There are some things that are universal about the aging process. Your body changes, and your cognitive abilities change too. Your vision might dim, your hearing might grow less acute. You become less independent than you were when you were younger, and you resent that fact, just as you did when you were a toddler.
How you experience that aging process, though, depends greatly on where you are — on the cultural assumptions that surround you and on the resources that are available to you.
Carol Silver Elliott is the president and CEO of the Jewish Home Family, the organization that oversees the Jewish Home at Rockleigh, Jewish Home Assisted Living, Jewish Home at Home, and the Jewish Home Foundation.
She is also about to become board chair of LeadingAge, the national organization that brings together nonprofit groups that work with the elderly, and advocate for that huge and quickly growing demographic category.
In that capacity, Ms. Elliott went to Shanghai two weeks ago, on a whirlwind trip that demanded more hours in the air or in airports than actually on the ground in China, to talk about how this country, at its best, provides services to the elderly.
She was representing the United States at a healthcare forum in China, Ms. Elliott said. She was joined by a Canadian there to talk about healthcare in his country. The two of them were the only English-speakers. The audience, about 150 strong, was “a mix of entrepreneurs looking for ways to find businesses working with a huge aging population, and government officials trying to figure out how to manage a significant increase in aging people in a country that has no significant infrastructure for it.”
It was in some ways an odd mix of people, she added. “This was a group of people where some of them were dealing with aging from a government perspective, and the others were trying to figure out how to make money out of it. It was hard to see what the broader perspective or values are.”
It is far better to grow old here, in North America, than there, in China, Ms. Elliott said. A century ago, she was told, life expectancy in China was in the mid-30s. That is a terrible thing, but it meant that few people had to worry about how to care for the elderly among them. There weren’t very many.
Now, “life expectancy has dramatically increased.” But “China is unprepared for managing an aging population,” she said; that lack of preparation is exacerbated by the one-child policy the country maintained from 1979 to 2015. That policy was established to keep the population from reaching nightmare levels, but it created unforeseen nightmares. One of the many bad outcomes is that a nation full of only children means that those children have to rely only on themselves, without the help of nonexistent siblings, in caring for aging parents.
In an odd way, Ms. Elliott probably experienced a bit of what it feels like to age. “People were very lovely,” she said. “They couldn’t have been nicer. But you feel very different when you can’t understand anything going on around you.”
It was an odd feeling, she said. “We are sitting on big chairs on stage, and people ask questions in Chinese, and you sit there and wait for the interpreter, and they just look at you.”
When she did hear the questions, though, she was struck, again and again, by “how unprepared China is for managing its aging population.”
The statistics are not encouraging.
“By 2040, China will have more people with dementia than there are elders in the world today,” she said, defining elders as people 65 and older. “By 2050, there will be 450 million elders in China.
“Fewer than 20 percent of people own their own homes in China,” she said; that makes the question of either housing or funding their care harder. In the United States, “for a lot of our elders, the money they have in their homes, which they own, is what they use to help fund their retirements. In China, you have people who don’t have any assets.”
So where do elderly people go? “As I understand it, the frail elderly end up in a hospital setting,” she said. “There is no place else for them to go. There is nothing else. But hospitals there are not like hospitals here. They are like old-fashioned wards.” And they don’t feed their residents. “There is the expectation that families will bring in food and other supplies.”
Many if not most elderly people live at home, generally alone, she added.
The questions were surprising, she said; in fact, “some of them would make your jaw drop.
“We were asked if in our facilities, people are trained as care givers. Um, yes, they are. We do have those requirements,” she said.
“And someone in high political office asked how we understand and measure quality. I was able to talk about the survey process, and the kinds of measures we are subject to, but for them — they really are starting from square one.”
The people talking to her “have no social service mentality,” Ms. Elliott said. “There is no Social Security. People are not receiving Medicare or Medicaid.”
The question of what a nonprofit is — not what, in an ideal world, it might be, but what in this real world it actually is — came up for discussion as well.
“At the Jewish Home, we always talk about family,” she said. That’s easier because the Jewish Home is nonprofit. So is Leading Edge. “But one of the questions there was what nonprofit means. We had some dialogue, and finally the moderator said that we should call them not nonprofits but no-dividends. They just don’t have the concept of nonprofit.
“They are having a lot of dialogue about the age-friendly community movement,” she continued. “How do we create places that will be more conducive for aging in place? They recognize that they can’t possibly catch up and provide housing for all these people, so they are trying to figure out how they can make places to better engage people in community settings.”
Is there anything Jewish about all of this? No, Ms. Elliott said. In fact, it felt noticeably different to be in a place where basically no one knew anything about Jews. “When my formal presentations” — there were two of them, and a question-and-answer panel session — “had to be translated, we got an email from the translator that tried to translate Jewish Home Family into the Jewish people.
“We don’t represent the entire Jewish people,” she said.