The over-65 population is the fastest-growing demographic in America, according to the United States Census Bureau, yet few foundations dedicate themselves to working on behalf of this group. Frustrated with this dynamic, Gary and Mary West are pursuing community-, state- and national-level change through their foundation, research institute and policy center.
The couple made their money through West Corporation, a private telecommunications provider based in Omaha, Nebraska. In 2006, the Wests sold their shares of the company for $1.4 billion. That was when they turned their sights on philanthropy, founding the Gary and Mary West Foundation.
The couple, then in their 60s, set about finding a cause.
“They were clear that they weren’t going to write 200 checks for $25,000 apiece for any organization that pulled on their heartstrings,” said Shelley Lyford, the foundation’s president and CEO. “Instead, they wanted to be much more strategic. They really wanted to focus in on areas where they could make an impact in their lifetime.”
The Wests settled on aging.
“They had several very personal experiences in caring for their own parents,” Lyford said. The experience opened up for them the emotional, mental and financial toll of caring for an aging family member can take.
“Listen, they’re billionaires. They could make a call to whomever they needed to call in the United States to get the best care for their parents, the best care coordination. They could have help navigating the healthcare system. They could have in-home help,” Lyford said. “They took this on. They’re very smart, very savvy, and they were completely overwhelmed.”
“It was an eye-opening experience of what families go through as we age, and as we enter the final years of life in America,” Lyford said. “It was those very personal experiences that drove them to want to focus their philanthropy in aging.”
Filling a Big Gap
The Wests were also motivated by the lack of interest among other philanthropists in tackling issues around aging. Of more than 100,000 private foundations in the United States, only about 10 focus exclusively on seniors, according to Grantmakers on Aging, even as the country rapidly ages. It’s estimated that the number of Americans 65 and older will more than double from 46 million today to over 98 million by 2060. Many of those now aging have few retirement savings, yet will need extensive care as a result of increased rates of neurodegenerative disease, obesity and diabetes.
Since 2006, the Wests have made more than 500 grants focused on aging, totaling $211 million, through the Gary and Mary West Foundation. In the intervening years, the Wests also added a research institute in 2009 and a policy center in 2012 to champion aging issues. The two additional organizations allowed the Wests to amplify their work beyond the community level, Lyford said.
“We realized that working in a vacuum of just philanthropy—of just kickstarting great projects and new models of care with philanthropic dollars—while that is really great for the community, it’s not going to change policy,” she said. “It’s not going to change trends. It’s not going to be sustainable on a state or national level.”
With the three organizations in place, housed under the umbrella of West Health, the couple and Lyford have developed a pattern to their investments. First, through the foundation, they invest in ideas and care models on the local level.
Back in 2016, for example, the Wests invested $2 million to create nonprofit dental care centers for low-income seniors in San Diego County. The two centers were housed in a senior wellness center and a Program for All-Inclusive Care of the Elderly (PACE) clinic, which serves low-income and sick seniors.
The West Foundation took on dental clinics because the absence of routine dental care for seniors can lead to much bigger problems down the line. Dental care isn’t included in Medicare, though seniors can access a dental benefit through Medicaid in some states, including California.
The absence of a dental benefit can mean seniors put off routine dental procedures, such as cleanings. When problems like an abscess develop, seniors head to emergency rooms, where doctors, not dentists, treat the pain with narcotics or the infection with antibiotics, but not the underlying problem. By the time seniors return, Lyford said, the problem may have escalated to something much more serious, like sepsis.
Through the West Health Institute, which partners with academic institutions to conduct medical research and evaluations, the Wests were able to demonstrate that the nonprofit dental clinics reduced healthcare costs to the system and taxpayers, and improved the quality of life for the elderly who used them.
Though the dental clinics were a boon to seniors who could access them, they also highlight the limits of philanthropy. The $2 million grant meant more seniors within San Diego County could access dental care, but did little to change lives for the elderly outside those communities.
That’s where the West Health Policy Center came in. Using the results and data provided through the research institute, the policy center successfully made the case in Sacramento to increase the Denti-Cal benefit for seniors. The policy change meant seniors across the state could access more dental care and extended West Health’s reach far beyond two clinics in one southern California county.
Next up, the Wests are taking on emergency care for seniors. A geriatric emergency care department developed by U.C. San Diego Health opened earlier this year. The department, which houses 18 beds, was designed with seniors specifically in mind. That means decisions about lighting, bedding, the PA system and more were made with consideration to the elderly and with an eye to reducing falls, confusion and delirium. The Wests funded the department’s design and construction with an $11 million grant.
Other changes to a normal emergency care department included care teams staffed with a pharmacist, social workers and geriatric nurses. “Those folks are able to help ask the right questions and prompt families and seniors to think about their continuing care in a slightly different way, a more holistic way,” Lyford said.
The overall goal is to reduce the number of seniors admitted to the hospital overnight.
“Most times, a senior is going to be admitted for overnight care just because we don’t know what’s going on with their social determinants of health,” Lyford said. “We don’t know what’s going on at home. We don’t know if there’s food in the pantry at home or if someone is at home to take care of them. The reason is not necessarily because of a medical reason.”
“Just by having some of these protocols in place, we have the data to show we are saving money for taxpayers. We’re not admitting people we normally would,” she said. “The quality of care our discharged seniors are getting in the community is proving to be a much better experience. We’re getting better outcomes for their health.”
“Aging is Living”
Like many working in aging, Lyford is sounding the alarm about the demographic changes primed to hit the country—and the need for a stronger response.
“Investing in aging, investing in seniors, means investing in life and investing in your community, because our country is graying,” Lyford said. “Our birth rate is declining. We’re entering a different demographic. I feel like there’s a huge opportunity to embrace it, rather than to pretend it’s not happening.”
The Wests aren’t the only philanthropists focused on aging. They’re joined by a small but dedicated group of foundations, including the AARP Foundation, the Archstone Foundation, the Endowment for Health, the H.W. Durham Foundation, the Isaac H. Tuttle Fund, the Maine Health Access Fund, the Stevens Square Foundation, the John A. Hartford Foundation and the McGregor Foundation.
Other foundations include seniors in work they fund, even when the focus isn’t exclusively on the elderly. It’s a strategy some advocates in the aging space think could be a way to get more foundations thinking about the elderly when it comes to their giving.
Lyford says a shift is required by philanthropists, and society more broadly, in thinking about aging.
“Aging is not about death. It’s not about the last weeks before you die. Aging is really about living,” she said. “We are productive members of our communities. We have a lot to offer as we grow old. We just need to surround our community with appropriate policies that make aging easier.”