Katie Smith Sloan, President and CEO of LeadingAge and Executive Director of The Global Ageing Network

As the president and CEO of LeadingAge, Katie Smith Sloan is advancing the organization’s strategic priorities to increase impact through advocacy, enhanced value, and improved service and support systems. Through her leadership, Smith Sloan works with many stakeholders to address ageism and promote innovation. She also serves as the executive director of the Global Ageing Network, an organization with a presence in over 50 countries committed to improving the quality of life for people as they age across the globe.

Through the Vision Series, Smith Sloan shares her vision for the future of health care as it relates to the aging population. With an emphasis on integrated care, Katie discusses the varying needs of different aging journeys and explains what we can do to create a system that serves them all. She paints a vivid image of an integrated care system that supports flexibility—providing access to quality care, in a setting of the patient’s choice, at a cost they can afford.

Ignoring current reality, what is your vision for a health care system that is truly equipped to serve aging Americans? Let’s say you can build it from the ground up

My view is a system that supports people how, where, and when they need services or support. Everyone’s aging journey is different — it’s not linear by any stretch of the imagination. Every American must be able to access the right care at the right time. What that means to me is an integrated system of care for older adults that’s backed by a financial structure that supports access to the right services at the right time in the place that they call home. 

I believe that can only be a reality when older adults receive excellent quality and person-centered care, and obviously delivered in a setting of their choice at the cost they can afford.

How far are we from reaching that goal? How much work do you think it’s going to take to get to a future where we have something like you described?

Well, change won’t happen overnight, but there has never been more opportunity for change than now. It’s really the most important moment that we’ve had in a very long time; a lot of that is due to the clarity [resulting from] the tragedy of COVID, and we need to take advantage of that. We need to […build] a strong and qualified workforce with jobs that actually offer adequate pay, good training and meaningful career paths. [This means] a fair and equitable partnership between older adults and the government in which each contributes to the cost of meeting needs, but not just when they’ve spent down all of their assets. We have a lot of older adults who are under-housed and need safe, affordable and appropriate housing for older adults. We need to create an affordable supply of that.

LeadingAge and the American Health Care Association recently came out with a sweeping proposal for reform and additional funding. With these reform discussions, there tends to be a deadlock between the industry — which always says, “We need more funding” — and critics of the industry, who say: “No, no, they don’t need any more funding. They have enough money to do what they can; they just don’t, or the money’s going to profits.” Do you think we have an opportunity here to change that conversation so it’s not just this deadlock?

I think there absolutely is, and I think part of that starts with really understanding the real costs of providing quality care. Then funding should be tied to quality of care. Based on that assessment of it, it’ll be different [across] settings, but we don’t have a good handle and what it costs to provide high quality care. We don’t pay our workforce well now, and that is part of the cost of providing high-quality care. I think we need to start there; start with quality.

Then [there’s] the question of: Is it nursing homes? Is it home health? It’s both. Nursing homes provide a unique type of care that more often can’t be provided in an individual’s home because of either health conditions or just life circumstances. Nursing homes aren’t going anywhere. We will continue to have nursing homes. It’s a false choice between one or the other. We need both, and they serve different purposes for people at different times.

In the evolution of care, what was a nursing home 20 or 30 years ago is now assisted living, or it’s now home care; there are all of these different entry points into senior care that didn’t exist before. I think operators will try to figure out: “Well, what exactly am I? What do I do? Am I just a nursing home, or am I a home health provider that has a post-acute function?” There’s opportunity to diversify and even just rethink the base level of what kind of services the operators provide.

I agree, and then the regulations need to keep pace with that, because nursing homes are saddled with regulations that are now 35 years old — and to your point, a nursing home is very different today than it was 35 years ago, when we didn’t even have the notion of person-centered care, for example. The staffing patterns have changed so much. The people who live in nursing homes, who call it home, are different in terms of their health acuity. We need to make sure that the systems that surround nursing homes and home health and the whole continuum keep pace with the changes that are inevitable, I think.

How do you think we can break down some of the barriers between the different care sectors, which often operate as their own standalone silos, and how do we improve the experience for the resident as they go through these different options?

It’s a great question, and my short answer is form follows finance. As long as the way we finance the services is fragmented, the system will be fragmented, because every service has a different stovepipe, if you will, for reimbursement and funding. It creates enormous problems. I think the other issue is that we’re looking at this from a service point of view, and we’re failing to look at it through the point of view of an older adult who is trying to navigate through the system; it makes transitions between and amongst services incredibly hard, because in a sense, they have to re-learn what’s paid for, how to access it, what quality looks like, and what to ask for with every service that they may need.

I think we’ve got to not only look at a system of finance that isn’t so fragmented, but we also need to look at, from a provider point of view, how to better connect at the community level with other service providers; how to develop those deep relationships to forge partnerships across the system so that older adults can more easily navigate the system.

Partnerships have been a big theme of our conversations with LeadingAge for the last several years, and I keep hearing it over and over from our members — that they recognize that they’re part of it, they need to partner with the rest of the system, and they can’t operate on their own.

No one really wants to think about needing this kind of care, and I personally think that spills over into investors. On paper, betting on better, more innovative senior services seems like a no-brainer — the demographics clearly show a growing demand over the coming decades, and we can all agree the current system is broken. How do you get people excited about putting money into quality care and new models that might not exist today?

What you’re describing — I think it comes down to ageism, and how we feel about aging, how we feel about older people, how we certainly haven’t prioritized them during COVID. We’ve really undervalued them and under-invested in older adults in this country — not just in this country, in countries all over the world.

I think a lot of it comes down to just our own denial about aging and our own unwillingness to accept the fact that we may actually become frail at some point. We may actually need help, but it’s easier to put that out of our minds than it is to address it head on. 

I think that has made it really hard for aging to get the investment it needs, to get the attention it needs, from policymakers, from philanthropy — and that’s my hope, is that the public exposure to how we treat older people in this world that happened through COVID actually caused people to really think hard about the fact that ageism is so ubiquitous.

Where do you see technology, in the next five to 10 years, bringing the most tangible gains — both to resident quality of life and care, and also the health of the sector more generally?

Technology is and will continue to be the glue that makes the systems work. It’s going to be the brains to analyze data to allow us to improve quality. It’s also the bridge to coordinate across settings, as well as we’ve seen during COVID [as] the key to older adults’ connectivity and empowerment. Where I see investments continuing is in health IT and telehealth. I think we’ve only just scratched the surface on the possibilities of telehealth.

I hope we’ll see greater investment in broadband, especially in rural and underserved areas. It’s not a nice-to-have anymore; it’s a need-to-have, an essential utility. Where I see some exciting developments are around social connectedness. I think that’s been key during COVID, and some of it has been fairly rudimentary, but I think we’re going to see a lot of more investment in that.

I’m really excited about some of the technologies in fall prevention, because that’s a game-changer. I think things like that, which are key to the safety and wellbeing of older adults, will really make a significant difference. Obviously, technology is now a lever for efficiency and effectiveness and operations. That’s not going to change. That’s true in every workplace. I think it’s even more true with the complexities of long-term care. We will continue to see investment in technology.

I think the key for providers is to sort the wheat from the chaff to really find the technologies that are going to hit best in their environment and will make the difference for their communities. That’s a lot of what we’ve tried to do for aging services — to help our members make good decisions about technology because these are expensive investments.

You mentioned the ageism piece. It’s something that I think can even happen from within the industry. When I started hearing the stories about how the government put out grants earlier this year so facilities could buy iPads to facilitate video chats with their loved ones — obviously it’s a good thing, and it’s better late than never, but I also thought, “Well, wait a minute, there have always been nursing home residents who have lived thousands of miles away from their loved ones. Why wasn’t this an investment before the pandemic?” I don’t really have a good answer to that question.

I think part of the answer to that is that families were speaking up. I think there was a whole new voice that entered this conversation [during] the pandemic. It was family members who felt so disconnected from their loved ones. Even if they didn’t use an iPad or FaceTime before — during COVID, they couldn’t until there was actually an investment. That’s my theory.

Even in nursing homes, there was suddenly the realization that family members were actually part of the care teams, and when they were no longer able to come in, the staff in a nursing home was cut off from a key part of their care team. Probably, they had never really considered as so integral to their ability to support a resident.

All these little things that you would think would be just the cost of doing business for any health care provider just somehow never made it to nursing homes.

I would say never made it to all nursing homes until now. I think there’s some [who have done a] great job of keeping their family members connected and whatnot. Maybe once a week or once a month instead of once a day, which is why COVID demands some of them to have the mechanisms in place.