Sandy Markwood—This is Growing Old Podcast Transcript

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Sue Peschin:

Hello, and welcome to This Is Growing Old, a podcast from the Alliance for Aging Research. I’m Sue Peschin, President and CEO of the Alliance for Aging Research. Today I’m thrilled to be talking with Sandy Markwood, Chief Executive Officer of the National Association of Area Agencies on Aging, also known as n4a. Sandy, thank you so much for joining us today.

Sandy Markwood:

Sue, it’s a pleasure and it’s an honor to be with you on the podcast.

Sue Peschin:

Thank you. All right. Sandy, tell us a bit more about what the National Association of Area Agencies on Aging do, and what are some of the services offered by local Area Agencies on Aging?

Sandy Markwood:

Sure, Sue. Well, the National Association of Area Agencies on Aging is the only organization that represents the nation’s 622 Area Agencies on Aging. Also, we serve as the voice in Washington for the 250-plus Native American aging programs.

Sandy Markwood:

Our members provide services and supports to over 10 million older adults, people with disabilities, and caregivers every year in every community in the country, and that number is growing. They provide services such as congregate and home-delivered meals, medical transportation, in-home personal care, medication management. They also offer a range of health promotion and disease prevention programs such as falls prevention and chronic disease self-management.

Sandy Markwood:

These broad range of services and supports are really meant to ensure that older adults can live successfully at home and in the community, which is where we know they want to live and remain. So to support that work n4a advocates for aging services and older adults in this nation through research. We track trends in older adults, innovations in service delivery. We also work to enhance the capacity of our members to address those trends and to spur innovation and replication.

Sandy Markwood:

And we also connect older adults and their caregivers with needed services at the local level, through the Eldercare Locator, which is a national call center that we operate for the Administration on Aging and the Administration for Community Living.

Sandy Markwood:

So our members do a lot. We stand behind them as their membership organization to help them do the great jobs that they do on the ground to serve older adults every day.

Sue Peschin:

That’s awesome. Yeah, you guys do do a lot. You do a ton, and your members do so much for people at the local level. What have been some of your priorities in the last few months since the COVID-19 pandemic started?

Sandy Markwood:

Well, the COVID pandemic has impacted all of us, but particularly hard hit have been our members, the people our members serve, older adults at the community level. In looking at the services and supports that Area Agencies and Title VI programs offer to older adults, really overnight all of those services were upended.

Sandy Markwood:

So to help support our members as an Association, we thought to ensure that initially that our members were seen as essential workers in the community, so that they could do the necessary outreach and deliver the critical services to older adults at the local level, many of whom were even more vulnerable than they were before the crisis hit.

Sandy Markwood:

Also in doing that is to ensure that Area Agency and Title VI staff members to the extent possible, recognizing that getting protective equipment, PPE, is difficult for healthcare workers. But also recognizing that our staff were going into homes and dealing with vulnerable adults, that we really fought to ensure that they were on a priority list after healthcare workers to get PPE as well.

Sandy Markwood:

Then also advocating for funding to meet the growing demand for meals and other supportive services that we were seeing at the local level. As older adults became sheltered in their home, that what they didn’t have was access to meals and to get their groceries and to get their prescriptions filled.

Sandy Markwood:

But in addition to that, we also saw a great increase in social isolation of older adults. Our members were working to be able to address all of those issues for the existing client base they had, but now more and more older adults were coming forward with needs. So we fought really for additional funding through the COVID legislation to be able to meet those needs.

Sandy Markwood:

Then additionally, really working hard to help our members transition their services overnight as senior centers closed and adult daycare centers closed and evidence-based health promotion programs closed because of the COVID crisis. We worked very hard and continue to work hard with our members to ensure that they can transition those programs virtually.

Sandy Markwood:

That’s been a struggle, because traditionally, our sweet spot in service delivery is that one-on-one interaction with clients. So moving to a virtual setting was both difficult in changing our programs around, but also in the fact that either older adults and/or sometimes our staff didn’t have the technology to really be able to make that happen.

Sandy Markwood:

So there’s been a lot of work that has gone on in Area Agencies on Aging since this whole crisis hit in February. We believe that older adults will be one of the last groups, even once there is a vaccine found, that our older adults that we serve every day will be the one of the last groups that will come out of their house and come back into the community.

Sandy Markwood:

So we really believe that this crisis, this pandemic, will impact service delivery for Area Agencies on Aging Title VI programs and, most importantly, for the clients they serve for a very long time.

Sue Peschin:

Yeah. Oh, gosh. I’m sure. And we’re going to work hard hopefully with you this fall on trying to make sure older adults are able to get access to the vaccines as they become available, not just COVID-19 vaccines. We’re making sure they get their flu vaccine and anything else that they might be due for, because that’s going to be critical.

Sue Peschin:

But you listed a lot of stuff, and I’m sure not everything was met either at all or in the timeline that you guys needed it: PPE, resources, staff, a whole bunch of different things. I’m just wondering, what are some of the key issues that have kept you up at night?

Sandy Markwood:

Well, I think, when I think of those issues that keep me up at night it’s we know that there’s still older adults who are not getting the meals and not getting all of the services and supports they need. We’re working very hard to be able to do outreach, to let them know that there are organizations, there are Area Agencies and other community groups that are there to help them.

Sandy Markwood:

I think one of the hidden crisises that has arisen, which is really an issue that we knew was there before. And there has been a lot of research to show that social isolation and loneliness is a public health issue, and when we look at Medicare spending, even before this crisis, costs Medicare $6.7 billion in increased medical expenses related to that.

Sandy Markwood:

But now during this pandemic and recognizing that people are sheltered at home, but they’re isolated from their families. They’re isolated from their friends. They’re not able to go to their places of worship and their social centers.

Sandy Markwood:

We are really seeing a dramatic increase in social isolation of older adults and are struggling really, really hard to be able to do that level of outreach and to make those important connections. To be able to alleviate the negative, both physical and mental and cognitive impacts of social isolation. So that’s a major priority.

Sandy Markwood:

Again, as I mentioned before, I don’t think that is going to go away overnight even if we have a vaccine. We’ll see how long it takes us to get the COVID vaccine. But also, Sue, as you mentioned, ensuring that older adults in this interim time gets their other health care needs met. Because the other thing that we’re seeing is, as people are fearful of leaving their home, they’re also fearful of getting medical care that they need. So we’re also concerned that at the end of this crisis, whenever it ends, that what we’re going to see is a more frail and vulnerable older population because of social isolation and because of the fact that they haven’t gotten their other medical needs met.

Sue Peschin:

Wow. You bring up some really important issues. I’m so glad we’re doing this and talking about it. One thing I was just thinking about as you were speaking with the social isolation, it’s been interesting to see the introduction of supplemental benefits in the Medicare Advantage program.

Sue Peschin:

I was just thinking about how where I live in Maryland, in the school system, they had Chromebooks available for kids who needed them to continue with online education. Wouldn’t it be great if there were some type of supplemental benefit that gave older adults who otherwise didn’t have people living with them or much social connection, something like an iPad or a Chromebook or something where there could be that outside connection.

Sue Peschin:

I know it’s not the same when you’re looking at somebody on a screen. But it may be an interesting thing for us to look into and pursue, because it does seem like right now with the need for social distancing and isolation, that that’s really hard to overcome over a long period of time. And technology could really maybe help.

Sandy Markwood:

I think you’re absolutely right. I think that when we look at some of the adaptations that Area Agencies on Aging have made during this crisis, and I mentioned just a few. Transferring programs and translating in-person programs to virtual, there have been some challenges there as I raised, either in ensuring that the Area Agency on Aging staff had the technology they needed to make that transition.

Sandy Markwood:

But also, as you pointed out, ensuring that older adults have the equipment to be able to utilize that equipment. During the crisis as doctor’s office closed and we really moved very, very quickly into telehealth, one of the challenges that we saw for older clients is, one, they didn’t have the equipment. But even if they did have it, they didn’t how to set up the telehealth visit.

Sandy Markwood:

So one of the other roles that Area Agencies were really looking at supporting was being a navigator to help make that connection happen. So I think as we move forward, that even after this crisis hits, what I’m hoping is that we will incorporate more uses of technology appropriately.

Sandy Markwood:

Not that technology can replicate or completely replace that in-touch, in-person interaction that I think is really a sweet spot of Area Agencies and so many community based organizations. But how can you blend those two together so that it enhances and increases the opportunities for interaction and service delivery?

Sue Peschin:

Definitely. Yeah. I think that’s one of those lessons that we need to really think through and work on as a community, because I think there’s tremendous opportunity there.

Sue Peschin:

Okay. Well, we were so fortunate and thankful to work with you and the Eldercare Locator on a fact sheet about staying safe at home during the coronavirus crisis. Can you go through some ways that older adults and their loved ones can stay safe and healthy during this continued crisis?

Sandy Markwood:

Sure, absolutely. And Sue, I really want to thank you and the Alliance for partnering with n4a and the Eldercare Locator on that consumer flyer.

Sandy Markwood:

What we found out at the beginning of the COVID crisis is that older adults didn’t have the information or they didn’t have the right information about the virus. So that flyer was really invaluable for us to get out to older adults across the country so that they could realize that the virus was real, realize that they were at higher risk. Learn ways to protect themselves, know the symptoms, know what to do if they got sick, protect themselves from scams. But also get connected to community services.

Sandy Markwood:

To your point, what can older adults and caregivers do? I think, one, they need to know that information; that’s foundational. But I think the other critical element there is to recognize and start looking at all of the different community activities that are out there, even during this crisis. If they are having a difficult time getting meals, if they have a difficult time ordering groceries, call the Area Agency on Aging.

Sandy Markwood:

We can arrange that. We can make sure that that happens even during this crisis. If someone needs to get to dialysis or a cancer treatment, we have opportunities and ways to provide medically-based transportation to them.

Sandy Markwood:

If they need in-home supportive services, now so many of our agencies have that critical PPE; we can come into the home and provide those services. So just knowing that even during this crisis, there is help out there from trusted resources that can come into their home or provide critical services and supports to them.

Sandy Markwood:

Also, even though this crisis is going on, we are still providing critical supports to caregivers. Much of that training is now more virtual than it is in person. But support groups and educational training on how to be a caregiver.

Sandy Markwood:

Unfortunately, one of the services that is most needed by caregivers is respite care and that’s become more difficult, but we’re still looking at ways to be able to do that as well. So just knowing that there is community supports out there that can help them during this crisis, I think is critical.

Sue Peschin:

Great, good. Yes, and that’s actually a good segue into my next question. Which is, how can people listening help support their local Area Agency on Aging, as well as older adults in their communities during the pandemic?

Sandy Markwood:

Perfect question, and I’m so glad you asked. There’s so many ways that people can support Area Agencies on Aging. But one of the critical ways right now, quite honestly, is volunteering.

Sandy Markwood:

Many of the traditional volunteers for Area Agencies on Aging, those people who are out there delivering home-delivered meals or being a volunteer driver, people who are on the phones checking on older adults, those traditionally have been older adults themselves. Which, because of the COVID crisis, either cannot safely perform those duties or have chosen that they were going to relieve themselves of those duties during the COVID crisis. Which means we really need other people to step up and to help out to provide those critical services.

Sandy Markwood:

So if any of your listeners are interested in helping older adults or caregivers in their community, there’s a great need for volunteers to deliver meals, to deliver groceries and to make check-in calls. Another way is to contact the Area Agency on Aging, just like to contact area food banks, just to check to see if they are in need of donations of food or other materials or equipment during this time.

Sandy Markwood:

Again, it’s because older adults and their caregivers are having a difficult time getting out of their homes, some of the necessary food and other equipment needs that they have may be going unmet. Through donations and also through volunteering, this is a great opportunity to try to help them get those needs met.

Sue Peschin:

Terrific. Okay, good. Well, we’re going to be giving everybody contact information at the end here, but I have a light-hearted question to kind of shift things a little bit. When you were a kid, what did you imagine growing older would be like?

Sandy Markwood:

Oh, that’s a great question. It’s funny; when I was growing up, most of my interactions with older adults were with my family members, my grandparents and great-aunts and great-uncles. We had very big family.

Sandy Markwood:

What was interesting as I think back on that time and even looking at pictures back at that time, is there were a number of people who now I realize were probably in their forties or fifties, which doesn’t seem old to me at all now, that seemed old, to have just an older attitude of not really being engaged.

Sandy Markwood:

Then I had relatives who are just the opposite of that. Others who remained active and involved and were the ones that were out there reading stories and playing in the yard with the grandchildren. People who really looked at each day as an opportunity to do something new and fun and different.

Sandy Markwood:

I knew when I was growing up that I wanted to be in that latter group. I wanted to emulate them as I grew up. So I think that’s really in some ways always been there in the back of my mind as I’ve worked in aging, is how to ensure that through the work that Area Agencies, the work that we all do, whether it’s personally or professionally, that we provide people as they age with those opportunities to be engaged?

Sandy Markwood:

It’s a matter of we’re all are growing older. But I don’t want to have that attitude of being old that I think some of my relatives had.

Sue Peschin:

That’s right. Yeah. There’s a great word Dan Perry, the founder of the Alliance, used to use: “generativity.” I love that word because it has a movement to it and it is really about continued engagement. I totally hear what you’re saying and agree with you. So what do you enjoy most about growing older now?

Sandy Markwood:

It’s interesting, because my kids are in their twenties and thirties and I keep telling them, “Oh, as you get older, there’s so many wonderful things.” I think I boil it down to a few words: perspective, priorities, willingness to take risks and to recognize that to really make change in this world involves failure as well as success, and that’s okay.

Sandy Markwood:

I think that I am so glad as I get older that you don’t sweat the small stuff anymore. You really have your priorities and you can see them. And you recognize that if you really want to make a change in this world, sometimes you’ve got to step off the curb. You don’t know exactly where the pavement is beneath you, but you got to do that if you want to make change.

Sandy Markwood:

As I said, to innovate, you’re not always going to be successful, but you’re always going to learn from it, from any of the non-successful things that you do, and that will propel you forward. To me, that’s the exciting thing about aging is just have that perspective on ways that you can move forward as an individual.

Sandy Markwood:

But also, if you really embrace that, that you can also move different endeavors that you’re involved with, whether it be an organization or a civic group or anything that you’re involved with. You can move that forward too. And that sense of change and evolution, I think, is something that I find very exciting.

Sue Peschin:

That’s awesome. I love it. I think that’s a really good message, especially for younger people. Because it is so true that when we’re at younger ages, we tend to think if we make a mistake, it’s the end of the world. It is great to hear about your change in perspective. That’s terrific.

Sue Peschin:

Well, Sandy, thank you so much for a wonderful conversation and for joining us on This is Growing Old. We encourage our listeners to learn more about n4a by visiting n4a.org. And Sandy, also let us know, do you have the Eldercare Locator number? Is there anything else you want to let folks know about?

Sandy Markwood:

Sure. If you’re interested in finding out more about your Triple-A in your local community, you can find that out by either going to the n4a website that Sue gave you, or you can go to eldercare.acl.gov. Or you can call 800-677-1116 and that’s the Eldercare Locator. They’ll connect you to services in your community, but also let you know where your Area Agency on Aging is if you want to get involved and volunteer with them.

Sue Peschin:

Awesome. Okay. Well, I hope everybody checks it out. All right. That’s all for this week’s episode.

Sue Peschin:

Please join us in two weeks for our conversation with patient advocates, Jim and Geri Taylor. I’ll be talking with them about their personal experience with Geri’s Alzheimer’s disease and what it’s been like during the pandemic, their work with the Alliance’s Talk NERDY to Me training, and their latest campaign to change clinical trial recruitment in Alzheimer’s disease trials.

Sue Peschin:

So visit us at agingresearch.org to learn more about age-related conditions, diseases, and issues that impact the health of older Americans. And thanks so much for joining us today. Have a great rest of your day.