Li: Baby Boomers changed how we live — it’s time to change how we age

Baby Boomers have spent their lives challenging the status quo. They reshaped our workplaces, families, culture and expectations for how we live. Now, as this generation ages, we face a question we have spent far less time considering: Have we built a system that allows people to grow older the way they actually want to?

The answer, too often, is no.

America is undergoing a profound demographic shift, and Santa Clara County is no exception. More than 400,000 county residents are already over age 60, and that number will continue to grow in the years ahead.

But longevity alone should not be the measure of progress. We should also be asking what those additional years of life look like.

For many older adults with complex medical needs, care remains deeply fragmented. They bounce between specialists, primary care providers, hospitals and emergency rooms, with no one connecting the dots. When the system falls short, families become the default coordinators — a spouse managing medications and appointments or an adult child balancing caregiving with work and their own family.

As people need more help with daily life, their options can narrow dramatically. Too often, the choice becomes struggling to remain independent or moving into institutional care.

For a generation accustomed to choice and determined to age on its own terms, that isn’t good enough.

We need to rethink aging around a different goal: helping people maintain independence, connection and purpose for as long as possible.

That means moving beyond a healthcare system organized primarily around individual appointments and episodes of illness. Medical care matters enormously, but so do transportation, nutrition, mobility, social connection, behavioral health, rehabilitation and support for family caregivers. Treating those needs separately ignores how people actually experience aging.

We know more integrated approaches are possible.

One example is the Program of All-Inclusive Care for the Elderly, or PACE, which began more than 50 years ago with a simple idea: older adults with complex health and long-term care needs should receive coordinated care in their homes and communities whenever possible. Today, more than 200 PACE programs operate across the country, including here in Santa Clara County.

Recent federal research provides an important lesson. A study of Medicare beneficiaries eligible for both Medicare and Medicaid found that participants in PACE, where medical and long-term care are coordinated by one team, experienced lower rates of hospitalization and emergency room use than comparable beneficiaries in a non-integrated model.

The point isn’t that every older American — or every older Santa Clara County resident — needs PACE. It’s that our broader system should learn from what models like it tell us: coordination matters. Community matters. Independence should be an outcome we actively design for, not something older adults are left to preserve on their own.

As we mark National PACE Month this September, that’s the larger conversation worth having.

Baby Boomers have never been a generation content to accept “that’s just the way things are.” We shouldn’t expect them to start now.

Here in Santa Clara County, where hundreds of thousands of residents are already entering their later years, we have an opportunity to rethink what aging looks like — not as a period defined primarily by decline and dependency, but as a stage of life in which people retain as much choice, dignity and connection as possible.

We have added years to our lives. Now we need to make sure our communities and healthcare systems are designed to support how people want to live them.

Grace Li is CEO of On Lok, a nonprofit organization that pioneered the PACE model of care and provides healthcare and social services to help older adults stay active, healthy and independent, including at PACE centers in South San Jose and the East San Jose area.