First View of Aging
William D Novelli
Executive Director and CEO, AARP
Presented at Joint Conference of NCOA and ASA
ASA Special Program Luncheon
Denver, CO
April 4, 2002
Out on the prairie a couple of hundred miles east of here is a place called Firstview, Colorado. It sounds like an unlikely name - and it is. But the early frontier explorers gave it that name for a good reason.
If you're traveling westward across the flatlands of the Midwest, ultimately you reach a special place here in Colorado where you first can see the Rocky Mountains. It's an incredible experience for the eyes and for the soul - especially after so long a journey westward.
It's not surprising, then, that when early settlers caught their first view of Pikes Peak and the Front Range, it signaled for them the dawning of new possibilities for building a life here in the Rocky Mountain West.
Those courageous people who crossed the frontier were not just making a casual journey. To the contrary, they had a vision about what they would achieve.
They traveled westward across the frontier to the high country here because of opportunity and the promise of creating better lives for themselves and for their families. At AARP, we also have a vision. We, want to help create better lives for people as they grow older. As professionals in the field, I'm sure you have similar goals to ours.
We - like the early settlers - are on the frontier.
- Their frontier was geographic.
- Ours is more demographic.
- Their frontier was filled with unique opportunities for people to work together and to create new partnerships in the westward expansion of a young nation.
- Our frontier is filled with unique opportunities to create new partnerships because of the unprecedented expansion of an aging population.
The pioneers were grateful for the path-finders who preceded them. And so it is with me. I began my term as Executive Director and CEO of AARP ten months ago, and I am grateful to Horace Deets for his creative leadership over 13 years as my predecessor. And, I am also appreciative of all of you, who do so much in your communities and in your own organizations on behalf of older people in this country.
Many people get their first view of aging when they turn 50. In our society, fifty is somehow the demarcation point signifying the beginning of old age-and it's deeply ingrained in our society. It's even evident in our language. Think about it. We become 21 as a glorious rite of passage. We hit 50 like a brick wall. Then, we turn 65 like it's the expiration date on a carton of milk gone bad.
As deeply ingrained as it is, this imagery is changing fast. It's changing because the baby boomers don't buy into the myth. And, it's changing because it simply isn't true, if it ever was.
I remember getting my first view of aging over a decade ago on my 50th birthday. I didn't think it was any big deal, but everyone tried hard to convince me that it was. I got the humorous birthday cards reminding me I was getting "old." I got the gag gifts, the black balloons, the condolences from friends telling me that I was now officially "over the hill." And, yes, I also received the letter inviting me to join AARP.
But, I also remember thinking, "They've got this all wrong. I'm not getting old-I'm just getting started… I never dreamed that ten years later, I would be the one sending out the letters inviting people to join AARP. But here I am-proud to be here with you and with committed professionals everywhere who have a vision for older America.
We want people's first view of aging to be something different from black balloons and "over the hill" birthday cards. And I want people to view their invitation to join AARP as an opportunity to be part of something exciting, a chance to connect with other people who want to make a difference.
Aging today is about being secure, independent, and healthy so that we can continue to contribute to society. We may look for milestones or landmarks in our lives-driving at 16, voting at 18, joining AARP at 50, and so on. If I had been speaking some years ago, I could have added "retirement at 65" to this list. But that is no longer the rule-or the law. In other words, our milestones are approximations-and changeable.
When I became AARP's CEO last June, I set out three goals for our organization:
- To be a leading force for positive social change in this country
- To deliver on our promise to our members to help them make their own choices, reach their goals and dreams and make the most of life after 50
- And, to be a world leader in global aging.
As we pursue these goals, we're paying close attention to the boomers because they are the largest American generation and also the most influential. As they age, we can count on them to be as demanding and innovative as they have been all their lives.
They have set the tone and determined the mood of this country for a long time-and they're not about to stop now. Their contributions and their needs will continue to affect the outlook and the well-being of America. As Peter Drucker has noted, "The youth market is over."
This is where it gets really interesting. We all have needs and we all have contributions to make-no matter our ages. We are all working against the notion that older people are a burden, that an aging nation is a misfortune-and that age consumes and produces nothing. We all know this is nonsense, but it's dangerous nonsense. Older people are not on the margins. As statistics indicate, people over 50 represent the mainstream.
We need to help keep that stream flowing freely. Older people are a vital part of our nation, and we want them to be able to contribute even more. Age does not turn people into net consumers of financial and social capital. It is our business to help older men and women to be secure, independent, healthy, and yes, productive. Some ways to accomplish this require education, others require advocacy-and all require careful thought and planning. And above all, they require the best efforts of all of us. No organization-AARP included-can do this alone. So, I am here today to share some of our ideas…and to welcome yours.
First, everyone should have security in age and retirement. For many years, it was routine to talk about "the three-legged stool" of Social Security, pensions, and savings. In today's world, that has become an incomplete way of looking at security. Today, we need four pillars:
- Social Security. This has not changed. Most people cannot put together a viable retirement without Social Security. The Trustees report released last week indicates that Social Security can now pay full benefits into 2041. But that's not good enough. We need to address Social Security's long-term solvency now, while we can fix the system with modest adjustments, rather than put it off until more drastic measures will be required. Because of its guarantee, Social Security will continue to be a critical source of retirement income, especially for low- and modest-income retirees.
- Continued earnings from work. Many older people are
continuing to work-and will continue. Our research indicates that
about 80 percent of baby boomers expect to keep working into
their so-called retirement. Some will work because they want to.
They will look at retirement as a time to try something new, not
a time to put down their tools and put up their feet. Many others
will continue to work because they will have to.
Pensions and personal savings combined. Putting these together stresses the personal responsibility people must accept and act on to help assure their own security. A pension plan from an employer is not enough, especially since the rise of defined contribution plans and the decline of defined benefit plans have shifted risk from the employer to the employee.
Saving and investing on our own is important. The self-employed have to be their own employers and look seriously at Keoghs, Roths, and SEPs as an obligation they have to themselves, not as a luxury. And workers whose jobs do not provide any sort of pension plan - which account for almost half the workers in this country - make the case for pension reform. And, the recent escapades of Enron and Arthur Andersen make pension protections a must. - Health insurance. This has usually been thought of as a separate issue, but it is critical to building a secure retirement. How do you build up your own savings if you have little or no health insurance? If a serious illness can wipe out any savings you have? And how can you afford to stay healthy and provide for yourself if health care is beyond your means?
This leads to another important and closely related issue: prescription-drug coverage in Medicare. Many health plans and HMOs offer a drug or pharmacy benefit. Medicare does not. This isn't a question of age or even wealth. It is a question of how many pills you need to take. Medical technology has enabled us to live longer-but often with chronic conditions or disabilities. Drugs can manage these conditions, and reduce costly hospitalizations and surgeries. If your health requires 18 prescriptions a year-the average for Medicare beneficiaries-then you have to have deep pockets. And you won't be alone, because 80 percent of retirees use a prescription medication every day.
The absence of a benefit in Medicare threatens both the security and the health-really, the entire well-being-of millions of Americans.
- That is why voluntary, affordable, accessible prescription-drug coverage within Medicare is AARP's top legislative priority.
Another crucial medical issue affecting retirees and younger people as well is how to use drugs, both prescription and over-the-counter. If lives are to be made better by drugs, then we must know how to use them correctly. That is why we are initiating a new campaign on the Wise Use of Medications to inform and educate our 35 million members. We will communicate that:
- If generics are available, there is every reason to take them as long as your physician agrees.
- If a drug is not necessary, there is no reason to take it or to badger a physician for a prescription. Over-utilization can be physically harmful, can compromise the effectiveness of needed drugs, and wastes money. And avoid overkill. Take Tums or Maalox for heart-burn, and save the expensive Prilosec for reflux disease.
- Under-utilization is just as bad. Many valuable antibiotics are no longer useful because people have not taken the full course of medication. The result is drug-resistant bacteria-tuberculosis is the most frightening example today.
Our goal is for medications to do people good, not harm, and at the same time help to lower the cost of prescription drugs. But we also want to make the point that our own health and well-being are in our hands just as much as they are in our doctors'. There are things we can accomplish only through legislation-like the prescription-drug benefit. But helping people take responsibility for themselves is where well-being begins.
We are all familiar with the phrase "a healthy mind in a healthy body." The entire statement is, "Pray that you might have a healthy mind in a healthy body." Prayer is fine, but getting regular check-ups also helps. So does proper use of medication, giving up smoking and drinking only in moderation. Staying engaged with people and life around you helps and so does a sound diet.
In 1991, 22 percent of Americans were obese. By this year, the percentage had increased to 30 percent, and the projections for 2025 are 42 percent. That is scary. Being seriously overweight is a precursor to many dangerous conditions and diseases-diabetes, heart attack, stroke, liver failure, and bone damage being just a few.
Next month we are going to release AARP's second Beyond Fifty report. The first one focused on economic security; this one will focus on health and well-being. One of the key findings we will report is that obesity threatens to undermine many of the health gains we have made in the past 20 years.
Lack of fitness, apart from contributing to being overweight, brings on its own problems, including a slowed metabolism, depression, brittleness of bones, and poor circulation. A recent study reported in the New England Journal of Medicine found that poor physical fitness is a better predictor of death than any other risk factor, including smoking, high blood pressure and heart disease. Being a couch potato is not funny-or fun. So we are telling our members to get off their… couches.
We will provide constant reminders-through all the channels of communication we have at our disposal-that exercise and fitness matter. And let's not underestimate the value of message reinforcement. In 1964, the Surgeon General warned about the dangers of smoking and we began seeing warning messages everywhere. People didn't all throw away their Camels and their Marlboros the next day, but more and more have-or never started smoking at all. Adult smoking is down by over 50 percent in those years. In the same way, education about fitness may be painstaking-but it's worth taking the pains to avoid the worse pain of an unhealthy body.
So we are getting our message out-including telling people what they can do to exercise-through grassroots activities, our publications, state activities, community service, new products and services to help with fitness, and through partnerships with others. And we are looking for more organizational partners.
We already have some wonderful allies in our efforts to improve fitness among older men and women. With a grant from the Robert Wood Johnson Foundation we are launching pilot fitness programs next month in Richmond, Virginia, and Madison, Wisconsin. Interventions in these two cities will provide the experience and knowledge we need to expand this Physical Activity Initiative in the future.
And last year, in partnership with USA Triathlon, we introduced our Tri-Umph Classic Triathlon-swimming, biking, and running-in six cities. This was the first such multi-sport event for people over 50. And we didn't just tell people to sink or swim. The program begins with an optional six-to-eight week training course. These successful events have expanded our commitment to physical activity and have paved the way for more. This year, we will hold the Tri-Umph Classic in 15 cities. Fitness takes work, but the sweat equity pays off. We look forward to seeing more triathlons for adults 50+-and more 50+ adults in great shape as the years go by.
Aging is a process, not a chronology. So, we must understand the process that people go through-and the needs they have-as they strive to continue living independently, as they face the need for long-term care, and confront decisions and seek quality care at the end-of-life.
We are working with other organizations to develop ways to help people with life choices around these issues. We are developing a national, integrated program in collaboration with our partners, and we have identified the outcomes that will set the direction for this work. We anticipate a long-term, collaborative effort that will include advocacy, community service, information and education and other strategies. We see this as an important opportunity to make a real difference in people's lives and in the nation's well being.
As I said, the first part of this continuum is Independent Living. Year after year, our research tells us that most people-85 percent of them-want to continue living at home as they get older. Not with family, not with friends, not in assisted living or a nursing home if they can avoid it. For people who remain healthy and robust, living at home presents few problems. But for others, the homes they live in as they age present challenges. Fortunately, simple modifications can make a home safer and more livable. A local community service program that provides help with simple chores can make it possible for a person who is in good health, but not strong, to stay at home. We are actively promoting volunteerism for activities like these among our members and anyone else who wants to help.
In the long run, it will be easier-and cheaper-to design and build houses and apartments from the ground up that are architecturally friendly to older people. Some states are requiring accessibility features in subsidized single-family houses. Others are looking at requirements or incentives for non-subsidized housing. There are proposals for tax or fee incentives for consumers. And consumer education is important, because the public's perception is that this kind of construction will add to costs.
We need to get information from legislators, builders, advocates, and our members-and we need to share information with the same audiences. There are no one-way streets to find those ideas and solutions that prolong independence.
The same is true of mobility and transportation. Like everyone else, about three-quarters of older Americans live in suburbs or rural areas. That means getting around in cars. Older people drive less and less as time goes by. That can mean isolation and dependency on others for transportation-for the simplest things, like grocery shopping, visiting with friends, going to the doctor.
And as we look at the broader question of mobility-getting around in the environment outside the home-then we confront major questions of infrastructure and technology. The ideal would be a public domain that accommodates everyone as nearly equally and equitably as possible.
This will be difficult to achieve. Public transit is unfortunately often the beginning and end of mobility in the minds of many planners. We have no national policy on mobility. At AARP, we are looking for allies so that together we can advocate for strong policies that increase mobility for older Americans.
But what happens when people can no longer live independently, and they require long-term care? As we all know, rather than a long-term care system, we have a patchwork of public and private programs, bewildering and expensive. Private nursing homes cost on average about $55,000 a year-which also happens to be the average American household income.
Medicaid spends a third of its budget every year on nursing homes for people who cannot afford the costs themselves. Caregivers spend on average about $20,000 over the typical two-to-six year period of nursing care for their relatives.
Caregiving is not just costly to those providing the care. A Met Life-sponsored study found that informal caregiving cost U.S. employers between $11 and $29 billion a year because of lowered productivity.
Most of the burden falls on women in their middle years-who find themselves stressed, who have to take time off from work or leave work entirely, and who then hurt their own prospects for future security. Private long-term care insurance is expensive and risky. People need options. Preparing for long-term care is about security, and it takes planning.
All of this inevitably raises the issue of end-of-life care. We need to eliminate the barriers to using Medicare's hospice benefit so more people will take advantage of it. More health-care professionals need to be trained in geriatrics and trained to manage pain better as well as deliver palliative care.
And, families need to communicate with each other about their end-of-life wishes-from drawing up advanced health-care directives to burial arrangements. In today's America, end-of-life quality care is sadly lacking. We can do better. And, we will when Americans demand that we do better.
And that brings me back to where I began. We all want to be able to contribute, throughout the aging process we call life. We have come a long way in the last century, but there is still much for us to do. Not everyone has all four pillars of security. We are fighting for prescription-drug coverage in Medicare. We are promoting wise use of medication and physical activity. But there is a great deal of room for improvement. Independent living and long-term care and improving care at the end of life present us with serious challenges, but also great opportunities to make a difference.
Look at some of the progress over the last 50 years-Medicare, prohibitions against mandatory retirement because of age, medical advances in therapies and diagnostics, the founding of the National Institute on Aging, a growing awareness that health and fitness mean more than chronological age, better health for people over 50, longer life expectancies. There is a lot to feel good about because we know more and more about aging, and aging itself is getting better for us all.
Many of you, and countless others, have contributed to this progress. In the same way, we all can collaborate in the work that remains to make aging secure, healthy, independent and productive. No one can do it alone. No one ever has. There is no such thing as a monopoly on good ideas or hard work.
I am greatly encouraged about the potential that we have at AARP to work in partnerships to accomplish great things. Together, we can help future generations understand that age is just a number; and life is what you make it.
