge report on Medicare Advantage.

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Ryan Fredericks launches Here to Embrace the Role of ‘Place’ in Healthy Longevity

Here is Finally Here: Ryan Frederick’s Organization, Here, Embraces the Role of ‘Place’ in Healthy Longevity

Did you know that life expectancy in 1900 was only 50 years old? In 2050, it’s expected to rise to 94. What contributes to this increased longevity? It’s not just better genes. In fact, only 20% of longevity is attributed to genetics. The remaining 80% is linked to lifestyle and environment.

Ryan Frederick, a Nexus Fellow, is a nationally recognized thought leader in the intersection of place and healthy longevity. He’s putting the spotlight on the fundamental role of where people live to optimize the odds of a long, healthy and financially secure life. In 2021, he authored the acclaimed book, Right Place, Right Time (Johns Hopkins University Press).

“Where you live and how you choose to engage where you live is one of the most important decisions in life,” says Frederick. “If you are concerned about living a long, healthy and financially secure life, start with finding your right place and good things will follow.”

With the acceptance of remote work, climate change risk and political polarization, finding the right place to live and thrive has never been more important and more urgent. This has been an impetus for Frederick to rebrand and rename his organization (SmartLiving 360) as ‘Here’, in order to better fit the company’s goals and mission. Here is a platform that provides consumer tools for individuals of all ages to make better informed decisions about the role of place. In addition, Here consults with leading real estate, finance and health entities focused on creating better places for people to thrive.

Frederick envisions that Here will help spark a movement that makes place equally foundational to an individual’s longevity as healthy eating, exercise and financial planning.

Are you in the right place for a healthy, long, fulfilling life? Get your results by taking “The Right Place, Right Time” assessment at here.life/assessment.

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