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September 19, 2023

The Measure of Our Age: Navigating Care, Safety, Money, and Meaning Later in Life

By M.T. Connolly

David Godfrey, JD

The PDF in which this article appears can be found at BIFOCAL Vol. 45, Issue 1. 

To measure is to assess, to examine, or to take stock.  This book does all of that and more by looking at the experience of aging, in the current age – and the meaningful history of how the experience of today came to be. The book examines the experience of growing old in today's world. I have known for several years that M.T. Connolly was working on this book. The time that she took in research, and development of thought is reflected in the quality of this work.

M.T. entered the field of aging while working at the Department of Justice when she was asked to see what the DOJ could do to address substandard care in skilled nursing facilities. Her approach to that challenge was novel, working with the facts and laws that were available, to seek to improve the care for the most vulnerable of adults. The assignment morphed into a life’s work on the joys and challenges of aging.  

The book provides an understandable history of the issues.  Every law, rule, service, benefit, or intervention was initiated for a reason.  She leads us to understand the origin of the issue, and what has been tried to improve the system. She then explores the weaknesses, failures, and criticisms of a wide spectrum of efforts to improve the experience of aging, and the tragedy of abuse, neglect, and exploitation. These are important issues to understand, if not always pleasant to acknowledge.  If you have ever wondered how or where programs like adult protective services or skilled nursing facilities dominating long-term care came from, this book will help you understand. 

The book is one part biography of M.T., and half a dozen other pioneers in the field of protecting the rights of adults as they age, one-part investigative journalism, and one part roadmap for improvement.

There are a couple of whole truths that struck me from the text. First, she points out the difference between life expectancy and good health expectancy - 6 to 8 years on average when many of us face the greatest challenges of our life. Many authors are in search of the fountain of youth or are simply in denial about the reality of age. Few of us are fortunate to die easily in perfect health. M.T. faces the decline that is a part of life, squarely. The second truth is that programs, services, benefits, and interventions for aging adults are critically underfunded.  Aging has always been underfunded, even when compared to other underfunded needs.  She explores some of the reasons why aging is harder to fund, and some of the failed approaches to seeking funding.  Funding is hard to get without data, and data is difficult to get without funding.  I would add to this that the limited funding that is often available is often insufficient to fund both the intervention, and a meaningful assessment of the intervention.  

I have been working in this field for 25 years.  The book added depth to my understanding, revealed new ideas, and reinforced my increasing feeling that some of what we are doing to help fails the person we are trying to help, and may leave them worse off than if nothing was done.  We have tried to create legal frameworks to solve social and health care problems.  We tried to adapt models that worked for other populations, without sufficient funding, and with no real follow-up research to examine if the work improves the quality of care, or quality of life of adults as we age. Services follow the money, and money has not always funded what is best. Early in my career, I realized that many- maybe most- of the people living in skilled nursing facilities didn’t need the medical model of care that a skilled nursing facility is designed to provide.  They are there because that model of care is what is funded, and it is funded, because of the failures of the model of care that predated it. And 25 years later, inpatient care is still mandatory, home care is an optional waiver with long waiting lists for Medicaid. 

Reading this book left me with a lingering question, “have we made the system any better?  I took a very long drive to be alone with that thought, and I have to say yes, we have made things a little better.  But many of the systems are flawed, many of the adults we are trying to help or protect, are let down, or left out. The available benefits and services do not always fill the need of the person, but they are the best that we have available. This book helped this old war horse reexamine the issues, and confirmed that we have made progress, but there is still a long way to go.

This book should be required reading for anyone who wishes to improve the experience of aging, or anyone who is getting older.  It examines health care delivery, skilled care, abuse, neglect and exploitation, civil and criminal interventions, APS, elder law, financial services and how each impacts our experience as we age.  

The book and e-book are available from your favorite book seller.

David Godfrey, JD

Director, ABA Commission on Law and Aging

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