A Thought Provoking Conversation on Aging with Gerontologist Dr. Jacob Kendall

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Erin 1:05

Hi, welcome back to another episode of the aspire for more with Aaron podcast. Where I, my voice is a little under the weather, but that's okay because we're going to push through it. I have a fantastic guest for you today. Dr. Jacob Kendall, who is a public health gerontologist. How did I get so lucky to have a doctor on my program? I do not know, but you can find out more about him at JacobEvansKendall. com. Dr. Jacob Kendall, welcome to the podcast. How are you today?

Jacob 1:37

I'm doing well, Aaron, and please refer to me, just as Jacob. I appreciate the introduction. I appreciate the opportunity to have a conversation.

Erin 1:44

Thank you. Thank you. I, as a, you are a public health gerontologist. And so explain to me what that is. The benefits are what you studied in the benefits that you see on the big scale of things. I'm curious to know.

Jacob 2:01

Yeah. And in answering that question, it also involves giving how I approach that and a little bit about my own background to help to connect the dots here. first of all, I'll say I have. my PhD is an interdisciplinary aging studies. I just say gerontology because that's a lot of syllables. And honestly, that's what the definition of gerontology anyway, is an interdisciplinary study of aging. and I have, Master's degrees in social work and public health, and I was all macro in those like big picture thinking in those degrees and in my doctorate program as well. I was trained by a demographer. I took a bunch of public health and epidemiology courses. And my favorite thing to do. I really nerd out on what's analyzing or looking at demographic and epidemiological trends, which. All point to an aging populated and aging world right now. And so to dial it back 1 step and give some a little bit of background on my self as well to explain, what I'm doing and how I see this topic, I'll say, there are typically 2 things I say about myself to identify myself professionally. I've already said the interdisciplinary piece. I much prefer to be. The jack of all trades than an expert of 1. I really love it. we looked at aging from the perspective of genetics and cell biology and cognitive neuroscience all the way to psychology, sociology, epidemiology, and everything in between. And in social work, we split it into micro and macro. but I really see it as a continuum. They're not these separate silos, right? It's one continuum. That's how I prefer to see it. That's how I think knowledge is. And yeah, we need experts who really dive into specific topics, but we also need interdisciplinarians and that's. That's my bag. That's what I like to do. I love to facilitate dialogues between different industries, different disciplines. we live in a very siloed world, whether that's in a university, or, different medical providers, not communicating with 1 another as much as they should. and I'll acknowledge here. The interdisciplinary is a term that is largely used in academia. I have racked my brain for a good term. That also applies to that kind of thinking outside of academia. Interprofessional multidimensional, I'm still playing around with it, but the same thing, right? And the other thing about me is that I've had to open heart surgeries. I have lifelong personal experience navigating my own complex medical needs. And over time, I just got really tired of our inefficient health care system push became shove. And so I'm shoving back where all that comes together is going back to that continuum. I love analyzing. Like I said, I'm really comfortable with the. Big picture here, and I'll get back. that's gonna be interwoven through any kind of response that I give to or any part of our conversation today. but I also have the individual side of it as well, being a patient, having chronic disease and dealing with that. And so what I would love to do is to connect the dots between the individual all the way up to big picture. And sometimes I even say, I'm a global health gerontologist. So what does public health gerontology mean? I think that it, It basically means accounting for the more macro aspects of aging. What are these population trends that are going on? and how does population aging everywhere in the world is aging right now? Every population in the world is basically getting older. and how does that fact impact? Interact with other things that are going on. For example, immigration. there are a lot of interactions there. I'd be happy to dive further if you want to, epidemiological transition. That means that more and more people are dying of chronic diseases. And so those are wrapped up with one another. Households are increasingly diversifying, right? You have a greater. variety of household types now than we did 100 years ago. That is wrapped up in population aging. Like all, none of this happens in a vacuum, public health, gerontology. What I mean by that is we. Analyze some of these patterns that happen at higher levels. and of course, that's informs policy as well. It's how we understand the economic implications of, agent of an aging population, et cetera. I would say that it focuses a lot of bigger picture issues. Yeah.

Erin 6:10

Yeah. that's a lot. It's a lot. and as we get age, as we are aging more, there's going to be more and more systemic failures that we see. Speaking of, your own personal experience and my personal experience inside it. The health care system, it does take very micro understanding of how to communicate with all the different silos of health care. If you have specialists and a primary care physician, you are the 1 that's responsible for making sure that each patient. Person understands what is going on within each specialist realm and as our parents age, or as we age, or as we care for a special needs child, it is important that somebody communicates. Each cog in the wheel, right? So the wheel can keep going in a much smoother, way through the journey. And if we don't, that's when medications get messed up. That's when medications get discharged that don't need to be discharged. That's when past experiences don't get communicated into the present. That really creates problems for the brain. for families and the aging loved one that we want to take care of. And as much as we want to give people their space and their independence, If they don't have that clear picture of what communication in the silos means, then we do them a disservice, because our healthcare system doesn't give them the benefit of the doubt, we don't see that. And so that's the caregiving side, right? I know that we're going to focus a lot on ageism, caregiving and senior living, but I figure we can roll right into that caregiving piece. And what what is the data? Tell you in your own personal experience and how do we support these family caregivers?

Jacob 8:08

Yeah, I'm glad that you brought all that up. And, also here I have both the, formal background, professional experience and a personal experience. I have been a caregiver and of course you can't, you cannot responsibly, be a, you cannot be a responsible or ethical gerontologist without, including that caregiving. and you mentioned my website, jacobevanskindle. com. The main focus of that website is what I do speaking and workshops on. And one of those is helping people. be better, be more savvier patients and caregivers because you're right. It is up to us to facilitate those connections between our different providers. we can sit here and we can complain about it. And sometimes I do about how it's just very inefficient, but how there's not enough communication. But at the end of the day, those problems are not going to change anytime soon. And over time of being a patient and caregiver myself, I've just learned these tips and strategies, to like of self advocacy and being assertive with your providers and trying to find those connections. And, sometimes when it comes to Our providers, it's a personality thing and they're just not going to have that good bedside manner kind of thing. but if you have 2 or 3, depending on how many providers you have, if you have at least a couple of providers who are willing to be in your corner, then I think that you can get a lot farther than the medical system wants you to, you can squeeze more juice out of it and, I also, when I think about the continuum of knowledge between micro macro, or between different disciplines and industries, I think health care is the same. it should be a smoother curriculum continue. I'm sorry. It should be a smooth continuum. It's not because again, we have all these separate, specialist and whatnot, but the way that I envision it in the way that when I think about my own, Provide my own medical care when I help other people do that themselves. I tried to get them to make it as smooth of a continuum as they can. I think that can be a helpful way of viewing it. And I want to go back to the macro piece here. because if I'm having a conversation with someone and they're struggling to that they can barely get through the day because they're a caregiver. And caregiving. If you're an informal caregiver, you have a higher morbidity than in lower life expectancy than someone who's not a caregiver. And within that, if you're a caregiver for someone who has dementia, you have a higher morbidity than someone who's a caregiver for some other kind of chronic disease. So there are these, it's a huge impact. And if someone's going through that, they're like, I don't care about all the policy or bigger picture stuff. And that's fine. But I do still encourage people to zoom out a little bit. And so let me give you a quick example of where. Let's, let's zoom out just a little bit and see how these bigger picture things even affect us at the individual level. So I live. Yeah, you and I live in the same area. this is 1 of the fastest growing areas in the country, definitely in the state of Alabama. And when I, 1 of the 1st things that I do when I move to a place, because I have complex medical needs is I. Establish myself with providers, especially cardiologists, because I've had two open heart surgeries and a primary care, right? And my wife doesn't have all these issues. So she's not quite as, that's not one of her priorities. And we moved here three years ago. And I got in, I was one of the last people in with my primary care provider, but when she did it a few months later, that person had already closed their office and, going to appointments in the first year. So I was like, man, I have to schedule these way out in advance, right? Go to the waiting room and it's a whole bunch of people, right? And it's really easy to be frustrated with the providers themselves. It's really easy. You think, why are these doctors taking all these patients in? Or why are they so slow? Why is this office so inefficient? But after a while, Knowing that this is a rapidly growing area, a lot of people want to move here. You can't drive 5 minutes in any direction without seeing evidence of that. There's always a neighborhood or apartment complex being built after a while. I'm like, you know what? I don't think this is. the blame of the providers themselves. I think it's population growth. We do not have the infrastructure to handle that. And so after a while I started just point blank asking my providers like, hey, I'm concerned about living in this area moving forward because of the population growth. Do you share that concern? And some of them are like, I think we'll adjust, but other ones like, yeah, I think that's gonna be a major concern. and, on the caregiving side, I think it's the same way, right? we have to, we need to be willing to be assertive and assertive self advocates for ourselves and ask these kinds of questions to our providers. And I help my mom navigate her own health care. I'm an intermittent caregiver for her. She has also complex medical needs and some part of this generational issue. But, the I think that this is changing, but a lot of people just have this notion like, if your doctor says to do it, you should do it. And I'm like, I don't know about that. let's add more meat to the bones. And I'll she and I, my mom and I tell 1 another about our, all of our medical appointments. And then sometimes I will say, hey, I asked the doctor this, or I said this to the doctor and she's whoa, you said that I'm like, you're damn right. If there's a question that you have, then say that. And, I think the ideal is when families, the patient, the caregivers, or whatnot are at the center of care, and it radiates out from there. We don't have that model on a consistent basis, but caregivers, families, and the patients themselves should, there should be a, a smoother continuum of all of them being involved in care. So I'll pause here because I know that was a lot, but those are the things that come to mind for me with, with caregiving.

Erin 13:37

Yeah, I, my doctor, my kid's pediatrician, I think that there is an element that you can do natural stuff. You can certainly try natural stuff. I think that. There are lots of things that physicians don't like about social media these days that teach you how you can do things naturally, and they don't buy into it. They don't believe it. I have seen a little bit of a disconnect from that standpoint, with caregiving in the sense of not always. Not trusting that's not the right word, but just I would like to try this route 1st, before we go to this route. And to bring evidence of what I believe has been positive changes, or there's no changes, or the doctor saying what you're hearing about this is not necessarily true. But then there is some evidence that it may be true within different circles. So trust, I believe is. It's a thing that we are all lacking in public health right now. In leadership in lots of different areas and I think a lot of that has to do with the access of information and somebody who says things on social media that look very believable, and so you just want to try something first before you jump into something else pharmaceutical, so listen to your physicians, right and then do your research and go from there. Thank you. so I, I bring that up just to add, some more fuel to your points, trusting people, trusting yourself and doing the work of investigation is very important. So the term ageism, I think that's certainly something that we can find in the healthcare system. You wouldn't think so, but it's there, and to some point there has to be conversations. About what is dignity and what is not right, especially if we're talking with people with cognitive disabilities, especially if they're older with cognitive disabilities, even with me and my son, sometimes I have to make decisions based on, the macro like. Is this going to make, can he work through the process? Is this going to make a difference? we have to figure out what the end result is going to be before we just jump into lots of different things. what do we want? What are we willing to sacrifice? Those types of things, but a carte blanche of, you're 75, 80 years old. So therefore. All these other things don't apply to you. I believe that's what ageism is, but you can expound on that a little bit more because there's a lot of life left to live if you're 75, 80 years old, so you dive in and tell me what ageism is to you and your mission on that.

Jacob 16:30

I'll connect to your previous point to the again, all the dots are connected. So, I really like providers who are curious by nature rather than ones that are just the stick to the status quo. And the ones who are curious are going to be more familiar with studies, right? And other evidence like that. And like, when you go to your. Doctor. And he said, like, how long do I have? I was a prognosis or how successful is this surgery going to be, or how long is the rehab going to be or whatever, every single, any kind of answer that one can give you isn't is inherently based on population studies. There's no such thing as a risk of dying at the individual level. It's the same with life insurance, right? When you get a policy based on your medical history and everything else that comes from, what is everyone else who's like you? What is the average of what's happened with everyone? Who's like you. If you're a male in your 70s or whatever, and they're going to look at similar populations. So the macro comes back into that, but that also, that trickles down to, are your providers curious, or are they just sticking to the status quo? And the status quo, unfortunately with older adults has been. you're just older. This is just natural. This is just going to happen. The body just declines and there's so much implicit ageism within medical care. And I'm like, I would rather have a provider who's curious and okay, it doesn't necessarily let's not just accept that. It has to be this way because you're older. your knees are hurting. your back is hurting. you're headed toward heart failure. You're forgetting things like a lot of times responsibly. You're just getting older. I'm like, no, it's a. Why do we have to stop at that point? there's a lot that we can do here. and I'll be so bold as to say the following, this is why ageism, I think the following statement is definitely true and it is, I also think that the implications of this or that it's why ageism is so difficult to address why it's so prominent. I believe that it is more okay. To be ageist in our society than it is to be racist and sexist. It is many ages, people who focus on ageism. I'm not one of those. I can definitely point people to experts in ageism. I can say a few things. and I think that most of the, most of them would agree with me here. That, I envision a society in which that's not true in which ageism is seen as, is the problem that it really is. And, So I don't think that I'm really making that bold of a statement in saying that, but because that is true, it does mean that ageism is going to be harder to address moving forward. here's one way that I like to look at it. I often think of aging, being a gerontologist. It is so common to go from birth forward, because that's how our lives function, right? And you have things like adverse childhood experiences, which means that basically things that happen to you in the womb or as infants or as toddlers increase your chances of having chronic disease 30, 40, 50 years later. And, chronic disease is the buildup over a life of Things that you, things that happen to you, if you start smoking, you're not going to get lung cancer next year. But if you keep doing it, you might get in 20 or 30 years. You know what I'm saying? And the tendency is to focus on time moving forward. I like to look at it also as time moving backward from death. I think that can give us a lot of interesting insights. So I, One of my favorite quotes, and I just keep forgetting the name of this person. He, I think he's a former British prime minister. It was like a century or two ago, but he said this quote, I'm paraphrasing here, you can tell the level of compassion that a society has for all of its citizens by observing the ways that society treats the dead. And if they treat dead bodies with compassion, that means they treat everyone with compassion. And I think that is really riveting. That is provocative. And if we take it one step back, I think we can say a very similar statement of, you can tell the compassion of a society on how that society treats people who are dying, as in they're still alive, but in their last few years. And here in the U S. A high percentage of our health care dollars are spent on the last two or three years because we have this, in the medical model is like test, and it's, it just, it builds up expenses and I think we can take it even one step farther back than that. You can tell the compassion the society has for all of its citizens by observing how it treats its older adults. See, so I'm just taking it 1 step back each time. And I think that's generally true. Does that make sense? I hope that makes sense. And when we look at ageism and how on the individual level, how that affects, medical care and whatnot, I think that's where we can start to connect these dots basically. And, there is a lot of ageism in the medical. a really noteworthy, I don't know the exact numbers, but something like of the hundreds of medical schools, when I was in my PhD program, however many medical schools are in the country, many, there were only 11, I think, who had any, who had a residency for geriatrics. And I think that tells you everything that you need to know.

Erin 21:34

Yeah. Yeah. There's not many.

Jacob 21:39

Yeah,

Erin 21:40

there's not many. And of the geriatric primary care physicians that are out there, they have their practice and they're also working inside long term cares and skilled nursing. I know in our area and they're spread. very thin. And that's why we see the rush to send people to the ER very quickly. Get them out, get them out. it's a very reactive. Isn't that life? Like very few people are very proactive and you can see that a lot in the healthcare industry, specifically when it comes to, to geriatric care inside senior living, the way senior livings work. There's a lot of reactive thought processes and not enough proactive thought processes. It's. we can. It's like being proactive is very boring. If you really think about it, I tell people all the time, you will never know what you prevented by choosing a proactive way. You will never know, but you will know what you could have prevented. You will know that you will never know what you prevented. so that's I would say that in the context of moving into senior living. I said that a lot and I will say that just in my context of caregiving and living a life from a proactive standpoint, which can be challenging. But if that's your North star, I will know what I could have prevented versus. Knowing, not knowing, you know what I'm saying, I've got confused with that statement, but I would rather not know what I could have prevented than be blaringly obvious, that because I didn't do this happened and therefore I have to look back and say hindsight is 20, 20, nothing is, each one is a choice. It's a choice. There's no judgment in any of it because I have certainly been very reactive and allowed myself to be very reactive when I could have been preventative, but it is true, there is no glory in working in prevention. they're just, there is, you don't get the streamers, you don't get all the things, but it is something very valiant in your effort to do that, which I think leads us into senior living, the most reactive industry. I think there is, what is your take on senior living? from your gerontologist standpoint, I'm sure you've got a lot of fun, perceptions or fun, viewpoints to discuss.

Jacob 24:13

Yeah. once again, you hit a huge issue right on the nose here. And it's not just the medical model. it's humans. We are horrible at planning for crises. We can sit here and we can just beat our, we can, beat a, against the wall, trying to sell people like, listen, you need to get a life insurance policy. You need to have plans for retirement. You need to be talking, having, talking with your parents about. What's going to go on near their deaths and what do they want to happen with disposition or their body? How are they providing for their survivors? But people just are terrible at having these conversations. You're right. You're absolutely right. And I do

Erin 24:51

not want to have those conversations. No, they don't. And I have conversations all the time and people look at me and I'm like, I'm sorry. You just. I know I need to know.

Jacob 25:00

And I think the following point might seem counterintuitive, but I believe it's true. And I think it makes sense when you dig into it. I actually think that the more we embrace our own and our loved one's mortality, the actual higher quantity and quality of life that we'll have. I think one of the reasons that we avoid those conversations is because of our fear of death, I think another one is because we live in us in a society where we're Both in and outside the medical model that is based not on prevention, but on reactivity. Like you said, we'd rather put band aids on things rather than prevent the cut in the first place. And, I think I like to believe that it's changing. my, my grandfather, who is in his nineties now, he said at one point, Jacob, I just never expected to even get to this age, which is why, which explains why he didn't plan for it. And that makes total sense when he was born, his life expectancy was probably two decades lower than what it is than his current age. So it'd be interesting to see what future generations, if they're better at planning for these things, I think that they will be. And this definitely plays into senior living as well. Again, All the kinds of, conversations that we should be having ahead of time include what do you want your living situation to be when you probably will reach the point of where you shouldn't be driving anymore. You shouldn't be living alone anymore. And it's, it theoretically, it should be a lot easier to have those conversations when you're still, you have all of your physical, cognitive, mental faculties, et cetera. But again, that's not what happens. And I think another important part of the conversation with, with senior living with any kind of residential situation for older adults is, We need to recognize, understandably, that most Americans want to die in their own homes. They want to spend their last minutes, days, years in their own house. Listen, I want to as well. That totally makes sense that is, what we want to do. of course that doesn't happen nearly as much as it should. That ideal is not being realized. And I think that we have, I guess I see senior living, again, it's a part of the continuum of being in your own home. Over at the opposite end of the spectrum is dying in a hospital, which is probably the least desired place to be. And we have all kinds of options in between that. And I think that moving forward, we're going to see increasing innovation of making these, I guess I would call them healthcare adjacent, right? It's not a full on. It's not full fledged hospital, but it's also not living at home, senior living communities, retirement communities, CCRCs, nursing homes, et cetera. I think we're going to see increasing innovation to probably try to make those, at least I hope that we will try to make those places seem as much as possible, like they're, they're in the home situation like they want to be, but they're radically being cared for. and I think we have to account for migration patterns as well. I said earlier that, population aging is tied to migration. So let me zoom out a little bit more here from on. I told you I can get really nerdy about this. I'll quickly mentioned two ways in which immigration migration are tied to population aging. One is, In the same Americans want to die in their own homes, but having health care come into their homes is the most expensive option. Those who can afford it have home like they'll pay home health care providers to come in and, be with them in their own homes. But again, that's more expensive. And increasingly, what we're finding is that those who are those yeah. Home care providers are immigrants from other countries. And so when I, when someone tells me that there, or when I hear that there are people are anti immigration, I'm like, okay, then you tell me how the you're older, how your parents and how you're going to be cared for when you're older, if you don't want to let more immigrants in here, because that's currently who's doing it. And this is all over the world. we largely bring in like Nigerians. not me. I'm sorry. I'm bringing in is not the right term. Nigerians, some other African from other African countries and Latin Americans are the ones who are doing a lot of the caregiving services in Eastern Europe. They hire Western European. I'm sorry. Western. They hire Eastern European, South Asian and African immigrants in East Asia. They hire Southeast Asian. help home health care workers because these are all post industrial, very older populations. And the opposite end is Japan, where they're extremely monocultural, very unfriendly to immigration, and they have an aging crisis on their hands because older, younger women, even though they're being incentivized by the government, Not having children and their older adults. It's a four to one model for older parents to the two adults and, one child, right? Cause fertility is declining there. Who's going to provide for their older adults. So it's an aging crisis. And I think we need to be paying attention to things like that in the U S as we think about, immigration. The other way, another way that a migration is tied to population aging is within our own country, right? And so a lot of people moved away from the Rust Belt and maybe their older adult family members were left behind. And it's just more common to move all over the place now. And so you have concepts like intimacy at a distance, which is you're playing a role in helping provide care for your older family member, like your older parents, but you're not there geographically. And I think that makes it more complicated. To make these decisions, but we're going to have to move. We're going to have to move forward, embracing that this is going to be our reality. it's good that we have advanced technology or, communications technology like zoom, and FaceTime and things like that, so that you can still be present in there and their lives. But we have to account for these realities. How do we help, address the situation of the fact that people are moving around a lot more often. And, the adult children of older adults. May not be living geographically nearby, but they're still making primary decisions about what are going to be the living arrangements of their aging parents as they need more and more care. okay. I'll zoom back down now. I just had to get nerdy for a moment with, with, macro. And I guess I'll, I still will stay there for, yeah, I'll mention one other thing. there are a lot of people who are, I guess I would say aging advocates, ageism is one kind of sector. Senior living is another kind of sector. Of aging, I'll say, you had asked me a few weeks ago, what's a good term to capture all of these? I still haven't come up with one. there, there's the caregiving sector as well. And, I'm connected to several professionals in each of these areas and the caregiving, industry in particular is really trying to push state and national politicians to have, You know how we have employers are mandated to provide health insurance if they have so many employees at their organization to, provide to include provisions for people who have to have to make caregiving decisions for their older adults, right? Either more time off or extra stipend to help care for them. I think that a senior living is and should be a part of that conversation. A lot of those policies have not come to fruition. I just simply want. Whoever's listening here now to know that there are people who are working on that. So it is a policy issue. but in, in the meantime, while we still have a lack of those policies, we still need strategies on the individual level for families to, to deal with these things. I may have not gotten as specific into senior living as you were wanting, if not ask specific questions. But those are the things that come to mind for me when you ask about that.

Erin 32:20

Yeah, I think that, having been a personal caregiver, Being a personal caregiver as a parent, and then seeing on the macro level that caregiving is about to become as important as parenting. It is really caregiving is parenting just another. It's like a reverse mirror image of parenting. Right? yeah, we're fixing to enter a world where again, the alarm, the warning signs, the warning alarms are being shot. They're starting to play, right? Who's listening and who wants to work preventatively towards it? I don't know, and we have to understand that senior living plays a huge role in helping the caregiving experience and then how can senior living create a space for a lot of seniors? Not just the ones who can afford it, but the ones who are in that I've often worried about the ones who are in the middle in those crack places that maybe can afford it for 2 years. But then after that, what happens, um. those are the main issues. And there's adult day and there's lots of other things, but, we're walking into a new time in life that we've known was coming for a long time and it's here slowly, but it will certainly be here in the next five to seven years. we're seeing the beginning parts of it. So what a wonderful conversation about high level stuff. it's fascinating to hear you talk about things and from your studies and just a new perspective of ways to look at things for me. So I appreciate your time. Is there any last thing, last topics, last thoughts that you want to leave with the audience today?

Jacob 34:18

Yeah, for sure. I want to respond to your most recent point. when I had these kinds of conversations, especially getting to the more macro pieces, if you zoom out far enough, you can zoom out the local level. And like I said, I zoomed out a little bit and realize that the population growth here affects the medical care access. But if you keep zooming out and zooming out, you're going to get to the point to the very top of the pyramid, so to speak. And you're going to realize, what? Yeah. The billionaires who are leading the entire medical industrial complex, they don't give a damn about actually changing these problems. They just care that they're going to continue staying wealthy. And I think that you have these, industries within aging. And I would say that, tell me if you think I'm wrong, I would say that senior living is one of those where it seems to me that If it hasn't gotten to that point already, it has the potential to be a profit making industry. And if I won't speak with authority on that, I'll let you do that. I get the impression that it might be headed there if it's not already. But I don't think that it inherently has to be. And so we have to have people at these kind of mid levels between the billionaires at the top and the individual at the bottom who simply have to make a choice of, what? I'm going to care about actually making a positive difference than I am about bringing in profit. And I, there are many days where I'm like, I, this is an intractable problem. We're never going to convince people to do that. But then there are other days where you know what, let's have conversations and see if we can come up with some kind of solution. I would love to see industries like senior living paved that way, but you can tell me whether you think that's going to happen or not.

Erin 35:48

Senior living is very much based on Profit and margin very much. I think in the nonprofit sector, it's not as driven, but I would say, maybe 75 percent to 80 percent not driven. so that's not, everything is driven on profit and margin inside. Inside senior living and I don't necessarily see that changing COVID took a chunk out of it. and then we had to run real fast to try to get back to those places without even taking a breath, it was almost cruel how that happened and why we see the staffing crisis today, if you want my honest opinion. Inside senior living, I don't know, do you there was no support for leaders after that? you go in from 1 crisis to the next. And, so I think that there are certainly companies and people who want to offer great services. But I don't ever expect senior living to not be driven by profit margin on the for profit or for the not for profit world.

Jacob 36:53

I guess the next, I guess the next question we have to ask him, if that's true, then is there a way that we can use that profit drive? The profit driven system to also benefit people in a good way. And I don't have solutions for that. I'm not an economist, but, I think these are the realities that we're going to have to contend with moving forward. An aging population really benefits the people who are at the very top of any kind of industry. That's the bottom line. It does.

Erin 37:19

It's true. It's true. It's true. thank you today for this today and for all these thoughts and thinking, thought provoking thoughts that, from a micro level, where can we affect change? And change starts with one person. there can be a movement. And we want massive sweeping change, but if we can affect small amounts of people, or change thought processes or get somebody else to think about things from a different perspective, then I think we've done our job. And I think that this was a great conversation to do that. So thank you for your time today. I appreciate it.

Jacob 37:59

Yeah. Thanks for the great conversation. I enjoyed it.

Erin 38:02

Yes, and so again, his website is JacobEvansKendall. com and he is a public health gerontologist. So thank you so much for your time today. And as for always, my guests or my listeners aspire for more for you.