What a geriatrician wants us to understand about rights-based healthcare, caregiving, and the future of ageing well.
In this episode, I spoke with Dr Warren Wong, a geriatrician whose career has been shaped by two intersecting commitments: a lifelong “social mindset” grounded in the idea that healthcare is a right, and a practical dedication to helping older people not merely live longer, but live with dignity, peace, and happiness.
His story begins in San Francisco’s Chinatown, born to parents who immigrated from China around the Second World War. Growing up through the Vietnam War era, he was drawn early towards medicine and trained at the University of California, Berkeley—an environment that, as he described it, reinforced the belief that systems can and should be organised around social purpose. That same orientation later led him to geriatrics, and to his formative work with On Lok, a program whose name translates to “peace and happiness” and whose mission is to support older people—especially those who are frail—to continue living well in their communities.
This conversation is both timely and confronting. Australia, like many countries, is experiencing demographic ageing. Yet many of our institutional arrangements remain oriented towards acute illness and episodic intervention rather than long-term support, relational care, and community-based living. Dr Wong’s perspective offers a clear framework for what is working, what is failing, and what could change.
Healthcare as a right: a simple comparison that exposes a structural gap
Dr Wong’s most compelling explanation of “healthcare as a right” was not abstract. It was comparative.
In the United States, he argued, most people accept education as a social right. Children can attend public school without families negotiating fees with individual teachers or navigating complex co-payments. Society has decided—imperfectly, but decisively—that education should be accessible as a public good.
Healthcare, by contrast, is often treated as a commodity. People must “find their own doctor”, confirm there is a service near them, secure insurance, and still expect out-of-pocket payments. This creates systemic insecurity: not simply the stress of illness, but the uncertainty of whether care is accessible at all.
The broader implication is structural. When care is a right, access is assumed and planned. When care is a market good, access becomes conditional, fragmented, and stratified. For ageing populations—where support needs are often continuous and cumulative—this difference is not merely political. It is determinative of wellbeing.
What modern medicine does well: technical progress that changes the prognosis
Dr Wong was careful to acknowledge genuine strengths in contemporary healthcare, particularly in areas where scientific and technological advances have dramatically improved outcomes for older people.
He pointed to two domains:
- Cancer care, where treatment has become less injurious and, in many cases, cancer has shifted from an immediate terminal diagnosis to a chronic condition people may live with for years.
- Ophthalmology, where surgical improvements have transformed age-related vision impairment, enabling many older people to regain clarity after decades of decline.
These examples matter because they illustrate an important distinction. Biomedical systems are often highly effective when the problem is framed as a technical pathology. Where the system struggles, however, is when the problem is not a disease to be treated, but a life to be supported.
What we do poorly: inequality, institutional drift, and the economics of frailty
One of the most consequential parts of the episode was Dr Wong’s analysis of how economic inequality shapes ageing outcomes.
He described a stark reality in the United States: if a person becomes very frail and needs 24-hour support, the pathway diverges sharply by wealth.
- A wealthy person is far more likely to receive intensive support at home.
- A poor person is far more likely to be placed in a nursing home.
- Most people in between may remain at home, but only by depleting life savings over time.
Although this example was US-specific, the underlying mechanism is recognisable elsewhere. When long-term care is not adequately publicly supported, families absorb the burden—financially, emotionally, logistically. In effect, the capacity to “age in place” becomes less a universal aspiration and more a privilege shaped by resources, housing, and family availability.
The 911 problem: how system-centred pathways push people out of home
Dr Wong offered a striking illustration of what happens when systems are designed around institutional responses rather than person-centred needs.
In many US contexts, after-hours medical advice is reduced to a default instruction: if you have an emergency, call 911. For frail older people, he argued, that instruction often initiates a predictable cascade:
- Ambulance transport to the emergency department
- Hospital admission
- High risk of confusion (delirium), infection, decline, or complications
- Discharge not home, but to a nursing facility—often against the person’s preferences
He cited a national pattern: for an older person around 85 years old, only about half may return home directly from the emergency department. Whether the exact proportions generalise elsewhere, the systemic principle is broader: when emergency systems become the default entry point, the downstream consequences can remove older people from their homes, disrupt continuity, and escalate costs.
The lesson is not that emergency care is “bad”. It is that emergency care is frequently a blunt instrument for complex frailty needs. A system built for acute episodes cannot easily provide the continuity and relational support that ageing well requires.
“What matters” not “what’s the matter”: the case for person-centred ageing
A key conceptual shift in the episode was the move from a problem-focused model (“what’s the matter?”) to a values-focused model (“what matters?”). Dr Wong referenced a global person-centred movement that aims to realign healthcare with the lived priorities of patients.
For older people, this is often the difference between:
- Living longer vs living meaningfully
- Being treated as a cluster of diagnoses vs being treated as a person with preferences, relationships, and dignity
- Being managed according to institutional categories vs being supported according to what makes life worth living
This distinction becomes especially important when the “best” medical intervention may conflict with what the person values most—independence, familiarity, home, autonomy, cultural connection, or simply peace.
Practical guidance for new caregivers: relationship, advocacy, and dignity
Although the conversation explored systemic issues, Dr Wong also offered pragmatic advice for individuals entering caregiving roles.
His most concrete recommendation was to build a strong relationship with the primary care doctor (GP). Not merely as a service provider, but as an advocate who understands the older person’s context, history, and priorities.
He framed it as a form of relational investment: caregivers should communicate that the older person is deeply valued and that the family wants care that would be given “as if this were your own parent”. The point is not sentimental. It is strategic. It attempts to activate the “art of medicine”—the part of clinical work that depends on judgment, continuity, and human attention, not only clinical protocols.
He also spoke candidly about life in aged care facilities: families can make a difference by showing consistent presence, affirming the older person’s personhood, and recognising caring staff. It “shouldn’t have to be that way”, he noted, but human systems are responsive to signals of relationship and accountability.
The undervaluation of care: why the most important worker is often invisible
A powerful moment in the episode came when Dr Wong stated plainly: physicians are often not the most important person in the day-to-day life of a frail older person. The person who matters most is the one providing daily care—helping someone eat, wash, move safely, remain connected, and retain dignity.
This observation challenges a common hierarchy. Modern health systems frequently privilege technical expertise and acute interventions, yet frailty is lived through ordinary routines. Care work is relational, skilled, emotionally demanding, and socially indispensable. When it is dismissed as “unskilled”, societies reveal a deep misunderstanding of what sustains human life across the lifespan.
This also connects to a broader political economy of care: much caregiving labour is unpaid, gendered, and hidden, while formal care roles are often underpaid and undervalued. Dr Wong noted an emerging “hybrid twist” in parts of the US: some programs—particularly veteran-related supports—pay family members to provide care, recognising both the value and cost-effectiveness of keeping people supported at home.
Technology and community: towards “high touch, high tech”
Dr Wong argued that supporting ageing in place will require two shifts operating together:
- Technology that enables monitoring and support “just in time”
He emphasised that supportive interactions do not always require long periods; brief contact can be profoundly meaningful if it is high-quality and responsive. Technology can help deploy limited human labour more efficiently, coordinate home visits, and provide reassurance and early warning when risks emerge. - A renewed social infrastructure of community
He described a “low point” in community cohesion across many developed economies and expressed interest in social experiments that rebuild neighbour-to-neighbour support. The goal is not to romanticise informal care or replace professional services, but to create networks where small acts—checking in, helping with errands, offering connection—reduce isolation and prevent crises.
His proposed endpoint was not low-tech nostalgia. It was a future of “high touch, high tech”: systems that integrate relational care with technological coordination so that people can remain at home where possible, supported by both formal services and community connection.
What gives hope: building “brick houses” in care systems
When asked what gives him hope, Dr Wong used an evocative metaphor: across his career he has helped build “straw houses”, “wood houses”, and occasionally “brick houses”—interventions that fail quickly, last somewhat longer, or become enduring parts of the system.
His optimism was grounded in a belief that societies reach tipping points. As demographic ageing accelerates, the current “lose-lose-lose” dynamic (high cost, poor fit for preferences, system overload) becomes increasingly unsustainable. Over time, the pressure to develop home- and community-based care will intensify, and the opportunity for systemic redesign expands.
He was candid: he cannot predict exactly how the shift will occur. But he believes it will.
The central message
Ageing well is not primarily a medical problem. It is a social design problem.
It involves rights, infrastructure, housing, labour markets, and community cohesion. It requires revaluing care work. It requires systems that start with what matters to the person, not with what the institution is built to do. And it requires moving away from default pathways that push frail older people into hospitals and facilities simply because community supports are insufficient.
The episode with Dr Warren Wong is a reminder that the future of ageing is being negotiated now—not only through policy reform, but through everyday decisions in families, clinics, and communities about what we treat as normal, what we treat as inevitable, and what we decide must change.
