American Society on Aging 575 Market Street, Suite 2100 San Francisco, CA 94105-2869


MOWA’s mighty volunteers p. 9 | Delivering meals to isolated elders proves to be its own reward.

The intersection of violence and isolation p. 12 | A Q&A with Elizabeth Tung


Covering advances in research, practice and policy nationwide

JANUARY–FEBRUARYR 2020 volume xli number 1

the bimonthly newspaper of the American Society on Aging t i t l f t i i t i

What happens when a nursing home closes its doors? Transfer trauma and stress

In this issue

FORUM How to solve a silent crisis? Reach out to neighbors, community page 3 AGINGWITH OPTIONS A roadmap to a longer— and healthier—life page 5 IN FOCUS Community—it’s all about human connection pages 7–11 Trust for America’s Health bridges public health and aging services page 14 Good reads: a unique view of direct care; on physician burnout; and tips on assisted living page 16

son, the potential for trauma to residents remains the same. Implementing better policies and practices, however, can mini- mize negative impacts.

By Cynthia Rudder and Lori Smetanka W hen a nursing home closes and a resident has to move, her health can deteriorate. Change is difficult for vulnerable nursing home residents, many of whomhave some form of dementia and most of whom have already reluctantly left their homes to move into a long-term-care facility. The response to stress caused by a relocation— often called “transfer trauma”—may in- clude depression, distress, agitation, withdrawn behavior, self-care deficits, falls and weight loss. Many nursing homes are closing across the country, and there seems to be an epidemic of closures in rural counties ( ). These closures are primarily due to bankruptcy or other financial issues; forced closure due to poor care or safety concerns; or a change in business model. Regardless of the rea-

Study Offers Strategies to Protect Residents

“best state practices,” highlighting effec- tive approaches being used to oversee clo- sures and minimize their negative effects on residents. One of the study’s clear messages is that state and federal oversight and en- forcement must be stronger to improve care before a facility is forced to close, and to hold providers accountable for follow- ing the rules when a facility does close. Several important findings, noted be- low, highlighted strategies for managing the closure process in a way that engages and protects residents. A coordinated team , made up of state agencies with roles in providing residents

The study by the National Consumer Voice for Quality Long Term Care, “Nursing Home Closures Toolkit for Ombudsmen Relocation can cause depression, distress, agitation, self-care deficits, falls and weight loss. and Advocates” ( ), funded by The Retirement Foundation, sought to identify obstacles to a success- ful transition for residents, as well as pol- icies, procedures and actions to overcome these obstacles. Also the study identified

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Even in independent living, community is all-important

By Verna M. Cavey H aving now lived in retirement communities for a decade, I val- ue this opportunity to write from the perspective of a resident (of inde- pendent living), and respectfully offer a few thoughts. I worked for many years in education, but it took retirement for me to reach the peak of satisfaction in work and in all oth- er compartments of my life—social, spiri- tual, emotional and intellectual. That’s saying a lot. At 72, the critical piece for my friends and myself is community, and the essence of community is human connection. Every- thing else is secondary. Yes, in retirement communities such asmine, budgets need to be followed and excellent programs may be run, but , if the people who live and work in these communities feel ignored or neglect- ed, there is a systemic failure. The workers in our retirement com- munity dwell in private areas beyond resi-

The AiA19 Panel of Pundits, from left: Bob Blancato, Allyson Schwartz, Yanira Cruz, Rich Browdie, John Zogby, Paula Basta.

dents’ view. Residents do as well, in their own hidden worlds. Amid the space of our larger retire- ment community, we residents have our mini-communities, sharing a glass of wine and friendship behind our apart- ment doors. We also have the outside sup- port of family and friends. And staff who are so caring become close to us. All of these people nurture us, emotionally and physically. But there are challenges in communi- ties such as ours: I watch residents in in- dependent living units try to hide their increasing losses of memory and other functions. Many people residing here

At AiA2020, policy takes center stage T he 2020 presidential election is top of the news most days, and though candidates are scrutinized ad infinitum, especially via pointed com- ments about their age, it is rare to see me- dia attention focused more generally on the topic of older adults. The 2020 elec- tions are critically important for elder policy and advocacy, and ASA’s 2020

Aging in America Conference (AiA) offers a concentrated track in these areas. Conference attendees can get the polit- ical lay of the land on Tuesday’s General Session, “Panel of Pundits 2020: The Decision Year.” Presenters first will fo- cus on such issues as Medicare, Social Se- curity, the Older Americans Act and elder justice. Then the focus will shift to the up- coming presidential and congressional elections andwhat election outcomes may mean for older adults in America. The “National Forum on Older Adults and Access to Justice,” on

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Aging Today January–February 2020




tising “OK Boomer” may be amusing, but it runs counter to ASA’s efforts for all gen- erations to see the positive in their respec- tive ages and realities. So let’s turn “OK Boomer” on its head, because it’s more than OK to be a Boomer. In mid-October, I had the opportunity to attend an AARP Academic Roundtable, held to brainstorm what demographic re- alities might mean in 15 years for institu- tions of higher education, as colleges struggle to fill classrooms with what has been their typical student body. AARP asked, “What might be the implications of these shifts for our education and work systems, especially as the traditional no- tion of retirement fades, and the need grows to continue working later in life?” Kamili Wilson, AARP’s vice president of Enterprise Initiatives, noted, “People now have multiple jobs and careers. What are the implications for learning over a life span, how do older adults remain cur- rent and connected, and retain the types of skills that will be needed as work evolves?” AARP’s hope is that college campuses will become cross-generational places for academic learning. “We want it to be so that you can’t decipher who’s the faculty and who’s a student,” Wilson said. AARP’s approach is big-picture, view- ing the question of academic health from the vantage point of affecting systems in place for how people will live, learn and earn for longer. Instead of perpetuating generational tension, AARP would like to assist in creating inclusive academic insti- tutions that don’t pit one generation against another. Insights from the AARP Academic Roundtable For instance, a person who has spent a career in the manufacturing sector might pivot to being a manufacturing instructor at a college in her or his community. Through this effort, AARP hopes to lever- age its local offices in 50 states and three territories to help explore, by connecting with local colleges, the evolving way we learn throughout life. Also at the Roundtable we learned of a partnership between the Academy for Ger- ontology in Higher Education and GSA to foster Age-Friendly Universities. There are 10 principles to becoming an Age-Friendly University ( ), fromen- couraging the participation of older adults in all core activities of the university, in- cluding education and research, and pro- moting personal and career development in the second half of life, to promoting in- tergenerational learning. A webinar series on Age-Friendly Uni- versities is starting in January, through a grant from the Retirement Research Foundation; please visit pro grams-services/gsa-webinars . n WRITE TO US We welcome your responses both to Aging Today articles and to guest commentar- ies, which present the opinions of their authors and not necessarily those of the American Society on Aging. Letters should be no more than 350 words long. We also welcome ideas for articles you would like to see in future issues of Aging Today .  mail Aging Today, “Letters” 575 Market St., Suite 2100 San Francisco, CA 94105-2869  fax (415) 974-0300  e-mail

American Society on Aging Aging Today (issn 1067-8379) is published bimonthly by the American Society on Aging. Articles may be reproduced by those obtaining written permission. Postmaster: Send address changes to Aging Today, ASA, 575 Market Street, Suite 2100, San Fran- cisco, CA 94105-2869. Phones: editorial (415) 974-9619; advertising (415) 974-9600; or visit . For membership or other information about ASA, call (415) 974-9600, fax (415) 974-0300 or visit . Subscription Price: individual non- members: $74.00/year (included with annual membership); nonmember institu- tions/libraries: $110.00/year. Subscription

On reframing aging and reinventing our educational system By Cynthia D. Banks | ASA Interim CEO tional Hispanic Council on Aging and the

T he civilizing po­ tential of words often has been pushed aside in these fractious times as we head into an election year. But words matter, especially when we talk about aging. One of the

FrameWorks Institute to promote more accurate perceptions of aging and to de- velop supportive aging policies. Funded by Archstone Foundation, The John A. Hartford Foundation, The Retire­ ment Research Foundation and The SCAN Foundation, with additional support from New Hampshire Endowment for Health, LAO in November activated a new Re- framingAgingwebpage, at www.reframing . The initiative also is benefiting from a new 12-member Advisory Board, which is working to identify key organiza- tions and decision makers who can help to advance the mission. Let’s work together to reframe how we speak (and think) about aging. The LAO and FrameWorks are always seeking examples (to feature online) of refram- ing activities conducted by people in the aging services sector, including work­ shops and presentations. To submit one, visit . While writing this column, there was a flurry of press over a New York Times ar- ticle, “ ‘OK Boomer’ Marks the End of Friendly Generational Relations,” a piece on how millennials and Generation Z say, “OK Boomer,” when frustrated with baby boomers’ attempts to navigate technolo- gy, or when they disparage stereotypical generational quirks. Merchandise adver-

Cynthia D. Banks

agency rate (institutional rate only): $94.00/year.

many rewarding parts of serving as inter- im President and CEO for ASA has been learning firsthand about the details of the many projects in which ASA is involved, including the Reframing Aging initiative. Original research by the FrameWorks Institute had found the public believes ag- ing is synonymous with decline and de- pendency, and is a battle to be fought. But those of us working in the aging sector know the reality, which is that with prop- er supports to foster well-being in later life, our society could instead benefit from the longevity dividend offered by the ag- ing population. As one of eight Leaders of Aging Orga- nizations (LAO), ASA is partnering with AARP, the American Federation for Aging Research, the American Geriatrics Society, The Gerontological Society of America (GSA), Grantmakers in Aging, the National Council on Aging, the Na-

Aging Today is indexed in the Cumula- tive Index to Nursing and Allied Health Literature and the Areco Quarterly Index to Periodical Literature on Aging. Printed in the U.S.A. © 2018 American Society on Aging. All rights reserved. The American Society on Aging (ASA) is the essential resource to cultivate leadership, advance knowledge and strengthen the skills of those who work with, and on behalf of, older adults.

ASA Board Chair: Karyne Jones

ASA Interim CEO: Cynthia D. Banks

Editor: Alison Hood

Senior Editor: Alison Biggar

Design & Production: Michael Zipkin | Lucid Design


Chair, Robert Espinoza, Vice President of Policy, PHI, Bronx, New York Immediate Past Chair: Robyn L. Golden, Director of Health and Aging, Rush University Medical Center, Chicago, Illinois Donna Benton, Director, USC FCSC/ LACRCA, Los Angeles, California Diane Brown, Executive Director, Medicare Strategy & Operations, Kaiser Permanente Northern California, Oakland, California Paul Greenwood, Elder Abuse Expert Witness and Teacher/Consultant, San Diego, California Anne Montgomery, Deputy Director, Center for Elder Care & Advanced Illness, Altarum, Washington, D.C. Kathy Sykes, Retired, Senior Advisor for Aging and Environmental Health, U.S. EPA, Washington, D.C. Laura Trejo, General Manager, Los Angeles Department of Aging, Los Angeles, California Peter Whitehouse, Professor of Neurology, Case Western Reserve University; and President, Intergenerational Schools International, Shaker Heights, Ohio

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Union Bug

Aging Today January–February 2020



Letter from the Editors A recent incident made us here at ASA stop and think a bit deeper about the status of community in

more. She also saw, balanced on the hood of his car, a half-empty fifth of vodka— likely the reason for his fall. Back in the house, Ms. E finally got a re- sponse, but from another older man, who made his way to the bottom of the drive- way, was introduced by the man on the ground as a brother-in-law and was in-

modern America. This past fall, an ASA staff member, Ms. E, was walking her dog in her neigh- borhood at 6 a.m. and came across an old- er man lying on his back at the bottom of his steep driveway. His feet were pointed uphill, his head nearly in the street. He told her he couldn’t get up because of ar- thritis, and asked if she would please rouse his wife? Ms. E sprinted up to the front door of the home and knocked repeatedly, to no avail. The door was unlocked, so she en- tered. Inside it was dark. Boxes, clothes, lamps and books crowded the stairs and hall, making it difficult to walk through the house. Eventually finding a bedroom door open and seeing a form under the bed- clothes, she called out the wife’s name. No reaction. She tried a few more times, and heard only mumbling. As she then ran back outside, a woman passerby pulled up in her car. Asked to help, she called 911. The man lying in the driveway was more cognizant now, yelling about his wife. Ms. Ewent back toward the house to again try to wake the wife. As she neared the front door, she noticed theman’s shoes scattered near the top of the driveway, meaning he likely tumbled 60 feet or

‘How connected—or disconnected—are we?’

structed to wake his sister. Confused, the man went back inside. Minutes passed as the man on the ground begged for water (911 had said not to give him any liquids), and ranted about being embarrassed. After a short time, the paramedics arrived, took note of the circumstances, asked Ms. E and the other witness what happened, then shooed them on their way. This is a story not just about a sad inci- dent, but one that drives questions about community, interconnectedness and re- sponsibility. How connected (or discon- nected) are we? Perhaps what needs to happen in situations like these is hyper- local advocacy, a fostering of personal connections and an “it takes a village” approach. As recently stated in its new Strategic Plan (through 2024), ASA’s mission is to “foster optimal quality of life for older

adults.” Theman on the driveway is not liv- ing anything close to an optimal life. Hin- dered by potential substance abuse issues, trapped in a dangerous hoarding situation and likely responsible, at least partially, for two other older adults, he is embarrassed by his plight, yet he is virtually unknown to his neighbors, who might help. ASA intends to advocate harder for new public policies that will aid people like this man and all other older adults who might face similar challenges. We’re also plan- ning to foster alliances with traditional ASA is planning to foster alliances with first responders. When it comes to friends, quality over quantity counts I n adults’ search for connection and community, it seems that how peo- ple feel about the friends they have is more important than the total number of friends. Recent research, “Age Dif­f er­ ences in Reported Social Networks and Well-Being” ( ), sur­ veyed 1,496 participants, both younger and older adults, and found well-being was more strongly related to social satis- faction than to the reported number of close friends. The study results were written by Wändi Bruine de Bruin, Andrew M. Parker and JoNell Strough and published by the American Psycho- logical Association. This finding tests the idea that online social networks, wherein younger adults cultivate numerous connections, are making people feel more connected. “Ste- reotypes of aging tend to paint older adults inmany cultures as sad and lonely,” said Bruine de Bruin, lead study author. “But the research shows that older adults’ smaller networks didn’t undermine social satisfaction and well-being. In fact, older adults tend to report better well-being than younger adults.” Participants assessed the number of people in their social networks—family, friends and neighbors and also “peripher- al others” such as coworkers, school or childhood relations and service provid-

and non-traditional aging organizations, from first responders to private-sector leaders, in the hopes they will align their goals for older adults with ours. There is a marked need now in our na- tion for people to reconnect more deeply— to that end, please see our In Focus on community in this issue, starting on page 7. The demographics on older adults speak volumes: there are people like Ms. E’s neighbor in every community, and their numbers are on the rise. It is ASA’s aim that its new Strategic Plan can help to lead the way in supporting and building com- munity, championing diversity and im- proving the quality, well-being and dignity of life not just for older people— but for people of all ages in community. n

Cultivate your leadership skills and expand your networks at ASA’s 2020 Leadership Institute March 23-27 in Atlanta Learn how you can make a difference while examining your leadership potential! The ASA Leadership Institute is a 5-day leadership development intensive that offers self-assessments of communication and leadership styles, presentations by recognized leaders in the field of aging, facilitated dialogue, networking opportunities, leadership literature and online learning. Program components are carefully designed to prepare the next generation

ers—with whom they had regular contact within the past six months. They then rated feelings of well-being across the past 30 days. Older adults in the study have smaller social networks, but for both older and younger adults, the number of close friends was unrelated to age group. Younger adults’ social networks were composed mostly of peripheral others, due to their heavier use of social media networking. The only factor affecting well-being and social satisfaction across all life spans was the reported number of close friends. This research also may debunk the idea that older adults’ well-being might be im- proved via expanded social networks. “Loneliness has less to do with the num- ber of friends you have and more to do with how you feel about your friends,” said Bruine de Bruin. n

of leaders in the field of aging. The program is offered onsite March 23-27, 2020 in Atlanta, and also includes pre-conference intensive activities. Enrollment will be open until February 28, 2020.

Enroll now at

Aging Today January–February 2020


Justice and Aging,” from the Forum on Religion, Spiritual- ity and Aging, which will examine the roles and duties of people of faith in past and current social justice movements. Also on Tuesday, March 24, the LGBT Aging Issues Network features “Foresight Is 20/20: Planning for the Future of LGBTQ Aging,” which will

Diversity and inclusion are in the AiA 2020 spotlight A core part of ASA’s mission is to embrace diversity and inclusion— within its products and services, its membership community and in the field of aging at large. Thus, the 2020 Aging in America (AiA) Conference theme, “Aging 2020: Examining the Needs of Today’s Diverse Older Adults,” is apropos, and the meeting will feature programs highlighting diversity, equity and inclusion. AiA 2020 takes place March 24–27 in Atlanta, Ga. (headquarters is the Hyatt Regency Atlanta), and will convene a large multidisciplinary group of professionals to explore the many issues, challenges and opportunities in aging. The 2020 Conference theme concentrates on America’s increas- ingly diverse and multicultural older adult population—a population that will require professionals to be ready to meet these older adults’ personal care and family caregiving preferences, to provide them with culturally sensitive services and to train existing and new health- care workers in cultural competence. With its laser focus on policy, advocacy and education, AiA 2020 will guide professionals in aging to help and support our nation’s diverse older people to age in health and with dignity. ASA Constituent Group offerings nicely adhere to the AiA20 diver- sity theme. Some examples are Tuesday’s “Religious Roots, Social

address how LGBTQ older adults are demanding recognition and equitable treatment, and discuss how what is learned from today’s LGBTQ elders can help to shape the future of policy, programming and service delivery. And on Wednesday, March 25, ASA’s Network on Multicultural Aging presents “Aging 2020 and Beyond: Practical Tools and Tips to Serve Diverse Elders.” With the goal of increasing cultural com- petency and facilitating conversation, this session addresses how to challenge unconscious biases and to improve cultural understanding. From the Diversity Summit (see article below) to numerous policy sessions (see article on page 1), including West’s Health Summit on lowering healthcare costs, AiA2020 promises a stimulating educa- tional and networking experience that offers ideas, strategies and best practices for multidisciplinary professionals working in the field of aging. Please visit for more programming information and to register. Other speakers will be National His- panic Council on Aging President/CEO Yanira Cruz and National Hispanic Coun- cil on Aging Board Chair Cindy Padilla; Larry Curley, executive director of the Na- tional Indian Council on Aging; Anjuli MishraCameron, researchdirector, Coun- cil on Asian Pacific Minnesotans; Linda AiA 2020 keynotes will inspire and spark debate Ellis, executive director, The Health Ini- tiative at the Rush Center in Atlanta; and Sandra Butler, professor and interimdirec- tor at the University of Maine and John Feather, CEO, Grantmakers in Aging. For more information on the Diversity Summit, and to register, please go to . n

The 2020 Diversity

Summit: a focus on rural aging A merica often is perceived as two countries, split between the coastal and more urban areas and the rest of what some refer to as the “flyover states.” Why do older adults choose to live in America’s rural areas, and what does that mean for their longev- ity—the ability to age well and in sus- tained good health? What are the particular challenges of aging in rural America, and what are the strategies and solutions to meet these challenges? The 2020 Diversity Summit, “Inequal- ity Matters: Focus on Diverse and Un- derserved Older Adults in Rural America,” will explore these questions and more on Thursday, March 26, 2020, at the 2020 Aging in America Conference. Moderated by E. Percil Stanford, presi- dent of Folding Voice, and Joyce L. Walker, vice president of Community Develop- ment at PK Management, the 2020 Diversity Summit will be particularly illu- minating, with its intensive focus on a part of America so often ignored. The Summit aims to cultivate an un- derstanding of the needs of people with marginalized identities who live in rural America, and to showcase programs and systems that work to support rural elders. The program also offers a unique twist: members of rural communities discuss the challenges of rural aging, and the difficul-

ties specific to diverse older rural adults. There is much to learn from their stories about the experiences of weathering the obstacles inherent in rural life. The Summit will feature selected pre- senters who wrote for the Summer 2019 issue of Generations , “Aging in Rural America,” as well as professionals who work directly with rural elders. Dennis Dudley, Guest Editor of Summer 2019 An audience member from the AiA19 Diversity Summit poses a question to the panel.

T his year’s Aging in America Con- ference offers five General Ses- sions. Beginning early on the morning of Tuesday, March 24, is “Panel of Pundits 2020: The Decision Year,” sponsored by Abbott Nutrition, Matz, Blancato & Associates, PhRMA and Pre- ferred Population Health Management. This lively annual session always draws a crowd. The session’s first half will focus on hot-button issues affecting elders, such as Medicare and Social Security, the Older Americans Act and elder justice. The sec- ond half concentrates on upcoming presi- dential and congressional elections. Also on Tuesday, March 24, CDW, Great Call and SafelyYou sponsor “Feet Forward: Improving Longevity by Taking One Step at a Time,” a session that focuses on falls—what are falls statis- tics, what is the status of falls prevention, what part can smart sensors and automa- tion play in reducing falls? On Wednesday, March 25, Age Wave Founder and CEO Ken Dychtwald will keynote “ The Longevity Revolution: Fierce New Challenges, Incredible New Opportunities,” sponsored by Edward Jones. In this session, which outlines the four grand challenges soci- ety faces around people’s increased lon- gevity, Dychtwald will reveal how to

ensure that older adults’ “health spans” match their life spans, how to safeguard financial security for all generations, how to activate a non-ageist longevity marketplace and how to boost life pur- pose for modern elders. “Inspiring Millennials to Care for the Aging Population,” on Thursday, March 26, features a panel sponsored by Home Instead Senior Care that will dis- cuss young adult caregiving, what it means to be a caregiver at a younger age, and how millennials can become and re- main inspired to do this work. On Friday, March 27, PhRMA sponsors “The Right Prescription: Affording and Accessing Your Medications,” which takes on the complicated issue of patients’ access to medication and the multiple proposals under consideration to help people to afford and gain access to much-needed medications. Please visit for more programming information and to register for the Conference. n

What are the challenges of living and aging in rural America?

Generations and former Aging Services Specialist for Region IX (which encom- passes a large rural section of California), will speak, along with a contributor to the issue, R. Turner Goins, Ambassador Jeanette Hyde Distinguished Professor at Western Carolina University. Additional presenters connected to the 2019 issue of Generations include Kathy Greenlee, former Assistant Secretary for Aging at the U.S. Department of Health & Human Services; and Ladisa Onyiliogwu, director of the Fulton County Department of Senior Services, who will discuss suc- cessful programming to improve outcomes for the older rural population.

Aging Today January–February 2020


A call to action: the Global Roadmap for Health Longevity AARP THOUGHT LEADERSHIP

Equal life expectancy means addressing disparities by income, race and geography. It is equally important to address the reality that not everyone is living longer and better. Ali Mokdad, chief strategy offi- cer of Population Health at the Institute for Health Metrics and Evaluation, pre- sented data on how health disparities are widening. He further identified the need to reduce socioeconomic disparities, ex- pand medical insurance and improve healthcare quality as important parts of a Healthy Longevity Roadmap . tems. A third workshop, to be held in Japan in June 2020, will address science and technology. As the potential for longevity increas- es, so does the importance of health (and healthy living) at all ages. At the first workshop’s plenary presentation, Dr. Lisa Berkman, director of the Harvard Center for Population and Development Studies at the Harvard T.H. Chan School of Public Health, discussed how “exposures in ear- ly and midlife will determine patterns of healthy life expectancy and health aging” ( ). Thus, the matter is urgent—for the research-based action the field of aging takes today will define how older adults age tomorrow. Across the globe, however, we see that countries with the highest average life ex- pectancy have the lowest level of dispari- ties ( . During the workshop’s keynote address, Sir Michael Marmot, chair of the Commission on Social Determinants of Health, World Health Organization, noted, “It’s not only about getting richer as a country, it’s about paying attention to the social determi- nants of health.” To reverse the recently observed re- duction in U.S. life expectancy, it is criti- cal to address disparities by income, race and geography ( ). AARP’s Chief Policy Officer Debra Whitman recently wrote, “Economists like me often talk about disparities in terms of income or wealth inequality. This goes well beyond that—we’re talk- ing about years of life. That’s time with family. Time making a contribution in the world. Our greatest longevity chal- lenge is making sure that all Americans get the same chance at longer lives.” To this end, AARP is taking a leadership role to ensure that issues of equity and the consumer voice are core focuses. Jo Ann Jenkins serves as the co-vice chair of the International Oversight Board, which oversees the work of the Road- map . In this role, she provides oversight for the international commission that will create a consensus report—the Glob- al Roadmap for Healthy Longevity . Previ- ous Academy (NAM) consensus reports have spawned action, including The Fu- ture of Nursing (2011) ( Developing a Global (and Inclusive) Roadmap

Living longer is not enough—it’s also about living healthy. tions. There is the potential to live non- linear lives wherein the three traditional life-stages—youth, adulthood and retire- ment—have been shuffled to include learning, play, productivity and genera- tivity as options across the life course. Yet, simply living longer is not enough. Instead, healthy longevity means being healthy longer, which not only requires measuring life span, but also measuring so-called health span, or the length of time that a person is healthy. An editorial by AARP CEO Jo Ann Jenkins and President of the National Academy of Medicine (NAM) Victor Dzau, recently sounded the call to action: “Achieving healthy longevity re- quires decisive, multisector action. In the past century, major breakthroughs have saved millions of lives that previ- ously would have been lost to infectious diseases. However, not all of these gains have been shared equally. It is just as im- portant to understand how individual biology, societal enablers, and science and technology can be harnessed to en- sure that all people have the opportunity to live longer, healthier, and more ful- filling lives worldwide. We all have a role and a responsibility for this, from the personal to the private and public. A comprehensive global effort to guide the implementation of evidence-based strategies to advance healthy longevi- ty among all people is urgently needed” ( ). By Erwin Tan and Jean Accius T his column is sponsored by AARP’S Global Thought Leadership, which identifies emerging topics and in- spires new solutions and approaches to em- power people to make the most of a longer and healthier life. By 2030, the number of people ages 60 and older will reach 1.4 billion globally ( ), and, in the United States, older people are projected to out- number children for the first time in its history ( ). Thanks to increased longevity, people today have opportunities unknown to prior genera- Enter an Evidence-Based Initiative Given that need, AARP is a primary spon- sor of NAM’s Global Roadmap for Healthy Longevity ( ), an in- ternational, independent and multidisci- plinary initiative that will explore research opportunities in the field of healthy longevity. This past November, at AARP headquarters inWashington, D.C., the Roadmap initiative held the first of three workshops on the behavioral and environmental enablers of healthy lon- gevity. The second workshop, to be held in Singapore on Feb. 3–4, 2020, will dis- cuss public health and healthcare sys-

y3j7mxcm ), which provided evidence- based recommendations that have been implemented by AARP’s Center to Champion Nursing in America; and Hearing Health Care for Adults (2016) ( ) , which provided the evidence base for a new class of over- the-counter hearing devices. For release in 2020, the upcoming con- sensus report will provide a critical road- map to making people’s extra years good ones—and helping to ensure that all com- munities benefit. Over the course of the discussions and workshops to develop the Global Roadmap , AARP’s Thought Lead- ership team will release a series of blogs Tracking trends in senior living settings A nnually, LeadingAge, the nation’s largest association of nonprofit aging service providers, and Ziegler, a leading underwriters of financ- ing for nonprofit senior living providers, produces a document reporting data find- ings from senior living facilities. The 2019 LZ 200 report surveyed the 200 largest nonprofit senior livingmulti-sites, govern- ment-subsidized housing multi-sites and single campuses ( ). Neither a qualitative report, nor an en- dorsement of any one organization, the report ranks governance and leadership in quality services and long-term success. The LZ 200 report has its share of infor- mation graphics, but also provides cogent analysis of what is occurring with senior living residences, summing up the follow- ing key findings in senior living: • Systems surveyed ranged in size from 20,513 units to 402 (and Minnesota has the largest total number of communi- ties, at 233); • The 10 largest senior living provid- ers represent 30 percent of the total num- ber of units; • The average annual growth for the past 10 years in total units was 2.8 per- cent, with independent living and assisted

and articles (such as this column) to ex- amine longevity’s implications from all angles, including what longer lives mean for work and financial security, as well as for the future of healthcare and the influ- ences of social determinants of health. The team also will confront the reality of increasing disparities, which threaten to leave people in many communities both bereft and behind. n Erwin Tan, M.D., is director of Thought Leadership—Health at AARP, inWashing- ton, D.C. Jean Accius, Ph.D., is senior vice president of Thought Leadership and International Affairs at AARP, in Wash- ington, D.C.

living growing each year, and the number of nursing care beds declining; • Memory care units are becoming an increasingly important component, with 75 percent of the LZ 200 offering memory care units; • Most growth has occurred at exist- ing campuses; and, organizations are disposing of dated nursing homes or financially stressed communities; and • There has been an increase in orga- nizations growing via affiliation, acquisi- tion or merger. Home-based services are on the up- swing, as are continuing care at home (CCaH) and PACE programs. About 50 percent of the LZ 200 facilities offer some type of home- and community- based services to non-residents. CCaH is offered by more than 10 percent of the LZ 200, up from 2 percent last year. n

Aging Today January–February 2020


If not now, when? Integrating social care into the delivery of healthcare

health-care activities— awareness, adjustment, assistance, alignment and advocacy. For in- stance, organizations should make and communicate a commitment to addressing health-related social needs at both the community and in- dividual levels. system Build a workforce to integrate so- cial care into healthcare delivery. For example, the scope of practice of so- cial careworkers should be expanded and standardized, and they should be considered providerswho are eligible for reimbursement by payers. Develop a digital infrastructure that is interoperable between healthcare and social care organi- zations. For instance, the federal government should establish a large- scale social care digital infrastructure and provide resources so that organiza- tions who provide and consumers who utilize social services can interact with each other and with the healthcare sys- tem. Finance the integration of healthcare and social care; e.g., the Centers for Medi- care & Medicaid Services should clearly define which aspects of social care Medi­ caid can pay for as a covered service. Fund, conduct and translate research and evaluation on the effectiveness and implementation of social care practices in healthcare settings. For instance, federal and state agencies, payers, providers, de- livery systems and foundations should contribute to advancing research on and evaluating the effectiveness and imple- mentation of social care practices. As a country, we have a ways to go, but this report offers a roadmap to better inte- grate patients’ social needs into the deliv- ery of healthcare. As a people, the rest is up to us. n Jolene Fassbinder, M.S.G., M.A.C.M., is a program officer for Archstone Founda- tion in Long Beach, Calif. A slightly altered version of this article first appeared on the Archstone Foundation blog, at archstone. org/blog/view/ . This version has been edited to match Aging Today style.

delivery, with the goal of achiev- ing better and more equitable health outcomes. The NASEM report, Integrating Social Care into the Delivery of Health ‘For every U.S. dollar spent on healthcare, we spend $0.90 on social services.’ Care: Moving Upstream to Improve the Nation’s Health ( ), comes at a time when we know that for ev- ery U.S. dollar spent on healthcare, $0.90 is spent on social services, which contrasts with other industrialized countries that spend $2 on social services, and see better health outcomes. Likewise, the report comes during a transition froma “fee-for-service” health- care model toward “value-based care.” There is active interest frommultiple sec- tors, and a need for better care. It is time to follow the lead of, and learn from, the aging services network and the commu- nities they serve, to address social factors

By Jolene Fassbinder T he aging services network has for decades played an important role in providing social services. More recently, healthcare organizations have begun to understand how social determi- nants of health impact the health out- comes they seek, but the reality is that health systems, payers, aging services and community-based organizations must come together to address social determi- nants, including housing, nutrition, educa- tion, transportation and social isolation, in order to improve the nation’s health. ANewNational Academies Report So how can social services addressing social determinants be integrated into clinical care? What sort of infrastruc- ture is necessary to make this happen? To answer these questions, the National Academies of Science, Engineering, and Medicine (NASEM) assembled an ex- pert consensus committee to examine and document the potential for inte- grating social services into healthcare

that contribute to illness, poor health and poor mental health care outcomes. According to the report, the challenge for the United States is financing the inte- gration of social care with healthcare, de- fining activities that are considered social care and identifying the best ways to pay for them. This may be easier said than ‘The scope of practice for social care workers should be expanded and standardized.’ done, but if not now, when? In just ten years, when there are 8.4 million people ages 65 and older in California? Or in 15 years, when there are 77 million people ages 65 and older in the United States? A Roadmap to Integrating Social Needs and Healthcare The report identifies and assesses current and emerging approaches and offers five overarching goals and accompanying rec- ommendations that healthcare systems, government agencies, community-based organizations and funders can use as a roadmap to better integrate patients’ so- cial needs into healthcare delivery: Design healthcare delivery to integrate social care into healthcare, guided by five

Acknowledgement Study supporters include: Archstone Foundation; the Association of Oncology Social Work; Bader Philanthropies; Chicago Community Trust; Community Memorial Foundation; Council on Social Work Education; Episcopal Health Foundation; Health Foundation for Western and Central New York; Healthy Communities Foundation; The Helen Rehr Center for Social Work Practice; Josiah Macy Jr. Foundation; Kaiser Permanente National Community Benefit; National Association of Social Workers (NASW) and the NASW Foundation; New York Community Trust; Robert Wood Johnson Foundation; The SCAN Founda- tion; and Society for Social Work Leadership in Health Care. Additional support was garnered from Boston University’s Center for Innovation in Social Work &

Health social work academic program match campaign. Read the full text of the report at

Healthcare consumers show little awareness about age-friendly health systems T o assess how the public perceives the concept of age-friendly health systems, The John A. Hartford Medication : Nearly 40 percent of re- spondents are unaware that certainmedi- cations can affect cognition, and only half know that certain drugs should be avoid- ed as one ages.

Foundation and Web MD recently com- missioned a consumer survey that as- sessed knowledge around the “4 Ms” of care—what Matters, Medication, Menta- tion and Mobility. More than 2,700 older adults and their family members respond- ed; 87 percent reported satisfaction with the care received within the past 12 months. As patients’ health declines, how- ever, so does the satisfaction rate. The study found a stark difference be- tween patients’ and caregivers’ responses, with caregivers reporting worse health and more medications needed than did the older adults. What Matters: Three out of four re- spondents decide healthcare and treat- ment optionswith their physicians; women do so more than men. But almost 20 per- cent of Hispanics say they prefer their doc- tors tomake healthcare decisions for them.

Mentation : Survey respondents could accurately identify characteristics of de- mentia and delirium; however, more than 40 percent mistakenly believe it is normal for people to become depressed as they age. Mobility : Nearly half of survey re- spondents have difficulty walking or mov- ing around, with women more likely to report mobility issues than men; whites were more likely than blacks or Hispanics to report a fall in the past 12 months. Overall, respondents had little familiar- ity with the age-friendly health systems concept, and the more conditions respon- dents had, the less familiarity there was. Only half of respondents said their care providers had done a good or excellent job at using an age-friendly approach. The en- tire report is at . n

Navigating a reverse mortgage, post disaster T his past October, just as fire sea- son was ramping up in states such as California, the Consumer Financial Protection Bureau published a helpful guide for borrowers holding a Home Equity Conversion Mortgage (col- loquially called a reverse mortgage). The guide ( ) includes de- tails on how to continue meeting reverse

mortgage obligations during and while recovering from a natural disaster. Borrowers have the following three major obligations that may be difficult to meet during or after natural disasters: keeping the home in good repair, occupy- ing the home as a principal residence and paying property charges on time. Avail- able in English and Spanish, this guide provides help with these challenges, in- forming consumers where to access help, what do to in the face of possible foreclo- sure, how to deal with insurance compa- nies and how to avoid prevalent home-repair scams. n

Aging Today January–February 2020


The power and healing potential of community— it’s about human connection Can community bolster older adults’ sense of well-being? If so, how—and what does community mean? To Verna Cavey, who resides in a retirement community, community is human connec- tion—neighbors, family, friends. Housing researcher and gero- geographer Stephen Golant muses that people might release the (more isolating) “ideal” of aging in place, and find community in a living situation that best meets later life’s challenges. For Habitat for Humanity’s Dan Rosensweig, community involves a collective perception: all home-building, he says, begins with the vision of those who will live in the community—an imagining that empow- ers people to shape home and community as they wish. For Legacy Project founder Susan Bosak, community is meaningful connection

and problem-solving across generations. And, for Meals on Wheels America volunteers, community means making daily human con- tact—not merely to drop off meals, but to listen to, care about and honor elders’ stories. What does community mean to you? Send your thoughts to the editor at

Aging in place—or trapped in place? By Stephen M. Golant A s older adults age into later life, they often face disruptive chang- es that make their dwellings,

and upgrades, and may pose fall risks due to stairs that are expensive to modify. Only about 15 percent of households with moderate mobility difficulties occupy dwellings that are accessible. Often, older adults must weather lone- liness and depression from the deaths of a Only about 2 percent of homeowners ages 65 and older annually move from their established residence. spouse or friends. And as neighborhoods evolve, chances for social isolation can in- crease if surroundings no longer seem safe or socially compatible. Nationally, among people ages 65 to 69 and ages 70 and older, 36 percent and 24 percent felt lonely, respectively. As health conditions, mobility limi­ tations and mental declines occur, activi- Although some communities don’t fea- ture all of these options, in true commu- nity, organic gardens are cared for lovingly. Residents find courage singing and performing in a musical in front of an audience, and that ritual unites and delights. Listening circles are a safe place for problem-solving among staff and resi- dents; these circles train people how to fa- cilitate and collaborate, necessary skills in a turbulent world and critical to modern, effective management. Armed with such managerial skills, community members can approach challenges with knowledge and energy instead of fear. In an egalitar- ian community, all are empowered. with specific characteristics that take hard work to create and to keep alive. Scholars in organizational manage­ ment tell us that we ignore culture at our own risk. Every element of a cul- ture—language, beliefs, sanctions, ritu- als, artifacts—contributes to creating a unified community. Understanding our cultures at much deeper levels will facilitate that. Intergenerational relationships keep us vibrant. Currently, in an affiliation with the University of Denver, I am hon- ored to be working with smart, empathic

neighborhoods and communities seem less appealing. When they retire and seek new leisure, volunteer or career activities, they may be disappointed by what is avail- able nearby. After their children depart, older adults may feel that their homes are uncomfortably large, and utility costs, property taxes and mortgage payments are overly high. The smaller income stream in retirement can mean that such home expenses become financially bur- densome. About 54 percent of ages 65 and older renters and 26 percent of older homeowners are cost-burdened, paying more than 30 percent of their monthly in- come for housing. Because these dwellings also are aging, they typically require constant repairs Community in independent living › continued from page 1 have left their homes for a tiny apartment; now they fear less privacy and personal space in assisted living. I confess, I feel the same. What is not spoken holds power. Finding the right lis- tening tools, which will help residents ex- press confidences to trusted personnel,

‘Intergenerational relationships keep us vibrant.’ graduate students in social work who consistently teach me and shake up my thinking. My fellow residents and I are ties such as residential upkeep, self-care, medication management and getting around become challenging. Low-density suburbs in particular present trans­ portation barriers when elders give up driving. About one-third of older persons have unmet travel needs. richer every time we interact with them. One holiday, international students who were alone on campus visited their elder classmates, bringing small gifts. All of us need to feel part of a larger world and to be exposed to exciting ideas and pro- found emotions. Of special importance is curiosity—to maintain one’s curiosity is a gift that aids both residents and staff. When I pondered growing older and dealing with issues such as immobility, I learned that the li- brary will bring books, music and film to my home. Publications keep me up to date on alternative therapies that I can try for chronic pain, as well as with information about health decisions that I can make when I am dying. Finding a Community: Defining What Is Important For residents and staff looking for a place of safety and support, I recommend

Despite these factors, older people find that moving is an unwelcome way to change their imperfect worlds. In most years, only about 2 percent of homeown- ers ages 65 and older, and 10 percent of the same-age-cohort of renters, change their

› continued on page 10

Jill Vitale-Aussem’s book on community, Disrupting the Status Quo of Senior Liv- ing: A Mindshift (Baltimore, MD: Health Professions Press, 2019). Compassion­ ately and intelligently, this pioneer of senior living and resident-directed com- munities offers instruction and reflec­ tion. Her writing moved me away from a weak, abstract sense of community, fostering in me a firmer grasp of what is essential . Over the years as a resident, I have known pleasure and incredible meaning and purpose. I have also known deep frustration and sadness. Whether we residents feel happiness or sadness often depends upon if we are given true roles to play in our community—ones that will allow us to tap into our better selves. When unheard and pushed aside, resi- dents can experience an almost unbear- able sense of loss. At 72, I have dreams—and I fulfill them. That has truly surprised me. And, it delights generations younger than myself. We can get the word out that aging can be a rich and productive time of life. Verna M. Cavey lives in Denver, Colo.; her background is in the social and be­ havioral sciences and in lifelong learning. n

‘The essence of community is human connection.’

offers a crucial path toward creating a home environment that is comforting. True community allows aging people to light the internal spark that is unique to them, whatever it may be. Further, we welcome being heard. National organiza- tions are opening doors to elders’ views: We are invited to present at conferences, sit on panels and committees, participate in research and write articles.

Characteristics and Strategies Can Foster Community

Person-centered and resident-directed communities mean more than just termi- nology to put into reports; they are places

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