Aging reframed: Seeing aging as an opportunity in healthcare

In this episode of the McKinsey on Healthcare podcast, McKinsey partner Dr. Pooja Kumar talks to Ursel J. McElroy, director of the Ohio Department of Aging, about a need to change the accepted narrative on aging, the challenges that women in leadership face, and her desire to ensure lessons learned from the COVID-19 pandemic are used to benefit the future of older populations. Prior to leading the Department of Aging, McElroy served as a deputy director within the Ohio Attorney General’s office. The following is an edited transcript of the discussion.

Pooja Kumar: You are the leader of one of the most critical human-services agencies for your state. How have your prior experiences shaped your work today?

Ursel J. McElroy: What fuels me is the motivation to help people to be their best selves. I’ve been afforded so many opportunities, considering that I had what many would consider a modest upbringing. I approach each day without taking anything for granted. Since I was a young person, I’ve always been in the constant pursuit of more—how can we do more; more for ourselves, more for others, more to make things better? I use this approach as a leader as well with my staff and with the people I have an opportunity to work with. I don’t take the opportunities that I’m given for granted. I use each moment to try and make changes.

Pooja Kumar: What drew you to work in service of vulnerable populations?

Ursel J. McElroy: Throughout my career, I’ve had the privilege of working with incredible people. My background for many years has been serving victims of crime. Whether it was child abuse, sexual abuse, elder abuse, or helping families who’ve had to deal with loss due to a homicide. What you learn working with people who have experienced unimaginable things is their resilience and their desire to make things better is incredible, not just making things better for their families but for all those who come after them. So I don’t believe I have the luxury of doing anything less than operating with intention, with a sense of urgency, and with constant purpose.

Pooja Kumar: What has been your biggest professional lesson in terms of health equity?

Ursel J. McElroy: I think it’s vital for people to understand that each one of us has our own lived experiences and there’s value in that. Those experiences are as unique as the fingerprints on our hands. So I don’t make assumptions. I try to be very careful to not operate as if any one group is a monolithic, static group of individuals. I appreciate differences and strive to try to meet people with the certainty that no matter where you started, you have a fair opportunity to be the best that you can be.

Pooja Kumar: How can an organization go all in on health equity?

Ursel J. McElroy: First, we have to be very intentional in our work, in our policies, and in our practices. We have to create lines of succession so individuals can bring to the table some of those very diverse, yet rich, experiences that can only further our businesses and our productivity. I believe if given the opportunity, most people want to succeed.

Within my department, we are very intentional about being inclusive. We are very intentional in the ways in which we provide opportunities, harness different viewpoints, and utilize the experiences of others to help us not only support our business but also support those individuals who rely upon our business. Each day we work hard to be certain that we’ve put in place those opportunities for those individuals to thrive.

Pooja Kumar: How do you apply this concept of health equity to your work in aging today?

Ursel J. McElroy: One thing we all have in common is that we will all age. The landscape of long-term care or healthy aging is ever evolving, and it has been accelerated by COVID-19. It is more important than ever to be certain that we have long-term care providers, families, and individuals who are agile enough to adapt to the diverse needs and preferences of older individuals across this world, no matter the setting. The emphasis on healthy aging must not stop at the front door of a provider or a facility. Rather, our strategies have to contemplate many things such as critical-care transitions or appreciating what individuals desire in living healthy lives, understanding this will require us to be very intentional.

It’s important to note that almost everything is possible if you maintain health into older age. However, if you don’t, many of your opportunities will be limited and the potential cost for all of us will be considerably higher. Healthy aging requires us to think about how we age across the life span. Healthy aging requires us to think about how we incorporate strategies and policies broadly and apply them often.

I think that old age cannot be seen as a burden because if we view it that way, we will have a natural tendency to focus on things that are limited to cost containment or to focus on things that do not necessarily allow us to be very bold and very innovative. However, if you think of old age as an opportunity for all of us to have a dignified life, then we are going to invest in those services for older individuals.

We fully understand what impacts how we age throughout our life span: more investments earlier on, more often, and in the right places and spaces will make healthy aging a reality for most of us and not an aspiration. This is simply about changing the narrative and being willing to invest in long-term strategy rather than short-term fixes.

Senior man consulting with a doctor on his laptop.

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Pooja Kumar: How has COVID-19 exacerbated or improved some of the challenges of healthy aging?

Ursel J. McElroy: COVID-19 has threatened the health, services, living arrangements, and interactions of older adults and their lives. Across the world there have been so many accounts of illnesses, hospitalizations, and deaths impacting the older population. The pandemic has laid bare many things and it has crystallized what many of us knew but had not faced head-on before. We are left to wrestle with the question of, “How did we get here?”

However, we have an opportunity to make considerable changes. We know what impacts healthy aging. We know what we now need to go back and correct. I think the cruel irony of COVID-19 will be that while there have been many losses, this will be the catalyst that helps save older lives in the future. It will require us to look at how we view older lives. It will require us to take an inventory of the services, investments, and opportunities available to provide a stronger system of long-term care for older individuals.

Pooja Kumar: If there were three things you could do across the country to improve the experience of aging, what would they be?

Ursel J. McElroy: First, I would want everyone to value what it means to age. You have to value something before you will invest in it, and I think for far too long, we have accepted a view of aging as one of decline, one of loss, one of decreased value, and that is simply not true. As you age, you have opportunities to continue to contribute, you have opportunities to live longer, thrive longer, and to be a valued part of our society.

I think the cruel irony of COVID-19 will be that while there have been many losses, this will be the catalyst that helps save older lives in the future.

I would also want many of our older individuals to be present in the decisions that are made on their behalf. Often, I am a part of policy-making and policy-setting decisions which do not include the very people who will be most impacted. It is going to be important for us to tune into what their needs are, to understand what their experiences are, and to appreciate how we can close the gap between what they desire and what we’ve been able to provide so far.

Finally, I would like to see true investments in aging. Investments beginning sooner in life, an appreciation for the upstream impacts, and how you can make a difference if you just begin a little earlier. Helping people to eat healthier, appreciate what it means to live in a safe and secure environment, understand what health literacy means, and what it means to prepare yourself as you continue to age throughout the life span.

Interestingly, many individuals do not put steps in place or understand the value of healthy aging until they have reached a later age. I would suggest we make it a part of our life span. Make it a part of everyday living to understand the things that we can do to empower each one of us to have the chance to live well as we age. It’s not just about increasing the amount of time you’re on this earth, it is about the quality of time you have while you’re on this earth.

Pooja Kumar: What role can the private sector play in partnership with states to provide needed services for the elderly?

Ursel J. McElroy: I believe it’s important to have public–private partnerships. This is not an issue that can be addressed by governments alone, nor is it an issue that can be addressed by the private sector alone.

When I think of examples of what it means to age in a healthy way, many of those will require public–private partnerships. When we begin to look at healthcare, education, or financing long-term care, there are so many opportunities for public–private partnerships to strengthen the infrastructure that we have created for aging well. I would like to see an expansion of those partnerships and bolder thinking about how this can be applied across the world for older individuals.

Pooja Kumar: We’re having this conversation just as International Women’s Day approaches. When you look more broadly at your role as a woman and a leader in healthcare, what are some of the greatest biases and challenges that you’ve encountered?

Ursel J. McElroy: Well, I will say that when you are a visionary sometimes your ideas can seem too big for the other people in the room. It can make you question your own intentions and compel you to curb your enthusiasm, so you shrink into a smaller space that is comfortable for the others in the room.

I think one of the challenges that I have overcome is being comfortable sometimes making other leaders uncomfortable. When I ask you, “Why are we moving too slow?” if I respectfully challenge a decision that could adversely impact millions of individuals, I am now comfortable with your discomfort. I have learned to reframe the issue, where needed, but stay the course.

People ask me, what are the things you would want younger women starting their careers to do? What sort of advice would you have for them? There are three things that I would offer to any woman. First and foremost, bring your whole self. Many of us lead high-pressure lives. As women we often have to juggle managing our families and our career, and our mental and physical health can often take a back seat. In fact, major barriers for women not maintaining a healthy lifestyle are often the lack of time and the deprioritization of their own well-being. So, I would say to women, you have to bring your whole self every day and that requires you to take care of yourself.

The second thing I would say is to give yourself grace: the permission to forgive your own mistakes. There will be times where you will have lapses in judgment—no one is perfect. Try not to ruminate for too long; it simply depletes your energy, and it compromises your ability to get off the ropes, reorient yourself, and stand tall the next day. So give yourself grace.

Finally, I would strongly recommend you get in the room. You must get in the room. What do I mean by that? Being aware, being heard, being included, being informed, being present. All these things are critical to advancement and success. You must be in the room. You must have a seat at the table. My advice to any woman is to take up the challenge to be certain that you are invited in that room, and when you get in that room and you have a seat at that table, speak up and be genuine so you will be heard.

Pooja Kumar: We are speaking around the time of Women’s History Month. What does this month and International Women’s Day mean to you?

Ursel J. McElroy: International Women’s Day is both empowering and sobering. It symbolizes the progress, resilience, solidarity, strength, struggles, and successes of women across the world from all different walks of life. It is powerful to be connected to so many women in this way and refreshing to know I am not alone. Yet, it is also sobering when you realize the amount of ground we still have to cover. So I intend to commemorate this important day, this important time, to not only create awareness but also to use it as a platform for action that will yield needed change.

Pooja Kumar: When you look at the place of women in leadership 20 years from now, what do you see?

Ursel J. McElroy: The pandemic has accelerated the need for many successful organizations to appreciate the value of women. Organizations need to be more flexible, innovative, thoughtful, and purposeful about how they harness, retain, and utilize the talents of all of employees, and in particular, women. The companies which have made workforce environments more conducive for the growth of women will be the companies that will thrive and succeed.

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