Improving Older Adults’ Mental and Emotional Well-Being with Home Health Care

Seniors go through a lot of changes that can impact their mental and emotional health. Some of these changes are minor and occur gradually, while others are significant and abrupt.

Below are some of the challenges older adults face that may compromise their psychological well-being.

Challenges That Impact Seniors’ Emotional and Mental Health

Isolation and Loneliness

Different factors can fuel feelings of loneliness and isolation among older adults. These include:

– the death of their spouse, relatives, or close friends
– losing their jobs
– retiring from careers that defined their identity and gave them a sense of purpose and self-worth
– the absence of people they can regularly talk to and confide in
– mobility and transportation challenges that also lead to decreased social activities

Prolonged loneliness can have detrimental effects on seniors’ health. It can weaken their immune system and put them at higher risk of chronic diseases.

Loss of independence

As their health continues to decline, older adults find themselves unable to do things on their own. They may need help cleaning the house, rely on others for transportation, or require assistance when using the toilet or taking a bath. Others may be suffering from chronic illnesses or recovering from injuries that keep them in bed for weeks or months.

All these may leave your elderly loved one feeling helpless and frustrated. They may fear losing their independence and having less control over their lives.

Memory issues

Occasional memory lapses are a normal part of aging. But factors like illnesses, lack of sleep, or depression may worsen older adults’ forgetfulness.

These memory issues can frustrate older adults and even pose threats to their health and safety. They may forget to take medications on time, or accidentally leave stoves and ovens on.

Vulnerability to stress and mental health concerns

Aside from the changes mentioned above, other challenges can increase stress among the elderly.

Their fear of slipping or getting injured can make them more anxious to go to the bathroom alone or leave the house without a companion.

Financial concerns may also weigh them down. They may be worried about not being able to pay for growing medical and living costs or long-term care.

Chronic stress can increase the risk of mental health issues among seniors. According to the World Health Organization, 7 percent of adults over 60 years are suffering from depression and 3.8 percent from anxiety disorders. Data from the Centers for Disease Control and Prevention also revealed that men 85 years or older had the highest suicide rate of any age group.

Chronic illnesses also leave seniors more vulnerable to depression and other mental health concerns. These mental health issues can further impact their physical health and recovery. For instance, seniors suffering from loneliness and depression have higher mortality rates. Depression also affects the success and duration of cardiovascular treatment in older adults. It can even aggravate insomnia and memory loss.

Augmenting Psychosocial Support for the Elderly Through Home Health Care

The benefits home care workers provide go beyond physical assistance. They become additional sources of psychosocial support, helping seniors navigate challenges that come with aging.

Regular emotional support

Having someone to talk to may help older adults manage difficult emotions like loneliness, fear, and frustration. Moreover, having constant emotional support can help reduce their risk of developing mental and physical issues.

Companionship and socialization

The companionship home care workers provide can alleviate chronic loneliness among seniors. They can also help older adults maintain an active social life by:

– driving them to community activities or visits to family and friends
– accompanying them during walks
– helping them use video chat tools to keep in touch with relatives and friends

These activities help seniors stay connected, keeping feelings of isolation and loneliness at bay. Participating in social activities gives them something to look forward to and allows them to create new memories and connections.

Supporting healthy routines

Healthy eating and exercise keep seniors strong and improve their balance. These also keep their memory sharp, boost their mood and help them relax and manage stress.

In-home senior caregivers and home health aides can help older adults stay fit and stick to healthy routines. For example, they can prepare nutritious meals and ensure these meet seniors’ dietary requirements. They assist them during light exercises, accompany them during walks, and inspire them to resume their hobbies.

Physical support to maintain their independence and quality of life

Aging in place allows seniors to retain their sense of independence and control over decisions that affect their lives. Living in a familiar place, surrounded by things that bring them comfort, may also give them a sense of security amidst the changes they are going through.

Home care workers help seniors stay independent while reducing the risks and difficulties that come with aging in place. They help older adults keep their homes clean and safe by handling light housekeeping tasks and removing hazards like electrical cords and rugs. They help them maintain personal hygiene by assisting them with bathing and dressing.

Home health care agencies provide seniors and their loved ones with cost-effective home care options. This flexibility in terms of the type of care and cost can reduce seniors’ financial stress. Clients can decide how often to request these services and what tasks they need help with. Older adults who are recovering from injuries or illnesses can also save on hospitalization costs through in-home skilled nursing care.

Promoting Holistic Health for Seniors

Changes that come with aging can hurt your elderly loved one’s mental and emotional well-being.

This is an area where home care can help. Home care workers become constant sources of social support for seniors, helping them experience healthy aging and a better quality of life.

How New Tech Can Support Caregivers as They Support Seniors

Up to 42% of Americans over the age of 65 take five or more medications, and in 2018, at least one in every five seniors experienced an adverse drug reaction. Such reactions are more common when seniors can’t properly adhere to the instructions that accompany their prescriptions.

In fact, according to U.S. Pharmacist, nonadherence accounts for about half of treatment failures and a quarter of hospitalizations every year. This, combined with the fact that healthcare providers are largely overwhelmed and overburdened, means caregivers have a unique opportunity to improve senior health outcomes. Caregivers can act as an extension of the medical industry to help seniors overcome the hurdles they face when it comes to medicating themselves properly.

Why Medication Adherence Is Challenging for Seniors

Experts agreed that the therapeutic efficacy of any medication requires an adherence rate of 80% or higher. To medicate properly, seniors must closely follow the instructions on each drug’s label and keep a consistent routine around consuming the right doses to avoid complications.

Unfortunately, the current average for medication adherence for chronic health conditions is only about 50%. For most patients, this isn’t enough to improve or stabilize their conditions — much less boost their life expectancy. But nonadherence is often a combination of hurdles that can be difficult for seniors to overcome on their own.

For example, the instructions on drug packaging may be confusing, and age-related memory loss can lessen the chances of proper adherence. The side effects of certain medications may also be uncomfortable, making patients hesitant to stick with them. Overall, keeping track of when and how to take various medications can be overwhelming for anyone.

The Important Role of Caregivers

Daily routines and medical schedules can be much easier for senior patients to adhere to with the assistance of a caregiver. As caregivers, a patient’s family members, friends, loved ones and volunteers can help ensure seniors take their prescriptions as directed and eat regular meals. What’s more, they can better monitor changing behaviors or symptoms that could indicate a poor reaction to medications.

Because the healthcare system is becoming increasingly overburdened, healthcare providers don’t always have the time or means necessary to devote to helping patients adhere to medications. Instead, the healthcare system should focus on providing caregivers with tools they can use to make senior care more manageable, especially when it comes to drug adherence. This will become even more necessary as the senior population grows.

The following tools can help caregivers address the medication adherence problem plaguing American seniors:

  • Automated medication dispensers: Medication dispensers have come a long way — from manually organized pillboxes to modern, automated dispensers that ensure people get the prescriptions they need. One of the most valuable aspects of automated medication dispensers is that they can sync with a mobile application to alert caregivers of missed doses and low prescriptions.
  • Personalized medication reminders: Medical alert systems and healthcare apps — or even simple reminders on a smartphone calendar — are vital to helping seniors prevent missed doses. Some apps are more detailed than others, so consider whether simple reminders will suffice or whether caregivers should receive confirmations as well.
  • Home delivery of presorted medications: In terms of convenience, having presorted medications delivered directly offers a critical advantage for both seniors and caregivers. Automated delivery systems can be synced with medication reminders to create a convenient, holistic routine that makes adherence more accessible than ever.

When Medication Adherence Is Easier

There are very clear, immediate benefits to practicing better medication adherence — the most obvious being the success of the medication. Data suggests that for every 10% improvement in medication adherence, healthcare costs can be reduced by 29%.

Adherence also has a halo effect on other aspects of a patient’s life, improving chances of eating healthy, exercising regularly and taking one’s own personal wellness journey more seriously. Better adherence is key to improving seniors’ quality of life and reducing the burden on the healthcare system, and caregivers are in a great position to help make it happen when armed with the right tools.

Dilemmas and Solutions for Americans Raising Children While Caring for Elderly Family Members

Approximately half of middle-aged people in American provide financial, health, or emotional support for adult parents and minor or adult children. The term “sandwich generation caregiver” emerged in the 1980’s to describe middle-aged people who support minor children while providing physical, emotional, financial, or legal assistance to adults. Of course, doing so much exacts personal costs. Sandwich generation caregivers often experience stress-related illnesses, lost income, and decreased work productivity. They also find it harder to provide prolonged assistance to adult children.

Historically, caregiving could be shared by extended family members who lived in close proximity. Now more people relocate for career opportunities. Younger people may do senior care at a long-distance, or aging parents may move closer to one of their adult children and increase the burden on that family.

Caregivers who are employed full-time and taking care of multiple family members must adjust their work schedule and often take unpaid leave to fulfill obligations. They may lose Social Security and pension benefits or experience stressful financial strains that can cause them to become ill. Very often, sandwich generation caregivers choose to attend to the health of a child or parent and neglect their own health. Poor caregiver health is becoming a public health issue.

Sandwich generation caregivers also face barriers in the workplace and increase the cost of health care for employers. Health care costs for caregivers are approximately $13.4 billion greater than for employees that do not have caregiving responsibilities. Working caregivers may have a hard time juggling the crushing time demands of work and caregiving; and they may pass up promotions, decrease work hours, and take unpaid leave because they have depleted paid vacation and sick days.

Caregiver absences cost the U.S. economy $25.2 billion annually in productivity; and workers often quit jobs, lose lifetime wages, retirement savings, and pension benefits. Less than half of U.S. employers offer flexible schedules or the opportunity to telecommute to accommodate caregiving tasks.

Guilt and Exhaustion

Sandwich generation caregivers at the same time express guilt that they are not doing enough – and say they feel exhausted from doing too much. Guilt and exhaustion about how caregiving affects their children is a perpetual undercurrent of stress that affects their own health. In one of my research interviews, Sophie said “I was a single mom at the time…[my kids] really needed me here and then it would be my night to go shower mom and put her to bed… I’d cry sometimes all the way there and then I’d get there and Mom would be sitting there, facing the wall …and then on the way home you’d cry because…how could I think that I didn’t need to be there.”  And in another interview, Ellie explained that she felt  “…sometimes it’s almost like a ball and chain and then I think, “What am I teaching my kids… I want them to have the freedom to live their life without feeling obligated to take care of me someday. And sometimes I wonder how strong a message I’m sending in that regard.”

Self-Care Helps Caregivers Cope – and Jobs Can Too

Parenting and caregiving are both consuming roles – yet many caregivers understand that they still need to take care of themselves because otherwise the pressure or anxiety can be overwhelming. Self-care takes many different forms for sandwich generation caregivers: leisure, exercise, and socializing.

Abby, for instance, told me that even during the hardest part of her caregiving experience she still did Friday night dinner and cards with her husband and friends, took her Tuesday golf outing and walked her dog daily. Abby realized that carving out time for herself helped her stay healthy and not resent taking care of her dad. Similarly, at the beginning of our interview, Zach, said he “was not the type of person to feel guilty” about taking time for himself. He incorporated his kids into his coping strategies by going for long walks with them.

Not only do most sandwich generation caregivers need the wages and benefits that work provides, they also need a break from caregiving. Work sometimes offers a “guilt-free” break, allowing them to feel productive and serving as either a social outlet or a place for solitude, as two interviewees explained:

  • Chloe stated that caregiving was mentally and physically exhausting.  She admitted that it was hard to not feel guilty about taking time for herself but she had a “wake up call” during a physical when her cholesterol and blood sugar were elevated. She allowed herself to relax and socialize during her quarterly conference for work.
  • Leah believed the hardest part of being a parent, caregiver, and professor was that she was “always surrounded.” Leah said that she didn’t take any time for herself. She felt she had to work to make up for the “hole” she put her family in to earn her degree but then she revealed that being in her office at work was like a “retreat”.  She could play music and work at the computer and just be by herself while she graded papers and worked on her research.

What Employers Can Do

Employee assistance programs, flexible schedules, and telecommuting options can reduce some of the stress sandwich generation caregivers experience. Such employees often miss work due to caregiving tasks and their own poor health as a result of stress. They may not have the time to practice preventative health habits and coping strategies, and some develop cardiac, psychological, and chronic illnesses. Employee assistance programs can reduce such problems, to the benefit of all concerned. Employers can, for starters, create a supportive environment for caregivers and help them to seek and utilize institutional and community resources.

In some cases, flexible schedules and telecommuting may allow caregiver workers to maintain their job productivity and prevent valued employees from having to reduce work hours or quit altogether. Employers and fellow employees should also realize that for some caregiver workers time at the office can also act as a coping strategy because it offers a physical and emotional break. This should not be seen as a problem. When caregivers practice self-care, they are healthier – and can be more productive even as they balance the complex demands of their work and family responsibilities.

The Critical Role of Caregivers, and What they Need from Us

Caring for loved ones who have aged or become disabled is not a new concept. Many of the services provided in hospitals, clinics and even funeral homes were once provided by families at home. Particularly in communities where traditional cultural beliefs are highly valued, taking care of an aging parent or grandparent is still a responsibility that families (usually women) are expected to take upon themselves. Inner discord can arise when caregivers challenge these traditions which can lead to guilt and in some cases lawsuits.

For example, proceedings from a roundtable hosted by the National Hispanic Council on Aging revealed that caregiver stigma is prevalent among Latinos, which can prevent them from seeking support and resources. Without help, the risk for burnout increases.

Results from a 2015 study by the National Alliance for Family Caregiving and AARP revealed that “an estimated 43.5 million adults in the United States have provided unpaid care to an adult or a child in the prior 12 months”. This number is likely to increase in the coming years due, in part, to an aging population.

Family caregivers perform a variety of services, including helping with ADLs, dispensing medications, managing finances, attending doctor appointments and advocating. Many do so while maintaining full-time employment outside of the home.

Respite is Essential, but lacking

The physical cost of caregiving is staggering, and there are few opportunities for respite. Even when respite is available, caregivers must consider the care recipients’ safety, and their desire to leave home. A person who has a disability or is ill can still make decisions regarding their care. So when they say no to respite care, it can’t be forced upon them. Desperate for a break, some caregivers have gone to extreme measures such as dropping off their loved one at the emergency room for respite. This is a problem that should be addressed in the years to come. But how?

Changes in the workplace

More companies and organizations are beginning to understand that caregiving without support can negatively impact worker productivity. In response, some companies have revisited their policies regarding family leave, allowing flexible work schedules and work from home opportunities. As employers seek new talent, they may find that policies such as these are attractive to job seekers. Two major companies, Deloitte and Microsoft, made headlines after incorporating paid time into their family leave policies. Other companies have adopted similar models.

As the nation grapples with how to provide better support to caregivers, it will need to improve major areas like extending paid leave to family caregivers, creating financial stability for those who need to provide full time care, and providing necessary training and respite to ensure the mental and physical well being for both the caregiver and the recipient. These changes require a shift in how we think about providing care, and changes in policy.

Accessible resources

Caregivers are operating on tight schedules and don’t always have time to attend in person support groups. So having the option of connecting with others through online chats and support groups is more convenient for some caregivers. In addition, they could benefit from ongoing training and resources that will help them to more effectively and safely care for their loved one. This past September, the U.S. Senate passed the RAISE Act, which would require the development of a national strategy to address the growing challenges and economic impact of caregiving. The bill must now go before the House of Representatives.

Money

The financial costs of caregiving cannot be ignored, and the average social security beneficiary does not earn enough to shoulder the burden of the financial costs they incur. Most caregivers likely work not only to maintain a sense of identity but also out of necessity.

Caregivers can face stressful decisions when it comes to choosing between work and providing care, particularly when their loved one is seriously or terminally ill. Too often, relatives are not eligible to be a paid for their time. And when they are, the earnings are not enough to make ends meet. Unfortunately, many caregivers often place their loved ones in skilled nursing facilities, simply because they cannot afford to care for them at home.

The question of who should provide care and how they will provide is one that has yet to be answered. While they wait, however, caregivers are facing stress and financial burden with few desirable options for support. And care recipients aren’t getting the care they so desperately need.

Stressed Out Caregivers Are Using ER Visits for Respite, Study Finds

Emergency room staff call it a “pop drop” – when a disabled older person comes in for medical attention, but it seems like the person who takes care of them at home is also seeking a break from the demands of caregiving.

It’s been hard to actually study the phenomenon. A new University of Michigan study suggests that tired family caregivers are associated with greater ER visits and higher overall health care costs for the person they care for.

In a paper in the new issue of the Journal of the American Geriatrics Society, the team reports their findings from a study of 3,101 couples over the age of 65, each with one spouse acting as caregiver for their disabled partner.

The researchers looked at the Medicare payments and emergency department visits for the disabled spouses in the six months after the caregiver spouses took standard tests to measure their fatigue, mood, sleep habits, health and happiness.

Even after they took into account many factors, the researchers found that in just those six months, emergency department visits were 23 percent higher among patients whose caregivers had scored high for fatigue or low on their own health status.

Patients with fatigued or sad caregivers also had higher Medicare costs in that same time period: $1,900 more if the caregiver scored high for fatigue, and $1,300 more if the caregiver scored high for sadness, even after all other factors were taken into account.

The cost of unpaid help

“Many of us who work in clinical settings feel that patients with high home caregiving needs, such as dementia, often rely on the medical system as a source of respite for their spouses or other caregivers, because other respite isn’t paid for,” says lead author Claire Ankuda, M.D., M.P.H. “But there hasn’t been a lot of data about it, and only recently has our society been talking about caregivers and potential ways to incentivize and support them as a way of keeping patients living at home.”

Ankuda, who led the study during her time at in the Robert Wood Johnson Clinical Scholars program at U-M’s Institute for Healthcare Policy and Innovation, is now training in palliative care at the Icahn School of Medicine at Mount Sinai.

“Informal caregivers, including spouses, enable older adults with functional disability to stay out of the nursing home and live at home where they’d prefer to be,” says senior author Deborah Levine, M.D., M.P.H., an assistant professor of internal medicine and neurology at U-M.

We need to do a better job of identifying and supporting caregivers experiencing distress, in order to help caregivers feel better and hopefully improve outcomes in older adults with disability.” Deborah Levine, M.D., M.P.H.

Long-term data gives key insights

The couples in the study were all taking part in the long-term Health and Retirement Study, conducted by the U-M Institute for Social Research on behalf of the National Institutes of Health. Ankuda, Levine and their colleagues probed HRS data because it allowed them to correct for factors that other, short-term studies can’t – such as the baseline level of Medicare costs, demographic differences including income and education, and even whether the couples have adult children living nearby.

The findings add hard new data about the link between caregivers’ own experiences and the amount the Medicare system pays to take care of those the caregivers take care of at home.

Nearly 15 million older adults get help with everyday activities from spouses and other family or friend caregivers. In the new study, the researchers included couples where one spouse got help from the other with activities such as bathing, dressing, walking, getting into or out of bed, shopping, cooking, and taking medications.

Helping with these tasks on a daily basis, without pay or respite, can take a toll on the caregiver’s own health, wellness and mental state – which can lead to burnout. Medicare does not offer payment or formal respite coverage for family or friends who take regular care of older adults – and only covers home care by certified agencies under certain circumstances.

More research & services needed

Ankuda notes that studies on the impact of supporting family caregivers more formally are just beginning to produce results.

Meanwhile, health policy researchers are beginning to suggest that it may make fiscal sense to incentivize home caregiving, to keep seniors from needing more expensive nursing home care.

“I definitely think there are specific services that could help caregivers, if we can identify those people who are highest risk and provide a basic level of support such as an around-the-clock geriatric care call line that could help caregivers feel less isolated and talk to a nurse about whether, for example, to go to the emergency department,” Ankuda says. “This is a high-cost, vulnerable population.”

Formal respite care, peer support groups and other options could also help stave off fatigue and sadness – and the hospital staff who notice “pop drop” practices could help steer caregivers to such options. So could the primary care clinicians who take care of both the disabled spouse and the caregiver.

Because the new study takes into account the level of Medicare spending for the disabled spouse in the six months before their caregiver was interviewed, it may actually underestimate the impact of caregiver fatigue, she notes.

Indeed, before the authors corrected for the full range of factors, they documented that Medicare costs were lower for patients whose spouse-caregivers who reported being happy or rested. They also saw higher costs among patients whose caregivers had higher depression scores on a standard mood questionnaire.

One factor that wasn’t associated with higher costs in the new study was the caregiver’s score on a standard measure of sleep habits. Sleep disruption is harder to quantify in older people, Ankuda notes. But the measurement of fatigue, which can result from both the strain of caregiving and poor sleep, was clearly associated with both higher rates of emergency department visits and higher overall costs.

Low Medicaid Rates Limit Beneficiaries’ Access to Assisted Living Facilities, Quality Care

More than 700,000 elderly and disabled Americans receive health care in residential care communities, such as assisted living facilities. As the population ages, this number will grow.

A new study by RTI International found that low Medicaid payment rates for services in assisted living and similar settings discourage residential care providers from serving Medicaid beneficiaries, which limits their access to community-based residential care.

The study found that some residential care settings limit the number of Medicaid residents they serve or decrease operating expenses in ways that may also reduce quality of care.

“Medicaid payment rates only cover services in residential care settings; they do not cover room and board,” said Michael Lepore, Ph.D., senior health policy and health services researcher at RTI and lead author of the study. “One of the access barriers is the difficulty that Medicaid beneficiaries have paying for room and board in residential care settings because of their low incomes. This situation dissuades residential care providers from serving Medicaid beneficiaries.”

Residential care settings are community-based homes or facilities that offer room, board and care services, the most popular being assisted living. Compared to nursing homes, these settings often are less institutional and are often the preferred setting.

If Medicaid beneficiaries with long-term service and support needs cannot access residential care settings, then nursing homes may be their only option, ultimately costing taxpayers more money because Medicaid payment rates for nursing homes are higher.

The study, published in the Journal of Housing for the Elderly, found barriers that influence Medicaid beneficiaries’ access to state-licensed residential care include Medicaid reimbursement rates for services, the supply of Medicaid-certified residential care settings and beds, and policies that affect room and board costs for Medicaid beneficiaries.

Researchers examined Medicaid policies in all 50 states and the District of Columbia, interviewed subject-matter experts, and conducted four state case studies informed by reviews of state policies and stakeholder interviews.

“States need to ensure their Medicaid rates for residential care services are sufficient to maintain an adequate supply of these settings and beds available to Medicaid beneficiaries, while also safeguarding quality of care and taxpayer resources,” Lepore said. “Higher Medicaid rates may encourage more residential care settings to serve Medicaid beneficiaries, which may help reduce nursing home use by older adults and people with disabilities and potentially reduce Medicaid spending on long-term services and supports.”

Elder Abuse in the Twenty-First Century

baby-boomers

In this “silver tsunami” era, elder populations are outnumbering the younger workforce. This creates significant inequity and more than enough opportunity for people to take advantage. Whether financially, neglectfully, emotionally, physically or sexually, seniors in the United States are at a high risk for exploitation.

Seniors can be abused by underpaid and overworked employees. Nursing shortages, along with an explosion of senior populations, lead to less competent care resulting in bedsores, malnutrition, falls, sepsis or other damages from neglect. In addition, economic woes lead to a rise in physical and financial abuse perpetrated by family members, caretakers and even outsiders. Older people are more susceptible in giving of information without asking questions, which makes financial abuse a low-risk, high-reward crime area. Having adequate representation can be a problem as well.

Social Security and other government assistance is typically managed by a person with power of attorney, but occasionally the government will designate someone to perform economic functions. The potential for abuse necessitates records to be very exact and reported regularly. Social security, wills, estate management, retirement portfolios and such accounts are difficult for most clear thinking people. It has been reported that any older person, much less those with dementia, make bad financial decisions.

Trends

Knowledge of elder abuse is not up with the times, decades behind the experts in the field. It’s difficult to even get a report filed. The myriad of potential problems is worsened due to many inappropriate state laws being slow in prosecuting offenses. Institutional Review Boards don’t commonly deal with such cases and there are not many federal regulations. Meanwhile, seniors don’t always have a great memory for testimony to help their cause in getting charges.

It is going to be hard for the courts to catch up with the times. Currently, elder abuse is acknowledged by WHO as a human rights violation with one in ten seniors falling prey to some crime. That ratio becomes one in two concerning people with dementia. As bad as the current populations trends look now, the future looks worse. 85+ is the fastest growing age group in the United States and the 60+ population is expected to double to over 2 billion people by the year 2050.

What to do?

Local district attorneys need tougher laws that focus on stopping predators and ways to enforce those laws. Whether with state or private agencies, seniors need more representation in housing placements or other living transitions and their monetary affairs.

Elders need younger people to show interest. Nursing home staff is going to be more careful with people they know are being checked on. Other relatives that are taking care of a loved one, should be helped out too. Stopping by or ask about older family members shows that someone is cared for, reducing the abuse risk. Importantly, it also breaks the cycle of care and provides everyday caretakers with the knowledge that they could get a break if needed.

The marks of abuse need to be more commonly known and easy to identify. Upwards of 500,000 seniors are victimized, but very few of these cases are ever identified, much less reported and charged. It helps to have advocates who can sense physical harm, negligence, medical malpractice and other atrocities. Physical and sexual abuse are easier to spot than most neglect, so it takes a concerned loved one to spot personality changes or injuries that are inconsistent with the individual.

Mistreatment is more likely to occur to seniors who have experienced past abuse, in part because those people are frequently left in bad situations and never given much help. Senior women are more victimized than men, as are people in poorer health and those with lower incomes. Many other obvious risk factors and tell tale signs exist to make others aware. We need to be more empathetic and better educated.

The onus is on the concerned relatives to care about what facility seniors are placed in. For-profit corporate chain nursing homes often have less than ideal conditions for staff or residents. Relatives should take the time to tour various homes, make observations, and find the right fit. The most important way to combat elder abuse is by being involved. We just can’t put elders into homes and forget about them. It’s not supposed to be a prison for people we can’t help anymore. Nursing homes are expensive places that should be treating residents like royalty. It takes our effort to keep things as they should be.

To facilitate better treatment, we need to listen to both seniors and caregivers. We need to be attuned to what seniors needs and worries are. We need to speak up and file charges when something has happened. One in ten reported cannot be acceptable. If a caregiver is stressed or burned out, we need to make sure they can get the breaks they deserve to provide the best care, just as we must make sure caregivers are getting paid adequately for the grueling work they put in.

As with raising a child, it takes a village to care for our elders. We need to impress upon society in general that it is everyone’s responsibility and how this needs to happen. We are all going to be in this position someday, we should be doing everything we would want others to do for us as we become more helpless.  

Are We Forgetting About The Sandwich Generation?

By Ed Kashi and Julie Winokaur
By Ed Kashi and Julie Winokaur

When working with elderly patients in health care facilities, it is likely that we may forget about the needs of their adult children aka The Sandwich Generation. The sandwich generation is adult children typically between the ages of 30-50 who are caring for their aging parents while taking care of their own family as well.

Taking care of young children while caring for aging parents puts a great deal of stress on the adult children. In my experience working with families in hospice, I’ve noticed some factors that contribute to the stresses of this generation:

  1. Financial Concerns – Older Americans are living off their fixed income such as Social Security, VA pension, and personal savings which may not be enough to pay for certain expenses. Many retirees can not afford to live in assisted living facilities, or private home attendants, and monthly expenses in their current homes. The children often struggle as they have to figure out how to pay for these expenses if their income is limited as well. This issue is very common for funeral expenses since many retirees don’t have life insurance.
  2. Feuding Relatives – Adult children may have a long history of sibling rivalry which can leave an impact on the care of their elderly parents. One child may agree to hospice care while the other beliefs in aggressive treatment. The rivalry can easily be carried into a facility where we, the social workers usually witness the drama.
  3. Lack of Awareness – You will be surprised how many adult children are not aware of health care proxy, advance directives, or how life insurance works. Some assume that their parents’ insurance will cover everything. Many times I had to inform the children that Medicare does not cover long term costs which brings back to #1 on this list.
  4. Bad Timing– Sometimes adult children may wait till the last minute to make handle their parents’ affairs. Reasons for this occurrence may be that they learn about the resources too late, procrastination, denial, or lax in their own time management. I had adult children asking me how they can get a power of attorney for their parents, and the patient is unresponsive, and near death.
  5. Mom and Dad Are Not The Same –  We know our parents from the time we were born. We are not use to seeing our parents getting older and sicker. Many adult children may not be prepared to watch their parents deal with a debilitating condition such as Alzheimer’s Disease. On the other hand, adult children may have their own personal issues about their parents that was unresolved. These changes can bring emotional distress to the children.

When working in hospitals, assisted living facilities, home care agencies, or adult day programs it’s very common to see these issues surface with this generation. However, social workers who work in private practice or other settings might encounter someone who experiences this as well. Unfortunately, we are unable to prevent adults from getting older and prevent the sandwich generation to face this situation.  We can, however, take some steps to reduce the burden and educate this generation at our place of employment. Here are a few things to consider:

  1. Assess All Legal Health Forms –  Many hospital staff is required to ask patients and families about advance directives, and health care proxy. Families should be educated on the advantages of having these forms in place. This can make health care decisions easier for the adult child.
  2. Discuss Available Services –  Be aware of the services in your community which will allow you to share them with your clients. Services include, Medicaid, home care services, senior subsidized housing, and elder law attorneys are some examples of resources for the elderly. It’s very important to be aware of the referral process of these services. For example, filing for food stamps in NYC is entirely different than filing it on Long Island. If we are knowledgeable about the services than the family is well informed of their options.
  3. Review their coping techniques – Caregiving is physically and emotionally stressful. It’s very important that we assess how adult children are coping. Do they have a counselor to who they can speak to? Do they receive support through their place of worship? Are they attending caregiving support groups? What are their personal issues about their parents that they are struggling with? These questions are some of the examples we can ask when assessing their situation.

How social workers intervene depends on the needs of the adult children. In one situation, the child may have all the concrete needs in place but still requires emotional support. On the other hand, there will be another case where the social worker may have to review health care proxy, discuss Medicaid service, and mediate the feuding siblings.

At the end of the day, you could never give too much emotional support to the sandwich generation.

Are We Afraid of Developing Technology for the Elderly

I work for a hospice program providing palliative care which means we attend to the emotional and spiritual needs of terminally ill patients at an inpatient facility or at the patient’s home, and I see lots of people near the end of their life. Some of them are too lethargic to use an iPad, but many are not.

birdbeard-300x300Though all of my clients are dying, they are otherwise able to function normally for a person their age. Those who are not lethargic or in their last days often tell me how bored they are!

They speak about their inability to find anything that entertains them. So, I did a little research on the subject thinking “Well maybe a computer for older folks might help.” Turns out there are some, the options are not great, and I have yet to see one in an assisted living facility.

So why has Apple not attempted to make iPad adaptable to Seniors’ needs?

Personally, I want to be able to browse the internet when I am seventy, and I want to be able to keep up with the news when I have arthritis and can’t swipe properly. Below are some reasons why we don’t have it and why we are going to need it.

Generational Gap

The affordable personal computer came out in the 80’s which means those who grew up with computers are now just entering their early to mid 40’s. To everyone else, computers were new and confusing.  However, this doesn’t excuse the lack of technology for those who are older, but it does help to explain the lack of attention to this market.

Infantilization

In-fant-til-ize-a-tion: To treat or condescend as if still a young child

Would you let a baby play with your expensive iPhone? If the answer is yes, you have more money than I do. Most people are afraid their child will break their expensive toy. They are not wrong either most children will. We assume the same of older adults, that they will either break it out of frustration or will not be able to comprehend its use. Neither is true. There are many older adults who know how and enjoy using computers to entertain themselves

Denial

Likely the worst offender, we refuse to make these adaptations to technology because doing so would be admitting our own mortality. It would require acknowledgment that we will grow old and may eventually need these devices ourselves. Once we can admit we are growing older as a society more and more of these devices will be present.

That’s it for now, but I can’t wait for the Angry Bird’s senior edition to come out. In the comments below tell me about what you want on your computer when you are older!

CleverCare Watch Brings Peace of Mind

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A few weeks ago at the Home and Community Health Association conference, I met some of the team behind CleverCare, a new service that connects an Android smart watch to a web interface and a 24-hour call centre.

CleverCare is the brain-child of Maria Johnston. As the website explains, “developing the Clevercare system was driven from a personal need for Maria to make a positive difference in the everyday life or her parents. She then found that her family’s problems were experienced by many and now, through Clevercare making lives better with independence and peace of mind can be achieved for many.”

clevercareMedicalAlarmUPDATEDFEB2015-e1429159091562Designed for people with dementia, the Android watch runs a simple app and contains a GPS geolocator. The device is tracked via Google Maps in an online dashboard. Boundaries can be set to alert family, friends or support workers if someone wanders beyond a safe distance. Reminders can be pushed to the watch via the dashboard.

The watch will also alert a call center at the push of a button. The watch can receive phone calls from the call centre (in fact any phone), to establish the person’s need. If unanswered the call centre will contact a nominated person or send an ambulance to the GPS location.

As a user of a Bupa alarm, which is wired to your home, the CleverCare watch’s potential to be a safety net to a wider range of people was instantly obvious to me. I was soon talking to Maria and Shane, CleverCare’s sales rep, about the possibilities for younger people with unique function living independently, but anyone who may be vulnerable to risk and need assistance could utilize the device.

I notice that since the conference, CleverCare has widened its target audience to include children, people working alone, cyclists and more. At the end of the conference Maria and Shane offered me a watch to use. Already I am noticing the peace of mind my Bupa alarm gives me at home but, of course, with the watch, I have it wherever I am.

The dashboard is currently oriented to be ‘driven’ by the support/contact person, not the watch wearer, because of the focus on dementia support. A reorientation could put the watch wearer in the driving seat and, if more contact people were able to be added, a chain of contact, similar to my Bupa alarm, would make this technology truly revolutionary in terms of providing people a sense of safety and confidence.

The watch CleverCare uses at the moment is not the most attractive accessory but, again, it is designed for simplicity of use by older people and those with unique cognitive function. I’m not sure what I’ll do when I get my Apple Watch!

Which brings me to what I see could be the ultimate opportunity – the development of a standalone CleverCare app. Whether on a smart watch, phone, tablet or even desktop device, an app could bring this safety technology to anyone, anywhere.

If you see the benefit of CleverCare for yourself or someone else, do contact them directly or let me know so I can pass the interest on to Maria and her team. There is a cost but I understand it can be funded by the likes of ACC or Individualised Funding. And of course, the bigger CleverCare’s market, I’m sure the more cost effective it can become.

https://www.youtube.com/watch?v=PwQcPc580bQ

Adult Services and Mobile Technology: There’s an App for That

Adult Services: There's an App for That
Adult Services Social Worker Kristen Hamilton helps a client sign a form using a mobile app

In today’s technology-enabled world, adult services social workers are looking for better ways to help them with their work, but they may be worried about how their clients will react.

In honor of World Elder Abuse Awareness Day on June 15, a day to bring together senior citizens, their caregivers, and governments to combat the problem of elder abuse, we want to show how implementing mobile technology can actually help adult services social workers improve the quality of interaction with their clients.

Workers at agencies that use a mobile app designed for adult services are able to update client and case information, complete new forms, and have the clients sign forms electronically on a tablet during visits.

Initially, social workers were worried their clients would be resistant to a change in how services were being provided. But with today’s technology where simply buying a gallon of milk means signing on an electronic signature pad, there have been no issues from clients, and amazing productivity gains and stress relief for social workers.

“I was a little iffy about how my elderly clients would handle the tablets… using technology, but they took to it great,” said Kristen Hamilton, Adult Services Social Worker for Beaufort County Department of Social Services.

The main benefits social workers experience are:

1. Improved Trust

With social workers having the ability to record and transcribe interviews or type case notes with their tablet, they have found they can be more engaged during the interview, building trust with those who are most in need.

2. Faster Community Referrals

Social workers are also able to coordinate faster care, as known client and case information auto populates within all forms and both the client and the worker can sign the forms using the tablet. The worker can then send any medical and mental health forms to a referred community services provider, directly connecting their client to the help they require.

3. Complete Case History

The instantaneous access to all of their client’s documents, including all of the client’s past medical history, saves the worker time and the client benefits by knowing all their records are secure in one place.

To learn more about implementing technology in adult services agencies, we hope you’ll join us for our upcoming Webinar, “Adult Services: There’s an App for That,” on Tuesday, June 30 at 12pm Eastern.

Are Social Workers Disempowering and Contributing to Widening the Power Differential

The last place one would expect to find ageism well and flourishing is in the helping professions, particularly among those who devote their careers to working with, helping, and advocating for older adults. Yet, we often see ageist attitudes prevail in these areas.  Not unnoticed are the unintentional ageist practices in our own field of social work.  A director of casework at a large senior service agency told me, “There are social workers who come into the field wanting to ‘help’ without realizing that their attitude could be disempowering and contributing to widening the power differential.”  These social workers are over-accommodating for what they perceive as a lack or weakness among their elderly clients.

social worker and clientAs social workers, it’s easier to think of diversity in terms of race, ethnicity, religion, gender and nationality. However, do we experience the older people we work with as “the other”? We need to understand that these people who have lived their experiences through to almost a complete life are some of the most complex and interesting people we will ever encounter. We may think we understand the experience of this “other”, but that is impossible.  The only way we can begin to understand older adults is to listen.

Listening is a primary skill when interacting with most people and is particularly salient when interacting with older adults.  There is much we can learn if we allow them to share their stories with us, but in order for that to take place, social workers and others working in the field of geriatrics need to remember these people have the same desire for autonomy and deserves respect as the rest of us. Each time we over-accommodate for a perceived weakness in an elderly client, we disempower that client a little bit more.

One of the most prevalent ageist practices that takes place in senior environments is  “elderspeak” or talking to older adults in the same way one speaks to a child.  This type of speech infantilizes the seniors with whom we interact.  Sweet baby talk does not pass muster with older adults, especially the oldest among us.  When a social worker talks condescendingly or uses “baby talk” to address an elderly person, we are guilty of making that elder feel like she is less than we are.  I once heard an aide greet my 92 year old dad with the words, “Don’t you look like a handsome young man today.”  This was executed with the same sing-song voice we would use when talking to a young child. As she walked away, my dad turned to me and said, “I don’t like that person.”

My dad resides in a senior care community where I visit quite often.  He has problems with his shot term memory, gets confused,  and cannot physically take care of himself.  Yet, he does not think of himself as less than any of the people around him.  He loves to tell stories and share experiences.  I know he will never do this with the person who reacts towards him as if he were a child.  Now, think of someone not as strong as my dad…someone frail and anxious.  This person is much more likely to internalize the baby talk and begin acting like the baby she is being told she is.

When we infantilize older adults, we are disempowering them.  We are compromising their autonomy. Another form of over-accommodating is over-helping. A friend of mine who is 79 years old experienced two strokes in her seventies.  Although she was left with some speech and mobility issues, she worked very hard to overcome these challenges.  Today she has returned to her career as a college professor and researcher and lives an dependent life.  Recently she told me about her trip to visit her daughter for Thanksgiving.

As it was, one of the guests at Thanksgiving dinner was a nurse who insisted on following my friend around throughout the day, prepared to catch her should she stumble or fall.  Knowing that the nurse’s intentions were well-meaning and not wanting to cause a scene, my friend accepted her “help” graciously.  However, she told me, “I was seething inside and desperately wanted to tell her to leave me alone!” She added,  “If I needed her help, I was perfectly capable of asking for it”. The same question arises.  Had my friend not been the strongly confident woman she is, she could have easily internalized the message of helplessness that was being covertly sent by this person who insisted on following her around.

We all know how it feels to take pride and a sense of accomplishment when we overcome obstacles in our lives.  Why would one think that need disappears when we age?  The situation above could have easily been handled by simply asking my friend if she required any assistance.  And, if the answer was “no thank you”, to accept it as the authentic answer to a heartfelt question.

These are powerful lessons for all of us when interacting with the older adults who we work with, as well as with the older adults in our lives.

A Gentle Approach to Dementia for Care Providers

dementia-patient

When I first became a hospice social worker, I was stunned to realize more than half of my patients were diagnosed with advanced dementia. I had been under the assumption that I would be working with mostly people with cancer or other chronic illnesses such as Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF). While many of my patients have suffered from those maladies in the latter category, the prevalence of dementia is rather high. After seven years as a social worker “in the trenches,” I would have to learn a whole new skill set if I was to survive and thrive in hospice.

Most of these patients eventually end up in nursing facilities as the burden of their care becomes too great for family members to keep them at home. In visiting such facilities, I have came to find that many more people than just those in hospice were in various stages of dementia. It is a fascinating phenomenon with several different causes, but I have developed my own way of working with these individuals based on their current level of capability to engage interpersonally. As a result, I have identify several areas of concern regarding the treatment elderly patients receive from care providers and other medical professionals.

Aside from the ways dementia affects different people on a physical level which can include the ability to ambulate, muscle contraction, etc., the mental symptoms can range from extreme forgetfulness to devastating interpersonal impairment. Some of the most pleasant conversations of my day are sincerely answering the same three questions over and over again for an hour with the same patients, but they have little to no short term memory.

I have also spent a lot of time in constant redirection and assurance with people that can no longer recognize relatives with whom they have spent the last eighty years. I have seen these individuals coddling realistic looking baby dolls as part of their care and have played music for people that are nearly catatonic, only to watch their bodies come alive with movement at the faint and automatic memory of their favorite songs, something that blessedly seems to remain long after their ability to speak has faded. I have heard ninety year old patients insist that their mother had just been to visit them or that their young children were running around the facility.

The common thread with which I approach these wounded patients is a measured gentleness that preserves their dignity and, to the greatest possible degree, facilitates their comfort in the immediate moment. For most of these people the present moment is all they have. Thus my preferred method is to redirect them in conversation and to by no means challenge their obviously factually incorrect assertions with harsh reality.

If an elderly woman whose mother has obviously passed insists that she must know when (her mother) will be visiting, I will respond that she’ll probably be around later. I have witnessed facility nurses and aides confronting such patients with the fact that their mother will not be visiting because “she’s dead,” repeating this every time the person asks. I will just as gently take such workers aside and explain that they are effectively breaking the news of the death of a patient’s loved one several times a day, each instance with its own accompanying trauma.

Another of my concerns is when I see people with dementia being treated like children because “they don’t know any better.” Almost every culture in the East has, currently or at some time in their history, had a practice of revering their elders simply for the fact they have lived longer and accrued more life experience than most.

Watching people with little wisdom earned through the kind of adversity their patients have faced treat said individuals as mere nuisances to be quieted makes me sad to say the least. I labor under the belief that my patients are people, whether they be completely lucid and able to participate in conversation or if they are unresponsive. As such, I also believe that each of these persons have the right to my full presence and attention and that, while their minds may have been rendered functionally impaired, their spirits are perfectly intact and engaging with mine. In short, I am no better than these people just because my mind is still functional.

Lastly, watching the pain endured by the family members of such patients is nearly unbearable. They faithfully and dutifully make their regular visits in the vain hope that they will see even the briefest signs of recognition in the eyes of their loved ones, only to inevitably leave disappointed and heartbroken. They deserve to know that their family members are being treated with the highest level of respect and dignity and with a kindliness and gentleness reserved for the most vulnerable amongst us.

Please keep these concerns in mind the next time you encounter a person with dementia. They are locked in a special kind of hell that I hope you and I will never have to experience.

Elder Abuse: Don’t Let It Be Your Grandma!

By Denise Bartley, Andre Juste, Rachel Meadows, and Guiseline Momplaisir

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According to a study by the National Center on elder abuse, 63.7% of the reported abuse cases were elderly women? Statistics suggest that the majority of elderly Americans, our grandmothers and grandfathers, are being abused and neglected. For those of you who don’t know, elderly abuse refers to any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult.

The problem is that we fail to recognize just how vulnerable the elderly are. The elderly are often seen as a wise and loving population who aim to educated and guide the young. But the sad truth is that elderly people are very likely to suffer from various illnesses and disabilities such as dementia. 14 million adults over 65 year in the U.S have some form of disability. Approximately 5.1 million adults over 65 in the U.S have some form of dementia and almost half of the adults over 85 have Alzheimer’s disease—or a disease closely related to.

Now, when you throw in the fact that the elderly are highly reluctant to report abuse because they fear worsening their situation it is clear that they are indeed vulnerable. They shouldn’t have to deal with abuse or neglect, and it is time for a change. Even though this population is reluctant to report their abuse, Adult Protective Services (APS) have shown that there is an increasing trend in the reporting of elderly abuse.

Research estimates that only 1 in 14 elderly abuse cases are actually being reported.  According to the New York State Elder Abuse Prevalence Study, it estimated for every 1 case of elderly abuse reported 24 cases go unreported. A sample study of adult women with disabilities showed that 67% experienced physical abuse and 53% experienced sexual abuse. In another study 55% of adult men experienced physical abuse after becoming disabled, 12% of which said it was from a personal assistance service provider. It is estimated that roughly 90% of the abusers in elderly cases were family members, the remainder of which being mostly service providers.  These statistics are a disgusting truth and can no longer go unheard.

For those of you, who may not empathize with the elderly after reading this, imagine if it was you. The U.S Census recorded the highest ever recorded population of individuals over the age of 65 in 2010 which is 13% of the U.S population or 40.3 million people. The currently fastest growing portion of the U.S population is the 85 and up elderly. By 2050, there will be an estimated 19 million people 85 years or older in the U.S making up 20% of the population.  If the national elderly abuse crisis is not rectified soon then based on the preceding statistics, it likely will be you.

There are various resources for the elderly across the country. Eldercare Locator is provided by the Department of Health and Human Services and helps connect older adults and their families with local service providers for the elderly. Eldercare Locator can be contacted at 1-800-667-1116 (Monday- Friday 9 a.m. – 8 p.m. Eastern Time) or at eldercare.gov (24/7). Because the majority of elderly abuse cases go unreported, ending abuse must start with reporting the abuse. If there is an immediate danger or threat of danger to your health, safety, or well-being call 911! Also, you can contact your local social services agency with their Adult Protective Services division to report suspected elder abuse in homes and care facilities.

In addition, we can stop the abuse by being there for our aging population. If they say someone is abusing them— listen and do something about it! Take action! We are all in the same boat, we are all aging, and we all know someone who is aging. By taking action we are not only protecting our grandparents, and we are not only protecting our future selves, we are protecting everyone!

We are students passionate about empowering people, and we’ve started this campaign to give a voice to those who don’t have one #‎outofyourshadow.

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Older People Living Alone With Dementia

Dementia-Signs-and-Symptoms-Include-Alzheimers

We are having a conversation, social worker to social worker, about the older constituents and clients who we each try to help. She works in a small senior center, and I work in the district office of a New York State Senator. I believe it is those of us on the front line of senior issues in our city who see first-hand the breadth and depth of the ever-growing population of older adults who are left to their own resources to navigate the complexities of life in this large urban city. So many are suffering from some form of mental illness, most often dementia. They are only one step away from winding up in a shelter system where they do not belong. To most people, they are invisible.

Sounding frustrated, she says,”They just keep coming”. I reply, “And they are all mentally ill or in some phase of dementia, right?” “Absolutely, she replies, “either that or they are broke…or, more likely, both.”

And yet, over the past several years, with a very heavy heart, I have had to refer elderly people to our city’s shelter system.This comes only after exhausting my own resources to find them even just a bed for the night. Programs that once offered temporary emergency shelter are full. One program director told me, “Clients used to come in and stay for a few weeks or a few months until they could find permanent accommodations. Now they seem to stay forever, and we very rarely have even a single bed available.”

Add to this the fact that these are people who have no social support network. They have no children or are estranged from their children, their friends have all died; and in some cases they have physical and/or mental limitations, that keep them isolated. These constituents are not anomalies, they are part of a cohort of seniors and elderly community members who come into or call our office every day. One day a young staffer said to me, “Wow, all seniors are mentally ill”. My answer was “No, not all seniors are mentally ill, only the ones that come to see us.”

The older adult that seeks our assistance comes with a legitimate presenting problem; i.e. my landlord is harassing me, someone is coming into my apartment when I’m not home, I’m not getting my food stamps or SSI credits. It is only when I sit down to talk with the constituent, whether in person or by phone, that I very soon realize that the presenting issue is just one piece of a much larger problem. When I make the decision that the constituent’s issues are not appropriate for a legislative office, I then refer the constituent to a senior service agency. It is my hope that the agency will be able to assign her to a case worker who can holistically see the entire picture and assist her in getting the help she needs.

While we need the many extraordinary social workers who are dedicated to helping these constituents with direct service, I can’t help wondering why we are having such an influx of older adults with mental health issues. It is only when we can answer that question that an effective solution can be found…or perhaps legislation can be written…to ameliorate the situation. As a macro social worker, this is my job.

HUD Awarded $7.5 Million to Assist Disabled & Elderly Americans Live Independently

Wheelchair in Front of Adapted Home 1In late September, HUD’s Secretary Julián Castro made the announcement that nearly $8 million in grant funding will be used to assist thousands of people with disabilities and senior citizens receive healthcare, meals, and other daily living activities and services in the comforts of their own homes, arranged by service coordinators.  Living independently as a disabled person or senior citizen, if possible, is important to one’s psyche, sense of well-being, and being afforded the opportunity to be fully comfortable in your own living quarters.  Becoming aware of the $7.5 million grants HUD awarded through its Multifamily Housing Service Coordinator Program (MHSC), I knew that I had to share this positive move towards increasing independence opportunities with the SWH readers.

Secretary Castro made the following statement about how the use of service coordinators will be vital to these particular populations:

Service coordinators connect senior citizens and those living with disabilities with the services they need to live independently … These grants will go a long way toward ensuring these vulnerable populations are well served and allowed to age in place.

The 39 grants awarded will be bestowed upon 39 owners of private housing developments that receive rental subsidies from the Department to house those who are low-income in 21 states.  The grant awardees are subject to hire or contract service coordinators who will be responsible for providing social services and assistance to residents who are disabled and elderly.  The grant money will cover costs related to salary, benefits, quality assurance, training, office space, equipment, and other related administrative expenses needed to retain and support these coordinators working for the grant awardees to provide these resources to residents.

Why is this grant award announcement so important?  Having the ability to stay in one’s home while conquering severe medical conditions has been proven to be beneficial to one’s overall health and improvement.  There is truly no place like home, and when you have chronic illnesses or disabilities, being in familiar surroundings eliminates the issue of having to recover in cold, foreign, unfriendly, sterile environments such as nursing homes and hospitals.  Being comfortable, location wise, is a priority for those with disabilities and our seniors, just as pain management and effective medical treatments are.  Being a helping professional, I have seen clients’ health and will to fight deteriorate when they were removed from their homes, and I have witnessed the complete opposite – clients’ health stabilized or deteriorated at a slower rate because they had the opportunity to remain at home.  Of course, remaining at home may not be the opportune choice in certain circumstances, but if it is favorable, it should be heavily considered as a possible option versus being institutionalized or hospitalized.

Another key point to note is that it is more cost-effective and cost-efficient for someone to remain in their home instead of being placed in an institutional setting; the latter would cost thousands of dollars each year just to house one resident.  The need for more federally-supported programs to assist in allowing individuals to live independently will undeniably reduce the financial strain on our healthcare system when it comes to this aspect.

Seeing that the well-being and quality of life of disabled and elderly Americans is on the consciousness of federal entities like HUD is imperative to ensure that everyone has a fair chance of living independently to the best of their abilities in our communities.

(Featured headline image:  Courtesy of The Little House Company.)

Spotlighting the Launch of the DOJ’s Elder Justice Website

Recently, the United States Department of Justice announced the launch of the Elder Justice website which was created to help further combat elder abuse and financial exploitation of seniors. Being the caregiver of a member of the Silent Generation and being a helping professional, I understand how dire it is to protect the older members in our society, and to report any forms of abuse or neglect they may endure.

Elderly Black Woman 1With a plethora of resources out there, it can be overwhelming to figure out what information is appropriate and current to utilize and pass along to those who need it. The U.S. Justice Department has taken steps to provide an online informational “hub” for older Americans, their families, law enforcement, helping professionals, and other stakeholders who have a vested interest in ensuring that older Americans’ rights and humanness are respected.

The Focus Behind Elder Justice:

The need for such a new resource is imperative, especially since one in ten Americans over the age of 60 suffer from abuse and neglect in this country.  Elder Justice’s aim is to be another proactive measure to assist in preventing elder abuse and financial exploitation.

Elder abuse can consist of an older individual experiencing physical, emotional/mental, financial, and/or sexual abuse; and neglect in one’s well-being and care, which can include health care.  The devastating effects of elder abuse is not just felt by the individual targeted, but by those within the community as well.  Elder abuse dwindles the resources set aside for elderly individuals, families, businesses, and public programs (including Medicare and Medicaid) by billions of dollars each year.  This depletion causes tremendous strains on our healthcare, financial, and judicial systems to transpire.

Protecting the elderly has continued to be a priority of the Justice Department, which were evident by the remarks Associate Attorney General Tony West made at the outreach event of the website launch in mid-September:

The launch of the Elder Justice website today marks another milestone in reaching our shared goal of keeping older Americans safe from abuse and neglect  …  The more we embrace our elders with respect and care, the stronger our society will be.  This tool helps move us closer to that goal.

Various forms of abuse and neglect are not the only issues concerning our seniors the Elder Justice website tackles.  Financial exploitation by consumer scams and healthcare fraud are forms of deception this population experiences.  Seniors are estimated to lose almost 3 billion dollars each year from these kinds of exploitation.  The consequences can greatly diminish older adults’ quality of life by creating a loss of independence and self-sufficiency, and increasing the infliction of health and psychological distress.  The Justice Department has taken several steps to focus on these matters, such as prosecuting those who purposefully targeted seniors with scams involving reverse mortgages and lotteries.  In regards to healthcare fraud, the implementation of enforcement, prevention, and consumer protection initiatives has aided to curb financial exploits of our seniors.

What to Expect When You Visit the Elder Justice Website:

Assistant Attorney General Stuart F. Delery made the following statement about what the public and professionals can find on the Elder Justice website:

The website provides resources and a means for improved communication among prosecutors, supports victims and families, and establishes a mechanism for collaboration for researchers and practitioners … While there are many other victim support websites available, we believed that the department could add significant value in this domain by consolidating information nationwide and making it more user-friendly.  The Civil Division will continue to strengthen its efforts to protect the elderly.

The website is easy to navigate, and seems to be very accessible for users of different technological abilities.  There are several tabs on the left column of the homepage that directs visitors to resources and information that may pertain to their unique situation or interests, such as “support for victims and families,” “practitioner resources,” “financial exploitation,” and “researcher resources.”  Each resource link provides several subcategories of information for that particular topic.

The “support for victims and families” resource link has the best information available on the website, in my opinion, because you can search for organizations in your particular state.  When I viewed the resources for South Carolina page, I was amazed at the simplistic layout the information listed was arranged in – the information was housed in an easy to read table format with the title headings “organization’s name,” “address,” and “contact numbers.”  Every organization listed was categorized under its appropriate mission focus, so that users would understand the kind of assistance to expect if they were to contact that organization.

You can also search for organizations by keyword, distance, zip code, or categories.  The various ways of finding organizations in your particular state/area is a great feature because it widens the possibility of connecting with agencies that could be a lifeline for you, your family, or your clients.  I critically viewed the functionality of the website through two lenses:  As a self-proclaimed semi-techie, I judge resource websites like this harshly because it should not be complicated or frustrating to search and locate information that could help and possibly save lives.

The website is accessible and can be effectively used by a layman or a professional equally with very little difficulty, which is how most websites should be.  As a helping professional, the Elder Justice website will make it easier for social workers and other professionals to be more aware of what resources they can direct clients and families to who are in need.  To me, the website is a great page to bookmark for future use, and to share with those who could benefit from the data compiled.

Final Thoughts About Elder Justice:

I was pleasantly surprised at the launch of a valuable resources such as this on the federal level.  As our elderly population grows with the Baby Boomers gracefully entering their golden years, the development of this website is indeed timely.  Though this website focuses on the elderly, it can be used for all populations that are vulnerable to abuse, neglect, and exploitation, including those with disabilities.

As one ages, the likelihood of acquiring a disability increases exponentially, so many of the adults who make up our senior population are living with disabilities or will be.  Their quality of life and well-being matters, just as that of a younger person.  Our seniors need us to protect and support them as they adjust to aging, and possibly living with chronic health conditions.  Resources like Elder Justice makes it easier to inform, empower, protect, and advocate for them, and to encourage them to empower and advocate for themselves.

(Featured headlining image:  Courtesy of Healthy Black Woman.)

Aging-in-Place: It Can Be Detrimental to Your Health

Surveys show that most people when asked prefer to spend the last years of their lives in their homes rather than in a community or institutional setting. What they fail to consider…or don’t want to consider…is the prospect of being homebound and spending their last years alone with only an aide for companionship. As human beings, we are social animals who are meant to interact. Living in isolation, for most of us, is detrimental to our health and has been shown to be one of the leading health risk factors contributing to the downturn in the health of older adults.

home healthUnderstanding that most state governments no longer want to be in the nursing home business and that it is their assumption that it is less costly for both the government and the elderly to remain at home, I can see why the aging-in-place movement has gathered so much steam in recent years. Prevailing ageism also factors in when those who need assistance with activities of daily living choose to protect themselves from the ageist attitudes that pervade the public discourse on “old people.” It feels safer to stay at home.

There is another secret that the aging industrial complex does not like to talk about…the cost.

If ,I will come back to the “if” later on,an elderly person can get the optimum care and needs help 12-24 hours a day, adding this to the overhead of keeping a home, the cost can be astronomical. Because of longevity, the soaring costs of medical care and personal assistance, and the lack of a good long-term care program in this country, many seniors today run out of financial resources before the end of life. In my role as a political social worker, I know that Medicaid was not originally set up to be a long-term care provider; and I am also concerned about the financial strain this puts on government. There has to be a better way, and boomers all over our country are searching for better alternatives for living out their lives.

Why do I feel so strongly that aging-in-place is not the panacea that our government, our media, and the many senior service providers around the country are promoting?

My story starts with Hurricane Sandy. At the time that Sandy struck the east coast of New York, my elderly parents were aging-in-place in their co-op apartment in Long Beach on Long Island’s south shore. My dad, who has multiple chronic conditions that keep him wheelchair bound and unable to take care of his own personal needs, had an aide. His financial resources had already been depleted by the cost of his care for the two previous years, and he was receiving Medicaid benefits for home care. Although he really needed 24/7 care, the most that Medicaid would approve was 12 hour live-in. (This is where that “if” comes in).

Twelve hour live-in means that the aide lived in with my parents but only provided care for 12 hours a day. It seems that my 90 year old mom was determined to be able to care for him the other 12 hours. Well, let me tell you, a 90 year old cannot care for another 90 year old without compromising their own health and well-being. As a result, my parents became emergency room regulars at Long Beach hospital, just a few blocks from their home. In turn my sister and I were also emergency room regulars. A couple of months before Sandy hit we began to have a discussion about aging-in-place and that it might no longer a viable option for our family. And then came Sandy.

When people ask me about aging-in-place, I tell them, “It works until it doesn’t.”

After evacuating my parents with aide in tow and all the attendant chaos around relocating them, we came to the realization that they could not return to their home. All of the services they used were compromised or non-existent. The hospital was washed away and has not opened to this day. My mom’s doctor’s office was under water, leaving her with no medical records. Fortunately my dad’s medical care was being provided at home by the Veterans’ Administration, so his care could continue without too much interruption. The only blessing we could see at the time was their car, which floated down the road with every other automobile in Long Beach.

With the advocacy and support of my colleagues in the aging community of NYC, the Hebrew Home at Riverdale came through and provided a permanent home for mom and dad. My mom, who passed away this past January, spent the happiest year of the last ten years of her life there. She was 91 years old. Her life in Long Beach was becoming more and more an isolated existence.  Most of her friends had died and the burden of caring for my dad kept her from leaving her apartment except for her trips to the supermarket and doctor. With the responsibility for my dad lifted, she was now free. Although frail and deaf, her cognizance was excellent.

She made wonderful friends, joined in activities, began going to synagogue on Friday nights, went on shopping trips, and began to care again about what she wore and how she looked. Her best friend at the Hebrew Home was Rose, who was born deaf and was teaching my mom American Sign Language. She attended several 100 year old birthday parties. She and my dad celebrated their 70th wedding anniversary at the Hebrew Home with all their new friends in attendance. The other thing I noticed was that she was secure about having her own needs met…no more 911 calls and emergency room visits. She fully embraced her new home.

My dad, who needed 24/7 care resided in a different section of the facility, where he remains today. All the buildings on this beautiful campus are connected to each other, and my mom saw him every day and was his best friend and advocate. The common denominator among my dad’s floor mates is their inability to care for their own physical needs. There is, however, a huge cognizance spectrum. My dad seems to be located about mid-point on the spectrum. It is easy to discount the inner humanity among these people who are often confused, do not make sense even when talking to each other, and sometimes do not even seem to be aware of their surroundings. I must admit that my own ageist attitudes often came to the surface when I would visit his floor. One emotional and dear incident changed my entire perception of who these people are.

My mom died of congestive heart failure, and she did not suffer much at all. She had only been diagnosed about three months before her death and was only ill the last three weeks while spending the last week in the hospital. Although we tried to prepare my dad, his memory issues prevented him from fully grasping the situation. After she passed away, my sister and I went to tell him. He was in his dining room just about to sit down to dinner. We wheeled him out to a private area and broke the news as gently as we could…but there really is no gentle way. He reacted as was expected and appropriate. It was very sad.

When we were feeling the need to leave, dinner was over; and most of his floor mates were out wandering the halls in their wheelchairs and with their walkers. As you can imagine, we were having a difficult time leaving. I walked over to one of the aides, saying, “We really need to go, but it’s so hard for us to leave him alone and just say ‘bye dad, we’ll see you tomorrow’.” She waved her finger and said, “No, no. You see all these people. They are just hovering, waiting for the two of you to leave.”

As we waited for the elevator, my sister and I could see into the area where we left my dad. One by one, each of his floor mates came up to him, and each in their own way told him how sorry they were. Some just patted his arm, others hugged him, and as we were getting on the elevator, we watched the aides help them form a circle around dad. I turned to my sister and said, “He’s not alone.”

African Americans Speaking Out About Alzheimer’s Disease

This month, we learned that former model and restaurateur B. Smith has been living with Alzheimer’s Disease.  Smith, dubbed the “black Martha Stewart” due to her career paths as a designer, author, and TV host, shared her story about remaining steadfast in fighting the disease, and having the support of her husband and business partner.

Hearing B. Smith’s candidness about the uphill battle of living with Alzheimer’s was empowering, especially since African Americans typically do not share their stories about Alzheimer’s.  Being an advocate and putting a face on what Alzheimer’s “looks like” in the African American community is a powerful testimony for and from Smith; her story validates the experiences of those living with Alzheimer’s, and the caregivers and families who care for their loved ones each and every day.

Alzheimer’s Prevalence

More than 5.2 million Americans live with Alzheimer’s, with over 200,000 being those 65 years and younger.  Of this population, 3.2 million are women and 1.8 million are men; women make up two-thirds of those living with the disease.  It is estimated that by 2050, the number of those with Alzheimer’s will triple from 5 million to 16 million.

Last year, almost 16 million American families and friends provided 17.7 billion hours of unpaid care to those with Alzheimer’s and other dementias.  This unpaid care has the value of $220.2 billion.

When it comes to medical care, Alzheimer’s is the most expensive condition in America.  With the projected tripling of those living with Alzheimer’s, this medical care expense strain will be astronomical.

Concerns Surrounding African Americans & Alzheimer’s

Senior African American couple holding handsAccording to the Alzheimer’s Association, many Americans dismiss the early warning signs of Alzheimer’s, inaccurately believing that what they are experiencing are normal developments in the aging process.  This misunderstanding of the aging process versus Alzheimer’s is especially true for African Americans, who are two times more likely to develop late-onset Alzheimer’s disease, and other dementias, than whites.  Missing the beginning stages of Alzheimer’s greatly disadvantage African Americans, as we are less likely to receive a diagnosis for our condition, which correlates to delayed treatment and planning.

How Alzheimer’s Disease Affects My Family

During the Summer 2008, my beloved Grandmother was diagnosed with the early stages of Alzheimer’s at the age of 78.  She, as well as us, noticed her having difficulty with routine tasks after she had a mild heart attack two years prior.  We decided to tell her general practitioner about our concerns, and he suspected Alzheimer’s, and placed her on a medication regimen to slow down the progression of the disease.  It has now been six years since the diagnosis, and we battle this disease every day.  Grandmother’s memory may not be as lucid as it used to be, but she is firmly holding on to the independence she still has, despite the disease.  Seeing her remain steadfast through it all gives me the strength when it comes to caregiving.

Resources for Those Living with Alzheimer’s Disease, & Caregivers

There are programs and organizations established for those who are impacted by this disease.  In order to overcome the struggles both those living with Alzheimer’s and caregivers endure, you have to educate yourself about the disease, and the supports that exist to help you during this journey.

The Alzheimer’s Association is a well-respected organization that works tirelessly to educate and support individuals and families affected by this disease, and create awareness about the prevalence in America and worldwide.  The Alzheimer’s Association has several resources that may benefit those affected:

African Americans & Alzheimer’s:  http://www.alz.org/africanamerican/

Provides information about warning signs, caregivers testimonies, and brain health, etc., specifically for African Americans and families affected.  

Living with Alzheimer’s:  http://www.alz.org/living_with_alzheimers_4521.asp

I Have Alzheimer’s Disease:  http://www.alz.org/i-have-alz/i-have-alzheimers-dementia.asp

Support Groups for Caregivers:  http://www.alz.org/apps/we_can_help/support_groups.a

2014 The Longest Day:  http://act.alz.org/site/TRfr_id=5860&pg=entry&s_src=alzfooter

2014 The Longest Day, a day observed around the world to honor the strength, passion, and endurance of those living with Alzheimer’s.  The goal is to raise funds and awareness to propel the mission of the Alzheimer’s Association.  The Longest Day is held on June 21, 2014, which is the Summer Solstice (the longest day in the year, and the first day of the summer season).  

Other resources for caregivers of those with Alzheimer’s

Help Guide – Support for Alzheimer’s & Dementia Caregivers:  http://m.helpguide.org/articles/caregiving/alzheimer-dementia-caregiver-support

AlzOnline – Alzheimer’s Caregiver Support Online:  http://alzonline.phhp.ufl.edu

Final Thoughts About Alzheimer’s

Education, medical research, awareness, community support, and acceptance are dire so that we can one day live in a world where Alzheimer’s does not rob us of those we love, and their memory.  I love my Grandmother, and Alzheimer’s will never be able to break the bond we have, no matter what lies ahead for us.

(Featured headline image:  Courtesy of A Place for Mom.)

Ageism and the Anti-Aging Industrial Complex: What Does Wisdom & Beauty Look Like?

How do you feel when you sit down to unwind in front of the television at the end of the day and you are bombarded with ads that tell you to “Stop the Hands of Time with Mrs. Smith’s Anti-Aging Formula 801”?  Or, you may want to try a little cosmetic surgery to lift that chin, or maybe some Botox to iron out those wrinkles.  This reminds me of laying my head across the ironing board while taking my mother’s two-ton steam iron to my long curly hair to straighten out the curly tresses that I obviously inherited from some mutant gene, but that was in the early sixties before curls were in.

Now, I am in my sixties, and they are telling me to leave the curls while erasing the lines of wisdom and experience from my aging face. I just don’t look good enough—code for “I don’t look young enough”.  What don’t I look young enough for, I ask myself.  I am fortunate to still be part of the workforce, but maybe if I looked younger I would get that raise I’ve been wanting.  Alas, the people that pay my salary know how old I am and assume that I’m not going to make any waves when so many of my peers are shipwrecked on the shore praying that a job, or maybe a little Botox, will arrive to save them.

anti-aging-creams-1Back to the TV ads. Every time, I see Debbie Boone touting the wonders of Lifestyle Lift, a company that provides facial and neck cosmetic procedures, I wind up in front of the bathroom mirror pulling my obliging skin back to see what I would look like if I just took a little from here and a bit from there.  Ugh, I am so mad at myself for even considering for a moment to alter the face I was totally comfortable with only 10 minutes ago.

It’s all about ageism.  It’s all about the youth culture in which we’ve been immersed.  It’s all about the message from the girl whose hair was spread across the ironing board: “Do not trust anyone over 30!”  So many retouched faces that we admire are telling us that we can look younger too. But, can we really trust anyone who looks older than sixty or seventy?  It’s all so familiar. Remember all those air brushed waifs that were presented to us telling us that we also could become “walking x-rays”?  All of a sudden anorexia and bulimia became part of the American lexicon.

I didn’t know if there was a term for people who are addicted to plastic or cosmetic surgery, so I looked it up.  This is what I found:

There is not a term for the addiction, but there is a recognized psychological disorder that affects some surgery addicts. It is called “body dysmorphic disorder” (BDD), and sufferers have a distorted image of their own appearance. This is sometimes manifested as disapproval after surgery is performed, leading to another surgery to correct the apparent flaws. Because of the high costs of plastic surgery, this disorder is usually apparent only in the very wealthy.  Read More

Whew, that’s a relief.  I am definitely not rich enough to have BDD.

A number of years ago I attended a “Wise Women’s” conference and participated in a workshop led by a Native American Elder.  To this day the image of her stunning lined face stays with me.  I thought of how I hoped to look like her when I became an elder myself.

The signs of age that mark our bodies are badges of wisdom, something that we need to be proud of, not something to be to be ashamed of—and certainly not something to erase.  I don’t want to go back to the age when my skin was perfectly smooth and taut and my mind was empty.

It’s time to let advertisers know that we want to see people we can identify with—people (especially women) who look like us. Wrinkles can be beautiful and we need to create a culture that sends the message that lines of wisdom are in.

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