Rob Ence is the executive director of the Utah Commission on Aging (UCOA), a state commission established in 2005 to coordinate efforts across the aging spectrum on policy, research and academia, and community services for the older adult population. Ence assumed the role in 2016 when the commission was tasked with reenvisioning its future and statutory purpose. He spoke to State of Reform about the challenges and opportunities facing the aging population as the legislature considers broadening the commission’s scope and creating a state Master Plan on Aging.
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State of Reform: Why is the passage of Senate Bill 104, a proposal to develop a 10-year Master Plan on Aging, important and how would it impact your work?
Rob Ence: “The work that will contribute to a master plan document is in play and has been ever since I’ve been involved. Years ago there was more of a master plan called Utah 2030 that had not been revisited since 2005. And so after coming out of the pandemic, [we were] trying to raise more awareness with legislators for the need to articulate a more coordinated approach between agencies, NGOs, [and] for-profit organizations out there. I worked with Sen. Kwan to modify the existing statute to include and delineate the need for a master plan. It really in spirit has been part of the commission work, but it was never owned by the legislature with outcomes that address the things we’re doing.
The outcomes that were being reported to the legislature were totally inadequate for what we really need to address future preparations for the state. There are elements that are already in existence out there that will constitute pieces of the plan. For example, we may have seven core sectors in the plan that we’re going to cover. Under the sector of health and wellness, we already have a well-established roadmap for Alzheimer’s disease and related dementias ….
We have a well-stated plan on community services related to Meals on Wheels, respite, and other caregiving kinds of things because that’s required of the Division of Aging and Adult Services. Those are all subsets of what the master plan encompasses. So the master plan pulls together what’s working, identifies gaps that exist, informs policymakers of things we need to consider doing differently, and pulls it all together so there’s not all these different siloed efforts on pieces of the puzzle, but to try and make it a whole collective effort.
We should be doing a master plan whether this legislation passes or not. What [SB 104] does is put the legislative stamp on it with agreed-upon deadlines, [the first iteration of which] will be due in early November … That’s why so many pieces are already in play, but not necessarily in place. The other thing that it helps to have [a] legislative voice [for] is that there are cohorts around the country that are working on various plans on aging. And most of them, in order to have any credibility, require you to have state leadership buy-in, either from the governor, the executive branch, or from the legislature.
While we have legislative branch support, it was really important for the legislature, in my view, to have this in our statutes so that they not only are asking for it, but expecting it and agree upon or will agree upon mutual outcomes that will be measured from it. So that was another important piece that was missing, is having sort of the backing of the state leadership voice that will certainly help us in terms of getting outside funding for special projects if we want to.”
SOR: COVID-19 continues to disproportionately impact the elderly population. What have we learned from the pandemic that the public should be keenly aware of in terms of supporting this population?
RE: “If there were problems that existed before the pandemic, the pandemic exacerbated almost all of them. It increased incidences of social isolation, it increased incidences of elder fraud and abuse, [and] it increased incidences of housing challenges because of economic suppression. So if there was a problem of unaffordable housing, it got worse. If there were people feeling not connected to their community, it got worse.
The circle around an individual who is vulnerable had opportunities for exploitation. We call them the ‘trusted others.’ And there were no checkpoints because that circle is very narrow and most fraud, financial, and elder abuse of other kinds, occurs from family members and also people you know. When there’s not a check and balance or other people involved or other trusted sources, exploitation went off the charts. It doubled, essentially, during that period of time.
[The pandemic] also taught us that we need to find better ways to integrate technology into our older adult population. So a lot of money has been spent for the federal government to increase broadband, for example. And so the idea is making sure that our rural populations, our immobile populations, have access to broadband, but that just having that capability out there doesn’t mean older adults can afford to access it, that they know how to do it. They don’t have devices, they don’t know how to use the devices, and even if they did, do they know how to use them safely?
So the commission’s role in all of that will be to come in [once the infrastructure is built] with volunteer groups to help mentor people, to help promote programs that make it affordable and help them understand the benefits of it, but also how to guard against some of the pratfalls that come with utilizing technology.
But what technology does is it opens the world for people to access a ton of information through the internet: education, virtual travel, or connecting to life travel opportunities, health classes—online or in-person— [and] social groups that network and just have conversations about everything.
It also is a very important vehicle for the delivery of health. And a lot of individuals, because they’re rural or they may be chronically ill or less mobile, for them to pull the resources together to go in and travel miles to a doctor’s visit is a real challenge and it’s detrimental to their health. What telehealth has done is allow these visits to occur via Zoom and save their energy, [and] they get good consults.
There are times when you need to have somebody physically present for some kinds of healthcare, but there’s a lot of healthcare that can be delivered through telemedicine or telehealth. Telehealth is a real advantage that has come out of [the pandemic], but to do that we’ve got to have folks out there who can use the technology.”
SOR: What are the needs of older Utahns and how can the legislature continue to support them through policy this session?
RE: “I think that the legislature does a reasonable job trying to understand and support our most vulnerable populations [through] expansion of Medicaid, [and] providing support for caregivers of Medicaid with financial stipends, so they can care for people in their home rather than having to go to institutions. Those are all good dollar trade-offs. People want to age in place if they can but the price of a family caregiver really weighs upon them economically as well as their own health. And so you’ve got to have programs that provide respite and some compensation for the most vulnerable.
Where I’d love to see it shift a little bit is that we spent a lot of money in our social services, fishing people out of the stream because they have fallen in at some point in their life. It could be all kinds of reasons—disability, accident, loss of job, divorce, or lack of health. What we want to do is put emphasis on the preventive side. The more outreach and education [there is], the more we can encourage people to live properly, save prudently, [and] try to make good choices, [the better]. That’s hard to do. But we still have to do more to keep people from falling in the river so we’re not fishing them out quite so frequently as the years go by.
[UCOA’s] goal is to really educate people and connect them to resources that are there. And it’s not just resources for need, it’s resources for healthy living, it’s resources for good opportunities and choices that build an enriching life. People want to have a purpose to get up in the morning. What we do is by connecting with people, help them identify what that might be for them whether that’s volunteerism or something else.
I just respect the fact that [legislators] are paying attention to some very tough issues. I hope that they’re able to give support to our most vulnerable populations, but at the same time, really help incentivize folks to take advantage of resources that will help them be better informed. We have this idea in the state that we really want to empower the individual. Well, you have to empower the individual when they still have the opportunity to act for themselves. When they have fallen into a circumstance where they no longer can, then those resources turn more into helping them survive than it is to helping them thrive.”
This interview was edited for clarity and length.