Investing in Compassion: Reimagining Care for Older Adults and Systemic Change

The podcast features Serena Mohanty, President of The SCAN Foundation, discussing the critical need to transform care for older adults. Mohanty, drawing from her experience as an internal medicine physician at Boston Medical Center and in Los Angeles, highlights the profound fragmentation, disparities, and inequities in the current healthcare system, particularly for vulnerable populations. She emphasizes that care extends beyond clinical treatment to encompass social needs and determinants of health, advocating for a holistic, person-centered approach. The core argument is that the existing volume-based healthcare system is misaligned with the needs and preferences of older adults, who overwhelmingly desire care that preserves dignity and independence within their homes and communities. Mohanty distinguishes between the current volume-based care model, which incentivizes numerous visits, and a value-based model that prioritizes comprehensive well-being. She points out the significant "gaping holes" in Medicare, specifically its lack of long-term care benefits, which leaves up to 70% of older adults without adequate support for their needs. The discussion also nuances the concept of "vulnerable populations," extending it beyond racial/ethnic minorities and low-income individuals to include older adults who face unique challenges like social isolation, chronic illness, and disability. The conversation highlights the distinction between purely physical health and the intertwined emotional, spiritual, and community aspects that contribute to overall vitality and quality of life. The SCAN Foundation advocates for macro system-level changes, including the development of "Master Plans for Aging" in every U.S. state. California's master plan, with over 100 initiatives, serves as a model for creating equitable, transformative systems of care. Practical recommendations include shifting incentives towards value-based payment models, investing in community care (e.g., hiring community health workers to reduce avoidable hospitalizations), and reimagining the role of older adults in the workforce to address labor shortages and provide economic benefits. The concept of "person-driven outcome measures" is introduced as a way to genuinely understand and cater to what matters most to individuals, moving beyond standard clinical quality metrics. The broader implications of this work are profound, extending beyond individual well-being to societal resilience and economic sustainability. By 2035, older adults will outnumber children in the U.S., necessitating a robust infrastructure that currently does not exist. The discussion connects to the economic argument for early childhood education (James Heckman's work), suggesting that investing in comprehensive elder care, like early childhood development, can yield significant long-term savings and societal benefits. The podcast implies that a compassionate, integrated approach to aging can alleviate anxiety and fear, leading to improved emotional and physical health, and ultimately enhance the quality of life for all generations, making the U.S. a more desirable place to live.

"there is no profit in curing the body if in the process you destroy the soul"

"she lost both of those things [dignity and independence]... she became her life became somewhat hopeless"

"why aren't the incentives aligned to support those [care in the home, dignity, independence]?"

"we have traditionally been a a health care system that focuses on the clinical the the high needs"

"in order to achieve health you have to achieve total health which is not only the physical the behavioral the social"

"medicare has gaping holes in the ability to support long-term care"

"by 2035 we're gonna have more older adults than children in this country and yet we are not we don't have an infrastructure so to to to support them and their needs"

"what matters most to me is going fishing that's what gives me joy that's what gives me um you know vitality"

"can we find a way to die alive"

"most of health is based on social needs housing food security transportation economic security"

"investment in community care... you see reductions in avoidable hospitalizations and emergency department use"

"we have a great opportunity to to take you know older you know older adults and say you don't have to retire at 65"