En español | For the past year, our country has been mired in not one deep crisis but three: a pandemic, an economic meltdown and one of the most fraught political transitions in our history. Interwoven in all three have been challenging issues of racial disparity and fairness. Dealing with all of this has dominated much of our energy, attention and, for many Americans, even our emotions.
But spring is nearly here, and we are, by and large, moving past the worst moments as a nation — which makes it a good time to take a deep breath and assess the changes that have occurred. While no one would be displeased if we could magically erase this whole pandemic experience, it's been the crucible of our lives for a year, and we have much to learn from it — and even much to gain.
AARP asked dozens of experts to go beyond the headlines and to share the deeper lessons of the past year that have had a particular impact on older Americans. More importantly, we asked them to share how we can use these learnings to make life better for us as we recover and move forward. Here is what they told us.
"The indelible image of the older person living alone and having to struggle — we need to change that. You're going to see more older people home-sharing within families and cohousing across communities to avoid future situations of tragedy."
—Marc Freedman, CEO and president of Encore.org and author of How to Live Forever: The Enduring Power of Connecting the Generations
Norman Rockwell would have needed miles of canvas to portray the American family this past year. You can imagine the titles: The Family That Zooms Together. Generations Under One Roof. Grandkids Outside My Window. The Shared Office. “Beneath the warts and complexities of all that went wrong, we rediscovered the interdependence of generations and how much we need each other,” Freedman says. Among the lessons:
Adult kids are OK. A Pew Research Center survey last summer found that 52 percent of the American population between ages 18 and 29 were living with parents, a figure unmatched since the Great Depression. From February to July 2020, 2.6 million young adults moved back with one or both parents. That's a lot of shared Netflix accounts. It's also a culture shift, says Karen Fingerman, director of the Texas Aging & Longevity Center at the University of Texas at Austin. “After the family dinners together, grandparents filling in for childcare, and the wise economic sense, it's going to be acceptable for adult family members to co-reside,” Fingerman says. “At least for a while.”
What We've Learned From the Pandemic
• Lesson 1: Family Matters
• Lesson 2: Medical Breakthroughs
• Lesson 3: Self-Care Matters
• Lesson 4: Be Financially Prepared
• Lesson 5: Age Is Just a Number
• Lesson 6: Getting Online for Good
• Lesson 7: Working Anywhere
• Lesson 8: Restoring Trust
• Lesson 9: Gathering Carefully
• Lesson 10: Isolation's Health Toll
• Lesson 11: Getting Outside
• Lesson 12: Wealth Disparities’ Toll
• Lesson 13: Preparing for the Future
• Lesson 14: Tapping Telemedicine
• Lesson 15: Cities Are Changing
Spouses and partners are critical to well-being. “The ones who've done exceptionally well are couples in long-term relationships who felt renewed intimacy and reconnection to each other,” says social psychologist Richard Slatcher, who runs the Close Relationships Laboratory at the University of Georgia.
Difficult caregiving can morph into good-for-all home-sharing. To get older Americans out of nursing homes and into a loved one's home — a priority that has gained in importance and urgency due to the pandemic — will take more than just a willing child or grandchild. New resources could help, like expanding Medicaid programs to pay family caregivers, such as an adult child, or initiatives like the Program of All-Inclusive Care for the Elderly, a Medicare-backed benefit currently helping 50,000 “community dwelling” seniors with medical services, home care and transportation.
"A positive piece this year has been the pause to reflect on how we can help people stay in their homes as they age, which is what everyone wants,” says Nancy LeaMond, AARP's chief advocacy and engagement officer. “If you're taking care of a parent, grandparent, aging partner or yourself, you see more than ever the need for community and government support, of having technology to communicate with your doctor and of getting paid leave for family caregivers. The pandemic has forced us to think about all these things, and that's very positive.”
Family may be the best medicine of all. “Now we know if you can't hug your 18-month-old granddaughter in person, you can read to her on FaceTime,” says Jane Isay, author of several books about family relationships. “You can send your adult kids snail mail. You can share your life's wisdom even from a distance. These coping skills may be the greatest gifts of COVID” — to an older generation that deeply and rightly fears isolation.
"One of the biggest lessons we've learned from COVID is that the scientific community working together can do some pretty amazing things."
—John Cooke, M.D., medical director of the RNA Therapeutics Program at Houston Methodist Hospital's DeBakey Heart and Vascular Center
In the past it's taken four to 20 years to create conventional vaccines. For the new messenger RNA (mRNA) vaccines from Pfizer-BioNTech and Moderna, it was a record-setting 11 months. The process may have changed forever the way drugs are developed.
"Breakthroughs” come after years of research. Supporting the development of the COVID-19 vaccines was more than a decade of research into mRNA vaccines, which teach human cells how to make a protein that triggers a specific immune response. The research had already overcome many challenging hurdles, such as making sure that mRNA wouldn't provoke inflammation in the body, says Lynne E. Maquat, director of the University of Rochester's Center for RNA Biology: From Genome to Therapeutics.
Vaccines may one day treat heart disease and more. In the near future, mRNA technology could lead to better flu vaccines that could be updated quickly as flu viruses mutate with the season, Maquat says, or the development of a “universal” flu shot that might be effective for several years. Drug developers are looking at vaccines for rabies, Zika virus and HIV. “I expect to see the approval of more mRNA-based vaccines in the next several years,” says mRNA researcher Norbert Pardi, a research assistant professor of medicine at the University of Pennsylvania.
"We could use mRNA for diseases and conditions that can't be treated with drugs,” Cooke explains.
It may also target our biggest killers. Future mRNA therapies could help regenerate muscle in failing hearts and target the unique genetics of individual cancers with personalized cancer vaccines. “Every case of cancer is unique, with its own genetics,” Cooke says. “Doctors will be able to sequence your tumor and use it to make a vaccine that awakens your immune system to fight it.” Such mRNA vaccines will also prepare us for future pandemics, Maquat says.
In the meantime, use the vaccines we have available. Don't skip recommended conventional vaccines now available to older adults for the flu, pneumonia, shingles and more, Pardi says. The flu vaccine alone, which 1 in 3 older adults skipped in the winter 2019 season, saves up to tens of thousands of lives a year and lowers your risk for hospitalization with the flu by 28 percent and for needing a ventilator to breathe by 46 percent.
"Not only does self-care have positive outcomes for you, but it also sets an example to younger generations as something to establish and maintain for your entire life."
—Richelle Concepcion, clinical psychologist and president of the Asian American Psychological Association
As the virus upended life last spring, America became hibernation nation. Canned, dry and instant soup sales have risen 37 percent since last April. Premium chocolate sales grew by 21 percent in the first six months of the pandemic. The athleisure market that includes sweatpants and yoga wear saw its 2020 U.S. revenue push past an estimated $105 billion.
With 7 in 10 American workers doing their jobs from home, “COVID turned the focus, for all ages, on the small, simple pleasures that soothe and give us meaning,” says Isabel Gillies, author of Cozy: The Art of Arranging Yourself in the World.
Why care about self-care? Pampering is vital to well-being — for yourself and for those around you. Activities that once felt indulgent became essential to our health and equilibrium, and that self-care mindset is likely to endure. Whether it is permission to take long bubble baths, tinkering in the backyard “she shed,” enjoying herbal tea or seeing noon come while still in your robe, “being good to yourself offers a necessary reprieve from whatever horrors threaten us from out there,” Gillies says. Being good to yourself is good for others, too. A recent European survey found that 77 percent of British respondents 75 and younger consider it important to take their health into their own hands in order not to burden the health care system.
Nostalgia TV, daytime PJs. It's OK to use comfort as a crutch. Comfort will help us ease back to life. Some companies are already hawking pajamas you can wear in public. Old-fashioned drive-ins and virtual cast reunions for shows like Taxi, Seinfeld and Happy Days will likely continue as long as the craving is there. (More than half the consumers in a 2020 survey reported finding comfort in revisiting TV and music from their childhood.) Even the iconic “Got Milk?” ads are back, after dairy sales started to show some big upticks.
So, cut yourself some slack. Learn a new skill; adopt a pet; limit your news diet; ask for help if you need it. You've lived long enough to see the value of prioritizing number one. “Not only does self-care have positive outcomes for you,” Concepcion says, “but it also sets an example to younger generations as something to establish and maintain for your entire life."
"The need to augment our retirement savings system to help people put away emergency savings is crucial."
—J. Mark Iwry, a senior fellow at the Brookings Institution and former senior adviser to the U.S. secretary of the Treasury
Before the pandemic, nearly 4 in 10 households did not have the cash on hand to cover an unexpected $400 expense, according to a Federal Reserve report. Then the economic downturn hit. By last October, 52 percent of workers were reporting reduced hours, lower pay, a layoff or other hits to their employment situation. A third had taken a loan or early withdrawal from a retirement plan, or intended to. “Alarm bells were already ringing, but many workers were caught off guard without emergency savings,” says Catherine Collinson, CEO and president of the Transamerica Institute. “The pandemic has laid bare so many weaknesses in our safety net."
Companies can help. One solution could be a workplace innovation that's just beginning to catch on: an employee-sponsored rainy-day savings account funded with payroll deductions. By creating a dedicated pot of savings, the thinking goes, workers are less likely to tap retirement accounts in an emergency. “It's much better from a behavioral standpoint to separate short-term savings from long-term savings,” Iwry says. (AARP has been working to make these accounts easier to create and use and is already offering them to its employees.)
Funding that emergency savings account with automatic payroll deductions is a key to the program's success. “Sometimes you think you don't have the money to save, but if a little is put away for you each pay period, you don't feel the pinch,” Iwry notes.
We're off to a good start. Thanks to quarantines and forced frugality, Americans’ savings rate — the average percentage of people's income left over after taxes and personal spending — skyrocketed last spring, peaking at an unprecedented 33.7 percent. On the decline since then, most recently at 13.7 percent, it's still above the single-digit rates characterizing much of the past 35 years. Where it will ultimately settle is unclear; currently, it's in league with high-saving countries Mexico and Sweden. The real model of thriftiness: China, where, according to the latest available figures, the household savings rate averaged at least 30 percent for 14 years straight.
"This isn't just about the pandemic. Your health is directly related to lifestyle — nutrition, physical activity, a healthy weight and restorative sleep."
—Jacob Mirsky, M.D., primary care physician at the Massachusetts General Hospital Revere HealthCare Center and an instructor at Harvard Medical School
Just a few months ago, researchers at Scotland's University of Glasgow asked a big question: If you're healthy, how much does older age matter for risk of death from COVID? The health records of 470,034 women and men revealed some intriguing answers.
Age accounted for a higher risk, but comorbidities (essentially, having two or more health issues simultaneously) mattered much more. Specifically, risk for a fatal infection was four times higher for healthy people 75 and older than for all participants younger than 65. But if you compared all those 75 and older — including those with chronic health conditions like high blood pressure, obesity or lung problems — that shoved the grim odds up thirteenfold.
Live healthfully, live long. More insights from the study: A healthy 75-year-old was one-third as likely to die from the coronavirus as a 65-year-old with multiple chronic health issues. The bottom line: Age affects your risk of severe illness with COVID, but you should be far more focused on avoiding chronic health conditions. “Coronavirus highlighted yet another reason it's so important to attend to health factors like poor diet and lack of exercise that cause so much preventable illness and death,” says Massachusetts General's Mirsky. “Lifestyle changes can improve your overall health, which will likely directly reduce your risk of developing severe COVID or dying of COVID."
Exercise remains critical. In May 2020 a British study of 387,109 adults in their 40s through 60s found a 38 percent higher risk for severe COVID in people who avoided physical activity. “Mobility should be considered one of the vital signs of health,” concludes exercise psychologist David Marquez, a professor in the department of kinesiology and nutrition at the University of Illinois at Chicago.
"Folks who have tried online banking will stay with it. It won't mean they won't go back to branches, but they might go back for a different purpose."
—Theodora Lau, founder of financial technology consulting firm Unconventional Ventures
Of course, the world has long been going digital. But before the pandemic, standard operating procedure for most older Americans was to buy apples at the grocery, try the shoes on first before buying, have your doctor measure your blood pressure and see that hot new movie at the theater.
Arguably the biggest long-term societal effect of the pandemic will be a grand flipping of the switch that makes the digital solution the first choice of many Americans for handling life's tasks. We still may cling to a few IRL (in real life) experiences, but it is increasingly apparent that easy-to-use modern virtual tools are the new default.
"If nothing else, COVID has shown us how resilient and adaptable humans are as a society when forced to change,” says Joseph Huang, CEO of StartX, a nonprofit that helps tech companies get off the ground. “We've been forced to learn new technologies that, in many cases, have been the only safe way to continue to live our lives and stay connected to our loved ones during the pandemic.”
The tech boom wasn't just video calls and streaming TV. Popular food delivery apps more than doubled their earnings last year. Weddings and memorial services were held over videoconferences (yes, we'll go back to in-person ones but probably with cameras and live feeds now to include remote participants). In the financial sector, PayPal reported that its fastest-growing user group was people over 50; Chase said about half of its new online users were 50-plus. In telehealth, more doctors conducted routine exams via webcam than ever before — and, in response, insurance coverage expanded for these remote appointments. “It quickly became the only way to operate at scale in today's world,” Huang says, “both for us as patients and for the doctors and nurses who treat us. Telemedicine will turn out to be a better and more effective experience in many cases, even after COVID ends."
Tech is for all. To financial technology expert Lau, the tech adoption rate by older people is no surprise. She never believed the myth that older people lack such knowledge. “There's a difference between knowing how to use something versus preferring to use it,” Lau says. “Sometimes we know how, but we prefer face-to-face interaction.” And now those preferences are shifting.
"One of the major impacts of the new working-from-home focus is that more jobs are becoming non-location-specific."
—Carol Fishman Cohen, cofounder of iRelaunch, which works with employers to create mid-career return-to-work programs for older workers
Necessity is the mother of reinvention: Forced to work remotely since the onset of the pandemic, millions of workers — and their managers — have learned they could be just as productive as they were at the office, thanks to videoconferencing, high-speed internet and other technologies. “This has opened a lot of corporate eyes,” says Steven Allen, professor of economics at North Carolina State University's Poole College of Management. Twitter, outdoor-goods retailer REI and insurer Lincoln Financial Group are a few of the companies that have announced plans to shift toward more remote work on a permanent basis.
Face-lift your Face-Time. Yes, many workers are tied to a location: We will always need nurses, police, roofers, machine operators, farmers and countless other workers to show up. But if you are among the people who are now able to work remotely, you may be able to live in a less expensive area than where your employer is based — or work right away from the home you were planning to retire to later on, Cohen says. As remote hiring takes hold, how you project yourself on-screen becomes more of a factor. “This puts more pressure on you to make sure you show up well in a virtual setting,” Cohen notes. And don't assume being comfortable with Zoom is a feather in your cap; mentioning it is akin to listing “proficient in Microsoft Word” on your résumé.
Self-employed workers have suffered during the pandemic — nearly two-thirds report being hurt financially, according to the “State of Independence in America 2020” report from MBO Partners — but remote work could fuel their comeback. Before the pandemic, notes Steve King, partner at Emergent Research, businesses with a high percentage of remote workers used a high percentage of independent contractors. “Now that companies are used to workers not being as strongly attached physically to a workplace, they'll be more amenable to hiring independent workers,” he says.
Travel less, stay longer. Tired of sitting in traffic to and from work? Can't stand flying across country for a single meeting? Ridding yourself of these hassles with an internet connection and Zoom calls may be the incentive you need to work longer. People often quit jobs because of little frustrations, Allen says. But now, he adds, “the things that wear you down may be going by the wayside."
Ageism remains a threat. Older workers — who before the coronavirus enjoyed lower unemployment rates than mid-career workers — have been hit especially hard by the pandemic. In December, 45.5 percent of unemployed workers 55 and older had been out of work for 27 weeks or more, compared with 35.1 percent of younger job seekers. Some employers, according to reports this fall, are replacing laid-off older workers with younger, lower-cost ones, instead of recalling those older employees. Psychological studies, Allen says, indicate that older workers have better communication and interpersonal skills — both of which are critical for successful remote work. But whether those strengths can offset age discrimination in the workplace is unknown.
"Truth matters, but it requires messaging and patience.”
—Historian John M. Barry, author of The Great Influenza
Even before our views perforated along lines dotted by pandemic politics, race, class and whether Bill Gates is trying to save us or track us, we were losing faith in society. In 1997, 64 percent of Americans put a “very great or good deal of trust” in the political competence of their fellow citizens; today only a third of us feel that way. A 2019 Pew survey found that the majority of Americans say most people can't be trusted. It's even tougher to trust in the future. Only 13 percent of millennials say America is the greatest country in the world, compared with 45 percent of members of the silent generation. No wonder that by June of last year, “national pride” was lower than at any point since Gallup began measuring. To trust again:
As life returns, look beyond your familiar pod. “Distrust breeds distrust, but hope isn't lost for finding common ground, especially for older people,” says Encore.org's Freedman. “Even in the era of ‘OK, boomer’ and ‘OK, millennial’ — memes that dismiss entire generations with an eye roll — divides are bridgeable with what Freedman calls “proximity and purpose.” Rebuilding trust together, across generations, under shared priorities and common humanity.” He points to pandemic efforts like Good Neighbors from the home-sharing platform Nesterly, which pairs older and younger people to provide cross-generational support, and UCLA's Generation Xchange, which connects Gen X mentors with children in grades K-3 in South Los Angeles, where educational achievement is notoriously poor. “Engaging with people for a common goal makes you trust them,” he says.
Be patient but verify facts. History also provides a guide. In the wake of the 1918 influenza pandemic that killed between 50 million and 100 million people, trust in authority withered after local and national government officials played down the disease's threats in order to maintain wartime morale. Historian Barry points out that the head of the Army's’ division of communicable diseases was so worried about the collective failure of trust that he warned that “civilization could easily disappear ... from the face of the earth.” It didn't then, and it won't now, Barry says.
Verify facts and then decide. Check reliable, balanced news sources (such as Reuters and the Associated Press) and unbiased fact-checking sites (such as PolitiFact) before clamping down on an opinion.
Perhaps most important, be open to changing conditions and viewpoints. “As we see vaccines and therapeutic drugs slowly gain widespread success in fighting this virus, I think we'll start to overcome some of our siloed ways of thinking and find relief — together as one — that this public health menace is ending,” Barry adds. “We have to put our faith in other people to get through this together.”
"Masks and sanitizers will be part of the norm for years, the way airport and transportation security measures are still in place from 9/11."
—Christopher McKnight Nichols, associate professor of history at Oregon State University and founder of the Citizenship and Crisis Initiative
The COVID-19 pandemic won't end with bells tolling or a ticker-tape parade. Instead, we'll slowly, cautiously ease back to familiar activities. For all our fears of the coronavirus, many of us can't wait to resume a public life: When 1,000 people 65 and older were asked which pursuits they were most eager to start anew post-pandemic, 78 percent said going out to dinner, 76 percent picked getting together with family and friends, 71 percent chose travel, and 30 percent cited going to the movies.
Seeing art, attending concerts, cheering in a stadium — even going to class reunions we might have once dreaded — we'll do them again. But how will we return to feeling comfortable in groups of tens, hundreds and thousands? And will these gatherings be different? How we come together:
Don't expect the same old, same old. Just as the rationing, isolation and economic crisis caused by World War I and the Spanish flu epidemic “led to a kind of awakening of how we assembled,” Nichols says, expect COVID to shake up the nature and personality of our public spaces. Back in the 1920s, it was the rise of jazz clubs, organized athletics, fraternal organizations and the golden age of the movie cinema. As the pandemic subsides, we'll probably see more temperature-controlled outdoor event and dining spaces, more pedestrian and bicycling options, more city parks and more hybrid events that give you the option to attend virtually.
Retrain your brain. Psychologists say the techniques of cognitive behavioral therapy can help people at any age regain the certainty and confidence they need to venture into the public space post-pandemic. “Visualizing good outcomes and repeating a stated goal can help overcome whatever obstacles are holding you back,” says Gabriele Oettingen, a professor of psychology at New York University, who suggests making an “if-then plan” to reacclimate to public life. If eating indoors at a restaurant is too agitating, even if you've been vaccinated, then try a table outside first. If a bucket-list family vacation to Italy feels too daunting, then book a stateside trip together first. “There's always an alternative if something stands in the way of you fulfilling your wish,” she says. “Eventually, you'll get there.”
"What we've learned from COVID is that isolation is everyone's problem. It doesn't just happen to older adults; it happens to us all."
—Julianne Holt-Lunstad, professor of psychology and neuroscience at Brigham Young University
How deadly is the condition of loneliness? During the first five months of the pandemic, nursing home lockdowns intended to safeguard older and vulnerable adults with dementia contributed to the deaths of an additional 13,200 people compared with previous years, according to a shocking Washington Post investigation published last September. “People with dementia are dying,” the article notes, “not just from the virus but from the very strategy of isolation that's supposed to protect them.”
Isolation may be the new normal. Fifty-six percent of adults age 50-plus said they felt isolated in June 2020, double the number who felt lonely in 2018, a University of Michigan poll found. Rates of psychological distress rose for all adults as the pandemic deepened — increasing sixfold for young adults and quadrupling for those ages 30 to 54, according to a Johns Hopkins University survey published in JAMA in June. And it's hard to tell whether the workplace culture many of us relied on for social support will fully return anytime soon.
Those 50-plus have a leg up. “Older adults with higher levels of empathy, compassion, decisiveness and self-reflection score lowest for loneliness,” says Dilip Jeste, M.D., director of the Sam and Rose Stein Institute for Research on Aging at the University of California, San Diego. “Research shows that many older adults have handled COVID psychologically better than younger adults. With age comes experience and wisdom. You've lived through difficult times before and survived.”
Help yourself by helping others. Jeste says that when older adults share their wisdom with younger people, everyone benefits. “Young people are reassured about the future,” he adds. “Older adults feel even more confident. They're role models. Their contributions matter."
"For older people in particular, nature provided a way to shake off the weight and hardships associated with stay-at-home orders, of social isolation and of the stress of being the most vulnerable population in the pandemic."
—Kathleen Wolf, a research social scientist in the School of Environmental and Forest Sciences at the University of Washington
One silver lining to COVID-19's dark cloud: Clouds themselves became more familiar to all of us. So did birds, trees, bees, shooting stars and window gardens. Nearly 6 in 10 Americans have a new appreciation for nature because of the pandemic, according to one survey that also found three-quarters of respondents reported a boost in their mood while spending time outside.
By nearly every measure, the planet got more love during COVID. And wouldn't it be nice if that continued going forward? The ins and outs on our new outdoor life:
Move somewhere greener (or at least move around more outside). How you access nature is up to you, but consider the options. Nearly a third of Americans were considering moving to less populated areas, according to a Harris Poll taken last year during the pandemic. Walking, running and hiking became national pastimes. One day last September, Boston's BlueBikes bike-share system saw its highest-ever single-day ridership, with 14,400 trips recorded. Stargazers and bird-watchers helped push binocular sales up 22 percent.
Once known mainly as a retirement activity, pickleball has been the fastest-growing sport in America, with almost 3.5 million U.S. players of all ages participating in the contact-free outdoor net game designed for players of any athletic ability. The return of the pandemic “victory garden” reflects research that finds 79 percent of patients feel more relaxed and calm after spending time in a garden.
Make the city less gritty. The University of Washington's Wolf thinks that our collective nature kick will go beyond a run on backyard petunias. Her research brief on the benefits of nearby nature in cities for older adults suggests we may rethink the design of neighborhood environments to facilitate older people's outdoor activities. That means more places to sit, more green spaces associated with the health status of older people, safer routes and paths, and more allotment for community gardens. “It's impossible to overestimate the value these outdoor spaces have on reducing stressful life events, improving working memory and adding meaning and happiness in older people's lives,” Wolf says.
If you can't get out, bring nature in. Even video and sounds of nature can provide health gains to those shut indoors, says Marc Berman of the University of Chicago's Environmental Neuroscience Lab. “Listening to recordings of crickets chirping or waves crashing improved how our subjects performed on cognitive tests,” he says.
Above all, the environment is in your hands, so take action to protect it. “We've seen a lot of older folks stepping up their activity in trail conservation, stream cleaning, being forest guides and things like that this year, which indicates a shift in how that age group interacts with nature,” says Cornell University gerontologist Karl Pillemer.
"There's an old saw that older people care less than younger people about the environment. But given this year's nature boom, I'm expecting that to change. As the generation that gave birth to the environmental movement enters retirement, we're likely to see a wave of interest in conservation among those 60 and up."
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"COVID-19, perhaps more than any other disaster, demonstrated that we need to continue ensuring response plans are flexible and scalable. You can't predict exactly what a disaster will bring, but if you know what tools you have in your tool kit, you can pull out the right one you need when you need it."
—Linda Mastandrea, director of the Office of Disability Integration and Coordination for the Federal Emergency Management Agency (FEMA)
The pandemic was among the toughest slap-in-the-face moments in recent history to remind us that everything — everything — in our lives can change in a moment. While older Americans may have a deep-seated desire for stability and security after all it took to get to an advanced age, we certainly cannot bank on it. Which is why the word of the year, and perhaps the coming century, is “resilience.” Not just at the individual level but at every social tier, from family to community to the nation as a whole.
Banish fear. “We don't have to live in fear” of some looming disaster, says former director of the Centers for Disease Control and Prevention Tom Frieden, now president and CEO of global public health initiative Resolve to Save Lives. “By strengthening our defenses and investing in preparedness, we can live easier knowing that communities have what they need to better respond in moments of crisis."
Preparation must start at the top. For government, that means a new commitment to plans that allow, not so much for stockpiles but for the ability to ramp up production of crucial equipment when needed. “We need increased, sustained, predictable base funding for public health security defense programs that prevent, detect and respond to outbreaks such as COVID-19 or pandemic influenza,” Frieden says.
Being creative and even entrepreneurial helps, says Jeff Schlegelmilch, director of the National Center for Disaster Preparedness at Columbia University's Earth Institute. Warehouses full of masks could have helped us initially, he says, but stockpiles of equipment aren't the answer on their own. In a free market there is pressure to sell off surpluses, so he suggests we reimagine our manufacturing capacities for times of emergency. When whiskey distillers stepped up to make hand sanitizer, and auto manufacturers switched gears to build ventilators, we saw “glimmers of solutions,” Schlegelmilch says, the sort of responses we may need to tee up in the future.
Focus on health care. Prime among the areas that need to be addressed, crisis management consultant Luiz Hargreaves says, are overwhelmed health care systems. “They were living a disaster before the pandemic. When the pandemic came, it was a catastrophe.” But Hargreaves hopes we will use this wake-up call to produce new solutions, rather than to return to old ways. “Extraordinary times,” he says, “call for extraordinary measures."
"It's outrageous that somebody could work full-time and not even be able to pay rent, let alone food and clothing. There's a recognition that there's a problem on both the left and right."
—Joseph Stiglitz, Nobel Prize–winning economist, Columbia University professor and author of The Price of Inequality
"The data is pretty dramatic,” says Stiglitz, one of America's most-esteemed economists. Government economists estimate that unemployment rates in this pandemic are less than 5 percent for the highest earners but as high as 20 percent for the lowest-paid ones. “People at the bottom have disproportionately experienced the disease, and those at the bottom have lost jobs in enormous disproportion, too."
As white-collar professionals work from home and stay socially distant, frontline workers in government, transportation and health care — as well as retail, dining and other service sectors — face far greater health risks and unemployment. “We try to minimize interactions as we try to protect ourselves,” he says, “yet we realize that minimizing those interactions is also taking away jobs.” The disparate effects of the pandemic are particularly evident along racial lines, points out Jean Accius, AARP senior vice president for global thought leadership. “Job losses have hit communities of color disproportionately,” he says. And there's a health gap, too, with people of color — who have a greater likelihood than white Americans to be frontline workers — experiencing higher rates of COVID-19 infection, hospitalizations and mortality, and lower rates of vaccinations. “What we're seeing is a double whammy for communities of color,” Accius says. “It is hitting them in their wallets. And it's hitting them with regard to their health."
Those economic and health crises, along with protests over racial injustice over the past year, says Accius, “have really sparked major conversations around what do we need to do in order to advance equity in this country."
A rising gap between rich and poor in any society, Stiglitz argues, increases economic instability, reduces opportunities and results in less investment in public goods such as education and public transportation. But the country appears primed to make some changes that could help narrow the wealth gap, he says. Among them are President Biden's proposals to raise the federal minimum wage to $15 an hour, increase the earned income tax credit for low-income workers and provide paid sick leave. Stiglitz also proposes raising taxes on gains from sales of stocks and other securities not held in retirement accounts. “The notion that people who work for a living shouldn't pay higher taxes than those who speculate for a living seems not to be a hard idea to get across,” Stiglitz says.
"Many people continue to say, ‘It's time for us to get back to normal,'” Accius says. “Well, going back to normal means that we're in a society where those that have the least continue to be impacted the most — a society where older adults are marginalized and communities of color are devalued. We have to be honest with what we are going through as a collective nation. And then we have to be bold and courageous, to really build a society where race and other social demographic factors do not determine your ability to live a longer, healthier and more productive life.”
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Top 10% Richest Americans
For Some, Hard Times Bring Opportunity
Want a positive reminder of the American way? When the going got tough this past summer, many people responded by planning a new business. In the second half of 2020, there was a 40 percent jump over the prior year's figures in applications to form businesses highly likely to hire employees, according to the U.S. Census Bureau. Significantly, no such spike occurred during the Great Recession, points out Alexander Bartik, assistant professor of economics at the University of Illinois at Urbana-Champaign. “That's cause for some optimism — that there are people who are trying to start new things,” he says. One possible reason this time is different: Unlike during that recession, the stock market and home values have held on, and those sources of personal wealth are often what people draw upon to fund small-business start-ups.
"The processes we developed to avoid face-to-face care have transformed the way we approach diabetes care management.”
—John P. Martin, M.D., codirector of Diabetes Complete Care for Kaiser Permanente Southern California
If there was ever any truth to the stereotype of the older person whose life revolved around a constant calendar of in-person doctor appointments, it's certainly been tossed out the window this past year due to the strains of the pandemic on our health care system. The timing was fortuitous in one way: Telemedicine was ready for prime time and has proved to be a godsend, particularly for those with chronic health conditions.
Say goodbye to routine doctor visits. Patients who sign up for remote blood sugar monitoring at Kaiser Permanente in Southern California use Bluetooth-enabled meters to transmit results via a smartphone app directly to their health records. “Remote monitoring allows us to recognize early when there should be adjustments to treatment,” Martin says.
We need to push for more access. The pandemic underlines the need for more home-based medical help with chronic conditions. But that takes both willingness and a lot of gear, such as Bluetooth-enabled blood pressure monitors and, on the doctor side, systems to store and analyze the data. “People need access to the equipment, and health care systems have to be ready to handle all that data,” says Mirsky of Massachusetts General Hospital.
Group doctor visits may be a way forward. Mirsky is conducting virtual group visits and remote monitoring of blood sugar for his patients with type 2 diabetes. “Instead of having a few minutes with each person to talk about important issues — like blood sugar testing, diet and exercise — we get an hour or more to go over it,” he says. “At every meeting somebody in the group has a great tip I've never heard of, like a new YouTube exercise channel or fitness app. There's group support, too. I see group visits like this continuing into the future, becoming part of routine chronic disease care for all patients who want it."
Bottom line: The doctor is in (your house). Managing chronic health conditions like diabetes “can't just be about getting in your car and driving to your doctor's office,” Martin says. Taking care of your health conditions yourself is the path forward.
"This is obviously a very big watershed moment in how we live, how we organize our cities and our communities. There are going to be long-lasting changes."
—Chris Jones, chief planner at Regional Plan Association, a New York–based urban planning organization
"When you're alone and life is making you lonely, you can always go downtown,” Petula Clark sang in her 1964 chart-topping ode to city life. Well, things change. Suddenly, crowds are the enemy, public buses and subways a health risk, packed office towers out of favor, and a roomy suburban home seems just where you want to be. But don't write off downtowns just yet.
The office and business district will look different. Many workers have little interest in returning to a 9-to-5 life. For those who do make the commute, they may find cubicles replaced with more flexible work spaces focused on common areas, with ample outdoor seating space for meetings and working lunches. And some now-empty offices will likely be converted into apartments and condos, making downtowns more vibrant. “Now you have an opportunity to remake a central business district into an actual neighborhood,” says Richard Florida, author of The Rise of the Creative Class and a cofounder of CityLab, an online publication about urbanism.
Public spaces will serve more of the public. Those areas set up for outdoor restaurant dining — some of those will likely remain. Streets and parking lots have been turned into plazas and promenades. Many cities have already opened miles of bike lanes; in 2020, Americans bought bikes, including electric bikes, in record numbers. “This idea of social space, where you can get outside and enjoy that active public realm, is going to become increasingly important,” says Lynn Richards, the president and CEO of Congress for the New Urbanism, which champions walkable cities.
Contributors to this report: Sari Harrar, David Hochman, Ronda Kaysen, Lexi Pandell, Jessica Ravitz and Ellen Stark