Live Long, Die Short (35 page)

Whether it is a continuing-care retirement community (CCRC), assisted living, or skilled nursing, providers of senior living today are experts at providing care. For almost a century, these institutions have been taking care of the destitute and then of the aging with impairments, and they’ve developed
reputations as both caring organizations and experts in delivering care. When someone is in need, when someone is impaired, or sick, or infirm, they look to these organizations as places to live. CCRCs have, in fact, had difficulty getting older adults to move into the independent-living parts of their communities, because many of those who are still functioning well “aren’t ready yet” for the traditional caring services these communities are most famous for.

Despite this now incorrect popular assessment of what many senior-living communities provide, most of these communities have done relatively little to wander from their tried-and-true reputation of delivering excellent care. They have started wellness programs that go not much further than an exercise room and the donated equipment. They even speak about a “holistic” approach to wellness, but other than this rhetoric and a few anecdotes involving one or two exceptional individual residents, they have done the minimum needed to compete for the new older adult seeking more from a living situation, seeking more than care. Despite a growing realization that new older adults are aware of the research on aging, on brain fitness, on the importance of socialization and purpose, and consequently are demanding more, these communities remain timid, unwilling to leave the safe bank of their reputation for caring, fearful of reinventing themselves. After all, isn’t quality care and nurturing a fine reputation to have?

It is, of course, but the world of aging has shifted to a new orbit and it will get very empty and lonely up on the moral high ground of caring as a more savvy group of older adults is drawn to places that promise continued growth—physical, mental, social, and spiritual. Places that are what Larry Minnix—president and CEO of LeadingAge, an association of notfor-profit organizations that is dedicated to making America a better place to grow old—calls “Centers for Healthy Aging.” I like to call such places “Destinations for Successful Aging.” Communities in our Masterpiece Living Network who attain the highest levels of culture enrichment are designated as “Centers for Successful Aging.”

And there are other reasons, also camped out on the moral high ground, that some offer for not making the transition to growth in senior living. Minimizing risk is one. This objections sounds like this: “They could fall.” “Regulations prevent us from offering challenging programming.” “We do not want to create unreasonable expectations.” “It’s not what
our
residents want. They are happy with things as they are.” “We’ve tried that.” “We’re already doing that.” Yet all these melt under scrutiny. Falls are in fact reduced when someone is moving more and becoming more confident in his abilities. Regulations, in fact, call for senior-living communities
to provide environments that help residents “attain the highest practicable physical, mental, and psychosocial well-being.”
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It’s a shame. For the most part, providers of senior living are a highly dedicated and altruistic group. They are wired to do the right thing. But, unable to evolve beyond the gold standard of caring to the platinum standard of continued growth and successful aging, they are struggling for relevance. Dr. Joseph Coughlin is director of the Massachusetts Institute of Technology AgeLab, whose mission is to invent new ideas and creatively translate technologies into practical solutions that improve people’s health and enable them to “do things” throughout their lifespan. In a 2011 summary of a strategy session sponsored by the International Council on Active Aging,
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Dr. Coughlin concluded that

• Senior living must change.
  
• Change will not come from within.
  
• There must be a new business model.
  
• The “aging in place” preference will create a whole new area of business.
  
• The new older adult will want customized services.
  

In light of the latest research on aging, the right thing—the moral imperative—is to facilitate and assist older adults in continuing to grow. Provide care where needed, yes, but not as the primary service, but as a necessary part of coaching aging adults, even significantly impaired older adults, to be all they can be. I believe that the change will come from outside the field, from objective problem solvers unencumbered by traditions of caring. However, I also believe that the change must involve experts from senior living. Fortunately, there are visionary communities that are making the transition and will hopefully lead most of their colleagues to a new model for senior living that better serves the new older adult.

Evolution is occurring and will continue to occur within the medical field. With healthcare costs looming like a time bomb and threatening the financial foundation of our country, healthcare legislation is providing, and will surely continue to provide, partial solutions by incentivizing a more preventive approach rather than a disease-based, fee-for-service model of care. And why shouldn’t this happen? Take, for instance, falls in older adults. In 2000, the total direct medical costs of all fall injuries for people sixty-five and older exceeded $19 billion.
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By 2020, the annual direct and
indirect cost of fall injuries is expected to reach $54.9 billion.
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In a 2002 study, Medicare costs per fall averaged between $9,113 and $13,507.
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Yet we know that something as simple as a home exercise program can reduce falls and injuries by as much as 35 percent.
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Medical care providers will take a closer look at what it takes to get, be, and remain healthy while aging. Much like the oil companies that are beginning to see themselves as energy companies, the medical industry will begin to view itself as a true
health
industry rather than just a curing or caring industry. It too will be looking for ways to meet the full range of health and successful-aging needs of all. Organizations and communities that approach aging and chronic conditions with a true holistic approach, one based on our core needs as humans, will be attractive as partners to both older adults and medical providers and insurers. This environment will provide an exciting opportunity for senior-living communities to reach out to the greater community to offer their expertise on successful aging.

One of our more progressive partners, Sun Health in Phoenix, is doing just that, reaching out to the aging west Phoenix area to provide its successful-aging expertise in order to help those who choose to live in their homes remain as independent as possible for as long as possible. Their Masterpiece Living–fueled, holistic approach and their expertise in building environments that foster growth is breaking down walls between the retirement community and the greater community it is part of. The winners of this enlightened approach will be the residents of west Phoenix, medical providers and insurers, the residents of the retirement community, and Sun Health itself. Again, it is the acknowledgment and incentivization of what it takes to be authentically healthy and to age successfully that makes this approach a much more cost-effective and, frankly, morally correct way of addressing health and aging.

So, once again, we’re left with the knowledge that we can age in a better way. That given a few minor adjustments in the environment, some education, and a few tools, older adults can indeed increase the likelihood they will live long and die short. That we all, in fact, can enjoy a much higher quality of life and avoid much of the painful and expensive decline often seen in the years, even decades, before death. How can we ignore this? How can we, as individuals, as organizations, or as a society, not use this
knowledge to bring it to reality for all? Are we not, as Dr. Jonas Salk frequently stated, obligated to make the world a better place? To do what we can to better the human condition? This is indeed the definition of moral imperative: the obligation to make something happen because we know it is the right thing. When we knew that with the smallpox vaccine and a determined effort we could eradicate the disease from the planet, were we not obligated to proceed? Likewise with polio? When we discovered that secondhand smoke could cause cancer and lung disease, were we not compelled to protect nonsmokers?

Are we not as individuals, knowing that how we age depends on our lifestyle, obligated to decide whether we indeed want to be around for our grandchildren’s weddings? To raise our children with the knowledge that their lifestyle has profound implications? To cease with a victim mentality and pursue continued growth no matter what life may have in store for us? Can we smoke, or gain large amounts of weight, or be sedentary, or avoid learning, and expect an aging experience other than decline? We all have a choice in how we will live our lives, but we cannot expect to live a high-risk lifestyle and be surprised when those risks take a huge chunk out of the quality and quantity of our lives.

Are we not as collections of people—schools, workplaces, towns, and cities—obligated to educate and provide environments where people are aware of their own potential to have a higher quality of life and avoid painful and expensive decline? How can we provide any service to people and ignore this very basic requirement for a better life? And these imperatives are not just for those in aging services. I believe the messages of lifestyle and authentic health and successful aging must begin in kindergarten. Anything less is tantamount to neglect.

As a society, isn’t providing an environment where citizens can flourish, experience the highest quality of life, and be healthy a core function of government? There may be some who argue that it’s the obligation of other organizations, but “life, liberty, and the pursuit of happiness” covers it for me. Not only is it advantageous for a society to have high-functioning, fulfilled, and engaged citizens, but with healthcare costs exponentially increasing and threatening the financial stability and strategic growth of the nation, doesn’t it seem plausible that public policy should reflect a commitment to assist people in preventing disease and decline, and in continuing to be viable and engaged?

My grandson Dylan is an intelligent, inquiring nine-year-old. He showers me with “what if” questions, and I feel blessed. Some questions are outrageous yet show an unbounded creativity and fearless desire to expand the boundaries of his world. He quite naturally does what Seth Godin, the popular entrepreneurial advisor and author, calls “poking the box”
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—in other words, he challenges the status quo. I wonder when I stopped asking “what if” questions. Was it the first time someone laughed at my question? Or when a teacher told me to get serious? Or when I tried one of the “what ifs” and it failed miserably? Whenever it was, it was a shame, and I’m back in the business as of now.

What if each person who actually accomplished his physician’s top recommendation for improving his health got a tax break as well as a premium reduction from his insurance company? What if Social Security were slightly increased if the recipient volunteered for an approved organization that needed assistance? What if groups of older adults were assigned duties as event-planning consultants for schools, towns, cities, and other organizations? What if twentieth-century history classes in schools and universities required older adults who had lived through the time to contribute? What if colleges and universities were required to have a minimum percentage of their students be older adults in order to obtain financial support?

What if an appointed, term-limited, pro bono board of directors of older adults gave nonbinding guidance on all major national policy? What if a national resource of screened older adults provided day care to infants and children at a nominal fee? What if there were a national registry of experienced older adult professionals who provided consultation on issues within their field of expertise? What if every child wanting or requiring an older-adult friend and advisor could readily be connected with one? What if there were a national registry of volunteers to work on trails, hold premature infants in hospitals, teach skills to inner-city boys and girls, or perform any task a school, town, city, or state might have a need for? What if older adults were seen as the potential solution to many of the problems facing towns, cities, municipalities, states, and organizations? What if older adults were seen as a resource instead of a burden? What if older adults began taking the advice author Marc Freedman gives in his book
The Big Shift: Navigating the New Stage Beyond Midlife
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and began to pursue meaningful work that improves society?

Of course, anyone can provide a list of reasons why these “what ifs” shouldn’t happen. Creativity and brave new approaches are not without risks, but when the potential benefit of lowered healthcare costs for successfully aging older adults is huge, when the possible solution to multiple seemingly unsolvable societal problems are staring us in the face, when the potential for building a national community guided by humanistic values is readily available, is it not worth the risk? There are those who believe that the way any society treats its animals, children, and older adults defines that society. Is it not worth exploring at least the possibility that older adults have the potential to age in a way that significantly limits decline, that they are not a drain but a powerful resource for guidance, nurturing, expertise, and overall functional stability of our nation? What, in fact, do we have to lose in trying? I believe we risk nothing in exploring this possibility, and much by not trying.