Transcripts For CSPAN3 M.T. 20240703

M t connolly, whos here to talk about her new book, the measure of our age navigating safety, money and meaning later in life in the prolog of her book, empty notes during the previous century, americans gained an average age of an extra 30 years of life. So 80 is the new 50, and there are many more octogenarians nonagenarians enjoying life than ever before are given and technological advance is empty rights. There has never been a better time to be old. This also means that millions more people than ever before need and will continue needing care. Yet current systems focused on caring for the elderly can be baffling and really do vary quite a bit in quality. Aging can be hard m. T observes. Its been made infinitely and unnecessarily harder by our failure to. Build the infrastructure we need to age well now empties. Ames in in the measure of our age she says was to provide a clearer sense for people of where the relevant systems are now and where might be headed in hopes of enabling us to forge what she calls a more just gentle and joyful old age for ourselves and for those we care about an empty is herself, especially well qualified to write a book like this . Shes a leading expert on elder justice, having served as a prosecutor in the civil fraud section of the justice department, a focused on elder care issues a doj she establish the departments Elder Justice Initiative and develop new legal theories of liability and, a novel investigation and strategies that led to successful prosecution cases involving the abuse and neglect in Nursing Homes. She also was instrumental in drafting the elder act, which in 2010 the First Comprehensive federal law to address the issue. Her commitment to raising of elder abuse and to seeking solutions. It was recognized a dozen years ago by the macarthur, which awarded her one of those genius grants. She knows as well as anyone whats been achieved in this field, but also her authoritative, thought provoking book makes clear. She also very well how much more needs to be done now in conversation me this evening will be Chris Jennings, who served as the Health Policy coordinate coordinator in two administrations for two president s and has also been a senior staff member on senates special committee on aging. Chris now heads a Consulting Firm that assists foundations and others in developing policies to secure more affordable, Quality Health care for all of us. So, ladies and gentlemen, please join me in welcoming m t connolly and Chris Jennings Chris Jennings. Oh. Wow. Rock star. I used to my father a he used to play recitals and you know, i would just move piano and thats how i feel tonight. So. First of all, thank you so much for coming out tonight. We it means the world to me and to us. It couldnt be a more important issue. And i have to say, this issue in particular is special to all of us. There is, as Rosalyn Carter, as ill paraphrase her, all of us are either past or future givers or recipients of caregiver, caregiving. And i have to say, this story that empty has conveyed to us for this wonderful evening and for this through this book really talks about in a very compelling way the challenges they face and how best to deal with them. I want to also say to you right. You know, many of you, i can tell our such fans of empty, but she is that person that was just introduced she is a special human being. Its a thrill to be with her and share the stage with her. She is not only an elder law and aging advocate, but she someone who can give us a prescription to better navigate the care, safety, money and. Probably most importantly, meaning aging in this society and my job today and i will youll see its going to be very easy, short as a fan and really sycophant of empty is to. Facilitate a conversation about her beautiful new book the measure of our age. So with that empty and give it turn it over to you im a little blown away. Thank you to politics and prose at my local bookstore for more than three decades and actually sort of a sacred place and i just have a reality check here you chris there are so many people i love and whom im grateful in the audience. I want. Make sure its not my funeral and are an angel or a human. Declare. Now im frequently not sure myself. I mean, why not both okay. Yeah, im a huge fangirl of chriss and you, brad, talk about himself. Thank you. Thank you all. So. Okay, fire away. I have no idea whats going to come out of my. All right, before we talk about this book, do want i want people to really give us give you the opportunity to tell you our tell these folks how you came to be such a defender and an advocate of aging. Well, you know, i had amazing parents, but they had decided on a course for me and. So i was supposed to be a psychiatrist and then sort of wasnt quite sure whether that was what made sense. And so to kind of, you know, test drive that proposition i went and lived in on a general admission psych ward at the Rochester State Hospital in rochester minnesota where i grew up, which was really sort of an amazing program, is called a volunteer a resident volunteer program. And i love the patients and i love the staff for many of them. But i also saw horrible things and was then sort of more interested figuring out where the levers of change were and it seemed to me that maybe would give me a better handle on the levers of change. So then i ended up at the department of justice. Brad was saying and doing civil fraud cases and i really didnt want to litigate anymore. And so i had this opportunity to head up something called the Nursing Home Initiative that the truth is didnt really exist but it was a response to congressional hearings relating to terrible about Nursing Homes. And i thought, oh my god, this is, you know, this new revelation. But as i got into it, it became clear that was actually a very old revelation. And it was only new to me. And actually, chris had worked on it before i ever did. And that these things have been going on for a very long time. And then what became even more clear was nursing home abuse and neglect was just the tip of the iceberg that there were many, many other related issues related to aging that we hadnt paid attention to for a very long time. And then i, you know, started to feel a little bit like the sorcerers apprentice, which, you know, not really knowing. I mean it was just like the issues started coming at. Me so and thats that was my start well and i have to say i would like you to build on so aging iceberg of nursing home and how much bigger the issue really is and what you found about and in particular you talk about the paradox the longer the scuse me the longevity paradox and what does mean to this country. So. Over the between 1902 thousand, we gained on average 30 years of life. I mean, that on average and that was due to all kinds of scientific Public Health and hygiene developments. And so we did this extraordinary thing of allowing people to live longer. But what we havent done yet, figuring out how to let people, how to help people age better and how to ensure quality life. In the years that weve gained. And we just we havent paid attention it. I mean, were fully capable of doing that. I think and so as i looked around, it became clear that this itself in so many different ways in our, you know, we relying on 40 million caregivers, family caregivers providing them very little support, and theyre doing a ton of work we have incredible financial issues, both in terms of families and in terms of budgets that we dont really talk about much. And we havent done very much to address. And so and theyre a really complex philosophical and ethical questions about, balancing autonomy and safety. So we just you know, we theres so much more we could do to improve old age. And so, you know, if were going to do all this work to live longer, why not figure how to live better to for not just for older people, but for everybody. And now i think we understand your motivation and, your inspiration for doing aging advocacy and doing the representation of the elderly, pushing for policy that youve done. But why do this book in particular . What was the reason . What motivated you to do this book . It certainly is no easy task. It was a cake walk chris. Hi so. So a bunch of different reasons. First of all, the problems were really invisible and really huge. And so there was sort of this disconnect in my head about how are there these problems that we that just kind of go under the radar. And a friend of mine whos a political told me that for really big social problems we need a language, we need a vernacular with which to even concept equalize the much less to have conversation about them or to debate them or to, you know or to start thinking about how to act on them or to change big policies. And so mean in a way, its a wildly ambitious goal. But what i wanted to do was to start figuring out how to put together the stories and the policies, the work of the professionals are working on these things and i really Extraordinary Group of professionals. Who are you know the heroes of the book in a sense. So theres that. Then there is just writing which id always wanted to do. Its a its a humbling process and i had an editor who said, you know, a lot of times the problem isnt so much in the writing. It is in the thinking. And its true. Its harder, you know, that hard writing often because the thinking is hard. So my hope is really, you know, to start some conversations in families among friends policymakers to say this is this universe style thing thats happening in life. What are we going to do about it . And i think its quite a gift actually, you know, i think youve captured personal and the policy so well but something i just need to know a little bit more about, which is, you know, ive known you for 25 years and all that time did elder abuse issues. So much stuff you were toiling in the fields you were very frustrated sometimes about the lack progress and and i guess i want to know, you know, to help us understand because you lived it. But id like you to define a little bit the scope of the problem in elder abuse that both how many people are affected, what is it . And really why does it take place. Oh, thats an easy question. Is so again, i was really shocked at how pervasive it was its at least one in ten people 60 and older and probably more a few because those are based surveys that are answered by people who dont have Cognitive Impairment and and and its its a problem to which mostly reacted as opposed to trying to get out ahead of it. Now thats endemic to all kinds of problems we we we think we should just let things get worse and, worse and worse and then, you know, send in the cops or send in the prosecutors and instead of preventing trouble often and so it is so that was that that was frustrating and i maybe one thing to do is to provide a case example of just how complex the issue is. And you know one relatively kind of prototypical case involve a parent who has a kid who has maybe some mental and Substance Use issues and been taking care of him for years, or at least hes been living with her and on her for housing and emotional support and financial support. And as she gets older her, her Health Declines and she needs more and suddenly son is put into the role of caregiver and then maybe she has a and ends up in the hospital and the caregiving needs escalate and you know, and that often may result in him taking her money and him screaming at her in him not providing her the of care she needs, but she wants to protect him. She wants to make she doesnt want to call the cops. She doesnt want to a protective services dont want to get him in trouble. And so a lot of people suffer alone and without any of recourse and. Its a really complicated family kind situation. So, yeah, so and i know its its so much its its thats why it makes it so hard to address. Its also the financial scams. Its the other things that prey. And i wonder if you could talk a little bit about how Older Americans feel about being preyed and whether they or even report about reports. You know, as with as with all complicated problems is no one answer. But a lot of older people dont want to report it because they, you know, well, for several reasons. Often they dont want to get the person they love in trouble, but maybe also they are worried about what might happen if they report maybe theyll be found to lack capacity, then not be able to live alone and then what happens to them then . And we have a much more robust system, residential care, that is to say nursing, assisted living, etc. Than well, its beginning to shift in because of advocates like chris, but to have more home and Community Based services so but the that the funding mechanisms work undermine peoples ability to get the care they want need in part because of the preferences for Nursing Homes and in part for a that a lot of people are unaware of which that medicare does not cover long care and most private health dont cover Long Term Care. So you either need to have private Health Insurance or you to basically impoverish yourself and rely on medicaid or you need to rely on family. And this is an issue weve talked about, which i think is really important in your whole travels in this process, you learned not just about the elder abuse issue, but how all these other issues were linked to the challenge. And id like you to talk a little bit about the breadth of that, but also why we havent made progress. I mean, weve been talking about you and i have been talking about this for a little while now, and i didnt used to not to have any gray in my beard when we first started. So when i have that effect on people, i you thats thats true. Those are so why havent we made some progress here . I think because were so freaked out about aging. We fear it. Were ashamed about it. We want to deny it. And we dont want embrace it as a society i think ive come to believe that thats a core part of it. And because of that sort of and because its invisible and because we tend to react opposed to prevent and, its just a huge problem. You know, that is visible in aging. So those are my three. And then i you have i know have eight others because youve told me about it, which why have we made progress on the legislative side. I mean people, i mean all politicians they lament they talk about they talk about doesnt seem that controversial. We care. We care, we care. Why dont you think there has been more progress on all this Long Term Care type support programs . Its well, its not ever the First Priority. And the consumers really pretty powerless and their voices are often not the people who need the care. And so. Yeah, i mean and its just not everybody, everybodys against it, but nobodys against it enough to really stake real political, financial social or other capital in being it. And i think this is a very important point and i think even amongst aging advocates, sometimes it isnt the priority. I do. I do my report that i think thats changing and im more encouraged i want to be more positive because i, i feel better about than i used to. I do want i want to shift. And i also want you know, im going to ask you to read a passage in a second because i think its so important because, well, i moved to the caregiving side of this issue and we speaking weve about the common issues. But what are the primary challenges we face when we try to navigate aging well . What would you say caregiving, money, balancing autonomy safety, a slew of broken relating to those and issues . How can i can i stop you right there about that caregiving . Because i, i want you to read first passage in the caregiving of the book because i just was so moved by that was right after. You quoted Rosalyn Carter do you know where im talking about . I think i happen to have it shocking. You have it here. Its hopefully its the its the first paragraph of the first chapter. Her. And this subsection is called and duty like a shift in the seasons its hard to pinpoint the moment when things begin to change as time and need recast our relationships and then recast them again. But whoever we become adults, some part of who were with our parents shadows us. If they live long enough to need our care. The role exists in a time warp, one that millions of us will at some point inhabit. The more i learned about aging, the more caregivers assumed center stage. They often determined, whether older people in ebbing health flourished or came harm their contributions as most unpaid or underpaid are measured in hours and days, in years and decades. Their work is composed of countless task rendered from near and from afar. Its beautiful. Thank you. Well, before i interrupted you, you were talking about caregiving money and autonomy, safety issues. And wonder if you could help navigate us in this conversation through. Those three care. So just one bridge. One bridge. Is that what i became convinced of . Is that really common issues aging end up getting us in serious trouble. I used to think that abuse and neglect was you know sort of this this thing that other that happened in other families that other people did. And just to be clear, not my family story, but but its a really its really common to run into trouble with issues caregiving. So i think we started to talk about it there. But theres no real decent for Long Term Care financing and people are really scared of going to facilities and. And so there are 41 Million People who are providing a lot of care every week. We dont have much care we dont have much help for those caregivers, even though theyre providing care for incredibly complicated illnesses that often, often people who are so sick that they previously would have been in Nursing Homes or hospitals and, you know, they dont. Its often mysterious for employers for Health Providers and the Health Impact of providing care is pretty serious, too. It it results in higher mortality rates and various other of Health Declines. So and that i think is in large part because dont honor the work because its invisible, because we dont help people take on this complicated task. And often they do so like very suddenly you get a call from the hospital and say mom fell, and can you please pick her up . And thats that. And suddenly your life changes overnight. So. So i think its so that money is complicated in other ways. So, you know, money is itself symbol and it has a lot of symbolic freight in in in in life. Right. It so for from the perspective of perhaps an adult child is taking their money, maybe they think ive earned it or i need it more, im going to get it anyway or no one will notice from a parents perspective. Maybe they use money to say, you know, to punish behavior they disapprove of or settle grudges or to show love or to leave a legacy. And then money can also really come up among siblings in ways that are very, very and can produce a lot of conflict. And a lot of is not actually about the stuff or about the money. Its about what it symbolizes about people feeling not loved enough or not appreciated enough. So that said, thats sort of the psychological level. Theres just having the conversations, the practical stuff like is the money going to through retirement . Weve done a pretty good job of helping people, creating to save to retirement. But we now have often 30 years beyond retire and were not helping people figure how to make the money last and, both in terms of means and meaning like what means something to them. And how do they evoke as much as possible and then as a society we also have you know, were also not thinking about the money we pour hundreds, billions of dollars into term care without really making sure that the places get it often are held accountable for they spend that money and then autonomy and safety. Oh, thank you. Yes. So here i think raised it. He put me through my paces. So so here, i think example would help. So say your recently widowed father has a best friend whos, you know, cute and 35 and who needs money for you know fill in the blank, you know maybe a great investment or maybe, you know, maybe a charity to which theyre incredibly or, you know, maybe theres, you know, some sort of romantic feeling. And so whats an and it clearly makes dad happy to be giving this person the money. And so whats the right thing to do as a Family Member . Adults have autonomy. Adults are entitled to make until. Theyre not. And so yet Cognitive Impairment we know can your ability to make good Financial Decisions often way before you see any other signs like Financial Capacity can can plummet and so so our duty as Family Members should we intervene should we not and then also as a society what kind of structure should we be building . Should we intervene, should we not . And so theyre really complicated questions, but theyre not. And, you know, theres no silver bullet, but there is a approach than we have and we need the help of ethicists and philosophers and others to provide really concrete guidance, to have conversations, also to say, okay, what do you want if you have a new friend whos making you really happy and know wheres the Tipping Point in terms of the amounts and all that stuff. And i what you did in your book, which was so helpful, is you talk about the honest conversations dont hold back. You have those conversations and theres theres some provide some tools that in to help navigate through those difficult and you know the one issue that seems clear is even when we have policy shortcomings is we can at least have those engaged conversations to do what we can do to manage the dynamic. At least thats what i got out of the book. Fair, fair. Okay. That was an excellent when i before we open it up a little bit. I did. I do want to have another important of this conversation, really, which is i think bigger than the interview components. Its really meaning of aging. It means the of it how it connects to our culture. And i wanted to these nice folks hear you talk little bit about this because i think its its very meaningful. Its how we better age in a society and moved as do to embrace positive as we age. Can you talk a little bit about that for me . And when we do, im going to ask to read a final passage. Then im going to ask people who want to make statements or have questions brief that they may be to come up here and to to ask questions at this microphone. But im youve have the mic right now empty. So this is the part of the book that came as the Biggest Surprise to me because i had worked sort of at the bleaker end of things for long time and so. Well first ill start bleak and then ill get more so so you know, we have a very age, just culture. If you think about how we feel about aging, we feel, you know, we feel all this animus about and we know that were not to feel animus about a lot of other issues. Right. But in this we think its fine. We think its fine to, you know, say really disparaging things about older people. We think its fine to feel really disparaging things about ourselves and about our bodies and to feel a shame we change. And so that that animus. It is like a toxin and its a toxin for the culture. I think its reflected in there in our institutions, like in that we dont have a better Long Term Care system, we dont have better Nursing Homes, dont a better guardianship system. Its also, if you think about it structurally, the dominant paradigms of aging right now, are that are isolation or, segregation, so that you either live alone, alone in your own house, or you live segregate with other older people and. Those arent really healthy paradigms. Those arent how human beings were meant to live. So thats that. So thats my argument about how ageism has is is being mirrored at us, which is one of the reasons its so important for us to take on the personal feeling and theres good data showing that ageism is really bad for our health. People who have the most views live seven and a half years shorter lives than people who have the least who have the most positive views of aging. So this is the revelatory part of this was, for me, the revelatory of my research is like what you can do it because we can actually move the needle from those negative feelings to more positive feelings and what we Pay Attention to and how we feel determines our existence. Large part. So its a really, really worth it. So theres connection stay connected to the people you love and to other people, the people you dont love but know the people here, the people you know in, your Community Garden or, you know, like do stay engaged, volunteer, stay, you know, stay engaged in your do not get isolated isolation. Loneliness are the enemy. From from kinds of perspectives have activity means something to you. So you know, have purposeful activity. And here theres good data showing that people who volunteered with kids at risk had much Better Health long term than people who didnt have purposeful activity in their lives. Old age is a great time to cultivate sort of an expanded consciousness for curious city and play and creative city and and based in i think is here tonight has done amazing stuff in terms of bringing creative opportunities for creative expression to older age then theres ah and you know my my family will mock me later you know theres the night sky and you know, and, and, and the grand canyon and and amazing music. I mean theres, you know, feeling those feeling of changes your brain and it helps make you a healthier and then theres and and storytelling which is kind meta because im trying to tell stories and we all tell stories but storytelling and you know, were its called narratives. You know we are narrating humans that how we make meaning of our existence because we you know, we make meaning of the hard and the good things and we shape we feel about ourselves as beings. And thats true for us as individuals. But its also true people coming together that we that we create a shared a create a shared understanding of what it means to be human, what it means to be connected and. So those are i mean, thats sort of what dave isay is after in storycorps. Right. Its incredibly important to evoke those stories. And, you know, after my dad died, i felt like, oh, i wanted to call him and ask for those stories, you know, like and we have that sense of, you know, that those stories are are precious and theyre finite. We should we should honor them and embrace them. Absolutely. And i and i want to end before we do the questions with something you said, connectedness as one of these. And i am i the unloved, loved connectedness way loved way, loved. That wasnt. The question before, you know, whatever is sacred crowd this is you you said there was a passage your book that really talked about the connectedness you had with your father and id like to id like to end with that before we open it up for questions. And when rounded 90, my father said hed lived longer than anyone else in his family had. Thats true in many these days, his frailty snuck up on me. It was discombobulating. He had always been so dominant, so unyielding. He had disapproved of my choices and was shocked when i didnt bend to his wishes about religion or profession. And for him, those demands were existential, good children acceded to their parents wishes. He hadnt counted on the provocations of raising a family, a world so different than the one hed known. But those years of conflict had long since healed over old age. Frailty brought forth a new pacifier and sweetness in him and in a new tenderness for him, mingled with anticipatory grief a little like the sensation when you first notice that the leaves have begun fall. Its beautiful. Thank you. I. I told her that id make her cry. Lets turn it over. I had to ask for a tissue. Yeah, please. I should say at the beginning, im 76, a childless widow. My credentials for talking about this. Im a physician and i took care of elderly people. Im an attorney. I represent whistleblowers who alleged medicare and medicaid fraud. So i seen it all. Im surprised that chris hasnt about how this is going to be solved by Competition Among private Insurance Companies and, private providers. This this is where the problem is. Dont you think that the fact that our system operates for profit is part of the problem of this Nursing Homes are large. Poor Profit Institutions with dozens Nursing Homes in commercial companies owned by by private equity, whose purpose in life is to extract money from the system instead of putting money into system, they are taking money out of the system and they are making money by paying the people provide the care whether at home in the new Home Health System or, in Nursing Homes or in other institutions. By paying them as little possible. And thats whats stopping congress from doing better. Its a huge industry. Yes. And you havent mentioned neither one of you. Well, im happy to mention it. And its in chapter three. Okay. And both the for profit and which is a bargain that congress made in thirties and. Yes. And private equity. And yes, i think its an issue and big issue. Yes, a significant issue. I totally agree. Yes, absolutely. And the Affordable Care act was not the solution. It has not been a silver bullet, especially since a class act was repealed. Yes, thank you. Thank. What do you of with article social intelligence and technology displacing so many jobs that there is now a big opening a groundswell of people to provide caregiving. Wow well i mean we right now in the midst of a desperate caregiver and i think in part that goes back to the that caregivers not properly paid or well or you know have the kinds of protections as so i have not yet seen evidence of a replacing caregivers which is in mostly a deeply human to human kind of work there some things i think that some kinds of technology can help with but we havent seen a lot of it yet. I think in this country. Chris, correct me. No, i agree i would just say in addition to that were never to address our workforce issue if we really do comprehensive immigration as well. And its ridiculous. We have not focused on that so and lets hear. Have you seen this phenomena it seems that when people get really old, sometimes they just decide when theyre just going to give all up. And so in a sense, assisted suicide is effectively legal everywhere. And people just starve themselves. That was not part of what i have done research into. So i dont feel to answer that. But i mean its clearly a big a big social issue. I was more focused on the aging, you know. Thanks next. Thank you. So appreciate what you your work and your writing this. I also, i worked in two of those snakepit type hospitals in pennsylvania many years ago and just before i make my question, i bought a birthday for a woman in philadelphia, lived with my father for 15 years. She is going to be 104 in august and im always she loves my birthday card. She saved shes not a literal literal relative but i know she many years to my widowed father they lived together and so so im always late with all my cards and ms. Manners recently wrote something about when someone said something about getting late birthday card, she said, well, why dont you consider it early for next year, which is why i was so. Anyway anyway wanted the statistics getting into the dismal politics of this one of the statistics thats been on my is the fact only 16 of american have been fully vaccinated and boosted and. I live about a mile in the suburbs here from a nursing home that very secretly had a lot of losses at beginning of covid and the last i heard, it was Something Like its Something Like 50 of the Nursing Homes have had not gotten patients boosted. And i wondered if you thought about that. And said, you know, this isnt Rocket Science is simple. What what is so messed that things were so bad so im aware of the numbers of boosted but i think that there are a lot problems in Long Term Care. I mean of the things that i think going back the first question is that Nursing Homes and continuing care communities get more than hundred billion dollars in taxpayer dollars a year in taxpayer money a year. And we dont actually know how that money spent and how much it reaches residents and goes to resident care. And we know that staffing is the most important factor in quality. And so, you know, that seems like a relatively simple kind of Accountability Measures to how the money spent, who owns the facilities that are receiving funds and and to make sure that staffing is adequate. Good luck with that next. Thank you for your work. I havent had a chance to read your book yet. I hail a period of time with kuhn and the gray panthers and they did a good job at that point in time, probably earlier on. Any of us needed of highlighting Hallmark Cards that were just we live in an age of society. Im wondering what your thoughts are on what it would take to foster a Movement Like right now . Such a great question. I mean i think we need to be willing to start conversations about aging and actually more disciplined in terms our own sentiments about it and have i mean weve seen what other movements have done and ive tried to you know ive tried to think we could do it tick tock actually you know there are some wonderful people on tick tock trying to Start Talking about these issues right. But whats at issue maybe i guess what youre both on tick tock, right . No, but i mean it, is you know, im hoping that we can start having more conversation about this. Thank you. Amt thank you so much for your wonderful book that you have. And chris, thank you for being in this fantastic conversation. Im curious, im t if you can talk a bit about rise, you can talk about a bit about of the perhaps other really amazing initiatives or projects that have actually from the book. Oh, wow. Thank you. I didnt pay her to ask. So as part of doing the research. I ended up working with a number of people over a long period of time and so you end up building trust. So thats part one. And then part two was that i began to understand, or at least to my mind understand what some of the more fundamental problems were that we werent addressing. And of the fundamental problems, i think is in the example of the mother with the son has Mental Illness and some substance issues. Oftentimes what that mother wants is help for her son. She didnt want help for herself initially. Her first order of priority is to get help for a kid. And most of the systems we say, im really sorry, we cant help you. You know, thats thats not within our can or within our mandate or within know. So and so what i so, i ended up talking to a guy named ricker hamilton who the head he was an Adult Protective Services worker in maine. Thats Like Child Protective Services for vulnerable adults and then ended up being the commissioner for and Human Services in maine and so he agreed to let us start doing some research to ask clients, what do you want . Like what is it do you think that the Services Helpful and what do you want . And so what we was that people there were wishes that that structurally were not addressable and so we built a little Satellite Program in a nonprofit in maine that is trying to provide advocacy based Services Based on what the client and if thats help for her son, then thats how for her son. And so weve been doing that. And i feel like if because theres little whats called prevention data, we dont know what works. We dont have much to give families in terms of like how do you prevent it . We dont have much information to give policymakers. And so what we wanted to do was to study. And so we had to randomize in maine. And its back very, very positive. The data been very positive. And so its really and now were trying to expand it to the criminal Justice System to really find an alternative to criminal cases and. So i think its a hopeful way of doing things and its whats called person centered. Its to ask the people that the programs are created for what do you want and then trying to build programs, those wishes, as opposed to saying, oh, the professionals, we know what you need and were going to help you, which really the dominant paradigm in a lot of different realms did i answer your question. Julie thank you. Thank you for. And i have to say, whats exciting about what you and they been doing is i think in the Care Movement overall, particularly people with illness and these arent just people who end of life but, you know, advanced we are learning and more if we just give what they want as opposed to throw things at them that they dont want, its they theyre happier. They live, theyre more attractive. And its less costly. And its so you have the right prescription. Were going in the right direction, right. Think thats right . I hope we have a long way to go. We a ways to go. You have to be employed. So i amt thank you for your time today. I curious if in your research you found any as models of success that you think that theres a chance that we could adopt features of it, that we could adopt, or if theres aspirational models of success that, we can look forward to. So its such a diverse problem. Do are you talking about i mean, i think rises one, i mean, there are other i was thinking more like internationally, like if theres other countries that like whether its yeah, yeah. So thats a super question. And as i got into my research, every time thought i had a great idea about how some other country, was doing it and thought it was this is wonderful. Somebody from country would say, oh no, you know, thats wrong. You have no idea its actually happening. And i was having enough. It was a significant enough challenge to really try and bring together the many different threads, all the different sort of policies and programs and issues in this country that i decided i would stick to the united. So i wish i could answer your question and i cant, but i do think that there are some hopeful programs here and, you know, like the ones just talked about and, you know the financial industry is starting to do some i mean, theres you know, there are a lot of different there are a lot of different promising. I dont know. Theres theres theres promise. We just have to see how it turns out. Im sorry. Yeah. No, no. Is that. Yeah, yeah. I was just curious if you, if you had it in your reading. Wish i did. Yeah. Sorry, sorry. Good evening. Im a regular ali. Im an Italian American lawyer. We have an option. K street and i. I heard what you said everything. You said my question is, are you aware of any legislative initiative. To change this or to improve this . I mean im opinion on capital hill we had Behavior International tax but i didnt know anything about it. Im so i, i, i did work on a piece of legislation to address some, some of the issues relating to elder. And it was humbling experience. It you know the, the law was actually i think i mean i think it a promise but wasnt the end as successful as we had and largely because it wasnt it wasnt funded at very robust levels and it wasnt implemented. So i think its a its been a lesson in legislation and that its not just the passing of the law also in terms of appropriate actions, in terms of how its implemented, in how it spreads. So there have been i mean, there are all kinds of aging. Theres a lot of aging legislation. But specifically, the one ive worked on, you know, it it was a humbling experience and i dont mean to be curious which level where you can where you house of of senate, which committee, where about i was on loan from the department of justice to the Senate Special committee on aging. When i when i when we did that work. And so it was at the senate. The house was involved in it. It was enacted. The Affordable Care act, as brad was saying. And one last question i should know. Are you aware of any initiative you in European Union . Im a less you know, i dont know about the european. Yeah, im sorry. Im not its not you know, im but i do i do believe. I mean, whats encouraging little bit more about the caregiving support policy. Theres theres as we speak, bipartisan bicameral interest in providing direct assistance for caregivers. And so im, you know, finally and this is the point that i believe that my was making so effectively that Long Term Care and any discussion on this has always been the second or third priority. And if youre not the First Priority even amongst aarp and as gray panthers or whomever Advocacy Organization you get one if youre lucky and frequently you dont. One. Now, the caregiving issues is a much higher priority, and i think its largely because if you look at the demographics its just undeniable we are being overwhelmed with burdens and a generation level that weve never seen and you know, two years ago the baby boomers started turning 75, okay, so the baby boom become a senior boom. Its here, its and so its an undeniable need. And and last thing ill just say, just to make it maybe even encouraging is even now are starting to ask explicit clarification about their to provide navigating services for their employees to figure out the labyrinth of what services are in their local community to get caregiving support. Why because their workers are not productive if they dont have, an easy way to access them. So not saying that this is, you know, weve still solved the problem, but we at least are starting hear the problem and starting act on the problem. And it will never be completely perfect because we are this country. But but i am encouraged. I just want to give you three. Youre going to say other thing. 41 Million People, 41 Million People providing on average, 24 hours a week of care over a course of four years. Thats more people than the state of california, on whom were relying for a lot care. I mean, just keep that in in terms of all this. Hey. Okay, thanks. I dont want to sound like shangrila here, but in our independent Senior Living facility. We are segregated. Yes, but its an amazing thing to find out that you can make friends at the end of your. And you can also look very deeply into seeing people, your good friends go down in a way that you do see sort of the philosophically you you get a real sense of what it is to be the exit lane and i think its really a very nice thing if. We are lucky enough to afford it. Yeah, yeah. But i will put in a word for segregated housing that i live in. Thank for that correction because i think. I deserve to be corrected on that and we need accessible good housing that you know we needed for many more people than have access to and community is a beautiful thing it is its and you know and and its yeah so im activities is coming to politics and prose for. People on that i think that were going to conclude and thank m. T give me a round of applause for