Where We've Been, Where We're Going

The USC Davis School of Gerontology hosts a conversation on aging policies past, present and future with Assistant Secretary for Aging Kathy Greenlee
By Jonathan Riggs

Photo Credit: Stephanie Yantz

With two decades of public service under her belt—18 years in Kansas state government and two (thus far) in Washington, D.C.—Assistant Secretary for Aging Kathy Greenlee is undoubtedly one of the most knowledgeable and powerful figures in the field. A rote recital of basic talking points during her appearance at the USC Davis School of Gerontology would have been understandable given her busy schedule.

“I hate reading a speech so I didn’t write one,” she said instead, showcasing a dry wit and forthright manner as she spoke from the heart rather than from the page. “This was billed as a conversation and that’s what I want to happen.”

Greenlee’s special policy forum, “Creating Aging Polices that Unite Country, Cultures and Generations to Come,” was sponsored by the National Association for Hispanic Elderly (ANPPM), the California Council on Gerontology and Geriatrics (CCGG) and the USC Davis School of Gerontology. It afforded experts in the field, community advocates, faculty and students the opportunity to interact with Greenlee, who was appointed to head the Administration on Aging (AoA) by President Obama and confirmed by the Senate in 2009.

“I want to talk to the students first,” Greenlee said, describing how her career came about by accident. “I found my way to aging because every job I had as a lawyer involved seniors: I worked with junk mail and telemarketer scams. I saw seniors who were sold too many policies, long-term care insurance, dread disease insurance: seniors who were over-insured because they were scared.”

Rising through the ranks of Kansas state government agencies, Greenlee described how even though she knew consumer protection was always her goal, the experience of holding a variety of positions and earning an eclectic blend of experience proved invaluable to her success.

“Here’s my advice: do as many different things as you can, then try to see the connections between them,” she said. “I have had the most unusual career path to get here, and I needed every single job I’ve had. Find every opportunity, find the challenge and do it. It will eventually all connect.”

A self-described “USC/UCLA agnostic” (she went to the University of Kansas), Greenlee also displayed an uncanny ability to help unite Los Angeles’s greatest cross-town rivals. The forum benefited from the participation of both universities, and Greenlee made a special point to thank former Assistant Secretary for Aging Fernando Torres-Gil, Ph.D., the associate dean of academic affairs at the School of Public Affairs at UCLA as well as an adjunct professor of gerontology at USC, who was in attendance.

Eschewing the podium altogether, Greenlee moved easily in front of the audience, speaking with conviction as she traced the evolution of aging services from 1965 to the present in what she dubbed “Kathy’s Brief History of the Universe.” Describing America’s current aging crossroads as a very dynamic time—in both the best and worst sense of the word—she began with the passage of Medicare, Medicaid and the Older Americans Act, pinpointing what she believed to be a big policy mistake with far-reaching ramifications: the lack of a long-term, community-based approach to health.

“Today, we’re still struggling with how to get that mix right. The Affordable Care Act gives us some opportunities in that regard, but I wish in 1965 there had been some vision of a holistic approach to those services,” she said. “Instead, we divided the world up in screwy silos that are so incomplete in understanding the role of chronic care.”

Discussing how the 1960s and 1970s saw the AoA largely focusing on building a network, providing technical assistance and oversight as well as creating a national infrastructure, Greenlee pointed to the 1980s as the organization’s heyday—until the Reagan administration cut it in half, severing its basic support, and the industry-wide transition to payer-services.

“So what do we now? How do we invest in this national infrastructure? We need it more than ever, but the budget structure has never reflected that,” she said. “One of the biggest challenges we have right now is that everything we’re all doing to show good evidence, good research, good outcomes, does not create more money.”

Fielding questions about getting funding for community-based services, revising the Older Americans Act to officially recognize “gerontology” and the importance of services for homeless, disabled and veteran older adults, Greenlee used the example of food insecurity for Los Angeles seniors to emphasize her bottom-line belief in the idea of the basic social safety net: the need to determine the basic services people have the right to receive, and then to ensure they receive them.

Returning frequently to her belief that the key to overhauling the health care system is to successfully focus on, promote and blend home and community-based services while advancing the national care infrastructure, Greenlee called for ingenuity firmly grounded in pragmatism.

“We are in a really challenging time. We can innovate all we want, but there’s no guarantee we will have the support for the social services we need,” she said. “What if we find all the care models that would work, but there’s no mechanism in the federal budget side? At the same time, the larger conversation needs to continue. How do we provide planning and support for people who need long-term services, and for people who will?”

As she acknowledged these issues, Greenlee discussed the vital necessity of establishing funding streams, supporting legislation such as this year’s reauthorization of the Older Americans Act and focusing on how crucial and delicate the role of policy is in all this, while keeping in mind the staff and resources limitations of the AoA.

“We’ve grown: we have 120 staff. The National Institutes of Health (NIH) has 17,000,” she said. “The Substance Abuse and Mental Health Services Administration (SAMHSA) has five times the number of staff of AoA. The California Department of Aging has more staff, and I had more staff in Kansas.”

Turning the focus to the critical role of researchers, Greenlee addressed the faculty present, speaking at length about how crucial it is to make future-reaching decisions rooted in evidence-based programs and good science in order to make the best financial case for the cause.

“What’s missing is an infrastructure to learn what you’re learning. How do I find out, other than talking to you, what you’re doing? What is the national system?” she said. “With aging, we’re challenged in terms of growth, but we’re not challenged in terms of strength or knowledge. I am quite sincerely trying to figure out how we can do this. This is my own phrase: data is our currency moving forward.”

After thanking the host organizations and event attendees, Greenlee closed with an anecdote about tours she had taken of Los Angeles hospitals, and the variations she had seen not only in the facilities, but in the budgets and emphasis between medical and social services.