416: Elder Justice: Taking the Initiative on Elder Abuse with Marie-Therese Connolly

Casey Weade: Welcome to Retire with Purpose podcast. My name is Casey Weade, and it is my mission to deliver you clarity and purpose and elevate meaning in your life through personal and practical financial strategies. We do that here in the podcast, both with the financial and non-financial aspects of life, finance, and retirement. If you’re new to the show, I want you to know what to expect. Every single Friday, I’m going to get together with you and discuss a trending topic and a lot of those trending topics that come from our Weekend Reading for Retirees email series. You have to get this email. You have to get yourself signed up to become one of our Weekend Reading for Retirees subscribers, because not only are we going to drop in your inbox every single Friday for articles on trending topics to keep you up to date on the latest trends, to make better decisions about your life and your finances.

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And then we have what’s going on today. So, every other Monday, we get together in long form and we bring to you a world-class guest. Today is no exception. We have M.T. Connelly joining us, a lawyer who draws on a blend of legal policy and legislative skills to combat the largely hidden but immense problem of elder abuse and mistreatment at a national level. She’s devoted her career to addressing the many forms of elder abuse, physical and psychological, as well as financial exploitation and wrongful deprivation of rights. She was the architect of the federal Elder Justice Act. She is the founder of the Department of Justice’s Elder Justice initiative and lead author of The Elder Justice Roadmap.

She’s also the author of a book which will be the focus of our discussion today, and we’re going to be giving away to you, The Measure of Our Age: Navigating Care, Safety, Money, and Meaning Later in Life. And if you’d like to get a free copy of that book, all you have to do is this, go ahead and write an honest rating and review of the podcast on iTunes, and then shoot us a text. If you’ve never requested a book before, this is a great way to get started. Just text us the word Book at 866-482-9559. We’ll send you a link to select the book that you would like to get. We will send you out a free copy of The Measure of Our Age. And for the first 10 people who make that request, M.T. has committed to giving you a signed copy. With that, I would love to welcome our guest at the pod today, M.T., how’s it going?

Marie-Therese Connolly: It’s going good. Thanks, Casey. Great to be here.

Casey Weade: I’m excited to have you here. I don’t feel that we’ve had a conversation quite like this on the podcast. And yet, it’s strange to me when we’ve done over 400 episodes of the podcast and we have yet to discuss in depth elder abuse. One of the things that comes up in conversations, the families we work with all the time, is this question of how do we protect ourselves? How do we protect our loved ones? How do we protect our parents and our grandparents? This is an important and very vital conversation. So, I’m really grateful to have you here with us today, because you’re someone that has a true passion for this, a true passion for this. And it’s been a huge part of your life for a really long time. I wanted to kick off the conversation just asking about that passion. When did this passion for law? And I’d say specifically, how society treats the most vulnerable within it become a passion of yours, where did that come from?

Marie-Therese Connolly: Well, as with many things, it started with my mother. My mother was a psychiatrist at a big state mental hospital back when there were a lot of those. And I thought I wanted to be a doctor. My parents thought I should be a doctor. But then I was trying to figure out what I wanted to do in medicine and how that would look. And so, I went and did what was called a resident volunteership, which was where you could go and live on a general admission psych ward for six months.

And so, I went and lived at that hospital where my mom worked, although she was in a different building, and I learned a lot. I took time off of college to do that. And what I saw was a lot of humanity, but also a lot of stuff that was really terrifying. And so, it really changed my focus because I wanted to know how to change what we do as a society in the ways that we treat the most vulnerable people among us. And clearly, with the big state hospitals, that was not a model that was working very well. And so, I wanted to figure out what were the levers and how do you get at that?

So, I went to law school, much to my parent’s chagrin at the time and then went to the Department of Justice as a baby lawyer to become, because that was like, it’s a great place to learn to be a lawyer. And I was bringing initially big civil fraud cases in the fraud section, and I really liked it, but I still sort of had in the back of my mind wanting to do something different. I had the opportunity to start leading what was initially called the Nursing Home Initiative because in the Senate, they were having a lot of hearings about abuse and neglect in nursing homes and some just really horrifying situations.

So, I started leading the Nursing Home Initiative and I thought, “Oh, look, I’ve stumbled on this huge problem.” And the more I looked, the more it became clear that I hadn’t stumbled on a new problem at all. That, in fact, it was a very old problem. And that we just as a society, had not figured out how to address the needs of the most vulnerable older people. And that, again, we had this set of institutions that often failed people.

And so, then I started digging further and it turned out that there were laws, there was what’s called the Child Abuse Prevention and Treatment Act that had been enacted in 1974, and the Violence Against Women Act that had been enacted in 1994. But there was no law to deal with elder abuse. And in fact, nursing homes were just like the tip of the iceberg in terms of what was going on for older people because most older people don’t live in nursing homes, they live at home and they live in communities and they live in other kinds of facilities. And so, you can’t just look at what’s going on in nursing homes in terms of understanding how people run into trouble in old age.

So, that then sent me on this journey, and the Elder Justice Act took a very long time to be implemented and then didn’t work out quite as well as I had hoped. There wasn’t the funding. And I thought, okay, there’s something much bigger going on here in terms of what’s going on in terms of how we as Americans think about aging, address aging, or more often, don’t address aging. So, that’s sort of what got me started on the work and what got me writing the book because I was like, there’s something much bigger going on here than I understand. And I wanted to do research, and I visited an awful lot of rabbit holes in doing that research, but also, I think, got a much clearer understanding of what’s going on.

And the way that I came to think about it is that this extraordinary thing happened in the 20th century. Between 1900 and 2000, Americans went from living an average of 48 years to an average of 78 years. That’s 30 extra years. That is a bigger jump in lifespan than all of human history combined. But our lifespans are longer than what are called our health span. So, our lifespans are 78 years, but our health spans are only 66 years. And so, that means that a lot of people have a lot of challenges as they grow older. And there are a lot more older people, so that we have all these needs as a society that we haven’t really caught up with, so that our culture and our systems and the way we even think about things haven’t kept up with the longevity. And that’s true of retirement, that’s true of how we handle health care. It’s true of long-term care system or the lack of a long-term care system. It’s true of how we manage money, and it’s true of how we think about balancing autonomy and safety interests as we grow older.

And so, sort of where I landed is that we underestimate the power of aging and we’re unprepared for its challenges. And we’re also unprepared for its best parts, for what matters most. And so, off too often, we lack the knowledge we need to improve our odds of a better old age. And that’s true as individuals. It’s true in our families, it’s true in our communities, and it’s true in society at large. And so, there’s a lot more that we can do and learn, which is why the kind of conversations that you’re having on your podcast are so important.

Casey Weade: Yeah. And you talk about all these different things. I mean, you’ve mentioned nursing homes, you talk about elder abuse, and you talk about all these different things you’ve worked on over the years. And then you have this book that is very encompassing. I read that an elder justice expert once told you that you needed to pick a lane in elder abuse field. And it doesn’t seem that you picked the lane. Maybe you did decline, but I missed it, but can you pick a lane? Have you picked a lane? What are these lanes?

Marie-Therese Connolly: Well, you’re right. I did get advice. It’s like, okay, you have to pick a lane. And the deeper I got into it, I thought, aging doesn’t pick a lane. To age well is a matter of health. It’s a matter of finances. It’s a matter of what kind of social support services we have. And it’s also a matter of our approach, our philosophy and attitude about aging. And so, I felt like I wanted to write a book that could provide readers of shortcut through some of those challenges and through some of the solutions that I was finding. And so, I wanted to put all that between the covers of the book that really looked at sort of aging writ large across a whole lot of different lanes, but also, and I didn’t really understand this as I was getting into it, sort of what a challenge I was taking on. And it was a sort of ridiculously ambitious book.

But also looking at the levels because aging is a matter of culture, like what does our culture teach us about aging? It’s a matter of the social systems. What kind of a long-term care system do we have? What kind of a financial system? What kind of a health system? What kind of social services? It’s a professional issue. How do our doctors or our bankers or our social workers think about aging and the needs of older Americans?

And then it’s a family question, and it’s a question for ourselves and sort of a deep question of consciousness of what we think about in terms of aging. And a lot of people are really, we want to get old, but we don’t want to be old. And we really don’t even want to think about what it means to get old. We want to say, “Oh, no, no, that’s not us.” And there’s a lot of fear and denial and kind of ostrich-y behavior of putting our head into the sand when it comes to aging when if we could admit it and think about it, we could actually really improve our odds of having a better old age, both ourselves and as a society.

And I think the one other way in which aging and my book doesn’t observe norms is that, I’ve come to think of it as, well, like this, that aging isn’t just an aging issue. Aging isn’t just an issue for older people. Aging is an issue for everybody. We all move through time and we’re all aging all the time and we’re all older people in training or actually older. And so, the failures of our aging policy have a profound implication on younger people, on caregivers, on the families of caregivers, on our communities, etc. So, I think we make a mistake when we think of aging has just been an issue for old people.

Casey Weade: So, I’m glad that you picked that broad scope, because there were so many different questions that came in from our Weekend Reading subscribers, and they were broad. And you’re able to actually speak to all those different things, which many are not. And I really appreciate the fact that you had that approach. Before we get into the book, I do want to make sure we talk a little bit about the Elder Justice Act. I think it’s good to add some color to this. This act you introduced to Congress in 2002 and didn’t become law until 2010, and then it was tucked into the Affordable Care Act. It didn’t actually get funded until 2015. We’re talking over a decade, like 15 years from the time that you started this till the end. And it’s probably broader than that, than we even know how long you’ve really been working on this. I assume you’re still working pretty diligently on these types of things today. When you think about that act, and it’s one that I don’t think has gotten a whole lot of attention. I don’t know that many people know what this Elder Justice Act is and what the basis of it is, what it’s actually going to do for society. What is the basis of the Elder Justice Act? I know you said you’re disappointed. What went right? What went wrong? What would you do differently?

Marie-Therese Connolly: Shortly after the Affordable Care Act was enacted, one of the leading advocates for the Affordable Care Act who had been to the White House a bajillion times and worked with Congress, I asked him about the Elder Justice Act, which was, as you said, tucked in there, 22 pages in the more than 2,000-page bill. He said, “Huh, I’m not familiar with that part of the law.” Just to give you some sense of like how much traction it had. And then, as you said, it wasn’t funded until 2015. Then it got like a pittance. There was a little bolus of money with COVID relief funds. And now, it’s gone back down to a pittance.

So, in terms of, like, if you’re measuring the impact of a law based on how much money it gets, it’s been very disappointing. You ask, I’ll start with what I would do differently today and then some things that I think it’s accomplished. What I would do differently relates primarily to prevention. When it comes to elder justice issues, we don’t really know how to prevent it. I mean, we know that good social support is correlated with reduced harm. And it kind of makes sense, right? If you’re alone in the world, you’re much more vulnerable.

But we don’t know, like, we can’t tell families or policymakers, if you do these three things, you’re going to be at lower risk for sure. We don’t have evidence-based prevention measures. So, I would have focused more on prevention because I think that with a big cultural problem like that, we’re never going to investigate or prosecute or those things are not that useful because the tears have been wept. So, I want to get further upstream. I would also want to know what’s the impact of what we’re doing now. And I would have wanted that to be part of the law to say, “Okay, what’s the impact of our current programs? And which ones are doing the most good? Let’s invest in those more.” Because we want to know that.

I would have done more what are called demonstration projects, trying to innovate at the community level, and really ask older people what kinds of things they want and need because a lot of the programs we have are either reactive or are based on what the professionals think are a good idea. Not asking the people who we’re trying to serve, what do you want? What do you think you need? And then building from there. And then, from a process perspective, there are kind of two general ways to legislate. One of them is to have a big omnibus law and to say, “Okay, here, this is this huge law, and we’re going to try and move it through Congress.” And that’s a big bet and really works best if you have a lot of political clout.

Another way to do it is to break up a law and try and put it on what’s called a moving train or moving vehicle. And I think what I learned is that elder justice issues, we don’t have very much clout politically. And so, I think I would have broken the thing up and tried to move it on different kinds of laws, a little bit on aging laws, part of mental health issues, part of substance use, because all of these issues are part of what’s going on in elder abuse often, some financial reform kinds of things. So, in terms of what I would have done differently, those are a few of the things.

In terms of what I think is hopeful, I’ll just focus on two things. One of them is, we created something called a coordinating council, the Elder Justice Coordinating Council, where the different federal agencies that have some piece of this elephant have to get together a couple times a year. And what happens when you ask the principals, the high-level people and agencies to get together is that the people who staff them figure out what’s going on on this issue and try and make sure that you have something to talk about. So, (a) it’s coordination, and (b) it’s shared accountability among a bunch of different agencies and hopefully, some kind of coordination. So, I think that has helped elevate the issue federally. It hasn’t done as much as I hoped, but it has done some stuff. And we have the 10-year anniversary of that coordinating council coming up, actually this month.

The second thing, and I think this is probably the biggest thing for me, is that it provided the field with kind of a maypole to say, “Okay, this is a real problem because it’s in the law.” And that kind of acknowledgment, elder abuse affects a ridiculous number of people. It affects 1 in 10 older Americans who are 60 and older. That’s a lot of people. That’s millions and millions of people every year. And it causes a ton of suffering. There’s also a term called concerned others, people who are trying to help older people who are in trouble. And they’re, as tens of millions of concerned others who are affected and for whom this causes a lot of stress and suffering. So, I think it’s a very invisible problem. And the law helped make it a little bit less invisible and helped create something of a constituency to say, “Okay, we need to do better as a society.”

Casey Weade: M.T., I’m grateful to have you here. And I know there’s so many that are, we need a hero like you. There’s 46 million Americans over the age of 65 that need that. And I think, as a country, we need it even broader than that. There was a quote that you had in your book that you opened the book with. “The manner in which a society behaves with its old people unequivocally reveals the truth of its principles and its ends.” And I wanted to ask you, the way that we treat our older people in our society here in the United States, what does that say about us as a country? How is that going to impact future generations?

Marie-Therese Connolly: So, it’s a quote from Simone de Beauvoir in a book she wrote on aging that’s really very bleak. But I thought that that quote was important because how we treat vulnerable people, the most vulnerable among us, reveals our character and that it’s true as a nation, it’s true as individuals. And also, we’re in this kind of liminal moment from a demographic perspective where we suddenly have a society that’s aging like it never has before in history. And so, how we address that challenge and privilege, I mean, what we lose track of, even though we don’t want to get old, we want to live longer. And so, that time is a privilege. And how we spend the time and how we look at old age in a clear-eyed way, I think, reveals a lot about us also as a people. And what we’ve done so far is pay way more attention to how we extend life to the quantity of time, as opposed to the quality of that time. And so, I think if we invest a comparable amount of energy and resources and our brain share in quality of life, that’s also going to reveal that we really value this gift of time.

Casey Weade: And you say that this is such a great time to grow old. You talk about how much longer we’re living. It all sounds like really positive stuff, right? We’re living longer. We’re healthier for longer. We have all these good things going for us. I mean, you said, this is the best time to grow old throughout history. But then, at the same time, I hear you talking about how broken things are. How can we get both?

Marie-Therese Connolly: By paying attention to both and by valuing both quantity and quality. And we haven’t kept up with our systems. I think long-term care is a great example of that. As I mentioned earlier, people’s health spans are not as long as their lifespans. A lot more people need care, a lot more people need long-term care. And yet, a lot of people think that Medicare covers long-term care. It does not. And a lot of people think that their health insurance is going to cover it, and it often does not. And long-term care insurance is very expensive. And so, the question is, how are we going to pay for care?

The other thing then is that most older people want to stay at home, understandably, as they age. So, how do we balance getting decent care at home and not becoming too isolated at home? And what that means is that a huge number of people, both because getting long-term care paid for is very expensive and beyond the reach of many millions and millions of American families and because people want to stay at home, we’re relying on family caregivers. There are more than 50 million family caregivers providing a lot of care, like on average, 24 hours a week over an average of four years. That’s a ton of care, and it’s valued at a half trillion dollars. And those caregivers are estimated to lose approximately a half trillion dollars in income.

But we’re not helping those caregivers. They’re supporting our families. They’re supporting our health system, but we don’t support them. And I think that’s a really huge problem. And then we tolerate a pretty broken long-term care system. There are a lot of bad nursing homes. Nursing homes and CCRCs get more than $100 billion in public money a year, and they get over 180 overall, but 100 billion in public dollars. And we don’t know how they’re spending those dollars. How many of those dollars actually reach the bedside and are spent on care or on staff for care. So, we need more accountability and transparency in how we spend the money that we’re spending and we need to help caregivers more. So, that’s just an example.

Casey Weade: So, you said $100 billion going to the nursing home industry and those are taxpayer dollars, right?

Marie-Therese Connolly: Correct, yeah.

Casey Weade: It’s $100 billion going to the nursing home industry. How are those dollars getting used? Where are those dollars going? Are they actually going back to the taxpayer? Or is this essentially another tax credit that an industry doesn’t need and they’re putting it in their wallet?

Marie-Therese Connolly: We don’t have the information to know how those dollars are being spent right now because they’re not required to report it. Yeah, I think it’s really a problem. I mean, it’s a problem with stewardship of the public fisc.

Casey Weade: And it seems like the owners of these communities. And largely, a lot of these communities are owned by real estate investment trusts or REITs and large private equity firms. It seems like they’re doing pretty well. I don’t see a lot of those dollars going back to improving those things, but maybe I’m wrong. But when I look at what I see from the outside, and I think this is what most people see, I mean, nursing homes get a pretty bad rap and that kind of makes me think that those dollars aren’t going to the right place.

Marie-Therese Connolly: That’s right. First, there are some wonderful nursing homes and we need good places. We need people to feel like it’s not a terrible thing if they need to rely on one. But there are a lot of bad ones. And as you said, 70% of the industry is for profit. And we don’t know how much profit has been pulled out. Everybody complains that there’s not enough money going into the system, but I don’t think we can even argue that until we know how the money is being spent. What we do know is that staffing is the most important metric in terms of quality of care, that it’s how many staff, how well they’re trained, how well they’re paid, how well they’re supervised, if they feel like their work is valued. All of those things really matter a lot to the quality of care. Like, do we value the work? Basically, also, if we value the work, it’s a way of showing that we’re valuing the people who are being cared for.

But too often, staff are not paid well, they’re not valued, etc. So, we need to do a lot, lot better in terms of that. And I think in terms of the transparency and accountability, because we can’t even really have the conversation until we know how the money is being spent, because we know what needs to be done to improve the places.

Casey Weade: I feel like we could just spend plenty of time complaining about the problem here and just really focusing on this $100 billion and just another line item on the federal budget that’s not being tracked, whatsoever. But I’m going to move beyond that and talk a little bit about that federal rating scale. So, you talk about the quality of care. The biggest marker there is the quality of those that are actually going to be working in these facilities. So, when we look at the federal rating scale for nursing homes, can we use that federal rating scale for nursing homes? Is that one of the major factors that’s actually accounted for in there? Is that a reliable metric?

Marie-Therese Connolly: So, I think, first, it’s important to say it represents progress that we have a rating scale and that we’re trying to collect some data relating to quality at all. And it’s a mixed bag, as with everything else, but there are some self-reported metrics that are not always reported accurately. The New York Times has done a bunch of investigations on this, and I cite those investigations in my book so that it’s some information. And with anything else, when we’re trying to figure out how to proceed, it’s important to look at many different kinds of information.

And here, in addition to looking at the five-star rating, which is called Nursing Home Compare and it’s part of Medicare.gov online, we should also consult with the long-term care ombudsman. The long-term care ombudsman program has been around for decades, and they represent residents and try and advocate on behalf of residents getting better care. And they also do systems advocacy. There’s also a nonprofit called the Consumer Voice for quality long-term care and they have some really great info on their website about how to find your local long-term care ombudsman, also about what are some ways that you want to go about improving how to get good care.

So, for example, how do you put together a family council if your loved one is in a nursing home and you’re a family member? Or if you’re a resident in a nursing home, how do you put together a resident council? So, there are a bunch of different things that you can do. And if you’re looking for a nursing home, you certainly want to visit, but also, you want to talk to the ombudsman, you want to talk with people on the resident council, on the family council to really get a sense. And you don’t just want to look at the dating behavior. You don’t just want to look at what they want you to see. You want to look at a bunch of different kinds of snapshots of the place to get a fuller picture.

Casey Weade: This sounds like the process that you’re really recommending for people to go through when they’re evaluating at least a nursing home. Does the same process apply to all those other levels of care, assisted living, memory care, nursing home care, the CCRCs, the continuing care retirement communities? Are all of these falling under the same rating agencies where we can kind of leverage all of these links that we’re going to put in the show notes to evaluate each of them? Or is this one pertaining to one segment?

Marie-Therese Connolly: Well, yes and no. Yes, certainly, you want to do your research no matter what kind of facility it is. And nursing homes, actually, I think, in one sense, do get an unfair rap and that there is data to measure them as opposed to assisted living and group homes, for example, in some parts of CCRCs where there’s much less data. So, it’s very hard to compare apples and apples there. So, you definitely want to do the research, but they’re not measured by the same kinds of regulators or programs.

When we were looking for my mother-in-law, who was just an extraordinary person, we visited several places. And I remember my brother-in-law asking the sales rep, “Okay, so who are the regulators?” And she went through a very long list. She said, “Well, it depends what part of the CCRC it is. Is it the memory care or the senior living or this or that?” Because there is a long list of different potential regulators, potential advocates. From an outsider’s perspective, it sounds nuts, right? And it’s so confusing. Like, how do you navigate it? You’re a family. We were fortunately not in crisis. We were trying to think about things in advance.

But especially if you’re in crisis, how do you navigate it? And I actually think complexity is one of the big problems in the system, too, is that I have been working in this field for decades and writing this stuff. The chapter four of my book is called Home, and I’m trying to lay out what are the different options and how are some ways that we can navigate them as families and individuals. And it’s so complicated. It’s something that is referred to by, I think, social scientists as administrative burden. Like, we have made things so complicated sometimes that it’s very hard to make good decisions. And I applaud you on your podcast for your focus on how do you help people make good decisions because it’s not so easy.

Casey Weade: Yeah. And I wonder if, just the bad rap a lot of nursing home gets or even assisted living facilities as well, and just the level of complexity in evaluating whether you’re making a good decision for a loved one or not results in us going, “All right, I’m overwhelmed. I just don’t know what kind of decision to make. I don’t know what the right decision is. So, I’m just going to keep mom and dad at home, or we’re going to do a home health care situation.” And that kind of becomes the default. And there’s some risks in that as well. What are some of the risks of the family taking on caregiving? What kind of factors they’d be taking into consideration?

Marie-Therese Connolly: It’s such a great question. I think, there’s getting overwhelmed. A lot of people are running pop-up hospitals in their living rooms, sometimes even pop-up ICUs, and they’re not trained to do that. Also, a caregiving journey is often not just like a few weeks or a few months. It can be years, it can be decades. And so, people, I think, underestimate the longevity of the caregiving journey. I mean, it can really create a challenge in terms of balancing caregiving and work, which is why I think we have such huge lost income numbers. It’s an area where employers are now learning that they really need to step up and understand the needs of caregivers, because I believe it’s 1 in 5 employees are caregivers. So, it’s really growing the weight, and complexity of the work often comes as a surprise and the ensuing stress.

It takes a real toll on a lot of caregivers in terms of both their physical health, their mental health. There’s huge increases in depression, anxiety, but also heart disease, immune issues, and premature mortality. It really hastens mortality of caregivers. There’s also an issue in terms of isolation, because a lot of times, people get increasingly isolated. Without the command performances of work and school, often an older person and/or a caregiver together will get increasingly isolated. And that can also be a recipe for trouble, which is another reason why we want to have a better long-term care system.

One of the models, when you think about how we have structured aging in this country, basically, there’s isolation, right? That people live alone in their houses with fewer and fewer interactions with the outside world or segregation by age that you live with other older people, either in senior living or in health facilities or care facilities that are designed generally for older people. Now, this didn’t evolve in a nefarious way, but this is what we have and we lose a lot because of that too. So I think that, and it’s another reason that we want a better system of care, one that’s inviting, one that where you feel like you’re not going to an island and being written out of your community or society, but one where you’re still part of a vibrant society and community, where you have interaction with other people and with arts and with culture and with opportunity to have purpose like volunteering and all of that.

So, I think we just need to reimagine how we provide long-term care, and we can do it. And I bet that it would be cheaper in many ways, because the medical model has failed us utterly. And there’s just so much more that we could do. And just one other footnote before that I forgot to say is that we should also, look, elder law attorneys, and care coordinators can also be really useful in terms of navigating the system at the local level.

Casey Weade: Yeah, I just want to emphasize something that you said that I think is very important, and I don’t want it to get lost on others and that is the importance of having these intergenerational relationships are being exposed to younger individuals as well. It’s a major concern of mine and something I think about maybe too much. But I look at what is happening to the retirement community and where are they going? They’re going to retirement communities, traditional retirement communities. They’re going continuing care retirement communities and that’s just leading to further and further isolation of them within those individuals that are in that same generation.

I think what I hear is most people feel like this is a great benefit. I’m going to be surrounded by people that are my age, and they’re going to be just like me, and they’re going to be in the same position. However, there’s a lot of health risks as a result of that as well. How do you think about the health risks that not having those intergenerational relationships is creating or even just thinking about a traditional retirement community, individuals going to a traditional retirement community? We know there are some really big ones in Florida, and going into those environments and not being surrounded by others that are in other generations and younger generations. How do you think about that?

Marie-Therese Connolly: I think of it as a squandering of human potential. The way that we’ve structured aging involves unnecessary losses. I don’t know if you’re familiar with the work of Marc Freedman, who runs...

Casey Weade: Yeah, he’s been on the pod.

Marie-Therese Connolly: Yeah, I’m a huge fan. I think he’s a visionary. But he says, “Young and old people are built for each other and have so much to contribute to one another.” There’s so many kids who benefit from having an older person in their lives, including mine. I feel very fortunate that my kids had, not just grandparents, but also my older friend. My law professor, Zipporah Wiseman, for example, was a very frequent visitor and was a friend to my kids in an important way. And so, those kinds of friendships across the generations, I think, are incredibly enriching in terms of our perspective of the world and also of making old age something that isn’t scary and alien, but is part of the human life cycle.

If we don’t have contact with older people when we were young, then it just seems like this shell or this husk. So, I think that a lot is lost also, I mean, in terms of what we can give one another. So, for example, one of the places in Maine, Gorham House, I believe, is a CCRC, but they’re co-located with a preschool. And so, the kids refer to the older people as grandfriends, right? There’s these relationships and really robust and lovely relationships. There are also organizations where they’re starting to have, including Marc’s CoGenerate, where they look at shared opportunities for activism across the age range. There’s so much learning.

There’s data that intergenerational workforces are more productive. It’s kind of an invisible harm in a sense. Like, we lose track of that kind of segregation. We have learned to see other kinds of segregation and the harms of other kinds of segregation. But the segregation by age, we haven’t really paid enough attention to, I think. Now, I have heard that baby boomers, of whom I am one, who tend to try and get their way and the culture, don’t want to live– they want to live in robust communities with people of all ages.

When I think about where I want to live, I don’t want to live alone, isolated in my house. I also don’t want to live in a hospital or something that’s built on a hospital with long linoleum, halls, and a nurse’s station in the middle. I want to live in a community where maybe I can get help if I need it, but with people, that’s part of the flow of my community where I have interaction with lots of different people. So, I think, we know that there are tremendous losses when we separate people and that there’s a lot to be gained in terms of health and well-being. And the people want it.

I mean, that’s the other crazy thing is that the polling on co-locating institutions for older and younger people or programs and libraries of whatever, there are a lot of different examples. And the data are amazing on them. Everybody loves the idea of it. But again, it’s that notion of administrative burden that it’s so complicated to figure out the zoning or figure out this or that, that we just sort of, as you pointed out, we give up and lose track of it and then forget what we’re losing and what could be gained.

Casey Weade: Well, it’s awesome to hear that. I love hearing about that community that’s doing that co-locating. That’s awesome to hear that we’re making some progress in that area. I want to make sure we get to some of our Weekend Reading subscribers’ questions. And we haven’t really talked about adult daycare yet, so I thought that might be a good place for us to start. You talked about working caregivers, right? A lot of those working caregivers are opting for something along the lines of adult daycare. One of our subscribers, Steve, asks, what’s the best way to use adult daycare? When is it the wrong way to deal with an aging partner or parent?

Marie-Therese Connolly: Wow. It’s a great question. There’s a lot of benefit to programs like adult daycare, and it provides often much needed respite for the caregiver at home. And so, I think that it can be a very important program. And there are some emerging good data about overall well-being in using adult daycare. Of course, you want a good program, like any kind of adult day or senior. It’s always both a structural and an idiosyncratic question. You want to do your research in your community to make sure that you’re finding a good place.

But it is a tremendous resource, and I think, for caregivers, well, there are all kinds of potential caregiver support. Again, this is where the complexity of navigating them can come in. But I think that it’s really important for caregivers to figure out what are the community supports that can help lessen the load of caregiving. And adult daycare is a really important one.

Casey Weade: I’ve seen it’d be a huge benefit to many families that we work with. And a lot of families we work with, they don’t have children. You mentioned this before is a major risk. One of the questions that we received from Cindy was, “What special challenges for elder and long-term care do retirees without children face?” And maybe, you kind of hit on this earlier. Maybe we take a deeper dive here with the second part of this question from Cindy being, “What are some of the ways to navigate them?” So, those without children, lone retirees, if you will, what are some ways that they should be navigating their elder and long-term care journey?

Marie-Therese Connolly: Such a great question. And there’s increasingly this notion of solo agers. I think, planning, planning, planning, actually, that’s true if you have kids or you don’t have kids, to start thinking about it in advance and to think about who do you want to live with, building community, because a lot of us have a combination of both blood relatives and chosen family, right? We have both our extended family and chosen families together. And a lot of us rely more on chosen family than actual family.

Actually, I recently broke my leg pretty seriously. And I live alone. And I was very dependent. And suddenly, the shoe was on the other foot. And I have the great good fortune of having three wonderful kids. My daughter lives in town, not far away, and she made all the difference. But also, my chosen family, my community was huge. I refer to it as the soup-industrial complex. I mean, I had people just bringing food and taking me to appointments and stopping by. And I was really very moved by it, and it was absolutely critical.

And they provided advice and solace and all kinds of things. So, I think, that was an example of a combination of chosen family and my kids. But it’s important if you don’t have kids, I think, to start thinking about it in advance. Like, how do you want to structure your old age? Who do you want to live with? I mean, I think about it. I don’t want to live with my kids. I want to live with my friends or with a group of people. I don’t want to be a burden on my kids. They have their own busy lives.

But I think it’s a really important question to start thinking about early before the need arises, so you can sort of start scouting around and thinking about different models, because there are so many different models in that way too. It’s an exciting world because there are a lot of different options now, and communities being built up around all sorts of interests and how do you incorporate the care element and how do you pay for it and urban world, whatever?

Casey Weade: I think the most important thing you said there is being very intentional about building a community. And I think that’s what you see when you look across the blue zones across the world. Those that have these deep, really intentional communities outside of their family, they tend to have the longest and healthiest lives as well. So, whether you’re a solo ager or not, being very intentional about that community building can be really valuable.

You spend a lot of time in the area of law. You’re a lawyer. And I think it’s important for us to touch on some of the legal questions that we received from our audience. And one is from Chris here. And Chris says that his mother is a resident at a care facility where she receives really no care. She’s 96 but fully capable, enjoys the lifestyle being with others versus being alone. She has complained of theft of some of her sentimental jewelry items that likely have little monetary value. She complains to management. No action has been taken. We’re skeptical because she may have lost or misplaced or forgot, that she no longer has the jewelry. What’s the best way to approach this type of situation?

I saw this with my grandmother, where I’d say, well, this was stolen or that’s no longer here. And you don’t really know what to do. I hesitate to go to this question because it’s so specific. I think it’s broader than that too. I think a lot of people experience this where they have someone that they love living in a facility, saying there’s theft and they don’t really know what to do about it. What’s your advice to those individuals?

Marie-Therese Connolly: It’s such a hard question and an important one. And it’s both specific and, as you said, very general too. I think it depends on the level of trust. And first of all, you want to take the allegation of face value. Too often, we disbelieve older people and to just say, “Okay, let’s look, let’s try and ask around.” Don’t assume wrongdoing. Maybe talk to the ombudsman to see whether there is a pattern in the facility, whether there have been similar complaints or not that can be sometimes a red flag.

But if she has full capacity, then there may be a problem. And so, then you go through the official channels you make the allegation, maybe you make a complaint to the survey. There are ways to make complaints through the survey system, etc. But I would talk to the long-term care ombudsman. And also, at the end of life, sometimes, as you point out, certain things take on greater value. And is there a way to think about either something else that might have value to her to assuage the psychic loss? Because it isn’t just a material loss. It’s a symbolic loss, which is I think one of the– you and I share an interest in sort of what we attach meaning to. And then how do we navigate it?

So, I think, in terms of the family, approaching it from that, what was the meaning of that of what was lost? And how can we address that best? Is there a way to either replace it or to sort of think about it or tell a story about it or to do something joyful in memory of whatever it represented?

Casey Weade: Yeah. It’s so easy to dismiss things that the vulnerable in our society say, right? And I think about it when it comes to my kids. It’s easy to dismiss what they might say or the feelings they might have, but it’s so important that we pay it so close attention to those feelings and emotions around these items, whether it’s lost jewelry or something else, and seeing how we can better understand. I think understanding might be the biggest key to that, but also doing that research, of course.

And next question comes from Mike. And it goes, “Well, what about our legal ramifications that we have here?” He says, “Is there a time limitation from the time of death that you can file an elder abuse lawsuit against the nursing home?” He says he lives in Wisconsin and assumes this may vary from state to state. How does that work? How do elder abuse lawsuits work post death? I think it’s quite obvious. It seems to be fairly straightforward how it worked during life. But what about afterlife?

Marie-Therese Connolly: Well, Mike’s exactly right. It does differ state by state. It depends on whether the kind of lawsuit would be one brought under federal law or state law. But generally, laws have what are called statutes of limitation. And so, it depends on the kind of lawsuit, what kind of statute limitations there is that would designate the time period. Often, you can sue on behalf of somebody’s estate if it’s involving some sort of material claim. So, it depends on the type of lawsuit. That is probably the best answer I can give and that talking to somebody at either legal services or an elder law attorney would be the ticket. But just because the resident has died does not mean that there’s no cause of action.

Casey Weade: That’s good to know. And we’re talking about a very specific type of scamming. Now, according to the National Council on Aging, in 2022, there are more than 88,000 complaints of fraud from people over 60 plus, resulting in $3.1 billion in losses. And we go, okay, what do we do about this? I know you’re working on the legal side a lot, but well, what can we do today? Joanne asks, “What can we do to prevent being scammed? Can a bank notify an adult child if they suspect an elderly parent is being scammed? If so, how do we set that up?” So, maybe you talk about this specifically or more broadly, how do we prevent being scammed ourselves as we age? And how do we prevent those that we love from that same risk?

Marie-Therese Connolly: So glad that Joanne had that question. So, when I think about financial exploitation, I think there are sort of three levels that we want to keep track of. One of them and we’ve just talked about this a little bit, is the symbolic value of money. Like, as we grow older, actually, all of life, but with some accelerating impact as we age, money has symbolic value. It can be a way to say thank you to somebody. It can be a way to leave a legacy. It can be a way to punish somebody, to say, “Oh, I’m going to give it all to X and not to Y,” right? So, we need to remember that in terms of financial exploitation because a lot of predators prey on– you might not have enough money to care for your loved one. And so, why don’t you invest in this get rich quick scam?

So, a lot of people become more vulnerable to scams as we age, just because of some of the ways that our brains changed. You can be completely fine in all other kinds of stuff, but it looks like we get a little bit less suspicious and that our financial capacity changes a little bit as we age or sometimes a lot. So, what does that mean in terms of financial institutions? Some of the mechanisms to protect older people can be something called a trusted contact. When you go to the hospital and you have an emergency contact, well, we now can also ask for a trusted contact on an account, somebody that the bank or investment has to contact if something looks fishy, like suddenly, money is just flowing out of the account. What’s going on? So, that’s one way.

Then financial institutions also have the capacity to put temporary hold on an account if it looks like something fishy is going on to do a quick investigation. And there are different ways that Minnesota has an interesting new law that is being tested right now. But there’s real potential here to try to stem the tide, the flow. We know, for example, also that gift cards are disproportionately used and that romance scams are more frequent with older people in terms of a way to separate older people from their money that scammers use.

But also, there’s family. Their family and friends sometimes have, let’s just say, different ideas about how an older person should dispose of their money than the older person does. And so, that then, I think, one of the things that you and I talked about earlier is having the conversation early enough. I think it’s really, really important for older people to have conversations with someone they trust, whether that’s family, financial advisor, friends, whoever it is to say this is how I want to spend my money. I want to make sure that I allocate this amount to doing travel or the concerts I want to see or the things that I really want to do versus the amount that you want to allocate for care versus sort of how do you want to spend your money and so that you think about it and talk about it in advance.

And then maybe designate a power of attorney or a trusted contact, somebody who you really trust because in all families, maybe there’s one person who’s better with the money, another person who might be better with care or arranging for care, or another person who’s better doing the research or wrangling with insurance companies. So, in any event, I think there are some protections that we can take that are largely preventive. But also, I feel like we’ve really failed as a society in this area by not giving people better tools. We don’t really have very good tools to offer people in terms of preventing against financial exploitation. And we need to do much better on that front.

And also, I think, one place I really want to see us do more work relates to purpose and isolation. We know that people who are isolated are more vulnerable to being financially exploited. So, that, I think, is a really important thing to know, to not get isolated. But then there’s also purpose. One of the stories I write about in the book relates to the saxophonist, Kenny G, whose father was in his mid to late 90s and the daughter of the father’s caregiver took $900,000 from the father over the course of a year. And the way she did it was to say, “Okay, we’re going to start a business together. I’m going to buy you an iPad and a phone and a computer, and we’re going to go into business.” It wasn’t really a business. She was buying clothes and surgeries and new cars and stuff, but it gave Mo Gorelick, Kenny G’s dad, a sense of purpose of being involved.

And then, she also said, “Okay, your kids are the enemy and I’m your friend,” right? So, drove a wedge between them. And I think the hint there for me, one really important hint, is that people need a sense of purpose. Even when you’re older, even when you have some cognitive decline, you want to have a sense of being engaged in the world. And if you don’t have that, it really makes you more vulnerable to predation of all sorts. So, I would like to see us look more at how purpose can also be protective.

Casey Weade: When you started that, I want to make sure I get this right. I think this is really important. You talked about the three different types of belief. And I don’t want to get the phrasing wrong. So, I want you to correct me. The three different areas of elder abuse, I think, so you mentioned the symbolic nature of money. I think the second one was maybe purpose. Well, just rephrase, what are those three things?

Marie-Therese Connolly: So, I think, in terms of thinking about money and financial exploitation, we need to think about the symbolic value of money. And that’s kind of the Kenny G dad. That’s like, that you want to have purpose or you want to make sure that you bolster your nest egg to take care of your wife who has medical problems or whatever. Then there’s the planning aspect, I think. So, what kinds of conversations can we have? What kinds of protections can we put in place? And just practical planning. Like, how do I want to spend my money?

And then there’s thinking very concretely about the scams and understanding that, educating ourselves about the scams as families, as individuals, so that we know more about how we’re going to be. It’s not whether, it’s how we’re going to be approached for money. And it can come from strangers. It can take a million different forms. That’s one of the problems. And why I want to say that education is not a silver bullet, because you learn about one IRS tax lien scheme, and then the next day, we’re going to fix the virus in your computer, and the next day, it’s going to be romance fraud. So, there are so many different angles and ways that people are going to be after older people’s money. And an AI is going to make it much easier, just be very, very credible in impersonating people. But I think we need to do much more as a society.

So, as individuals, we need to be aware of the symbolic value, we need to plan, and we need to educate ourselves about what are the different kinds of ways that we’re going to be approached and how can we protect against them. As a society, we’ve basically helped people get to retirement, to save to retirement, but not how to plan through retirement. And that’s both playing offense and defense. That is, thinking about how do I want to spend my money, what gives me the most meaning and purpose, and also, how do I protect the money I have so that I can spend it in the ways I want, and so that it will last throughout what is an increasingly long old age.

And so, we need to be thinking about how to play both offense and defense much better. And I think that we need to, as a society, start creating sort of like retirement plans, opt-in plans that do a number of different kinds of protection. And I write about this at the end of the money chapter that I think we should be absolutely all over, creating ways for people to, like, when you sign up for Social Security that you can say, yes, I’d like to opt in to a financial protection program that includes alerts for fraud, helpline, and assistance, financial management assistance, and not just for people who can afford it, right? Because mostly, people who can hire financial advisors, they’re people who already have money, but people who have less money need to protect it even more. And so, we need to make it affordable. And I think there are relatively simple ways to do it. We’re just not doing it.

Casey Weade: I think, as you can see here, this is a wide-ranging topic. We can’t fit it into 60 minutes. And that’s why we have this book on hand. And so, this is a very important topic. If you listen for this long, you know it’s an important topic and you probably want to go deeper, you want those checklists, you want the right questions, you want a guidebook for yourself and your family. And that’s why we partnered up here with M.T. to give away her book, The Measure of Our Age: Navigating Care, Safety, Money, and Meaning Later in Life.

If you’d like to get a free copy of that, again, just write an honest rating and review over on iTunes and then shoot us a text. Text us Book, B-O-O-K, to 866-482-9559. We’ll send you a link so that you can get your free book. And the first 10 of you that request that book, you’re going to get a signed copy directly from M.T. With that, I want to bring things to a close, but I just really want to thank you for the work that you’re doing for on the behalf of so many millions of individuals here in our country and abroad. Thank you for being a hero to us.

Marie-Therese Connolly: Well, thanks for having me. And thanks for your podcast and for amplifying these messages. It’s so important to have these conversations. So, thanks, Casey.

Casey Weade: Thanks, M.T.