A New Focus on Aging

Advocates for the elderly urge grant makers to do more

Retiring baby boomers will head not for Sun City, Fort Lauderdale, or other popular havens for the elderly but for places like Pittsburgh — if a new $200,000 foundation grant achieves its goal.

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Pittsburgh’s Jewish Healthcare Foundation provided the grant last month to develop the Senior Engagement Enterprise Zone for the Greater Pittsburgh Community, a comprehensive effort to provide elderly people from the region, as well as visitors, with easy access to volunteer opportunities, college courses, health-care information, museums, parks, hiking trails, and other cultural and recreational amenities.

The foundation, which is trying to secure support from other area grant makers to pay for the project, which is estimated to cost $1-million, hopes that it will not only make Pittsburgh a mecca for retired people but also demonstrate to other cities how services for elderly people can be improved.

“Our goal is to make this time of life as stimulating as it can be,” says Karen Wolk Feinstein, president of the foundation. “We want that goal to be part of the community’s civic and economic agenda. We are not writing off this population.”

Ms. Feinstein is among a small but growing number of grant makers and charity leaders who are encouraging organized philanthropy to take a much closer look at ways that it can improve health care and other aspects of life for the elderly. They fear that foundations have done too little to prepare for changes that will occur in American society now that people over 65 are the fastest-growing age group in the United States.

“Our country is organized for a much younger average-age population,” says Donna I. Regenstreif, a senior program officer at the John A. Hartford Foundation, in New York, which devotes virtually all of its grant making to improving health care for the elderly. Foundations, she says, need to “re-orient our thinking, not only to what are the needs of very frail elders, but also to what would a community look like if a quarter of the population were above age 60.”

Experts say that society in the coming decades will need to focus on issues that only a few grant makers have begun to tackle. Among them:

* Easing a shortage of medical professionals who are adequately trained to treat elderly patients.

* Improving care for the frailest elderly people, especially by providing alternatives to hospital-like nursing homes.

* Finding a way to preserve the Social Security system, which now threatens to become insolvent by 2010 — right before the huge wave of baby boomers begins to turn 65.

* Overhauling Medicare and Medicaid, which guarantee elderly and disabled patients access to acute and long-term health care, so that those federal programs take into account changes in the health-care system and the population bulge among the elderly.

* Making cities and towns more responsive to the needs of the elderly by providing them with better housing and transportation options, among other things.

Not all foundation leaders agree that the emerging needs of America’s aging population are reaching a critical point, however.

“When it comes to access to health care, the elderly have the best deal,” says Steven Schroeder, president of the Robert Wood Johnson Foundation, the nation’s largest foundation devoted to health care.

Dr. Schroeder says he is not especially concerned that aging baby boomers will lack for sufficient services beyond health care, whether financial or recreational.

“As I’ve watched the baby-boom generation, I have tremendous respect for their ability to lobby for and get services, and I don’t guess that will get any different as they age,” he says.

But, he adds, foundations must continue to work to help low-income elderly people who are in poor health. To illustrate its commitment, the Robert Wood Johnson Foundation recently became a member of Grantmakers In Aging, an organization of foundations that support issues related to the elderly.

The group is using a $56,000 grant from the Hartford Foundation to try to attract new members.

“Discussion about aging is not sexy,” says Michael Marcus, a member of Grantmakers In Aging’s Board of Directors and a senior staff associate at the Chicago Community Trust, which spends about $1-million a year on aging-related grants. “Boards are uncomfortable discussing it simply because it’s a subject that people in general don’t like to talk about.”

That situation, he adds, is beginning to change. One reason, says the 48-year-old Mr. Marcus, is the “narcissism of my generation.”

“As we begin to think about our own aging,” he says, “we will begin to focus more on these issues.”

That appears to be the case with policy makers as well. In his State of the Union speech last week, President Clinton, himself a baby boomer, repeatedly emphasized that the country must prepare for the aging population. He outlined a 15-year plan to turn over $2.7-trillion in projected budget surpluses to Social Security.

Numbers alone present a strong reason to focus on the elderly. Since 1960, the number of people in the United States over the age of 65 has doubled, to more than 33 million, and now represents nearly 13 per cent of the population. By 2030 that figure is expected to double again. By then, older Americans will account for nearly a quarter of the population.

Beyond the population bulge caused by the number of people born from 1946 to 1964, people in general are living longer, thanks to advances in medicine, improvements in nutrition, exercise options, and other healthful changes.

However, grants to charities that help the elderly have not kept pace. Just 2 per cent of all grant dollars — about $120-million — went to programs that specifically benefit the aged in 1997, according to the Foundation Center, compared with more than 15 per cent, or about $1.1-billion, that was earmarked for projects to help children and teen-agers.

Advocates for the elderly acknowledge that such figures tend to be misleading because they don’t count many programs that help old people but are not specifically designed for them, such as those that help the chronically ill or disabled.

Still, those advocates say, even if the amount awarded for projects to help the elderly were to double, it wouldn’t be enough to handle all the needs of a burgeoning elderly population.

“There is no more profound social, economic, ethical, medical, and human challenge for the next 100 years than how we meet the unprecedented reality of large numbers of older people living in our midst,” says Daniel Perry, executive director of the Alliance for Aging Research, a Washington group that promotes scientific research on aging-related issues.

Exactly how unprecedented the growth of the elderly population is — and whether it portends a crisis — is a matter of debate among experts.

A new report from the National Academy on an Aging Society concludes that the post-World War II baby boom, which produced 76 million people, was not as big as people think. Even without a boom, as many as 64 million babies would have been born from 1946 to 1964, according to the report, “Demography Is Not Destiny.”

The academy, a Washington think tank associated with the Gerontological Society of America, says that with reasonable economic growth, the percentage of federal spending on such programs as Medicare and Social Security is not likely to increase substantially. However, it also cautions that, whatever the economic picture, families and communities will still have to contend with questions about housing, transportation, and long-term care for the elderly.

Grant makers concerned about aging are divided over whether to emphasize providing direct services for the elderly or on working to change policies that affect them.

The Pew Charitable Trusts used to make numerous grants for services for the elderly, but it cut back such awards last year when it overhauled its grants program in health and human services.

Rather than support direct services, the program now makes grants to help charities educate the public and encourage discussions on health and social policies that affect many people, not just one segment of the population.

To that end, Pew is spending $12.5-million on an effort to encourage diverse groups of people — from women’s groups to minority-group organizations to policy makers — to look for ways to make sure that Social Security remains sound for the next century.

Although the project will not affect today’s elderly, it could have a big influence on future generations of retired people, says Sharon Gallagher, a Pew spokeswoman.

“When you spend large sums of money on one category, like the elderly, or children, after all is said and done there’s no real impact,” Ms. Gallagher says. “There may be an impact for a specific organization, but not for the elderly as a population.”

She adds, “We felt there was a better way of reaching all those populations through policy.”

But Brian Hofland, senior vice-president of the Retirement Research Foundation, in Chicago, disagrees. Mr. Hofland, whose foundation supports research and groups that help older people live independently, says that support for direct services is crucial.

“Policy work is important, but at the same time there are very pressing needs,” he says. “We have an ethical obligation to make sure there are good service models.”

To improve services for the elderly, many grant makers say more money needs to be poured into scientific research on a variety of fronts, from the biology of aging to the steps that people can take to increase their chances of living longer, healthier lives.

In addition, many grant makers say more needs to be done to attract doctors and other health-care professionals to careers in the field of aging, and that those professionals need to be trained better to work with elderly patients.

Of the nation’s 128 medical schools, only 14 require students to take geriatrics courses. And only 8,000 of the nation’s 700,000 physicians specialize in geriatrics.

Several foundations have started programs designed to fill the knowledge gaps. The AARP Andrus Foundation, in Washington, which distributes $1.5-million a year in aging-related grants, spends about $500,000 each year on scholarship programs to attract more members of minority groups to careers in treating the elderly and conducting research on their needs.

“Minorities are the single fastest-growing segment of the aging population,” says John Feather, executive director of the AARP Andrus Foundation. “Yet their representation in certain areas of aging research is extremely sparse.”

Since 1990, the John A. Hartford Foundation has spent more than $83-million on programs that recruit and train medical professionals in geriatrics.

Last month, the foundation started a five-year, $7.5-million program to train primary-care physicians to better treat elderly patients for depression, a chronic condition that is common among people of advanced ages.

It has also given more than $16-million to support a $36-million fellowship program aimed at attracting scientists and physicians to focus on aging.

“We’re building a cadre of leaders in medical schools that will set up programs for teaching all medical students about geriatrics,” says Mr. Perry of the Alliance for Aging Research, which administers the fellowship program with the American Federation for Aging Research.

Medical research can make a significant difference far beyond the doctor’s office, Mr. Perry says.

“The way we design assisted-living facilities, long-term living situations, and senior day care — all of these have been refreshed by what we’ve learned through research,” he says.

Some foundations have poured their resources into supporting innovative programs designed to improve services to the elderly, and to make cities and towns more inviting to them.

For many years, the Luella Hannan Memorial Foundation, in Detroit, operated an assisted-living home for the city’s elderly. But five years ago, when it became clear that plenty of low-cost housing was available for older people, the foundation converted the facility into a center, housing several non-profit organizations that provide elderly residents in downtown Detroit with a variety of services, including health education, exercise classes, a legal clinic, a computer-training program, and a job-training and placement program, among other things.

Tim Wintermute, executive director of the foundation, says finding a way to give elderly people easy access to services was a priority in Detroit, which has limited public transportation.

Many advocates for the elderly say that even larger efforts are needed to accommodate the needs of the growing number of older residents.

A few comprehensive efforts are already under way. In Bloomington, Ind., the Evergreen Institute on Elder Environments is using a $460,000 grant from the Retirement Research Foundation to work on ways to keep older residents physically and socially connected to the city by improving their access to transportation, providing them with diverse and affordable housing options, and giving them opportunities to interact with different groups of people, such as college students or young children. For example, the institute has plans to turn an abandoned Coca-Cola bottling plant into an apartment complex for older people.

One reason the bottling plant was chosen was because of its location. Its neighbors include a park, a Boys & Girls Club, a police station, a museum, and a home for abused women.

“We think the whole community benefits from having old people in its midst,” Mr. Stafford says.

Perhaps nowhere are philanthropic efforts to build comprehensive services for the elderly as ambitious as the one in Pittsburgh that is financed by the Jewish Healthcare Foundation.

The foundation, which distributes $2.5-million in age-related grants each year, decided in 1996 to broaden its focus on the elderly beyond health, largely as a result of a demographic survey that found that the elderly make up 18 per cent of the area’s population — more than five percentage points above the national average, and growing.

A central part of the foundation’s plan is a partnership with Elderhostel, a Boston non-profit group that organizes inexpensive educational travel opportunities for older people, to make Pittsburgh one of its destinations.

Among the attractions are nearly a dozen colleges and universities, and the Carnegie Institute, a collection of four museums. The foundation hopes to draw up to 12,000 visitors — from near and afar — by 2001.

“People are really looking at this as a way to make a distinction for our community,” says Nancy D. Zionts, a senior program officer at the foundation. “We are not accepting aging as a process of debilitation, a series of losses,” she says. “Aging is living.”