Aging and innovation: the future is older

Dr. Zayna Khayat is a futurist and expert in health care innovation — a visionary who does not shy from asking tough questions or confronting the status quo. She has spent much of her career imagining better ways to do things, exploring best practices in other countries and finding ways to integrate them here.

From 2014 to 2017, Khayat led health system innovation with the MaRS Discovery District, a major innovation hub based in Toronto. In 2017, she spent the year on secondment to the REshape Health Innovation Centre at Radboud University in Nijmegen, Netherlands as their “Innovation Sherpa.”

Today, Khayat is Vice President, Client Success & Growth, at Teladoc Health, and an adjunct professor at the Rotman School of Management. She is also a founder and faculty member of the Health Innovation School in Netherlands, and a co-author of the 2020 book The Future of Aging.

Research Money’s Leah Geller spoke with Khayat about the kinds of changes needed to improve elder care in Canada and the bright side of our rapidly aging population.

How would you describe the state of care for the elderly in Canada today?

Our care system is doing what it was designed to do. It was built on a medical model based on deficiency and sick care. We wait for symptoms of illness, for something to go wrong, and then we go fix it.

In reality, there are multiple interconnected moving parts in aging. The medical component is just one piece. There’s also interwoven social complexity such as housing, access to recreation, income security, transportation, and more.

In Canada, we equate the words long-term care with facilities like nursing homes. We think about it in terms of buildings, instead of a system of care for the elderly. When buildings are what define long-term care, you subscribe to a default pathway of warehousing the elderly when they can no longer function independently, where the system controls the variables in their environment.

It’s not surprising that this is a completely unsustainable model. According to the Conference Board of Canada, in order to keep up with demographics, we would need to more than double the current footprint of some 150,000 beds in the next decade. This is fiscally impossible and few want, need, or can afford to go into these facilities anyway.

What are the forces that are keeping Canada from performing better?

I always start with mindset. We’ve been locked in a medical mindset, a warehouse mindset, for a long time. But the approaches that stemmed from this mindset simply no longer serve us.

People are staying alive a lot longer now and, with that, accumulating medical and sociological issues, such as heart disease, dementia, isolation, or lower income. Plus, needs and expectations evolve as we age. Yet, in Canada we have these static, fixed models for elder care that are pegged to design features from more than 50 years ago.

The other barrier is governance. We’ve largely relegated care of the elderly to ministries of health, which are based on a sick care paradigm. However, caring for those who are aging is a public good that cuts across multiple sectors, such as housing, labour markets, retail, and social constructs such as ageism.

Can you provide examples of jurisdictions that are innovating around elder care?

Australia has made some big policy moves. Instead of a one-size-fits-all system like ours, they provide the elderly and their family with a budget to take care of their long-term needs on their terms. They crafted five packages (budgets) based on means and need. They basically say, “What do you need to age in the way you want to age? Figure out what services or technology you need and go get it.” And that creates a much stronger market for relevant services.

Japan has what we call a super-aging population, whereby more than 20 per cent of their population are over 65 years old. Canada will cross that threshold in around 2030, but Japan was already there more than a decade ago. They knew they could not keep approaching elder care with a medical model, using labour- and capital-intensive resources such as personal support workers and buildings. That’s where technology comes in — it can replace labour and physical assets. For example, they commonly use robots to help with cleaning, bathing and even social connection, and it is not a taboo concept there.

What are your top three recommendations for elder care in Canada?

Overall, I would say that the umbrella recommendation would be personal agency, which coincidentally has the word “age” in it — meaning choice, self-efficacy, and letting our elderly citizens call as many of the shots as possible.

My first recommendation is to expand the basket of services that can be accessed by the elderly, and are funded by the state. Instead of only funding professional health services and nursing homes, this might include a food shopping budget, or a fitness membership, or unlimited use of Uber to get around.

Secondly, I think system funders should give budgets directly to patients and their families, to enable aging in the place of choice. Provincial funding for long-term care in 2020 was more than $70,000 per resident. Give the operating budget to the family and let them get on with it, and then you can do away with the capital expenditures required to build so many buildings.

Thirdly, for the medical part of elder care, which requires trained health professionals, we need to use a team-based model instead of a solo practitioner as the gatekeeper. On that team, you’d have social workers, nurses, nutritionists — a whole complement of expertise that you can mix and match, and dial up or down as the individual moves through the later stages of aging.

If you look at the Buurtzorg model of neighbourhood-based elderly care in the Netherlands, they have teams of nurses that are self-governing and empowered to provide both medical and supportive home care services. They work at the neighbourhood level, covering about 40 patients. Team members function more like “health coaches”, focused on prevention and care independence, leveraging existing support systems in the community.

Do you see things changing in Canada any time soon?

In Ontario, we tried to adopt something like the Buurtzorg model, piloting test labs in London and Toronto. In Edmonton, they ran a patient budget pilot similar to the Australia model, where they gave a stipend to elderly patients and their families, and relatively loose guidelines on what they could spend it on. In Airdrie, Alberta, they did a bold experiment where they attempted to become a Blue Zone — a place where people live longer and healthier lives. They were at it for many years, trying to reengineer longevity back into their city.

Unfortunately, COVID happened and undermined many of these efforts in Canada. Rightly so, as the priority was managing through the crisis.

But COVID also opened up opportunities to approach care of the elderly differently. For example, it created new forms of solidarity. It exposed a lot of gaps that we can’t unsee. People had no choice but to stretch their ideas and mental models, and I’m very optimistic that social movements of change will restart and new ones will spawn.

I will say, though, that change will not come from large government entities, such as the social welfare or health care system. Here’s a case in point. After two years of COVID and many proven models to consider, look at what Ontario’s health system came up with as the fix to the lack of community capacity to help frail elderly citizens age in place: warehousing again.

Real progress will come from a groundswell of social movements for change, with visionary communities trying something out and then scaling them up. And I expect many unusual suspects will be at the table.

What else do we need to know about the future of aging in Canada?   

We need to look at the economy of aging, not from a negative perspective, but as a completely new phenomenon. As this massively influential generation of boomers move into their seventh decade, whole new sectors of the economy are emerging.

I’ve been imagining in Canada how large trusted brands and retailers need to create entirely new categories of products and services — and associated business models — to meet this demographic where they’re at. Best Buy, for example, has already jumped on board. They’ve created a new division called Assured Living and have hacked their Geek Squads with sub-teams that specialize in helping older people set up and troubleshoot their home technology. Gillette created a new type of razor for people who are shaving other people, such as adult children grooming their elderly parents.

Our ideas about the purchasing power of this segment, and how they will continue to participate in the labour force, are also rapidly evolving. For example, social norms about working after 65 years old are getting smashed, and the possibilities for societies that harness this talented workforce are immeasurable.

There’s even a whole new market emerging around death and dying. They call it the “necrotech” economy. New offerings and business models are emerging around ways to die, for example, allowing people to live on after death by preserving one’s voice or creating holograms.

Where can readers find out more?

Coming out of COVID, the Canadian social enterprise SE Health started a social movement called CourAGE: Action for Better Aging. They are a national coalition created by people and organizations working closely with aging adults. They are putting out content and ideas about changing how we look at and fulfill the needs of older adults.

I also recommend the book The Longevity Economy by Joseph F. Coughlin from the MIT AgeLab. Finally, check out Aging 2.0, an international community that is shaping what aging is going to look like in the future.

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