Creative Minds Needed: Barriers and Opportunities to Better Care of Frail Elders

Posted originally by Disruptive Women In Health Care, June 14th, 2012


Janice Lynch SchusterBy Janice Lynch Schuster. When I was majoring in math, I was often stymied by theoretical problems that asked me to imagine things I could not conceptualize. I’d turn to my professor, JR Boyd, for advice, and it was invariably the same: Go home, lie in bed, daydream.

I thought of JR’s advice this week as I read Jonah Lehrer‘s bestseller, Imagine: How Creativity Works. Among the book’s many neurological, psychological, and sociological observations is that creative people daydream—a lot. They daydream not mindlessly or purposelessly, but with attention and intent.

Creative work, Lehrer suggests, also requires engaging outsiders, drawing in people for whom a problem is not old hat, and who can bring to it new ideas, visions, and possibilities. He suggests that creativity also requires a steady interaction with others and with the world, a willingness to see and make connections to which others are seemingly blind or indifferent.

Lehrer’s observations have some implication for work we do to make a better world for an aging population.  It may take all of us daydreaming to create a society in which we are able to see, understand, and respond to the needs of increasingly old and frail people.

As it is, the current health care system is anything but. For our elders who run into it—and run into it they do, with scores of doctors’ appointments and prescriptions and hospitalizations each year—the system is too often fragmented, failing to meet their needs for daily support and care.

Millions of Boomers will enjoy a longer old age than has any previous generation, most living into their late 70s and beyond. As they have with every other lifestage, Boomers are likely to want the current system to change, and change fast, to accommodate them. It’s what they’ve always done, only this time, they really will be charting new territory. No other generation has ever lived in such numbers for so long. But Boomers will be shocked to discover that the system they encounter  is in no position to care for them. Instead, in its current configuration, it will leave many people impoverished, isolated, and ill. We do not have the kind of comprehensive social and medical services that could enable aging people, and their caregivers, to thrive, or to live through to the end of life with meaning and dignity.

Some forward-thinking organizations are working to change the course, and have set sail in many directions, trying to find a way that will work best for most of us. Among the many innovations underway, the Community-based Care Transitions Program (CCTP) funded by the Center for Medicare and Medicaid Services, is injecting half-a-billion dollars into communities that are trying to improve what happens as people move from one care setting or provider to another. These innovative programs encourage the usual health care players to go beyond their walls and boundaries, and to work with untapped but essential partners, specifically community-based organizations. The first thirty of these awards have been made, with more to come. All are committed to breaking out of their usual medical model, working across agencies and programs to find ways to help people as they move across care settings. In the course of their work, CCTP communities are likely to find new ways to interact and engage with one another. They have the opportunity to apply some of what Lehrer suggests is essential to problem solving and creative work—the chance to work with outsiders, to welcome new players, to find more effective ways to communicate with one another, to brainstorm, to be critical, and to daydream.

With any luck, their daydreaming will become the foundation for real improvements not only in the selected communities, but in others around the country. More and more, local communities and organizations are finding that they have the ideas and the passion to overcome long-standing barriers, and to see opportunities to improve the care system. These local efforts have a long way to go—but they are a start in the journey now to secure a better future (and end) for us all.


Key words: aging, caregiving, frail elders, creativity, problem solving