The Case for Medicare to Cover Home Safety Renovations

1
00:00:00,170 --> 00:00:03,950
[Music]

2
00:00:08,639 --> 00:00:12,080
hello this is olivia olson and you are

3
00:00:10,559 --> 00:00:13,920
listening to the bigger picture

4
00:00:12,080 --> 00:00:15,360
a podcast where we interview scholars

5
00:00:13,920 --> 00:00:17,119
about their research about how their

6
00:00:15,360 --> 00:00:18,720
research can make our communities better

7
00:00:17,119 --> 00:00:20,480
and more democratic

8
00:00:18,720 --> 00:00:22,320
today we're going to look into the case

9
00:00:20,480 --> 00:00:24,240
for medicare coverage of home safety

10
00:00:22,320 --> 00:00:26,000
renovations for seniors to minimize

11
00:00:24,240 --> 00:00:29,119
injurious falls

12
00:00:26,000 --> 00:00:31,519
with me today are richard green

13
00:00:29,119 --> 00:00:32,800
anthony orlando and patricia harris

14
00:00:31,519 --> 00:00:33,520
welcome and thank you so much for

15
00:00:32,800 --> 00:00:35,200
joining us

16
00:00:33,520 --> 00:00:36,960
could i have you introduce yourselves

17
00:00:35,200 --> 00:00:37,520
starting with you richard hi i'm richard

18
00:00:36,960 --> 00:00:39,920
greene

19
00:00:37,520 --> 00:00:42,399
and i am director of the usc lusk center

20
00:00:39,920 --> 00:00:44,160
for real estate and a professor

21
00:00:42,399 --> 00:00:45,440
in the price school of public policy

22
00:00:44,160 --> 00:00:48,160
marshall school of business and

23
00:00:45,440 --> 00:00:50,160
department of economics at usc

24
00:00:48,160 --> 00:00:52,399
thank you for being here with us today

25
00:00:50,160 --> 00:00:56,160
patricia hi i'm patricia harris

26
00:00:52,399 --> 00:00:59,199
i am a geriatrician at ucla

27
00:00:56,160 --> 00:01:02,879
i run a medical home visit program

28
00:00:59,199 --> 00:01:04,559
and i that's what i do

29
00:01:02,879 --> 00:01:06,479
well it's wonderful to meet you and

30
00:01:04,559 --> 00:01:07,280
finally anthony i'm an assistant

31
00:01:06,479 --> 00:01:09,840
professor of

32
00:01:07,280 --> 00:01:10,960
finance uh real estate and law at cal

33
00:01:09,840 --> 00:01:12,880
poly pomona

34
00:01:10,960 --> 00:01:14,720
but more important for the bedrosian

35
00:01:12,880 --> 00:01:16,880
center i got my phd

36
00:01:14,720 --> 00:01:18,240
in public policy and management from the

37
00:01:16,880 --> 00:01:20,080
price school at usc

38
00:01:18,240 --> 00:01:22,000
wonderful well i'm so glad that you are

39
00:01:20,080 --> 00:01:24,080
all able to join us today

40
00:01:22,000 --> 00:01:25,439
and i would love if you could tell our

41
00:01:24,080 --> 00:01:27,200
listeners right off the bat just a

42
00:01:25,439 --> 00:01:29,280
little bit about your research

43
00:01:27,200 --> 00:01:30,799
richard you want to start it off it kind

44
00:01:29,280 --> 00:01:32,159
of started with a conversation between

45
00:01:30,799 --> 00:01:34,640
the two of us so i think

46
00:01:32,159 --> 00:01:36,400
you know the inspiration the best so the

47
00:01:34,640 --> 00:01:37,840
inspiration was this was actually a

48
00:01:36,400 --> 00:01:40,079
paper that was written by

49
00:01:37,840 --> 00:01:42,799
a couple of guys named gary engelhardt

50
00:01:40,079 --> 00:01:44,799
and mike erickson

51
00:01:42,799 --> 00:01:47,280
uh five or six years ago that looked at

52
00:01:44,799 --> 00:01:50,159
the impact of

53
00:01:47,280 --> 00:01:50,880
uh falls on the frail elderly and in

54
00:01:50,159 --> 00:01:53,680
particular

55
00:01:50,880 --> 00:01:55,600
the impact of grab bars on the

56
00:01:53,680 --> 00:01:57,840
prevention of balls

57
00:01:55,600 --> 00:01:59,680
and by grab bars i mean much

58
00:01:57,840 --> 00:02:01,439
specifically in bathrooms so

59
00:01:59,680 --> 00:02:03,280
grab bars to allow people to get out of

60
00:02:01,439 --> 00:02:06,960
showers and get off the toilet

61
00:02:03,280 --> 00:02:09,920
with some support and what they found is

62
00:02:06,960 --> 00:02:11,840
you had substantial falls reduction

63
00:02:09,920 --> 00:02:13,599
when you installed these grabbers and

64
00:02:11,840 --> 00:02:15,440
they had a very clever strategy

65
00:02:13,599 --> 00:02:17,120
for determining that it was the grab

66
00:02:15,440 --> 00:02:20,400
bars not that people

67
00:02:17,120 --> 00:02:21,680
were more cautious people would put in

68
00:02:20,400 --> 00:02:24,160
grab bars which is

69
00:02:21,680 --> 00:02:25,599
if one spouse fell and as a result of

70
00:02:24,160 --> 00:02:28,239
that had grab bars

71
00:02:25,599 --> 00:02:30,560
installed if you observe the falling

72
00:02:28,239 --> 00:02:32,319
pattern of the other spouse

73
00:02:30,560 --> 00:02:33,920
you would see that they would fall much

74
00:02:32,319 --> 00:02:36,080
less often than

75
00:02:33,920 --> 00:02:37,920
those in a control group whose spouses

76
00:02:36,080 --> 00:02:38,560
did not fall and who didn't so didn't

77
00:02:37,920 --> 00:02:41,519
have

78
00:02:38,560 --> 00:02:42,400
the grab bars and what they found long

79
00:02:41,519 --> 00:02:45,200
story short

80
00:02:42,400 --> 00:02:48,959
is the cost of installing grab bars pays

81
00:02:45,200 --> 00:02:51,120
over itself in less than a year

82
00:02:48,959 --> 00:02:52,400
because of false prevention and at the

83
00:02:51,120 --> 00:02:54,160
same time

84
00:02:52,400 --> 00:02:55,440
because falls are expensive to the

85
00:02:54,160 --> 00:02:58,800
health care system

86
00:02:55,440 --> 00:03:00,000
when people break something obviously

87
00:02:58,800 --> 00:03:01,519
that's going to cost a lot of money

88
00:03:00,000 --> 00:03:02,080
because you're getting into orthopods

89
00:03:01,519 --> 00:03:05,360
when you

90
00:03:02,080 --> 00:03:08,800
when you do that um and so what there

91
00:03:05,360 --> 00:03:11,040
was a possibility of a policy

92
00:03:08,800 --> 00:03:13,760
that both saved taxpayers money and led

93
00:03:11,040 --> 00:03:16,879
to happier and more dignified

94
00:03:13,760 --> 00:03:19,440
aging that seems like a no-brainer

95
00:03:16,879 --> 00:03:20,239
okay about the time i was reading this

96
00:03:19,440 --> 00:03:23,360
paper i was

97
00:03:20,239 --> 00:03:24,480
also in the uh obama administration as a

98
00:03:23,360 --> 00:03:26,640
senior advisor to the department of

99
00:03:24,480 --> 00:03:28,879
housing urban development and i said

100
00:03:26,640 --> 00:03:30,159
at hud we should just install this stuff

101
00:03:28,879 --> 00:03:32,080
and they said yeah but

102
00:03:30,159 --> 00:03:33,840
that doesn't score well from a budget

103
00:03:32,080 --> 00:03:35,519
standpoint because we would spend all

104
00:03:33,840 --> 00:03:36,879
the money and hhs would get all the

105
00:03:35,519 --> 00:03:40,319
benefit

106
00:03:36,879 --> 00:03:40,959
and so i went to hhs and i said to them

107
00:03:40,319 --> 00:03:44,000
well

108
00:03:40,959 --> 00:03:44,879
this should be a medicare benefit but it

109
00:03:44,000 --> 00:03:46,799
proved

110
00:03:44,879 --> 00:03:48,879
difficult from both an administrative

111
00:03:46,799 --> 00:03:52,159
and legislative standpoint to actually

112
00:03:48,879 --> 00:03:55,120
implement this and so that's sort of

113
00:03:52,159 --> 00:03:56,319
my point of departure and then i'll talk

114
00:03:55,120 --> 00:03:58,400
to anthony about

115
00:03:56,319 --> 00:04:00,000
how he picked it up from there yeah i've

116
00:03:58,400 --> 00:04:02,000
been doing some research for a couple

117
00:04:00,000 --> 00:04:03,519
of years with our mutual friend and

118
00:04:02,000 --> 00:04:06,879
colleague raphael bostic

119
00:04:03,519 --> 00:04:09,120
on social determinants of health

120
00:04:06,879 --> 00:04:10,959
and how so much of our health care

121
00:04:09,120 --> 00:04:13,360
expenditures can be linked back not just

122
00:04:10,959 --> 00:04:16,479
to the medical system but to

123
00:04:13,360 --> 00:04:18,000
things out in the world everything from

124
00:04:16,479 --> 00:04:19,840
the neighborhood you grow up in with the

125
00:04:18,000 --> 00:04:21,759
type of environment that you

126
00:04:19,840 --> 00:04:23,440
live in and the air that you breathe to

127
00:04:21,759 --> 00:04:24,880
the type of the housing quality that you

128
00:04:23,440 --> 00:04:26,720
have which includes

129
00:04:24,880 --> 00:04:29,120
whether it's been renovated to have

130
00:04:26,720 --> 00:04:30,880
these home safety kind of features

131
00:04:29,120 --> 00:04:33,120
one of the challenges that raphael and i

132
00:04:30,880 --> 00:04:35,280
faced uh we did a report for the

133
00:04:33,120 --> 00:04:36,960
national academies of science was

134
00:04:35,280 --> 00:04:39,040
it's challenging to pay for these things

135
00:04:36,960 --> 00:04:40,320
for exactly the reason that richard is

136
00:04:39,040 --> 00:04:43,040
talking about which is

137
00:04:40,320 --> 00:04:44,400
you're crossing over boundaries between

138
00:04:43,040 --> 00:04:46,639
silos

139
00:04:44,400 --> 00:04:48,240
so much of social determinants of health

140
00:04:46,639 --> 00:04:50,400
requires

141
00:04:48,240 --> 00:04:51,919
fixing something that doesn't seem like

142
00:04:50,400 --> 00:04:54,960
a health care problem

143
00:04:51,919 --> 00:04:58,400
but will result in a health care

144
00:04:54,960 --> 00:05:00,000
benefit to society and so

145
00:04:58,400 --> 00:05:01,440
when richard and i started talking about

146
00:05:00,000 --> 00:05:02,080
it it seemed like a natural thing that

147
00:05:01,440 --> 00:05:04,320
we should

148
00:05:02,080 --> 00:05:06,000
propose that medicare should be more

149
00:05:04,320 --> 00:05:07,600
interested in addressing these kinds of

150
00:05:06,000 --> 00:05:09,759
social determinants of health

151
00:05:07,600 --> 00:05:10,720
and then i'll pass it over to dr harris

152
00:05:09,759 --> 00:05:13,120
because

153
00:05:10,720 --> 00:05:15,520
we realize that neither of us has any

154
00:05:13,120 --> 00:05:18,000
expertise in gerontology or

155
00:05:15,520 --> 00:05:19,919
expertise in older americans health care

156
00:05:18,000 --> 00:05:24,479
and so we really needed somebody to make

157
00:05:19,919 --> 00:05:28,160
sure that we weren't crazy

158
00:05:24,479 --> 00:05:31,520
so i was very happy to provide the

159
00:05:28,160 --> 00:05:35,520
uh boots on the ground expertise

160
00:05:31,520 --> 00:05:37,440
including risk factors for falls

161
00:05:35,520 --> 00:05:38,720
interventions that have been shown to

162
00:05:37,440 --> 00:05:41,120
reduce falls

163
00:05:38,720 --> 00:05:42,639
and and just give a general background

164
00:05:41,120 --> 00:05:46,160
as to

165
00:05:42,639 --> 00:05:47,919
how one could implement a policy like

166
00:05:46,160 --> 00:05:51,919
this and and make it

167
00:05:47,919 --> 00:05:53,440
workable so i i kind of was the the

168
00:05:51,919 --> 00:05:57,120
background person and the

169
00:05:53,440 --> 00:06:00,720
um out of ivory tower person

170
00:05:57,120 --> 00:06:03,039
as well and i think it's a great idea

171
00:06:00,720 --> 00:06:05,280
and you're absolutely right this is a

172
00:06:03,039 --> 00:06:08,319
social determinant of health

173
00:06:05,280 --> 00:06:10,400
it is also a problem that people don't

174
00:06:08,319 --> 00:06:11,600
recognize as a problem unless it's

175
00:06:10,400 --> 00:06:15,360
brought up to them

176
00:06:11,600 --> 00:06:17,440
and a policy that would put a grab bar

177
00:06:15,360 --> 00:06:20,880
in place before

178
00:06:17,440 --> 00:06:21,520
a person actually fell could only be a

179
00:06:20,880 --> 00:06:23,440
benefit

180
00:06:21,520 --> 00:06:25,440
and i think the dark paper shows that

181
00:06:23,440 --> 00:06:27,360
wonderful so one of the things that was

182
00:06:25,440 --> 00:06:29,520
both mentioned in the article and that

183
00:06:27,360 --> 00:06:30,560
you all touched on to some extent was

184
00:06:29,520 --> 00:06:32,639
the issue of

185
00:06:30,560 --> 00:06:34,240
generating political will and actually

186
00:06:32,639 --> 00:06:37,039
implementing this policy

187
00:06:34,240 --> 00:06:38,720
how do you see overcoming the barrier of

188
00:06:37,039 --> 00:06:40,960
generating political will and

189
00:06:38,720 --> 00:06:42,560
what do you hope to have happen as an

190
00:06:40,960 --> 00:06:43,919
outcome well i i'd be curious for

191
00:06:42,560 --> 00:06:45,199
richard to say a little bit more about

192
00:06:43,919 --> 00:06:46,960
his experience in the obama

193
00:06:45,199 --> 00:06:49,280
administration and what he sees

194
00:06:46,960 --> 00:06:51,280
as the as he knows some of the people

195
00:06:49,280 --> 00:06:51,759
who are in the biden administration now

196
00:06:51,280 --> 00:06:53,280
but

197
00:06:51,759 --> 00:06:55,120
i will say that i think we're more

198
00:06:53,280 --> 00:06:56,479
optimistic that these types of ideas

199
00:06:55,120 --> 00:06:58,000
will be taken seriously

200
00:06:56,479 --> 00:07:00,000
over the next four years than they might

201
00:06:58,000 --> 00:07:02,319
have been over the previous four years

202
00:07:00,000 --> 00:07:04,240
and i do think that at least in the

203
00:07:02,319 --> 00:07:05,840
spheres that we work in in public policy

204
00:07:04,240 --> 00:07:08,000
there is a growing

205
00:07:05,840 --> 00:07:10,400
understanding of the fact that so many

206
00:07:08,000 --> 00:07:12,720
issues are interdisciplinary and that

207
00:07:10,400 --> 00:07:13,199
they require interdisciplinary solutions

208
00:07:12,720 --> 00:07:15,840
and

209
00:07:13,199 --> 00:07:17,759
places like usc and ucla are starting to

210
00:07:15,840 --> 00:07:19,199
invest more and more in that so

211
00:07:17,759 --> 00:07:21,520
hopefully there's a growing awareness

212
00:07:19,199 --> 00:07:23,440
that pushes for it but i can't speak to

213
00:07:21,520 --> 00:07:26,400
the inside politics as

214
00:07:23,440 --> 00:07:28,080
as well as richard came so well to some

215
00:07:26,400 --> 00:07:29,599
extent

216
00:07:28,080 --> 00:07:32,080
patricia helped me with the inside

217
00:07:29,599 --> 00:07:32,639
politics because she was a health policy

218
00:07:32,080 --> 00:07:34,319
fellow

219
00:07:32,639 --> 00:07:36,240
at the department of health and human

220
00:07:34,319 --> 00:07:38,639
services some years ago

221
00:07:36,240 --> 00:07:39,520
and while she was there one of her

222
00:07:38,639 --> 00:07:42,560
colleagues

223
00:07:39,520 --> 00:07:44,000
as a fellow uh became a senior official

224
00:07:42,560 --> 00:07:46,240
at cme who are the people

225
00:07:44,000 --> 00:07:47,440
who determine how medicare and medicaid

226
00:07:46,240 --> 00:07:49,840
spending is

227
00:07:47,440 --> 00:07:51,919
done is it both medicare i guess just

228
00:07:49,840 --> 00:07:54,560
medicare not medicare medicaid

229
00:07:51,919 --> 00:07:56,560
anyway it could be both okay that's

230
00:07:54,560 --> 00:07:58,479
where yeah dr harris knows a whole lot

231
00:07:56,560 --> 00:07:59,120
more than i do but anyway i brought this

232
00:07:58,479 --> 00:08:02,479
idea

233
00:07:59,120 --> 00:08:04,160
to this official and she was very

234
00:08:02,479 --> 00:08:06,639
enthusiastic about it

235
00:08:04,160 --> 00:08:08,080
and on the grounds that for starters i

236
00:08:06,639 --> 00:08:09,599
was the rare person who was bringing an

237
00:08:08,080 --> 00:08:10,720
idea about something that should be

238
00:08:09,599 --> 00:08:13,440
covered

239
00:08:10,720 --> 00:08:14,479
where i had no financial interest in it

240
00:08:13,440 --> 00:08:17,520
being

241
00:08:14,479 --> 00:08:18,560
covered is usually for if somebody wants

242
00:08:17,520 --> 00:08:20,879
equipment

243
00:08:18,560 --> 00:08:22,639
covered under medicare the person

244
00:08:20,879 --> 00:08:24,879
wanting that equipment to be covered is

245
00:08:22,639 --> 00:08:26,720
the manufacturer or inventor of that

246
00:08:24,879 --> 00:08:28,000
equipment they have a financial stake in

247
00:08:26,720 --> 00:08:29,680
it and so she said that

248
00:08:28,000 --> 00:08:31,039
the nice thing about me bringing this to

249
00:08:29,680 --> 00:08:34,959
their attention was

250
00:08:31,039 --> 00:08:37,039
that i was pristine

251
00:08:34,959 --> 00:08:39,440
in general i'm not a pristine person at

252
00:08:37,039 --> 00:08:40,000
all but in this particular matter i was

253
00:08:39,440 --> 00:08:43,200
pristine

254
00:08:40,000 --> 00:08:44,800
i had no financial interest in uh

255
00:08:43,200 --> 00:08:46,640
making sure this happened and so she was

256
00:08:44,800 --> 00:08:47,279
very enthusiastic about it she saw the

257
00:08:46,640 --> 00:08:51,120
idea

258
00:08:47,279 --> 00:08:53,040
right away but as she explained it to me

259
00:08:51,120 --> 00:08:57,200
there had been legislation

260
00:08:53,040 --> 00:08:58,000
several many years ago that defined grab

261
00:08:57,200 --> 00:08:59,839
bars and

262
00:08:58,000 --> 00:09:02,560
what are called convenience devices

263
00:08:59,839 --> 00:09:04,560
instead of medical equipment devices

264
00:09:02,560 --> 00:09:06,480
and as a result of that you needed to go

265
00:09:04,560 --> 00:09:08,240
through a process for a patient to be

266
00:09:06,480 --> 00:09:09,120
able to get access to this and have it

267
00:09:08,240 --> 00:09:12,320
be covered so

268
00:09:09,120 --> 00:09:13,839
it can be covered but it is it's almost

269
00:09:12,320 --> 00:09:16,560
like this is the problem it's an

270
00:09:13,839 --> 00:09:17,360
after the fact kind of thing right you

271
00:09:16,560 --> 00:09:20,399
have to show

272
00:09:17,360 --> 00:09:22,720
demonstrated need uh

273
00:09:20,399 --> 00:09:23,519
which often means people have fallen

274
00:09:22,720 --> 00:09:25,279
already well

275
00:09:23,519 --> 00:09:26,959
the whole point is you want to install

276
00:09:25,279 --> 00:09:30,320
it before it's fallen

277
00:09:26,959 --> 00:09:32,959
and in order for this to

278
00:09:30,320 --> 00:09:33,839
um so for in order for there to be a

279
00:09:32,959 --> 00:09:35,440
change there would have to be

280
00:09:33,839 --> 00:09:38,480
legislation

281
00:09:35,440 --> 00:09:40,399
that would allow for cme to

282
00:09:38,480 --> 00:09:42,480
designate this a medical device which

283
00:09:40,399 --> 00:09:45,519
could mean that they use it

284
00:09:42,480 --> 00:09:47,160
as a preventative as opposed to a

285
00:09:45,519 --> 00:09:48,839
curative

286
00:09:47,160 --> 00:09:50,880
[Music]

287
00:09:48,839 --> 00:09:52,800
intervention well when i was in the

288
00:09:50,880 --> 00:09:56,000
obama administration as you may remember

289
00:09:52,800 --> 00:09:57,839
republicans held both seats of congress

290
00:09:56,000 --> 00:10:01,040
both sides of congress

291
00:09:57,839 --> 00:10:03,680
and you know i will be bipartisan here

292
00:10:01,040 --> 00:10:04,160
although i really hate to be bipartisan

293
00:10:03,680 --> 00:10:05,680
uh

294
00:10:04,160 --> 00:10:07,760
i mean nobody was interested in making

295
00:10:05,680 --> 00:10:10,800
anybody look good in washington

296
00:10:07,760 --> 00:10:11,519
at that time and and so trying so so i

297
00:10:10,800 --> 00:10:13,760
talked

298
00:10:11,519 --> 00:10:14,560
with some of the usual lobbying groups

299
00:10:13,760 --> 00:10:17,839
they

300
00:10:14,560 --> 00:10:19,120
showed some interest in it

301
00:10:17,839 --> 00:10:20,399
i think people can figure out who i'm

302
00:10:19,120 --> 00:10:22,160
talking about but i don't want to throw

303
00:10:20,399 --> 00:10:24,640
them under the bus as being an effective

304
00:10:22,160 --> 00:10:26,240
because i think they tried but just

305
00:10:24,640 --> 00:10:27,440
getting anything through congress and

306
00:10:26,240 --> 00:10:30,640
onto the president's desk

307
00:10:27,440 --> 00:10:32,160
during that period was very difficult uh

308
00:10:30,640 --> 00:10:34,399
and now i think the key thing

309
00:10:32,160 --> 00:10:37,440
politically is now that we have

310
00:10:34,399 --> 00:10:37,920
uh a president and congress from the

311
00:10:37,440 --> 00:10:41,360
same

312
00:10:37,920 --> 00:10:43,279
party uh perhaps

313
00:10:41,360 --> 00:10:45,200
if this has adequately raised people's

314
00:10:43,279 --> 00:10:46,079
attention there might be an opportunity

315
00:10:45,200 --> 00:10:48,640
in the next two years

316
00:10:46,079 --> 00:10:49,920
to do something with this wow that is

317
00:10:48,640 --> 00:10:52,160
wonderful news

318
00:10:49,920 --> 00:10:54,800
well no no no i said perhaps i mean i

319
00:10:52,160 --> 00:10:56,320
just do a bunch of caveats out there and

320
00:10:54,800 --> 00:10:58,000
still i'm still taking that as a

321
00:10:56,320 --> 00:11:00,480
positive and here we are

322
00:10:58,000 --> 00:11:02,800
doing an interview and raising some more

323
00:11:00,480 --> 00:11:06,079
attention and interest in this topic

324
00:11:02,800 --> 00:11:09,120
so i can only help right

325
00:11:06,079 --> 00:11:11,040
well you mentioned your own pristine

326
00:11:09,120 --> 00:11:13,200
financial interest background

327
00:11:11,040 --> 00:11:15,120
but on the subject of this one

328
00:11:13,200 --> 00:11:16,480
particular and this one okay yes

329
00:11:15,120 --> 00:11:18,720
in this one particular we'll get into

330
00:11:16,480 --> 00:11:20,240
that a different time

331
00:11:18,720 --> 00:11:22,000
but could you talk a little bit about

332
00:11:20,240 --> 00:11:23,760
the financial feasibility

333
00:11:22,000 --> 00:11:25,839
of this getting off the ground and being

334
00:11:23,760 --> 00:11:27,680
financed by medicare i can give a couple

335
00:11:25,839 --> 00:11:28,240
numbers to get the conversation started

336
00:11:27,680 --> 00:11:30,880
so

337
00:11:28,240 --> 00:11:31,519
we uh richard mentioned that in the

338
00:11:30,880 --> 00:11:33,920
paper by

339
00:11:31,519 --> 00:11:35,200
mike erickson and gary englehart that

340
00:11:33,920 --> 00:11:37,120
you know they had done an initial

341
00:11:35,200 --> 00:11:38,480
benefit cost analysis and they

342
00:11:37,120 --> 00:11:41,279
essentially showed that

343
00:11:38,480 --> 00:11:42,079
in only a year or two afterwards the

344
00:11:41,279 --> 00:11:45,200
benefits were

345
00:11:42,079 --> 00:11:46,959
over ninety percent of the cost uh and

346
00:11:45,200 --> 00:11:47,440
inching towards a hundred percent and

347
00:11:46,959 --> 00:11:49,040
then

348
00:11:47,440 --> 00:11:51,440
what we did was try to update those

349
00:11:49,040 --> 00:11:53,519
numbers because the health care

350
00:11:51,440 --> 00:11:55,600
costs since they had done their study

351
00:11:53,519 --> 00:11:57,360
had grown a lot faster than inflation so

352
00:11:55,600 --> 00:12:00,320
the medical savings

353
00:11:57,360 --> 00:12:00,959
that you could get was actually now much

354
00:12:00,320 --> 00:12:03,279
higher

355
00:12:00,959 --> 00:12:05,360
than the costs we said we found that it

356
00:12:03,279 --> 00:12:08,320
was uh somewhere closer to over

357
00:12:05,360 --> 00:12:10,639
you know 20 percent so a dollar 20 cents

358
00:12:08,320 --> 00:12:12,480
is saved in the long run

359
00:12:10,639 --> 00:12:13,920
relative to the costs it extremely

360
00:12:12,480 --> 00:12:15,680
happened it wasn't really long run i

361
00:12:13,920 --> 00:12:16,560
mean a year is not oh sorry you're right

362
00:12:15,680 --> 00:12:18,160
over two years

363
00:12:16,560 --> 00:12:19,680
not the long run at all so that's

364
00:12:18,160 --> 00:12:20,320
another point that we made in the paper

365
00:12:19,680 --> 00:12:22,800
is that

366
00:12:20,320 --> 00:12:24,480
actually mike and his co-authors did a

367
00:12:22,800 --> 00:12:26,560
very conservative estimate because

368
00:12:24,480 --> 00:12:29,120
they're only looking over two years

369
00:12:26,560 --> 00:12:30,000
uh they're not looking at fatal falls

370
00:12:29,120 --> 00:12:33,040
which can be

371
00:12:30,000 --> 00:12:35,279
a lot more expensive uh and

372
00:12:33,040 --> 00:12:36,079
they're not looking at non-medical

373
00:12:35,279 --> 00:12:37,600
savings

374
00:12:36,079 --> 00:12:39,839
so richard mentioned you know the the

375
00:12:37,600 --> 00:12:41,600
stresses that come with a fall

376
00:12:39,839 --> 00:12:42,959
the stress is not only on the person

377
00:12:41,600 --> 00:12:43,839
who's affected but also on the

378
00:12:42,959 --> 00:12:46,000
caregivers

379
00:12:43,839 --> 00:12:47,839
which i think dr harris can speak more

380
00:12:46,000 --> 00:12:50,000
specifically about what that's like

381
00:12:47,839 --> 00:12:52,399
from the from the perspective of seeing

382
00:12:50,000 --> 00:12:54,399
the families go through all this so the

383
00:12:52,399 --> 00:12:56,160
benefit cost was one thing that we tried

384
00:12:54,399 --> 00:12:57,760
to emphasize

385
00:12:56,160 --> 00:12:59,360
and speaking is what we can do

386
00:12:57,760 --> 00:13:00,880
politically to your other question i

387
00:12:59,360 --> 00:13:02,639
think it's relevant to say

388
00:13:00,880 --> 00:13:04,240
as scholars there's only so much we can

389
00:13:02,639 --> 00:13:06,240
do but at least we can

390
00:13:04,240 --> 00:13:07,760
try to give the evidence that people can

391
00:13:06,240 --> 00:13:09,839
use to make the argument

392
00:13:07,760 --> 00:13:11,360
and so the other uh the other

393
00:13:09,839 --> 00:13:12,399
calculations that we did that we thought

394
00:13:11,360 --> 00:13:14,240
would be helpful

395
00:13:12,399 --> 00:13:15,920
is to show how much cost are we really

396
00:13:14,240 --> 00:13:18,480
talking about to medicare

397
00:13:15,920 --> 00:13:19,279
you can imagine a politician saying well

398
00:13:18,480 --> 00:13:21,200
maybe it'll

399
00:13:19,279 --> 00:13:23,120
pan out in the long run but right now i

400
00:13:21,200 --> 00:13:24,720
don't want to spend that much money

401
00:13:23,120 --> 00:13:26,959
and we said okay let's look at three

402
00:13:24,720 --> 00:13:28,880
different scenarios a very small

403
00:13:26,959 --> 00:13:31,440
scenario where you do a pilot program

404
00:13:28,880 --> 00:13:34,639
with a hundred thousand beneficiaries

405
00:13:31,440 --> 00:13:35,519
a middle scenario where you do any new

406
00:13:34,639 --> 00:13:38,240
enrollees

407
00:13:35,519 --> 00:13:40,079
each year which is about 1.7 million

408
00:13:38,240 --> 00:13:41,680
enrollees every year

409
00:13:40,079 --> 00:13:43,199
or a scenario where you try to cover

410
00:13:41,680 --> 00:13:45,040
everybody no matter how long they've

411
00:13:43,199 --> 00:13:47,360
been on medicare

412
00:13:45,040 --> 00:13:48,480
and in the smallest scenario which is

413
00:13:47,360 --> 00:13:50,480
not small 100

414
00:13:48,480 --> 00:13:52,880
000 people would be a great benefit for

415
00:13:50,480 --> 00:13:55,279
society you're talking about

416
00:13:52,880 --> 00:13:56,720
less than one-tenth of one percent of

417
00:13:55,279 --> 00:13:58,240
the medicare budget

418
00:13:56,720 --> 00:13:59,920
you know it's a very small amount these

419
00:13:58,240 --> 00:14:01,440
are very cost-effective things to do

420
00:13:59,920 --> 00:14:02,720
it's not expensive to make these

421
00:14:01,440 --> 00:14:05,199
renovations

422
00:14:02,720 --> 00:14:06,560
especially relative to the size of how

423
00:14:05,199 --> 00:14:09,519
much medicare spends

424
00:14:06,560 --> 00:14:11,279
and even in the situation where everyone

425
00:14:09,519 --> 00:14:13,199
could possibly get it and we were making

426
00:14:11,279 --> 00:14:13,760
very conservative assumptions about all

427
00:14:13,199 --> 00:14:14,959
of this

428
00:14:13,760 --> 00:14:17,199
you're talking about less than two

429
00:14:14,959 --> 00:14:18,480
percent of the medicare budget

430
00:14:17,199 --> 00:14:20,000
so those are kind of the ballpark

431
00:14:18,480 --> 00:14:21,680
numbers that we came up with and we

432
00:14:20,000 --> 00:14:23,760
hoped would be helpful to

433
00:14:21,680 --> 00:14:25,600
policymakers trying to make this pitch

434
00:14:23,760 --> 00:14:29,440
patricia do you have anything to add

435
00:14:25,600 --> 00:14:31,839
no i think he made his case very

436
00:14:29,440 --> 00:14:33,040
succinctly the the only thing i could

437
00:14:31,839 --> 00:14:36,000
add is sometimes

438
00:14:33,040 --> 00:14:37,519
in population health we look at the

439
00:14:36,000 --> 00:14:41,839
number needed to treat

440
00:14:37,519 --> 00:14:44,160
so how many people would require

441
00:14:41,839 --> 00:14:45,600
how many grab bars would be required

442
00:14:44,160 --> 00:14:49,120
before you actually

443
00:14:45,600 --> 00:14:51,440
prevented one injurious fall and our

444
00:14:49,120 --> 00:14:53,519
we don't have the exact numbers but just

445
00:14:51,440 --> 00:14:55,760
knowing not in this paper but in other

446
00:14:53,519 --> 00:14:58,240
papers a intervention like this the

447
00:14:55,760 --> 00:15:01,519
number needed to treat is quite low like

448
00:14:58,240 --> 00:15:03,519
five people would need to be treated so

449
00:15:01,519 --> 00:15:06,160
to speak with a grab bar before you

450
00:15:03,519 --> 00:15:08,959
prevented one fall

451
00:15:06,160 --> 00:15:10,480
you know in cancer number needed to

452
00:15:08,959 --> 00:15:13,600
treat is sometimes

453
00:15:10,480 --> 00:15:15,680
up to a hundred to get one benefit so

454
00:15:13,600 --> 00:15:19,360
you're looking at a very

455
00:15:15,680 --> 00:15:21,760
cost effective way of

456
00:15:19,360 --> 00:15:24,000
keeping people healthier and anthony to

457
00:15:21,760 --> 00:15:25,760
to go back to your earlier point about a

458
00:15:24,000 --> 00:15:27,199
limited role as scholars and

459
00:15:25,760 --> 00:15:28,800
implementing change

460
00:15:27,199 --> 00:15:30,720
what do you think that people such as

461
00:15:28,800 --> 00:15:33,360
our listeners can do to

462
00:15:30,720 --> 00:15:34,800
help promote this as change that needs

463
00:15:33,360 --> 00:15:36,000
to happen well that's a question i

464
00:15:34,800 --> 00:15:38,000
wrestle with a lot

465
00:15:36,000 --> 00:15:40,079
i think we all feel like we wish we had

466
00:15:38,000 --> 00:15:43,120
more influence for those of us

467
00:15:40,079 --> 00:15:45,759
who are um you know invested in caring

468
00:15:43,120 --> 00:15:49,360
about these issues and about our society

469
00:15:45,759 --> 00:15:50,959
um i mean part of it is is just

470
00:15:49,360 --> 00:15:52,800
making sure that you vote and making

471
00:15:50,959 --> 00:15:55,680
sure that you vote for leaders who you

472
00:15:52,800 --> 00:15:58,800
think take these issues seriously

473
00:15:55,680 --> 00:15:59,680
who both have the intellectual capacity

474
00:15:58,800 --> 00:16:02,160
that they really

475
00:15:59,680 --> 00:16:03,920
think about these issues and that they

476
00:16:02,160 --> 00:16:06,000
actually care about

477
00:16:03,920 --> 00:16:07,040
these issues i think it's i'm not going

478
00:16:06,000 --> 00:16:08,399
to again

479
00:16:07,040 --> 00:16:10,480
following richard's lead i'll keep it

480
00:16:08,399 --> 00:16:12,000
bipartisan i'm not going to recommend

481
00:16:10,480 --> 00:16:13,839
any particular

482
00:16:12,000 --> 00:16:15,279
politicians but i think it's clear that

483
00:16:13,839 --> 00:16:17,519
some uh

484
00:16:15,279 --> 00:16:18,880
experts think more about these things

485
00:16:17,519 --> 00:16:20,399
and care more about these things than

486
00:16:18,880 --> 00:16:23,600
others

487
00:16:20,399 --> 00:16:26,160
and i mean i i'd be curious to hear what

488
00:16:23,600 --> 00:16:29,279
richard and patty have to say because

489
00:16:26,160 --> 00:16:32,639
you know we in our personal roles

490
00:16:29,279 --> 00:16:34,399
as professors as a doctor

491
00:16:32,639 --> 00:16:36,079
you know we interact with people on a

492
00:16:34,399 --> 00:16:37,600
daily basis where we can educate

493
00:16:36,079 --> 00:16:40,160
them a little bit more about these types

494
00:16:37,600 --> 00:16:41,680
of issues and i think we all hope

495
00:16:40,160 --> 00:16:44,000
that people will then take what they've

496
00:16:41,680 --> 00:16:46,079
learned and then talk about it with

497
00:16:44,000 --> 00:16:47,920
with other people in their community i

498
00:16:46,079 --> 00:16:49,600
mean one challenge we have in

499
00:16:47,920 --> 00:16:51,519
with the social determinants of health

500
00:16:49,600 --> 00:16:53,680
is that some communities are just much

501
00:16:51,519 --> 00:16:54,800
better educated about these issues than

502
00:16:53,680 --> 00:16:57,199
others

503
00:16:54,800 --> 00:16:58,959
and even spreading the word about how

504
00:16:57,199 --> 00:17:00,800
important this issue is

505
00:16:58,959 --> 00:17:02,560
might inspire some families to make the

506
00:17:00,800 --> 00:17:04,079
renovations on their own if they can

507
00:17:02,560 --> 00:17:06,240
afford to do it

508
00:17:04,079 --> 00:17:08,559
and that would be a plus too if it's

509
00:17:06,240 --> 00:17:11,439
within their financial means

510
00:17:08,559 --> 00:17:13,439
yeah i would agree with that completely

511
00:17:11,439 --> 00:17:16,559
the big picture obviously

512
00:17:13,439 --> 00:17:19,679
is making it a medicare benefit but

513
00:17:16,559 --> 00:17:24,240
from a smaller

514
00:17:19,679 --> 00:17:27,439
scale we could consider education on the

515
00:17:24,240 --> 00:17:28,319
more local level including senior

516
00:17:27,439 --> 00:17:33,360
centers

517
00:17:28,319 --> 00:17:37,280
once they're up and running again

518
00:17:33,360 --> 00:17:40,880
or even uh considering

519
00:17:37,280 --> 00:17:43,520
a alternative payment

520
00:17:40,880 --> 00:17:46,480
system in medicare for example medicare

521
00:17:43,520 --> 00:17:50,080
advantage which is an hmo

522
00:17:46,480 --> 00:17:52,799
uh scheme for payment they have

523
00:17:50,080 --> 00:17:53,200
much less stringent requirements on

524
00:17:52,799 --> 00:17:56,720
their

525
00:17:53,200 --> 00:17:59,919
capitated fees and so they may actually

526
00:17:56,720 --> 00:18:01,200
consider putting in grab bars for their

527
00:17:59,919 --> 00:18:03,120
insurers without

528
00:18:01,200 --> 00:18:05,280
going through medicare was they're

529
00:18:03,120 --> 00:18:08,000
allowed to do that kind of thing

530
00:18:05,280 --> 00:18:10,000
so if we are thinking more broadly we

531
00:18:08,000 --> 00:18:12,880
should start thinking more locally

532
00:18:10,000 --> 00:18:13,760
can you explain cavitation briefly oh

533
00:18:12,880 --> 00:18:17,120
excuse me

534
00:18:13,760 --> 00:18:20,799
capitation is a system where an

535
00:18:17,120 --> 00:18:22,720
insurer will pay or

536
00:18:20,799 --> 00:18:24,640
in this case medicare will pay the

537
00:18:22,720 --> 00:18:27,039
insurer a top rate

538
00:18:24,640 --> 00:18:29,440
cover a patient for all of their medical

539
00:18:27,039 --> 00:18:32,960
needs regardless of how much that

540
00:18:29,440 --> 00:18:35,120
person actually costs so

541
00:18:32,960 --> 00:18:37,360
the idea is to pull resources among

542
00:18:35,120 --> 00:18:40,559
everybody in that

543
00:18:37,360 --> 00:18:43,440
hmo every patient and

544
00:18:40,559 --> 00:18:46,400
spend them according to to need rather

545
00:18:43,440 --> 00:18:50,480
than simple costs

546
00:18:46,400 --> 00:18:50,480
therefore they have many more

547
00:18:50,799 --> 00:18:54,960
what's the word they have much more

548
00:18:52,799 --> 00:18:55,360
leeway to do what they want with the

549
00:18:54,960 --> 00:18:57,679
money

550
00:18:55,360 --> 00:18:59,919
including population health and public

551
00:18:57,679 --> 00:19:03,200
health kind of measures

552
00:18:59,919 --> 00:19:04,480
like grab bars um whereas medicare would

553
00:19:03,200 --> 00:19:07,200
be much more stringent

554
00:19:04,480 --> 00:19:08,480
yeah so it's you just gave me an idea i

555
00:19:07,200 --> 00:19:10,559
didn't have before as we should be

556
00:19:08,480 --> 00:19:13,360
pitching this to hmos

557
00:19:10,559 --> 00:19:14,640
yeah we should be absolutely so patricia

558
00:19:13,360 --> 00:19:15,679
what you just mentioned that really

559
00:19:14,640 --> 00:19:17,240
resonated with me

560
00:19:15,679 --> 00:19:20,080
was not just thinking

561
00:19:17,240 --> 00:19:22,640
interdisciplinarily but also thinking

562
00:19:20,080 --> 00:19:24,320
so in the title of your study is

563
00:19:22,640 --> 00:19:25,919
breaking down silos to improve the

564
00:19:24,320 --> 00:19:27,600
health of older adults

565
00:19:25,919 --> 00:19:29,679
can you tell us a little bit about what

566
00:19:27,600 --> 00:19:31,679
it means to break down silos and why it

567
00:19:29,679 --> 00:19:34,320
is important to do so

568
00:19:31,679 --> 00:19:35,360
sure well the silo we were considering

569
00:19:34,320 --> 00:19:38,559
is the

570
00:19:35,360 --> 00:19:42,720
cost savings for medicare

571
00:19:38,559 --> 00:19:45,440
um would actually be

572
00:19:42,720 --> 00:19:45,760
so it caught it would cost uh somebody

573
00:19:45,440 --> 00:19:48,080
say

574
00:19:45,760 --> 00:19:48,960
in housing like in hud to put in grab

575
00:19:48,080 --> 00:19:51,520
bars if they're

576
00:19:48,960 --> 00:19:52,320
say building subsidized housing so the

577
00:19:51,520 --> 00:19:54,480
grab bar

578
00:19:52,320 --> 00:19:56,480
the cost would go to a hug but the

579
00:19:54,480 --> 00:19:58,880
benefit would go to medicare

580
00:19:56,480 --> 00:20:01,679
and so that's actually a financial silo

581
00:19:58,880 --> 00:20:04,159
that you can't overcome in government

582
00:20:01,679 --> 00:20:06,799
is hud doesn't really care if medicare

583
00:20:04,159 --> 00:20:10,000
saves money

584
00:20:06,799 --> 00:20:10,640
and and medicare is really not

585
00:20:10,000 --> 00:20:12,799
interested

586
00:20:10,640 --> 00:20:13,919
in getting into the home building

587
00:20:12,799 --> 00:20:16,400
business

588
00:20:13,919 --> 00:20:17,600
and so that silo there they would there

589
00:20:16,400 --> 00:20:21,120
would actually have to

590
00:20:17,600 --> 00:20:24,799
be some work among legislators to

591
00:20:21,120 --> 00:20:28,000
overcome that kind of financial silos so

592
00:20:24,799 --> 00:20:31,280
that we could actually implement change

593
00:20:28,000 --> 00:20:34,000
at the federal level

594
00:20:31,280 --> 00:20:36,640
there are other silos like the fact that

595
00:20:34,000 --> 00:20:39,520
working with um

596
00:20:36,640 --> 00:20:40,080
richard and tony meant that i had to

597
00:20:39,520 --> 00:20:43,120
look at

598
00:20:40,080 --> 00:20:45,440
statistics which i know how to do except

599
00:20:43,120 --> 00:20:48,080
our terminology is completely different

600
00:20:45,440 --> 00:20:49,520
so we could be running exactly the same

601
00:20:48,080 --> 00:20:51,600
calculations

602
00:20:49,520 --> 00:20:53,440
but my terminology was so different from

603
00:20:51,600 --> 00:20:54,720
theirs i had absolutely no idea what

604
00:20:53,440 --> 00:20:57,679
they were telling me

605
00:20:54,720 --> 00:20:59,200
and vice versa and and we've actually

606
00:20:57,679 --> 00:21:01,200
had to

607
00:20:59,200 --> 00:21:02,480
overcome some of that among the three of

608
00:21:01,200 --> 00:21:04,240
us

609
00:21:02,480 --> 00:21:06,000
well the other thing is from a standard

610
00:21:04,240 --> 00:21:08,559
of care standpoint

611
00:21:06,000 --> 00:21:10,320
is physicians tend to think too much in

612
00:21:08,559 --> 00:21:13,840
terms of silos sometimes

613
00:21:10,320 --> 00:21:15,840
is you know they are uh

614
00:21:13,840 --> 00:21:17,520
heart people and they don't think about

615
00:21:15,840 --> 00:21:20,000
the remainder of the body

616
00:21:17,520 --> 00:21:22,000
and and again this is not a criticism

617
00:21:20,000 --> 00:21:23,440
it's really really hard to be an expert

618
00:21:22,000 --> 00:21:27,360
on the heart

619
00:21:23,440 --> 00:21:29,200
it takes all of your intellectual power

620
00:21:27,360 --> 00:21:30,400
in order to be an expert on the heart

621
00:21:29,200 --> 00:21:32,480
but nevertheless you

622
00:21:30,400 --> 00:21:33,919
become so focused on the heart that then

623
00:21:32,480 --> 00:21:36,320
you forget about

624
00:21:33,919 --> 00:21:37,840
maybe other parts of the body and

625
00:21:36,320 --> 00:21:40,960
similarly

626
00:21:37,840 --> 00:21:43,280
physicians can look at patients as

627
00:21:40,960 --> 00:21:44,640
just people who show up on their in

628
00:21:43,280 --> 00:21:48,799
their offices

629
00:21:44,640 --> 00:21:51,679
or at the hospital whereas medicine

630
00:21:48,799 --> 00:21:53,440
say i'm queuing you up patty on this

631
00:21:51,679 --> 00:21:54,880
understanding the context in which

632
00:21:53,440 --> 00:21:56,640
people live is important to practice

633
00:21:54,880 --> 00:21:59,679
some good medicine right

634
00:21:56,640 --> 00:22:02,720
yes yes that's the yes

635
00:21:59,679 --> 00:22:06,000
the average cardiologist or

636
00:22:02,720 --> 00:22:08,000
cardiothoracic surgeon is

637
00:22:06,000 --> 00:22:09,600
sometimes unaware of the social

638
00:22:08,000 --> 00:22:11,039
determinants of health that we have been

639
00:22:09,600 --> 00:22:13,760
talking about today

640
00:22:11,039 --> 00:22:15,200
uh that that cardiologist may say wow if

641
00:22:13,760 --> 00:22:16,320
you fall again you're gonna have another

642
00:22:15,200 --> 00:22:18,880
heart attack but

643
00:22:16,320 --> 00:22:20,400
and has absolutely no idea how to

644
00:22:18,880 --> 00:22:23,600
implement change that would

645
00:22:20,400 --> 00:22:26,159
reduce the risk of falls

646
00:22:23,600 --> 00:22:27,200
so there are silos within medication in

647
00:22:26,159 --> 00:22:28,480
medicine as well

648
00:22:27,200 --> 00:22:30,640
yeah i always loved the story michael

649
00:22:28,480 --> 00:22:32,400
marmot who's who was one of the pioneers

650
00:22:30,640 --> 00:22:34,640
in social determinants of health who's a

651
00:22:32,400 --> 00:22:36,000
british epidemiologist talked about

652
00:22:34,640 --> 00:22:38,400
years ago

653
00:22:36,000 --> 00:22:40,080
before anybody was talking about this

654
00:22:38,400 --> 00:22:40,799
you know he's in the hospital they're

655
00:22:40,080 --> 00:22:43,760
treating

656
00:22:40,799 --> 00:22:44,799
a patient who had a heart attack and

657
00:22:43,760 --> 00:22:47,760
they they treated

658
00:22:44,799 --> 00:22:49,600
the man and then they sent him home and

659
00:22:47,760 --> 00:22:51,600
he realized i'm sending this person

660
00:22:49,600 --> 00:22:52,880
right back to the exact circumstances

661
00:22:51,600 --> 00:22:54,720
that caused the heart attack

662
00:22:52,880 --> 00:22:57,200
he's not going to change anything about

663
00:22:54,720 --> 00:22:59,280
his behaviors he's not going to change

664
00:22:57,200 --> 00:23:01,440
anything about his environment

665
00:22:59,280 --> 00:23:02,799
and so what good am i really doing i

666
00:23:01,440 --> 00:23:04,240
saved him today but

667
00:23:02,799 --> 00:23:06,000
shouldn't i be also thinking about

668
00:23:04,240 --> 00:23:07,760
saving him tomorrow and the next day and

669
00:23:06,000 --> 00:23:09,600
preventing down the line

670
00:23:07,760 --> 00:23:11,200
and so you know part of the silo is just

671
00:23:09,600 --> 00:23:12,880
what's happening inside your office

672
00:23:11,200 --> 00:23:14,400
which happens to all of us

673
00:23:12,880 --> 00:23:16,080
and trying to understand how the role

674
00:23:14,400 --> 00:23:17,360
that we're playing connects to the role

675
00:23:16,080 --> 00:23:18,720
that other people are playing

676
00:23:17,360 --> 00:23:20,640
i mean one of the things that was fun

677
00:23:18,720 --> 00:23:22,159
for me about this project was working

678
00:23:20,640 --> 00:23:24,320
with dr harris i

679
00:23:22,159 --> 00:23:25,280
you know that that's not a silo that we

680
00:23:24,320 --> 00:23:26,559
usually break down

681
00:23:25,280 --> 00:23:28,720
i learned a lot just from that

682
00:23:26,559 --> 00:23:29,120
collaboration see it from her point of

683
00:23:28,720 --> 00:23:31,520
view

684
00:23:29,120 --> 00:23:33,120
very interesting do you have anything

685
00:23:31,520 --> 00:23:34,960
else that you would like to make sure

686
00:23:33,120 --> 00:23:35,600
that we touch on before we wrap up for

687
00:23:34,960 --> 00:23:37,760
today

688
00:23:35,600 --> 00:23:39,200
i guess i'd like to ask patty one more

689
00:23:37,760 --> 00:23:41,120
question that occurred to me as we were

690
00:23:39,200 --> 00:23:43,039
having this conversation

691
00:23:41,120 --> 00:23:46,480
and if this is awkward i'm sure you have

692
00:23:43,039 --> 00:23:46,480
people jonathan editor

693
00:23:46,880 --> 00:23:50,480
you know on the political stuff since

694
00:23:48,640 --> 00:23:53,919
you're involved with

695
00:23:50,480 --> 00:23:55,600
um organizations that advocate for

696
00:23:53,919 --> 00:23:57,440
health care and particularly general

697
00:23:55,600 --> 00:23:58,480
internal medicine and geriatrics and so

698
00:23:57,440 --> 00:24:00,240
on

699
00:23:58,480 --> 00:24:01,760
do you think this would be a priority

700
00:24:00,240 --> 00:24:02,720
for any of the groups that you're

701
00:24:01,760 --> 00:24:05,760
involved with

702
00:24:02,720 --> 00:24:07,760
or are they so caught up in other issues

703
00:24:05,760 --> 00:24:09,120
that they would not make this a

704
00:24:07,760 --> 00:24:12,559
legislative priority

705
00:24:09,120 --> 00:24:15,120
that is a very good question

706
00:24:12,559 --> 00:24:17,679
i think that we have all been beaten

707
00:24:15,120 --> 00:24:21,039
down by the last year and are just

708
00:24:17,679 --> 00:24:23,200
now kind of coming back

709
00:24:21,039 --> 00:24:24,320
up and trying to figure out what our

710
00:24:23,200 --> 00:24:27,360
priorities

711
00:24:24,320 --> 00:24:29,760
are i my guess is

712
00:24:27,360 --> 00:24:32,480
not this year there's enough to do this

713
00:24:29,760 --> 00:24:34,720
here but perhaps in a year or two

714
00:24:32,480 --> 00:24:35,919
it might be an issue that they would

715
00:24:34,720 --> 00:24:37,600
address

716
00:24:35,919 --> 00:24:40,000
the other thing is sometimes all you

717
00:24:37,600 --> 00:24:43,360
need is a legislative advocate

718
00:24:40,000 --> 00:24:45,279
so for example if we could find a

719
00:24:43,360 --> 00:24:47,840
member of the appropriate committee

720
00:24:45,279 --> 00:24:50,240
whose parents both fell and broke a hip

721
00:24:47,840 --> 00:24:52,320
recently

722
00:24:50,240 --> 00:24:53,760
they'd get all on top of the grab bar

723
00:24:52,320 --> 00:24:56,320
and rush it through

724
00:24:53,760 --> 00:24:57,679
so um maybe we should read the gossip

725
00:24:56,320 --> 00:24:59,360
columns more often

726
00:24:57,679 --> 00:25:00,960
does she does it need to be both parents

727
00:24:59,360 --> 00:25:01,919
or would one parent be good enough do

728
00:25:00,960 --> 00:25:04,880
you think

729
00:25:01,919 --> 00:25:04,880
that's a good question

730
00:25:08,080 --> 00:25:12,159
but seriously you know advocacy is is

731
00:25:11,200 --> 00:25:14,880
all personal

732
00:25:12,159 --> 00:25:17,600
right you find the personal angle and

733
00:25:14,880 --> 00:25:19,760
perhaps we could take this further

734
00:25:17,600 --> 00:25:21,600
but without that personal angle it's

735
00:25:19,760 --> 00:25:23,760
going to be slower on the

736
00:25:21,600 --> 00:25:25,039
priority list right now yeah i think you

737
00:25:23,760 --> 00:25:26,559
know you mentioned the

738
00:25:25,039 --> 00:25:28,480
the difficulties of the past year

739
00:25:26,559 --> 00:25:30,320
weighing on this in some ways

740
00:25:28,480 --> 00:25:31,760
i think that could be an inspiration

741
00:25:30,320 --> 00:25:34,159
because if

742
00:25:31,760 --> 00:25:35,760
one thing that has become pretty clear

743
00:25:34,159 --> 00:25:37,760
to all of us in the last year

744
00:25:35,760 --> 00:25:39,120
is the importance of feeling safe in

745
00:25:37,760 --> 00:25:41,120
your own home

746
00:25:39,120 --> 00:25:43,279
and the importance of especially for

747
00:25:41,120 --> 00:25:46,159
older adults feeling like they have a

748
00:25:43,279 --> 00:25:48,320
safe place to age in place

749
00:25:46,159 --> 00:25:49,840
so that they won't be institutionalized

750
00:25:48,320 --> 00:25:51,520
prematurely and they

751
00:25:49,840 --> 00:25:53,480
they you know during a time like a

752
00:25:51,520 --> 00:25:56,240
pandemic it's becoming

753
00:25:53,480 --> 00:25:58,400
increasingly obvious um

754
00:25:56,240 --> 00:26:00,240
how important that is to our society to

755
00:25:58,400 --> 00:26:00,960
allow people to have that option if they

756
00:26:00,240 --> 00:26:03,840
can

757
00:26:00,960 --> 00:26:06,320
and that might just add an extra reason

758
00:26:03,840 --> 00:26:09,360
for people to care about this

759
00:26:06,320 --> 00:26:12,559
true absolutely well thank you so much

760
00:26:09,360 --> 00:26:15,279
for your time and for writing this

761
00:26:12,559 --> 00:26:16,240
really brilliant paper i encourage all

762
00:26:15,279 --> 00:26:18,480
of our listeners

763
00:26:16,240 --> 00:26:20,080
to read the whole the whole paper which

764
00:26:18,480 --> 00:26:22,240
will be linked with the summary on the

765
00:26:20,080 --> 00:26:24,640
bedrosian center website

766
00:26:22,240 --> 00:26:25,600
it's not very long either so it is not

767
00:26:24,640 --> 00:26:27,840
very long

768
00:26:25,600 --> 00:26:29,679
i think it is the most accessible

769
00:26:27,840 --> 00:26:32,400
academic paper i've ever read

770
00:26:29,679 --> 00:26:34,159
it is succinct it is clear and it is a

771
00:26:32,400 --> 00:26:37,360
really important issue

772
00:26:34,159 --> 00:26:39,440
so thank you all and i

773
00:26:37,360 --> 00:26:41,120
am honored to have had the opportunity

774
00:26:39,440 --> 00:26:42,480
to talk to you today

775
00:26:41,120 --> 00:26:44,400
thank you for listening to the bigger

776
00:26:42,480 --> 00:26:45,679
picture for links of some of the things

777
00:26:44,400 --> 00:26:49,919
we talked about today

778
00:26:45,679 --> 00:26:52,159
visit our show page bedrosian.usc.edu

779
00:26:49,919 --> 00:26:54,000
big picture and if you have more

780
00:26:52,159 --> 00:26:55,279
questions for our speakers or topic

781
00:26:54,000 --> 00:26:57,679
topics you'd like to cover

782
00:26:55,279 --> 00:26:59,440
let us know check out our website social

783
00:26:57,679 --> 00:27:01,360
media or even email us

784
00:26:59,440 --> 00:27:02,880
subscribe on your favorite podcast app

785
00:27:01,360 --> 00:27:03,919
and leave a review so other people can

786
00:27:02,880 --> 00:27:05,679
find us

787
00:27:03,919 --> 00:27:06,799
until we catch up again we hope that you

788
00:27:05,679 --> 00:27:08,559
will take care of yourself and your

789
00:27:06,799 --> 00:27:09,919
neighbors from all of us at the usc

790
00:27:08,559 --> 00:27:17,279
bedrosian center

791
00:27:09,919 --> 00:27:17,279
thank you