Report: Home Health Aides Scraping By on Low Wages During Pandemic

On Equal Pay Day, the Rutgers Center for Women and Work highlights the growing number of home health aides in New Jersey and the economic challenges they face

New Jersey’s home health aides are caring for seniors and people with disabilities during the COVID-19 pandemic, while earning an average salary of just $25,000 per year, according to a report released today by the Center for Women and Work at the Rutgers School of Management and Labor Relations. Since home health aides and other domestic workers are predominantly women, their low wages help to explain why the gender wage gap persists in New Jersey and across the U.S.

“With all of the attention rightly focused on our incredible doctors, nurses, and first responders, it’s easy to forget about the thousands of home health aides who are caring for vulnerable New Jerseyans every day,” said Debra Lancaster, executive director of the Rutgers Center for Women and Work. “We’ve seen a growing demand for their services over the last 20 years. Yet, they remain among the lowest-paid workers in our state.”

Home health aides check vital signs and assist their clients with bathing, dressing, meals, medications, and other daily activities, while providing companionship and emotional support. Some aides live with their clients 24/7. Others work for home health agencies and visit multiple clients daily. The Rutgers Center for Women and Work’s analysis of federal data finds:

  • New Jersey has about 36,000 home health aides. That’s more than almost every other state.
  • 95 percent are women; 51 percent are immigrants; and 69 percent are Black, Hispanic, or Asian.
  • The number of home health aides in New Jersey is on the rise due to an aging population.
  • Despite the important services they provide, home health aides are low-wage workers.
  • The average home health aide in New Jersey earns between $23,380 and $25,330.

The Center for Women and Work made the announcement on Equal Pay Day, the symbolic date on which women’s earnings catch-up to men’s earnings from the previous year. New Jersey ranks at or near the bottom of all states on pay equity for women of color. Latina women in New Jersey earn 42 cents and black women earn 56 cents for every dollar a white man earns, according to data from the National Women’s Law Center.

“The low wages paid to home health aides and other domestic workers are a major reason why we still have a wage gap in 2020,” said Yana Rodgers, economist and faculty director of the Rutgers Center for Women and Work. “It’s not always a function of overt discrimination. In many cases, the problem is that jobs thought of as ‘women’s work’ do not pay as much as ‘men’s work.’ Until that changes, the wage gap is not going away.”

About the School

The Rutgers School of Management and Labor Relations (SMLR) is the world’s leading source of expertise on managing and representing workers, designing effective organizations, and building strong employment relationships. SMLR’s Center for Women and Work engages in research, education, and programming that promotes economic and social equity for women workers, their families and communities.

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.

Loneliness Found to Be High in Public Senior Housing Communities

Older adults living in public senior housing communities experience a large degree of loneliness, finds a new study from the Brown School at Washington University in St. Louis.

Nevertheless, senior housing communities may be ideal locations for reducing that loneliness, the study finds.

“There are many studies on loneliness among community-dwelling older adults; however, there is limited research examining the extent and correlates of loneliness among older adults who reside in senior housing communities,” wrote Harry Chatters Taylor, doctoral student at the Brown School and lead author of “Loneliness in Senior Housing Communities,” published in the Journal of Gerontological Social Work.

The study was co-authored by Yi Wang, doctoral student at the Brown School, and Nancy Morrow-Howell, the Bettie Bofinger Brown Distinguished Professor of Social Policy and the director of the Harvey A. Friedman Center for Aging.

The study examines the extent of loneliness in three public senior housing communities in the St. Louis area. Two of the three complexes were in urban neighborhoods, and the last was located in a suburban neighborhood. All were publicly funded under Section 202 Supportive Housing for the Elderly Program. Data for the project was collected with survey questionnaires with a total sample size of 148 respondents. Loneliness was measured using the Hughes 3-item loneliness scale. Additionally, the questionnaire contained measures on socio-demographics, health/mental health, social engagement and social support.

‘We believe that senior housing communities could become ideal locations for reducing loneliness among older adults.’

Results showed approximately 30.8 percent of the sample was not lonely; 42.7 percent was moderately lonely, and 26.6 percent was severely lonely. In analyzing the data, researchers found loneliness was primarily associated with depressive symptoms.

“We speculate that loneliness may be higher in senior housing communities for a few important reasons,” Taylor said. “The first is older adults residing in senior housing communities often have greater risk for loneliness. In order to qualify to live in these senior housing communities, older adults must have a low income, and having a lower income is a risk factor for loneliness.

“Additionally, most of the residents we interviewed identified their marital status as single, which is another risk factor for greater loneliness. Many older adults living in senior housing communities also have greater health and mental health vulnerabilities, which increases the likelihood that an older adult will experience loneliness.”

Despite all that, the study finds, senior housing communities may be better suited to combat loneliness than traditional residential homes.

“We believe that senior housing communities could become ideal locations for reducing loneliness among older adults,” Taylor said. “Senior housing communities are embedded in communities with peers who may have similar age and life experiences. There are occasional activities and support from senior housing management to encourage the building of friendships, bonds and social support among senior housing residents.

“Most senior housing communities also have a common space or multipurpose room available for use, which can also help facilitate building bonds between residents. Senior housing communities are frequently located close to public transportation, which provides access to transportation for residents without automobiles.”

Still, loneliness is frequently a stigmatized condition, he said.

“We often do not like to talk about our feelings of loneliness,” Taylor said. “For practitioners, it is important to be patient when working with older adults, and it could take a while for an older adult, regardless if they reside in a senior housing facility, to admit they are feeling lonely.

“Whether you are a child, relative or family member to an older adult, or provide services to older adults, be patient when discussing issues of loneliness and mental health with older adults.”

10 Useful Apps for Your Tech-Savvy Aged Parent

Are your parents aging but still wanting to keep in touch, be in the know, and continue to be avid fans of their smartphones? Now is a great time to be a tech-savvy senior, as they have far more options to choose from when it comes to applications designed to keep their lives simpler and more streamlined. While your mother or father may be huge fans of the new phones available, they may not be aware of all the great options.

They can do more than shop for best deals for catheters online; now they can take control of their lives with some great new products.

Here are ten apps every tech-happy parent should download onto their phone.

1. Pillboxie

This useful app, which is only available for iPhone, gives a visual guide to help with daily, short-term, or weekly medications. Rather than just a note that pops up on your calendar, this is a virtual medicine cabinet that helps users see and organize their meds easily, gives them a gentle reminder to mark what they have taken and see if they missed anything. This app is great for anyone taking medication that just needs a little reminder not to miss a day.

2. Mint Bills and Money

This application is here to make sure you never miss a bill payment. Available for Android as well as iPhone, the app is especially nice because, after its initial set-up, all that’s needed is a quick confirmation to go ahead and digitally pay a bill. This app makes sure that the power never goes off, the cable is always on, and the gas is available. It can also monitor your bank accounts and credit cards to show you any unusual activity or just help you check your balance. No more forgetting a payment or making troublesome trips to the bank.

3. Goodreads

Reading is such a great activity for all of us but, especially, for those of us getting on in years. This app completes the experience with a social element—users can make friends with other fans of their favorite books and leave messages for one another. Book reviews are also encouraged, and readers can list books they plan to read in the future, as well as communicate with their favorite authors. Best of all, the app is free and available for all phones and tablets.

4. Words with Friends

This app goes beyond note writing or just chatting. With this popular word game application, users can challenge friends, family, or random users to a game of scrabble. While traditional rules apply, this app puts a new twist on an old favorite. The game has no time limit, so one match can last if the two opponents need to do other things, they can message one another in the chat section, and those who want to play alone have the solo play option.

Anyone looking for a new friend to play also has the Smart Match option. This option evaluates one’s skill level and matches them to someone at a similar level. Scrabble champions can easily find others who can keep up with them while beginners do not have to get creamed by a pro.

5. Spotify

You may think of Spotify—for Android as well as iPhone—as a place to find new music, but it is also a great place to find old favorites. Does your dad go on and on about the genius of Lawrence Welk? He can find the man’s music here. Users can create personalized radio stations based on their interests and even use the app on their desktop computer to fill the room with their favorite tunes. Don’t be surprised if you catch them dancing once they have their membership.

6. Skype

Keeping in touch is extremely important to everyone in your family, especially those who are getting older. Skype is a wonderful, free app that can be used on a desktop or any phone. The technology combines video and audio for a great option to catch up. Group conversation options are also available, as well as calling a landline or cell phone if necessary. See new babies, check in on distant relatives, and even go exploring together with the help of this very fun application.

7. Lumosity

Designed to keep brains active and memory alive, Lumosity is essentially a gym for your brain that you can access from any phone or tablet. The games on this application were designed by neuroscientists in hopes of helping people challenge themselves mentally and do so in a way that is entertaining and helps them have fun.

You will not feel like you are taking a test, but rather like you are playing a low-key, entertaining video game. The application can help prevent mental issues like Alzheimer’s and dementia. It also just improves general cognition so anyone can jump in on the fun. The app has gone worldwide for a reason—it is just great!

8. Blood Pressure Monitor

Only available for Apple phones, Blood Pressure Monitor helps users take control of their heart health and keep track of their pressure, their heart rates, and their activity. The app comes complete with reminders to take medicine or do an activity, as well as help to export any unusual activity to a doctor’s email. While this is not meant to replace any professional tools, it can help anyone with heart concerns feel better with a visual chart of just how their heart is doing and give a clear warning when something is going wrong.

9. Evernote

Evernote is an especially good one for senior citizens living alone or with limited care. The digital notebook comes in three versions, from free to premium, and offers all kinds of things. Listing different things to remember, a to-do list, audio notes, digitizing business cards, and just writing out documents are all available for both Android and Apple users. Also, it syncs up phones with desktop computers so that it can be used from any interface. Never forget a thing with the help of this great digital personal assistant.

10. WebMD Pain Coach

You have likely already used the WebMD website, which helps identify problems through symptoms, but you may not have tried this great app, though you and your parents absolutely should. It is designed to be a holistic approach to pain management and to take the mystery out of health problems, the app has a pain tracker, offers advice on pain reduction, and helps the user keep a kind of journal to show their doctor to help explain the problem. The app also has a daily goal tracker, dietary suggestions, and a built-in library of articles about preventative health to help users.

Alzheimer’s Foundation of America Celebrates World Social Work Day

Today is World Social Work Day, a time to honor social workers and recognize the contributions they bring to society.  As social workers play an instrumental role in the health and improved quality of life of individuals with dementia, the Alzheimer’s Foundation of America (AFA) is offering a special discount, throughout the month of March, on its “AFA’s Partner’s in Care: Supporting Individuals with Dementia” training DVD.

“This month is an opportunity to put a spotlight on the profession as we recognize the more than 600,000 social workers across the country,” said Charles J. Fuschillo, Jr., AFA’s president and chief executive officer. “Social workers are a vital part of the care team.  They face challenging issues on a daily basis, working with individuals and families, helping them to reach their full potential.  It is beneficial for them to have dementia-specific training so they can learn how to make a greater impact in the lives of individuals with Alzheimer’s disease and related dementia.”

Social workers help individuals increase their ability to solve problems, cope with stress, and find valuable resources.  It is always advantageous for health care professional to increase their knowledge, especially when it comes to disease-specific topics.

The “AFA Partners in Care” training series assists health care professionals in gaining a better understanding of dementia, learning effective communication strategies, facilitating care transitions and developing relationships with the individuals in their care in order to foster more meaningful living. It also includes tips and strategies for professional self-care.  Developed by healthcare professionals for healthcare professionals, the program is appropriate for a variety of disciplines. 

Individuals who complete the program and pass the associated exam can pursue designation as an AFA Dementia Care Partner. They will also be eligible for six continuing education contact hours.  Social workers can order the “AFA Partners in Care” training DVD, and take advantage of the discount, which is only $150 this month, by contacting Molly Fogel, AFA’s director of educational and social services, at 866-232-8484 x131 or mfogel@alzfdn.org.

How Do We Protect the Elderly from Fraud

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According to the United States Department of Justice, 1 in 10 seniors over the age of 60 is abused every year in the U.S, and elder fraud is another tactic used to abuse our aging population. Many of these cases often go unreported. Factors such as social isolation, lack of family/friends support, cognitive decline, loneliness, lack of awareness of financial matters can put individuals at risk for elder fraud.

One morning, I was waiting for the building exterminator to arrive to my apartment. When Luis* was spraying my apartment, he told me how he discovered his 85 yr old Dominican father was a recent victim of fraud. It all started when his father received a phone call from a person claiming that he won thousands of dollars but in order to receive the prize, the “winner” has to provide his bank account information so the prize money can be directly deposit. Needless to say, Luis’s father did as such and within a couple of days his entire savings of $40,000 was stolen from his account. Sound familiar?

People would often hear stories how the caregiver (usually a family member) would take advantage of the individual’s finances however, the abuse can occur from strangers from the community as well. Perpetrators have their way of finding the perfect victim to scam. Sometimes the perpetrators work in pairs when scamming victims. For example, in 2014 two contractors scammed $500,000 from senior citizens in Southern California during a two year span.

They managed to manipulate the customers in paying more money for work that it was not needed and forged their checks.  Stories of con artist who tag team against the elderly are common. In some cases, one contractor (usually unlicensed) would talk to the victim in the dining room, while the contractor would search the bedrooms for cash, jewelry, or other valuables to steal. It may take hours or days for the victim to realize their valuables were stolen.

It’s important for social workers and other professionals to understand how financial fraud affects the elderly. Can you recall a time when someone stole something that was important to you? Do you remember how you felt afterwards? Some of the affects of financial fraud can include but not limited to anger, embarrassment, lost of control, stressed, fear, etc.

My exterminator, Luis stated that it took a few weeks before he and his brothers found out about his father’s financial fraud. His father who worked many years for the telephone company and saved his money for he and his wife was all gone. Luis said he and his brothers did not understand why his father was asking for money all of the sudden since he is known as a very frugal. His father did not immediately report the incident to his sons because he wanted to try to fix the problem himself.

To reduce and prevent elder fraud cases United States Department of Justice has a Division of Elder Justice that provides education and resources to the public. More health care agencies are hosting conferences to help educate health care professionals, social service staff, and other professionals about elder abuse.

Families, neighbors, friends can report abuse through the adult protective service agency in the county where the victim resides. Some counties make it easy for people to report the abuse. For example, in New York City, residents and health care workers can report abuse to adult protective services online and it will allow you to print the report upon completion. A google search for adult protective services in your county and State will help direct you to the local reporting agency.

Some of the examples of action and prevention mentioned above sounds promising for the seniors, but there should be more steps to be taken to help raise awareness and protect potential victims. For those working with an aging population or concerned about a love one, Caregiverstress.com has put together a comprehensive toolkit to help protect against elder fraud. You can also visit StopElderFraud.gov for more information.

[gview file=”https://swhelper.org/wp-content/uploads/2016/02/1_Seniors_Fraud_Protection_Kit_US.pdf”]

*Names has been changed to protect the identity.

Holiday Depression and Our Elderly

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When we think of the holiday’s we often think of joyful times with family and friends but for some of our elderly it can be a time of sadness, isolation and loneliness. Seasonal affective disorder (SAD) is prevalent during the holidays and winter season due to issues such as being confined indoors, missing loved ones (living or deceased) or chronic illness/pain.

Depression in the elderly looks different than the younger generations as it can mask itself as health related issues which often causes the depression to go on untreated. For example, symptoms like decreased or no appetite, sleep disturbances, incontinence, chronic pain, memory loss/confusion, mood disturbances and fatigue can be signs physical illness like diabetes or an urinary tract infection but they are also signs of depression.

According to the Center for Disease Control ) approximately 6 million elderly seniors suffer from depression and have the highest rate of suicide because as only 10% get treated for it. If you suspect that your loved one may be suffering from depression express concerns to their doctor as soon as possible. You may also ask for a referral to a psychiatrist for a second opinion.

Signs of depression are sadness, fatigue, loss of interest in socializing, poor appetite, sleep disturbances, loss of self-worth, feelings of hopelessness and increased use of alcohol/drugs and fixation on death.

OTHER RED FLAGS TO LOOK FOR

Unexplained or aggravated aches and pains

Anxiety and worries

Memory problems

Lack of motivation and energy

Slowed movement and speech

Irritability

Neglecting personal care

WHAT TO DO WHEN SOMEONE IS IN IMMINENT DANGER?

Call 911 for emergency services

Go to nearest hospital emergency room

Call National Suicide Hotline toll-free, 1-800-273-8255 or TTY 1-800-799-4889

Call your doctor

What to do when someone is not in immediate danger?

Acknowledge that their pain is legitimate and offer to work together on getting help.

WHERE TO GET HELP?

Family physicians, clinics and health organizations: Can provide treatment or referrals

to mental health specialists.

Mental health specialists: psychiatrists, psychologists, therapists and social workers.

Psychiatrists can prescribe medications as they are actual doctors but the therapist

and social workers work together with doctors to make sure seniors are getting medications and care they need.

Community mental health centers: provide treatment based on ability to pay, and usually have a variety of mental health specialists.

Hospitals and university medical schools: May have research centers that study and treat depression.

When Basic Living is Considered a Utopia for the Poor

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With our fast paced lives in a technological age of instant gratification and easy distraction, it’s no wonder news channels are beginning to advertise “distractify” sections on their web pages. It’s not difficult to see how quiet unassuming people may get pushed aside, and their needs relegated to the back burner. We assume that they’ll get social security which will provide some basic living. After all, we are told that all Americans can get social security once they retire. Right?

But, retiring means that you have worked, and social security is based on earnings over your lifetime. For homemakers, this doesn’t help much. We assume that they’ll receive Medicare, and yes we might even hear about the problems and costs associated with what Medicare doesn’t cover. We might even assume that the elderly will get food stamps without realizing just how meager food stamp grants really are. In an age of cuts to social programs, not only are all of these so-called entitlements at risk, programs such as food banks, meals on wheels, and utility assistance are also at risks which leads me to tell you about Mrs. Jones.

Mrs. Jones* is a vibrant and lovely elderly woman, free with stories of years gone by and quick with an ear for friends and neighbors. She loves working in her garden and sitting on her porch chatting with passers-by. Many in her community in Atlanta look forward to the spritely older woman and her tales. Many more loved her homespun wisdom and down home recipes, both of which she’s quick to share.

So, it was with great shock and profound sadness that the community witnessed its first day without the fixture that was Mrs. Jones and the loss was palpable. The shock and sadness only increased as the story behind Mrs. Jones’ absence spread.

In all the time she was cornerstone of the community, the very bedrock that most communities seek to cultivate, no one guessed she might have a secret. Mrs. Jones was used to being relied upon in her community and never thought to ask for anything in return. While her neighbors were friendly, caring, and even supportive of her, no one thought to inquire into how this lovely elderly woman, a widow who’d largely been a homemaker, was fairing. Sadly though, Mrs. Jones is one of countless citizens in an unenviable position. She is one of the 3.4 million citizens aged 65 and over in our country who live in poverty making her part of an extremely vulnerable population and one that is often forgotten in our society.

As a widow she did qualify for survivor’s benefits, but as someone who was largely a homemaker, her social security was meager at best. She did happen to qualify for Medicare, but was judged to be over the resource limit for food stamps. Living alone without dependent children reduced her benefits limit to the point that she was deemed to make too much. In short, after a lifetime of raising children, keeping house, and being a good and supportive wife to her husband all things lauded as family values to be protected, the system failed Mrs. Jones.

On the night where we pick up Mrs. Jones’ story, the night before her community witnessed the absence of its cornerstone, Mrs. Jones dialed 911 in a panic. She was having incapacitating abdominal cramps coupled with vomiting. When she arrived at the emergency room she was quickly diagnosed with a bowel obstruction and raced into emergency surgery. Afterward she was admitted to the ICU to recover from surgery and to stabilize her condition. A few days after she was admitted, a concerned friend came to visit and that’s when the true tragedy of Mrs. Jones case was revealed.

Her neighbor, perhaps one of her closest friends, knew that Mrs. Jones had been diagnosed with a heart condition, and that the treatment course was not covered by her insurance. This is not uncommon among the elderly who frequently have too many medical bills and not enough money or insurance. Many Americans think that supplemental insurance like Medicare part D picks up the rest, but the truth is it doesn’t cover everything and creates what some call the Medicare donut. In this position, Mrs. Jones was left to decide between medication and other necessities like food, which also is not uncommon among the elderly.

What makes this story less common, but by no means unheard of, is how Mrs. Jones decided to solve the problem. With too many financial needs and too few dollars at her command, Mrs. Jones decided that she would have to resort to eating dog food to afford her medications. That’s right, as she was trading recipes with her neighbors, offering an ear to all and being the foundation of her community, Mrs. Jones had resorted to eating dog food.

Mrs. Jones had been failed by the very society of whom she was a bedrock. Even more tragically, she is now saddled with even more medical debt which lead to her illness in the first place. Only time will tell how Mrs. Jones’ story will end. With her grown children having moved away and her husband  now deceased, it is very likely her community will forever lose its cornerstone. The debt she’s incurred will drive her to even more austere measures and ultimately lead to her being placed in assisted living.

Mrs. Jones’ story and the stories of millions like her doesn’t have to end this way. It doesn’t have to be a story of poverty, increased health care costs, and increased demand for limited assisted living spaces. The only solution that eliminates poverty and corrects societal tragedies like Mrs. Jones story is a universal basic income.

Had Mrs. Jones lived in a country that provided a guaranteed basic income for its citizens, Mrs. Jones would not live in poverty. She’d receive a stipend that guaranties her a comfortable existence where she could afford food and adequate health insurance. Insurance where her medication is covered, thus eliminating the strain of poverty on our health care system.

Clearly our current system, which leaves 3.4 million of our elderly in poverty, estimates as many as 44% of seniors would be living in poverty if it were not for social security. As stated in the findings by Center for American Progress, the system is broken, and it’s time to find a solution. 

Editors Note: *Mrs. Jones and staff at Emory University Hospital spoke to me on condition of anonymity. Mrs. Jones name was changed to protect her privacy.

A Gentle Approach to Dementia for Care Providers

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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.

Alcohol and Prescription Drug Use in Older Adulthood

Substance abuse, specifically alcohol and prescription drug use, is one of the most rapidly growing healthcare problem for older adults, 60 years of age and older in Canada and the United States. Researchers project a 3-fold increase in substance abuse in adults aged 50 and older by 2020. Consequently, an estimated 5 million older adults will require treatment for substance abuse problems in the near future. Researchers are only beginning to recognize the prevalence of substance abuse among people age 60 years of age and older as alcohol and prescription drug use in older adults was seldom discussed until recently.

Substance use and misuse place older adults at risk for a variety of possible clinical dangers, contributing to increased use of healthcare resources and a need for age-specific interventions with the increased proportion of older adults living in North American society. Presently, the misuse of prescription and over-the-counter medications is recognized as a problem.

Alcoholism-Disease-Or-Not2However, baby boomers are expected to have had more contact with illicit substances (ie. marijuana, hashish, cocaine (including crack), inhalants, hallucinogens, heroin and prescription-type drugs used non-medically) than past and present cohorts of older adults. Illicit drugs may also be increasing in a small percentage of older adults.

The National Survey on Drug Use and Health reported that illicit drug use by adults 55 to 59 has increased from 1.9% in 2002 to 5.0% in 2008, which depicts the potential for growth in illicit drug use in the baby boomer cohort. However, illicit drug use in older adults is typically linked to individuals who are lifelong drug users.

In addition, approximately 15% of individuals 65 years of age and older living in the community are at risk for alcohol abuse or dependence and 50% of individuals living in personal care homes drink moderately or are dependent on alcohol. However, only 90% of individuals who are at risk for alcohol abuse or dependence do not receive alcohol treatment services.

Therefore substance abuse services in the future will need to anticipate and acknowledge problems with the use and misuse of both licit and illicit substances in older adulthood. However, due to insufficient knowledge, limited research data, and limited and rushed healthcare visits and appointments, healthcare providers often overlook substance abuse and misuse among older adults. Therefore, despite the number of older adults experiencing problems related to substance use, the situation remains underestimated, underidentified, underdiagnosed and undertreated.

The reasons for the inability to acknowledge substance use problems in older adults are due to many factors. First, healthcare providers often overlook substance abuse and misuse among older individuals, as their symptoms are often mistaken for depression, dementia and health problems common to old age such as falling, infections or digestive difficulties. Second, older adults may also hide their substance use and are less likely to seek help for their problems with substance use. Third, many family members of older adults with substance use, particularly adult children, are often embarrassed of their family members’ problems which often results in their inability to seek treatment.

As a result, thousands of older adults who need treatment never go, and the number of substance abusers among older adults continue to rise. Healthcare professionals must acknowledge that older adults’ struggles with substance abuse are becoming a prevalent issue and the stigma associated with these issues must be addressed as well.

Healthcare professionals must acknowledge that older adults’ struggles with substance abuse are becoming a prevalent issue and the stigma associated with these issues must be addressed as well. Mental health practitioners should also receive specific training and education to develop sensitivity towards these issues.

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.)

The Role of Marijuana in The Baby Boomer’s Revolution

Baby boomers, born between 1946 and 1964, lived in an era where experimentation with drug use was encouraged. The children of the 1960s who rocked out to the Grateful Dead, Janis Joplin, and The Who, stood up for what they believed in and protested the Vietnam War, and joined the Summer of Love in Haight-Ashbury were part of the cultural revolution of the 1960s. Now, the 1960s “wild child” has aged, and this age cohort is part of a new revolution—the baby boomer’s revolution.

marijuana-1The baby boomer’s revolution refuses to become “elderly”; they refuse to be frail, isolated, or lonely.  They refuse to have someone tell them they must grow old. Their ways are not changing, and they are living out their life as they always have…with continued drug use.

The baby boomers lived during a time in United States history when popular culture accepted substance use. The popular culture of the 1960s -1970s has resulted in the majority of this age group having been exposed to substances at rates unlike any other age group. Marijuana use has increased among baby boomers over the past decade. From 2002 to 2012, marijuana use increased from 4.3% to 8% among boomers aged 50-54, 1.6% to 7.4% among boomers aged 55-59, and from 2.4% to 4.4% among individuals aged 60-64.

The legalization of marijuana supports the baby boomer’s revolution. We are beginning to see how this group is redefining what it means to be old, but what will the new elderly look like?

Research indicates that 62% of all adults over the age of 65 have several chronic conditions, and in fact, 23% of Medicare recipients have five or more chronic conditions. These chronic conditions, combined with substance use may complicate treatment or result in poor treatment outcomes.

The National Association of Social Workers states that “social workers’ primary responsibility is to promote the well­being of clients. In general, clients’ interests are primary.” As social workers, where do we stand on this issue? Do we embrace the baby boomer’s revolution? Do we embrace aging with choice, dignity, self-determination and subsequently, substance use? Or do we return to the status quo?

For more posts like this, follow me on Twitter @karenwhiteman

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Does Obamacare Benefit Baby Boomers?

Baby boomers, born between 1946 and 1964, are changing the definition of what it means to grow old. Baby boomers don’t want aging services the same way their parents did, boomers don’t want senior centers and adult day care centers, they want wellness centers and spas. They don’t want to be isolated in nursing homes, they want to live in active communities. They don’t want to stay home and watch Gunsmoke reruns in their moo moo, they want to go out dancing in high heels wearing Gucci. Boomers are spearheading the movement to age in place and our health care policies are following.

Obama_healthcare_signatureThe health home model of service delivery in section 2703 of the Patient Protection and Affordable Care Act is the most recent federal initiative promoting integrated health care and aging in place. The Patient Protection and Affordable Care Act (H. R. 3590) is a federal policy that signed into law by President Obama in 2010, also referred to as Obamacare.

Section 2703 of the Affordable Care Act authorized states to develop a system of coordinated care through a health home. The health home facilitates access and coordination of health services through home health care, including primary health care, behavioral health care, and community-based services for Medicaid recipients with a chronic condition.

Health homes are of particular importance to older adults since the passage of the Affordable Care Act means reducing health disparities for older adults. For example, the barriers that prevent screening and assessment, and treatment among all older adults have a larger greater impact on homebound older adults due to transportation issues, handicapped accessibility, and isolation. Homebound older adults have greater physical health issues, and therefore, seeking treatment for chronic health conditions presents a significant barrier.

The passage of the Affordable Care Act, Obamacare, brought increasing recognition of the need to consider the totality of an individual’s health and health care. This means fostering overall health and wellness by promoting the integration of behavioral health (mental health and substance abuse) and primary health care to increase access to affordable and effective integrated health care, treatment, and recovery support services.  Within this context, now is a perfect opportunity to engage stakeholders and partners to embrace recovery and all of its dimensions.

However, as the baby boomers redefine what it means to be “elderly” or “senior”, what will this new healthcare system look like for older adults? The home health model is an idea that promotes aging in place. It hasn’t been researched fully to know the benefits of this system. More research needs to be done, but what do you think, is the home health model truly of benefit to older Americans?

For more posts like this, follow me on Twitter @karenwhiteman

Silver Surfers: Seniors on The Web

Seniors or the elderly are sometimes unfairly subject to gentle mockery on the basis of their supposedly unreliable memories and an inability to adapt to technological innovations, but as this article will argue, it is now an anachronistic stereotype. Today, most people are now fortunate enough to have access to the internet and retirees are no exception. It helps, of course, that the Internet itself is approaching its twentieth birthday, and technology has become more compact as well as more user-friendly.

Changes For The Better

Microsoft at St. Barnabas Senior Center
Microsoft at St. Barnabas Senior Center

One factor that has encouraged mature citizens to embrace digital technology is that the experience itself is has become simpler. Dial up and ISDN connections were appalling and frustrating to use. In hindsight the early days of the Internet was dominated by poorly designed web pages that were non-interactive and not visually appealing to users.

It has only been since the advent of broadband access that surfing the Internet has become a much more palatable experience. Five or six years ago, accessing video could be a vexing experience dogged by low picture quality and problems with streaming. Nowadays, Netflix demonstrate that whole TV series can be watched on demand at the click of a button.

Additionally, the advent of WiFi was a critical innovation because it made computer access mobile in addition it enabled multiple users to connect to the net from wherever they chose inside the home.

Simpler Hardware

The hardware that we used has changed dramatically too. Perhaps the first decade of the Internet’s existence, from around 1995, the dominant device was the desktop.

Heavy, immobile and expensive, the desktop  is undoubtedly powerful, but it can nonetheless be a difficult beast to handle. By contrast, today’s touchscreens are widespread and are intuitive to use which makes accessing the web less intimidating. Tablets, in particular, combine reasonably sized screens with portability and ease of use.

A 103-year old great grandmother from Wales is the oldest Facebook user and probably the oldest iPad user in the world as well. Lillian Lowe is said to have created an account on Facebook weeks ago with the intention of getting updates from her seven grandchildren and 13 great-grandchildren. Lowe says she has become a Facebook fan since she signed up. The tech-savvy grandmother updates her Facebook account twice a week, and is said to have loved the new features this social networking site offers. Read Full Article

Modern devices are simply much less intimidating than their antecedents. Given that so many aspects of modern life are dependent on or best accessed through the Internet, it’s no surprise that pensioners have adapted to its benefits. Whether asking Google “How much is a stairlift?” or online banking, senior citizens can no longer be accused of being technophobes. Silver Surfers are a large and growing part of the web’s daily traffic and more app development should be made to cater to their needs.

Photo Credit: Microsoft

Multidisciplinary vs. Interdisciplinary Teamwork: Becoming a More Effective Practitioner

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Both multidisciplinary and interdisciplinary teamwork have been used in healthcare in the past. However, although there is a clear difference between the two approaches to care, many educational researchers and practitioners use these terms interchangeably. The fundamental difference lies in the collaborative care plan that is only developed in interdisciplinary patient interventions, as multidisciplinary care does not emphasize an integrated approach to care.

Multidisciplinary teams are unable to develop a cohesive care plan as each team member uses his or her own expertise to develop individual care goals. In contrast, each team member in an interdisciplinary team build on each other’s expertise to achieve common, shared goals. Therefore, it is crucial to indicate that multidisciplinary teams work in a team; whereas, interdisciplinary teams engage in teamwork.

An interdisciplinary care plan is developed by answering these questions:
1. What are the issues?
2. Who will be involved?
3. What will the interventions be?
4. What are the goals of the intervention?
5. When will re-evaluation occur?

Therefore, interdisciplinary care must occur to bring about improved patient outcomes such as more efficient practice, an increased individualized and patient-centred approach and improved quality in care. If healthcare professionals do not have the same intervention goals, patients may suffer. Therefore, if practitioners focus on a single, shared goal, a patient will be more successful in receiving the care that they require.

In addition, the need for interdisciplinary care is increasing as a result of:
• A growing aging population with chronic and complex needs
• The increasing knowledge and skill required to provide comprehensive care to patients
• The increasing specialization in healthcare fields
• The growing encouragement to develop multi-faceted teams in healthcare, and
• The increased emphasis on continuity in care planning.

Therefore, changes in practice approaches and interventions need to take place to advocate for the use of integrated care plans. With a growing aging demographic and the development of more complex health problems, it is crucial that interdisciplinary care is used in all areas of the healthcare field. Interdisciplinary care aims to be an all-inclusive resort to meet the unique care needs of individuals. It is considered to be the “Hallmark of Geriatrics”; therefore, it must be represented in practice to improve quality and efficiency of care to all individuals.

References:

Walter C. Chop Regular H. Robnett, ed., Gerontology for the Health Care Professional, ed. (Boston: Jones and Bartlett Publishers, 2010).

Andrew Booth, Steven Ariss,Tony Smith, Pam Enderby,and Alison Roots4 Susan A Nancarrow, “Ten principles of good interdisciplinary team work,” Human Resource Health, 2013: 1-11.

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