How do the attitudes and beliefs of leadership, staff, and residents stand in the way of providing a path to wellbeing for older adults?
Wellness has become the buzzword in senior living. As 10,000+ Boomers turn 65 everyday, they are driving unprecedented demand for personalized services that add years to life and life to years. But what are the roadblocks to delivering wellness in a senior living community?
Roadblock One: Ageism
Most senior living executives are aware of external forms of ageism from the media and corporations motivated to sell products and services, but fewer are aware of the internal ageism within their own communities. Ageism from leadership, staff and residents undermines the ability for acceptance and inclusion and forms an unsurmountable roadblock to wellness.
The negative effects of ageism on individuals are well documented. A comprehensive study of 45 countries across 5 continents shows internalized ageism actually shortens lifespan. This systematic review of 422 studies around the world that included over 7 million participants found evidence of the adverse effects of ageism in 96% of the studies.
The biggest myth is that older adults are a “burden to society,” although there is much evidence that debunks this damaging storyline. According to the World Health Organization: “Contrary to common assumptions, ageing has far less influence on health care expenditures than other factors. There is growing evidence from high-income countries that starting at around age 70, healthcare expenditure per person falls significantly.”
Thankfully, anti-ageism activists such as Ashton Applewhite’s (This Chair Rocks: A Manifesto Against Ageism) and gerontologist Tracey Gendron’s (Ageism Exposed) are bringing awareness to outdated stereotypes. New intergenerational, mixed-use models such as university co-housing help break down negative stereotypes. The path to understanding is to bridge the generations.
Roadblock Two: Separatism
Ageism and ableism within a senior living community creates an “us versus them” mentality that contribute to fear and exclusion and prohibits people of all ages from reaping the rich rewards of intergenerational connection. The benefits of intergenerational living are well documented. Programming that values authentic connection between old and young reduces ageism, increases social connections, improves community infrastructure, and contributes to overall wellbeing.
According to Intergenerational housing as a model for improving older-adult health | British Columbia Medical Journal (bcmj.org), intergenerational programs benefit seniors through improved self-rated health scores, physical function, and cognition. Such programs have positive effects on society at large, fostering a sense of community, improving intergenerational ties, cultivating economic gain, and increasing social capital.
The article Don’t Mind the Gap in Intergenerational Housing - The New York Times (nytimes.com) observed that residents in traditional senior living communities “appear to be living in exile, far removed from whatever their lives had once been.” Progressive senior living operators are moving beyond “senior islands” to more inclusionary models. Real estate that brings generations under the same roof, however, is just part of the equation. A culture of diversity, equity and inclusion requires commitment and agency—the ability to act or intervene at all levels.
Roadblock Three: Affordability
Most senior living operators would agree that delivering wellness services is crucial, but with rising costs and staffing shortages, there is the ongoing question of who will pay for it. The issue of affordability will be at the forefront--even affluent retirees can be penny pinching when it comes to paying out of pocket.
Len Fishman, former director of the Gerontology Institute at UMass Boston's McCormack Graduate School of Policy and Global Studies, is concerned about the issue of affordability of basic human needs for many financially strapped older adults. “The percentage of older people living under the federal poverty level will increase significantly over the next 20 years because people are living longer and no longer have pensions, and housing is way more expensive. There will be more poverty, homelessness, and hunger without changes in federal and state policy.”
Affordability provides access to social determinants of health (SDoH), which determine our ability to stay well and expand our health span. SDoH include socioeconomic status, education, work, food security, zip code, community safety and access to care. According to data from the National Library of Medicine, “medical care accounts for 10 to 20% of the modifiable contributors to health outcomes for a population, while the other 80 to 90% is made up of SDoH.” One’s poverty, lack of education, and racism are significant roadblocks to wellness.
One bright spot is technology. Programs such as telehealth increase accessibility and lower the cost of providing health and wellness resources. In a new study, “Breaking the Cost Curve,” Deloitte predicts health spending as a percentage of GDP will decelerate over the next 20 years because traditional barriers to health care access, like geography and lack of resources, could be significantly reduced. The survey shows use of telehealth by Medicare Advantage members doubled from 2019 to 2020 (from 13% to 26%).
Beyond Wellness Speak
Ageism, separatism, and socioeconomic disparity must be addressed head-on within senior living communities to move wellness beyond empty rhetoric. The process is multilayered and messy, but the rewards are priceless--improved quality of life for residents, staff, and families.