Health & Medicine founding board member and chair of the Aging Equity Center Committee Michael Gelder has been part of a research team conducting a comparative research study of COVID-19 morbidity and mortality in older adults throughout Illinois based on residential status in nursing homes vs. the community. Read more here. Michael has also worked to get death certificate data from the Illinois Department of Public Health and is seeking to move this research to a new phase.

Aging equity is about health equity: The aging equity focus of the Aging Equity Center supports Health & Medicine’s overall mission to build power and momentum for social justice and health equity in Illinois. Our aging equity approach seeks to advance policies and programs that redress ageism and other inequities in our society that overlap with, and compound ageism.

Life course perspective: Inequities experienced throughout life shape the aging process across our entire life. These inequities shape our health at all ages, determine whether we reach older adulthood, and lay out what kind of quality of life we can expect if we do.

Intersectionality: Ageism overlaps with other systems of inequity and oppression that harm health and deny people their inherent dignity. Our intersectional approach challenges the aging field to consider overlapping and compounding systems of oppression that affect individuals with marginalized identities. Aging equity requires counteracting and redressing all systems of oppression, not only ageism.

Systems of oppression include but are not limited to racism, anti-Blackness, white supremacy, socioeconomic class inequity, gender inequity, sexism, heterosexism, transphobia, xenophobia, anti-immigrant bias, white nationalism, ableism, ageism, Islamophobia, anti-Semitism, and other identity-based discrimination, hatred, and deprivation. All these oppressions harm health, reduce people’s ability to age well, and cause suffering, shorter lives, and health inequities.

Intersectoral approach: Supporting aging equity also requires an intersectoral approach that seeks equity and justice not only in the aging sector of services, but in every other facet of life, including health care, education, transportation, housing, workforce participation, the broader economy, the criminal legal system, greenspace, and more.

Given this, our approach includes a focus on structural inequities—the policies, systems, and norms that stratify the distribution of the social determinants of health. We seek to build bridges with sectors that are typically considered outside of “health” because we know that everything we encounter shapes our health.

Reframing aging: Ageism exists not only in structures, systems, and policies — but also in attitudes, day-to-day interactions, and broader narratives and myths told about older persons and the aging process. Our efforts to reframe aging seek to counteract and replace the ageist narratives and attitudes that guide our collective understanding about the positive possibilities for aging well.

We reframe aging as a lifelong process that requires a life course perspective. Because we are all aging all the time and may be called at one or more points into caregiving roles, conversations about aging are not limited to older adults. We must all consider our place in advancing aging equity and shaping the type of society we want, including the conditions in which we may provide care for loved ones and the ways we are cared for and about as we age.

We also seek to use language that promotes positives of value, meaning, and purpose as we age. By reframing aging, we help our society reimagine aging in terms of the true positive opportunities that exist and benefit everyone as we age. This effort has been informed by the Reframing Aging initiative, which you can learn more about here.

Movement building: Advancing aging equity requires the development of a movement of people and organizations to transform systems and policies to support aging equity across the life course. To make progress toward aging equity, we build power and a movement of people and organizations committed to a common vision. That’s why we launched Illinois Aging Together, a statewide movement for aging equity. Learn more and get involved here.

• COVID-19 Cases and Deaths in Skilled Nursing Facilities in Cook County, Illinois, August 2021  
• Long-term Care Reform in Illinois: 2019 Agenda for Change
• Critical Issues: Illinois’ Managed Care “Re-Boot” (2017) 
• Quality Matters: A Managed Care Approach to Disparity Reduction (2016) 
• Quality Matters: Getting Readmissions Penalties Right (2016)

Aging Equity Center Committee Members

• Michael Gelder 
• Sara Lindholm 
• Phyllis Mitzen 
• Robyn Golden 
• John Holton 
• Julie Bobitt 
• Carol Aronson 
• Tom Wilson 
• Bonnie Ewald

Aging Equity Center Staff Members

• Margie Schaps, Executive Director 
• Wesley Epplin, Policy Director
• Alizandra Medina, Health and Aging Organizer

In 2001, Health & Medicine created the Center for Long-Term Care Reform—now called the Aging Equity Center—to work on policy to promote the rebalancing of Illinois’ long-term care system for older persons in favor of home and community-based care. 

Through this Center, Health & Medicine has been centrally involved in Illinois’ long-term care reform process, working closely with legislators, state agency leadership, advocates, and providers in support of a long-term care system for older adults that is affordable, accessible, high-quality, adequate to meet needs, and predominantly home and community based. 

In 2001, the Center convened bipartisan study groups to inform and educate a broad base of Illinois legislators about the need and potential for long-term care reform. In response to legislators’ insistence that their constituents were not concerned about long-term care, the Center conducted community forums around the state with older adults and their family members. The final report, “Illinois Residents Speak Out on Long-Term Care” (May 2004), demonstrated unequivocally that long-term care is a significant concern and priority issue for Illinois’ older adults and their caregivers. 

Development of the Older Adults Services Act: The Center’s work helped set the foundation for the 2004 development and passage of SB 2880, the Older Adult Services Act, which began an unprecedented process of systems change in Illinois, intended to “promote a transformation of Illinois’ comprehensive system of older adult services from funding a primarily facility-based service delivery system to primarily a home-based and community-based system.” The legislation also created the Older Adults Services Advisory Committee (OASAC), which paved the way for a $63 million increase in state spending to support older persons wishing to remain in their communities.

The Bridge Model: Transitions in care after a hospitalization are often complex, stressful, and difficult for patients and their caregivers to navigate. The consequences of poor transitions are serious and costly: high re-hospitalization/readmission rates, unnecessary nursing home admissions, and deteriorating health – as well as increased burden and costs on individuals, insurers, public funding sources, and safety-net healthcare providers. Further complicating this problem, national research shows that readmissions affect minorities at disproportionately high rates and are often caused by lack of or inadequate care coordination across medical and social services following a hospitalization.

To address these issues, Health & Medicine joined with other partners in 2008 to collectively develop and disseminate the Bridge Model of transitional care, an interdisciplinary and social work-led intervention that helps individuals safely transition from the hospital to their homes and communities. The Bridge Model improves transitions of care by utilizing master’s-prepared social workers in a case management role, who conduct comprehensive biopsychosocial assessments, help coordinate medical and social services after discharge, and utilize psychotherapeutic techniques to target patient engagement. Bridge programs emphasize care continuity across settings, interdisciplinary teamwork, and the importance of caregiver supports. Bridge helps reduce hospital readmission rates, decrease patient/caregiver burden and stress, and improve physician follow-up. Earlier on, Health & Medicine managed the Bridge Model in collaboration with Rush University Hospital. The program is now at the Center for Health and Social Care Innovation at Rush University Hospital.

Behavioral Health and Primary Care Integration: Recovery from mental illness is a life-long process, and therefore requires long-term services and supports. However, programs and providers that serve people with mental illness are too often siloed and marginalized within the overall health and social services system, resulting in fragmented services, exceptional challenges to information sharing and care coordination, and chronic underfunding of programs.

Recognizing budgets and regulations of programs that serve people with mental illness often reflect stigma, the Aging Equity Center started the Behavioral Health-Primary Care Integration Learning Collaborative in 2015 to guide local advocacy and facilitate practice-level change to improve the lives of people with mental illness and substance use disorder. Health & Medicine launched a multi-phase project to help primary care and behavioral health providers develop strategies to better implement evidence-based models for integration of behavioral and physical care to facilitate more effective utilization of available resources and expand the capacity of behavioral health and primary care providers to provide high quality, person-centered care to more people in need.

In the fall of 2015, Health & Medicine initiated a Behavioral and Primary Care Integration Learning Collaborative — a team-based approach to improving processes, practices, and systems by sharing experiences, resources, and challenges — to identify and adopt best practices for behavioral health-primary care integration in Illinois. The collaborative brought together community behavioral health agencies, primary care providers, facility-based behavioral health providers, and people in recovery to share their experiences, participate in trainings, and prepare to pilot evidence-based models that can be tested and continuously improved by systematically tracking processes and outcomes.

Illinois’s State Plan on Aging: In 2020, Health & Medicine worked with the Illinois Department on Aging to research, develop, solicit public comment, and respond to public comments of the State Plan on Aging, which is the Administration on Community Living requires for state agencies that administer Older Americans Act dollars. Health & Medicine was contracted to support the advancement of a stronger health equity and aging equity focus in the 2021-2023 plan. You can view the plan here.

The Center has remained centrally involved and has served on all OASAC committees; worked closely with providers, advocates, policymakers, and legislators; and provided the analysis, information, and perspective needed to advance an informed, person-centered, and equity-focused reform agenda that prioritizes home and community-based care for all older persons in our state. In that capacity, we have served as an advisor to the Illinois Department on Aging and other state leaders on aging issues across several administrations.