In mid-May, I was at the Social Impact Exchange (SIE) meeting, thinking about the relationship between our work and what I was hearing from other funders and non-profits. I was struck by how much of the “problem” that others were describing had to do with too many funder dollars chasing the same non-profits and too many non-profits working on the same social issue (e.g., to improve the education of at-risk youth).
It made me feel very lonely. With the coming spend-down of The Atlantic Philanthropies and the Donald W. Reynolds Foundation, two of our biggest colleagues are exiting the field. Not only will we miss their money helping to advance the care of older adults, but we will also miss the expertise and shared knowledge of our peers. Of course, there are new funders emerging, such as the Margaret A. Cargill Foundation who have an aging focus, but, given the growth of the population, it just doesn’t feel like enough.
One thing that one hears at the SIE meeting is a lot of succinct case statements describing the rationale for an area of funding. For example, the poverty rate for children in America was reported this week to have reached 23 percent. And of those low-income children, fewer than half will graduate from high school. It isn’t unusual when the wasted lives are described to see stern professional program officers get a bit teary.
If we were going to make our best case for the need to improve quality of care for older Americans, what should we be saying? If we want to get our fair share of the budding social entrepreneurs, foundation investments, and social sector attention, how should we describe the situation?
I know we won’t persuade everyone—some part of what makes people resonate to a cause is totally idiosyncratic. But part of the battle is connecting a particular issue with fundamental values and positioning it for collective action in a way the culture defines as legitimate.
Given the values of our society, it is not surprising that people are intensely concerned with expanding the life opportunities of young people. The notion that poor and minority youth would be structurally disadvantaged by weak schools, lack of role models, poor health, and violence strikes at the heart of our values of social mobility, equal opportunity, and the value of the individual.
What argument can we make that will produce the same sense of a visceral wrongness and will drive people to action to improve the health of older Americans? As a community of people interested in aging and health, we’ve tried over and over again to make a persuasive case, but I can’t say that I am entirely satisfied.
We know some important facts:
- Older adults need excellent health care because of the burden of chronic disease they have accumulated over their lifetimes—lifetimes of work and caring for us and our society.
- We are all aging and most of us will have multiple chronic diseases when we arrive at 65. And most of us will eventually need long-term care when we can no longer live entirely independently.
- The quality of care older adults receive is particularly poor—the ACOVE indicators research shows us that vulnerable older adults receive only 30 percent of indicated care for their geriatric syndromes.
- The weakness of the ambulatory care system is such that 10 percent of all hospitalizations are potentially preventable, and—of those nearly 4 million unnecessary hospitalizations—a vastly disproportionate 60 percent, or 2.4 million, are of older adults.
- Once in-hospital, rates of adverse events are also disproportionately elevated for older adults—both overall and for preventable events. In 2010, the U.S. Department of Health and Human Services’ Office of Inspector General estimated that 15,000 Medicare beneficiaries die each month from an adverse event in hospital.
This is not what we want for ourselves or our families. It also undermines our values of fairness and equity as well as poses a pragmatic threat to our national finances and future. Perhaps most frustrating, there is a great deal already known about what we need to do to improve. Given this common fate, surely communal action to benefit all citizens must be a priority.
The health care system may be in the thrall of perverse incentives, but we can see patches of quality and we have a cadre of experts who can guide the process of improvement. Compared to improving public education or ending poverty in sub-Saharan Africa, this should be easy.
Of course, it’s hardly surprising that I would think that we have an issue that strikes at our fundamental values and calls out for collective social action. I’d like to hear what you think. Please take a moment to comment: How would you make the argument? What has worked for you? And what have you tried that has backfired?
How can we put our best foot forward to make a strong case for the importance of aging and health as an area for philanthropy, innovation, and concern?