ASA Generations - Generations: The Latest Age-Related News, Articles and Opinions http://generations.asaging.org/ en Housing: Often Overlooked but a Critical Pillar for Older Adults http://generations.asaging.org/housing-older-adults-health-inequities-policy <span class="field field--name-title field--type-string field--label-hidden">Housing: Often Overlooked but a Critical Pillar for Older Adults</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><a title="View user profile." href="/user/6" class="username">asa_admin</a></span> <span class="field field--name-created field--type-created field--label-hidden">Sat, 07/18/2020 - 01:19</span> <div class="field field--name-field-tags field--type-entity-reference field--label-above"> <div class="field__label">Tags</div> <div class="field__items"> <div class="field__item"><a href="/ageism-culture" hreflang="en">Ageism &amp; Culture</a></div> <div class="field__item"><a href="/economic-security" hreflang="en">Economic Security</a></div> </div> </div> <div class="field field--name-field-channel field--type-entity-reference field--label-above"> <div class="field__label">Channel</div> <div class="field__item"><a href="/generations-journal" hreflang="en">Generations Journal</a></div> </div> <div class="field field--name-field-teaser-text field--type-string-long field--label-above"> <div class="field__label">Teaser Text</div> <div class="field__item">Why is housing a backburner issue, how does it determine health, what are the inequities and how might we fix it?</div> </div> <div class="field field--name-field-paragraphs field--type-entity-reference-revisions field--label-above"> <div class="field__label">Paragraphs</div> <div class="field__items"> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><h6>Abstract</h6> <p>Housing is central to older adults’ life outcomes. Housing’s affordability, physical quality, and location can impact physical and mental health. Housing policies and practices have systematically limited access to homeownership for persons of color and segregated many into disadvantaged neighborhoods. For many, this has curtailed economic and wealth building opportunities over the life course and exposed them to negative health consequences of segregated neighborhoods. Encouraging and supporting equitable access to safe and quality housing options for older adults should be a role for all aging services stakeholders.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><h6>Key Words</h6> <p>housing policy, social determinants of health, homeownership, equity, discrimination, COVID-19</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><hr /><p class="dropcaps">Housing policy tends to be overlooked when it comes to older adults. Attention is focused on programs and services that help older adults to stay in their homes—homemaker supports, personal care assistance, or meal deliveries—but housing fails to command the same consideration.</p> <p>Maybe this is because housing policy, in my opinion, has broadly been a backburner issue. Despite the housing affordability “crisis” that has been impacting broad swaths of American households for years, for example, housing is infrequently addressed in presidential or other election campaigns.</p> <p>Part of the challenge is that housing in America is viewed as a private market good, and framed as a way to build wealth. As such, housing policies, regulations, and practices are largely viewed through the lens of homeownership, increasing and protecting home values, and allowing market forces to dictate response. For example, the largest federal housing subsidy remains the mortgage interest deduction, even after the Tax Cuts and Jobs Act of 2017 lowered the cap on the size of the mortgage on which interest can be deducted (Thornton and Estep, 2019). In many cities, a large proportion of land is zoned exclusively for single-family homes (Manville, Monkkonen, and Lens, 2019).</p> <p>Recently, however, the aperture on housing has been expanding. As the social determinants of health gain attention and racial and ethnic inequities are spotlighted, we’re recognizing housing’s role in physical and mental health and life opportunities.</p> <h3>Social Determinants of Health</h3> <p>The social determinants of health are the social, economic, and physical conditions under which people are born, grow, live, work, and age. These conditions affect a person’s health risks and outcomes. Housing—including stability and affordability, physical structure, and location—is a key social determinant.</p> <p><strong>Affordability and stability: </strong>Individuals who are unstably housed, which may mean they are falling behind on rent, moving frequently, or staying with friends or relatives, are more likely to experience poor health than those who are stably housed. Research has found that people who are housing insecure are less likely to have a usual source of medical care, more likely to delay doctor’s visits and to use the emergency room for treatment, report poor or fair health, or report poor health that limits their daily activities (Stahre et al., 2015; Braveman et al., 2011).</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--quote paragraph--view-mode--default"> <blockquote> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>‘Housing in America is viewed as a private market good, and framed as a way to build wealth.’</p> </div> <footer class="blockquote-footer mt-2"> <cite title=""> </cite> </footer> </blockquote> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>Studies also have found housing instability is related to elevated stress levels, depression, and hopelessness (Center for Housing Policy and Enterprise, 2007). Unsurprisingly, high housing costs can force people to make tradeoffs with other essentials like food, healthcare and medications, and heating or cooling (Joint Center for Housing Studies of Harvard University [JCHS], 2019).</p> <p><strong>Physical structure:</strong> Quality and safety deficits in one’s home can be detrimental to health. Water leaks, poor ventilation, dirty carpets, or bug infestations can produce mold, dust mites, or other allergens associated with poor health. Lack of heating or air-conditioning, leading to extreme high or low indoor temperatures, has been associated with increased mortality. Structural features such as steep stairs, holes in floors, or inaccessible bathrooms and kitchens can result in accidents and injuries (Braveman et al., 2011).</p> <p><strong>Location: </strong>The environment in which one’s home is located can also impact health and well-being. Older adults often spend decades in their communities and thus experience higher levels of exposure to neighborhood conditions. In addition, as older adults retire or become less mobile, they may spend more concentrated time in their neighborhood.</p> <p>Research shows that living in disadvantaged neighborhoods—characterized by high poverty—is associated with weak social ties, problems accessing healthcare and other services, reduced physical activity, health problems, mobility limitations, and high stress. The difference can be explained, in part, by the characteristics of people living in these neighborhoods, but also studies suggest that neighborhood characteristics may independently influence older residents’ health and well-being. Disadvantaged neighborhoods often have more crime, more pollution, poorer infrastructure, and fewer healthcare resources. Walkability; accessibility (including public transportation); safety; availability of public resources, like community centers, parks and libraries, and grocery stores with nutritious food; and healthy air all are related to health behaviors and outcomes (Mather and Scommegna, 2017, Bell et al., 2013, Braveman et al., 2011).</p> <h3>Housing Inequities</h3> <p>Today’s neighborhoods are shaped by mortgage lending practices started almost 100 years ago. In the 1930s, the Home Owners Loan Corporation graded neighborhoods according to lending risk, which was based largely on their minority makeup. Neighborhoods with racial and ethnic minorities were deemed “hazardous” and outlined in red on maps. The newly created Federal Housing Administration (FHA) would not insure loans in or near these neighborhoods, which effectively led to the entire mortgage industry refusing to make home loans to persons of color. As home ownership is a key source for building wealth in this country, this set the stage for the racial wealth gap that persists today.</p> <p>Additionally, the FHA also encouraged the use of race restrictive covenants by lowering the mortgage risk on individual properties with exclusionary deed language. It also often required that developers receiving construction loans place race restrictive covenants in their subdivisions’ property deeds (Rothstein, 2017). This denied African Americans the opportunity to participate in the postwar housing boom and to move to new suburbs, trapping them in inner cities that faced declining investment.</p> <p>Discriminatory lending practices were legal until 1968, when the Fair Housing Act was passed. Despite being outlawed, discriminatory and predatory lending practices and residential segregation continue today (Massey, 2015).</p> <p>It is important to understand the impact of these housing practices on many current and future older adults of color.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--quote paragraph--view-mode--default"> <blockquote> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>‘In 2018, 82 percent of white adults ages 65 and older owned a home, compared to 62 percent of black older adults.’</p> </div> <footer class="blockquote-footer mt-2"> <cite title=""> </cite> </footer> </blockquote> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>Black older adults have had less opportunity to purchase a home. In 2018, 82 percent of white adults ages 65 and older owned a home, compared to 62 percent of black older adults (JCHS, 2019). For those who were able to buy, many have been limited to neighborhoods with lower home value appreciation and-or may have only had access to unfavorable loan products and terms. In 2012, the median home value for black households ages 65 and older was $93,000, compared to $165,000 for older white households (Butrica and Mudrazija, 2016).</p> <p>These circumstances inhibited minority older adults’ opportunity to accumulate wealth over their lifetime. In 2013, the median net worth of African American older adult households ($56,700) was roughly one-fifth of the median net worth of white older adult households ($255,000) (Rosnick and Baker, 2014). While this difference cannot be attributed to home ownership alone, home equity is a primary way for American households to gain wealth</p> <p>Because the housing stock in redlined areas tends to be older, older adults’ homes in these neighborhoods may be in greater need of repair (Perry and Harshbarger, 2019). With lower home values or growth in home values, older adults of color may have less equity that could be tapped into to finance needed repairs or modifications to help maintain the safety and accessibility of their home. This could put them at risk for falls or other injuries. Also it could limit their ability to ambulate in and out of the home, leading to social isolation. Similarly, they have less equity to tap into to pay for services to help them age in place, if needed.</p> <p>Historically redlined neighborhoods have been and generally remain more segregated and more economically disadvantaged today than other neighborhoods (Perry and Harshbarger, 2019). These neighborhoods have faced a legacy of disinvestment, which has impacted economic opportunities, access to resources, and the physical environment.</p> <p>Evidence suggests segregation is a primary cause of racial difference in income by impacting access to education and employment opportunities (Williams and Collins, 2001). Lower incomes in addition to lower opportunity for home ownership has impacted the ability of older adults of color to build wealth to help support them in retirement.</p> <p>Disadvantaged and segregated neighborhoods have less access to options for buying affordable and healthy food and fewer healthcare resources (United States Department of Agriculture, 2009; Gaskin et al., 2012).</p> <p>Disadvantaged neighborhoods also often have higher crime, more environmental pollution, and poor infrastructure (sidewalks, street lighting, and traffic-calming measures). These elements can influence residents’ sense of safety and willingness or ability to engage in physical activity (Center on Social Disparities in Health, 2015).</p> <h3>The COVID-19 Effect, on Housing</h3> <p>Housing is probably not the first thing that comes to mind when considering the effects of COVID-19 on older adults. The economic impact of the pandemic, however, is potentially concerning, particularly for near retirees. Drawing on the 2008 Great Recession for comparison, experts predict the COVID-19 pandemic could diminish current and future retirement savings, as well as threaten public and private retirement systems (Johnson, 2020).</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p style="margin-bottom:14px">Older adults may be more inoculated from the economic impact of the pandemic than younger persons, as many are already retired and-or own their home outright. However, some near retirees may have lost their jobs, thus potentially impeding their ability to save for retirement. This could impact their future ability to sustain housing costs or inhibit future choices about housing, such as making repairs or modifications, or moving to an alternative housing type. For some lower-wage near retirees without a savings cushion, it could have a more immediate and lasting impact on their ability to afford housing costs.</p> <h3>Why Does This Matter for Aging Services Stakeholders</h3> <p>Housing is a broad and complex topic, and aging services stakeholders may not understand the connection to their role, or know how to engage. But the discussion above shows that an older adult’s housing situation plays a fundamental role in their ability to maintain health and quality of life. Aging services providers and policymakers should consider it a key platform supporting the implementation or success of their services and initiatives.</p> <p><strong>Affordability: </strong>Housing affordability is a fundamental problem in this country, including for older adults. Nearly 10 million older adult households, both owners and renters, are cost-burdened and pay more than 30 percent of their income for housing (JCHS, 2019). Excessive housing costs can lead to tradeoffs on other necessities like food or medications, living in unsafe conditions, or, at the extreme, homelessness.</p> <p><strong>Options: </strong>Zoning and other land-use regulations often create and protect single-family development, which can limit the range of housing types and impact affordability in neighborhoods. Rental housing or alternatives such as accessory dwelling units or cottage housing may be excluded. This limits opportunities for older adults to leverage their housing for income or care needs or to downsize or move to an alternative housing type to fit their changing needs and interests and remain in their neighborhood, where they have history and a social network.</p> <p><strong>Opportunity: </strong>Older Americans’ life course contributes to their health (Vega and Wallace, 2016). The ability of many older adults of color to purchase a home has been systematically limited, impeding a primary path for building economic opportunity and wealth; and many have been segregated into disadvantaged neighborhoods, limiting economic opportunity and exposing them to environments that increase risks for health problems.</p> <p>While many aging services stakeholders may not be engaged in housing delivery or policy, the success of their services and supports often is intertwined with the stability and quality of their client’s or constituent’s housing. Aging services providers and policymakers should look for opportunities to support or encourage initiatives that will provide older adults (particularly lower income elders and older adults of color) with adequate housing. This could include paying attention to and being an ally around funding for the creation and preservation of affordable housing stock and rental subsidies, mechanisms for financing home repairs and adaptations, reforms to local and state land-use regulations and building inclusionary zoning opportunities, granting approvals for construction of new affordable senior properties, promoting and enforcing equitable housing finance opportunities, and eliminating barriers to fair housing.</p> <p>Where we live has a profound impact our opportunities and outcomes in life. It’s important to recognize this for today’s older adults and to shape the prospects for future older adults.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><hr /><p><em>Alisha Sanders, M.P.Aff., is director of Housing and Services Policy Research at LeadingAge, in Washington, DC.</em></p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><hr /><h6>References</h6> <p>Bell, J., et al. 2013. “Access to Healthy Food and Why it Matters: A Review of the Research.”<u> </u>Oakland, CA: PolicyLink. tinyurl.com/l8l4flw. Retrieved May 22, 2020.</p> <p>Braveman, P., et al. 2011. “How Does Housing Affect Health?” <i>Issue Brief #7</i>. Princeton, NJ: Robert Wood Johnson Foundation. <a href="https://www.rwjf.org/en/search-results.html?at=Braveman+P">tinyurl.com/y82zk7oh</a>. Retrieved May 22, 2020.</p> <p>Butrica, B. and Mudrazija, S. 2016. “Home Equity Patterns Among Older American Households.” <a href="tinyurl.com/y9n6zfpw">tinyurl.com/y9n6zfpw</a>. Retrieved June 11, 2020.</p> <p>Center for Housing Policy and Enterprise. 2007. “The Positive Impact of Affordable Housing on Health: A Research Study.” <a href="tinyurl.com/y8oonp4k">tinyurl.com/y8oonp4k</a>. Retrieved May 22, 2020.</p> <p>Center on Social Disparities in Health. 2015. “How Do Neighborhood Conditions Shape Health?” <a href="tinyurl.com/y7bxt6ya">tinyurl.com/y7bxt6ya</a>. Retrieved May 29, 2020.</p> <p>Gaskin, D., Dinwiddie, G., Chan, K. and McCleary, R. 2012. “Residential Segregation and the Availability of Primary Care Physicians.” <em>Health Services Research</em> 47(6): 2353-2376. <a href="tinyurl.com/y8s3yzw6">tinyurl.com/y8s3yzw6</a>. Retrieved June 11, 2020.</p> <p>Johnson, R. 2020. “Seven Ways the COVID-19 Pandemic Could Undermine Retirement Security.” <em>Urban Wire.</em> <a href="tinyurl.com/ybloxa5p">tinyurl.com/ybloxa5p</a>. Retrieved May 29, 2020.</p> <p>Joint Center for Housing Studies of Harvard University. 2019. <em>Housing America’s Older Adults 2019</em>. Boston, MA: Joint Center for Housing Studies of Harvard University.</p> <p>Manville, M., Monkkonen, P., and Lens, M. 2019. “It’s Time to End Single-Family Zoning.” <em>Journal of the American Planning Association</em> 86(1): 106–12. <a href=" tinyurl.com/y9m989zl">tinyurl.com/y9m989zl</a>. Retrieved June 2, 2020.</p> <p>Massey, D. 2015. “The Legacy of the 1968 Fair Housing Act.” <em>Sociological Forum </em>30(1): 571–88.</p> <p>Mather, M., and Scommegna, P. 2017. “How Neighborhoods Affect the Health and Well-Being of Older Americans.” <em>Today’s Research on Aging</em>. Washington, DC: Population Reference Bureau. <a href="tinyurl.com/y94ztxr9">tinyurl.com/y94ztxr9</a>. Retrieved May 22, 2020.</p> <p>Perry, A. and Harshbarger, G. 2019. “America’s Formerly Redlined Neighborhoods have Changed and so Must Solutions to Rectify Them.” <a href="tinyurl.com/yczg24ko">tinyurl.com/yczg24ko</a>. Retrieved May 22, 2020.</p> <p>Rosnick, D., and Baker, D. 2014. “The Wealth of Households: An Analysis of the 2013 Survey of Consumer Finances.” Center for Economic and Policy Research. <a href="tinyurl.com/ybzk5h7z">tinyurl.com/ybzk5h7z</a>. Retrieved May 29, 2020.</p> <p>Rothstein, R. 2017. <em>The Color of Law: A Forgotten History of How Our Government Segregated America.</em> New York: Liveright.</p> <p>Stahre, M., et al. 2015. “Housing Insecurity and the Association with Health Outcomes and Unhealthy Behaviors, Washington State, 2011.”<em> Preventing Chronic Disease</em> 12: 140511. <a href="tinyurl.com/ydy7m3e4">tinyurl.com/ydy7m3e4</a>. Retrieved May 22, 2020.</p> <p>Thornton, A., and Estep, S. 2019. “Take Stock of Spending Through Tax Code.” <a href="tinyurl.com/y9r9fvne">tinyurl.com/y9r9fvne</a>. Retrieved June 2, 2020.</p> <p>United States Department of Agriculture. 2009. “Access to Affordable and Nutritious Food: Measuring and Understanding Food Deserts and Their Consequences.” Report to Congress. <a href="tinyurl.com/yx5hwfxo">tinyurl.com/yx5hwfxo</a>. Retrieved May 29, 2020.</p> <p>Vega, W., and Wallace, S. April 2016. “Affordable Housing: A Key Lever to Community Health for Older Americans.” American Journal of Public Health, 106(4): 635–6. <a href="tinyurl.com/yc4anlh9">tinyurl.com/yc4anlh9</a>. Retrieved June 3, 2020.</p> <p>Williams, D., and Collins, C. 2001. “Racial Residential Segregation: A Fundamental Cause of Racial Disparities in Health.” Public Health Reports, Volume 116. <a href="tinyurl.com/y7sm7lml">tinyurl.com/y7sm7lml</a>. Retrieved June 2, 2020.</p> </div> </div> </div> </div> </div> <div class="field field--name-field-teaser-media field--type-entity-reference field--label-above"> <div class="field__label">Teaser Media</div> <div class="field__item"><a href="/media/13" hreflang="en">Housing</a></div> </div> <div class="clearfix text-formatted field field--name-field-byline field--type-text-long field--label-above"> <div class="field__label">Byline</div> <div class="field__item"><p>By Alisha Sanders</p> </div> </div> <div class="field field--name-field-issue field--type-entity-reference field--label-above"> <div class="field__label">Issue</div> <div class="field__item"><a href="/summer-2020" hreflang="en">Summer 2020</a></div> </div> Fri, 17 Jul 2020 23:19:02 +0000 asa_admin 43 at http://generations.asaging.org Averting a Housing Crisis and Shining a Light on Inequities in Elder Housing http://generations.asaging.org/housing-crisis-older-adults-alisha-sanders <span class="field field--name-title field--type-string field--label-hidden">Averting a Housing Crisis and Shining a Light on Inequities in Elder Housing</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><a title="View user profile." href="/user/6" class="username">asa_admin</a></span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 07/07/2020 - 23:12</span> <div class="field field--name-field-tags field--type-entity-reference field--label-above"> <div class="field__label">Tags</div> <div class="field__items"> <div class="field__item"><a href="/economic-security" hreflang="en">Economic Security</a></div> <div class="field__item"><a href="/innovation-social-impact" hreflang="en">Innovation &amp; Social Impact</a></div> <div class="field__item"><a href="/justice-equity" hreflang="en">Justice &amp; Equity</a></div> </div> </div> <div class="field field--name-field-channel field--type-entity-reference field--label-above"> <div class="field__label">Channel</div> <div class="field__item"><a href="/generations-journal" hreflang="en">Generations Journal</a></div> </div> <div class="field field--name-field-teaser-text field--type-string-long field--label-above"> <div class="field__label">Teaser Text</div> <div class="field__item">‘I wanted to recognize the key role of the “shelters” in which most older adults live.’</div> </div> <div class="field field--name-field-paragraphs field--type-entity-reference-revisions field--label-above"> <div class="field__label">Paragraphs</div> <div class="field__items"> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><figure role="group" class="caption caption-img align-right"><img alt="Alisha Sanders headshot" data-entity-type="file" data-entity-uuid="ea630ef1-65f7-4b82-8ad0-d5ccb53e452c" src="/sites/default/files/inline-images/Sanders-Alisha.png" style="margin:8px" /><figcaption>Summer Generations Guest Editor Alisha Sanders</figcaption></figure><p class="dropcaps">When asked about her motivation for guest-editing this Summer issue of Generations, Guest Editor Alisha Sanders said, “I wanted to help bridge two worlds­­–to help aging services people understand more about housing and to help housing people understand more about older adults.”</p> <p>Sanders directs housing and services policy research at LeadingAge, in Washington, DC, and is thrilled that Generations chose to devote an edition of the journal to housing.</p> <p>“Housing doesn’t often get emphasized in the aging services world,” said Sanders. “My intent with this collection of articles was to keep the focus on ‘housing’ and not slide into residential care settings. That’s not to say those settings aren’t crucial, and of course there are important policy and practice issues to address in that realm. But I wanted to recognize the key role of the ‘shelters’ in which most older adults live, to help people to fully understand the housing situations of older adults, where gaps exist and which issues need addressing,” she added.</p> <p>At LeadingAge, Sanders studies programs and models that link affordable senior housing communities with health and supportive services. With colleagues and partner organizations, they’ve built a new knowledge and evidence base on the implementation and outcomes of these initiatives to help foster their spread.</p> <p>“I’ve always been passionate about housing policy, and sort of ‘fell into’ the older adult aspect,” Sanders said. She stayed in the older adult arena, however, because she’s intrigued by the way housing intersects with other aspects of older adults’ lives, and how central the combination can be to quality of life, especially for low-income older adults.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--quote paragraph--view-mode--default"> <blockquote> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>‘I wanted to recognize the key role of the “shelters” in which most older adults live.’</p> </div> <footer class="blockquote-footer mt-2"> <cite title=""> </cite> </footer> </blockquote> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>Sanders also feels it is critical to recognize older adults in housing discussions, as currently they are often left out. A perception remains that older adults tend to live in stable situations in housing they own. But older adults face significant gaps in access to quality, affordable housing, and many live in precarious situations. And there are a burgeoning number of older adults with no housing at all. Plus, as the work LeadingAge and others have done has shown, housing can play a key role in addressing social and health needs as well.</p> <p>“I hope these articles will help to reveal the significant implications housing policy has on other aspects of life, particularly for persons of color. Current U.S. housing policy is strongly intertwined with economic opportunity and security, which is clearly shown in the disparities in homeownership rates, home values, and wealth between white older adults and black older adults,” said Sanders.</p> <p>She points to a r<a href="https://www.redfin.com/blog/redlining-real-estate-racial-wealth-gap/">ecent study</a> showing that homeowners in previously redlined neighborhoods—in which, until 1968, federal government policy effectively denied mortgage loans to people of color—have gained 52 percent less in home equity over the past 40 years than homeowners in previously greenlined areas.</p> <p>“Home equity is a key component of wealth in this country,” said Sanders. “And this study found that black homeowners today are about five times more likely to own a home in a formerly redlined area than a greenlined neighborhood. So many black homeowners are not able to realize the same potential wealth-building benefit as white homeowners because they have been tracked into segregated neighborhoods that have faced decades of underinvestment.</p> <p>Many older adults will be unable to afford the care they will need as they age in the years to come, and housing is at least one contributor to this lack of funds. Many elders of color would have been denied the opportunity to purchase a home or would have been limited to neighborhoods that experienced and continued to experience years of disinvestment, thus earning far less in home equity. To the extent that an older adult may tap into home equity or sell a home to help support care needs, this source of funds is limited for those whose housing equity opportunities have been curtailed. </p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--quote paragraph--view-mode--default"> <blockquote> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>Black homeowners are about five times more likely to own a home in a formerly redlined area.</p> </div> <footer class="blockquote-footer mt-2"> <cite title=""> </cite> </footer> </blockquote> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>Of course, for many older adults who were lower-wage workers over their lifetime, buying a home was never an option. Many of these older adults tend to rely largely on Social Security for their retirement income. According to the <a href="https://www.ssa.gov/news/press/factsheets/basicfact-alt.pdf">Social Security Administration</a>, Social Security makes up 90 percent or more of the income for 45 percent of unmarried older adults. In May 2020, the <a href="https://www.ssa.gov/policy/docs/quickfacts/stat_snapshot/">average monthly benefit for retired workers was $1,512</a>. Given high rent costs across the country, it is clear that many lower-income renters will struggle to find affordable options. </p> <p>Sanders encourages ASA members to become allies to housing advocates and help push for expansions in rental subsidies, learn more about local or state housing advocacy organizations to build collaborations, and get out and help advocate for better housing policies, building and land use regulations, and funding initiatives.   “An older adults’ housing situation can have implications on their health, functionality, and quality of life--all of which many ASA members are addressing,” said Sanders. The success and optimization of the services they are providing can be intertwined with the safety and quality, accessibility, and affordability of their constituents’ housing. Sanders hope this collection of articles will help build ASA members’ understanding of housing issues and the connection they can have to their work.</p> </div> </div> </div> </div> </div> <div class="field field--name-field-teaser-media field--type-entity-reference field--label-above"> <div class="field__label">Teaser Media</div> <div class="field__item"><a href="/media/23" hreflang="en">Line of Classic Rusty Blue Rural US Mailboxes</a></div> </div> <div class="clearfix text-formatted field field--name-field-byline field--type-text-long field--label-above"> <div class="field__label">Byline</div> <div class="field__item"><p>By Alison Biggar</p> </div> </div> <div class="field field--name-field-issue field--type-entity-reference field--label-above"> <div class="field__label">Issue</div> <div class="field__item"><a href="/summer-2020" hreflang="en">Summer 2020</a></div> </div> Tue, 07 Jul 2020 21:12:35 +0000 asa_admin 8 at http://generations.asaging.org Overcoming the 'silver tsunami' http://generations.asaging.org/silver-tsunami-older-adults-demographics-aging <span class="field field--name-title field--type-string field--label-hidden">Overcoming the &#039;silver tsunami&#039;</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><a title="View user profile." href="/user/6" class="username">asa_admin</a></span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 07/07/2020 - 07:00</span> <div class="field field--name-field-tags field--type-entity-reference field--label-above"> <div class="field__label">Tags</div> <div class="field__items"> <div class="field__item"><a href="/ageism-culture" hreflang="en">Ageism &amp; Culture</a></div> <div class="field__item"><a href="/innovation-social-impact" hreflang="en">Innovation &amp; Social Impact</a></div> </div> </div> <div class="field field--name-field-channel field--type-entity-reference field--label-above"> <div class="field__label">Channel</div> <div class="field__item"><a href="/generations-today" hreflang="en">Generations Today</a></div> </div> <div class="field field--name-field-teaser-text field--type-string-long field--label-above"> <div class="field__label">Teaser Text</div> <div class="field__item">Aging is a first-person experience.</div> </div> <div class="field field--name-field-paragraphs field--type-entity-reference-revisions field--label-above"> <div class="field__label">Paragraphs</div> <div class="field__items"> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p class="dropcaps">The phrase “silver tsunami” drives me nuts. It is a common expression used to describe the unprecedented increase in the number of older people in the world, and it is used even in the aging services sector. People employ this doomsday term as a way of demonstrating they are “in the know” about the demographics of aging.</p> <p>Fact check: a tsunami is a large wave that results in vast destruction and mass casualties. A natural disaster of catastrophic proportions, it is planned for, mitigated against and feared.</p> <p>Unfortunately, this phrase is fun to pronounce. Silver tsunami became embedded in our collective psyche because of its alliteration. And, to some, the phrase sounds clever.</p> <p>Using silver tsunami to describe population aging was intentional as a shorthand description of the burden that will befall the country when millions of people grow old, get sick and need care. It is an economic term, based in calculations of increasing cost. On the nation’s balance sheet, the great silver tsunami rests squarely in the liability column. This drain on financing is coming. Be aware. Be warned. Plan ahead.</p> <h2>Re-Evaluating Impacts of Longevity and the Meaning of Aging</h2> <p>I am all for planning ahead. Increasing numbers of older people will strain our healthcare resources, place increased burden on caregivers and accelerate a workforce shortage. I do not take issue with cost concerns. My protest lies elsewhere.</p> <p>The term silver tsunami fails to account for the asset of increasing numbers of older people, many of whom are reaping the benefits of better health and increased longevity. Its economic assumption presupposes a future of healthcare delivery that resembles the past. We are re-valuing how, and what, we pay for in healthcare and where we should invest in prevention. Even the delivery of long-term care will evolve in the future.</p> <p>Also this phrase does not convey what it means to get old and be old. The swell of people in the wave are individuals, with lives of purpose, meaning, and, yes, difficulty. Aging is a first-person experience.</p> <p>But our culture remains awash with negative images and stereotypes of older people. Ageism is used to diminish and devalue people and is a convenient way to divide adults into two categories: us and them. Ageism distracts from the fundamental truth that advanced age is a period of human development.</p> <p>The FrameWorks Institute is the research partner for the <a href="https://frameworksinstitute.org/reframing-aging.html">Reframing Aging Project</a>, an initiative sponsored by eight leading organizations in the field of aging. FrameWorks has developed strategies for changing the way we think and speak about aging. Consider this question, “What do older people need?” The answer to this question brings to mind an abstract group of old people who will need transportation, housing, care and so forth.</p> <p>As an exercise, now ask the same thing differently, “What will I need when I get old?” The issues of aging are not about other people. The issues of aging are about everyone. Older people are individual glimpses of our future selves, given time.</p> <h2>People Live Longer but Better Lives</h2> <p>In 2017, a person reaching age 65 had an average life expectancy of 19 additional years. A child born in 2017 could expect to live more than 30 years longer than a child born in 1900. In the span of a life, where were those extra years added? Although the average life expectancy has increased, additional years weren’t tacked on at the end. Americans are enjoying more and better years before the declining years of advanced age.</p> <p>In 2009, Harvard Professor Sara Lawrence-Lightfoot wrote a book called “<a href="https://www.amazon.com/Third-Chapter-Passion-Adventure-Years/dp/0374532214">The Third Chapter: Passion, Risk, and Adventure in the 25 Years After 50</a>.” Professor Lawrence-Lightfoot’s research has led her to conclude that this third chapter is a stage of life when “many women and men are embracing new challenges and searching for greater meaning in life.”</p> <p>Marc Freedman, CEO and founder of <a href="https://encore.org/">Encore.org</a>, explores meaning and purpose in people older than age 50. Freedman is the creative force behind <a href="https://purposeprize.encore.org/">The Purpose Prize</a>, an award given to “demonstrate that older people comprise an undiscovered, and still largely untapped, continent of solutions to an array of pressing societal challenges.” His organization works to innovate “new ideas and models to leverage the skills and talents of experienced adults to improve communities and the world.”</p> <p>These are the assets I’m talking about. Experienced adults can improve the world. They are cherished members of their families and communities. Older people in the third chapter of life are finding additional purpose and exploring creativity. A true accounting of a future full of 95 million older people must be balanced, with an eye toward planning for both the burden of care and the benefit of contribution.</p> <p>Personally, I prefer the term “age wave.” You can ride a wave, but it can capsize you. We must prepare for both. It is essential that we understand the impact on the U.S. economy when, in 2060, nearly 25 percent of the population will be older than age 65. Who will provide care when those individuals reach advanced age? How will it be paid for?</p> <p>These challenging questions have already arrived with the front edge of this surge. In an August 2019 <a href="https://www.washingtonpost.com/business/economy/this-will-be-catastrophic-maine-families-face-elder-boom-worker-shortage-in-preview-of-nations-future/2019/08/14/7cecafc6-bec1-11e9-b873-63ace636af08_story.html?arc404=true">article</a>, The Washington Post explored in detail the elder boom and worker shortage currently facing the state of Maine. The article predicts the issues confronting Maine are a preview of the nation’s future.</p> <p>As we prepare for this wave, we also must plan to surf it. Millions of us will have time and experience to share. We need to be healthy enough to do so, mentally and physically. It is essential we devote additional time and more resources to healthy aging, as individuals who are growing older and as a nation concerned about health.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><hr /><p><em>Kathy Greenlee, J.D., previously served as U.S. Assistant Secretary for Aging and Kansas Secretary for Aging. She is a member of the Board of Directors of the National Council on Aging, and member of the Generations Editorial Advisory Board.</em></p> </div> </div> </div> </div> </div> <div class="field field--name-field-teaser-media field--type-entity-reference field--label-above"> <div class="field__label">Teaser Media</div> <div class="field__item"><a href="/media/7" hreflang="en">Tsunami</a></div> </div> <div class="clearfix text-formatted field field--name-field-byline field--type-text-long field--label-above"> <div class="field__label">Byline</div> <div class="field__item"><p><strong>Op-Ed</strong><br /> By Kathy Greenlee</p> </div> </div> <div class="field field--name-field-issue field--type-entity-reference field--label-above"> <div class="field__label">Issue</div> <div class="field__item"><a href="/july-aug-2020" hreflang="en">July-Aug 2020</a></div> </div> Tue, 07 Jul 2020 05:00:00 +0000 asa_admin 10 at http://generations.asaging.org Generous, Down-to-Earth, Brilliant, Creative: The Mentorship and Legacy of Dr. Phoebe Liebig http://generations.asaging.org/obituary-dr-phoebe-liebig <span class="field field--name-title field--type-string field--label-hidden">Generous, Down-to-Earth, Brilliant, Creative: The Mentorship and Legacy of Dr. Phoebe Liebig </span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><a title="View user profile." href="/user/6" class="username">asa_admin</a></span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 03/08/2021 - 20:05</span> <div class="field field--name-field-tags field--type-entity-reference field--label-above"> <div class="field__label">Tags</div> <div class="field__items"> <div class="field__item"><a href="/ageism-culture" hreflang="en">Ageism &amp; Culture</a></div> <div class="field__item"><a href="/innovation-social-impact" hreflang="en">Innovation &amp; Social Impact</a></div> </div> </div> <div class="field field--name-field-channel field--type-entity-reference field--label-above"> <div class="field__label">Channel</div> <div class="field__item"><a href="/generations-now" hreflang="en">Generations Now</a></div> </div> <div class="field field--name-field-teaser-text field--type-string-long field--label-above"> <div class="field__label">Teaser Text</div> <div class="field__item">‘You can just call me Phoebe.’</div> </div> <div class="field field--name-field-paragraphs field--type-entity-reference-revisions field--label-above"> <div class="field__label">Paragraphs</div> <div class="field__items"> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p class="dropcaps">Thirty-five year ASA member and University of Southern California (USC) Leonard Davis School of Gerontology Professor Emerita Phoebe Stone Liebig died in Los Angeles Feb. 24, 2021, at age 87.</p> <p>Dr. Liebig was an expert in aging who helped build the entire field—in programming, research, policy and advocacy. Within ASA, she spoke at many annual conferences, was for five years a Public Policy Committee member, co-authored journal articles about <a href="https://www.researchgate.net/publication/237296555_Economic_Well-Being_and_Security_of_Older_Americans_State_Approaches_and_Innovations">Economic Security</a> and <a href="https://www.ingentaconnect.com/content/asag/gen/2009/00000033/00000003/art00004">Housing </a>for Generations and was active in ASA’s Network on Environments, Services and Technology (NEST) Constituent Group. </p> <p>“Through her life and her work, Phoebe Liebig’s impact on the USC Leonard Davis School and the field of gerontology cannot be overstated,” said USC Leonard Davis School Dean Pinchas Cohen. “Her research and advocacy around age-friendly policies and the importance of creativity improved the lives of countless older adults, and the example she set as a lifelong learner who pursued her passions and interests leaves a legacy we all should emulate.”</p> <p>Dr. Liebig was a high school teacher and then forged a career in aging at USC before earning her doctorate in Public Administration at age 50. Having worked as a grants specialist, raised her son and completed her doctorate as a middle-age woman, she was an inspiration to me and many others whose career paths unfolded in ways not recognized as orthodox. As a non-traditional-age doctoral student with two small children of my own, I first met Dr. Liebig in Social Policy and Aging class at USC. </p> <p>Hundreds of former students and staff would concur that Dr. Liebig was extremely generous—at first with her use of a red pen in correcting our syntax!  However, beyond the initial read, Dr. Liebig was especially munificent with career advice, intuitive lifestyle suggestions, remembering birthdays, collaborating with budding scholars on publications and setting up the USC Phoebe Liebig Endowed Scholarship Fund. </p> <p>Many people had the privilege of knowing Dr. Liebig for longer than I did, and she was a persistent advocate for all with whom she connected. Since the late February announcement of her death, dozens of gerontology alums have been sending me their remembrances of her influence.</p> <p>“Receiving a merit-based scholarship under Dr. Phoebe Liebig’s name in 2018 was an honor. Although I did not have the opportunity to be directly mentored by her, through the brief chats on different occasions with her, she was a very approachable professor. I was impressed with the practical insights for interacting with the audience at a poster presentation. I was impressed by the stories of her active retirement life, and by her friendliness in saying, ‘You can just call me Phoebe,’ ” Mengzhao Yan, MASM, 2019.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--quote paragraph--view-mode--default"> <blockquote> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>‘She was a persistent advocate for all with whom she connected.’</p> </div> <footer class="blockquote-footer mt-2"> <cite title=""> </cite> </footer> </blockquote> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>“Dr. Phoebe was one of a kind, and I will miss her dearly,” said Shirley Kirksey, retired USC staff.</p> <p>Anyone who worked alongside her quickly came to know her as Phoebe. With that familiarity, we learned about her active participation in her family life, especially how much she loved her son Steuart, daughter-in-law Leslie and grandchildren Anya and Aron.</p> <p>Phoebe was an exemplar in exhibiting a healthy work-life balance and in pursuing everyday creative practices such as singing and gardening. Her decision to retire from USC but continue active involvement in the Retired Faculty Association, travels with family and friends, artistic aging research and consulting, is a model for all of us. </p> <p>Phoebe wasn’t overly impressed with fancy titles or intimidated by academic and political bureaucracy. Her life growing up on the East Coast afforded her an instinctive command of how the conventional Western world works, but the adult life she built in California, India and through her travels, offered her more innovative and creative approaches to understanding wellness, and a more diverse world view. While Phoebe had a huge impact on me personally and on my education and career, I am no exception. Phoebe mentored many students, staff and faculty, and her legacy will continue.</p> <p>"Dr. Phoebe Liebig, [was] an amazing person, who has sponsored me by providing partial scholarship for my graduate studies at University of Southern California. She took her time in mentoring and coaching me in becoming a Gerontologist. I'm forever grateful to this loving person who played a pivotal role in my journey to the West,” said Sai Raj Kappari, PharmD and USC MSG, 2017. “Her book ‘Aging India’ signifies her dedication and compassion for our fellow beings. She will be missed. My gratitude to her and USC."</p> <p>Phoebe treated us all, whether new acquaintances or long-time office mates, as humans, as colleagues, as workers who can and will be better. She knew the details of our personal lives and our intellectual faults and strengths. Phoebe encouraged us to “work smart” and find our focus, to take care of ourselves and our families, plan for our futures and remember our pasts. She balanced being a scholarly advisor, professional coach, cheerleader and discerning editor, with motherly and grandmotherly advice, smiles and hugs sprinkled in to keep us going. </p> <p>“It’s hard to say goodbye to someone who, like Phoebe, was so much more than an early leader in gerontology. She touched our lives personally and professionally. As a student, she held us to a high standard, just as she did herself. As her friend, I always knew that she was there for me. Her contributions have changed the lives of so many of us. Phoebe will be forever in our hearts.” Jolene Fassbinder, MSG, Program Officer, Archstone Foundation.</p> <hr /><p><em>Caroline Cicero, PhD, is an instructional associate professor of Gerontology and director of the USC Age Friendly University Initiative at the University of Southern California in Los Angeles.</em></p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p><em>Photo of Phoebe Liebig (top) courtesy of USC Leonard Davis School of Gerontology.</em></p> </div> </div> </div> </div> </div> <div class="field field--name-field-teaser-media field--type-entity-reference field--label-above"> <div class="field__label">Teaser Media</div> <div class="field__item"><a href="/media/289" hreflang="en">Phoebe Liebig</a></div> </div> <div class="clearfix text-formatted field field--name-field-byline field--type-text-long field--label-above"> <div class="field__label">Byline</div> <div class="field__item"><p>By Caroline Cicero</p> </div> </div> Mon, 08 Mar 2021 19:05:05 +0000 asa_admin 297 at http://generations.asaging.org http://generations.asaging.org/obituary-dr-phoebe-liebig#comments National Blueprint Updates Malnutrition Care Strategies for the New Decade http://generations.asaging.org/blueprint-updates-malnutrition-care-strategies <span class="field field--name-title field--type-string field--label-hidden">National Blueprint Updates Malnutrition Care Strategies for the New Decade</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><a title="View user profile." href="/user/6" class="username">asa_admin</a></span> <span class="field field--name-created field--type-created field--label-hidden">Fri, 03/05/2021 - 22:44</span> <div class="field field--name-field-tags field--type-entity-reference field--label-above"> <div class="field__label">Tags</div> <div class="field__items"> <div class="field__item"><a href="/health-well-being" hreflang="en">Health &amp; Well-being</a></div> </div> </div> <div class="field field--name-field-channel field--type-entity-reference field--label-above"> <div class="field__label">Channel</div> <div class="field__item"><a href="/generations-now" hreflang="en">Generations Now</a></div> </div> <div class="field field--name-field-teaser-text field--type-string-long field--label-above"> <div class="field__label">Teaser Text</div> <div class="field__item">&#039;Disease-associated malnutrition in older adults is estimated to cost nearly $53 billion annually.&#039; </div> </div> <div class="field field--name-field-paragraphs field--type-entity-reference-revisions field--label-above"> <div class="field__label">Paragraphs</div> <div class="field__items"> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p class="dropcaps">The COVID-19 pandemic has changed many aspects of our daily lives. It also has brought into sharper focus ongoing issues that have increased in severity for older adults, including the issue of malnutrition. For example, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7308600/pdf/11357_2020_Article_218.pdf">a recent publication by Bencivenga et al.</a> outlined the many ways in which malnutrition and immunosenescence likely lead to higher morbidity and mortality in older patients with COVID-19, and how improving their nutritional status earlier in life could help to reduce harmful immune responses.</p> <p>Results of a <a href="https://www.nature.com/articles/s41430-020-0642-3#Ack1">cross-sectional study in Wuhan, China</a>, showed that among older patients with COVID-19, 27.5 percent were at risk of malnutrition and 52.7 percent were malnourished, leading the authors to highlight the importance of strengthening nutritional support during treatment. The Academy of Nutrition and Dietetics also recently published <a href="https://jandonline.org/article/S2212-2672(20)30481-0/fulltext">guidance </a>for caring for malnourished adult patients in various settings during the COVID-19 pandemic, including screening and assessing for malnutrition among adults with suspected or confirmed COVID-19 infection, and providing medical nutrition therapy for adults with suspected or confirmed infection in their homes.</p> <p>Such guidance is significant given the current lack of nutrition guidelines focused on adults with or at risk for COVID-19 infection. Thus, the timing couldn’t be better for a new <em><a href="https://www.defeatmalnutrition.today/sites/default/files/National_Blueprint_MAY2020_Update_OnlinePDF_FINAL.pdf">National Blueprint: Achieving Quality Malnutrition Care for Older Adults, 2020 Update</a></em>.</p> <p>Nearly <a href="https://pubmed.ncbi.nlm.nih.gov/20863332/">one of every two</a> older Americans is malnourished or at risk of malnutrition. Disease-associated malnutrition in older adults is estimated to cost nearly <a href="https://pubmed.ncbi.nlm.nih.gov/25249028/">$53 billion</a> annually. With the release of the <em>National Blueprint</em>, a broad group of advocates presents an updated roadmap for continuing national efforts to address this critical clinical and public health issue.</p> <p>The <em>National Blueprint</em> calls for a range of <a href="https://www.defeatmalnutrition.today/sites/default/files/National_Blueprint_Infographic_MAY2020_Update_FINAL.pdf">strategies </a>to implement across the healthcare continuum and focuses on four primary goals:</p> <ul><li>Improving quality care practices</li> <li>Improving access</li> <li>Generating research</li> <li>Advancing public health</li> </ul><p>The original <em>National Blueprint </em>was released in 2017. Some progress toward these goals has been made, such as:</p> <ul><li>Publication of a 2019 U.S. Government Accountability Office <a href="https://www.gao.gov/products/GAO-20-18?mobile_opt_out=1#summary_recommend">report </a>on federal nutrition assistance programs;</li> <li>2020 reauthorization of the <a href="https://www.congress.gov/bill/116th-congress/house-bill/4334/text">Older Americans Act</a>, which recognized malnutrition prevention as part of the Act’s purpose;</li> <li>Approved inclusion of <a href="https://www.eatrightpro.org/news-center/in-practice/quality-and-coverage/cms-approves-inclusion-of-malnutrition-quality-measures">malnutrition quality measures</a> in two qualified clinical data registries for 2020 participation in the Merit-Based Incentive Payment System (MIPS);</li> <li>Expansion of the <a href="http://malnutritionquality.org/">Malnutrition Quality Improvement Initiative’s</a> Learning Collaborative to 289 leading healthcare institutions across the country. It seeks to improve quality of care for malnourished patients (many of whom have <a href="https://jandonline.org/issue/S2212-2672(19)X0003-9">published abstracts</a> about their experiences and positive outcomes); and</li> <li>Creation of state resolutions and commissions on malnutrition in at least eight states across the country.</li> </ul><p>However, much more remains to be done to expand the impact of these initiatives.</p> <p>The American Society on Aging (ASA), a <a href="https://www.defeatmalnutrition.today/members">member </a>of the <a href="https://www.defeatmalnutrition.today/">Defeat Malnutrition Today</a> coalition, joined <a href="https://avalere.com/">Avalere Health</a> and a multi-stakeholder Malnutrition Quality Collaborative of experts to update the National Blueprint. Even before the pandemic, these leading organizations pointed to concerning statistics that demonstrated the significant healthcare costs of older adult malnutrition. The lack of systematic use of malnutrition best practices, standards and screening tools in routine medical care or across care settings contributes to the current epidemic of malnutrition.</p> <p>While the Centers for Medicare &amp; Medicaid Services <a href="https://www.federalregister.gov/documents/2017/08/14/2017-16434/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the">agrees </a>that malnutrition is a serious issue and MIPS offers inclusion of malnutrition quality measures beginning this year, malnutrition care is not a mandatory component of inpatient healthcare quality incentive programs. The updated National Blueprint aims to help address this and other gaps, particularly as growing disparities and social isolation exacerbate the risk of malnutrition and its related negative health outcomes.</p> <p>The multiple and complex causes of malnutrition among older adults require collaboration among many organizations, government bodies and communities to find solutions. The updated National Blueprint offers strategies across all points of care—including healthcare institutions, community settings and even telehealth services. ASA members can use these implementation-ready recommendations in their individual care settings.</p> <p>ASA members and other stakeholders across the continuum of care can work together to promote innovative and effective approaches to delivering high quality malnutrition care, and thus make a real difference in the health and wellness of older Americans.</p> <p><em>The National Blueprint: Achieving Quality Malnutrition Care for Older Adults, 2020 Update</em> was developed by the Defeat Malnutrition Today coalition, Avalere Health and other multidisciplinary stakeholders, with support provided by Abbott.</p> <hr /><p><em>Kristi Mitchell, MPH, is practice director at Avalere Health and leads its Center for Healthcare Transformation in Washington, DC.</em></p> </div> </div> </div> </div> </div> <div class="field field--name-field-teaser-media field--type-entity-reference field--label-above"> <div class="field__label">Teaser Media</div> <div class="field__item"><a href="/media/165" hreflang="en">Older adults malnutrition</a></div> </div> <div class="clearfix text-formatted field field--name-field-byline field--type-text-long field--label-above"> <div class="field__label">Byline</div> <div class="field__item"><p>By Kristi Mitchell</p> <p>July 2, 2020</p> </div> </div> Fri, 05 Mar 2021 21:44:44 +0000 asa_admin 296 at http://generations.asaging.org Shelter from the Storm http://generations.asaging.org/shelter-storm <span class="field field--name-title field--type-string field--label-hidden">Shelter from the Storm</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><a title="View user profile." href="/user/6" class="username">asa_admin</a></span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 03/01/2021 - 18:12</span> <div class="field field--name-field-tags field--type-entity-reference field--label-above"> <div class="field__label">Tags</div> <div class="field__items"> <div class="field__item"><a href="/health-well-being" hreflang="en">Health &amp; Well-being</a></div> <div class="field__item"><a href="/ageism-culture" hreflang="en">Ageism &amp; Culture</a></div> </div> </div> <div class="field field--name-field-channel field--type-entity-reference field--label-above"> <div class="field__label">Channel</div> <div class="field__item"><a href="/generations-now" hreflang="en">Generations Now</a></div> </div> <div class="field field--name-field-teaser-text field--type-string-long field--label-above"> <div class="field__label">Teaser Text</div> <div class="field__item">At 78 McCulley had already spent one career at Raytheon, and now is a paid caregiver for a 97-year-old.</div> </div> <div class="field field--name-field-paragraphs field--type-entity-reference-revisions field--label-above"> <div class="field__label">Paragraphs</div> <div class="field__items"> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p class="dropcaps">The storm that blew across the U.S. on Valentine’s Day dumped record <a href="https://www.nytimes.com/2021/02/15/us/winter-storm-today.html">snowfall </a>in Texas, where power was knocked out in <a href="https://poweroutage.us/">2.8 million homes</a> and businesses, and Houston set a record low of <a href="https://www.weather.gov/hgx/2021ValentineStorm">15 degrees Fahrenheit</a>, beating the <a href="https://www.nytimes.com/2021/02/15/us/houston-snow.html">last severe cold snap’s record in 1905</a>. A likely underestimate of dozens of deaths occurred in the state, experts expect that number to rise in the following weeks and months.</p> <p>Suzanne McCulley, 78, has worked as a paid caregiver for Synergy HomeCare of Northwest Houston for the past six years, lives in Humble, Texas, near Houston, and cares for a 97-year-old about a half an hour from her home.</p> <p>In this post-retirement endeavor—McCulley already spent one career working as a subcontract administrator for Raytheon—she generally works 12-hour shifts from 7 p.m. to 7 a.m., as needed.</p> <p>On Feb. 14 it had snowed so heavily that the woman on tap to replace McCulley at 7 a.m. on Feb. 15 called in stuck at home with small children and neither power nor water. McCulley agreed to stay on, as long as she could find some of her necessary blood pressure meds, which luckily she located in her car.</p> <p>Synergy’s Client Care Manager Margaret Robinson had promised McCulley she’d be leaving the night of Feb. 15, but as the other caregiver remained stuck with no water or power, she ended up staying over again at her client’s house, totaling three straight 12-hour shifts.</p> <p>Granted, McCulley says the woman she cares for is independent, has children that check in often, and enjoys hobbies like jigsaw puzzles.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--quote paragraph--view-mode--default"> <blockquote> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>‘Now, it’s not just the disasters you know, but that the disasters will come with something else.’</p> </div> <footer class="blockquote-footer mt-2"> <cite title=""> </cite> </footer> </blockquote> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>“I really had no choice,” said McCulley, about staying put. “I was worried about driving on ice, my car windows were all covered in snow and I didn’t know how to get it off. Plus, to get home I have to drive over a bridge that can be icy.”</p> <p>The power in the client’s house stayed on all night, and with water left to drip out of the taps, the pipes didn’t burst and they had water as well. By the time McCulley was finally able to drive home she found her garage door wide open, meaning her house had lost power and was freezing.</p> <h4>Meanwhile, Back at the Office</h4> <p>Robinson said the Synergy office lost power for 24 hours while everyone worked from home. Fortunately, she had the forethought pre-storm to instruct staffers to bring home their laptops, “as you never know what might happen,” she said.</p> <p>The pipes at the office burst, and 11 days later, water was being sopped up and some colleagues were still not working.</p> <p>Generally, Robinson said, Synergy doesn’t schedule people who have young children to work during crises, but the woman originally scheduled to relieve McCulley lives only five minutes from the client so she thought it would work out. For most of Synergy’s clients they were able to move caregivers around to ensure full coverage and the option of sticking around if things got ridiculous.</p> <p>Two other Synergy caregivers went to work on Sunday like McCulley and stayed through Wednesday. In one instance the pipes in the client’s house had burst, they had no electricity and the family ended up having to move to a hotel. Another caregiver packed a bag ahead of time knowing she had to traverse a major highway that would likely be shutdown, and stayed with that client Sunday through Wednesday, without water or power.</p> <p>“Only one client had a real issue,” said Robinson. The caregiver lives next door and was able to provide care, but the client was bedbound for two days because they require a Hoyer lift to be moved and had no power to do it.</p> <p>“We have to be prepared for the worst,” says Robinson. “Last year with COVID-19 taught us a lot.” For starters, they’re going to start stocking lots of bottled water in the office.</p> <p>“Now, it’s not just the disasters you know, but that the disasters will come with something else, with other effects we don’t think about. We have had major hurricanes, but the power never went out. And the water—that was unexpected,” said Robinson.</p> <p>McCulley is rather sanguine about the whole thing, admitting that she might get called to work more often than other caregivers because, “I’m the old person who doesn’t have anything else to do.”</p> <p>When she signed on with Synergy she made it clear it was for part-time work, just something to “pick up when someone needs help,” but it hasn’t always worked out that way, as it didn’t during the storm. McCulley sought out the caregiving job because, she said, she “likes helping.” And she’s talented at it, said Robinson. So talented that last year Synergy gave her the Caregiver of the Year Award. Not sure how they’ll top that this year, with her storm coverage.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><hr /><p><em>Image (top) courtesy of Synergy HomeCare shows Synergy Client Care Manager Margaret Robinson, left, and caregiver Suzanne McCulley.</em></p> </div> </div> </div> </div> </div> <div class="field field--name-field-teaser-media field--type-entity-reference field--label-above"> <div class="field__label">Teaser Media</div> <div class="field__item"><a href="/media/288" hreflang="en">Margaret Robinson, left, and Suzanne McCulley. </a></div> </div> Mon, 01 Mar 2021 17:12:26 +0000 asa_admin 294 at http://generations.asaging.org Tips on Mask-wearing for People With Dementia http://generations.asaging.org/tips-mask-wearing-people-dementia <span class="field field--name-title field--type-string field--label-hidden">Tips on Mask-wearing for People With Dementia</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><a title="View user profile." href="/user/6" class="username">asa_admin</a></span> <span class="field field--name-created field--type-created field--label-hidden">Fri, 02/26/2021 - 19:17</span> <div class="field field--name-field-tags field--type-entity-reference field--label-above"> <div class="field__label">Tags</div> <div class="field__items"> <div class="field__item"><a href="/ageism-culture" hreflang="en">Ageism &amp; Culture</a></div> <div class="field__item"><a href="/health-well-being" hreflang="en">Health &amp; Well-being</a></div> </div> </div> <div class="field field--name-field-channel field--type-entity-reference field--label-above"> <div class="field__label">Channel</div> <div class="field__item"><a href="/generations-now" hreflang="en">Generations Now</a></div> </div> <div class="field field--name-field-teaser-text field--type-string-long field--label-above"> <div class="field__label">Teaser Text</div> <div class="field__item">Gently remind the person that the virus is ongoing and they need to protect themselves and others.</div> </div> <div class="field field--name-field-paragraphs field--type-entity-reference-revisions field--label-above"> <div class="field__label">Paragraphs</div> <div class="field__items"> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p class="dropcaps">Although the temptation is strong now that vaccines are gaining distribution to become more relaxed about COVID-19 prevention, we cannot afford to let down our guards and stop masking up. In the United States, <a href="https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html'">the CDC recommends </a>anyone older than age 2 wear a mask, but there are many who are resistant to wearing one, including some people with conditions like Alzheimer’s disease. This may mean missing out on safe ventures outside of the home, to stores or other indoor venues.</p> <p>Here are some tips from our friends at <a href="https://www.dementiauk.org/advice-about-face-coverings/">DementiaUK </a>and <a href="https://www.alzheimers.org.uk/blog/should-person-dementia-wear-face-mask-coronavirus#:~:text=The%20rules%20on%20face%20coverings,would%20cause%20them%20severe%20distress">Alzheimer’s Society</a> on how to help people who have dementia or Alzheimer’s to stop resisting mask wearing.</p> <h4>Why might a person with dementia or Alzheimer’s struggle with the idea of wearing a mask?</h4> <p>Individuals with dementia may be uncomfortable with the mask’s texture or feel. Experimenting with different materials, using a familiar scarf as a mask or engaging the person in choosing their own mask or in making one, could help. Making this a fun activity can go a long way in helping them get over the discomfort. Also, always putting the mask on at home, instead of in public, can lessen feelings of stress around mask-wearing.</p> <h4>What about if it’s a matter of discomfort from fit?</h4> <p>If the way the mask fits is an issue, trying varied styles could work. And if the person with dementia is afraid they may not be able to breathe, you can reassure them via demonstrating how it works best and trying to help them to remain calm.</p> <h4>What if they just resist the idea of wearing a mask?</h4> <p>Practice putting on your mask in front of the person with dementia and ask them to mirror your steps. This may reassure them. Also, you’ll likely continually need to remind them to wear it, but try not to use unfamiliar words like pandemic, and instead say virus or infection—words that would already have been in their vocabulary. With dementia it can help to bring up the past, so you might reference a flu they have had.</p> <p>Another idea is to put a sign by the door for when you leave. Then gently remind the person that the virus is ongoing and they need to protect themselves and others.</p> <h4>What if the masks remind them of past trauma?</h4> <p>In some cases, perhaps rarer in the United States, masks may remind the person with dementia of a traumatic incident, such as having been in a war in their youth.</p> <p>Talking about what they’re feeling, if possible, and trying to find ways to reassure them should help.</p> <h4>What if they feel they are the only people encountering this mask problem?</h4> <p>In this case it may work to validate their feelings, reassure them and help them to live as comfortably as possible during this “new normal.”</p> <h4>How best to talk to someone with dementia while wearing a mask?</h4> <p>Communicating while wearing a mask is challenging for people without dementia, but for those talking to older adults with Alzheimer’s or other dementias, it can be particularly challenging.</p> <p>Some tips for this include using short, simple phrases and hand gestures; remaining clear, calm and friendly; smiling big enough that it’s evident in one’s eyes; thinking about body language, possibly mirroring their gestures if that helps to connect; and being empathetic, trying to understand how they are feeling and support them as patiently as possible.</p> <p>If, despite all methods, the person still does not want to wear a mask, there are cards to carry and hand out to concerned people indicating that the person has Alzheimer’s or dementia. In this situation it’s important to always stay more than 6 feet away from others. And this may mean no indoor shopping or visiting.</p> </div> </div> </div> </div> </div> <div class="field field--name-field-teaser-media field--type-entity-reference field--label-above"> <div class="field__label">Teaser Media</div> <div class="field__item"><a href="/media/63" hreflang="en">closeup of older woman wearing mask waving</a></div> </div> Fri, 26 Feb 2021 18:17:28 +0000 asa_admin 293 at http://generations.asaging.org Working Longer Cannot Solve the Retirement Income Crisis http://generations.asaging.org/working-longer-cant-solve-retirement-crisis <span class="field field--name-title field--type-string field--label-hidden">Working Longer Cannot Solve the Retirement Income Crisis</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><a title="View user profile." href="/user/6" class="username">asa_admin</a></span> <span class="field field--name-created field--type-created field--label-hidden">Thu, 02/25/2021 - 23:09</span> <div class="field field--name-field-tags field--type-entity-reference field--label-above"> <div class="field__label">Tags</div> <div class="field__items"> <div class="field__item"><a href="/ageism-culture" hreflang="en">Ageism &amp; Culture</a></div> <div class="field__item"><a href="/economic-security" hreflang="en">Economic Security</a></div> </div> </div> <div class="field field--name-field-channel field--type-entity-reference field--label-above"> <div class="field__label">Channel</div> <div class="field__item"><a href="/generations-now" hreflang="en">Generations Now</a></div> </div> <div class="field field--name-field-teaser-text field--type-string-long field--label-above"> <div class="field__label">Teaser Text</div> <div class="field__item">When we control for all factors that help a person prepare for retirement, working longer has no independent effect.</div> </div> <div class="field field--name-field-paragraphs field--type-entity-reference-revisions field--label-above"> <div class="field__label">Paragraphs</div> <div class="field__items"> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p class="dropcaps">One of the warning signs of the oncoming retirement crisis is how often people are told to work longer. If you haven’t been able to save enough—work longer. If your savings are wiped out by divorce or medical bills—work longer.</p> <p>But even if people have the health and strength to keep working past traditional retirement ages, <a href="https://www.economicpolicyresearch.org/insights-blog/working-longer-cannot-solve-the-retirement-crisis-202102031004">our research</a> (Ghilarducci et al., 2021) finds that working longer increases income in retirement by significantly less than predicted by spreadsheet models.</p> <p>Why? Because spreadsheet models don’t reflect older workers’ real experiences in the labor market. In reality, many older workers earn so little they cannot afford to delay claiming Social Security benefits, nor can they save for retirement.</p> <h4>Studies Overestimated Benefits of Working Longer</h4> <p>Working longer for practical reasons is anchored in a number of what we call “spreadsheet” studies, which are mechanistic models based on ideal behavior. One such <a href="https://crr.bc.edu/working-papers/how-important-is-asset-allocation-to-financial-security-in-retirement/">study </a>from 2013 by Munnell, Orlova and Webb was optimistic about the benefits of working longer. It projected the wealth and Social Security benefits of workers in their 50s and concluded that most would be financially prepared for retirement if they remained in the labor force until age 70, or even into their late 60s.</p> <p>They found that only 26 percent of people could maintain their pre-retirement standard of living if they retired at age 62, but 72 percent could reach financial security if they waited until age 70 to retire. But even these numbers overstate the advantage. When we control for all the other factors that help a person to be prepared for retirement, working longer has no independent effect.</p> <p>These optimistic predictions are, unfortunately, not supported by survey data based on interviews with older workers that report their real experiences in the job market and as they prepare to retire. Using data from the Health and Retirement Study, a nationally representative sample of older Americans, our researchers at the Retirement Equity Lab <a href="https://www.economicpolicyresearch.org/insights-blog/working-longer-cannot-solve-the-retirement-crisis-202102031004">found </a>that working from age 62 to 70 increases the share of workers financially prepared for retirement by only 18 percentage points—28 percentage points less than predicted by the Munnell, Orlova and Webb study using a spreadsheet model based on overly optimistic assumptions.</p> <p>More than two-thirds of the gap in predicted increased financial preparedness for retirement is because most older workers claim Social Security benefits and miss out on the Delayed Retirement Credit. By age 65, more than half (51 percent) of remaining workers in the 1943 to 1947 birth cohort claimed Social Security, and by age 66, 89 percent have claimed benefits. By age 67, almost all workers have claimed benefits.</p> <p>A further 6 percentage points of the 28 percentage-point gap exists because actual increases in retirement plan balances fall short of projected increases that assume consistent contributions, low fees and zero pre-retirement withdrawals.</p> <p>This shortfall is not surprising. Studies (for example, <a href="https://crr.bc.edu/briefs/why-are-401k-ira-balances-substantially-below-potential-2/">Biggs, Munnell and Chen</a>, 2019) show that people’s actual retirement savings accumulation from age 25 to age 60 similarly fall short of projections.</p> <h4>Older Workers Need Social Security to Supplement Low Wages  </h4> <p>Advocates of the benefits of work at older ages argue it gives workers additional opportunities to save for retirement—either directly by contributing to their retirement plans or indirectly by delaying claiming Social Security. However, for most people who claim Social Security benefits early, delaying is not the rational choice.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--quote paragraph--view-mode--default"> <blockquote> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>‘The purported solution of working longer ignores the effect of the recession by doing nothing for jobless older workers.’</p> </div> <footer class="blockquote-footer mt-2"> <cite title=""> </cite> </footer> </blockquote> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>More than half (54 percent) of those claiming benefits while working do so to supplement low wages. By age 66, more than half (56 percent) of workers who have claimed Social Security earn less on the job than their projected income in retirement, including Social Security benefits and other retirement savings. Overall, these households are using Social Security to smooth consumption over time, just as economic theory says they should.</p> <p>Some low earners might be better off delaying claiming Social Security by tapping financial assets to make up their consumption shortfall. But most have minimal financial assets. By age 66, almost half (44 percent) of workers who claim Social Security earn less than their projected post-retirement income and have less than $20,000 in financial assets.</p> <p>Older workers’ inability to save is not due to overspending. We find no evidence that workers are living it up, or using Social Security to enjoy a level of consumption before retirement that they will not be able to sustain in retirement. In fact, older workers who claim benefits spend less than they could afford. At the median, they spend $42,000 compared with the $49,000 they could afford.</p> <h4>Covid-19 Job Loss Exacerbates Retirement Savings Crisis</h4> <p>The drastic job loss experienced by older workers in the wake of the COVID-19 crisis reveals the risk older workers face when working longer is the policy substitute for an effective retirement security system. Beginning in March 2020, nearly 5 million workers ages 55 to 70 lost their jobs in the recession resulting from the virus.</p> <p>Post-pandemic job loss, coupled with early withdrawals puts an additional <a href="https://www.economicpolicyresearch.org/jobs-report/recession-increases-downward-mobility-in-retirement-middle-earners-hit-from-both-sides">3 million</a> people in older households at risk of poverty in old age. Many unemployed older workers are now at risk of never finding another job, a risk they continue to face the longer it takes the economy to recover.</p> <p>The purported solution of working longer ignores the effect of the recession by doing nothing for jobless older workers, while deflecting from the need for comprehensive policy reform to ensure retirement security.  </p> <p>This calls for <a href="https://www.economicpolicyresearch.org/insights-blog/a-policy-agenda-for-the-biden-administration">immediate policy support</a> for older workers out of the labor force, as well as systemic reforms to end retirement insecurity for generations to follow. The former includes reinstating early withdrawal penalties, lowering the Medicare eligibility age, increasing and extending unemployment benefits, and enforcement of anti-age discrimination regulations.</p> <p>Needed systemic reforms include expanding Social Security and creating <a href="https://www.economicpolicyresearch.org/retirement-tools/a-primer-on-gras-and-how-they-work">Guaranteed Retirement Accounts</a> that give workers access to a secure and accessible way to save for their retirement and supplement their Social Security benefits.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><hr /><p><em>Bridget Fisher is associate director, researcher and communications specialist with the Schwartz Center for Economic Policy Analysis at The New School in New York City.</em></p> </div> </div> </div> </div> </div> <div class="field field--name-field-teaser-media field--type-entity-reference field--label-above"> <div class="field__label">Teaser Media</div> <div class="field__item"><a href="/media/287" hreflang="en">Older worker driving a forklift</a></div> </div> <div class="clearfix text-formatted field field--name-field-byline field--type-text-long field--label-above"> <div class="field__label">Byline</div> <div class="field__item"><p>By Bridget Fisher</p> </div> </div> Thu, 25 Feb 2021 22:09:29 +0000 asa_admin 292 at http://generations.asaging.org Shoulder to Shoulder, Men’s Shedders Engage with One Another, Save Lives http://generations.asaging.org/mens-shedders-engage-one-another-save-lives <span class="field field--name-title field--type-string field--label-hidden">Shoulder to Shoulder, Men’s Shedders Engage with One Another, Save Lives</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><a title="View user profile." href="/user/6" class="username">asa_admin</a></span> <span class="field field--name-created field--type-created field--label-hidden">Thu, 02/25/2021 - 20:19</span> <div class="field field--name-field-tags field--type-entity-reference field--label-above"> <div class="field__label">Tags</div> <div class="field__items"> <div class="field__item"><a href="/ageism-culture" hreflang="en">Ageism &amp; Culture</a></div> <div class="field__item"><a href="/innovation-social-impact" hreflang="en">Innovation &amp; Social Impact</a></div> <div class="field__item"><a href="/health-well-being" hreflang="en">Health &amp; Well-being</a></div> </div> </div> <div class="field field--name-field-channel field--type-entity-reference field--label-above"> <div class="field__label">Channel</div> <div class="field__item"><a href="/generations-today" hreflang="en">Generations Today</a></div> </div> <div class="field field--name-field-teaser-text field--type-string-long field--label-above"> <div class="field__label">Teaser Text</div> <div class="field__item">‘Shedders are not slackers.’</div> </div> <div class="field field--name-field-paragraphs field--type-entity-reference-revisions field--label-above"> <div class="field__label">Paragraphs</div> <div class="field__items"> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p class="dropcaps">“There’s magic in it,” is not a sentiment often heard when referring to post-retirement programming, but it is echoed by many involved in the U.S. Men’s Sheds Association. And it’s a quote from board member Mark Winston, who has witnessed what Sheds can do. He added, frankly, that the program saves lives.</p> <p>Men’s Sheds is an international organization of social clubs designed to encourage men to socialize in a way that’s comfortable for them, while doing other things. Unfortunately, the Men’s Sheds’ core demographic of retired men is sometimes in need of that help. Suicide rates in this group are high and growing, and were called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5916258/">a public health crisis</a> prior to the pandemic. Men’s Sheds, however, have endured the pandemic (Sheds are often open air and socially distance friendly) and the people running them are excitedly awaiting its end to pursue their work forming more and more Sheds.</p> <h2>Shedding Down Under</h2> <p>Men’s Sheds began in Australia in the 1990s as a way for men socialized not to discuss feelings and well-being to do just that. The idea was a nod to backyard sheds, where men traditionally restored furniture or fixed lawnmowers. The first Australian Men’s Shed opened in 1998 to encourage social activities and friendships in older men, while at the same time providing health information to members. There are now at least 1,100 Men’s Sheds in Australia.</p> <p>In 2013 the concept migrated to the U.K., where it got a lot of traction and where <a href="https://menssheds.org.uk/about/">its mission states</a>, “We won’t stop until every man who would benefit from a Men’s Shed has access to one.” The Brits concentrate on reducing isolation and loneliness and empowering local communities. Now there are more than 600 Men’s Sheds in the U.K., with 150 in the works.</p> <p>About three years after Men’s Sheds launched in the U.K. the concept crossed the pond, landing first in Honolulu, in a Shed that now has more than 100 members. In 2015 Glenn Sears’ wife had shown him an article in The Rotarian Magazine about Men’s Sheds in Australia, and, he says, “it was exactly what I had been looking for.”</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--quote paragraph--view-mode--default"> <blockquote> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>‘I feel rich meeting new people, supporting each other, doing projects together. It’s just a continuation of my life.’</p> </div> <footer class="blockquote-footer mt-2"> <cite title=""> </cite> </footer> </blockquote> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>Sears searched for one in Honolulu, then on the mainland, and came up empty. He called the Australian Men’s Sheds organization and they suggested he start one—so he did. The Honolulu Shed is now housed in a 6,000-square-foot warehouse and outfitted with all sorts of tools. One of its specialties is rebuilding and rehabbing old outrigger canoes until they gleam like museum pieces, said Sears.</p> <p>The U.S. Men’s Sheds motto is “Men don’t talk face to face, they talk shoulder to shoulder,” and the clubs, as they’re called here, focus on making friends and discussing troubling health issues. There are now about 20 Sheds in the United States.</p> <p>Winston tells a story of one Shedder who had been so depressed he never came out of his house, yet two months after joining a Shed he walked up to Winston, hugged him, and said, “thank you for giving me my life back.” This man still opens and closes that Shed seven days a week, Winston added. “Whenever I think I’m overwhelmed, I think if we could just change several hundred, or a thousand lives, it’s all worth it.”</p> <h2>Some Sheds Are Not Sheds At All</h2> <p>In the United States Sheds are not all technically sheds. Some Shedders take on community charity projects, some work at food banks. But they all share the commonality of allowing men, many of whom are older and retired, an outlet for talking to other men. Some Sheds bring in speakers to cover topics of interest to Shedders in that locale.</p> <p>Not all Shedders are older men, either, there are a smattering of women Shedders and younger men who benefit from the mentoring they find in a Shed. “Each Shed is unique,” said Phil Johnson, a U.S. Men’s Shed board member who holds the distinction of starting the most Sheds (at five and counting). “They pick out the activities they want to do that the group decides on. Any activity the men want to do is fine, as long as they are able to talk and share experiences with each other.”</p> <p>“The difference between, say, a Men’s Shed and a coffee group,” said Johnson, “is the Men’s Sheds do a variety of activities, they find something interesting to do instead of sitting in a circle just looking at each other.”</p> <p>Walt Miyashiro, age 80, Vietnam Veteran and retired for 12 years, four years ago joined the Honolulu Shed. He loves getting to know new people and taking advantage of the equipment the Shed has available for completing home projects. Although admittedly a rough carpenter, “I put some putty on it, put some paint on it, get it done,” for him the Shed is about connection. “You get to meet people, talk about your personal lives and have familiar interests,” he said.</p> <figure role="group" class="caption caption-img align-center"><img alt="Walt Miyashiro engages with other Shedders in Honolulu." data-entity-type="file" data-entity-uuid="1b9e23bc-a0e1-4645-ada3-53f81b3b1e83" src="/sites/default/files/inline-images/Walt-Miyashiro-Two-Hats.jpg" /><figcaption>Walt Miyashiro engages with other Shedders in Honolulu. Photo courtesy of Howard Wolff.</figcaption></figure><p>Miyashiro has had his share of health issues causing missed time in the Shed, but now that he’s on the mend he’s helping another Shedder who had bypass surgery. “We happen to have had the same surgeon, so I try to be supportive that way,” said Miyashiro, and although the man isn’t chatty in person, Miyashiro has found he opened up via email.</p> <p>His family benefits, too, as “they’re tickled that I’m open to joining new activities. I feel rich meeting new people, supporting each other, doing projects together. It’s just a continuation of my life. … And you get out of it what you put into it.”</p> <p>One man in the Honolulu Shed just finished a hollow-core, strip-plank paddleboard. Miyashiro had bumped into this man as he was hanging the paddleboard from the Shed roof. “I was flabbergasted! It was so beautiful,” said Miyashiro. Now the man is building a rowboat.</p> <h2>Pushing Into Senior Centers and Assisted Living Facilities</h2> <p>An early U.S. Men’s Shed was launched in the Hopkins Activity Center near Minneapolis, which was a stroke of brilliance as it tapped into a place already staffed with an activity director and a willing group of potential Shedders. Susan Newville, recently retired as the Hopkins Activity Center Director, had been approached by Johnson in 2016, asking if the center might like to sponsor a Shed.</p> <p>“It had always been difficult to engage men in our programs,” said Newville. She was intrigued, and after some due diligence decided to try out the Shed idea. They alerted the community, held a meeting and 20 guys showed up. Weekly meetings followed and the first sponsored Shed was up and running.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--quote paragraph--view-mode--default"> <blockquote> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>‘I look at these guys, who show up time and again, and I see the camaraderie between them—the handshakes, joking, sharing—the laughs.’</p> </div> <footer class="blockquote-footer mt-2"> <cite title=""> </cite> </footer> </blockquote> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>Johnson notes it works best if someone comes forward with the idea that they want to start a Shed and they have the skills to organize it. “It’s often easier if you’ve started a business before and like to work in a group,” said Winston. Or like at Hopkins, it can work well if someone working in a senior center starts one.</p> <p>The Hopkins Shed is not a physical shed. These Shedders have completed multiple community projects—refinishing benches, sprucing up and maintaining city parks, painting fences, repairing bikes for a charity project, even scooping ice cream for the Hopkins Raspberry Festival social.</p> <p>They’ve bagged and distributed Christmas bags, and ferried food to food banks. The Shed hosts speakers such as an expert to talk taxes, a physician to address men’s health issues, and even an AARP representative to explain AARP classes. Some Hopkins Shedders work as handymen around the activity center. The Shed has 25 active members, who also meet for fun to play mini golf or, say, visit the federal reserve bank in Minneapolis to see how it runs. Shedders are not slackers.</p> <p>Newville, as someone who started a successful Shed, is an advisor to the Men’s Shed board, focused on developing solid relationships between sponsors and Sheds (not all Sheds have sponsors). Many are sponsored by senior living communities. “They already have a niche, and they have the audience,” she added.</p> <p>Newville thinks one relatively unexplored area would be for Shedders to approach faith communities for sponsorship, as well as local healthcare clinics.</p> <p>“I look at these guys, who show up time and again, and I see the camaraderie between them—the handshakes, joking, sharing—the laughs,” said Newville. “One of our active Men’s Shedders lost his wife suddenly and those guys gathered around this gentleman and supported him through his loss.</p> <p>“They are not just standing shoulder to shoulder to do something, but standing shoulder to shoulder on life’s journey,” said Newville.</p> <p>Recently a group of five Minnesota Men’s Sheds, led by Johnson and Newville, received a research grant of $5,000 from the National Institute of Health and University of Minnesota. “We’re tasked with figuring out how best to engage men in rural Minnesota,” said Johnson. “And to try new ways to get Sheds started—it could be in the back of a feed store, in a tractor dealership or it could be in a church.”</p> <p>To start a Shed, contact: Philip Johnson, Managing Director, U.S. Men's Sheds Association, <a href="mailto:phil@usmenssheds.org">phil@usmenssheds.org</a>; 952-239-0965.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><hr /><p><em>Alison Biggar is ASA's Editorial Director.</em></p> <p><em>Image (top): Men work shoulder to shoulder on a project in the Honolulu Men's Shed. Courtesy of Howard Wolff. </em></p> <p><em>For more great shots from the Honolulu Men's Shed, <a href="https://www.howardwolffphotography.com/mens-shed-gallery-slideshow">check out Wolff's other work</a>. </em></p> </div> </div> </div> </div> </div> <div class="field field--name-field-teaser-media field--type-entity-reference field--label-above"> <div class="field__label">Teaser Media</div> <div class="field__item"><a href="/media/286" hreflang="en"> Men work shoulder to shoulder on a project in the Honolulu Men&#039;s Shed. </a></div> </div> <div class="clearfix text-formatted field field--name-field-byline field--type-text-long field--label-above"> <div class="field__label">Byline</div> <div class="field__item"><p>By Alison Biggar</p> </div> </div> <div class="field field--name-field-issue field--type-entity-reference field--label-above"> <div class="field__label">Issue</div> <div class="field__item"><a href="/march-april-2021" hreflang="en">March-April 2021</a></div> </div> Thu, 25 Feb 2021 19:19:06 +0000 asa_admin 291 at http://generations.asaging.org Seeking Concern for Community in Broadening Internet Access http://generations.asaging.org/seeking-concern-community-internet-access <span class="field field--name-title field--type-string field--label-hidden">Seeking Concern for Community in Broadening Internet Access</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><a title="View user profile." href="/user/6" class="username">asa_admin</a></span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 02/24/2021 - 17:33</span> <div class="field field--name-field-tags field--type-entity-reference field--label-above"> <div class="field__label">Tags</div> <div class="field__items"> <div class="field__item"><a href="/justice-equity" hreflang="en">Justice &amp; Equity</a></div> <div class="field__item"><a href="/innovation-social-impact" hreflang="en">Innovation &amp; Social Impact</a></div> </div> </div> <div class="field field--name-field-channel field--type-entity-reference field--label-above"> <div class="field__label">Channel</div> <div class="field__item"><a href="/generations-today" hreflang="en">Generations Today</a></div> </div> <div class="field field--name-field-teaser-text field--type-string-long field--label-above"> <div class="field__label">Teaser Text</div> <div class="field__item"> ‘Cooperatives continue to be the lead agents of rural Internetification.’<br /> <br /> </div> </div> <div class="field field--name-field-paragraphs field--type-entity-reference-revisions field--label-above"> <div class="field__label">Paragraphs</div> <div class="field__items"> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p class="dropcaps">Having worked in the field of aging for 45 years, I’ve had the privilege of listening to stories from two very different generations. Working in mental health in the early years gave me the opportunity to hear privately held true stories of challenge and, more importantly, resilience. This is a form of storytelling distinctly different from, “When I was a kid we walked three miles in the snow to school.” I remember the names but withhold them here.</p> <p>One was the story of the 80-year-old man suddenly overcome with what proved to be cathartic emotion upon speaking of his memory of sitting on the front porch, his mom reporting she was going to get eggs, and never returning. Another was the story of a 13-year-old child becoming pregnant in a household ruled by her strict preacher-father and, when she spontaneously aborted twins, her enraged father throwing the tiny fetuses into the living room stove. A third was a story that had been withheld for 65 years, of the 24-year-old father who, during the worst of the Depression and living without electricity, disconnected the battery from his coupe regularly to power the radio for his young children and to listen to FDR’s fireside chats.  </p> <h2>Old Thinking Vs. New, not Improved, Thinking</h2> <p>In my mind, I often return to these Depression-era stories and lament the passing of that New-Deal type of thinking. I lament because it is painful to see modern young adults having to reinvent solutions to the press of daily life in an economy without opportunities for far too many—cooperative living (formerly, families with boarders), community kitchens (soup lines), walking to work (holes in your soles), washing clothes in the bathtub (washboard living).</p> <p>What a shame that the needed intergenerational learning and mentoring did not occur. Could it be that the Baby Boom generation, in its rush to reject anyone over 30, dropped the “memory” ball?</p> <p>Then, and occasionally now, old people reminisce about when government could pull off big national projects: the Hoover Dam, the Manhattan Project, the Civilian Conservation Corps and Works Progress Administration sidewalks in thousands of neighborhoods across the nation—on both sides of the street, no less!</p> <p>Recently, as I was sitting in on the ASA Forum on Tech and Aging, which addressed older adults’ significant lack of access to the Internet (especially in rural communities), my thoughts turned to one of those New Deal BIG deals—the Tennessee Valley Authority (TVA).</p> <p>I wondered, Why don’t we today see the Internet as an essential utility in the way we used to see telephones and electricity? There may be several reasons, summed up in mindless political slogans: “Government is not the solution.” (thanks, Ronald Reagan); “People should take personal responsibility.” (thanks, Newt Gingrich}; “It will be impossible to pay for that.” (thanks, Paul Ryan). This is the same kind of thinking, of course, that would never produce the notion that healthcare is a right.</p> <p>I did a little research on the concept of the Internet as a public utility. It seems that, in the late 19th century, telephone and power companies began as highly local endeavors. Power companies using direct current, by definition, were restricted by geography. (See the recent movie “The Current Wars,” on the battle between direct and indirect current).</p> <p>Similarly, telephone exchanges were tiny. Every small town had its own “one line” exchange. Given the capitalist business model as well as technological change, these local industries became quickly consolidated during the first decades of the 20th century. Industrialists argued that a “<a href="https://cs.stanford.edu/people/eroberts/cs201/projects/corporate-monopolies/benefits_natural.html">natural monopoly</a>” was necessary to afford the large capital needs of the companies.</p> <h2>When the Market Fails to Serve Everyone, Government Steps In</h2> <p>As companies failed to see a profit in serving poor populations in rural areas, regulatory frameworks emerged and guided the growth of these industries until the “deregulation” spirit took over late in the 20th century, forgetting the desperation of the Depression, which clearly revealed the failure of the market system to meet the needs of the poor.</p> <p>The federal government stepped up to the plate with federal construction projects such as TVA and low interest loans to expand the grid. Many of these loans went to local cooperatives, established by groups of farmers and others seeking to promote the public good. This democratized the system with local control and, today, nearly 1,000 and more than 500 locally owned cooperatives operate in the electric and telecom industries, respectively. On their websites, these cooperatives continue to share the seven cooperative principles originally stated in Rochdale, England, in 1844. </p> <p>The telecom industry has replicated the growth model of other major industries going back to the days of crank telephones and party lines. In businesses that require heavy capitalization, however, the market generally fails to serve everyone. Growth in profit outweighs growth in service. With the unlikely prospect of a major change in our economic system, government support will need to step in, as always, where the market system fails. I am encouraged by the growing debate surrounding the future of capitalism.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--quote paragraph--view-mode--default"> <blockquote> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>‘It is painful to see modern young adults having to reinvent solutions to the press of daily life in an economy without opportunities for far too many.’</p> </div> <footer class="blockquote-footer mt-2"> <cite title=""> </cite> </footer> </blockquote> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>With a few exceptions in Indiana, smaller cooperative telecom and electric companies seem to effectively compete with the mega ones in the percentage of the population being served. In fact, in some of southeastern Indiana’s poorest counties’ percentage of broadband service rates range from the high 80s to high 90s.</p> <p>Moreover, the state legislature has shown national leadership through legislation that <a href="https://muninetworks.org/content/indiana-eases-easements-electric-co-ops-fibre-act#:~:text=Also%20known%20as%20the%20Facilitating,same%20easement%20for%20fiber%20infrastructure">allows electric cooperatives to install fiber systems using their own public easements</a>. Fiber will enable customers to outdistance the frequent telephone line dial up, DSL and satellite options, which don’t even quality as broadband.</p> <p>While AT&amp;T and Verizon prioritize investment in dense urban areas, cooperatives continue to be the lead agents of rural Internetification. Yet, they work at a disadvantage. The <a href="https://ilsr.org/">Institute for Local Self-Reliance</a> has issued a valuable set of policy recommendations from which one can infer the competitive disadvantages they encounter and possible solutions going forward:</p> <ol><li>Design funding programs with cooperatives in mind: a. Letters of credit from the largest banks may be hard to come by for smaller cooperatives. b. Make applications as simple as possible—staff time is limited at small cooperatives. c. Develop grant and loan programs rather than creating incentives in the tax code for infrastructure investment.</li> <li>Encourage cooperatives by removing barriers and fostering partnerships. a. Remove barriers to electric cooperatives exploring the possibility of a fiber network—cooperatives should not be prevented from applying to federal grants for which they are eligible because of malformed state laws. b. Encourage partnerships, including with existing muni networks.</li> </ol><p>For more information on Fiberizing Rural America, click <a href="https://ilsr.org/wp-content/uploads/2019/06/2019-06-Rural-Coop-Policy-Brief-Update.pdf">here</a>.</p> <p>So, as in the days of FDR, government has been playing a big role, but perhaps the wrong role, rolling back regulations in favor of large corporations. It took Obama-era net neutrality regulations to put all customers on a level playing field, as users of “common carriers,” akin to old-fashioned utilities.</p> <p>The repeal of net neutrality by the FCC during the Trump administration paved the way for corporations to provide faster service to wealthier customers and leave lower income, often rural, often older customers behind.</p> <p>In the Biden administration, we’re likely to see a return to net neutrality, and local cooperatives will once again be able to pursue Goal No. 7 of the Rochdale principles: concern for community.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><hr /><p><em>Philip B. Stafford, PhD, is the CoDesign director at Commons Planning, Inc., and adjunct professor in the Department of Anthropology  at Indiana University in Bloomington. He has been a longstanding leading voice in the age-friendly community movement. Stafford serves on ASA’s Board of Directors.</em></p> </div> </div> </div> </div> </div> <div class="field field--name-field-teaser-media field--type-entity-reference field--label-above"> <div class="field__label">Teaser Media</div> <div class="field__item"><a href="/media/279" hreflang="en">Abstract data/internet image</a></div> </div> <div class="clearfix text-formatted field field--name-field-byline field--type-text-long field--label-above"> <div class="field__label">Byline</div> <div class="field__item"><p><strong>Op-Ed</strong><br /> By Philip B. Stafford</p> </div> </div> <div class="field field--name-field-issue field--type-entity-reference field--label-above"> <div class="field__label">Issue</div> <div class="field__item"><a href="/march-april-2021" hreflang="en">March-April 2021</a></div> </div> Wed, 24 Feb 2021 16:33:36 +0000 asa_admin 290 at http://generations.asaging.org To Go Back to School Or Not: For These MSW Students It’s a Resounding Yes http://generations.asaging.org/msw-students-say-yes-school-later-life <span class="field field--name-title field--type-string field--label-hidden">To Go Back to School Or Not: For These MSW Students It’s a Resounding Yes</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><a title="View user profile." href="/user/6" class="username">asa_admin</a></span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 02/24/2021 - 01:29</span> <div class="field field--name-field-tags field--type-entity-reference field--label-above"> <div class="field__label">Tags</div> <div class="field__items"> <div class="field__item"><a href="/ageism-culture" hreflang="en">Ageism &amp; Culture</a></div> </div> </div> <div class="field field--name-field-channel field--type-entity-reference field--label-above"> <div class="field__label">Channel</div> <div class="field__item"><a href="/generations-today" hreflang="en">Generations Today</a></div> </div> <div class="field field--name-field-teaser-text field--type-string-long field--label-above"> <div class="field__label">Teaser Text</div> <div class="field__item">&#039;Learning is always about discovery, it opens up things I didn’t know about and didn’t know I was interested in.&#039;</div> </div> <div class="field field--name-field-paragraphs field--type-entity-reference-revisions field--label-above"> <div class="field__label">Paragraphs</div> <div class="field__items"> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p class="dropcaps">Older adults with more education tend to keep working longer, which is one of the many benefits to going back to school later in life. Others include making more money, changing careers entirely and pursuing an idealistic goal.</p> <p>Columbia Masters in Social Work students John Perra and Chris Bowman fall into the latter category. Both are students in Columbia’s School of Social Work, in the Advanced Generalist Practice and Programming track, which means approaching social work from individual and systems levels, including program planning, advocacy and evidence-based interventions. </p> <p>How did they arrive at the decision to pursue an advanced degree and what will they do with it? Read their stories below.</p> <h2>John Perra, age 53:</h2> <p>John Perra worked for years as a journalist at Time Inc., after graduating from the University of Massachusetts at Amherst with an undergraduate degree in that topic. He then segued into teaching writing and research at a graduate school in the Bronx. Always in the back of his mind was the thought that someday he’d like to make a big change.</p> <p>In 2005 he covered Hurricane Katrina in New Orleans, where despite knowing the value of telling people’s stories and reporting on the devastation, he says he, “really felt I was on the wrong side of the story. The need and devastation and trauma were so great.</p> <p>“An experience like that can transform you personally and professionally, to the point where when you ask why you’re here, you trace it back to that instant,” Perra says now. “I really wanted to do something fulfilling and of value, making a difference in a professional capacity.”</p> <p>Although Perra, who still teaches graduate classes, applied to and was accepted into several law schools, in the back of his mind he thought of family members with chronic and progressive illnesses and began to wonder if becoming a medical social worker might be the right path. Ultimately, he decided upon Columbia’s School of Social Work.</p> <p>While there, each semester seems to bring a new idea of how he might use this education. Last semester he was fascinated by the psychopathology of personality disorders. “Learning is always about discovery, it opens up things I didn’t know about and didn’t know I was interested in,” he said. “So many areas of study in this field are so intriguing.”</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--quote paragraph--view-mode--default"> <blockquote> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>'Having all that experience is valuable, you’ve had a career, now you’re adding to your toolbox.'</p> </div> <footer class="blockquote-footer mt-2"> <cite title=""> </cite> </footer> </blockquote> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>Recently Perra was speaking with a professor, who happens to call him professor, too, and it occurred to him, he says, that “I’ve been listening to people’s stories my whole life: my grandfather would tell stories, then in journalism, and now this work—social work—is about people’s stories. I had never seen that through-line before,” he says.</p> <p>As he heads to the finish line of the 16-month program at Columbia, Perra says that while he loves teaching, he is excited about what else lies ahead. “Like a lot of people my age, I’ve entered many new rooms in my life and been in many, sometimes challenging situations. It goes back to that sense of discovery, of what’s possible and one’s place in the narrative.”</p> <p>He knows people have reservations about being too old to go back to school as they’ll likely be the oldest person in the room. “It doesn’t work that way,” he says. “My experience is not like that at all.</p> <p>“Having all that experience is valuable, you’ve had a career, now you’re adding to your toolbox. Also, all of that experience can make one less self-conscious,” Perra says.</p> <p>“Older adults have a wealth of experience to draw insights from that add to the classroom and to the discussion. I’ve found that to be true in both my teaching and in being a student,” Perra adds. And he sees great value in older people putting things into perspective that younger people definitely benefit from.</p> <p>“The professors at Columbia make everyone feel comfortable, and they’re skilled in using subtle ways to draw out students who have a lot of experience and can add something to the class,” says Perra.</p> <p>For people on the fence as to whether or not to go back, Perra says, “You don’t know yet how it’s going to change you. It’s going to stretch you. Why not add to your experience and learn as much as you can?”</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><h2>Chris Bowman, age 48:</h2> <p>Chris Bowman also spent a good part of his working life documenting the human condition, but as a photographer, both art photography from the street, and for Conde Nast, freelancing events. While doing double time as a sound designer and sometimes an administrative assistant. As he says, his career was not linear.</p> <p>In 2018 he was working rather unhappily at a creative agency, felt he wasn’t growing or learning and wanted to do something more fulfilling. “My calling has always been in service, I have a servant’s heart,” he says. And he’s always felt a connection to older adults that he traces back to his grandparents and regular gigs volunteering at the Coalition for the Homeless and New York Cares.</p> <p>A friend had planted the seed of social work in his mind and after some research he realized that was exactly what he wanted to do. He applied to multiple New York City social work schools and when Columbia said yes, he signed up.</p> <p>His focus at Columbia is on older adults and working with individuals and communities at the systems level. “This enables me to look holistically at a client’s condition and environmental factors to gain a better understanding of why they are facing the issues they are facing. I’d like to look at the individual on the micro, meso and macro level.”</p> <p>Bowman has a rather specific vision of what he might like to do once he graduates and that is to conduct an assets and needs assessment of a community of low-income older adults experiencing health disparities. “I can work in a nonprofit,” he says, “helping communities apply for funding to start programming that will enhance the well-being of the community.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--quote paragraph--view-mode--default"> <blockquote> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>'My calling has always been in service, I have a servant’s heart.'</p> </div> <footer class="blockquote-footer mt-2"> <cite title=""> </cite> </footer> </blockquote> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>“East New York is one of the hardest hit areas regarding the COVID-19 death rate, and it’s mainly African-American. Why was this? Was it because of co-morbidity, why are they unhealthy, is it nutrition? Mistrust in the medical system? I’d look at their strengths and needs and design a program to meet those needs.</p> <p>“As a generalist social worker, the AGPP program is not just focusing on one-on-one sort of work, but on going into the community and looking at the systems that are responsible for the lack of nutrition, the lack of clinics, why healthcare access is not as good. What are the environmental and social factors?” said Bowman.</p> <p>He encourages people considering going back to school to just do it. He has enjoyed the entire experience—the learning, the professors, and “surrounding myself with such smart and compassionate people. It’s surprising how compassionate, how empathetic the group I’ve fallen into with have been. And not only to populations they work with but to us as students. And altruistic, it’s really beautiful to see,” he said.</p> </div> </div> </div> </div> </div> <div class="field field--name-field-teaser-media field--type-entity-reference field--label-above"> <div class="field__label">Teaser Media</div> <div class="field__item"><a href="/media/280" hreflang="en">The Low Memorial Library at New York City&#039;s Columbia University</a></div> </div> <div class="field field--name-field-issue field--type-entity-reference field--label-above"> <div class="field__label">Issue</div> <div class="field__item"><a href="/march-april-2021" hreflang="en">March-April 2021</a></div> </div> Wed, 24 Feb 2021 00:29:07 +0000 asa_admin 288 at http://generations.asaging.org An Ethic of Care Needed in Our Long-term Care System http://generations.asaging.org/ethic-care-needed-long-term-care-system <span class="field field--name-title field--type-string field--label-hidden">An Ethic of Care Needed in Our Long-term Care System</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><a title="View user profile." href="/user/6" class="username">asa_admin</a></span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 02/24/2021 - 01:04</span> <div class="field field--name-field-tags field--type-entity-reference field--label-above"> <div class="field__label">Tags</div> <div class="field__items"> <div class="field__item"><a href="/ageism-culture" hreflang="en">Ageism &amp; Culture</a></div> <div class="field__item"><a href="/health-well-being" hreflang="en">Health &amp; Well-being</a></div> </div> </div> <div class="field field--name-field-channel field--type-entity-reference field--label-above"> <div class="field__label">Channel</div> <div class="field__item"><a href="/generations-today" hreflang="en">Generations Today</a></div> </div> <div class="field field--name-field-teaser-text field--type-string-long field--label-above"> <div class="field__label">Teaser Text</div> <div class="field__item">‘Commitment to personal autonomy is an inherent feature of an LTC ethic of care.’</div> </div> <div class="field field--name-field-paragraphs field--type-entity-reference-revisions field--label-above"> <div class="field__label">Paragraphs</div> <div class="field__items"> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p class="dropcaps">The COVID-19 pandemic has had a devastating multidimensional impact on the world, especially among older adults, and specifically nursing home residents. More than 130,000 nursing home residents have died and for untold thousands their health and lives have been scarred by lingering long-term effects. The pandemic’s impact on the nursing home population brings up a critical and unavoidable moral question: why were so many of our most vulnerable fellow citizens living in such exposed circumstances?</p> <p>The nursing home tragedy was a result, in large part, of moral failures in our long-term care (LTC) system that date back many years. The fact that so many Americans were living in nursing homes and so vulnerable to becoming infected was a situation caused by policymakers failing to fund the expansion of in-home services and much smaller community facilities. Older people greatly prefer such residences, and we have long known how to provide them.</p> <p>The moral failure of not providing enough in-home and community-based services as an alternative to nursing homes is compounded by the absence of regulation concerning quality of care and quality of life, and insufficient enforcement resources. These regulatory inadequacies have been documented for years but have never been adequately addressed by federal and state governments.</p> <p>We fund LTC at the lowest level among wealthy countries (.9 percent of GDP vs. 1.5 percent to 3.5 percent among European countries) and we rely on for-profit providers, mainly nursing homes and large insurance companies to administer state Medicaid LTC programs.</p> <p>Our LTC policies and practices should have been guided from the beginning of major publicly funded (mainly Medicaid) LTC programs 50 years ago by an ethic of care. This care ethic would prioritize providing every person with LTC needs the kind of help they preferred, which could best preserve their quality of life as they become more impaired. In the absence of such an ethic of care we have allowed the moral vacuum to be filled by organizations seeking maximum shareholder value and policymakers obsessed with budget austerity.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--quote paragraph--view-mode--default"> <blockquote> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>'We fund LTC at the lowest level among wealthy countries.'</p> </div> <footer class="blockquote-footer mt-2"> <cite title=""> </cite> </footer> </blockquote> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>An LTC program designed with an ethic of care would prioritize improving quality of care and increasing access to care rather than prioritizing efficiency objectives tied to cost containment. This limited notion of efficiency is used by austerity hawks to justify the kind of underfunding that keeps the United States at the bottom of wealthy countries in the percentage of GDP spent on LTC services.  </p> <p>This does not mean that efficiency has no place in an ethic of care–oriented LTC system. It does mean, however, redefining the criteria we use in assessing efficiency to include measures of achieving an improved quality of care and life in LTC services and expanding access to them. This does not mean that efficiency has no place in an ethic of care–oriented LTC system. It means redefining the criteria we use to assess efficiency, including measures of achieving an improved quality of care and life in LTC services, and expanding access to them.</p> <p>Commitment among policymakers and LTC providers to an ethic of care would not require giving up on preserving the autonomy of LTC recipients, including those living in nursing homes. An LTC system governed by an ethic of care would do more to protect autonomy than our current LTC system by making recipient autonomy an essential criteria for measuring service quality.</p> <p>An ethic of care–guided LTC system also would support greater autonomy by expanding access to services to many more people who now are trapped in their homes by impairments for which they get little help. This greatly restricts their ability to make choices and to act upon them. In my judgement, commitment to personal autonomy is an inherent feature of an LTC ethic of care.</p> <h2>A New Moral Compass and Culture</h2> <p>A moral culture based on a communal ethic of care that includes prioritizing personal autonomy, but leaves no one to their own devices when they need help, is our surest guide to a morally defensible LTC system. Autonomy without care can quickly become neglect and an excuse for indifference. An exclusive focus on care, however, is a recipe for meeting bodily needs while ignoring psychological and spiritual needs.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>The best way I think for us to memorialize the tragic fate of those who suffered and died in LTC facilities is to insist that policymakers honestly and explicitly commit to an autonomy-respecting ethic of care and then operationalize this commitment by moving without delay to transform our LTC system.</p> <p>A true transformation would mean vastly expanding publicly supported in-home services programs and replacing our large, antiquated, traditional nursing homes. These facilities are not designed to protect residents from pandemics or to provide them with an acceptable quality of life. Preferably they would be replaced by smaller, more human-scale residences properly staffed by well-trained and fairly compensated staff.</p> <p>A model for this kind of LTC facility is the Green House program, which for the past 18 years has been building and operating 10- to 15-bed small house residences that have proven to better protect the health and well-being of residents than traditional nursing homes, without being prohibitively expensive.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--quote paragraph--view-mode--default"> <blockquote> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>Policymakers should soon decide to make LTC a Medicare benefit, as Sen. Claude Pepper had proposed more than 30 years ago.</p> </div> <footer class="blockquote-footer mt-2"> <cite title=""> </cite> </footer> </blockquote> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>President Biden’s proposal to spend $473 billion over the next 10 years to expand in-home LTC services is a strong move in the direction of the system transformation we need. Congress should adopt the President’s proposal as soon as possible.</p> <p>I also hope that our policymakers soon decide it is time to make LTC a Medicare benefit, as Sen. Claude Pepper had proposed more than 30 years ago. By incorporating LTC into the Medicare program, we can ensure the level of funding required to support the LTC transformation that the pandemic has revealed to be a moral necessity. This transition is sorely necessary if we are ever going to treat impaired, dependent older and younger Americans with disabilities with the love and appreciation they deserve.</p> <p>The French philosopher Emmanuel Levinas called ethics “first philosophy” because it is so fundamentally central to how we see ourselves and others. Ethics is the main source of what we value most, including the importance we place on virtues like courage, honesty and compassion, our daily behavior toward others, and the lens through which we view our lives’ moral arch, see our moral failings, and find opportunities to make amends and to seek and to give forgiveness.</p> <p>Levinas thought the necessity to make moral decisions was a conscious constant in daily life and was most powerfully encountered in the faces of others, where we could see their joys, suffering and need for care. The capacity to see the faces of others in this way and feel the moral imperative to care for them depends upon preparing ourselves to recognize the true meaning of what we see and learn from the face of the other and then cultivating the moral capacity to respond.</p> <p>This is a message that should be heard by all of us in thinking about how to be most responsive to our moral failings that contributed to the LTC tragedy. Levinas’ decisive message is that if we sincerely care about why this tragedy happened and want to take steps to ensure it doesn’t occur again, we will look into the faces of those who have needed the kind of care in old age they never received and are still not receiving and know that an ethic of care is first philosophy for LTC policy and daily practice.</p> <hr /><p><em>Larry Polivka, PhD, is the executive director of the Claude Pepper Center and scholar-in-residence with the Claude Pepper Foundation, at Florida State University in Tallahassee.</em></p> </div> </div> </div> </div> </div> <div class="field field--name-field-teaser-media field--type-entity-reference field--label-above"> <div class="field__label">Teaser Media</div> <div class="field__item"><a href="/media/282" hreflang="en">Hallway long term care facility</a></div> </div> <div class="clearfix text-formatted field field--name-field-byline field--type-text-long field--label-above"> <div class="field__label">Byline</div> <div class="field__item"><p><strong>In Focus</strong><br /> By Larry Polivka</p> </div> </div> <div class="field field--name-field-issue field--type-entity-reference field--label-above"> <div class="field__label">Issue</div> <div class="field__item"><a href="/march-april-2021" hreflang="en">March-April 2021</a></div> </div> Wed, 24 Feb 2021 00:04:39 +0000 asa_admin 287 at http://generations.asaging.org Ethical Uncertainty in the Care of Hospitalized Older Adults: Challenges and Pandemic Considerations http://generations.asaging.org/ethical-issues-care-hospitalized-elders <span class="field field--name-title field--type-string field--label-hidden">Ethical Uncertainty in the Care of Hospitalized Older Adults: Challenges and Pandemic Considerations </span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><a title="View user profile." href="/user/6" class="username">asa_admin</a></span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 02/24/2021 - 00:39</span> <div class="field field--name-field-tags field--type-entity-reference field--label-above"> <div class="field__label">Tags</div> <div class="field__items"> <div class="field__item"><a href="/ageism-culture" hreflang="en">Ageism &amp; Culture</a></div> <div class="field__item"><a href="/health-well-being" hreflang="en">Health &amp; Well-being</a></div> </div> </div> <div class="field field--name-field-channel field--type-entity-reference field--label-above"> <div class="field__label">Channel</div> <div class="field__item"><a href="/generations-today" hreflang="en">Generations Today</a></div> </div> <div class="field field--name-field-teaser-text field--type-string-long field--label-above"> <div class="field__label">Teaser Text</div> <div class="field__item">Planning, including with advance directives, does not cover all decisions and needs people face as they age.</div> </div> <div class="field field--name-field-paragraphs field--type-entity-reference-revisions field--label-above"> <div class="field__label">Paragraphs</div> <div class="field__items"> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p class="dropcaps">The typical patient in an American hospital is an older adult. During the coronavirus pandemic, people ages 85 and older have had the highest rates of death from COVID-19, followed by people ages 75 to 84.</p> <p>When hospital physicians and nurses are unsure of “the right thing to do” for a patient, they are experiencing ethical uncertainty. These situations frequently arise in the care of an adult who lacks the capacity to make decisions about potentially life-sustaining interventions. Capacity in this context means the cognitive ability to understand diagnosis, prognosis and treatment options (including forgoing treatment); make an informed and reasoned decision that reflects the potential consequences of this decision; and communicate this decision.</p> <p>An adult is presumed to have decision-making capacity unless it is determined that they lack it. Dementia, medication effects or a metabolic condition can impair decision-making capacity. In medical contexts, capacity is decision-specific. A person whose capacity to make decisions about life-sustaining treatment is absent or impaired may have capacity to make decisions about other aspects of care.</p> <p>All accredited hospitals are required to have some mechanism to assist with ethically complex cases. Clinical ethics services consult with care teams, patients and families on ethical challenges arising in practice. These services may be provided by an individual consultant (clinical ethicist) or by an ethics committee.</p> <p>This article focuses on ethical uncertainty in medical contexts involving older adults as patients. Our perspectives reflect healthcare ethics, a methodological approach that responds to ethical uncertainty arising in healthcare work. As scholars and researchers, we also reflect interdisciplinary work across fields such as gerontology, disability studies and bioethics.</p> <h2>Role and Limits of Advance Directives</h2> <p>Ethical practice in healthcare is aligned with patients’ legal and ethical rights. For example, the right to refuse life-sustaining interventions is a long-established Constitutional and common-law right in the United States, secured via the U.S. Supreme Court’s <em>Cruzan </em>decision in 1990 and reflected in state law and hospital policy. Advance directives reflect these rights as they apply to people who lack or may someday lack decision-making capacity, by recognizing decisions and preferences communicated when a person had capacity.</p> <p>Advance directives (See Sidebar, at bottom) are designed to help medical professionals manage ethical uncertainty during treatment decision-making by providing guidance concerning patient preferences. The value of advance directives is often limited. When a person has multiple comorbid, often age-associated conditions, it is difficult to anticipate every situation in which a person’s values and preferences could be conveyed through a treatment decision.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><table align="center" border="0" cellpadding="20" cellspacing="0" style="width: 90%;"><tbody><tr><td style="background-color: rgb(153, 227, 255);"> <h3>Advance Directives</h3> <p>A treatment directive (“living will”) documents a person’s preferences for treatment and care.</p> <p>A do-not-resuscitate (DNR) order is an example of a treatment directive.</p> <p>A proxy directive, also known as a durable power of attorney for health care, enables a person to appoint someone else—such as a partner or an adult child—to make decisions as a surrogate should this person lose decision-making capacity. Most states have legal guidelines concerning the priority order or appropriate process for identifying a surrogate decision-maker if no surrogate is appointed or identified by the patient.</p> <p>In some states, portable orders for life-sustaining treatment (often known as a POLST or MOLST) consolidate advance directives and provide instructions for medical professionals, including emergency medical services, concerning the care of a seriously ill person facing foreseeable emergencies. See: <a href="https://polst.org/">POLST: Portable medical orders for seriously ill or frail individuals</a></p> </td> </tr></tbody></table></div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>What a person values, such as their social relationships or their ability to continue activities that provide meaning or pleasure, may not translate into a medical decision. Crucially, advance directives do not create—or finance—the care environment a person may need or prefer.  </p> <p>People who have experienced racial, ableist or other forms of bias in healthcare may be wary of advance directives, perceiving them as limits on treatment. In these situations, clinical ethics consultation may be helpful in listening to the concerns of patients or family members, and in collaborating to develop a care plan that reflects what the patient wants. Clinical ethicists also can provide guidance if a patient loses decision-making capacity. Healthcare providers must be prepared to support patients and families during hospitalization, whether or not a treatment decision is at hand.</p> <h2>Managing Ethical Uncertainties</h2> <p>Patient care teams can turn to clinical ethics services for help in ethically uncertain situations, not limited to interpreting advance directives. Here are examples of challenging situations that frequently arise in caring for hospitalized older adults:</p> <p><strong>Disagreement or conflict: </strong>Surrogate decision-making is often stressful. Surrogate decision-makers need support from care team members and information about the surrogate’s role, even when they are well-informed about a now-incapacitated person’s preferences. Sometimes a patient’s surrogate decision-maker disagrees with a clinical recommendation concerning whether to start, stop or continue a treatment plan. Sometimes conflict within a family, or distrust between a patient’s family and patient’s care team, delays decision-making or care. </p> <p>A team or family may request clinical ethics consultation to help resolve disagreements and reduce interpersonal conflict. Some hospitals offer bioethics mediation training to help patient care staff communicate and rebuild trust with surrogates and others. Understanding the sources of the disagreement—for example, why a surrogate decision-maker may press for an intervention that a patient’s physician sees as burdensome or even harmful to a patient—is crucial in these difficult cases.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--quote paragraph--view-mode--default"> <blockquote> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>Resource allocation decisions should guard against implicit ageism and ableism.</p> </div> <footer class="blockquote-footer mt-2"> <cite title=""> </cite> </footer> </blockquote> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>If an older adult who has rebounded from previous crises associated with a progressive condition is now in deteriorating health, the patient’s surrogate may be uncertain how to make decisions that reflect the patient’s values and preferences and also the patient’s current condition. A family member may express concern that forgoing treatment or acknowledging that the patient is nearing the end of life is “doing nothing” or “giving up,” adding further stress to the surrogate’s role. Explaining how the patient’s pain and symptoms will be managed may help reduce sources of disagreement by clarifying what can benefit this patient at this point in their illness.</p> <p><strong>Patient who is alone—or unrepresented/unbefriended:</strong> In this situation, an adult may have multiple co-morbidities, have deteriorating health, or be experiencing repeated crises. A decision about whether to start, stop or continue a treatment plan is at hand. An unrepresented patient has insufficient capacity to make this decision, has no relevant treatment directives, and has no available surrogate decision-maker to provide insight into the patient’s preferences. Unrepresented patients are not uncommon; many older adults experience cognitive decline that limit their decision-making capacity and have lost touch with family or have no surviving family or friends with capacity. Many patients alone have a history of homelessness, substance use disorder, and/or complex psychiatric diagnoses that have led to long-term estrangement from family and friends.   </p> <p>How should treatment decisions be made for this patient?  State law may specify which decisions can be made on behalf of an unrepresented patient by the physician responsible for the patient’s care, with review by clinical ethics, a hospital’s chief medical officer, a court-appointed guardian or another independent reviewer. For state laws, see <a href="https://www.nejm.org/doi/full/10.1056/NEJMms1611497?query=recirc_inIssue_bottom_article">“Who Decides When a Patient Can’t? Statutes on Alternate Decision Makers.” </a></p> <p>When a patient’s values and preferences concerning a medical decision are unknown and cannot be communicated by the patient (who may be able to communicate about other aspects of care, such as food preferences), a clinical ethics consultant or ethics committee would advise implementing the best interests standard. This standard aims to identify which option would provide greatest benefit relative to burden and risk for a person in this patient’s condition. Applying the best interests standard includes attention to what can reliably be known about this patient’s life to this point, such as information about the patient’s religious or moral commitments that may be relevant to a medical decision.</p> <p>A way to picture the best interests standard is to ask, what would provide the most benefit overall for the patient and cause the least harm? Discussion among care team members with support from clinical ethics helps to elicit different perspectives, avoid starting interventions that are likely to fail, and call attention to generalizations (for example, concerning “quality of life”) that may reflect biases about age or disability.</p> <p><strong>Care transitions:</strong> Hospitalized patients who have been living in the community typically want to return home. When a patient has moderate dementia, has post-hospital care needs (such as daily medication), and lives alone (or with a similarly impaired partner), the patient’s care team may be unsure how to balance patient preferences with regulatory and ethical duties to ensure a safe discharge plan. Organizational pressure to “clear beds” once patients are stable and no longer need hospital care adds stress.</p> <p>Clinical ethics services in partnership with hospital discharge planning, social work case management or transitional care hospital-to-home nursing (if available) can help clarify whether and how a person with moderate dementia can continue to live independently and what services and supports are available and acceptable to this person in the community where they live.</p> <p>The lack of adequate public financing for home-based services and supports associated with dementia creates inequity for people with dementia and for their families, who pay out-of-pocket for services and provide unpaid care to a far greater extent compared to other major end-of-life trajectories. Hospital care teams and clinically based ethicists witness this inequity frequently. They can contribute their voices and perspectives to efforts to create better systems of care for our aging society. See <a href="https://www.pbs.org/newshour/show/dementia-takes-huge-financial-toll-families">“Why dementia takes a huge financial toll on families.”</a></p> <h2>Is Age Relevant in Medical Decision-making and Resource Allocation?</h2> <p>In the medical care of adults, a patient’s age may be relevant to the expected benefits and risks of treatment. Many chronic progressive health conditions are age-associated, and vulnerabilities such as loss of bone density may accumulate as part of physiological aging. Factors relevant to a patient’s potential for good or bad treatment outcomes include their overall condition, which should not be reduced to chronological age. </p> <p>As noted above, pandemic data show that people in in the ages 85 and older and ages 75 to 84 cohorts are at highest risk of severe COVID-19. These data also reveal that mortality occurs at younger ages in racialized minority populations that have long experienced health inequities resulting from social inequalities such as racism.</p> <p>As health systems have grappled with immense pressure on limited resources—staff, equipment, medication, space and most recently, vaccines—age arises in decisions about prioritizing patient groups in resource allocation.</p> <p>Implicit ageism and ableism in a society can seep into the framing of resource allocation decisions. When scarce resource allocation plans try to correct for ageism, they can end up being overly broad. For example, prioritizing all “seniors,” or “people older than age 65” for vaccination fails to account for significantly different levels of risk within America’s immense older adult population. If adults at highest risk of severe COVID-19 are crowded out, vaccine allocation will be less equitable and less effective.</p> <p>Going forward, reflection and action on ethical challenges arising from the pandemic across aging societies will be strengthened via continued collaboration between gerontology and bioethics.</p> <hr /><p><em>Nancy Berlinger, PhD, is a research scholar at The Hastings Center in Garrison, New York. Laura Guidry-Grimes, PhD, HEC-C, is an assistant professor and clinical ethics consultant in the Department of Medical Humanities and Bioethics at the University of Arkansas for Medical Sciences in Little Rock. Adira Hulkower, JD, MS, HEC-C, is chief of the Clinical Ethics Consultation Service at Montefiore Medical Center in the Bronx, New York. </em></p> </div> </div> </div> </div> </div> <div class="field field--name-field-teaser-media field--type-entity-reference field--label-above"> <div class="field__label">Teaser Media</div> <div class="field__item"><a href="/media/281" hreflang="en">older person along in hospital, lying in bed</a></div> </div> <div class="clearfix text-formatted field field--name-field-byline field--type-text-long field--label-above"> <div class="field__label">Byline</div> <div class="field__item"><p><strong>In Focus</strong><br /> By Nancy Berlinger, Laura Guidry-Grimes and Adira Hulkower</p> </div> </div> <div class="field field--name-field-issue field--type-entity-reference field--label-above"> <div class="field__label">Issue</div> <div class="field__item"><a href="/march-april-2021" hreflang="en">March-April 2021</a></div> </div> Tue, 23 Feb 2021 23:39:38 +0000 asa_admin 285 at http://generations.asaging.org The Ethics of Misogyny http://generations.asaging.org/ethics-misogyny <span class="field field--name-title field--type-string field--label-hidden">The Ethics of Misogyny</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><a title="View user profile." href="/user/6" class="username">asa_admin</a></span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 02/24/2021 - 00:12</span> <div class="field field--name-field-tags field--type-entity-reference field--label-above"> <div class="field__label">Tags</div> <div class="field__items"> <div class="field__item"><a href="/ageism-culture" hreflang="en">Ageism &amp; Culture</a></div> <div class="field__item"><a href="/economic-security" hreflang="en">Economic Security</a></div> <div class="field__item"><a href="/health-well-being" hreflang="en">Health &amp; Well-being</a></div> </div> </div> <div class="field field--name-field-channel field--type-entity-reference field--label-above"> <div class="field__label">Channel</div> <div class="field__item"><a href="/generations-today" hreflang="en">Generations Today</a></div> </div> <div class="field field--name-field-teaser-text field--type-string-long field--label-above"> <div class="field__label">Teaser Text</div> <div class="field__item">‘Women have long been taken for granted as the default safety net.’</div> </div> <div class="field field--name-field-paragraphs field--type-entity-reference-revisions field--label-above"> <div class="field__label">Paragraphs</div> <div class="field__items"> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p class="dropcaps">Last year alone, <a href="https://fred.stlouisfed.org/series/LNS11000002">2.1 million</a> women left the workforce. A majority of these women left not by choice, but because either their jobs were eliminated or their caregiving responsibilities became too arduous during the pandemic. The long-term consequences of women exiting the workforce will be devastating for the financial and retirement stability of women and our families.</p> <p>The systemic inequities embedded in our society got us to where we are today and threaten to turn back the clock on women’s advancement in the workforce, widen the pay gap and the racial wealth gap and undermine the long-term financial security of women and families.</p> <h2>Women Were Paid Less, and Picked Up More Responsibilities During COVID-19</h2> <p>While women have long been taken for granted as the default safety net, picking up any responsibilities that fall upon us, this pandemic stretched the safety net to a near-breaking point. Women took on additional childcare responsibilities when our children's schools and daycares closed, forcing some women to <a href="https://www.pewresearch.org/fact-tank/2020/10/22/fewer-mothers-and-fathers-in-u-s-are-working-due-to-covid-19-downturn-those-at-work-have-cut-hours/">work less</a> or <a href="https://www.pewresearch.org/fact-tank/2020/11/24/in-the-pandemic-the-share-of-unpartnered-moms-at-work-fell-more-sharply-than-among-other-parents/">separate from the workforce</a> altogether. When older loved ones need care, the <a href="https://www.americanprogress.org/issues/women/reports/2020/06/03/485855/valuing-womens-caregiving-coronavirus-crisis/">responsibility </a>disproportionately and reflexively falls upon women. </p> <p>Women of color generally face greater risk from the pandemic: we are more likely to hold <a href="https://cepr.net/a-basic-demographic-profile-of-workers-in-frontline-industries/">frontline jobs</a> and are <a href="https://www.bls.gov/cps/cpsaat11.htm">overrepresented </a>in domestic care and in the lower wage healthcare workforce, where basic workplace protections are lacking. The devastating health and financial consequences of this risk only worsen the status quo for women of color, who already grappled with higher unemployment rates and health disparities due to systemic racism. These layered crises mean that many women of color will have to work longer in unsafe, lower paying jobs, deal with life-long medical complications, and manage retirement with very little in savings.</p> <p>These structural barriers will not be addressed until those in power—policy makers or business leaders—open their eyes and fight for change.</p> <p>One of the biggest impediments standing in the way of financial security for women is the significant gender and racial wealth gaps. In 2019, women <a href="https://www.nationalpartnership.org/our-work/resources/economic-justice/fair-pay/americas-women-and-the-wage-gap.pdf">were paid 82 cents for every dollar paid to men</a>. Black women and Latinas, who have been on the frontlines of the pandemic, earn $0.63 and $0.55, respectively, for every dollar earned by white men.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--quote paragraph--view-mode--default"> <blockquote> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>‘We must challenge the archaic notion that women are the primary caregivers.’</p> </div> <footer class="blockquote-footer mt-2"> <cite title=""> </cite> </footer> </blockquote> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>When a woman isn’t paid her fair wage, it impacts her retirement and long-term financial security. Because women are so often pushed to spend time out of the workforce, the wage gap grows over time.</p> <p>Over a 15-year period, women are paid just 49 cents for each dollar paid to a man. And by the time women have reached retirement age, they have <a href="https://www.nirsonline.org/reports/shortchanged-in-retirement-continuing-challenges-to-womens-financial-future/">saved less in private retirement</a> than men and will receive <a href="https://www.ssa.gov/policy/docs/statcomps/supplement/2019/5a.html#table5.a6">20 percent less </a>in Social Security benefits due to lower wages, leaving them more likely to live in poverty.</p> <h2>Why Are Women Still Seen as the Primary Caregivers?</h2> <p>To ensure women and men have equal opportunity for financial stability, we must challenge the archaic notion that women are the primary caregivers and responsible for household needs. We need to normalize the idea that women and men can and should perform caregiving and household duties equally.</p> <p>When caregiving needs arise, and women are forced to either step back from the workforce entirely or cut down their work hours, it impacts their ability to contribute financially to the family, advance in the workplace and build wealth in the future. And months or years without income impacts Social Security contributions and retirement savings, impacting women as they age.</p> <p>One policy that is critical for leveling the playing field for women is a comprehensive and inclusive paid family and medical leave policy. Today, 80 percent of workers do not have access to paid family and medical leave through their employer. For the majority of Americans, this means that if they need to take time off to care for themselves or a loved one they risk missing a paycheck.</p> <p>This pandemic has demonstrated the inequities in paid leave access as well as the urgent need for a comprehensive and inclusive nationwide program. Paid family and medical leave must include the full range of caregiving responsibilities that a worker may face—whether it’s caring for an older relative, adult dependents or a young child.</p> <p>And it must address the needs of the <a href="https://www.caregiving.org/wp-content/uploads/2020/05/Full-Report-Caregiving-in-the-United-States-2020.pdf">47 percent of adults between the ages of 40 and 55</a>, also known as the sandwich generation, who are responsible for both children and older adults requiring care. While this group is often invisible, it is the lived experience in many communities of color and those who are a part of multigenerational households.</p> <p>Our society must learn from the lessons of the pandemic. Leaders must seek to enact policies that address long-standing racial and gender inequities. This will require a comprehensive approach that addresses the imbalances facing workers today and provides economic solutions to protect Social Security and older adults.</p> <p>All of our eyes have been opened to the immense gaps in our social safety net. We can’t afford to wait for solutions.</p> <p>ASA members—to get involved, please check out the below resources:</p> <ul><li><a href="https://www.nationalpartnership.org/our-work/economic-justice/family-act.html">Information on paid family and medical leave</a></li> <li><a href="https://action.momsrising.org/letter/permanent_paidleave_congress/?source=action">Contact Congress in support of permanent family and medical leave</a></li> <li><a href="https://action.momsrising.org/letter/permanent_paidleave_congress/">Contact Congress in support of emergency paid leave and paid sick days</a></li> <li><a href="https://www.nationalpartnership.org/our-work/economic-justice/fair-pay.html">Information on fair pay</a></li> <li><a href="https://womenswealthgap.org/wp-content/uploads/2017/06/Closing-the-Womens-Wealth-Gap-Report-Jan2017.pdf">Background on the women’s wealth gap</a></li> <li><a href="https://p2a.co/T2AOwF3">Urgent call to action to email Congress about paid leave </a></li> </ul><hr /><p><em>Erika L. Moritsugu is vice president for Congressional Relations and Economic Justice for the <a href="https://www.nationalpartnership.org/">National Partnership for Women &amp; Families</a> in Washington, DC.</em></p> </div> </div> </div> </div> </div> <div class="field field--name-field-teaser-media field--type-entity-reference field--label-above"> <div class="field__label">Teaser Media</div> <div class="field__item"><a href="/media/283" hreflang="en">Stressed</a></div> </div> <div class="clearfix text-formatted field field--name-field-byline field--type-text-long field--label-above"> <div class="field__label">Byline</div> <div class="field__item"><p><strong>In Focus</strong><br /> By Erika L. Moritsugu</p> </div> </div> <div class="field field--name-field-issue field--type-entity-reference field--label-above"> <div class="field__label">Issue</div> <div class="field__item"><a href="/march-april-2021" hreflang="en">March-April 2021</a></div> </div> Tue, 23 Feb 2021 23:12:02 +0000 asa_admin 284 at http://generations.asaging.org International Medical Graduates Key to Innovative Hospital to Home Program http://generations.asaging.org/keys-hospital-home-program <span class="field field--name-title field--type-string field--label-hidden">International Medical Graduates Key to Innovative Hospital to Home Program</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><a title="View user profile." href="/user/6" class="username">asa_admin</a></span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 02/23/2021 - 23:54</span> <div class="field field--name-field-tags field--type-entity-reference field--label-above"> <div class="field__label">Tags</div> <div class="field__items"> <div class="field__item"><a href="/health-well-being" hreflang="en">Health &amp; Well-being</a></div> <div class="field__item"><a href="/justice-equity" hreflang="en">Justice &amp; Equity</a></div> </div> </div> <div class="field field--name-field-channel field--type-entity-reference field--label-above"> <div class="field__label">Channel</div> <div class="field__item"><a href="/generations-today" hreflang="en">Generations Today</a></div> </div> <div class="field field--name-field-teaser-text field--type-string-long field--label-above"> <div class="field__label">Teaser Text</div> <div class="field__item">‘Spending time with clients to build trust and understand their personal health goals is key to the success of the program.’</div> </div> <div class="field field--name-field-paragraphs field--type-entity-reference-revisions field--label-above"> <div class="field__label">Paragraphs</div> <div class="field__items"> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p><em><strong>Editor’s note: </strong>The John A. Hartford Foundation, the Administration for Community Living (ACL) and The SCAN Foundation fund the <a href="https://www.aginganddisabilitybusinessinstitute.org/">Aging and Disability Business Institute</a>, led by the National Association of Area Agencies on Aging (n4a). The mission of the Aging and Disability Business Institute is to build and strengthen partnerships between aging and disability community-based organizations (CBO) and the healthcare system. As partners in the Institute, ASA and n4a are collaborating on a series of articles and case studies in </em><strong>Generations Today</strong><em> that highlight community-based integrated care networks.</em></p> <hr /><p class="dropcaps">JASA, a 53-year-old aging services agency supporting more than 40,000 older adults in the Bronx, Brooklyn, Manhattan, Queens and parts of Long Island is this year’s winner of The John A. Hartford Foundation’s Business Innovation Award. The award recognizes aging and disability community-based organizations for innovative approaches used in reducing healthcare costs and improving the well-being of elders and people with disabilities through partnerships with healthcare entities. This year, the <a href="https://www.aginganddisabilitybusinessinstitute.org/nominations-open-for-the-john-a-hartford-foundation-2020-business-innovation-award/">Business Institute</a> was especially interested in recognizing innovations in CBO-healthcare contracting related to addressing health equity or health disparities.</p> <h2>Innovative Program for Complex Patients</h2> <p>Arielle Basch is senior director of Health Services and Business Development at JASA, and has led the development of an innovative Hospital to Home Care Transitions program that has been highly effective in reducing hospital readmissions for older adults. </p> <p>As part of this program, JASA has contracted with several healthcare entities, including Healthfirst, Maimonides Medical Center, Woodhull Medical Center and Wyckoff Hospital Medical Center. “Healthfirst has conducted a preliminary evaluation of the program. Early results indicate that the cohort of members who agreed to receive JASA’s Care Transitions intervention had 26 percent fewer readmissions in the 30 days following an index admission compared to the cohort of members who did not receive the intervention,” said a spokesperson for Healthfirst.</p> <p>The program is designed to address challenges faced by older adults who are discharged from the hospital to prevent adverse events when they return home. Geared toward the many older New Yorkers who do not speak English as a first language and/or who have complex medical and social needs, it works like this: Managed Care Organizations and Hospitals refer patients to JASA, and a JASA team member meets the patient in the hospital (during COVID this is done virtually). Patients can opt in or out at that time, but if they opt in, they are assessed to determine health conditions, medications, what they were admitted for, any comorbidities and needs they’ll have at home.</p> <h2>Home Visit within 48 Hours of Hospital Discharge</h2> <p>When discharged all patients are given discharge instructions, the only challenge being they are generally in English or in language that is hard to understand, which makes them difficult to follow for much of JASA’s clientele. JASA staff will make a home visit to translate these discharge instructions for the patients as a first step toward preventing them from returning to the hospital.</p> <p>One imaginative element that may be unique to JASA and really helps with this tricky transition is that the agency employs International Medical Graduates (IMGs) to work in the Care Transitions program. Not only are most from Spanish-speaking countries, but they are fully trained medically and working at JASA is a stepping stone toward a residency in the United States.</p> <p>After translating the discharge instructions, the IMGs ensure the patients understand the instructions, have all necessary medications and know their proper uses, and make appointments to follow up with the patient’s physician(s) within a week.</p> <p>These patients often have multiple complex comorbidities, and the IMGs spend time on intensive patient education. They go over red flags, making sure clients know when they should contact their doctor to prevent an emergency at home, review and update the patient’s medical record, and work with the patient to outline questions for their next doctor’s appointment.</p> <h2>Social Needs Assessment Critical to Prevent Readmissions</h2> <p>During the home visit, IMGs assess client’s social needs; they identify potential depression or other mental health needs, whether the patient needs help with food or nutrition education, transportation, housing, homecare, medication or caregiving support. (For example, in one case a client received help moving to an assisted living facility as their housing situation with a family caregiver was untenable.)</p> <p>IMGs connect the recently hospitalized person to skilled services, mental health and social support, such as Senior Centers and Friendly Visitor Programs, food, transportation and any other necessary referrals.  IMGs also provide COVID-19 education and are helping clients schedule appointments for vaccinations. IMGs generally make one to two home visits per client, with approximately three remote follow-up appointments. </p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--quote paragraph--view-mode--default"> <blockquote> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>Discharge instructions are generally in English or in language that is hard to understand, which makes them difficult to follow for much of JASA’s clientele.</p> </div> <footer class="blockquote-footer mt-2"> <cite title=""> </cite> </footer> </blockquote> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p style="margin-bottom:11px"> </p> <p>JASA has one social worker on the Care Transitions team for clients with intense social care challenges an IMG may not be able to solve, but generally the IMGs are trained to deal with most such issues that crop up. The Care Transitions team also taps into the expertise of JASA social workers and other professional staff who have specialized experience in adult protective services, legal services, palliative care, mental health services, homecare and other areas. </p> <p>Basch says JASA employs 15 IMGs, generally for a year or two as they apply for residency. “IMGs have been a wonderful addition to JASA’s staff,” she says. “I love the team I work with. The IMGs bring diverse cultural perspectives, language skills and strong medical training to JASA. They are incredibly committed to using their skills to address the social determinants of health and help seniors transition home safely. JASA and our clients benefit so much from our work with IMGs and we hope this program helps to prepare them for residency programs.”</p> <p>Also, as a bonus for the IMGs, they’re learning the complexities of social needs, which isn’t all that common in medical school. And they’re receiving actionable geriatrics training, so perhaps Basch is coaching the next crop of geriatricians as well.  </p> <p>JASA’s client base is one with complicated, entrenched health issues, making it more remarkable that the agency is able to prevent so many hospital readmissions. Many clients are taking more than 10 medications and have some combination of COPD, congestive heart failure, diabetes, low health literacy levels and, more often than not, live in poverty.</p> <p>“We have to deliver culturally competent care in a language the person speaks, while being considerate of their culture, backgrounds and personal goals,” Basch says. IMGs spend time building trust with patients, and Basch finds patients will call JASA team members even after they have completed JASA’s care transitions program. These clients are more comfortable asking JASA staff questions and for help with medications, home care, food and transportation or other issues beyond hospital discharge.</p> <p>“Spending time with clients to build trust and understand their personal health goals is key to the success of the program. JASA’s care transitions program is designed to actively engage clients in the healthcare system and to advocate on their behalf,” says Basch.</p> <p>As one 78-year-old woman client explained when asked about JASA’s program, “I was facing uncertainty, sadness, loneliness and illness. It was made more difficult because of challenges communicating with the hospital [during the COVID surge], and the death of my husband, but the support and understanding provided by JASA's staff gave me a new family in the midst of so much tragedy.”</p> </div> </div> </div> </div> </div> <div class="field field--name-field-teaser-media field--type-entity-reference field--label-above"> <div class="field__label">Teaser Media</div> <div class="field__item"><a href="/media/285" hreflang="en">Social worker visiting a home</a></div> </div> <div class="field field--name-field-issue field--type-entity-reference field--label-above"> <div class="field__label">Issue</div> <div class="field__item"><a href="/march-april-2021" hreflang="en">March-April 2021</a></div> </div> Tue, 23 Feb 2021 22:54:34 +0000 asa_admin 283 at http://generations.asaging.org Aging While … in a Post-Pandemic World http://generations.asaging.org/aging-while-post-pandemic-world <span class="field field--name-title field--type-string field--label-hidden">Aging While … in a Post-Pandemic World </span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><a title="View user profile." href="/user/6" class="username">asa_admin</a></span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 02/23/2021 - 23:24</span> <div class="field field--name-field-tags field--type-entity-reference field--label-above"> <div class="field__label">Tags</div> <div class="field__items"> <div class="field__item"><a href="/ageism-culture" hreflang="en">Ageism &amp; Culture</a></div> <div class="field__item"><a href="/economic-security" hreflang="en">Economic Security</a></div> </div> </div> <div class="field field--name-field-channel field--type-entity-reference field--label-above"> <div class="field__label">Channel</div> <div class="field__item"><a href="/generations-today" hreflang="en">Generations Today</a></div> </div> <div class="field field--name-field-teaser-text field--type-string-long field--label-above"> <div class="field__label">Teaser Text</div> <div class="field__item">‘More low-income older adults will become entrepreneurs, freelancers and gig workers.’ </div> </div> <div class="field field--name-field-paragraphs field--type-entity-reference-revisions field--label-above"> <div class="field__label">Paragraphs</div> <div class="field__items"> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p><em><strong>Editor’s Note:</strong> This </em><strong>Generations Today</strong><em> column, “Aging While...” is sponsored by AARP Foundation. It focuses on creating and advancing innovative solutions that help older Americans build economic opportunity and social connectedness.</em></p> <hr /></div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p class="dropcaps">With vaccine administration well underway, it is time to forecast what’s ahead when the pandemic ends for adults ages 50 and older—especially vulnerable, low-income older adults, and those affected by systemic racism. In part 1 of a two-part series, we look at economic issues brought on by the pandemic and opportunities it presented. Part 2 will focus on issues of health and well-being.</p> <h2>Challenges</h2> <h6>Prediction: After the pandemic, more older workers will be unemployed and have difficulty getting hired, potentially pushing millions into poverty.   </h6> <p>Unlike in past recessions, during the pandemic recession, <a href="https://www.aarp.org/work/working-at-50-plus/info-2020/october-jobless-rate.html">workers ages 55 and older</a> lost jobs at a higher rate than workers even a few years younger, and those who were Black or Hispanic fared worse. Once the pandemic ends, many older adults will need to work longer to repair the damage to their financial health.</p> <p>Yet if history is any guide, it may be difficult for older adults to remain in the workforce longer or gain employment after a layoff. <a href="https://www.urban.org/sites/default/files/alfresco/publication-pdfs/412574-Age-Disparities-in-Unemployment-and-Reemployment-During-the-Great-Recession-and-Recovery.PDF">During and after the Great Recession</a>, older adults took twice as long to find work as younger workers, and <a href="https://www.marketwatch.com/story/why-millions-of-older-workers-will-pay-a-big-financial-priceforeverfrom-the-coronavirus-2020-05-01?mod=article_inline">one-third</a> were still unemployed a year after losing their jobs.</p> <p>Experts believe after today’s pandemic older workers <a href="https://www.aarp.org/work/working-at-50-plus/info-2020/october-jobless-rate.html">will face a much slower recovery, more difficulty finding jobs and more long-term unemployment</a>. Stereotypes and myths about older workers costing more, and pervasive age discrimination play a role. <a href="https://www.economicpolicyresearch.org/jobs-report/a-first-in-nearly-50-years-older-workers-face-higher-unemployment-than-mid-career-workers">Black, female or non-college degree-holding older workers</a> will find it even tougher to find new jobs.   </p> <p>Today’s downturn could be more difficult for older workers because, during the Great Recession, <a href="https://www.frbatlanta.org/cweo/workforce-currents/2020/09/03/older-workers-face-new-risks-because-of-the-covid-19-recession">many older workers became gig workers or took low-paying, part-time jobs as warehouse workers, ride-share drivers or home-health aides. Today, those jobs are much scarcer. </a></p> <p>Some experts predict that the economic fallout from COVID-19 <a href="https://d2mkcg26uvg1cz.cloudfront.net/wp-content/uploads/2020-C19-DG06_COVID-19-Issue-Brief_4-14.pdf">could push 1.4 to 2.1 million older Americans into poverty, joining the more than 25 million Americans ages 60 and older who are economically insecure and living at or below 250 percent of the federal poverty level.</a></p> <h6>Prediction: Older adults’ retirement security will be at greater risk following the pandemic.</h6> <p>A <a href="https://www.prnewswire.com/news-releases/new-survey-finds-americans-are-withdrawing-significant-amounts-from-retirement-accounts-to-cover-living-expenses-during-the-pandemic-301201580">January 2021 poll </a>found that as of last November, nearly 60 percent of Americans withdrew or borrowed money from an IRA or 401(k) during the pandemic, and 63 percent used those retirement savings to cover basic living expenses. Thirty-five percent said they now plan to work longer due to the financial impact the pandemic has had on retirement plans.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--quote paragraph--view-mode--default"> <blockquote> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>‘Employers will increasingly use skills-based criteria to hire and promote workers.’</p> </div> <footer class="blockquote-footer mt-2"> <cite title=""> </cite> </footer> </blockquote> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>While older adults contemplate the need to work longer to make up these shortfalls, many will be unable to do so. <a href="https://www.aarp.org/work/working-at-50-plus/info-2020/october-jobless-rate.html">As many experience long-term unemployment and therefore face greater difficulty getting hired</a>, they may drop out of the labor market and retire early. If they do, and claim Social Security earlier than their full-retirement age, it can cause <a href="https://www.morningstar.com/articles/998954/the-coronavirus-pandemic-and-retirement-security">sharp, permanent reductions</a> to their annual benefits, <a href="https://www.morningstar.com/articles/998954/the-coronavirus-pandemic-and-retirement-security">loss of late-career earning years</a> to save for retirement, and the need to stretch their money over many more non-working years. <a href="https://www.ssa.gov/OACT/quickcalc/early_late.html#:~:text=In%20the%20case%20of%20early,of%20one%20percent%20per%20month.">For example, if someone whose full retirement age was 67 retired at 62 and took Social Security, their monthly benefit would be permanently reduced by 30 percent</a>.</p> <h2>Opportunities</h2> <h6>Prediction: More low-income older adults will become entrepreneurs, freelancers and gig workers. </h6> <p>With older adults facing more barriers to finding work in the post-pandemic economy, they will increasingly turn to entrepreneurship as a viable way to make a living. One metric suggests this may be happening. As of mid-November 2020, applications entrepreneurs must file for tax purposes when starting a new business grew <a href="https://www.census.gov/econ/bfs/index.html">38 percent over last November</a>, according to the U.S. Census Bureau, which is astonishing given the high rate of small business failures during the pandemic.</p> <p>Older adults who start businesses are more likely to succeed, with<a href="https://www.inc.com/jeff-haden/a-study-of-27-million-startups-found-ideal-age-to-start-a-business-and-its-much-older-than-you-think.html"> a 50-year old being 2.8 times as likely to establish a successful high-growth startup as a 25-year old</a> and more than<a href="https://aarpsharex-my.sharepoint.com/personal/drubin_aarp_org/Documents/ASA Article/Aging While Being an Entrepreneur/And in general terms, a 50-year-old entrepreneur is almost twice as likely to start an extremely successful company as a 30-year-old."> twice as likely to start an extremely successful company as a 30-year-old</a>. Success at starting a new business increases with age, even into one’s 60s and 70s. Still, many low-income older adults need confidence, skills, coaching and connections to succeed at becoming an entrepreneur, with <a href="https://workforyourself.aarpfoundation.org/">AARP Foundation’s Work for Yourself@50+</a> being the only national program to provide it to low-income adults who are ages 55 and older. </p> <p>After the pandemic, <a href="https://www.mckinsey.com/featured-insights/future-of-work/what-800-executives-envision-for-the-postpandemic-workforce">businesses expect to rely much more heavily on freelancers and temporary workers</a>, so older adults also may turn to freelancing or gig work to make a living. These options can be a powerful vehicle to create economic opportunity and ensure sustainability. AARP Foundation’s <a href="https://freelancing.aarpfoundation.org/registration/">Work for Yourself@50+ Freelancing Resource Center</a> provides support to first-time freelancers and experienced independent workers with lessons and resources, including a tool to help aspiring freelancers find and secure work.</p> <p>Although gig work and freelancing are valuable ways for older adults to earn income, we remain concerned that these jobs lack benefits such as health and unemployment insurance that come with traditional work arrangements. A wide range of policymakers and experts have called for a better safety net for the contingent workforce, either by extending current protections and benefits to them or by creating new arrangements such as portable benefits, or both.</p> <h6>Prediction: Employers will increasingly use skills-based criteria to hire and promote workers, creating new opportunities for older, low-income and diverse adults to compete for jobs.  </h6> <p><a href="https://www.businessroundtable.org/">The Business Roundtable</a>, an association of major company CEOs, last December announced a <a href="https://www.businessroundtable.org/business-roundtable-launches-initiative-to-place-greater-emphasis-on-skills-in-hiring-and-advancement-improve-equity-and-diversity-in-employment#:~:text=Dec%204%2C%202020&amp;text=Washington%2C%20DC%20%E2%80%93%20Business%20Roundtable%20today,equity%2C%20diversity%20and%20workplace%20culture.">multiyear initiative</a> to focus their member companies’ hiring and promotion practices on candidates’ skills rather than on their degrees or credentials, and to improve equity, diversity and workplace culture. The new initiative will support efforts to address inequity in employment practices, including how people are hired and how they advance; and will work toward eliminating unintentional bias. This effort will accelerate skills-based hiring—which assesses a candidate’s competencies for a specific job instead of relying upon their educational credentials, particularly four-year degrees, as a proxy for skills. </p> <p>Research supports the effectiveness of this new direction. A <a href="https://www.nytimes.com/2020/12/03/technology/work-skills-upward-mobility.html?">recent study </a>where researchers combed through occupations and skills data discovered that <a href="https://www.nytimes.com/2020/12/03/technology/work-skills-upward-mobility.html?">up to 30 million U.S. workers</a> without four-year college degrees possess the skills necessary to do jobs that pay 70 percent more, on average, than their current jobs.<a href="https://www.nytimes.com/2020/12/03/technology/work-skills-upward-mobility.html?"> Labor experts and workforce organizations</a> have also begun to advocate for skills-based hiring based on fairness and economic efficiency. People who have significant skills, but lack college degrees, represent a “<a href="https://opportunityatwork.org/stars/">massive talent pool with skills and potential to excel at in-demand jobs</a>.”</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--quote paragraph--view-mode--default"> <blockquote> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>Employers will also need workers who are ready to work remotely, as 84 percent of employers plan to expand remote work post-pandemic.</p> </div> <footer class="blockquote-footer mt-2"> <cite title=""> </cite> </footer> </blockquote> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>Widespread adoption of skills-based hiring can assist low-income ages 50 and older workers with lower education levels who have work experience to get hired if they can show their skills are a match for in-demand jobs in a post-COVID economy. Skills-based hiring also can help such workers get promoted from low- to middle-skilled jobs, increasing their economic security and mobility. And it can help diverse candidates gain entry to jobs that were previously denied to them.</p> <h6>Prediction: As the pandemic rapidly accelerated the digital transformation for businesses, older, low-income adults who have digital skills and are remote-work ready will have an edge in the post-COVID labor market, as will businesses that invest in reskilling and upskilling their workforces.</h6> <p>Before the pandemic, <a href="https://www.urban.org/sites/default/files/publication/100843/foundational_digital_skills_for_career_progress_2.pdf">digital skills were increasingly essential</a> for workers in almost all types of jobs. The COVID-19 pandemic has dramatically sped up that trend. <a href="https://www.twilio.com/covid-19-digital-engagement-report">Ninety-seven percent </a>of enterprise decision makers believe the pandemic has accelerated their company’s digital transformation.</p> <p>Post-pandemic, employers will increasingly seek workers with a continuum of digital skills starting with “foundational digital skills”—<a href="https://www.urban.org/sites/default/files/publication/100843/foundational_digital_skills_for_career_progress_2.pdf">the ability to use digital tools to complete tasks in various settings</a>—as the digitization of jobs and tasks accelerates, <a href="https://www.urban.org/sites/default/files/publication/100843/foundational_digital_skills_for_career_progress_2.pdf">even in many low-skilled jobs</a> or those that have not traditionally required technology proficiency. Workers will need to move beyond basic digital skills to more advanced or specialized digital skills, which most higher wage, in-demand jobs posted today require.</p> <p>Employers will also need workers who are ready to work remotely, as <a href="https://www.imf.org/external/pubs/ft/fandd/2020/12/WEF-future-of-jobs-report-2020-zahidi.htm">84 percent of employers</a> report they plan to significantly expand remote work post-pandemic. Being remote-work ready—including the ability to collaborate and communicate in a virtual environment—will become an enhancement of foundational workplace skills that employers need.  </p> <p>Many workers, especially those who are low-income and ages 50 and older, are woefully unprepared for this digital work world. <a href="https://www.nationalskillscoalition.org/news/blog/nearly-1-in-3-workers#:~:text=Overall%2C%20nearly%20one%20in%20three,policymakers%20can%20do%20about%20it.">Nearly one in three workers lack foundational digital skills</a>, and <a href="https://nces.ed.gov/pubs2018/2018161.pdf">as many as 28 percent of low-income, ages 50 and older workers lack digital literacy skills</a>.</p> <p><a href="https://blog.shrm.org/blog/reskilling-and-upskilling-your-workforce-for-the-post-covid-19-era">Reskilling and upskilling workers are important ways that business can narrow that gap for today’s workforce</a>. Globally, <a href="https://learning.linkedin.com/resources/workplace-learning-report">more than half of companies plan to implement an upskilling program </a>in their organizations to educate or train their employees on more advanced skills, while <a href="https://learning.linkedin.com/resources/workplace-learning-report">47 percent will do the same for reskilling</a>, training or educating their employees in new skills for a different job. Low-income older adults will surely benefit from business’s new focus on upskilling and reskilling their workforces for post-pandemic jobs.  </p> <h6>Prediction: The pandemic has accelerated the adoption of new digital skills by older adults.</h6> <p>Many older adults have increased comfort with and willingness to use new technology to survive in an increasingly digital world. Whether working from home, staying in touch with family and friends, ordering groceries, conducting telemedicine visits or attending church services virtually, many older adults had no choice but to master new skills. </p> <p>AARP Foundation helped many older adults learn to conduct financial transactions virtually and learn to use online platforms for <a href="https://www.smartinsights.com/managing-digital-marketing/personal-career-development/current-and-future-demand-for-digital-skills/#:~:text=An%20overall%20finding%20of%20the,career%20progression%20pay%20more%20likely.">the first time </a>by accessing the free resources and workshops available at <a href="http://www.fintech.aarpfoundation.org/">www.fintech.aarpfoundation.org</a>. Even volunteering during the pandemic required mastering new digital skills. In AARP Foundation’s Experience Corps, our volunteers are using digital platforms to tutor underserved elementary students in reading, and AARP Foundation Tax-Aide volunteers use these digital tools to help prepare and file their mostly low-income, older clients’ tax returns.</p> <p>Because of older adults’ new comfort with and willingness to use technology, fintech entrepreneurs will increasingly design and market their products and services in a way that is relevant and appealing to older adults to capitalize on this opportunity. This virtuous circle will continue to integrate older adults more fully into the digital economy as time goes on.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><hr /><p><em>Lisa Marsh Ryerson is the president of AARP Foundation, in Washington, DC.</em></p> </div> </div> </div> </div> </div> <div class="field field--name-field-teaser-media field--type-entity-reference field--label-above"> <div class="field__label">Teaser Media</div> <div class="field__item"><a href="/media/181" hreflang="en">Self Employed</a></div> </div> <div class="clearfix text-formatted field field--name-field-byline field--type-text-long field--label-above"> <div class="field__label">Byline</div> <div class="field__item"><p><strong>From Our Sponsors</strong><br /> By Lisa Marsh Ryerson</p> </div> </div> <div class="field field--name-field-issue field--type-entity-reference field--label-above"> <div class="field__label">Issue</div> <div class="field__item"><a href="/march-april-2021" hreflang="en">March-April 2021</a></div> </div> Tue, 23 Feb 2021 22:24:52 +0000 asa_admin 282 at http://generations.asaging.org Fighting Ageism in Crisis Standards of Care http://generations.asaging.org/fighting-ageism-crisis-standards-care <span class="field field--name-title field--type-string field--label-hidden">Fighting Ageism in Crisis Standards of Care</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><a title="View user profile." href="/user/6" class="username">asa_admin</a></span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 02/23/2021 - 23:12</span> <div class="field field--name-field-tags field--type-entity-reference field--label-above"> <div class="field__label">Tags</div> <div class="field__items"> <div class="field__item"><a href="/ageism-culture" hreflang="en">Ageism &amp; Culture</a></div> <div class="field__item"><a href="/health-well-being" hreflang="en">Health &amp; Well-being</a></div> <div class="field__item"><a href="/justice-equity" hreflang="en">Justice &amp; Equity</a></div> </div> </div> <div class="field field--name-field-channel field--type-entity-reference field--label-above"> <div class="field__label">Channel</div> <div class="field__item"><a href="/generations-today" hreflang="en">Generations Today</a></div> </div> <div class="field field--name-field-teaser-text field--type-string-long field--label-above"> <div class="field__label">Teaser Text</div> <div class="field__item">‘Considerations of prognosis must be limited to the risk of imminent mortality.’</div> </div> <div class="field field--name-field-paragraphs field--type-entity-reference-revisions field--label-above"> <div class="field__label">Paragraphs</div> <div class="field__items"> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p><em><strong>Editor’s note: </strong>This past summer, as the urgent issue of racial injustice took center stage, ASA and Justice in Aging embarked upon a series of articles in </em><strong>Generations Today</strong><em> highlighting for the aging advocacy community how aging, identity and racial equity intersect. Called On Aging, Race, Identity and Equity, the articles will run in each issue for a year.</em></p> <hr /></div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p class="dropcaps">As governments began planning for restrictions to stem the spread of the novel coronavirus in early March 2020, horrible images out of <a href="https://www.nytimes.com/2020/03/12/world/europe/12italy-coronavirus-health-care.html">Italy </a>showing crowded hospitals and <a href="https://www.washingtonpost.com/health/2020/03/15/coronavirus-rationing-us/">stories </a>of older adults being denied ventilators due to scarcity were a rude awakening for healthcare providers and state governments, prompting them to consider the need for Crisis Standards of Care (CSC).</p> <p>CSC shift resources to save the most lives, rather than save all lives, and are used when crucial scarce resources—beds, medical supplies and medication—are insufficient. Where demand for these resources outpace supply, the healthcare system must shift from the conventional standard of care, where the focus is on the needs of each individual. CSC include triage plans to determine who receives medical care or equipment when there is not enough to meet the need. When properly developed, these plans create a set of standards for providers so that individual and implicit biases based on a patient’s age, race, ethnicity, disability, gender or other protected classification are not wrongly considered when healthcare providers make care decisions.</p> <p>Older adults and people with disabilities are often subject to ageist and ableist assumptions about their social worth or quality of life. Discrimination in healthcare <a href="https://khn.org/news/why-black-aging-matters-too/">compounds </a>when older adults of color face ageist stereotypes while having lived with decades of systemic racism.</p> <p>Several provisions in federal law prohibit discrimination in healthcare. The federal Patient Protection and Affordable Care Act’s anti-discrimination provision, also referred to as Section 1557, prohibits discrimination based on age, disability, sex, race, color or national origin by incorporating protections from several key civil rights statutes, including the Age Discrimination Act of 1975 (the Age Act).</p> <p>The Age Act establishes that “no person ... shall, on the basis of age, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under, any program or activity receiving Federal financial assistance.” Section 1557’s incorporation of the Age Act, as well as the Americans with Disabilities Act (ADA) expands protections for older adults and people with disabilities to all health programs and activities receiving federal financial assistance.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--quote paragraph--view-mode--default"> <blockquote> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>‘CSCs must ensure that scarce resources are allocated to save the most lives, based on individualized, clinical assessments that guard against explicit and implicit bias.’</p> </div> <footer class="blockquote-footer mt-2"> <cite title=""> </cite> </footer> </blockquote> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>Since the early days of the <a href="https://www.hhs.gov/about/news/2020/03/28/ocr-issues-bulletin-on-civil-rights-laws-and-hipaa-flexibilities-that-apply-during-the-covid-19-emergency.html">pandemic</a>, the Office for Civil Rights (OCR) in the Department of Health and Human Services has been fielding complaints of discrimination by advocates alleging that CSC policies are discriminatory against older adults, people with disabilities and people of color. OCR has resolved many of these complaints and clarified what it views as violative of the Age Act and the ADA.</p> <p>In the end, CSCs must ensure that scarce resources are allocated to save the most lives, based on <a href="https://nam.edu/national-organizations-call-for-action-to-implement-crisis-standards-of-care-during-covid-19-surge/">individualized</a>, clinical assessments that guard against explicit and implicit bias.</p> <h2>Most Common Issues in Crisis Standards</h2> <p>Many CSCs rely on Sequential Organ Failure Assessment (SOFA) scores or other similar clinical assessment to determine a patient’s mortality risk by measuring respiratory, cardiovascular, nervous, liver, kidney and coagulation levels. While these clinical assessments may seem impartial, they often measure a patient’s underlying disability rather than capturing their actual prognosis.</p> <p>For example, the Glasgow Coma Scale is one part of the SOFA score that measures visual, verbal and motor responses. Someone with an underlying neuromuscular disorder may have abnormal motor response resulting in an unfavorable score, even if they have a good prognosis. Several CSCs use Modified SOFAs (or MSOFA,) which factor in the patient’s baseline functioning to determine if a patient’s health is actually declining, instead of noting an underlying disability. The <a href="https://www.hhs.gov/about/news/2020/06/26/ocr-resolves-complaint-tennessee-after-it-revises-its-triage-plans-protect-against-disability.html">OCR </a>requires SOFAs and other similar tools to include reasonable modifications to “ensure that people with disabilities are evaluated based on actual mortality risk, not disability-related characteristics unrelated to their likelihood of survival.”</p> <p><strong>Long-term survival:</strong> While crisis standards should prioritize “saving the most lives,” they often also prioritize “saving the most life years,” by considering long-term survivability. CSCs should consider a patient’s likelihood of surviving the hospitalizing illness or injury. However, crisis standards may deny a patient life-saving treatment if they are not expected to survive long-term, which can be as little as six months or up to five or ten years. Survivability beyond six months is often very difficult to accurately predict, particularly for patients with <a href="https://www.jpsmjournal.com/article/S0885-3924(12)00443-5/pdf">dementia</a>. Further, long-term survivability hurts older adults of color who, due to decades of systemic racism and structural inequities, have worse health outcomes and <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2011359">reduced </a>life expectancy. Assessing survivability to hospital discharge prevents clinicians from furthering systemic inequities. In resolving a complaint against <a href="https://www.hhs.gov/about/news/2020/06/26/ocr-resolves-complaint-tennessee-after-it-revises-its-triage-plans-protect-against-disability.html">Tennessee</a>, OCR found that considerations of prognosis must be limited to the risk of imminent mortality.</p> <p><strong>Categorical exclusions: </strong>Categorical criteria that exclude people from care unjustly prevent older adults and people with disabilities from receiving life-saving treatment. These exclusions occur when crisis standards list certain criteria that would automatically prevent someone being considered for treatment. These criteria can be broad—having a severe neuromuscular disorder, dementia or advanced cancer are examples of conditions that could exclude someone from care. Exclusions also can be based on age or functional limitations like needing assistance with Activities of Daily Living. <a href="https://www.hhs.gov/about/news/2020/04/08/ocr-reaches-early-case-resolution-alabama-after-it-removes-discriminatory-ventilator-triaging.html">OCR </a>requires CSCs to remove any categorical exclusion in favor of an “individualized assessment based on the best available objective medical evidence.”</p> <p><strong>Other improper considerations: </strong>Some CSCs include factors that discriminate against older adults and people with disabilities. <a href="https://www.hhs.gov/about/news/2020/08/20/ocr-resolves-complaint-with-utah-after-revised-crisis-standards-of-care-to-protect-against-age-disability-discrimination.html">OCR </a>has provided guidance to states that prohibit the consideration of patients’ “resource-intensity” and requires CSCs to include protections against providers “steering” patients into Do Not Resuscitate orders as a tool to preserve resources at the expense of people with disabilities and older adults.</p> <p><strong>What about when there is a tie?</strong> CSCs may include tiebreaker provisions to apply when two or more patients have similar prognoses or SOFA/MSOFA scores. When these tiebreakers are age-based they are biased against older adults because older patients will always be denied life-saving treatment, even if the older patient is expected to survive the hospitalization with treatment.</p> <p>CSCs must use non-discriminatory criteria for tiebreakers. For example, <a href="https://coronavirus-download.utah.gov/Health/Utah-Crisis-Standards-of-Care-Guidelines-v9-11122020.pdf?eType=EmailBlastContent&amp;eId=b0048439-52ad-4640-a7b4-ed4b51286f1c">Utah’s</a> CSC removed its prior age-based tiebreaker, in favor of language that says, “if one patient’s clinical trajectory is declining more rapidly than the other patient needing the same limited resource, the limited resource should be assigned to the patient with the less rapid rate of decline, and thus the greatest prospect of short-term survival.”</p> <p>In addition, the tie breaker language in Utah specifically requires that “this judgment is not based on any unlawful considerations of race, color, national origin, disability, age, or sex.” Some crisis standards have used first-come, first-served as a tiebreaker, but this can <a href="https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-five-key-questions-and-answers/">exacerbate </a>systemic inequities because marginalized communities often have reduced access to healthcare. The most unbiased option is the use of randomized assignment (like a lottery) in the event of a tie.</p> <h2>Advocating for Improved Crisis Standards</h2> <p>Improving crisis standards requires multidisciplinary collaboration between aging and disability rights advocates, civil rights groups and medical providers. Collaboration should be proactive to allow ample opportunity to educate and train providers on crisis standards. Advocates also can seek to remove discriminatory provisions in crisis standards by filing a complaint with the OCR and working to implement statewide adoption of non-discriminatory crisis standards.</p> <hr /><p><em>Gelila Selassie is a staff attorney and Regan Bailey is litigation director, both at Justice in Aging, based out of its Washington, DC, office.</em></p> </div> </div> </div> </div> </div> <div class="field field--name-field-teaser-media field--type-entity-reference field--label-above"> <div class="field__label">Teaser Media</div> <div class="field__item"><a href="/media/284" hreflang="en">Hospital scene</a></div> </div> <div class="clearfix text-formatted field field--name-field-byline field--type-text-long field--label-above"> <div class="field__label">Byline</div> <div class="field__item"><p>By Gelila Selassie and Regan Bailey</p> </div> </div> <div class="field field--name-field-issue field--type-entity-reference field--label-above"> <div class="field__label">Issue</div> <div class="field__item"><a href="/march-april-2021" hreflang="en">March-April 2021</a></div> </div> Tue, 23 Feb 2021 22:12:26 +0000 asa_admin 281 at http://generations.asaging.org Help for Southeast Asian American Caregivers Facing PTSD, Trauma, Racism and Language Barriers http://generations.asaging.org/help-southeast-asian-american-caregivers <span class="field field--name-title field--type-string field--label-hidden">Help for Southeast Asian American Caregivers Facing PTSD, Trauma, Racism and Language Barriers</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><a title="View user profile." href="/user/6" class="username">asa_admin</a></span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 02/23/2021 - 01:40</span> <div class="field field--name-field-tags field--type-entity-reference field--label-above"> <div class="field__label">Tags</div> <div class="field__items"> <div class="field__item"><a href="/justice-equity" hreflang="en">Justice &amp; Equity</a></div> <div class="field__item"><a href="/health-well-being" hreflang="en">Health &amp; Well-being</a></div> </div> </div> <div class="field field--name-field-channel field--type-entity-reference field--label-above"> <div class="field__label">Channel</div> <div class="field__item"><a href="/generations-today" hreflang="en">Generations Today</a></div> </div> <div class="field field--name-field-teaser-text field--type-string-long field--label-above"> <div class="field__label">Teaser Text</div> <div class="field__item">Some 70 percent of older Southeast Asian American immigrants or refugees have been diagnosed with PTSD.</div> </div> <div class="field field--name-field-paragraphs field--type-entity-reference-revisions field--label-above"> <div class="field__label">Paragraphs</div> <div class="field__items"> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p><strong>Editor’s Note:</strong> <em>This article represents the third in a series by the Diverse Elders Coalition (DEC) to be published in </em><strong>Generations Today</strong><em>. Articles are connected to ASA-hosted webinars; see end of article to register.</em> <em>The series of articles by the DEC highlights research from <a href="https://www.johnahartford.org/grants-strategy/addressing-unmet-family-caregiving-needs-in-diverse-older-communities">The Caregiving Initiative</a>, a multiyear research project funded by <a href="https://www.johnahartford.org/">The John A. Hartford Foundation</a>.</em></p> <hr /><p>Challenges facing family members have been exacerbated by the pandemic. While such challenges existed well before COVID-19’s onset, they have come to light in recent months as the global pandemic highlighted disparities in health and aging. For many Southeast Asian American (SEAA) caregivers, these <a href="https://www.latimes.com/socal/daily-pilot/entertainment/story/2020-09-17/mental-healthcare-for-cambodian-vietnamese-refugees-limited-by-shortage-of-bicultural-bilingual-providers">inequities </a>are worsened by language barriers that can lead to increased burden and strain or can trigger intergenerational trauma. Additionally, the COVID-19 pandemic has brought new hardships for SEAA caregivers such as anti-Asian racism and xenophobia.</p> <h2>Who Are Southeast Asian American Caregivers?</h2> <p>Beginning in 1975, the confluence of the Vietnam War, the Secret Wars in Laos and the Cambodian Genocide forced millions of people to flee their home countries in Southeast Asia. This continues to be the largest refugee diaspora that the United States has seen, with <a href="https://www.nbcnews.com/news/asian-america/how-southeast-asian-american-refugees-helped-shape-america-s-resettlement-n1187961">more than 1.1 million refugees</a> resettled from Vietnam, Laos and Cambodia. Today, more than 3 million <a href="https://www.searac.org/press-room/searac-and-advancing-justice-la-launch-groundbreaking-report-on-the-state-of-the-southeast-asian-american-community-in-the-united-states/">Southeast Asian Americans</a> call the United States home, populating all 50 states and embodying a rich piece of our nation’s past, present and future.</p> <p>Approximately <a href="https://www.napca.org/wp-content/uploads/2017/10/55-population-report-FINAL.pdf">98 percent of SEAAs</a> older than age 55 are immigrants or refugees, suffering from some of the highest rates of trauma and depression in the nation (70 percent have been diagnosed with <a href="https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&amp;lvlid=54">PTSD</a>), and their care largely falls to family and community members.</p> <h2>Culturally and Linguistically Competent Services and Resources</h2> <p>Through the Diverse Elders Coalition (DEC) caregiving initiative, a project aimed at improving the multicultural capacities of healthcare and social service providers, we discovered that there is an urgent need for culturally and linguistically competent services and resources for SEAA caregivers. More than one in four SEAA caregivers in <a href="https://www.diverseelders.org/wp-content/uploads/2019/11/Culture-Related-Task-Difficulty-GSA-2019-Poster-sent-to-Jenna-11-4-19-2.pdf">our survey</a> (36.5 percent) reported some or a great deal of difficulty with cultural tasks, such as translating health-related information, overcoming language barriers when talking with providers and legal issues related to immigration or naturalization procedures.</p> <p>Those who reported some or a great deal of difficulty with cultural tasks were more likely to have elevated levels of four types of strain and depression. Although more research is needed to determine causality, it is clear that there are negative health outcomes associated with cultural task difficulties, emphasizing the importance of culturally and linguistically competent services and resources.</p> <p>In addition to these cultural task difficulties, in a yet-to-be-published DEC analysis, more than 60 percent of SEAA caregivers reported some or a great deal of difficulty with healthcare tasks such as managing medications or caring for wounds and coordinating or arranging for care or services from healthcare providers, nurses and other service providers.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--quote paragraph--view-mode--default"> <blockquote> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>‘Hostile immigration policies and increases in SEAA detentions and deportations have resulted in adult caregivers being removed from their families.’</p> </div> <footer class="blockquote-footer mt-2"> <cite title=""> </cite> </footer> </blockquote> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>SEAA caregivers in our focus groups reported needing more information about programs that could help them, from instructions on how to administer medications to how to access financial support. Such programs exist, but instructions on how to access them are rarely translated into SEAA languages (e.g., Hmong, Khmer, Lao, Mien and/or Vietnamese). Additionally, rates of limited-English proficiency are as high as 95 percent among SEAA older adults and 55 percent among all SEAA adults, leaving older adults and caregivers vulnerable to scams, increased fear, misinformation and disinformation.</p> <h2>Navigating the Legal System around Citizenship/Naturalization, Detention and Deportation</h2> <p>“Responsibility of becoming a caregiver for an ill family member can be shared; however, this responsibility usually ends up [with] those who speak the most English,” said one Cambodian caregiver in a focus group. This need for greater assistance to navigate complicated systems, such as the U.S. immigration system, is seen in our survey results as well as in regular inquiries received by the Southeast Asia Resource Action Center (SEARAC).</p> <p>More than a quarter (28.4 percent) of surveyed SEAA caregivers reported having difficulty with healthcare, legal and financial tasks. Additionally, hostile immigration policies and increases in SEAA  detentions and deportations have resulted in adult caregivers being removed from their families and their communities, such as <a href="https://actionnetwork.org/petitions/urge-governor-newsom-help-keep-an-nguyen-home/?fbclid=IwAR1HnW6FBcrg3egEk4NBBGLKbucgPcjBtcGQ0SvC0KTF7ikCthRN2TRHU0Q">An Nguyen</a>, who cares for his elderly mother. Access to the few supportive, linguistically competent services that exist is limited, and greater outreach, resources development and language access is needed to support SEAA caregivers through these complex systems.  </p> <h2>How Has COVID-19 Impacted SEAA Caregiving?</h2> <p>Due to the COVID-19 pandemic, many in-person resources that elders and caregivers relied upon have become unavailable. Additionally, the transition to virtual services is challenging for older adults and caregivers who speak limited English, who may not write or read in their native languages and who have limited access to technology. Support groups for caregivers, direct services and basic daily activities such as buying groceries or picking up medications all look different than they did prior to COVID-19.</p> <p>SEARAC’s partners report that they have spent significant time fighting misinformation and disinformation throughout the pandemic, such as a rumor that COVID-19 was transmitted through electronic devices. Basic information such as how to properly wear a mask, the importance of hand-washing, how COVID-19 is transmitted and why social distancing is critical is rarely translated into SEAA languages. A bitter and brutal side effect of COVID-19 has been the uptick in Anti-Asian abuse and harassment that stemmed from our leaders' insistence upon calling COVID-19 “the China virus.” This may exacerbate existing health disparities among <a href="https://www.latimes.com/california/story/2020-12-31/filipino-vietnamese-americans-coronavirus-silicon-valley?fbclid=IwAR1r5Ee-m7t5P3aWGQzGt51_d8M5CRg7utfJGoU2Wfj7PCOhWouTvyjdHSQ">SEAA caregivers</a>.</p> <h2>Best Practices</h2> <p>To meet the needs of SEAA caregivers, service providers must develop culturally and linguistically competent <a href="https://www.latimes.com/socal/daily-pilot/entertainment/story/2020-09-24/addressing-a-lack-of-culturally-sensitive-healthcare-for-cambodian-and-vietnamese-communities-in-o-c">services and resources </a>such as in-language programs and information. Service providers must also acknowledge and support <a href="https://seaacovidhub.squarespace.com/stories">existing programs</a> that effectively address caregiver needs. Below are some best practices outlined in our cultural competency training curriculum that may help service providers to better serve SEAA caregivers:</p> <ul><li>Assess for difficulty with cultural tasks in caregiver and patient screening;</li> <li>Develop translated, culturally competent in-office materials for disease knowledge, treatments, outreach and training;</li> <li>Create partnerships and foster funding to community-based organizations that provide services to SEAA communities;</li> <li>Understand that high levels of trauma, PTSD and depression disproportionately impact SEAA refugees, resulting in family involved care;  </li> <li>Provide culturally competent referrals and resources to resolve high difficulty with cultural tasks.</li> </ul><p>For more guidance, support and resources to address SEAA caregivers and older adults, visit the Diverse Elders Coalition website at <a href="http://www.diverseelders.org/caregiving">www.diverseelders.org/caregiving</a>.</p> <p>To attend DEC trainings on the needs of diverse caregivers, register for the March 18 Webinar: <a href="https://asaging.org/web-seminars/caring-those-who-care-meeting-needs-american-indian-and-alaska-native-caregivers">Caring for Those Who Care: Meeting the Needs of American Indian and Alaska Native Caregivers</a>.</p> <hr /><p><em>Sina Sam is the partnership manager at SEARAC in Pullman, Wa. Jenna McDavid is a communications consultant at SEARAC, and Ocean Le, MS, is a program coordinator at the Diverse Elders Coalition, both in New York City.</em></p> <p><em>Photo courtesy of SEARAC.</em></p> </div> </div> </div> </div> </div> <div class="field field--name-field-teaser-media field--type-entity-reference field--label-above"> <div class="field__label">Teaser Media</div> <div class="field__item"><a href="/media/278" hreflang="en">Vietnamese older adult and her caregiver at a COVID-19 testing site.</a></div> </div> <div class="clearfix text-formatted field field--name-field-byline field--type-text-long field--label-above"> <div class="field__label">Byline</div> <div class="field__item"><p>By Sina Sam, Jenna McDavid and Ocean Le</p> </div> </div> <div class="field field--name-field-issue field--type-entity-reference field--label-above"> <div class="field__label">Issue</div> <div class="field__item"><a href="/march-april-2021" hreflang="en">March-April 2021</a></div> </div> Tue, 23 Feb 2021 00:40:50 +0000 asa_admin 280 at http://generations.asaging.org Inside California’s New Master Plan for Aging: An Opportunity for Reimagining and Reform http://generations.asaging.org/inside-californias-new-master-plan-aging <span class="field field--name-title field--type-string field--label-hidden">Inside California’s New Master Plan for Aging: An Opportunity for Reimagining and Reform</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><a title="View user profile." href="/user/6" class="username">asa_admin</a></span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 02/23/2021 - 01:23</span> <div class="field field--name-field-tags field--type-entity-reference field--label-above"> <div class="field__label">Tags</div> <div class="field__items"> <div class="field__item"><a href="/ageism-culture" hreflang="en">Ageism &amp; Culture</a></div> <div class="field__item"><a href="/health-well-being" hreflang="en">Health &amp; Well-being</a></div> <div class="field__item"><a href="/justice-equity" hreflang="en">Justice &amp; Equity</a></div> </div> </div> <div class="field field--name-field-channel field--type-entity-reference field--label-above"> <div class="field__label">Channel</div> <div class="field__item"><a href="/generations-today" hreflang="en">Generations Today</a></div> </div> <div class="field field--name-field-teaser-text field--type-string-long field--label-above"> <div class="field__label">Teaser Text</div> <div class="field__item">Goals for the Master Plan are informed using population and program data, which will guide implementation.</div> </div> <div class="field field--name-field-paragraphs field--type-entity-reference-revisions field--label-above"> <div class="field__label">Paragraphs</div> <div class="field__items"> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p class="dropcaps">California’s much anticipated <a href="https://mpa.aging.ca.gov/">Master Plan for Aging</a>, released Jan. 6, 2021, provides a roadmap for coordinated, system-wide change that equitably uplifts older adults, people with disabilities and their family caregivers. In this time of urgent need, the Master Plan is a once-in-a-generation opportunity to boldly advance solutions over the next 10 years.</p> <p>This past year, COVID-19 has magnified long-standing system challenges, health disparities and racial inequities, while also revealing <a href="https://www.thescanfoundation.org/publications/californias-use-of-federal-and-state-policy-flexibilities-to-ensure-access-to-long-term-services-and-supports-during-the-covid-19-pandemic/">opportunities to reshape</a> how high quality services are delivered and financed. Informed and framed by a diverse group of stakeholders, including consumers, advocates, community organizations and providers, this landmark Master Plan signifies tremendous progress to decisively address the needs of aging Californians through a comprehensive, person-centered and outcomes-oriented strategy.  </p> <h2>What’s in the Plan</h2> <p>With an emphasis on equity and inclusion, the Master Plan outlines five goals with 23 strategies, and more than 100 initiatives to drive action and results in the first two years of implementation.</p> <figure role="group" class="caption caption-img align-center"><img alt="California's Master Plan for Aging: Five Bold Goals for 2030" data-entity-type="file" data-entity-uuid="ef94f139-6d36-406b-9f63-898520f9d272" src="/sites/default/files/inline-images/Master%20Plan%20Goal%20List_0.jpg" /><figcaption>California's Master Plan for Aging: Five Bold Goals for 2030</figcaption></figure><p> </p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p><strong>Data: </strong>The <a href="https://letsgethealthy.ca.gov/mpa-data-dashboard-for-aging/">Data Dashboard for Aging</a> will measure progress on the execution of the Master Plan. The state will provide an annual progress report that will be used to evaluate and develop new initiatives throughout the next 10 years.</p> <p><strong>Local Planning:</strong> The <a href="https://mpa.aging.ca.gov/LocalPlaybook/">Master Plan for Aging Local Playbook</a> is designed to help communities, private and philanthropic organizations and government leaders to build environments that promote age-friendly and disability-friendly outcomes at the local level.</p> <p><strong>Addressing Alzheimer’s:</strong> The Master Plan includes key recommendations of the <a href="http://caalztaskforce.org/">Governor’s Task Force on Alzheimer’s Prevention and Preparedness</a>—chaired by Maria Shriver, former first lady of California—addressing ways California can prevent and prepare for the rise in the number of cases of Alzheimer’s disease and forge a bold path forward for an aging state and its families.</p> <h2>California’s Master Plan: The Potential to Make a Meaningful Impact</h2> <p>A truly impactful plan requires leadership, clear goal-setting that is backed by data, a comprehensive approach to system change, an engaged stakeholder process and accountability for implementation. These <a href="https://www.thescanfoundation.org/publications/building-a-master-plan-for-aging-key-elements-from-states-planning-for-an-aging-population/">five essential elements</a> of system planning are addressed in California’s Master Plan, as outlined below.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><table align="center" border="0" cellpadding="8" cellspacing="0" style="width: 100%;"><tbody><tr><td><strong>Decisive Leadership</strong></td> <td>Governor Newsom in 2019 issued an Executive Order calling for a Master Plan for Aging with continued leadership from the administration for its development.</td> </tr><tr><td style="background-color: rgb(153, 227, 255);"><strong>Rational</strong></td> <td style="background-color: rgb(153, 227, 255);">Goals are informed using <a href="http://www.dof.ca.gov/Forecasting/Demographics/Projections/">population</a> and <a href="https://letsgethealthy.ca.gov/mpa-data-dashboard-for-aging/">program</a> data, which will guide implementation. </td> </tr><tr><td><strong>Comprehensive</strong></td> <td>All 10 Cabinet agencies contributed to the development of the <a href="https://mpa.aging.ca.gov/Goals/1">Master Plan</a>, and identified their lead roles for impact and accountability on initiatives where appropriate.</td> </tr><tr><td style="background-color: rgb(153, 227, 255);"><strong>Stakeholder Involvement</strong></td> <td style="background-color: rgb(153, 227, 255);">The state formally engaged a <a href="https://mpa.aging.ca.gov/StakeholderProcess/">Stakeholder Advisory Committee</a> and three subcommittees/workgroups (Equity, Long-Term Services and Supports and Research) through public meetings. The state also administered surveys and held additional public meetings, webinars and community roundtables.  Moving forward, stakeholder engagement will be reimagined through development of an Implementation Council.</td> </tr><tr><td><strong>Accountability</strong></td> <td>The <a href="https://letsgethealthy.ca.gov/mpa-data-dashboard-for-aging/">Data Dashboard for Aging</a> includes a robust <a href="https://embed.resultsscorecard.com/Scorecard/Embed/66348">Indicator Progress Dashboard</a>. The state will provide an annual progress report that will be used to evaluate and develop new initiatives throughout the next 10 years.</td> </tr></tbody></table><p> </p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><h2>State Investment in Planning</h2> <p>A state’s budget is a reflection of its priorities. Governor Newsom’s <a href="https://www.thescanfoundation.org/publications/2021-22-proposed-budget-impact-on-californias-older-adults-and-people-with-disabilities/">proposed 2021–22 budget</a> identifies key investments to implement the Master Plan. The proposed budget focuses on core principles of equity and inclusion to address the system’s most pressing issues impacting older adults, people with disabilities and family caregivers, while also emphasizing leadership to promote system change. Specifically, the governor proposes establishing a Senior Advisor for Aging, Disability and Alzheimer’s within his office; a Medicare Innovations and Integration Office, statewide expansion of Aging and Disability Resource Centers, housing investments and expansion of telehealth flexibilities, among others.</p> <h2>System Planning as a Launch Pad to Reframe Aging: Engaging Other States</h2> <p>Negative stereotypes and fears of aging have historically pushed aging issues into the background of societal discourse. The COVID-19 pandemic has magnified long-standing system problems that for years have been neglected. We know this to be true across the country, with <a href="https://www.thescanfoundation.org/publications/building-a-master-plan-for-aging-key-elements-from-states-planning-for-an-aging-population/">other states</a> facing similar challenges. California’s Master Plan has the potential to reimagine aging—affecting how society thinks about, plans for and responds with equity and inclusion to the needs of a diverse aging population that is often forgotten. There has been success in other states engaging in similar activities to plan for and respond to the needs of this growing demographic imperative. With strong state leadership, engaged stakeholders, public/private partnerships and an overarching commitment to system change, it can be done. Many said it would be impossible to accomplish in California, but today there is hope for meaningful reform.</p> <p>During these difficult times, the Master Plan provides a critical template for a better life for all Californians, not only for our older generations—but for all of us—to age in dignity and with justice. As Governor Newsom has noted, California’s demographics are shifting, and older adults are the fastest-growing population group. All of us, young and old alike, share a stake in planning for our future. A Master Plan that enables older Californians to age well at home, with innovative solutions to address isolation and loneliness, enriches all of our communities.</p> <p>California’s Master Plan for Aging provides a strong platform from which to build these efforts. As leaders of eight California-based foundations, we celebrate the Master Plan’s release. We are proud of the resources our foundations collectively committed to support its development, yet we recognize that the real work begins now.</p> <p>As the state embarks on implementing the Master Plan, we all play a role in transforming services across healthcare, housing, social supports, transportation and workforce to meet the needs of a diverse aging population. No one entity can do it alone, and meaningful system change relies on committed, ongoing partnerships and leadership from the state, local, public, private and philanthropic sectors. We stand ready to work alongside leaders across public, private and philanthropic sectors to implement a Master Plan for Aging that will well serve Californians for generations to come.</p> <p>For more information and resources, go to <a href="https://mpa.aging.ca.gov/">https://www.mpa.aging.ca.gov</a>.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><hr /><p>Sarita A. Mohanty, MD, MPH, MBA, President and CEO, <a href="https://www.thescanfoundation.org/">The SCAN Foundation</a><br /> Shelley Lyford, President and CEO, <a href="https://www.westhealth.org/what-we-do/outcomes-based-philanthropy/#grantmaking">Gary &amp; Mary West Foundation</a><br /> Christopher A. Langston, PhD, President and CEO, <a href="https://archstone.org/">Archstone Foundation</a><br /> Janet Y. Spears, CEO, <a href="https://www.mettafund.org/">Metta Fund</a><br /> Mark Stuart, CFRE, President and CEO, <a href="https://www.sdfoundation.org/">The San Diego Foundation</a><br /> Richard S. Ziman, Trustee and CEO, <a href="https://www.thegilbertfoundation.org/">The Rosalinde and Arthur Gilbert Foundation</a><br /> William Smith, CEO, <a href="https://smithct.org/">May &amp; Stanley Smith Charitable Trust</a><br /> Edward B. Kacic, President, <a href="https://www.ihf.org/">Irvine Health Foundation</a></p> </div> </div> </div> </div> </div> <div class="field field--name-field-teaser-media field--type-entity-reference field--label-above"> <div class="field__label">Teaser Media</div> <div class="field__item"><a href="/media/277" hreflang="en">Welcome to California</a></div> </div> <div class="field field--name-field-issue field--type-entity-reference field--label-above"> <div class="field__label">Issue</div> <div class="field__item"><a href="/march-april-2021" hreflang="en">March-April 2021</a></div> </div> Tue, 23 Feb 2021 00:23:17 +0000 asa_admin 279 at http://generations.asaging.org Without Trust, There Can Be No Healthcare Equity http://generations.asaging.org/without-trust-there-can-be-no-healthcare-equity <span class="field field--name-title field--type-string field--label-hidden">Without Trust, There Can Be No Healthcare Equity</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><a title="View user profile." href="/user/6" class="username">asa_admin</a></span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 02/23/2021 - 00:22</span> <div class="field field--name-field-tags field--type-entity-reference field--label-above"> <div class="field__label">Tags</div> <div class="field__items"> <div class="field__item"><a href="/health-well-being" hreflang="en">Health &amp; Well-being</a></div> <div class="field__item"><a href="/justice-equity" hreflang="en">Justice &amp; Equity</a></div> <div class="field__item"><a href="/ageism-culture" hreflang="en">Ageism &amp; Culture</a></div> </div> </div> <div class="field field--name-field-channel field--type-entity-reference field--label-above"> <div class="field__label">Channel</div> <div class="field__item"><a href="/generations-now" hreflang="en">Generations Now</a></div> </div> <div class="field field--name-field-teaser-text field--type-string-long field--label-above"> <div class="field__label">Teaser Text</div> <div class="field__item">Public health and aging services must regain lost trust, or gain the trust they never had earned. </div> </div> <div class="field field--name-field-paragraphs field--type-entity-reference-revisions field--label-above"> <div class="field__label">Paragraphs</div> <div class="field__items"> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p class="dropcaps">Mistrust of the healthcare system and other public institutions is a critical barrier to equity in health as we age. Today, a legacy of mistrust sown by a history of racial discrimination—through government policies, healthcare institutions and individual providers—is glaringly revealed in the high levels of skepticism in Black Americans concerning the <a href="https://www.kff.org/coronavirus-covid-19/report/kff-covid-19-vaccine-monitor-december-2020/">COVID-19 vaccine</a>.</p> <p>Discussions of mistrust tend to start with the individual or community experiencing the mistrust. Yet that can be the wrong place to start; instead we need to ask why the targets of mistrust—the institutions—are not considered trustworthy, examining today’s lived experience through historical context.</p> <p>Richard J. Baron, president of the American Board of Internal Medicine, recently wrote that amid such stark health disparities threatening vulnerable populations, “<a href="https://aarpsharex-my.sharepoint.com/personal/etan_aarp_org/Documents/Documents/Disparities/Baron RJ, Khullar D. Building Trust to Promote a More Equitable Health Care System. Ann Intern Med. 2021 Feb 2. doi: 10.7326/M20-6984. Epub ahead of print. PMID: 33524292.">nurturing trusting relationships between physicians and patients is an urgent objective</a>.”</p> <p>Understanding the impact of mistrust on health equity—and putting in place interventions to increase the trustworthiness of healthcare and aging services —has become increasingly urgent during the COVID-19 pandemic.</p> <h4>No Trust, No Equity</h4> <p>Indeed, the healthcare systems’ ability to help people make the best decisions for themselves and their families requires a key ingredient: trust. A <a href="https://www.nap.edu/catalog/12875/unequal-treatment-confronting-racial-and-ethnic-disparities-in-health-care">2003 report</a>, <em>Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care</em>, highlighted how disparities in care result from biases and prejudice in the healthcare system and how people who are racial and ethnic minorities experience a range of barriers to accessing care, which include stereotyping. Such realities undermine trustworthiness.</p> <p>Evidence suggests that experiences of being stereotyped by race, gender or age in the healthcare setting—experiences called <em>healthcare stereotype threat</em>—can lead to lower trust, worse health and lower healthcare use. In <a href="https://pubmed.ncbi.nlm.nih.gov/26497263/">a 2016 study</a>, patients ages 50 and older who reported experiencing a <em>healthcare stereotype threat</em> also reported higher levels of physician distrust and dissatisfaction with healthcare (lowering the likelihood of long-term relationships with providers), along with poorer mental and physical health. </p> <p>Mistrust also is associated with lower medical adherence, and patients who reported a <em>healthcare stereotype threat </em>also reported lower flu vaccination rates. Underlining that reality: Recent <a href="https://doi.org/10.26419/res.00432.003">AARP research</a> revealed that most adults ages 50 and older who are hesitant about getting a flu vaccine are also hesitant about getting a COVID-19 vaccine. Instead of starting with the individual or community experiencing the mistrust we should ask why the targets of mistrust—the institutions—are not considered trustworthy.</p> </div> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--quote paragraph--view-mode--default"> <blockquote> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>Instead of starting with the individual or community experiencing the mistrust we should ask why the targets of mistrust—the institutions—are not considered <em>trustworthy</em>.</p> </div> <footer class="blockquote-footer mt-2"> <cite title=""> </cite> </footer> </blockquote> </div> </div> <div class="field__item"> <div class="paragraph paragraph--type--text paragraph--view-mode--default"> <div class="clearfix text-formatted field field--name-field-text field--type-text-long field--label-hidden field__item"><p>To regain trust we also must address racial discrimination in aging services such as the inequitable <a href="https://generations.asaging.org/health-disparities-older-adults-color-covid-19">access to quality home- and community-based services</a> and other policies that have denied older adults of color access to housing. There is additional evidence of inequitable supports and services for <a href="https://generations.asaging.org/unfair-aging-sexual-and-gender-minorities">sexual and gender minorities</a> as they age. Today, as public health and aging services seek to promote health and provide preventive services such as vaccines, they are operating from a deficit. They must regain lost trust, or gain the trust they never had earned.  </p> <h4>A Need to Understand History</h4> <p>Thus, to find solutions to the racial disparities in deaths from COVID-19, we must first look to the causes of mistrust. Deep in the ground of history lie roots that include, for example, the racist and unethical <a href="https://www.npr.org/2021/02/16/967011614/in-tuskegee-painful-history-shadows-efforts-to-vaccinate-african-americans?utm_campaign=storyshare&amp;utm_source=twitter.com&amp;utm_medium=social">U.S. Public Health Study of Untreated Syphilis</a> that took place in the City of Tuskegee. Over time, discriminatory policies and the dehumanizing personal interactions experienced by generations have strengthened and deepened these roots. Recent <a href="https://www.kff.org/coronavirus-covid-19/poll-finding/attitudes-towards-covid-19-vaccination-among-black-women-and-men/?utm_campaign=KFF-2021-polling-surveys&amp;utm_medium=email&amp;_hsmi=111922410&amp;_hsenc=p2ANqtz--8Xwzb7LyxR9k6dC9SDrC2i7txwsFBVi7HpGYmXfwGUZXwAMSiMelh1SIn2nbPK-XhzjS8EPvKjQggH_bhakBs0Q0ORg&amp;utm_content=111922410&amp;utm_source=hs_email">research </a>suggest that messages that  build “trust by addressing historic mistreatment and inequities in the vaccine distribution process may play a part in helping alleviate vaccine hesitancy among Black women and men.”</p> <p>Efforts to illuminate these root causes are emerging. Recognizing the negative impact of racism on health, the <a href="https://www.ama-assn.org/delivering-care/health-equity/ama-racism-threat-public-health">American Medical Association</a>  has encouraged the medical education system to develop programs and curricula that engender “a greater understanding of the causes, influences, and effects of systemic, cultural, institutional and interpersonal racism to prevent and ameliorate the health effects of racism.”</p> <p>Meanwhile, the <a href="https://healthcareanchor.network/2020/09/it-is-undeniable-racism-is-a-public-health-crisis/">Health Anchor Network</a>, a consortium of healthcare systems and institutions, has identified racism as a public health crisis, stating a “commitment to providing anti-racism and unconscious bias training for our administrators, physicians, nurses, and staff.” The <a href="https://www.asaging.org/sites/default/files/2019-10/ASAVision2024.pdf">American Society of Aging</a> also announced a diversity, equity and inclusion vision for 2024, signaling the need for interventions in aging services as well as healthcare.</p> <h4>Real-Life Experiences</h4> <p>A <em>healthcare stereotype threat</em> can manifest from verbal, nonverbal, and environmental communication. It includes such situations as when a person experiences stereotyped expectations in the service setting that conflict with their identity and experience. For example, a person may experience slights, snubs or insults, whether intentional or unintentional, which signal the judgement that certain interventions are not appropriate for the individual due to a racial, gender or age stereotype, with older people of color potentially experiencing multiple stereotypes. Other individuals may feel biases in a care setting have affected their access to services such as testing or vaccinations.</p> <p>The urgency of the current situation notwithstanding, much work lies ahead to effect lasting change. AARP recognizes that there are serious concerns among many people, especially in the Black community, that reflect shameful moments in American history where the medical community violated their trust.</p> <p>That's why AARP has created a <a href="https://www.aarp.org/coronavirus/">website </a>to continue to educate its members and the public about COVID-19 vaccines. Equity in health requires we address the historic and current reasons behind mistrust. If we do not engage in interventions to establish trust, simply providing equal access to services does not help.</p> <p>When people from any background think of our healthcare and aging services, one perception should arise first: <em>trustworthy</em>. Without that starter, disparities will persist.</p> <hr /><p><em>Erwin Tan, MD, is a director at AARP Thought Leadership; Jean C. Accius, PhD, is senior vice president at AARP Global Thought Leadership in Washington, DC.</em></p> </div> </div> </div> </div> </div> <div class="field field--name-field-teaser-media field--type-entity-reference field--label-above"> <div class="field__label">Teaser Media</div> <div class="field__item"><a href="/media/272" hreflang="en">Medical school</a></div> </div> <div class="clearfix text-formatted field field--name-field-byline field--type-text-long field--label-above"> <div class="field__label">Byline</div> <div class="field__item"><p><strong>From Our Sponsors</strong><br /> By Erwin Tan and Jean Accius</p> <p>February 23, 2021</p> </div> </div> Mon, 22 Feb 2021 23:22:48 +0000 asa_admin 278 at http://generations.asaging.org