New Models for Aging with Abundance

Rev. Beth Long-Higgins 00:07
Hello, and welcome to The Art of aging part of the abundant aging podcast series from United Church homes. And this show, we look at what it means to age in America, and in other places around the world with positive and empowering conversations that challenge, encourage and inspire all to age with abundance. Today, we’re talking with Bob Kramer about his work and the work of Nexus insights and other organizations he is leading were part of to promote positive programming and to address outdated views. Hello, Bob.

Bob Kramer 00:38
Good morning, Beth, great to be with you appreciate what you all are doing through the art of aging podcast. And this is what I would call a revolution. I like being part of revolutions. And as I have listened to some of your other podcasts, and some of the listener input, I think this whole idea of really shaking up and disrupting how we think about the aging experience so that the lived experience of aging is different. And so I applaud what you all are doing through this and excited to be joining you today.

Rev. Beth Long-Higgins 01:11
Thanks, Bob. First of all, before we go any further, please share what it is about your work and what brings you to this topic and what you’ve been doing to address ageism and call attention to these issues.

Bob Kramer 01:24
I first got introduced to the whole field of aging and aging services as a state freshman state legislator in Maryland in the early 80s. And at that time, it was clear to me that we were totally unprepared as a society, and that the solutions would not just be government and public dollars, but that there would have to be private sector investment and ultimately a change in attitudes. And now, a little more than three years ago, I launched something called Nexus insights, a think tank not accidentally launched, or just as we were confronting COVID and dealing with the unknowns of what that experience was going to mean, but the known impact that it was having the greatest impact on older adults. But Nexus Insights is a think tank advancing the well being of older adults, through innovative models of housing, community, and health care. And I would say the key word there is probably community, what builds community, either the communities we’re presently in, or the communities we can create, that enable us to really age magnificently. In the final decades of our lives. I’m also part of an organization I founded to educate and attract capital, private sector capital, into the aging and senior housing and care space is the National Investment Center for seniors housing and care. I co-founded that in 1991. Was it CEO for many years, continuing to serve on the board and as a strategic advisor. And then lastly, I do a lot of writing and speaking on topics related to aging. And, and now put a lot of personal perspective in it as a sort of leading edge Boomer and with perspectives of my own, and from my wife and me, and what we look for and want for ourselves, and what we think can be the role that our generation can play in, in the broader society.

Rev. Beth Long-Higgins 03:30
Thank you, Bob. Yeah, it’s an interesting field that people can study for their whole career in the area of gerontology and geriatrics. And if they’re fortunate enough, they’ll get to see them live, what they’ve been teaching, and reflect on. Okay, what did we get right? And what do we need to change? And how is the culture changing around us? Yeah, absolutely. Yeah, absolutely. So I just read a synopsis yesterday. And they were talking about the work of Jennifer Molinsky, from the Joint Center for Housing Studies at Harvard, and she was talking about being trapped in the gap. And I think that this is the same concept that you call the forgotten. And I have to say that neither being trapped nor forgotten, or things that any of us want to be. So do you want to explain what this is, and why you are so passionate about this? Yeah,

Bob Kramer 04:28
that’s it. The Forgotten middle is a phrase that I coined to refer to what will actually be the single largest socio economic cohort of older Americans by the end of this decade. And who are these folks? These are folks that have too little in resources, financial resources, to be able to afford most of what I would call the private pay options for long term care and housing and care. as they age, or at least, they wouldn’t move into those options or have someone come and care for them at home because they’d be afraid their money would run out. On the other hand, though, they have too much in resources to qualify for government subsidy and support programs like Medicaid, when it comes to long term care, or housing vouchers and different types of subsidized housing. So, and I say they’re forgotten why, because the private sector market investors, Senior Living providers, definitely cater to those that can afford their products. And on the other end, the advocacy groups are no doesn’t mean all the things are there for the low income folks that shouldn’t be there. But the reality is, the advocacy groups are very focused on advocating for programs and services, housing, long term care, and so forth. But this group in the middle, we know that, you know, in our study, which we did with North, the research arm of the University of Chicago, and we projected that this group would be over 14 and a half million by 2029. And the SCAN Foundation just paid to have NORC do an update on this running the net projection through 2033. And the number by then will be well over 16. In this group. And again, there was a wonderful story just a couple of weeks ago by Christopher Richmond, a reporter for The Washington Post in this forgotten middle. And one of the most telling phrases there, he gave, he put a human face on who these people are. And the one and this one couple, and the woman was trying to provide herself and find care for her husband. And her comment, which was searing, was, we did everything our country told us to do. Maybe we did everything to plan for what we thought would be a safe and secure retirement. So these weren’t chronically poor. These weren’t folks that hadn’t tried to plan for their retirement. But what they were finding was her husband’s care needs and the dollars that costs being part of this forgotten middle, we’re wiping them out financially, and they still couldn’t get the care they needed. And the physical and emotional burden on her as the caregiver was huge. And so this is a national crisis. And, I see I referred to it as my capstone project and Nic meeting, okay, I’ve got the private sector investment, community focused and understanding seek private pay seniors housing, well, now here’s a real challenge. Here’s the largest underserved cohort of adults over age 75. And there are hardly any programs for them. And so how are we going to serve this group? This is a national challenge. And there was just another lengthy article in The New York Times again, each of those the Post piece, the New York Times piece, both what I would say put a human face on this problem, they did a great job, underscoring the challenge of the problem, now we got to move to the solution.

Rev. Beth Long-Higgins 08:32
Yeah. And it strikes me that the woman that you were illustrating, recognizes part of the challenge that we tend to say that it’s everyone’s individual responsibility, to plan for retirement. And if you don’t have enough, then it’s your fault. And she is helping to recognize that it is not, it has to do with the structures and the institutions, and the programs and the policies that are in place, or that are not in place that help us all, as we age. And that’s one of the big challenges. I think that people feel guilty, you know, and they feel shamed, that they’re not better prepared, that they aren’t able to, you know, do whatever they want to do, and how do we help individuals move out of that place of shame, and empower them, given where they are to make the decisions that need to happen?

Bob Kramer 09:26
Well, I think as part of that, if I can take a step back for a moment, Beth, let me make a sort of sweeping statement, but it’s the rubric under which we have to understand this, our society in terms of our economy, our social expectations about careers and workforce and older adults are all is built around people retiring and dying in their 60s and 70s. And we haven’t adjusted to the fact that with the longevity revolution. Many people who quit at 65, are going to have a third of their life ahead of them. And so how do you have planned purposeful longevity and prepare for that, when so many of the social social norms and expectations, for instance, the mandatory retirement ages, and pushing you so to speak out, and then when you try and come back in, or zoning, alternative dwelling units and the ability to have a small dwelling unit such that, you know, you have your own space at age 82, but your daughter or your son and their family are literally 50 feet away. You know, whether it’s zoning policies, whether it’s retirement policies, whether it’s financial planning and financial advisors, none of them have woken up to the new reality. And so, you know, my friend, Joe Coughlin at the age lab and MIT, has been doing a series of programs and podcasts and blogs, and part of his focus has been the whole world of financial advisors and retirement planners. Because, you know, what I laughingly refer to, are you going to have enough to, in a sense, do some of the key items on your bucket list before you kick the bucket with the idea being that when you retire, you’ll have maybe five to 10 years ahead of you? Well, the reality is, many people will now have a whole new stage of life ahead of them. And have you planned for that stage? I mean, one of them I was just talking about at lunch yesterday, and was talking about how this creates an unprecedented opportunity as we disrupt higher education. Higher education has been focused on students during the ages of 18 and 30. And the fact that this is your education, quote, for your career. But as we are seeing the challenges of small liberal arts colleges with declining enrollments, as basically the number of 18 year olds going off to college is shrinking. This gives an opportunity for a college in university to rethink who their student is, and rethink who their professor is, and rethink who’s living in their dorms. Just as a for instance, I would argue, we’re now going to have three distinct groups that are going to want to learn one group, that traditional group 18 to 32nd group, the group that is retraining or learning new for next career, either because maybe their first career chat GPT, or robot has put them out of their first career, or because of the fact they’ve now raised their kids. And now they want to think about doing something differently. Or because of the fact they were in a physically dangerous or demanding job from which they’ve now retired, think military, think public safety, think construction, but now, taking retirement from that job, what am I going to do next? So there’s that age of I would say really 45 to 65, where you’re retooling and relearning for what’s next. But then there’s also going to be a third group, which I expect to be part of. And that’s the group that’s basically 75 to 110, where they see learning as not lifelong learning. But learning as my friend commonly likes to say, for a long life. And they are excited to go back to school, but they’re also you know what, they’re really inexpensive faculty, they’re not looking for tenure. They’re not looking for health insurance. And yet, many of them would love to be able to teach. So these, that’s just one area where the longevity revolution is going to turn higher education upside down. But sadly, there aren’t too many college administrators and university leaders that are realizing this opportunity to really rethink who their students are, who are their professors, and who’s going to live in their dorms. And I think that is a kind of multi-generational intergenerational learning. Wow, that’s going to be exciting.

Rev. Beth Long-Higgins 14:43
Five, I’m just sitting here grinning from ear and biting my tongue so that I’m not just sitting here saying amen. Amen. Pre John, pre John. I’ve been saying those things and I feel like my voice is wafting in the breeze. I heard Ken decK wild last week, and he went so far as to say that higher education is the one of the most ageist institutions that we have in this culture. And, yeah,

Bob Kramer 15:09
it and it will, there will be there are there are education leaders, and there are institutions that get it, they are few in number. But that’s going to be the Rethinking education now, again, like with many things, as, as horrible as COVID was, and as much of a tragedy, it has forced us to rethink, I mean, obviously virtual, which was kind of looked down upon, or Secondly, by many of the, quote, more elite schools, you know, during COVID. Got to revisit, just as, for instance, telehealth, and digital health, got a rethink during COVID. And so, as is often the case, disasters, and great tragedies, often and this reflects the human spirit are opportunities to learn new ways that we didn’t think possible.

Rev. Beth Long-Higgins 16:00
Okay, so we’ve talked a little bit about higher education. You started talking about telehealth here, coming back to the Forgotten Middle here? How do we help to support? What kinds of support are going to be needed by individuals who are not living in, in life plan communities that don’t have the money to pay for those things? How are we going to provide those supports for this significant number of people in the population?

Bob Kramer 16:31
The honest answer is, we don’t know yet. Because the models, honestly Beth, haven’t yet been created. Does that discourage me? Not at all. But that’s also a candid, honest answer. There are lots, there’s a lot of experimenting going on. Now. Understanding that there, I’d put the needs in sort of three areas. One is housing. And we’ve understood with a radical rethinking of what constitutes health, that housing is health is a very common phrase today. And so housing is a backbone at being able to have a healthy life. But secondly, then, how do you have available to you the types of support and services you need to, in particular, be engaged, not just simply get your apartment cleaned? But how are you able to stay purposefully engaged in the broader community, and then the relationships that give you a sense of connection and purpose? So there’s the and that’s often put into the bucket of sort of social services. But it’s much more than social services. It’s basically its purpose matchmaking, put simply. And then the third bucket is the bucket of wraparound preventative health services that involve chronic disease management. I mean, having multiple chronic conditions is not a death sentence, and does not keep one from having a robust, very active, fulfilling life. But not managing those chronic conditions, then leads to acute care flare ups, that causes people to get frailer than they need to and to be more likely to need to be institutionalized. So we’re also going through a really difficult and not short term reordering of our healthcare system, we have had a sick care system. And as a sick care system, what I mean is, it’s reactive, it’s curative. And it’s passive. Each word it’s reactive, we wait for you to fall, we wait for you to get sick, that’s when the system kicks into gear, that’s what you’re getting insured for. It’s curative, the goal is to cure you of that broken leg or of that disease that you got. Not a bad goal at all, but not always appropriate in the way we pursue it, particularly as we get older. And then lastly, it’s passive. Since it’s a it’s since it’s basically a sick care system. We wait until you get sick. So that means by definition is passive. What we’re moving to is a welfare system, which is a welfare system. I define it as three P’s. It’s preventative. It’s predictive, and it’s participatory. It’s preventative. by that. I mean, we want to focus on what can you do and what can we do to prevent you from getting sick to prevent you from having a fall for to prevent you from having to go to the hospital or the ER, then it’s predicted. It uses data, your data and tons of other data To be able to predict when you’re at risk of a bad event so that we can intercede, then not afterwards. And lastly, it’s participatory. When it comes to staying well, versus recovering from getting sick, there’s a ton the individual can do. And the individual does have a real responsible role in staying healthy. So if we bear if we think about this, and this is part of the move to what’s called value based care, and a focus on outcomes, and and this is a tough, we have a very entrenched healthcare system that’s built around sick care. And we are slowly but surely moving to a more of a welfare system, partly because, you know, we spend more money than any other country, but we don’t have as good outcomes as many other countries. And I think it’s particularly the case, some of the most expensive consumers of healthcare are older adults, in the last five to 10 years of their lives. But oftentimes, we’re approaching this from a fleet wrong perspective. So that’s a long winded answer to what do I mean by having wraparound preventative health care services, where you engage individuals, you engage the community on? How do we stay healthy, where rather than measuring as a good thing, gee, I’ve gone to the hospital and get fixed up five times? No, you measure that? I know, the way I put it is, there’s now a moat around the acute care hospital. And basically, you know, yes, hospitals in the future, I think will be ers and ICUs. And there’ll be trauma care centers. But basically, our goal is to do whatever we can to stay out of the ER in the hospital on Sep, when it’s absolutely necessary. So that, to me, is the kind of health care we need. And we especially need it for older adults. And we especially needed for the Forgotten middle. Why? Because what happens is this is the group, most likely to forgo preventative health checkups, to not be taking all the medications they ought to take and to not be managing their chronic conditions. So by the time they spend down to qualify for Medicaid, they are frailer, sicker, and more likely to need to be institutionalized, and most importantly, to the system. They’re far more expensive. So we all have a vested interest in our own health, and society, in figuring out how we’re going to do this specific model. We know that as you’re doing United Church homes, having a role of a service coordinator, some call it a care navigator, All others call it a life advisor or life manager. But a key role in these communities is a person who I would ultimately say they’re not only the care navigator, they are also the purpose matchmaker for every resident and that connecting them with people and resources, that person is absolutely key. But a second thing is how are we going to have this wraparound preventative health care. And I think we’re starting to see some experiments with what are called non medical chronic benefits. And under Medicare Advantage. And we’re starting to see some experimentation where Medicare Advantage plans will pay for things to keep people healthy that aren’t considered directly healthcare related. And I think that’s promising. But we’re in the very early innings of that, Beth. And they’re sort of nascent models right now. But do we need to figure this out? We absolutely do. And it’s an enormous challenge right now. So you have the housing piece, you have the service piece and the engagement piece, and you have the preventative health care piece. If we just do housing. Unfortunately, we’ve provided the housing but the first time somebody falls, they may end up with no other choice but the nursing home after that, because they can’t stay in that setting. So we’ve got to be much more than just housing. And its social determinants of health is a phrase that is used but it’s a holistic view of the person. And to me, that means by definition is going to be grassroots. I look at the best of the PACE programs of all inclusive care for the elderly. The best of those programs are really rooted in the local community, and they really engage the local community, not in terms of not only in terms of social service support, but ultimately in what’s a meaningful role for these individuals in their community. That’s going to give them a sense of purpose. So I see.

25:18
I see these hopeful things.

Bob Kramer 25:21
But none of them is at a large scale and scalable to serve the 16 growing to 20 million folks that are right now, the most underserved population in America when it comes to housing and supportive services.

Rev. Beth Long-Higgins 25:37
Yeah, absolutely. I am aware that you have a way to help think about each of these. And you’ve already talked about several, you’ve already talked about Collegeville, the role of learning. You’ve already talked about the wellness bill, and the role of wellness. You’ve talked some about service still, and volunteerism and mentoring. And that kind of goes with that matchmaking of purpose matchmaking. The other two visuals that I know are on your list or change Ville and fun filled. Do you want to say anything about either of those?

Bob Kramer 26:12
Well, first of all, let me say that I came up with this as sort of a shorthand, catchy shorthand for the fact of whether it’s multi generational intergenerational or whether it’s a senior’s community, basically, I think there are a series of these different themes that are not mutually exclusive. That will be the sorts of things people are looking for. And they’re important. And so that’s where change will serve will Collegeville change Ville, quite frankly, is the fact that many boomers, change Ville is basically social change. And it’s about wanting to change society, both at the very local level, farm to table, sustainable in terms of footprint and our ecological footprint. But change Ville Put another way is, for many boomers, they had the experience of the protest movement and wanting to change society, in their teens and in their 20s. And this is a return to that role. And realizing, okay, you’ve raised your kids, now you have a chance to know how you are going to leave society better. And what and so again, it can be global warming, it can be dei and belonging initiatives. It can be education, it can be the, this incredible lost learning years of, of children, particularly between the ages of five and 12, where for many kids, they lost two to three years of learning. This is a national crisis, that if we don’t address it, we will face a huge price in the future. And so, so service Ville, is about mentoring. It’s about volunteering. But it’s also about how that is an illustration, that theme creates community Opus, which is the middle income model that two life communities in Boston are developing. They tested with the prospective residents, different levels of volunteer commitment they would want. And the residents chose the highest level. They said they wanted at least 10 hours of volunteer commitment required of every new resident. And when asked why they said, because we want the others moving into this community with us to be as committed to making this community work as we are. And so rather than being a turn off 90% of the people that they’ve already sold out 90% of the people that are signed up, and they’ve only just had the groundbreaking said what attracted that was this volunteerism, this was a community of like minded folks. So service Ville, and by the way, part of service will in the future. One of the payment models for care and housing in the future will be volunteerism, and what I call a pay it forward model where you put in hours. It reminded me of the Cambridge food Co Op, my wife and I were part of when we were newly married in Cambridge, Massachusetts, in 1971. You put in it as a cooperative effort in that sense. So service Ville college Ville, Chang Ville fond Ville is a recognition that to varying degrees people want to be able to have fun, they don’t want to be heavy out all the time. Now for some people that may meet Jimmy Buffett’s Margaritaville or Disney’s new announcement that they’re going to have themed older adult communities, those would not be attractive to my wife and I, but I recognize that there are, but it’s important to realize that that to a certain extent, you want to be able to laugh, and have fun, because that’s a key part of daily life, you don’t want to be heavyweight. And so I see these as not mutually conflicting or competing themes, but different communities will be more known for certain things. You know, one of my siblings lives in a life plan community that is very focused on ecological sustainability and footprint, and 60% of their residents come from out of state because they’re attracted to that. Those are like minded people to them. And I think this is, but for others, they’re going to want to live in a multi generational setting, they’re not going to want to feel they were separated and parked away somewhere in a place for older adults. So, you know, one of the good things is because of the sheer numbers of boomers and how they forced the market throughout their lifespan, they have forced the market to respond to them. There will be a lot of different variations of housing, and services and community, for boomers. Anybody that says this is the one model that boomers are going to love. They’re by definition have just said they don’t understand boomers. But I think it is a key thing for our society. And I once gave a talk at the University of Southern California. And I titled boomers willing and wanting or unwilling and unwanted meaning, were they willing to be part of the solution to the problems society is facing? And did they want to contribute what they could contribute? Or were they unwilling? You know, I worked all my life dammit, you owe me my Social Security and my Medicare and will and greater benefits? And if it burns you with too much taxes? Tough luck? Or, would they be unwanted? You know, you’re at what do you have to contribute? You’re finished, you’re done. You know, we’ve already put black crepe and bunting and black balloons all over your birthday cards. Because, you know, just your baggage of deficits and decline? And what could you possibly have to offer our society? Well, that’s gonna get changed. Thank goodness. Yeah. But these are different, you know, fun Ville service Ville change. Collegeville. Wellness Ville is from many communities are media defined by a focus on wellness, I would say that for many boomers, they have lived through the experience of their parents. And though they love their parents, they may have been very grateful for the assisted living communities, or whatever it was that was available. They themselves want to live in a setting and do things that will enable them to avoid being put by their children into assisted living for as long as they can, if not completely. And that means wellness will, that means a focus on lifestyle, that’s going to give me that purposeful longevity. And that’s going to basically, we know for instance, with dementia, and with Alzheimer’s specifically, there are a lot of things you can do in lifestyle that will delay the onset of the conditions. And so, to me, much of the new wave of thinking about housing communities and health care for older adults is going to be around. I don’t accept just putting more years in my life. I want to be in a setting that puts more life in my years. And that I think is going to be the clarion call for so many older adults.

Rev. Beth Long-Higgins 34:23
Thank you, Bob. We could keep going on forever, but I know that there are other things you have to do today. So I’m just gonna reword one question here. reflective questions as we close here. What for people who look to you and see you as being an abundant aging influencer? What is one thing that you would hope that they see in you that they will apply to their own lives and their own aging process? Because there are people who do look up to you as an aging influencer?

Bob Kramer 34:57
Yeah. Look at the people around you. that you care for? And say, How can I be a positive influence in their lives today? So don’t just think, broad base, how can I change the world, but think, really locally, the issues in my community, the people that are important in my life. And, secondly, as you go about thinking about that, be a good listener, as you go about thinking about that perfect art of the good question, which will then make you a good friend, which will then give you a relationship that will last for a long time. And where I think we’re human beings, we are wired for purpose, but that purpose is most frequently realized, in our relationships with other people. And so the oh, one of the things one has to consciously do as you get older, don’t just joke about now you got to read the obituary pages are natural friendship groups shrink. So we have to take conscious effort to broaden that group out again, for my wife and I, during COVID, it was making a list of literally friends that we had interacted with over the 50 plus years of our marriage and saying, gee, we’ve lost touch with them, Let’s reconnect. And because we realize we have to purposely widen that circle again. Because ultimately, those friendships, those relationships, that’s that and feeling like, I need to get up tomorrow, because this person is looking forward to breaking bread with me or having a conversation with me. And so I think it’s that connectivity. And also, I would say our nation needs it more than ever before. And so, to me, those are really just, absolutely, he thinks it’s local. It’s personal. It’s relational. But ask the questions. Don’t start with the answers.

Rev. Beth Long-Higgins 37:19
And let the people say I’m a man. Those are words literally to live by. Thank you. Thank you for this time, Bob. Thank you to all of our listeners for listening to this episode of The Art of aging, part of the abundant aging podcast series with United Church homes. And we want to hear from you what’s changed about you as you’ve aged? What has surprised you most about aging? How do you define abundant aging and who is your abundant aging hero? Join us at WWW DOT abundant aging podcast.com to share your ideas. You can also give us feedback when you visit the Ruth Pross Parker Center website at United Church homes.org backslash Parker hyphen center. And finally, cheap October 6 2023. On your calendar, when we will be hosting the eighth annual Ruth Frost Parker center symposium you can join us live or virtually for a great day of sessions around this year’s topic, dismantling ageism, stay tuned for more information about the speakers. And Bob, do you want to share how people can connect with you?

Bob Kramer 38:30
Absolutely. They can reach me through Nexus insights, Nexus insights.net. They can write me RGK at Nexus insights. Now, they can also reach me through NIC W. W w.nic.org. By all those ways and on LinkedIn and on Twitter as well. So I look forward to hearing from your listeners and I look forward to working together on this journey as we basically rethink and recreate the expectations of aging leading them to a different lived experience of aging.

Rev. Beth Long-Higgins 39:06
Peace. Thank you.