Jason Maciejewski (00:00):
Welcome to Inside The Senior Alliance, a podcast exploring resources and issues in the field of aging. I’m Jason Maciejewski, CEO at The Senior Alliance, the Area Agency on Aging, serving Western Wayne and the downriver area. Today we’re continuing our conversation with Sandy Markwood, CEO of USAging. Sandy’s been the CEO at USAging since 2002. Prior to that, she worked at the National Association of Counties, the League of Cities, and is a graduate of the University of Virginia. She holds a bachelor’s degree in history and a master’s degree in urban environmental policy. With The Senior Alliance, we’ve seen a consistent need for transportation services, which was also identified in a variety of input sessions that we’ve had on public hearings, and we hear it from program participants. At The Senior Alliance we have five transit vehicles we use for non-emergency medical appointments. It’s a small program, but it does have a bit of an impact. What do you see in terms of transportation issues across the nation?
Sandy Markwood (00:54):
Well, Jason, just like housing, transportation is a major issue that we’ve heard from our members and again, from older adults themselves. We, as, I mentioned earlier, we operate the Elder Care Locator, which is a national call center that older adults and caregivers call into looking for aging services. Transportation has consistently been one of the top three issues, if not the top issue that older adults and caregivers are calling about. Because if you don’t have transportation, it is difficult to age at home and in your community. It is difficult to be a part of your community if you can’t have transportation to successfully navigate it. And so this is a huge issue for communities as we face those challenges along with the older adults, because transportation is a complex need, as you know, because you operate those vans. And looking at that is, you know, recognizing what we need to do to help people as they either cut back on driving because of site limitations or just fears.
Sandy Markwood (02:02):
And often people don’t just stop driving. They either stop driving at night, they stop driving on the freeway, and then they get to the point where they either give up the keys or they are persuaded to give up the keys because driving is no longer safe for them. But what happens then? How do they get to the doctor? How do they get to the grocery store? How do they not become socially isolated because they can’t get to church or a synagogue or their local club? So in looking at transportation, it is so multifaceted. It’s what types of public transportation exist. And in rural and suburban communities, that is a huge challenge. But even in urban areas, it’s a challenge and how you make those connectors between urban areas, suburban areas, and then rural areas. Having the opportunity to have vans like the Area Agency on Aging have to get people to critical places that they need to go is one opportunity.
Sandy Markwood (03:02):
Also, volunteer driving programs, you know, area agencies rely so heavily on volunteers, and I’m so pleased to hear that after Covid that the volunteers are coming back into play providing these critical services. But volunteer driving programs are critical, ensuring that in the public transmit realm, that buses are accessible to people, older adults, and people with disabilities. And that drivers are trained to be able to have a sensitivity to the specific needs of older adults and people with disabilities. There’s a whole range of opportunity out there in this space. We are so pleased at USAging to operate along with Easterseals, the National Aging and Disability Transportation Center, that is not only researching these areas, but also providing seed grants to seed innovation in aging and disability transportation.
Jason Maciejewski (03:58):
Transportation is one of those top three issues that we hear about at The Senior Alliance, and I think we’ve hit on the other two being housing and in-home services community-based services. So these are all really big topics that we deal with in the Aging network. And the way that people really encounter us to begin talking about these issues and how they’re impacting their life or what they may need assistance or resources for is through our information and assistance lane, really the gateway to our agency. AAAs offer information assistance, some places that’s called information and referral is a way to connect with us that kind of front door. But it’s also a way for people as caregivers to connect with our resources. We’re seeing more people caring for friends and family as they age now. And when you think about caregiving, what do you see as the upcoming challenges in the years ahead? Whether it’s a family member or even a friend of the family who’s providing care for an older adult?
Sandy Markwood (04:55):
You know, the caregiving issue, Jason has really come to the forefront. It certainly has for policymakers, and we’re really hoping that we get more legislative action and more national investment in caregiving. In 22, we had the introduction of the national strategy for family caregivers. The first time in this nation, we had a national strategy to really address the heroic deeds that caregivers do in this country. So in looking at that, the fact that this has come to the forefront of both policymakers and the public psyche is we really need to address these issues across the board and you raised so many of them. When you’re looking at caregivers in this country, is also recognizing that because of the demographics and changing family dynamics, in some ways we’re going to have fewer family caregivers than we’ve had before. So how does that play out? And it’s more and more critical if there are fewer family caregivers to be able to provide the support to those family caregivers to be able to do the heroic work that they do.
Sandy Markwood (05:58):
And what we know from family caregivers, it’s a balancing act between balancing work and balancing family responsibilities and being able to ensure that there is flexible work schedules, paid leave for family caregivers, as well as there’s a number of pieces of legislation looking at tax deductions for family caregivers, recognizing the financial contributions that they make in their caregiving role, but also recognizing the importance of giving family caregivers a break, which is really respite care. And what we know from studies is by getting family caregivers involved in programs offered by the National Family Caregiver Support Program, which is a part of the Older Americans Act, by providing them with support groups and information and respite services, what we know is that family caregivers report that they can care better and care longer for their loved ones. So we need to invest more in that. Also, we need to invest more in paid caregivers.
Sandy Markwood (07:05):
And I talked earlier about the workforce challenge that we saw in the AAA survey related to AAA staff that provide in-home services. Well, this is across the board, not only in area agencies on aging in nursing homes, assisted living, but also in private home care, that there is a huge lack of direct care workers to be able to meet the needs of older adults and supplement the important work that family caregivers do. So that’s a challenge. And we really need to, again, invest in the paid workforce in that regard. And as we look at this, it’s really looking at a whole range of solutions and programming and USAging is so pleased that to have received a grant. And we have lots of different partners involved in that grant that is looking at how to develop innovative services and supports to meet the needs of family caregivers now and in the future. We just started that effort and we will be building on that with a range of partners looking at caregiving across the lifespan. And so more to come on that, Jason, but we are very excited about that administration for community living because of the national strategy on family caregiving is really investing in a supporting range of activities to really hold up caregivers in this country. And we’re pleased to be a part of that.
Jason Maciejewski (08:30):
That national strategy is really important, comes at a really critical time as we saw during the pandemic and coming out of the pandemic. The issues around caregiving are even more heightened, much more aware of them, I think, than maybe we were four or five years ago. And at The Senior Alliance, you know, we’re paying a lot more attention to combating isolation and caregiver resources. We really reassessed many of our programs and services to try and be flexible for the needs that exist in our community. Things like hybrid workforce. We’re trying to grow our online presence to make sure that our information is more accessible to people aside from just calling into us, but online as well. Trying to use technology in that way, trying to engage people socially through outreach events. We’ve continued many of those innovations which were started during the Covid pandemic, but what are some of the innovation trends that you’re seeing across the Aging Network? Maybe not specific to caregiving, but other areas as well.
Sandy Markwood (09:25):
Well, I think, you know, as you said, Jason, that as a result of the pandemic and the flexibility that the Aging Network was granted to be able to meet those immediate emergency needs and through the regulations that were just released by the ACL, by the Administration for Community Living, they recognize the value of a lot of those flexibilities and have put those in place. So as we move forward, things like grab and go meals, which were introduced during the pandemic to meet the nutrition needs of older adults in new and different ways, those are now allowable as part of the Older Americans Act. So it’s looking at meal delivery in different ways, which is a critical piece of the Older Americans Act. It’s looking at, as you mentioned, opportunities to do hybrid, both in person and also virtual types of training sessions, whether they be evidence-based programming or social engagement programming.
Sandy Markwood (10:28):
Also programming and engaging volunteers who may be home bound in a virtual way to be able to meet their social engagement needs, but also to give back to others. So I think that as we look at the lessons that were learned during Covid, it’s really meeting people’s needs where they are now. Again, not looking at the confines of a program, but looking at the needs of individuals and being able to adapt programming to meet those needs. I think technology will continue to play a major role in the delivery of aging services as we move forward. I think from our perspective, we’re ensuring that we keep in the forefront that balance between what technology can do and do well. But also what has always been the sweet spot of the Aging Network is being able to do that one-on-one in-person connection point with older adults.
Sandy Markwood (11:28):
And just to give an example, when you go in and you deliver a home delivered meal and you go into the house and you see that there may be hoarding issues or there may be in-home safety issues, or you put the meal in the refrigerator and you see that there is a problem because there is expired food in there, opportunities for the Aging Network to intercede on a broader front. But if we were just using technology, we might not have that whole person vision of their needs. So it’s a balancing act between technology and in-person as we move forward. But I, again, I think the one thing that I am so excited about is the range of innovations that I’m seeing in the Aging Network, from meal to delivery, social isolation, looking at how to address the needs of homeless individuals by partnering with the continuum of care workers that are working in the homeless arena. Looking across the board, it’s just really opened up a new way of looking at service delivery, new partnerships. And I really think that that will spur what I think is the next frontier of aging services and supports in this country.
Jason Maciejewski (12:42):
So I agree that the balance between technology and in-home services is really important to keep in mind, just can’t rely on technology to do everything. It’s those eyes and ears that we provide as an Aging Network. It’s as area agencies on aging in the home that are really critical piece of the work that we do and the services that people can access. I’m personally fascinated with the advancements that we’re seeing in aging services and especially medical technologies that are seemingly on the horizon. Things like swallowable diagnostics and all kinds of different medical things that are coming to the forefront and really interested in how we as an Aging Network can play a role in that as experts in the home and community environment. But when you think of 10 to 20 years down the road and you think of how older adults and caregivers are going to be accessing services, how do you think that’s going to change? What are some of the things that you’re looking forward to seeing in the future?
Sandy Markwood (13:37):
Well, I think, you know, in my years and Jason and it’s been a while that I’ve been so privileged to work with USAging is what I have seen is a huge growth in the breadth of services and supports that the Aging Network is providing. And we talked about housing, we talked about transportation, we’re now talking about homelessness, we’re talking about the growing area that the Aging Network is working in, in partnership with healthcare. We now have 47%, almost half of area agencies on aging are contracting with healthcare to provide the social care that research has now shown is critical to improving people’s health. So as I look for the next five years, I see more of a role for the Aging Network in healthcare. I think that as we look at moving forward, that really, I look at area agencies on aging and the staff there is almost social clinicians being able to really ensure that people’s social determinants of health are met as part of their healthcare needs.
Sandy Markwood (14:49):
So I think there’ll be real advances there and a real integration of medical care and social care as we look at, especially in the aging arena. I also think that there is more of a realization and also there is a generational preferences now for older adults to be able to remain living at home and in the community even more so than in the past. And so how is the community going respond? And I think the growth in what we’re seeing of these multi-sector plans, state plans on aging that are looking across aging and healthcare, but looking at transportation and housing and taxation and land use, planning, all of those things that quite honestly in the Aging Network, we realized were important issues are now being looked at at a much higher level. And I think that that will result in a broader and more amplified role for the Aging Network moving forward because the aging network is going to have to be critical and pivotal in the implementation of any of those plans.
Sandy Markwood (15:56):
So I just see as we look to the future, that the Aging Network will have a greater role as we look at how to ensure, again, going back to the mission of USAging, of optimal health, dignity, wellbeing, independence, what does that mean? What does that mean for older adults? And we’re looking at older adults, we’re looking at multiple generations of older adults, not just one group of older adults. We’re looking at multiple generations. We’re looking at older adults with dementia. And you mentioned about medical progress, been a lot of medical progress and hope in that arena, but most people who are living with dementia are living at home and in the community. 80%. How are we going to meet their needs? How are we going to meet the needs of the growing population of people with disabilities who are now aging in the community? All of these things, I don’t see them as challenges, I just see them as opportunities for us in the future to build an Aging Network that truly meets everybody’s needs as they age. I’m excited about that.
Jason Maciejewski (17:00):
I am too, and I join you in viewing this as opportunity. I think that we can really partner with other organizations and healthcare and really make some improvements in terms of how people are able to age and what they’re able to do and accomplish over time. I really think it’s an opportunity for us and I was hoping that you could share with us one of the stories that you might have about someone you were involved with during your time in the field of aging and how has your work maybe impacted someone?
Sandy Markwood (17:29):
Well, Jason, I have a bunch of stories, but I I’m going to share with you one that’s both close to me personally and professionally. My mother had vascular dementia and as an aging professional with access to all the area agencies on aging in the country, getting my mom’s services was not the difficult part as her disease progressed. It was taking my mom out in the community. So we had the opportunity at USAging to become part of a program that was launched in 2005 called Dementia Friending America, and then subsequently Dementia Friends, USA, which was really targeted to be able to ensure that people living with dementia and their care partners were welcomed into the community and got the services and supports that they needed to be able to live well as they went through the journey of their disease. And so I am so excited that because of my own experience where, quite honestly with my mother, not because anybody was a bad person by any means, but when I would take my mom out into the community with, at that point my younger children and I needed help or support, people would walk away from me instead of walking towards me to offer me any level of support.
Sandy Markwood (18:47):
Not because again, they were bad people, but because they didn’t understand, they were so worried about misstepping, they just didn’t understand dementia. So what I am so excited about is that now we have 400 communities and growing across the country who are part of Dementia Friendly America, and we have over 15,000 dementia friends across the country, people, individuals who are taking these, you know, these video courses to find out what it means to have dementia and how you can help somebody who is in my position. So I am really excited about that. There in my hometown, there is a dementia friendly community. And what I’ve heard from people who other neighbors and other community leaders saying to me is now I feel like I’m seen for who I am not for my disease. I see people responding to me as a person rather than responding to my disease.
Sandy Markwood (19:45):
That I have to say, Jason, just fills my heart from my own personal experience and professional experience. So the work going on across the country through USAging in our partners in that arena, I think is key. But it’s also, you know, looking at people who, and working in aging, you get these calls too, who, you know from friends neighbors saying, you know, mom’s really failing. I think I need to look at a nursing home. And you kind of ask them the question, well, tell me about mom’s needs. Well, I’m leaving work every day to be able to bring her lunch or I can’t get her to her doctor’s appointments. She seems lonely. And then you recognize, well, if she had home delivered meals and if we could arrange transportation to the doctor and if we had a friendly visitor calling her a couple of times during the week, do you think she’d be okay? And they say yes. And as those programs got put in place, the caregiver stress went away. But most importantly, mom felt good living at home. People who are now being able to work with area agencies to navigate Medicare enrollment caregivers, participating in support groups and getting respite. All of these stories that I am so privileged to hear from across the country just reinforced to me the importance of the work that area agencies on aging are doing, the important work that The Senior Alliance is doing and the difference it’s making in people’s lives.
Jason Maciejewski (21:12):
Sandy, thank you for sharing that story, a very personal story and highlighting that. I too get those calls from friends and even family members who are trying to figure out solutions and ways to address issues that people we care and love are dealing with. So thank you for highlighting that and sharing it. I also want to thank you for taking the time to join me today on this episode. I greatly appreciate your knowledge and insight and leadership for us at USAging.
Sandy Markwood (21:37):
Well, Jason, I just appreciate being asked and for everyone that’s listening, I just really hope that you both contact and support The Senior Alliance, your Area Agency on Aging. It’s just an important hub at the community level to ensure that older adults can age well at home and in the community.
Jason Maciejewski (21:55):
Thank you, Sandy. I appreciate it. And if anyone has questions about services or programs The Senior Alliance offers, you can call us at (734) 722-2830 or email us at info@thesenioralliance.org. Information about our agency or the programs and services we offer can be found on our website at thesenioralliance.org. On Facebook, we can be located by searching for The Senior Alliance. And finally, our X, formerly known as Twitter handle, is @AAA1C. I’m Jason Maciejewski. Thank you for listening to this episode of Inside The Senior Alliance.
Speaker 3 (22:29):
Inside The Senior Alliance is a production of the Senior Alliance and Blazing Kiss Media.