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.”

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.

Who Is Old?

Edith Connors 77 year old body builder
Edith Connors 77-year-old body builder

Who is old?  What does old mean?  Who decides that you are old?  Who do you identify as old?

Is it age?  Do you automatically become old the day you start collecting your social security? Some people collect at 62, some at 66, and some at 70.  Or, maybe it’s the year you become eligible. Can it be the day you retire from your career job?  Or maybe it’s the day you become a grandparent.

My mother-in-law didn’t become old until she turned 90, while my mother decided she was old at 80. They self-selected when to be old. Meanwhile, my best friend who has a form of rheumatoid arthritis self-identified as old when she was only 55. So, it’s possible that old is when you need assistance with certain activities and realize that you are slowing in your performance. A 72 year old friend mentioned to me, “I can’t believe how much longer it’s taking me to walk to the office each morning. I used to be such a fast walker.“  Is she now old?

I am certain that my grandchildren identify me as old, while my peers tell me how young I look. Maybe that’s the answer. Old, like beauty, is in the eye of the beholder. My husband tells me I look as young as the day we met, which can hardly be true since that was over fifty years ago. Maybe we are old when our hair turns gray. Yet, I have a friend who went prematurely gray in her thirties.

Another answer might be that we are old when we start receiving senior discounts. I do have a senior Metro-Card that entitles me to use New York City’s subways and buses at half price. I have an AARP card, and I now go to movies and visit museums for senior admission rates.

Do all cultures and societies see “old” similarly?  Eastern cultures tend to value age and equate age with wisdom. Unfortunately, Western cultures put a higher value on youth. This causes many of the aging people I know to go to great lengths to appear younger than their actual age. I have an 85 year old constituent who came to see me one day carrying a large umbrella. “Is it raining?” I asked. “Oh, no”, she replied, but I refuse to walk with a cane.”

We, here in the United States and other Western industrialized counties, are experiencing a longevity boom. People here may not be perceived as old until they are in their 70s or maybe even 80s. Yet, in third world countries that are ravaged by war and hunger, people are perceived as old at a much younger age.

So, old may be determined by the place you live or the era in which you were born. My grandmother at 70 was an old woman. I am 68 and would not be described as an “old woman” by most people I know. Old can also be determined by one’s environment or the circumstances under which one lives. Those who live in poverty and those who are marginalized may not have access to good health care or healthy food. People who live in these minority communities are old sooner than those from middle and upper class majority neighborhoods.

So, it seems then that old is a socially constructed category. What old is to me may be different than what old means to you.

There is much truth in the adage, “Once you’ve seen one old person, you’ve seen one old person.” We are aging from the moment we are born; and the more we age,–the more we experience our own individual lives–the more diverse we become. Our individual lived experiences then may be the only key to determining when each of us is old.

Are you old?  If so, when did you become old?  If you are not old, what makes you see someone else as old?  Why do you think a society’s definition of old is important?

Ageism In The Workplace

If we are not welcome in the workplace and we are expected to live well into our nineties and beyond, how can we ever hope to be able to sustain ourselves financially?

Can you imagine a workforce made up of 3 generations?  I am 68, my children are in their forties, and my oldest grandchild is 17. I am one of the fortunate aging boomers who is still part of the American workforce. I have no problem envisioning a workplace where my granddaughter, my son, and I will all be participating in the growth of our nation’s economy. Yet, there is one major obstacle to achieving this goal. It is the oldest, most entrenched form of discrimination in this country. Ageism!

agediscriminationintheworkplace02Nowhere is it easier to identify ageism than in the workplace. As older workers are staying longer and younger workers enter the field, more often than not they will find themselves part of a multigenerational workforce. By the middle of the next decade, the United States will be an aging society, with more Americans over age 60 than under age 15.

What this means for an evolving job market is that there will not be enough young workers to fill entry level jobs. We will then have two choices. We can import young workers from other countries, or we can prepare ahead by accommodating older workers and encouraging them to remain or re-enter the workplace. This would be a welcoming departure from the cold shoulder that older workers receive when applying for jobs today.

Our country’s leaders are always a day late and a dollar short when it comes to planning ahead. For years and years people have been writing about the “graying of the American workforce” and the “aging tsunami”. The boomers are not coming; we have arrived!

We are healthier than previous generations, and we are living longer–in many cases, as much as 20 years longer. Yet, when we leave our career jobs, whether by choice or not by choice, we step into a void. We discover that there is no role for us in society. We become invisible. The invisible man today is not a bandaged wrapped non-body. He is an invisible somebody.

Here’s the dilemma: If we are not welcome in the workplace, and we are expected to live well into our nineties and beyond, how can we ever hope to be able to sustain ourselves financially? We have the intelligence, skills and wisdom to become one of society’s greatest assets.  Yet, without the opportunity to earn our own way, we will certainly become society’s burden. Most salient is our position as repositories of historical and cultural history and our ability to solve long term problems that younger people do not have the time for.

One excuse I hear for not keeping or hiring older workers is the fear that it will be too expensive. “They will be sick too often and, therefore, be less productive.” Not true. Older workers come with an innate work ethic. We take less sick days than our younger co-workers. We also come with our own health insurance, namely, Medicare. And, older workers are often willing to work for lower salaries as a supplement to our Social Security.

Mainly, we want to be valued and be seen as contributors to a better society, not as a drain. I wonder if those who would shut older adults out of the workforce are ageists who drank the youth-obsessed Kool-Aide that the media hands out. They probably do not even recognize their own internalized ageism. Have they thought about why they do not want a workplace filled with grey haired people? Could it possibly be the threat of having a workforce who reflect the true life process of aging that they would rather deny?

Ageism does not only affect the old. It affects our entire society. It deprives one generation the opportunity to pass on knowledge to the next, while depriving the younger generation the opportunity to learn and build on that knowledge.  It deprives an older generation the opportunity to keep growing and learning new skills for which the young are our best teachers.

The stereotypes of older people that we all own do not match up with the reality of today.  They are out of date.  It’s time for an upgrade.

 

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