 This is Rob Johnson, president of the Institute for New Economic Thinking. Serena Mahanti, who is the president of the SCAN Foundation. She's an MD. She's got a master's in public health. She's got an MBA. She's worked with Kaiser Permiente. She's practiced medicine, sat down, and she filled what I would call a new and what I believe extremely important horizon with questions, ideas, and images. And I haven't cooled down since. So I thought it was important to bring her on to this podcast and share the ideas that she and the SCAN Foundation are exploring, illuminating, advocating for, and helping us all understand what does it mean to take care of older people properly. And as we know, there's a lot of controversy, as she once said to me, unmasked by the pandemic, about the nature of healthcare. So I think this is a propitious time to get back in and explore. This isn't about vaccinations in farm-up only. It's about older people. And I think with the baby boom generation aging, with all of these questions, with some comparative work going on around the world, our friends at the Luton Academy had a wonderful seminar just today or so ago that Sarita and I both attended. I just, I think this is one of those things that someday you're going to thank her for waking us all up to something that's on the horizon and alongside climate change and many other things is going to be of the essence of the quality of our lives going forward in our parents' lives and eventually our children's lives. So Sarita, thanks for joining me. I'm very inspired by your insights and from the conversations we had and I'm really looking forward to sharing it with the folks here. Thank you so much, Rob. It is really a pleasure to be here today and I'm very excited about talking about this work around aging and improving the lives of older adults. So older adults, I mean, you could be worried about elbow surgery for Los Angeles Dodgers pitchers. You could be worried about all kinds of things, creating new uses of tech and data, whatever. But you zeroed in on this. You've defined a purpose with a great deal of experience which gives me a confidence in you and where you're going. But what's the core? What's the, what was the launching pad of inspiration that brought you to embrace the challenge you have today? Yeah, no, I, you know, as you mentioned, I am a physician, internal medicine physician. And early in my career, actually when I was in training at Boston Medical Center, which was in the heart of a very low-income, popular count, you know, county population in Boston, Massachusetts, it became glaringly apparent, you know, and I saw this firsthand, the fragmentation, the grave disparities and inequities in care. You know, I worked with in Boston, but then also moved to Los Angeles, where I continued to work as a physician and mostly at that time uninsured and Latino populations, African American populations, where literally there was no continuity of care, things were siloed, fragmented, complex, it was a patchwork. You know, sometimes not even recognizing that this was not about just clinical care, it was also about the social needs, the social determinants of health. There were many things that just came front and center to me as I was practicing. You know, I look at an example, I had this patient, Joey, 66 years old on both Medicare and on Medicaid, and he was homeless, he was abandoned on the streets early in his life. He, life had just not been kind to Joey and he had no family or social supports and he ended up coming in to our establishment, our clinic, and was diagnosed with head and neck cancer. And at that point in care, certainly we had to figure out ways to take care of Joey, at the same time recognizing that the stethoscope was not the most crucial tool to help Joey in the immediate situation, and he needed navigation, he was actually still a substance use disorder user, he was a use substance, you know, certain substances that were that he wanted to combat because he wanted to get better, but he wanted a kindness, compassion, someone to hold his hand as he dealt with this new blow. And so these were, these were the, this was really for me, you know, my, define my purpose, gets to your question, my purpose, which was to improve the health and well-being of vulnerable populations. And that's a very broad phrase, vulnerable populations. It can include, you know, those that are more disenfranchised, racial ethnic minorities, low income populations, the older adults, children, there are subsets that have more vulnerabilities and may, sometimes don't access the quality care that, that we, we want them to achieve and, and have. So that is really kind of what got me going. And, you know, I go back to, I'll say one thing, there was this really interesting quote that has always driven me, Samuel Goulter, he was, he used to work, he was the executive director at the City of Hope, which is a, a cancer center in Los Angeles, California. And he, and I was always drawn to something he said, there is no profit in curing the body if in the process you destroy the soul. And that to me was really, again, made me realize I need to be an advocate, I need to be a champion and, and have my purpose to improve the lives of vulnerable populations. So, how would I say, as you mentioned, vulnerability can take on many different identities, minority populations, or you can be low income people, or the, how did older people come onto your radar as qualifying in this realm? Yeah. Well, it's, it's really, you know, there are professional stories as I've, you know, alluded to, Joey is a great example of somebody who was an older adult and witnessing somebody who was challenged with so many chronic disabling illnesses. I do have a, my own personal story, you know, and, you know, I, it's a hard one for me because it's about my grandmother. And, you know, this was, and this really gets into access to quality home care. So, my grandmother, she is, you know, was raised and lived in India and she was brought over by my uncle and my mom to, after my grandfather passed away, after ailments with Alzheimer's disease. So, she came over and, you know, wanted to be close to her grandkids, her kids, and one day, you know, she slipped and fell. And we never thought at that time that this would really essentially pay the course for the rest of her existence in a very negative way. She essentially, after falling, went into a nursing home because she had needed some, she was significantly with disability in terms of being unable to move, just pain and chronic pain. And the challenge was, at that time, it was very difficult to afford the level of home care that my grandmother needed. And so, two years later, she ended up passing away in this long-term care facility. And for me, you know, you know, we think about this, our work, you know, and Mike, the work around aging at the Scant Foundation, but it is about dignity and independence. And she lost both of those things at being in a facility where she didn't have, she couldn't speak English. You know, I mean, so she didn't, you know, oftentimes she couldn't communicate with the staff. She had strangers, you know, bathing her, changing her, feeding her. So, you know, she became, her life became somewhat hopeless. And it really, it still eats at me every day to even think that, you know, not only, and my grandmother had certain resources, but think about those that even have less resources. And in her case, she suffered tremendously. So that is really what has really, that and, you know, seeing even, you know, my in-laws who passed away from cancer and some of the home care needs that they didn't get. And again, we had a lot of, we had resources to help them, yet to navigate this broken, complex system that we call health care was not easy even for a physician like myself. So we have, we have too much to do. We have a lot to do here. Yeah. So the, this is a fascinating thing. The integration of the care of older people, sometimes they can come to the house, other times you have to go there, how would I say, makes me envision a ranch style home as I get older, so I don't have to go up and down the stairs so much. But the, I'm just, I'm just exploring here this idea of things being fragmented. Where does that come from? Why isn't there what you might call the better mousetrap of coherent combination offered that would inspire lots of clients? Usually economists talk like the market will serve what people demand as opposed to the predation will tear apart the different components to make more profit and leave you half as well off as you might have been. Right. No, it's a really important question, Rob, and I think we, we've all been, you know, grappling with this. What, why is it that we know that, you know, aging older adults, they want care in the home. They want care that preserves their dignity and independence. So why aren't the incentives aligned to support those? And part of it is that we have traditionally been a healthcare system that focuses on the clinical, the high needs, and so a lot of institutions, you know, hospitals, and we have, I don't think we've, we've quite still embraced, I think we're doing better, but embraced the public health mindset about working that in order to achieve health, you have to achieve total health, which is not only the physical, the behavioral, the social, and right now the incentives are all aligned so that they actually are misaligned, I should say, so that these, these different groups that work on different aspects of care are, are siloed. And so the, so the incentives are just not there. And, you know, even in Medicare as a great example, you know, people generally when they get Medicare to cover their insurance, they, you know, overall like their Medicare benefits, but it does have some real gaping holes. A lot of people get Medicare and assume that they have long-term care benefits afforded to them and they don't in Medicare. That is not part of the benefit package. And I think to your answer your question, Rob, it is because the incentives, again, have been mostly aligned towards volume-based care. So making sure that, you know, providers, physicians, whomever get paid for seeing, you know, these, you know, having these number of visits versus value. And so we are really, one of the things we really seek to do is make sure that we emphasize value-based payment, value-based models. That just has not been set up. It's starting to be set up and we need to reinforce that going forward. And that really is one of the calls to action for effective coordinated care. So at some level, I guess it sounds to me like you're shedding light on the possibility of a better model and developing that kind of momentum is good. I'm reminded of work done by a very interesting scholar who I believe is now at the Harvard Kennedy School named Naomi Oreskes and her talk is about how the fossil fuel industry or her talk, her books, and she has a book called The Merchants of Doubt, how the cigarette companies kept everybody in confusion, how the climate people are acting as though this is a haunted conspiracy. Going back to Adam Smith and economics, when there is an existing firm or industry and it's challenged with changing, whether it was international trade or a new technology or whatever, we tend to see, not surprisingly, the incumbent institutions try to protect themselves as opposed to see the better mousetrap and embrace that and evolve themselves because they've made a lot of big fixed investment in their way and keeping that running. So I guess what I'm coming back to is now we have this thing called a government that's supposed to oversee and as many people know in America we have a whole lot of money related to lobbying, public relations, campaign contributions, and what have you. How does the SCAN Foundation, once you have envisioned a better model, start the process of inspiring evolution rather than resistance to the new vision? About having that vision of where do we want to go and as a society and again our focus being on aging and I think you're right it's, we are, as I said, I always go back to creating a movement. How do we really work towards developing these macro system level changes that and run programs and policies to improve care for older adults and that really is what our foundation is about and what we have really tried to do is, I'll talk a little bit about these some of these more specific things that we're working on, but fundamentally making sure there's a level of awareness of the problems that are continued to plague older adults. The fact that by 2035 we're going to have more older adults than children in this country and yet we are not, we don't have an infrastructure to support them and their needs and being person-centered which is again about the needs, wants and preferences of what they want and they want to be in their home, they want to be in their community to to live vitally and so we are trying to, what we're trying to do is really advance, really continue to, I mean it's a persistence like over and over message and being able to let our stakeholders or policymakers know that this is something that we have to work on collectively. You know there, we are, one of the things we're working very, very specifically on is that we think that every state in the United States needs a master plan for aging and you know because you know California and we're start, we work in California as well as nationally but California you know there was recent data that showed that Medicare enrollment among California's older than 65 grew over 11 percent over the past five years and and the challenges as I mentioned Medicare has gaping holes in the ability to support long-term care and we know that up to 70 percent of older adults are going to need some type of long-term care supports so how are they going to pay for those and so what we're trying to do is say got to figure this out and we need to have structures and processes so that they are supported in their communities as much as possible so that is something that we're working on the master plan for aging is this you know just to give more context is a roadmap for creating what we call equitable transformative systems of care for aging. It's recently just celebrated its first anniversary in California and it really is about a multi-stakeholder process of what do we need to do what are the what are the initiatives right now we have over a hundred initiatives outlined in California to support the infrastructure on aging so that is something that you know and we want to showcase this we're actually working with other states to actually advance master plan efforts we got a chance the scan foundation to partner with New York state and one of the foundations there who said let's help get New York to a point where they're ready to start building a master plan for aging and I'm happy to report that Governor Holtzschel in her state of the state ended this past year created an executive order for a master plan for aging for the state of New York and I know your home state your original state Michigan which has one of the highest rates of eight older adults and growth of older adults in the country in terms of states has its own state plan on aging as well and they're an inspiration because they've really worked on you know what they call I think the older Michiganders I think is what they're called Michiganders that's right yeah to access available services make sure they're not they're that more socially connected because I think the statistics on social isolation are so high in like Michigan and other states so that that is I mean you know to really say that this is this is really core to our work is is an understatement it is it is critical and we if I had my bold vision it would be like every state has a master plan that not is just not just a plan that sits on a shelf but it is about now execution what are the what's the core infrastructure and and mindset and culture and movement that needs to happen well I think also to the extent that one is aware as you become older that that plan is in place it probably improves your emotional health and makes you less susceptible to deterioration and disease so there's there's there's some healing contained within that being a broad based and many are being aware that it is a platform upon which they could rely which in many places does not exist today and you know I made a little bit of a parable a few minutes ago about the old entrenched interests versus what's new but I'm also mindful of the fact that there are times when everybody can win if you make the adjustment in our work at Inet we work with a very an outstanding scholar man named James Heckman from University of Chicago on early childhood education and it's about prenatal nutrition it's about children learning how to collaborate with each other in preschool before brain development has reached a certain stage and essentially by the time you're age seven if you've done all those things right your ability to assimilate the different skills and you know courses mathematics and science and literature and languages etc is mass is quite improved and what heckman did one day is he came to New York and we did a breakfast with potential donors and a lot of wall street people and he said what if i told you that all of the layoffs and welfare and all these other things are such that if everybody had publicly funded from prenatal nutrition through age seven that all of the transitions in difficulty society face would be greatly diminished and if you do the math on it he estimated for an investment in that meaning the public's investment you'd save on a per annum base is something like 11 percent of your money and he's he's saying how many of you guys this is with interest rates running at around two and a quarter percent how many of you if you could borrow money to invest in 11 percent wouldn't do it and he's saying and we are sitting here not doing something that will save us money for other purposes in the long run by investing now i would imagine in the care for older adults that we could invent systems that improve the quality of what they had experienced but wouldn't add a net burden onto the public treasure and that's where i think what's your the journey you're embarked on is is remarkable because i've watched my mother died quite suddenly but my father long period he was quite vital when he was 78 and 79 he was still doing master swimming and playing the piano and so forth but his mental deterioration in this case Alzheimer's settled in he slowed down and lived in a couple of nursing homes and then with a wonderful couple in portland oregon where my sisters were and and i watched the quality of his spirit go up where it was a condominium complex with three or four units the caregiving family lived in one and there were like three units that were their clients slash customers and i watched how attentive and how aware they were of my father my sister who was an icu nurse in portland she was in awe of the quality of service she got so i i get excited reflecting on the last five years of my father's life and the quality of his experience and i'm imagining you can see how to impart that to everyone to make that a reason to want to live in the united states or to the extent that your foundation becomes international living on earth becomes better yeah yeah no i i so resonate with what you just said uh robin one thing that reminded me is that in order to live with this level even if you're dealing with chronic illness and disability which you know as you get older the the likelihood does go up just it's a it's a fact you know we get frail we we deal with arthritis number of issues but it's important to ask like your father or anybody what do you want in your in your in your life like what matters to you the most and that's what i talk about person-centered care what matters the most to you and uh there's we're working with this there's an entity called the national committee for quality assurance in cqa on you know we have a lot of quality measures that health plans and providers have to measure and report on to be able to say you're meeting these basic you know measured requirements of care but we don't have what we call person-driven outcome measures so where we ask actually ask the individuals what they want and we're starting to test those out or we're helping to support the testing of those measures i'll give you a great example i was talking to one of the physicians who's one of the testing sites and you know they had a patient who was you know deteriorating having a lot of medical challenges depression was um on top of that not surprisingly given all the challenges and the anxiety and the and when they went through this ask asking what matters most he said what matters most to me is going fishing that's what gives me joy that's what gives me um you know vitality i use that word a lot it's like how do we keep that you know even in the midst of physical and maybe maybe emotional what can we do to to so to make things easier and the family was around him in that when that question was asked and answered and they took him in his final days to actually go and and spend some time doing fishing which didn't require a whole lot of you know physical activity but kept it just kept him alive you know even to the point until the time he passed away and i just i get moved by stories like that that's what keeps us going it's like you know you you know somebody told me can we can we find a way to die alive and i love that yeah yeah well i have a very i'll share this with you because i i'm commemorating my older children's grandfather on the maternal side lived to 102 and 11 months and when he through almost the entire time i knew him he was an orthopedic surgeon in los angeles his wife had suffered uh some heart failure bypass surgery strokes breast cancer whole sequence of things and at one point i asked her how does she survive and she said because he's a caretaker and he loves me so much i want to prove to him it's worth it and then when she expired this man about 90 years old at the time took his nieces and nephews and climbed machu Picchu and he lived with the vitality on his 100th birthday we walked down the street to a cocktail party in a slideshow about his life and came back and before the korean barbecue which he loved was served he played rock mountain off piano concerto number two at age 100 for the audience and i watched this man just propelling other people and propelling himself and he had broken hips and he'd had all the different kinds of things before he expired but he he knew how to lift himself emotionally and sustain himself and inspire other people including his wife and that to me felt more like health than something that's just purely you know physical tests and what have you and and so that's where my sense that the interaction between emotion fear the degree of fear the sense of vulnerability and the quality of health are intertwined so if you're providing the systems that create the reassurance it isn't about a chemical that is you know picked up at the pharmacy well it may be a change in biochemistry that comes from alleviation of anxiety and fear within and so i think this i i really uh sometimes worry i'm an mit trained engineer that we get too mechanical about people and that bringing this more holistic warm integrated emotional and physical together i see understanding how they're intermingled in the design of these systems is an extraordinary uh i'm calling an extraordinary innovation or change of consciousness and the questions uh like when you hear opposition when you hear critics what do they say do they say it's too expensive do they and what is expensive about what you're suggesting so because what we're especially when you talk to healthcare and i know the mindsets are changing but if you talk to the healthcare system there's these comments like it gets to what you said earlier about when we it's more about the more than just the physical health it's the emotional the spiritual the the community which i can i i mean i definitely want to talk about because there's this well that's not something first of all we're not getting reimbursed for it so we should you know how do we how do we support social health and the communities when it's you know our incentives are tied to our ability to to function is resides on clinic offering clinical care and so i i i really feel like you know that they there's this this they i don't think they're looking at the long view of the things we just you talked about that if you make those investments in the the social you know most of the most of health is based on social needs housing food security transportation economic security i mean there's a number of facets there that's been studied that's been proven right now people feel that if we put too much into that it's going to cost more than what we'll see in terms of a return on investment financially and i don't i don't i think that can be definitely as we continue to evolve even even if we break even we would still be able to see such improved clinical outcomes and satisfaction and you know vitality and and so i yeah it's not i mean my sense you know we and we've looked at some of the analyses what are the things we do at the scan foundation is we look at data to say what is working what is evidence based what are things that we know will not cause increased burden on the health you know the costs of the health care system the rising gdp and there's couple things one is investment in community care there has been studies that if you hire community health workers these are lay community people from the community to help people with navigation and get them connected to food banks so whatever they might need you see results because what you see is reductions and avoidable hospitalizations and emergency department use and you see that people get to stay with because they get to stay within their communities and get the sort services they need so that is i think one uh area of a ripe opportunity in terms of workforce and and and making sure that people get the services you know and at a low and a lower cost that's a low option and a valuable option and then the other thing we heard about yesterday in the in the uh the lujan webinar series and the discussions was this idea that we should um it's it's i think somebody called it that's wasted uh opportunity when you have a workforce that is in is forced to retire uh and what and and we are we are struggling with workforce issues as we all hear you know the the great resignation people you know not having enough nurses or other supports in in in the health care system or even in other other um jobs and uh industries so you know he we have a great opportunity to to take um you know older you know older adults and say you don't have to retire at 65 you can do you know you could if you want to work there are ways to to get you into the into the um labor force and i think that's one thing that we need to do a much better job of too and that that will reap economic benefits getting to your question versus being more costly if we invest in a workforce development opportunities for older adults um you know so that they know that they can continue to have the savings but also contribute to society i think we we could we could really transform um the challenges with workforce in particular we're making people more productive or productive for longer adds to the revenue base from which taxes are collected and therefore uh underpins all the needs in society and so i think uh how would i say uh we still have lots of issues related to younger people coming into the workforce but i don't see that improving the vitality and duration of people has much downside as well as the what i will call emotional factors uh i read a book which i think i shared with you uh my awareness of by a woman named connie's wife uh was called uh the inner work of age from role r-o-l-e to soul s-o-u-l and it was about that transformation in purpose and using young in psychology all the shadows that got in the way of that redefining of purpose and that the idea of being productive and being vital etc rather than being a wise older person helping the younger people see a newer path she plays with all these dilemmas but she talks a lot about how the fears in people who are aging are met with willpower and denial depression and all kinds of uh which you might call false sources of satisfaction that don't materialize but are in combat with the fears that descend upon people as they age in our culture and i think they're she gave a which might call a psychological partnership to the kind of work you're doing or i won't even call a partnership but it's it's aligned with how much which you might call weight can be taken off the shoulders of people as they age by reimagining what how would i say what the limits on their productivity are and what the duration and the nature of their productivity might evolve into and uh and i think that kind of dignity it's the kind of thing i watched my father my father was a very gifted jazz pianist played professionally and all kinds of other things and when he asked me to move him out of the nursing home when we went to cut from Detroit to Oregon he requested it and there were two things one he was losing track of the name of people he'd known for years and he didn't want to hurt their feelings and secondly it hadn't happened yet but every night at seven o'clock he played piano for everybody in the nursing home and he was afraid he was going to lose his ability to play the piano and he wanted to vacate before he went through embarrassment he obviously went to the next place and start playing the piano again but but i watched how much dread and he was all a very vivacious i used to say to him you're addicted to accomplishment he was an all-american swimmer a championship sailor the head of the north central section the american neurological association has retired man he ran a cable television show a couple times a week uh at lunchtime with guests and interviews and so forth in a senior men's club they called it so he was always striving but watching his sense of vulnerability and fear rise with age and frail his frailness coming on stream i just i can see what you're doing i i guess what i'm thinking is he's up there smiling at you and me talking about this stuff and he was a physician too so i had had a chance to meet him it sounds uh and uh no i i think you you said something that really like it's not to say that you're not this aging is not going to provoke you can't say that aging is not going to provoke some level of anxiety i mean it is hard it's not easy it's you know you know getting you know chronic illness i mean you know as i mentioned that's that is you're more gonna be more predisposed to that so as you get older so we can't we can't although i think one thing we should think about and i i i think this is like also looking at it from the standpoint like versus the past let's look at the future of longevity right is we are advancing in technology in digital space and you know in medical therapeutics um so it is conceivable that we will we are continuing and we are continuing to find ways one to make it easier for as we get older to be able to live in your home in your community versus having to show go to a clinic or a hospital right are being admitted to a to a clinic or hospital and uh we're seeing that we saw that with the with the pandemic the one thing the pandemic one many things but it really helped us realize that we could move things faster if we have to and in our case with the covid 19 pandemic we had to get people the care they needed but they couldn't come into the institution so we had to advance telehealth and telemedicine and that really that i mean now we're seeing you know huge huge um ongoing utilization of telehealth i myself do clinic visits with patients via video visits and it's you know not you still sometimes do need to see the patient but there oftentimes you can have a relationship and you can address the core issues in the comfort of somebody's home um and they and you can and that i think that is phenomenal but but what is that what can you do to improve their and and the people analogous like them throughout society and you know i think they like you talk about with telehealth or whatever the frequency and attendance and allowing people to be in their own domain where they're familiar and all those things are good but there just seem to be so many dimensions that are almost like knocking at our door to evolve right now i think you have an enormously important and probably economically important mission and as you mentioned in 2025 as the baby boom generation ages out you got what you might call a quantitatively big challenge to address i don't know if i want a reference actually based on what you just said there is a great report by the stanford um center for longevity and i can we could share this with our listeners after this you know podcast but i would i would recommend a reading i thought it was really insightful and very data a lot of important data one statistic that they they highlighted which i thought was fascinating and i i say this all the time when i talk to folks is that they said that they determined that in the united states the demographers have predicted that as many as half of today's five-year-olds are going to live to the age of 100 wow yeah when they said that i was like i'm i i couldn't believe it i mean i imagine that imagine that so so it's really about changing this mindset about when we think about aging that as a society we you know we're all aging i think they talk about the fact that you know in this report that you know there's so at the first in the first time in our lives we will have so many different generations all living at the same time so it is an intergenerational aging is intergenerational and we say that a lot at the scan foundation it's you know this is not that's why we don't say that we're taking care of adults 65 and older we talk about you know we definitely focus on the more vulnerable um subsets of older adults lower income those with that are lacking long-term care but and it's not just it's it's how we take care of the caregivers who are most in the millennials are a lot of the caregivers for older adults they they they support a huge percentage of the caregiving unpaid caregiving workforce so these are the kind of things that um we can shed some light i think we're going to see a much a bigger active movement of people wanting to you know really figure this out the things we describe you know mass planning on aging building infrastructures you know making you know things safe for older adults so they don't trip and fall because if they're having disability there's so many things that have to be done and we're just at the we're just starting and we still have so much to do but we we can get there yeah i do think you know it's hard to be grateful for the pandemic but there is a bit of a wake-up call within i've seen uh there's a woman that used to work with me who's a meditation instructor uh she runs a thing called the open heart project and she's friendly with a man named dr mark hyman who has a thing in organization it's based in lenox mass choose called the ultra wellness center and i'm watching that organization blossom with things like nutrition sleep meditation exercise plans life which might call prevention of disease through self-care and i'm seeing more and more attention or my peers tuned in to these kinds of things as the uh i think the pandemic started us all and the idea of which am i called the doctor is there when you got damaged to repair it as opposed to putting you in focus with recipes and diet and dietary supplements and exercise plans so that you avoid withering or at least for a longer time it's i find it fascinating how much is stirred up right now and uh we have we have to stir it up we have to start really um like you know the thing that you mentioned uh you know kind of gets it makes me it reminds me of an important thing that um we're in the aging you know landscape and the ecosystem and as policy makers or or as philanthropy we're trying to combat um what we call ageism you know we there's a lot of ageism um that continues to permeate our health care systems and non-health care systems and and that is something you know uh that uh you know like you know examples we talked about oh well old old people are unproductive consumers of gun government benefits okay so the solution would let it be that's the first of all it's a myth and the second of all they can be productive why wouldn't we promote productivity if they have the ability to be productive why is this forced retirement what are things that we can do to keep them vital uh you know they're you know oh they're causing a slower economic growth and mounting pressures on the on the public budgets well no i mean then again same thing it's like well then how do we how do we how do we keep them vital and active and prevent them from going to hospitals and institutions that you know drive up the costs of care and you know those words like silver tsunami uh or you know the uh you know i mean there's so many different uh words that are being used to to with a negative connotation on aging that's we're going to flip that on its head for sure that's i know that's what we're doing in everything we talk about it's all about the positivity um of aging my i got a really quick example a great example of my mom so she's in her 70s and um and she has very she's very healthy and has had no medical real issues and uh walk was walking a mile a day you know and and she started she heard her knee she heard her knee you know and you know it was getting i've seen her limping and she couldn't even walk she's dying you know she was feeling very sad she's like i this is what i love to do i can't walk i said okay well we got to figure out how to fix this you know what what can we do and i got on a video visit with an orthopedic surgeon and her we finally got the appointment it took a while and we got it and and the orthopedic surgeon said to her well there's probably not much we can do you have a lot of arthritis based on the x-ray and i said to the i said to the orthopedic i said so two things first you're telling me that my mother has to live with this pain for the rest of her life okay you're just saying so she should just be on a leave for the rest of her life and second would you have said the same thing to me because i'm 21 years younger than my mom and he was like oh like and and and it turned out and i didn't use all my i could have used all i'm a doctor and i'm going to you know no i just was like reality check here and before we knew it i think he had an aha moment too he said okay well let's really check what the problem is it ended up she had a little bit of a tear in her knee and and he actually did some injections and you know just to help with the the swelling bottom line there was more that she could they could do for her but because of her age she was essentially almost discriminated against in terms of access to the services even though you know i i mean and i might be like blowing this out of proportion but i don't think i am i was really um i was very uh compelled to say like what the hell said and and i recognize that probably in my training or as a physician i probably did something very similar i probably said well you're you're old so there's probably not a lot we can do because it's just part of being old but we do knee replacements on 70 80 years old all the time so why would you why would somebody say this is not even an option that was a very like so that is one thing we have to change the current belief system and that's the anti-age ageism movement i'm calling it as well so i'm gonna i'm gonna take it to my hometown where my father was a physician Detroit michigan i'd love to see the same foundation dig in the people in our metropolitan area we've gone through an awful lot of what i'll call negative economic transition going back to my childhood if you were to say this afternoon i've got to meet the economic club of Detroit or the group called homecoming Detroit which is all the expats who go back and try to see how to help and i'm going to nominate you to speak to them next year at our annual meeting what would you what would you say what's the big picture that you would say to the city of Detroit about what your foundation has to impart to make their lives better yeah well i would first acknowledge michigan in terms of that you know knowing that they're one of the fastest growing fastest aging states i should say in the nation yes you know i think they've already recognized that there are ways to and savings that could be realized if you invest in age-friendly services they're part of an age- friendly movement in michigan i look at i look at what they do quite often just because i'm so intrigued you know and they're talking about aging in place being staying in place living at home so what i would just say first and foremost keep going i mean there are you build this infrastructure you will you will see those savings that i think um i think the state director has i think a a rp even has been working with them and saying there are things that are happening in michigan and other states that just got to keep the movement going another example i also remember about michigan my would i would reinforce this social isolation that in that work to stay in place um age in place or stay in place um there i think they said something like 41 percent of michiganers live alone i don't know how current that is but it was a statistic i found wow and and michigan is starting to figure out ways programs then you talk you know like group programs so older adults who are alone can connect socially and i think that is one of the things we are all at scan foundation we are trying to do as well so that would be the other thing figuring out ways to connect to to to combat social isolation develop social connectedness the when i'm talking to this group that you defined i would say there's we are working at the foundation to think about how we can partner more effectively with private capital who can spur innovation on some and accelerate the pace of some of these things i just mentioned uh one example is at the scan foundation we helped start a startup a startup studio at incubator for to develop products and services that meet the needs of older adults and get entrepreneurs excited about investing in those products and services based on a co-design model that is that the startup studio does with older adults like saying okay what do you want and what would you buy what would help you age in place not be socially isolated remain vital and i would say i would encourage the um the private side to partner with foundations with um with academic institutions with the government on on on investments in this space of versus versus and ask what older adults want make sure they do that as well like make sure that you're not creating certain products or that that are not gonna they're not going to use and we see that a lot in health care so i there would be some core message on this and i would just say keep ongoing with your master plan have measurable results outcomes and you know monitor those results because you don't want this to be a plan that sits on a shelf so those are some of the things that i would i'd love to see and i think michigan is on the right track quite honestly well with our friend hillary we uh we might we got a pathway into the michigan she said at scout she's really building things and uh so i i look forward to continuing to work with you in that regard uh i i'm very uh how would i say i from my own experience and from meeting you i'm very moved by what i've seen i've imagined with your leadership your stimulus and which we're calling the quality and credibility of your experience base how can people help the scan foundation is it donations is it making connections with business is it all of the above how can help me help you well i i love that um no i i would say first of all you know we don't we don't do fundraising as a foundation we we um you know we have a you know annual you know kind of we have investments and we try to read you know reinvest every year and so um that being said if there is our dollars to support a cause i mean coming in with us to to partner on on um like co-investments we do that a lot with other foundations we bring foundations together and say okay we all agree this is an important problem we need to solve and here is a program or product or data analysis we need to conduct let's do it together uh like the work on the quality outcome measures that i mentioned earlier the person driven quality outcome measures we're working with the john a hartford foundation to support the national quality on those national committee on quality assurance to develop those and so this this is all about partnership uh so to the extent i mean my biggest thing is always about connection so not so we're not all doing things in isolation or being redundant how do we bring forces together so if hillary or somebody else is saying to me oh i'm doing this well we're doing this so maybe we should come together and do it together so you know strength by numbers um not only of financial like um investment but also it could be you know intellectual and and all and you know just having we need that we need that we need that thinking we need um and that that goes back to even like the private side like i so i would what i would say to your your listeners um is think about how those partnerships can can come about we as a foundation we see ourselves as conveners um and catalyzers we we do this all the time and we'd love bringing a diverse group of stakeholders to the table to say let's get a problem identified and a solution mapped out and then let's have some core action and or maybe admit maybe like a consensus statement that goes and we do briefings on the hill collectively to say this is something that needs to be uh needs to be um you know incentivized or a policy needs to be developed to to make sure we get older adults the home and community-based services they need as an example so i would just yeah connections coordination interest passion you got all of those come to me come to us and you know and and knowing what we do in terms of wanting to have people live and and with in a person-centered way getting the home and community-based services they need if you see an alignment with what our mission and vision are then we would love to find ways to partner okay well i hope to uh stay in touch with you and really come back to this over and over and over again and i mentioned Connie's Wags book you've mentioned the stanford report i'll try to create a place on our website for those who are curious can come uh including direction to your own website which is probably the fountain of how would i say all the different things and readings and learnings that they must how do you say embrace along with this challenge but as i close today i'm looking forward already to the next time we do an episode together where you bring us up to date i've already promised to nominate you to speak in detroit and i'm gonna get on out this afternoon but i have to say i woke up this morning very excited about this and as often the case with me the way i'm communicated with is through the music that pops into my head so this morning there was a very clear message and i won't go through the whole song but the famous bob dillon has a song called my back pages and i'll just read the one verse a self ordained professor's tongue too serious to fool spout it out that liberty is just equality in school equality i spoke the word as if a wedding vow but i was so much older than i'm younger than that now it's my hope that when your work is complete to your satisfaction not frustrated but realized that we will all say in america and around the world i was so much older than i'm younger than that now thank you very much