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Darcy Grabenstein: Hello, from SmartLinx Solutions. In today's podcast, we'll talk about unique senior housing options. Our guest is Dr. Bill Thomas, an author, entrepreneur, musician, teacher, farmer, and physician ― a geriatrician to be exact ― whose wide-ranging work explores the terrain of human aging. The Wall Street Journal has highlighted Dr. Thomas as one of the nation's top 10 innovators changing the future of retirement in America, and US News and World Report has named him as one of America's best leaders.
Bill, before we get started, can you tell us a little about your revolutionary approach to aging?
Dr. Bill Thomas: Well, as you were mentioning that I'm a geriatrician, so I actually devoted my life and my career to thinking about aging, pretty much every day. I think the most important insight I've gained in all that time is that aging isn't really about decline, it's about growth, and that's sometimes a difficult concept in our culture to really grab a hold of. I've really been associated with this concept of developmental aging.
DG: Can you tell us a little bit about the ChangingAging Initiative and more specifically, the ChangingAging Tour?
BT: Yeah, as a physician I certainly have an opportunity to impact people's lives by taking good care of them. I've always been pleased to do that, but I've also really been active trying to change the cultural conversation about aging. Back in I think about 2007, I started a blog called ChangingAging. You can find it at ChangingAging.org. It's really a forum for people who want to look past the decline-only vision of aging and talk about new innovations, new approaches, new philosophies, new language that can define a new approach to aging.
Back in I think about 2014, we decided to take the blog on the road, and we put together a traveling pro-aging festival that tours the country in a rock-and-roll tour bus. We performed, so far, in 125 cities, basically rocking the conventional view of aging and really trying to tell a new story about aging.
DG: That's very cool. From your professional experience, how would you compare Americans' attitude toward aging compared with other advanced countries? Are we ahead of or behind the curve, would you say?
BT: Luckily, I've been able to actually travel the world and I think ― not only my view, there's a consensus view ― that Scandinavia, among advanced industrial economies, Scandinavia does the best job with aging. Interestingly, the reason the Nordic countries seem to do so well is that they routinely weave support and services for older people, just weave that right into the fabric of society. There's a lot less age segregation in Scandinavia. There's some, but much, much less than what we're accustomed to, and much more of the idea that cultures in societies need older people in order to be healthy. That's not really an idea you find in the American cultural fabric.
DG: You mention segregation. Do you think that also ties into age discrimination?
BT: Oh, my, yes, yeah. Like a lot of people in this world, I'm opposed to the “isms”: racism, sexism, and I also include ageism in that. I think that in our society there's a lot of ageist prejudice. In fact, I'll just tell you, even in the medical profession, geriatrics is not regarded as a premier specialty, I have to admit. It's largely ― you know, when you talk to physicians about it they're like, ah, that must be terrible; ugh, being with old patients all day, ugh. Actually, I love it, but there's a lot of ageism everywhere you look ― at work, in the healthcare system, in higher education, in our society ― and I'm definitely a warrior against ageism.
DG: I know that you mentioned that you're only one of a very few in your specialty. But as Boomers age, do you feel that your field will grow?
BT: Actually, no. Talking about medical doctors specializing in aging, there's actually only about 5,000 of us in America right now, and there are fewer geriatricians every year. Yeah, it's going down. So just as the Boomer generation is arriving on the scene, we're going to see fewer and fewer geriatricians every year.
The reason really for that ― I can go back to ageism again ― is that it's one of the only specialties where if you take the advanced training, an additional two years of training, your income goes down. There aren't a lot of examples of that in American society, but that's definitely one of them. I think that we're not going to have enough geriatricians going forward.
DG: No, it sounds like not. I'm interested in ― a recent industry article focused on your unique housing model for seniors. When you talk about downsizing, you're serious. Serious downsizing! Can you tell us about your MAGIC concept and also about Minka? I know that traditionally when we think about senior housing it's, as you said, segmented by age and ability or disability. How does your model differ from that?
BT: Well, we'll start with MAGIC. So again, the years I've spent studying this, I've spent a lot of time in these segregated environments. Not only are they age segregated, as you commented, they're also segregated by ability. If you have these abilities, you go to this building; if you have these abilities, you go to that building. So MAGIC is a kind of simple idea. It stands for multi-ability/multi-generational inclusive communities, so MAGIC.
This concept is an attempt to break away from conventional practice in aging, not only segregating by age but segregating by ability. I'm very excited because the University of Southern Indiana has signed on with us to create the first MAGIC village on a college campus. We're working with them to create a housing option that will mix undergraduate students with older people, with people living with dementia, with people living with physical disabilities, and that together this multi-ability/multi-generational inclusive community can actually create a college experience for students that's much richer and more meaningful than conventional dorm life.
DG: This would be open to students of any major?
BT: Oh, yeah, absolutely.
DG: That's great. Is the idea behind Minka to give individuals who need supervision a certain measure of autonomy or maybe a sense of independence?
BT: Yeah, actually the way we're framing ― and I'll say this second concept is called Minka. That's a Japanese word that means “a house for regular people.” The concept of Minka is a compact, pre-fabricated, modular house that is optimized for independence. So rather than thinking about the Minka in terms of dependence, we're really designing a house that can help people protect and extend their independence.
As you know, when people do surveys about what older people want, they're really clear; they're abundantly clear. Older people, when you ask them, say “I want to live where and how I want to.” That's what they want. It's only when circumstances beyond their control intervene that they leave that life and wind up living in some kind of facility. The goal of the Minka is to help people live where and how they want to as long as possible. That's the key.
DG: That's great. Bill, I understand that your own daughter, Haleigh, provided inspiration for this project. Would you mind sharing a little of her story with us?
BT: I wouldn't mind at all. My daughter Haleigh is 23 years old. When she was born, she was found to have something called Otahara syndrome. She was only expected to live about a year, but because she stayed home with us she's actually still here with us. Haleigh lives with blindness and many seizures a day. Developmentally, her age is about one month. Practically speaking, her abilities are about a person who's a month old.
Now, at the same time she's a human being, and we love her. We've learned a lot over 23 years about how to create a space where somebody like Haleigh can live with dignity and as much autonomy as possible. The very first Minka was actually built for Haleigh, and it's designed to meet all of her needs. We think that if we can build a Minka that suits the needs of Haleigh Jane Thomas, we could probably do pretty well for other people as well.
DG: Yeah, it sounds like it. That's an amazing story. Thank you for sharing with us. As you know, at SmartLinx our focus is on technology. Could you explain to us how technology is used in the Minka houses?
BT: The approach I take to technology is probably very similar ― from what I know ― very similar to what you guys look at, which is use technology unobtrusively to enable people to live the way they want to live. I mean, it's all about using design and tools to support people in living in the place and manner of their choosing. I'll give you an example.
One of the projects we're using with the Minka is we're working directly with Amazon to build a Minka-specific set of Alexa skills, so that people are able to access a wide variety of supports through a voice-activated framework. That's one approach, but it's important to make sure that the technology is as transparent as possible, as unobtrusive as possible, and yields the greatest benefit.
One of the reasons we chose to work with Amazon is, as you're very well aware, they really are good at logistics, really good. I know as a geriatrician that many people actually wind up losing their independence, not really because of their health status but because they are no longer able to keep up with the logistics that go along with maintaining a household. Minka plus Alexa is going to help people stay where they want longer.
DG: Thank you. That makes sense. It sounds like you use technology so that people can live more efficiently and effectively, and we use technology so people can work more efficiently and effectively.
BT: Super cool! I love it.
DG: Let me transition to the next question. How do you see the traditional long-term care facility fitting into your scenario? Wouldn't you agree that in some circumstances nursing home care is the most appropriate option?
BT: Oh, yeah. Actually, this is a really important question from my point of view. I'll really dive into that. I actually ― it's not just the work I do, there's a lot of things happening where it leads me to believe that we're entering into a historical period quite like the shift from mainframe computers to PCs. Some of your listeners won't be old enough to remember this, but some will. There was a time when computers were as big as houses, and where you had to have a lot of very specialized people just to turn it on. Then, along came sort of the PC revolution, and what happened is computing power moved out of big corporations, and out of big governmental agencies, and really came home ― whether the computers are in our homes, they're in our workplace ― and it distributed the technology in a new way. I think that's what's happening in the whole field of aging.
We have a history of sort of a mainframe approach to the needs of older people, which is oh, you need this; you're going to go to this big building that's way bigger than a house, and you're going to live there, and there's a lot of very specialized people who know to do. Well, I think we're going to see that start to break apart, and in addition to classical, historical, senior living options, we're going to find more and more options for people to create dwellings, access services, use tools that support their independence right where they are and how they are. I think that that's a very key thing, to say that we're in the middle of a historical shift and technology ― one reason I was so excited to get on your [podcast] ― technology is really driving it. People often think of aging as a technology dead zone, but there's actually quite a lot of exciting new stuff happening there.
DG: Yes, there is. Didn't you even say that perhaps some facilities would have Minka structures on their properties?
BT: Oh, yes. We're actually already seeing that. There's a group in Ohio that is already planning to do that in 2018. It's funny because this company ― I won't name them ― but this company acquired some properties that an earlier owner had constructed some little cottages on these properties, and they had large assisted-living facilities on them. They struggled to fill the assisted-living facilities, but the cottages were always full. It's like that's how it is. People are voting with their dollars and their feet that if possible, they would rather not live in a large facility. We know that to be true.
DG: Realistically, Bill, where do you see aging care headed? In other words, how long do you think it will take before we really see a paradigm shift when it comes to the senior population?
BT: I think we're looking ― given the pace of change and the incredible lock-in that is a part of senior housing and services ― I think the next five to ten years are going to be decisive. You know, we are just in the very early beginning phases of feeling the influence of the Boomer generation here. Mostly, right now, that influence is felt through the parents ― the Boomers advocating for the parents, which is a good, loving thing to do ― but pretty soon, people who've been accustomed to more choices their whole lives are going to be entering into the scene and they're going to accelerate what I think is already an existing trend. Over the next five to ten years I think you're going to see older Boomers starting to redefine the marketplace for support and services.
DG: Thank you so much, Bill, for sharing your vision with us today. We're all about innovation, so it's very exciting to see other types of innovation in the industry. To all our listeners, thank you for tuning in. If you'd like to learn more about SmartLinx Solutions and our fully integrated suite of workforce management solutions, visit us online at SmartLinxSolutions.com.
BT: Thanks for having me.
DG: Thank you. Bye, everybody.