Leaders & Innovators

10 Questions with Dr. Bruce Chernof

Dr. Bruce Chernof is President and CEO of the SCAN Foundation, an independent public charity devoted to transforming care for older adults in ways that preserve dignity. In our conversation, Dr. Chernof shares what’s working within our current care system—and what still needs to be done to improve the quality of health and life for older Americans.

This is adapted from a Who Cares? podcast episode with Dr. Chernof. He covers a lot of ground during the conversation, so we’ve edited his responses for this post. To hear the complete interview, visit Honor’s Who Cares? podcast page.

Tell us about the SCAN foundation and the work you do.

At the SCAN Foundation, our goal is to help every older adult live with dignity, choice, and independence. We’re working to achieve that goal by influencing:

  • Healthcare system behavior. We believe healthcare systems should be more person-centered, incorporating the goals and desires of individuals and their families.
  • Public policy. We leverage public policy to encourage healthcare systems to operate in more effective, efficient, and person-centered ways.
  • Product and service innovation. We look at how older adults operate in the real world and try to develop better services and product solutions to help them thrive.

You mentioned person-centered care—how does that differ from patient-centered care?

With patient-centered care, the balance of power belongs to the healthcare system. People are only patients—their quality of health is the only outcome that matters. Person-centered care demands a plan that provides quality care but also accounts for what people want.

If we spend more time listening to people and aligning treatments to help them reach their goals, we’ll achieve better care—and lower costs. We spend so much time in healthcare pushing interventions without really stepping back and asking patients, “Does this achieve your goal?”

For example, if you can give someone a super toxic therapy that might extend their life by two months over the next year—but they’ll spend eight of those months sick in the hospital—do they really want to risk it? For many of us, that sort of treatment to the very end isn't the most important thing—it's quality of life.

Mother and daughter in kitchen together laughing.

How did you become so passionate about improving healthcare and the quality of life for older adults?

As a young physician, I was interested in the question, “How do we build better, more sustainable systems that meet the needs of vulnerable populations and how do we judge quality in those systems?” Throughout my career, I've been working on that question with various underserved communities, including older adults.

And we all have somebody we love or care about who's struggled to navigate our healthcare system. It can feel unresponsive, and getting answers to simple questions can be hard. Caring for my own aging loved ones drove home how tough it can be—if, as a physician, it’s challenging to figure out the system, how difficult is it for others?

Let’s discuss the challenging demographics and current landscape we’re facing in the senior care space.

In the United States, thousands of people turn 65 every day. America is becoming a much older, grayer population. But this is not a Silver Tsunami. Getting old isn’t the equivalent of a natural disaster—we're all going to do it.

Our country’s demographic pyramid is shifting to have more older people than younger people—and this shift won’t end with the Boomers. Gen Xers and Millennials can expect this age imbalance to remain once they’re older, too. So we should build a care system that we want—not just for our parents or grandparents—but for ourselves, our kids, and our grandkids.

How do we get people to start thinking about this more and trying to solve these problems?

One of the real challenges is that our support programs for older adults operate in silos. For example, your healthcare comes from Medicare and Medicaid, but your social support may come from an Older American's Act program or your faith-based community. If you qualify for Meals on Wheels, you may qualify for a low-income energy support program or a housing voucher—but you wouldn’t know it.

People have needs across their lives but they’re interacting with many separate programs that don’t work together. We need a model that's more integrated to support the full person.

What's your take on how prepared we are to finance our care as we age?

Our population generally doesn't understand what Medicare covers—or what our needs will be when we age. Half of adults over 65 today will require long-term support with activities of daily living—things like grocery shopping, bathing, and driving—as they grow older.

How are we going to pay for that support? Many Americans wrongly assume that Medicare alone will take care of all their medical needs when they’re older. But Medicare pays for acute and chronic medical services from hospitals and doctors—it doesn't cover home and community-based services for more than 100 days. Personal spending is the largest source of payment for long-term support services. So it’s important for people to think about the future and consider what their safety net will look like once they’re not earning.

Image of older adult reading.

In 2019, California Governor Gavin Newsom announced a Master Plan for Aging for the state. What does a Master Plan do, and how was the SCAN Foundation involved with that initiative?

A Master Plan sets a long term, measurable blueprint for important issues that take time and often span different administrations. In the past, California has successfully used Master Plans to deal with issues like transportation and higher education.

Polling indicates that issues like the cost of care and the caregiver workforce shortage are top of mind for many Californians, so the SCAN Foundation helped drive awareness and advocacy for a Master Plan. We created an organization called “We Stand with Seniors,” which focused on engaging the public to speak up about the need for a plan to address these challenges.

And it got the government’s attention. In 2019, Governor Gavin Newsom publicly committed to creating and funding a Master Plan for Aging. We're excited that the governor sees this as an important issue.

How can we support the SCAN Foundation’s advocacy efforts?

Visit We Stand With Seniors for current information and updates. And if you want a Master Plan that’s going to help you—whether you’re a caregiver, an older adult, or a family member—speak up. Send an email, write a letter, or pick up the phone to let your local government know what you care about, because those numbers add up.

When an older adult needs care, it’s not just an individual issue—it impacts the whole family. Can you elaborate on this?

So much of the way we think about caregiving today is outdated—we imagine a two-person model with husband and wife caring for one another. And while that model definitely exists today, more often many people are involved in caring for older adults.

Family members may be unpaid caregivers or they may pay for care for older relatives who can’t afford it themselves. They make trade-offs between their work, raising their children, and caring for loved ones, families, or friends who need help. So having a discussion that recognizes the impact of care on families is critical.

What do you see on the horizon that may be helpful for people who need care?

The federal government passed the Chronic Care Act, which supports older adults with the highest needs. We also saw improvements in telemedicine and telehealth so that more people can get healthcare at home. And most excitingly for me, the government created the first opportunity for Medicare to provide some home and community-based services. It’s a potentially powerful step to transform a medically-oriented system to a more holistic program that supports older adults with many of their different care needs.

To learn more about the SCAN Foundation’s advocacy efforts and browse resources for older adults, families, and care providers, visit their website.

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