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Needed: A vision and a strategy to realise successful Ageing

March 26, 2009

Question. Is Australia ageing successfully?

I have asked this question to hundreds of people and so far only one person has ever said yes. Many, perhaps most, say no and the rest say we are doing OK but that there is massive room for improvement.

From those who say we are not doing a good job at creating a Successfully Aging Australia (SAA), why do you say so and can you nominate some :
Obstacles and Problems in current arrangements you would remove?
Improvements to current practices, policies and actions which you would make?
Initiatives- what would you do to accomplish new ends and means or to give attention to current neglected areas of concern?
Heritage- what would you would keep and nurture so that when you change every thing else you would not throw out babies with bathwater?
Baggage –what current mindsets, attitudes , policies and behaviours you would eliminate because their retention is preventing us from implementing successful change?

In addition if you think there is room for improvement could you nominate a quality, facility or opportunity to create successful aging which you would introduce

There are some places where demographic change is well in advance of us, such as Japan. It is my view that the Japanese are doing a somewhat better job of successfully aging than us, but it is also my belief that they also could do a lot better. Therefore what I am suggesting is that if Australia finds a way to age successfully then we will have a major 21st century export industry as we could export of successful aging products and services to the world which also want to know how to age successfully. In previous generations when more people died younger successful aging would not have the priority it should be now. People are now living longer but I don’t think any of us could say that these extended lives are as fulfilled as they could be. Our failure is that we are not imagining enough of what is possible.

Leadership and Management for realising successful ageing

Each of us want to influence the future, and when we seek to do so we do it in two kinds of ways.
We can act as a manager-of-self and become prophets. We ask the question what will the future be like – what is the probable future? We look and trends and seek where we think where they are taking us –either to paradise , hell or something in between , and then we seek to eliminate the problem and obstacles which could limit our capacity to maximize the benefits and minimize the costs of following along this trend line. This is a rather fatalistic way of behaving , but in fact many of us, including our major corporations do just this
We can also act as leader-of-self and become visionaries. We ask the question what should or could the future be like- what is the preferred future? Leaderdhip is about have a dream of a preferred future and seeking to realise it.

Australia is an over-managed and under-led country and there is too much prophecy and management, and not enough vision and leadership.

George Bernard Shaw summarised this difference between the manage and the leader in each of us when he said
Some people see things as they are and ask why? I see things as they could be and ask why not

This is true for so called ‘aged care’. We confront a probable future of apparently inevitable increases in disability and illness as a part of ageing and in response to this we create a system which accepts this as inevitable and construct often expensive systems to ameliorate this increasing disability and illness . The result is an over medicalised illness care system which consumes vast resources, which assumes that people who are not ill, but not necessarily well, should receive little support even if they are poor from the pension they receive from so called aged care system, and only need help them when they a show increasing disadvantage or disability. We need public policies which give more attention to assisting those who are not working full time and are well to live fulfilled and balanced lives. And we need to remember that a stich in time often saves nine.

No long ago I advised a so called a health insurance company (read illness insurance company). It was struggling to remain profitable and had just about run out of ideas about how to contain costs. After getting them to admit that their business had nothing to do with health, but a lot to do with illness , they admitted that their core business was illness rather than health insurance. I asked them could they imaging creating good health- establishing wellness creation as a goal as well as healing illness – and though this change becoming a true health care ( read promotion) company. I suggested that they could do so by becoming involved (say) in gymnasiums, health and yoga retreats, health food, and personal training? They were so what I called problem-centred in their strategic thinking- that is focussing on overcoming problems rather than pursuing new initiatives outside their current core business – that this possibility had not really occurred to them . I then suggested by making people healthy in their health creation business they could give a reduced fee for their illnessinsurance services to their healthier customers- just like a no claim bonus in car insurance. Similar thinking totally dominates aged care in Australia

Our aged care system has not yet willing or is even or is unwilling to commence a conversation about what a successful aging Australia, would look like as a preferred future vision, and what a elements would be elements of a mission directed strategy to create such an outcome. To me there seems very little real leadership in the so our called aged care sector – both in government and in the age care industry itself– leadership which would be willing to commence an envisioning and strategic planning process to create a successfully aging Australia.

When I work with clients in your industry I have fun asking facilities owners and CEOs this question ’when your time comes will you be happy to live in one of your own facilities. There are very few who answer yes. They then tell me that plan to stay at home. This is a classic example of being over managed and under led. The manage/prophet in these CEOs follows the trend and then constructs facilities based on their own understanding of these trends. The result is a bricks and mortar and over medicalised response to fulfilling the needs of the aged . What they seem less willing do is to walk into the future in their own imagination (which is what leaders do) – visualise their own preferred future and that of their friends and colleagues, and then realise this vision by constructing it on the ground. So I ask them if you want to live at home yourself why are you not using this knowledge to inform you business rather than following trends ? They could invent the ‘nursing home at home’ if they did so, and therefore minimise the institutionalisation of aging. Such a solution would be a marvellous export industry. consider ‘meals on wheels; and create a generic ‘X on wheels’. What could ‘X’ become if we were to construct a major national initiative based on inventing the ‘ nursing home at home’ This could include new forms of housing to create new synthetic extended and nuclear family arrangements to make up for any decline in natural family support for the aged

The fact is we have no idea of what would compromise successful ageing, simply because we have not asked the question and sought to answer it. We cannot work to create a future which we do not first imagine.

Now what might be some components of successful ageing?

Here are few ideas.

Indian Summer Adulthood

Most of us enjoy a period after we finish full time employment, when we can live for decades of mostly healthy living . This is a period in our lives which I call ‘Indian Summer Adulthood’ when living fulfilled lives in not only possible but actively sought by most people. In this period of life we might work a couple of days per week to maintain our career paths as an active core in our lives, but usually we will act in a more of a mentoring/advisor role rather than a hands on role – where our accumulated wisdom will be valued by younger work colleagues. There is no reason why we should not persist in doing this until we no longer wish to or are unable to do so.

Balancing wellness and illness in successful ageing

To create successful ageing we need to pay at least as much attention to wellness as we do to illness. Right now wellness is almost invisible in our discussions about ageing. Wellness is the opposite of illness but illness and disability have so dominated our dialogues about ageing it has become the norm. Wellness consists of two parts, what I call wellbecoming –becoming well or healing, and wellbeing- being well and – maintaining wellness. We have institutionalised aged care not with the aim of promoting wellness but to try to achieve the efficient management of illness and the model we have come up with the nursing home many or may not be the most efficient way to achieve this goal. We have created many problems for our aged by too readily separating them from their families and by over institutionalising our response to the aging of our society. Yes families struggle to look after their aged but this does not mean that separation into institutionalised facilities is the only way to go. How could we keep our old at home and give them the support they need on tap but decidedly not on top? How could we not only have a nursing home at home, but also support families so they are more resilient and better able to look after the old? Unless we ask these questions we will not answer them. Again it is time we asked more questions to explore alternatives to current solutions. In our journey through life we start as dependent children, then transform into independent adolescents and finally into interdependent adult hood. We all know that the we all prefer interdependence as the optional form of relationship and we willingly surrender some of our independence in adulthood because of the benefit and synergy which comes from union. As we get old the process reverses with widow/ widower hood and nursing home and increased dependence . However we need new public policy as well as greater entrepreneurship to maximise the retention of the years of interdependence and independence , including encouraging new forms of interdependence when a spouse dies.

Wellness and Meliors

I have borrowed a concept from the human ecologist Stephen Boyden. In introducing this concept he says:

Much emphasis has been given, quite rightly, to the importance of stressors as aspects of life experience likely to interfere with human wellness. But this is only part of the picture…any human being should be regarded on a continuum between a state of distress and its opposite—let us call it a state of bliss. Stressors are those experiences which tend to push the individual towards one end of the continuum—towards a state of distress. We suggest that, in our attempts to describe or analyse human situations we should pay as much attention to those experiences that can have exactly the opposite effect to stressors, and that push the individual towards a state of bliss. We call these experiences meliors. The position of the individual on the distress–bliss continuum is thus largely a function of the balance between meliors and stressors in her or his life experience.

I now work with clients to identify their own meliors- and we all have individual list which we add to and delete from throughout our lives. I encourage all my clients assemble their meliors into a kitbag into which they reach on a regular basis. The bliss industry and the provision of meliors is a huge 21st century global industries and it is growing rapily ( eg spas , organised sport of concerts. We should be encouraging our old to consider their current melior list and consider both adding to it and taking melior time more often.

Insight , Foresight and Hindsight in future making .

As we age most of us do more future taking and less future making. However I think that maintaining a capability to be a marvellous future maker and not merely slipping into increased future taking, is a critical component of successful ageing. The best way to predict the future is to make it. Even in the last years of life a commitment to keeping a balance between future taking and future making is critical . Success is largely about being able to intervene in ways so that we remain able to shape future outcomes.

Good future making requires that we plan for the future through insight, foresight and hindsight. When I work with the young or people in mid career about career and life paths and choices, I work with them on three dialogues which I call respectively the destiny dialogue ( based on insight), the destination dialogue (based on foresight ) and the derivation dialogue (based on hindsight). In each of these one can conduct a dialogue with family, colleagues and friends ,and increase ones understanding As we get older we often have a deeper understanding of our own special gifts- our destiny –which for me is a summation of one’s purpose in life . One’s destiny is a combination one is good at (aptitude) and what one loves doing passion). As we look forward we should be seeking emerging opportunities which are closest to ones destiny. Following your destiny and realising in a forward journey defines ones work – that which one does which gives meaning to ones life. Whether of not this also becomes one’ s employment – earning income from doing ones work – depends on ones own personal priorities. The final dialogue is what I call the derivation dialogue, (based on hindsight) – as we review our journey thus far. We can determine what is the heritage we should keep and nurture and – as we age- consider leaving behind us as a legacy- and what is baggage (the accumulation of experiences, mindsets and behaviours which we should throw out , because its retention will prevent one being a successful future maker. and we are never too old to contemplate one’s baggage and seek to remove it from our lives.

I often ask senior executives this question:

The year is 2050 your children and grand children are standing beside your grave on your birthday. In on sentence how are they remembering you? . Thinking about creating and nurturing the legacy one wants to leave behind is to me a critical part of successful aging.

Keeping resilience into old age: re-imagining future options and possibilities

Aging is associated with decreased physical and mental capabilities. Sometimes we lose the capacity to do something we love to do –playing a sport for example. One door closes, but the challenge is to find now doors to open, new things which one can do within the constraints of one’s current abilities. This can be done by reviewing ones destiny again , one’s aptitude plus passion in the new modified circumstances. Commencing something new or initiating a new relationship can be totally revitalising. As we get older many of us tend to do this less.

Elderhood

Throughout human history ageing has been associated with elderhood . Respect for traditional elderhood disappeared with the rise of modernity and the spread of imperialism and religious evangelism , which placed little respect for old and traditional knowledge. Traditional societies carefully considered what skills and behaviours were necessary for success in the adult world and sought to ensure that these were well learned by the young during a process called initiation during the age of puberty. At this stage the responsibility for raising the young was formally transferred form the parents to the grandparents generation . Initiation of the young, who at puberty are thirsty for sip the cup of adult knowledge were given formal entry into the secrets and responsibilities of adulthood. The elders accepted this responsibility, and this minimises the distress that every parent and child faces at puberty when the relationship between the two is being reconstructed from one based on the child’s dependence into on based on the child’s independence.

We are not only not created successful aging because we have never tried to consider what might constitute successful ageing. We have likewise also failed to envisage and create successful adulthood because, unlike most of our traditional ancestors, we have never tried to consider what might constitute successful adulthood and then established a specific curriculum at puberty to realise it. In our rush to modernity we threw out all this baby with the bathwater. Now with the arrival of post modernity we are starting to bring it back , but again without any coherent vision of successful adulthood. Every teacher I know tells me that year in our secondary school is a waste of time and money. What we should do is reintroduce a universal ‘initiation into adulthood year in about year 9 to teach out young how to be successful adults. At that time the responsibility for the raising of the young was passed from the parents generation to the grandparents generation-to the elders. Imaging a transformed secondary school where elders come back into the education system and help transform the young for successful adulthood. Imagine two associated credentials: one received by the young as a certificate of adulthood on completion of the initiation year and another which is a qualification held by aged people who want to playa r role as elder- perhaps a one year certificate in a university.

Creating a pathway to effective healing, fulfilled wellness and successful ageing

It should be a goal of all public policy to ensure that each of us assumes the maximum possible responsibility to create for themselves their own health and wellness, and to age successfully so they burden the community to the minimum extent. What we need to do is to create a framework so that this becomes possible.

Imagine a pathway—a sort of yellow brick road to realize one or more of the ends of : effective healing, wellness and successful ageing. Each of us should have a vision of ourselves having achieved this successfully. As a motivator, we should bear in mind that the probable future of more of what is happening now will often lead to continuing decline and even a lifetime of palliative care. Doing nothing new will inevitably lead to this outcome.

Along this yellow brick road the travelers should be provided with information about their current status and progress and
be provided with information to enable them to make choices about the next steps on the pathway. Where possible this journey should be undertaken by independent, sensible individuals and communities who accept the responsibility for navigating their own way to effective healing, fulfilled wellness and successful ageing, and who negotiate and accept services from appropriate service providers while traveling down it. The relationship with each provider would be an interdependent one where both parties make mutual obligations so that the benefits of the service are maximized. For example, many people with chronic illnesses can and should visualize and then accept more responsibility for creating their own healing and they should have much better command over their healing and wellness journeys.

There will always be times when the sick, infirm and aged will be incapable of making informed choices and dependent on services. But this should be the exception rather than the rule, which is clearly not the case at present. The majority of us will be able to travel down such a pathway under our own steam most of the time. We should be able to negotiate which services we need and to maximize choices about future directions and service options. Imagine an interactive computer program involving not only IT (information technology ) but also for its 21st century successors KT (knowledge technology) and WT (wisdom technology) as well, which provides a set of guideposts enabling millions to undertake this conceptual journey. It also connects them to service providers, to learner-driven and just-in-time knowledge, and to insights about their current status and the next tasks and possibilities on their journey out of illness (if they are ill) and into wellness or successful ageing. Such a system would not replace interactions with real people such as service providers, but it would enable each person to understand their situation, status and progress, and to establish goals to be sought and realized at each stage of the journey. They could obtain different opinions at different stages in order to minimize risk of misadventure and maximize their forward journey while at the same time accepting responsibility for the choices they make. Such a client-driven process would be a challenge to many current service provision regimes. With wellness services we are currently at liberty to make free market choices as we like and we mostly navigate our own way down a pathway to wellness even if we do not recognize the existence of such a pathway.

When we make choices about our lifestyle we commit ourselves to traveling down a pathway to either increased likelihood of illness or increased likelihood of wellness. Some of us make good choices and act on them, and we travel down a pathway to better health and wellness. Some of us do it badly or not at all. With each cigarette we smoke we travel down a path which shortens our life journey, and with each walk we don’t take we do likewise. However, it would save a lot of health dollars and lead to happier and more productive lives if we were encouraged to make better choices by a mission-directed system.

We could also ensure that all service providers in the healing, wellness and ageing industries have software pathway templates. In this way all their clients can be serviced through case-management programs based on their clients accepting responsibility to walk this pathway themselves and accept
services, support and guidance when it is needed. This would be a case-management system for effective healing, fulfilled wellness and successful ageing.

Ways and wares for successful aging

To create/invent any new future including successful aging we will need many new innovations . Success goes to those who get to the future first. And those who create it have an export industry, provided we market the innovations needed to create successful ageing. I want to introduce on of my core concepts – which I call ‘ways’ and ‘wares’. When we want to achieve a new outcome or future we need to invent the means to get there, and it follows that we must create and market the new innovations needed to realise our goals . Ways are innovations to what we do and to how we behave : Wares are innovations to what we use- new products , services and technologies to accomplish a new sought outcome. Here is an example A water conservation way would be shortening your shower time from six to three minutes. A water conservation ware would be a new low volume shower head. Here are some of the ways and wares we could innovate and market to create successful aging:

• aged and disabled worker support ways and wares. Imagine the innovations that could be developed to enable a disabled person to work in a normal work environment, so that his/her productivity in and fulfillment from work is maximized.
• working-from-home ways and wares. Imagine how we can better connect home office environments with other work environments to enable seamless and productive work outcomes for all.
• aged mobilisation ways and wares. Imagine new ways to help old people remain mobile so that they can visit or go out shopping. Some would involve public transport and some private transport.
• remote aged healing and wellness support ways and wares. Imagine how healing and wellness can be promoted through home visits and the remote delivery of goods and services.
• shopping-from-home ways and wares. There is shopping we enjoy and want to do, and shopping we hate doing and have to do. Shopping perfection involves doing the first ourselves, and replacing the second with home delivery. How could we best do
this?
• aged home services ways and wares. Imagine all the things which could be delivered through an aged people specific home
services industry.
• nursing-home-at-home ways and wares. Think of all the elements which are in a nursing home, how many of these could be delivered remotely into homes, and how.

Aged and disabled worker support ways and wares will keep people in the workplaces for longer: providing, of course, they want to. During Indian Summer Adulthood there should be increased freedom to determine the balance between going to work and working at home, provided that the workplace as a whole does not suffer significantly as a result. Many professionals—lawyers, doctors and teachers—already do this, and now more trades people are joining their ranks. Many baby boomers have rejected the concept of retirement as it has been traditionally understood, are not leaving full-time work as they used to, and continue to work as part-time knowledge workers. Working lives are lengthening and working weeks are shortening in the 21st century. In this way income from work is being derived for longer periods in the often decades-long period of Indian summer adulthood, therefore lessening pressure on superannuation programs and government pensions. Indian Summer Adulthood will therefore be a time when society adjusts to ensure that all those who want to work can do so for as long as they would like to or need to. And governments will need to make the same public investment to provide the physical and social infrastructure for an Indian Summer Adulthood world in the way they have built and funded the operation of schools for the young in past decades.

As for aged mobilisation ways and wares, older people or those who have a disability need to be given the capacity and flexibilityto keep much of the mobility they enjoyed in their earlier lives. How could this be done? Significant advancements in innovation in personal transportation have been developed for the disabled sector, and many of theses innovations can be tailored to the aged. There will be a huge market for these innovations. If an aged person can’t (or shouldn’t) drive a car the employer or the welfare system could provide flexible public transport. This could include vouchers for taxis or dial-a-bus services for work journeys or for going out for shopping or entertainment, or to see friends. How do you feel when you see an old and fragile woman wheeling a heavy shopping wagon back home from the supermarket? There has to be a better way. That better way is a part of the whole Indian Summer Adulthood industry.

Imagine the many aged home services ways and wares which might comprise components of this industry. Another huge industry for aged people is education, which has already started with organisations such as University for the Third Age. In twenty years it is likely that the budget for learning for older people will be as big as the budget for children. As there is some evidence that keeping the brain active is one means of deferring dementia . Imagine aged learning ways and wares. All of these categories of innovations will be in more demand as Indian Summer Adulthood becomes a major focus for our ageing society and all will be important for the creation of successful ageing. There will be many innovations needed to fulfill this journey. Those who create the ways and wares for successful ageing will prosper, for there will be huge global markets for their innovations.

Can you imaging some of the new ways and wares to realise – for example – successful adulthood, to create a nursing home at home, to enable partly disabled to continue to work during Indian Summer Adulthood , to make Elderhood effective in our schools , and to provide new meliors to create greater aged bliss.

Conclusion

I have suggested some ideas about of what might constitute successful ageing. What are your own thoughts?

We need a vision for successful ageing. At present we have what I call a problem centred approach to ageing-when we identify an area of failure and then seek to ameliorate the problem. We dedicated ourselves to removing problems caused by unsuccessful aging not create a vision and a strategic mission to realise successful aging. Irrespective of what you think should be a constituent of successful aging, we all know that merely fixing the obvious failures will not get us to where we want to go. To remove problems from the future merely creates a future which is less awful. To create a magnificent future including one where our society successfully ages, we have to imagine and then discuss what constitutes successful aging. And successful aging for me means that we design it so that the ageing remain in command of their lives and future to the maximum possible extent, and they ensure that they are effective future makers.

We cannot work to create a future which we do not first imagine.

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