Bruce Chernof, President and CEO, The SCAN Foundation
We live in a world where all older adults, whether they are 65 or 95, are viewed the same—as just a set of deficits to be solved. The reality is that when someone turns 65, they have roughly 8,000 days ahead of them, almost a third of their life. Why are these 8,000 days so invisible?
I lead a foundation focused on transforming the lives of older adults, particularly those living with complex needs or who are underserved. We have found that two ways of thinking—one individual and one institutional—tend to reinforce this perpetual overlooking of later life and what is needed to live it well.
The first is present bias. We generally look back on our past and think that yesterday was much like the day before, and look ahead thinking that tomorrow will be much like today. We miss the major markers of change until our realities are all of the sudden different, and the rulebook we’ve always used in our lives doesn’t seem to apply anymore.
Secondly, in aggregate we are creatures of our culture and shared public consciousness. As time has passed, we now live much longer and differently than we did decades ago, but the policy frameworks that shape our collective imagination remain pretty much unchanged.
How did 65 get to be so magical, such a turning point? When Social Security was passed in 1935, the average life expectancy was 62; most people were dead before they could use the program and those who did mostly didn’t use it for long. In 1965 when Medicare and Medicaid were passed, the average life expectancy was 69. Medicare covered medical needs of older adults while Medicaid was a health program for poor women and their children. Today, Medicaid is the largest public payer of long-term care services in this country. Medical advances over the last 20 years have added more than a decade of life expectancy. We will all live longer and likely with some needs as we age. Nevertheless, the world is still designed as one where we won’t live much beyond 65 – a world designed for the problems of those deemed sick, poor, and alone.
Like many health care foundations our argument for impact, for change at scale, has centered in changing the behaviors of major programs like Medicare and Medicaid. We have worked to change what gets paid for and by extension, how health care organizations provide services. However, as we have done that, we have also begun to wonder what would be possible if we started with the older adult and their family first and worked from there. What would it take to really build resilience in older adults, in their families, and in their communities?
With the help of IDEO, the human-centered design firm maybe best known for designing the first Apple mouse, we started a journey to better understand why aging is so challenging and what could be done to put the older adult first.
What we learned is that the world of older adults was purpose-built for a time and place that no longer exists. An older adult’s ecosystem is defined by five pillars of aging: health, environment (e.g., supportive services, transportation), community (e.g., family and friends), home, and self-worth. When an older person faces a serious threat, it usually involves more than one pillar, and all pillars are inextricably linked to financial health. Unfortunately, each pillar is governed by different organizations and providers, with different protocols and ways of seeing the needs of the people they serve. Today, as a result, most aging-related solutions—products, services, and programs—focus on a single pillar of aging when they ought to consider the intersections and the dynamic interactions between pillars. They neither reflect a deep understanding of needs, nor solve the actual problems faced by older adults.
At The SCAN Foundation, we see that these intersections materialize for older adults as four major threats that lead to profound and irreparable harm: income insecurity, retirement and disconnection, a major shift in health, or a family break (often someone’s passing). Enhancing resilience and the capacity to both anticipate and respond to these threats represents an enormous opportunity to improve the lives of older people. As institutions—philanthropies, health systems, government programs, and the like—this is our way of seeing “the problems” of aging. But digging deeper, we have found that while older adults recognize that these threats are serious and important, they themselves don’t dwell on them.
The mismatch gets in the way of truly addressing the wants and needs of older adults as they age. We configure our systems to design and deliver services to “fix” the deficits of older adults. We seldom see older adults as customers whose business we must earn by excellently delivering what they want at a price that feels fair to them. We tend to focus instead on what the health care system, or the housing provider, or the family caregiver needs to provide service. Design for older adults is broken.
Seeing this, we went back and looked and listened again. This time, we worked with a different human-centered design firm, Birsel+Seck, to explore what it would mean to turn threats on their head, and look at the wishes older adults have for themselves. What we learned should change the face of the worlds of design, entrepreneurship and maybe most importantly, philanthropy.
What drives the last 8,000 days of our lives are the same goals, hopes, and desires that we have in every phase of our lives: love, friendship, purpose, and vitality. It’s the same, just different. And no matter how we may appear to others—sick or well, physically limited or not, living on a fixed income—we yearn to have our “wants” met and not be defined by the “needs” that others would ascribe to us. This is what it means to be alive at every age.
Transforming how we see aging requires us to learn to think and act this way, individually and institutionally. And it means that new platforms for defining and meeting the desires we carry as we age are necessary. Building these new platforms is risky. They will be challenging to get right, limited as we have been by our old frames and old systems. But while risky, these are exactly what we in philanthropy ought to be endeavoring toward.
Our response to this challenge has been to move upstream in order to conceive and develop entirely new services for older adults within a commercial framework. We believe that creating wholly new brands, products, and experiences for older adults will demonstrate that older adults are excited to adopt solutions to their everyday challenges so long as those solutions are designed for them and not for a provider’s idea of what they ought to want.
To this end, we have funded a new startup studio, Alive Ventures, to lead the work on developing these offerings, and hope to inspire and support leading entrepreneurs and innovators to come with us as we build better insights and better models for seeing what older adults want. We’ll do that centering older adults in the process – designing with them and not just for them. And we will—we hope—all learn to imagine together what a thriving life feels like as we age. Not the one society told us decades ago we should expect. But the one to be invented now.
I think a willingness to be inventive in not just our programs but also in the structures and organizational forms of our engagement with pressing problems is vital. Collectively within our field of philanthropy, whether we work at local, national, or global scales, there is much still to be tried for broadening our circles of influence into new spheres with new people and organizations not traditionally drawn to our ways of framing problems. At The SCAN Foundation, we expect to learn a lot from our latest experiment in inventing new forms, and we are excited to share these lessons with the field. I am likewise excited for the new experiments each of us in the broader GIH community will take on, and to together moving our field forward.