Investing in Compassion

The tradition of abandoning our elderly populations needs to end. Sarita Mohanty talks with Rob Johnson about her work at the SCAN Foundation, and the critical importance of combating "ageism" to strengthening our society. Learn more: https://www.thescanfoundation.org/

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Transcript

Rob Johnson:

Welcome to Economics and Beyond. I'm Rob Johnson, president of the Institute for New Economic Thinking.

I'm here today as a result of good fortune. Former communications director for INET and good friend, Rick Keating, last year towards the end of the year said there is someone you have to meet. And Sarita Mohanty, 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 Permanente, 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 and pharma 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 Luohan Academy had a wonderful seminar just a day or so ago, that Sarita and I both attended. I think this is one of those things that someday you are going to thank her for waking us all up. So 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. And 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.

Sarita Mohanty:

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.

Rob Johnson:

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 was the launching pad of inspiration that brought you to embrace the challenge you have today?

Sarita Mohanty:

Thank you. Yeah, no, as you mentioned, I am a physician, internal medicine physician, and early in my career, actually, when I was training at Boston Medical Center, which was in the heart of a very low income county population in Boston, Massachusetts, it became glaringly apparent. And I saw this firsthand, the fragmentation, the grave disparities and inequities in care. I worked 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. 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. 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. 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... Certain substances that he wanted to combat because he wanted to get better. But he wanted kindness, compassion, someone to hold his hand as he dealt with this new blow.

And so this was really, for me, defined my purpose. Gets to your question, my purpose, which was to improve the health and wellbeing of vulnerable populations. And that's a very broad phrase, vulnerable populations. It can include those that are more disenfranchised, racial ethnic minorities, low income populations, the older adults, children. There are subsets that have more vulnerabilities and sometimes don't access the quality care that we want them to achieve and have. So that is really what got me going. And I go back, I'll say one thing, there was this really interesting quote that has always driven me. Samuel Golter. He was the executive director at the City of Hope, which is a cancer center in Los Angeles, California. 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 have my purpose to improve the lives of vulnerable populations.

Rob Johnson:

So how would I say, as you mentioned, vulnerability can take on many different identities. Minority populations, or you can be low income people. How did older people come onto your radar as qualifying in this realm?

Sarita Mohanty:

Yeah, well, it's really there are professional stories, as I've 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 my own personal story, and it's a hard one for me because it's about my grandmother. And this really gets into access to quality home care. So my grandmother, she was raised and lived in India and she was brought over by my uncle and my mom, after my grandfather passed away after ailments with Alzheimer's disease. So she came over and wanted to be close to her grandkids, her kids. And one day she slipped and fell and we never thought at that time that this would really essentially pave the course for the rest of her existence in a very negative way.

She essentially, after falling, went into a nursing home because she was significantly with disability in terms of 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, we think about our work and the work around aging at the SCAN Foundation, but it is about dignity and independence. And she lost both of those things being in a facility where she couldn't speak English. I mean, so oftentimes she couldn't communicate with the staff. She had strangers bathing, her, changing her, feeding her.

So her life became somewhat hopeless and it really, it still eats at me every day to even think that not only... And my grandmother had certain resources, but think about those that even have less resources. But, in her case, she suffered tremendously. So that is really what has really... That and seeing even my in-laws who passed away from cancer and some of the home care needs that they didn't get. And, again, we had resources to help them, yet to navigate this broken, complex system that we call healthcare was not easy, even for a physician like myself. So we have too much to do. We have a lot to do here. Yeah.

Rob Johnson:

So 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 do 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 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 mouse trap of coherence 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.

Sarita Mohanty:

Right. Now, it's a really important question, Rob. And I think we've all been grappling with this. Why is it that we know that 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, hospitals. And I don't think 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... Or misaligned, I should say, so that these different groups that work on different aspects of care are siloed.

And so the incentives are just not there. And, even in Medicare, as a great example, people generally, when they get Medicare to cover their insurance, they, 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 answer your question, Rob, it is because the incentives, again, have been mostly aligned towards volume-based care. So making sure that providers, physicians, whomever get paid for 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.

Rob Johnson:

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 in 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 mouse trap 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?

Sarita Mohanty:

Yeah, no. And it is 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, as I said, I always go back to creating a movement. How do we really work towards developing these macro system level changes, 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, and I'll talk a little bit about 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 continue 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 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 live vitally. And so what we're trying to do is really advance, really continue to... I mean, it's a persistence. Over and over message and being able to let our stakeholders, our policy makers know that this is something that we have to work on collectively. 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. Because California, and we work in California as well as nationally, but California, there was recent data that showed that Medicare enrollment among Californians older than 65 grew over 11% over the past five years.

And the challenge is, as I mentioned, Medicare has gaping holes in the ability to support long-term care. And we know that up to 70% 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, we've 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, just to give more context, is a roadmap for creating what we call equitable, transformative systems of care for aging. It 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 initiatives? Right now we have over a hundred initiatives outlined in California to support the infrastructure on aging.

So that is something, 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 Hochul, in her state of the state end of this past year, printed 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 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, what they call, I think, the older Michiganders, I think, is what they're called.

Rob Johnson:

Michiganders.

Sarita Mohanty:

Yeah. Michiganders. Yeah. To access available services, make sure they're more socially connected. Because I think the statistics on social isolation are so high in Michigan and other states. So that is, I mean, to really say that this is really core to our work is an understatement. It is critical. And if I had my bold vision, it would be every state has a master plan, that is not just a plan that sits on a shelf, but it is about now execution. There's some core infrastructure and mindset and culture and movement that needs to happen to make that.

Rob Johnson:

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 some healing contained within that being a broad based, and many being aware that it is a platform upon which they could rely, which in many places does not exist today. And I made a little bit of a parable a few minutes ago about the old entrenched interest 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 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 courses, mathematics and science and literature and languages, et cetera, 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 and difficulty society faced 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 basis, something like 11% of your money. And 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 at 11%, 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 treasury. And that's where I think the journey you're embarked on 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 as 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 I watched the quality of his spirit go up, where it was a condominium complex with three or four units.

The care giving family lived in one and there were three units that were their clients slash customers. And I watched how attentive and how aware they were of my father. My sister was an ICU nurse in Portland. She was in awe of the quality of service she got. So 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.

Sarita Mohanty:

Yeah, no, I so resonate with what you just said, Rob. And one thing that it reminded me is that, in order to live with this level, even if you're dealing with chronic illness and disability, which, as you get older, the likelihood does go up. It's a fact. We get frail, we deal with arthritis, number of issues. But it's important to ask, like your father or anybody, what do you want in your life? What matters to you the most? And that's why I talk about person-centered care. What matters the most to you? And we are working with, there's an entity called the National Committee for Quality Assurance, NCQA, on 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 measured requirements of care. But we don't have what we call person driven outcome measures.

So where we 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 they had a patient who was deteriorating, having a lot of medical challenges. Depression was on top of that, not surprisingly given all the challenges and the anxiety. And when they went through this, 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 vitality." I use that word a lot. How do we keep that? Even in the midst of physical and maybe emotional, what can we do to make things easier?

And the family was around him when that question was asked and answered, and they took him in his final days to actually go and spend some time doing fishing, which didn't require a whole lot of physical activity, but it just kept him alive, even to the point until the time he passed away. And I get moved by stories like that. That's what keeps us going. Somebody told me, "Can we find a way to die alive?" And I love that.

Rob Johnson:

Yeah. Yeah. Well, I have a very... I'll share this with you because I'm commemorating. My older children's grandfather on the maternal side lived to 102 and 11 months. And through almost the entire time I knew him, he was an orthopedic surgeon in Los Angeles. His wife had suffered some heart failure, bypass surgery, strokes, breast cancer, a 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 a vitality. On his hundredth birthday we walked down the street to a cocktail party and a slideshow about his life, and came back and before the Korean barbecue, which he loved, was served, he played Rachmaninoff 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 had broken hips and he'd had all the different kinds of things before he expired, but 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 physical tests and what have you. And so that's where my sense that the interaction between emotion, 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 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 really 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, I would call it, an extraordinary innovation or change of consciousness. And the questions when you hear opposition, when you hear critics, what do they say? Do they say it's too expensive? And what is expensive about what you're suggesting?

Sarita Mohanty:

It's 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. It gets to what you said earlier about it's more than just the physical health, it's the emotional, the spiritual, the community, which I can, 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 how do we support social health and the communities when our incentives are tied to our ability to function resides on offering clinical care? And so I really feel that there's this... I don't think they're looking at the long view of the things you talked about, that if you make those investments in the social, most of health is based on social needs, housing, food security, transportation, economic security.

I mean, there's a number of facets. 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 think that can be definitely, as we continue to evolve, even if we break even, we would still be able to see such improved clinical outcomes and satisfaction and vitality. And, I mean, my sense, and we've looked at some of the analyses. One of 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 costs of the healthcare system, the rising GDP?

And there's a couple things. One is investment in community care. There has been studies that if you hire community health workers, these are laypeople from the community to help people with navigation and get them connected to food banks or whatever they might need. You see results because what you see is reductions in 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 services they need. So that is, I think, one area of ripe opportunity in terms of workforce and making sure that people get the services, and at a lower cost. That's a low cost option and a valuable option. And then the other thing we heard about yesterday in the Luohan webinar series and the discussions, was this idea that we should, I think somebody called it it's wasted opportunity when you have a workforce that is forced to retire. And we are struggling with workforce issues, as we all hear. The great resignation. People not having enough nurses or other supports in the healthcare system or even in other jobs in industries.

So we have a great opportunity to take older adults and say, you don't have to retire at 65. If you want to work, there are ways to get you into the labor force. And I think that's one thing that we need to do a much better job of too. And that will reap economic benefits, getting to your question, versus being more costly. If we invest in a workforce development opportunities for older adults, so that they know that they can continue to have the savings, but also contribute to society. I think we could really transform the challenges with workforce in particular.

Rob Johnson:

Well, making people more productive or productive for longer adds to the revenue base from which taxes are collected and therefore underpins all the needs in society. And so I think, how would I say? 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. I read a book, which I think I shared with you my awareness of, by a woman named Connie Zweig, was called 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 Jungian psychology, all the shadows that got in the way of that redefining a purpose. And that the idea of being productive and being vital, et cetera, 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, 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 she gave a, which you might call, a psychological partnership to the kind of work you're doing or I won't even call it partnership, but it's aligned with how much, what you might call, weight can be taken off the shoulders of people as they age by reimagining, 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 I think that kind of dignity is the kind of thing I watched my father. My father was a very gifted jazz pianist, played professionally in all kinds of other things.

And when he asked me to move him out of the nursing home, when we went 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 started playing the piano again. 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 of the American Neurological Association. As a retired man he ran a cable television show a couple times a week, at lunch time 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 his frailness coming on stream. I can see what you're doing. 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.

Sarita Mohanty:

Yeah. I wish I had had a chance to meet him. It sounds... And no, I think you said something that really... It's not to say that 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 getting chronic illness. I mean, as I mentioned, you're more predisposed to that as you get older so that we can't... Although I think one thing we should think about, and I think this is also looking at it from the standpoint versus the past, let's look at the future of longevity, is we are advancing in technology, in digital space, and in medical therapeutics.

So it is conceivable that we are, 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 go to a clinic or a hospital, or being admitted to a clinic or hospital. And we're seeing that. We saw that with the pandemic. The one thing the pandemic, 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, I mean, now we're seeing huge, huge, ongoing utilization of telehealth.

I myself do clinic visits with patients via video visits. And you still sometimes do need to see the patient, but oftentimes you can have a relationship and you can address the core issues in the comfort of somebody's home. And I think that is phenomenal. And I think one thing we should just be excited about is that there are the advances in technology and in medical therapeutics will help us live with more vitality and hopefully reduce some of that anxiety you mentioned.

Rob Johnson:

Yeah. Well, I think your sense here is there's so much, what you might call, unrealized goodness that you can envision. And beginning to understand why you took on this purpose. I mean, you can say, I really care about my parents. Everybody does. But what can you do to improve their, and the people analogous like them throughout society? And I think the, like you talk about with telehealth or whatever, the frequency and attentiveness 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 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.

Sarita Mohanty:

Yeah, we do. We do. I mean, I don't know if I want to reference actually, based on what you just said, there is a great report by the Stanford Center for Longevity. And we could share this with our listeners after this podcast. But I would recommend reading it and I thought it was really insightful and very data, lot of important data. One statistic that they highlighted, which I thought was fascinating. And 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.

Rob Johnson:

Wow.

Sarita Mohanty:

Yeah. When they said that, I was like, I couldn't believe it. I mean, imagine that, imagine that. So it's really about changing this mindset about when we think about aging, that, as a society, we're all aging. I think they talk about the fact that, in this report, that at 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. That's why we don't say that we are taking care of adults 65 and older. We talk about, we definitely focus on the more vulnerable subsets of older adults, lower income, those that are lacking long-term care.

And it's how we take care of the caregivers who are mostly in... The millennials are a lot of the caregivers for older adults. They support a huge percentage of the unpaid caregiving workforce. So these are the kind of things that we can shed some light. I think we're going to see a bigger active movement of people wanting to really figure this out, the things we described. Planning on aging, building infrastructures, making 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 starting and we still have so much to do, but we can get there.

Rob Johnson:

Yeah, I do think it's hard to be grateful for the pandemic, but there is a bit of a wake up call within. I've seen some woman that used to work with me, who's a meditation instructor. 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 an organization that's based in Lennox, Massachusetts called the Ultra Wellness Center. And I'm watching that organization blossom with things like nutrition, sleep, meditation, exercise plans, life, which you 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, I think, the pandemic startled us all. And the idea of what you might call the doctor is there when you got damage 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. I find it fascinating how much is stirred up right now.

Sarita Mohanty:

We have to stir it up. We have to start really... The thing that you mentioned, it reminds me of an important thing that we're, in the aging landscape and the ecosystem and as policy makers, or as philanthropy, we're trying to combat what we call ageism. There's a lot of ageism that continues to permeate our healthcare systems and non-healthcare systems. And that is something that, like examples we talked about, oh, well, old people are unproductive consumers of government benefits. Okay. So the solution would be, first of all, that'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? Oh, they're causing a slower economic growth and mounting pressures on the public budgets. Well, no, I mean then again, same thing. Well then how do we keep them vital and active and prevent them from going to hospitals and institutions that drive up the costs of care. And those words like silver tsunami, I mean, there's so many different words that are being used with a negative connotation on aging. We're going to flip that on its head for sure. That's what we're doing and everything we talk about, it's all about the positivity of aging. I have a really quick example, great example of my mom. So she's in her seventies and she's very healthy and has had no medical real issues and was walking a mile a day. And she hurt her knee.

She hurt her knee. And I seen her limping and she couldn't even walk. She was feeling very sad. She's like, "This is what I love to do. I can't walk." I said, "Okay, well, we got to figure out how to fix this. 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 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 orthopedist, 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." And it turned out, and I didn't use all my... I could have used all my, I'm a doctor and I'm going to... 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 he actually did some injections, just to help with the swelling. Bottom line, there was more that 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... I mean, and I might be blowing this out of proportion, but I don't think I am.

I was very compelled to say, why the hell... And I recognize that probably in my training, or as a physician, I probably did something very similar. I probably said, "Well, 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 somebody say this is not even an option? That was a very... 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.

Rob Johnson:

So I'm going to take it to my hometown where my father was a physician, Detroit, Michigan. I'd love to see the SCAN Foundation dig in the people in our metropolitan area who'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 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?

Sarita Mohanty:

Yeah, well, I would first acknowledge Michigan in terms of knowing that they're one of the fastest aging states, I should say, in the nation. 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 what they do quite often just because I'm so intrigued. And they're talking about aging in place, staying in place, living at home. So what I would just say, first and foremost, keep going. I mean, you build this infrastructure, you'll see those savings that I think the state director has... I think ARP even has been working with them and saying there are things that are happening in Michigan, in other states, that just got to keep the movement going.

Another example, I also remember, about Michigan. I would reinforce this social isolation. That, in that work to stay in place, age in place or stay in place there, I think they said something like 41% of Michiganders live alone. I don't know how current that is, but it was a statistic I found. And Michigan is starting to figure out ways, programs and you talk 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 combat social isolation, develop social connectedness. When I'm talking to this group that you defined, I would say, we are working at the foundation to think about how we can partner more effectively with private capital, who can spur innovation and accelerate the pace of some of these things I just mentioned.

One example is at the SCAN Foundation, we helped start a startup studio, an incubator 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 this startup studio does with older adults. 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 encourage the private side to partner with foundations, with academic institutions, with the government, on investments in this space. And ask what older adults want. Make sure they do that as well. Make sure that you're not creating products that they're not going to use. And we see that a lot in healthcare. So, there would be some core message on this. And I would just say, keep on going with your master plan. Have measurable results or outcomes and 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'd love to see. And I think Michigan is on the right track, quite honestly.

Rob Johnson:

Well with our friend Hillary, we got a pathway into the Michigan. At scout, she's really building things. And so I look forward to continuing to work with you in that regard. I'm very, how would I say that? 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, what you might call, in 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? Help me help you?

Sarita Mohanty:

Thank you. Well, I love that. No, I would say, first of all, we don't do fundraising as a foundation. We have investments and we try to reinvest every year. And so, I mean, that being said, if there are dollars to support a cause, I mean, coming in with us to partner on 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. 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 Committee on Quality Assurance to develop those.

And so this is all about partnership. So to the extent, I mean, my biggest thing is always about connection. So we're not all doing things in isolation or we 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. Maybe we should come together and do it together. So strength by numbers, not only of financial investment, but also it could be intellectual and having... We need that. We need that. We need that thinking. And that goes back to even the private side. So what I would say to your listeners is think about how those partnerships can come about. We, as a foundation, we see ourselves as conveners and catalyzers. 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 maybe a consensus statement that goes, and we do briefings on the Hill collectively to say, this is something that needs to be incentivized, or a policy needs to be developed 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, interests, passion. You got all of those, come to me, come to us. And knowing what we do in terms of wanting to have people live 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.

Rob Johnson:

Okay. Well, I hope to stay in touch with you and really come back to this over and over and over again. And I mentioned Connie Zweig's book. You've mentioned the Stanford Report. I'll try to create a place on our website for those who are curious, can come. And 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 going to get on that this afternoon. But I have to say, I woke up this morning very excited about this. And is 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 Dylan 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, spouted out that Liberty is just equality in school. Equality, I spoke the word as if a wedding vow, but I was so much older then. 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 then, I'm younger than that now. Thank you very much.

Sarita Mohanty:

Oh, thank you. You've inspired me. Thank you so much for this. And I love talking to you today.

Rob Johnson:

Well, the inspiration, in my view, closed in the other direction from you toward me and towards our audience. So thanks for being here today. And well, like I said, in the not too distant future, we'll pick it up again.

Sarita Mohanty:

Great. Thank you so much.

Rob Johnson:

Bye-bye for now. And check out more from the Institute for New Economic Thinking at ineteconomics.org.

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