Incorporating Homophobia into the Definition of Elder Abuse

Although many older adults receive necessary support from family, friends, and external agencies, some older adults experience exploitation and abuse. Since there is no universal definition for abuse against older individuals, a broader definition refers to elder abuse and neglect as, “any action or inaction by any person, which causes harm to the older or vulnerable person”.

Abuse of older adults includes physical abuse, psychosocial abuse, financial abuse, neglect (active or passive), institutional abuse and domestic violence. Research indicates that family members instigate much abuse against older individuals. Thus, as a result, many abused older adults suffer in silence, making it extremely challenging to estimate and eliminate abuse cases against older adults.

older lesbian coupleEvery year, approximately 4 million older Americans are victims of elder abuse. Additionally, for every case of elder abuse and neglect reported, researchers estimate that as many as 23 cases are unreported. The quality of life for older adults who experience abuse is significantly altered.

They often experience decreased functional and financial status as well as increased dependency, poor self-rated health, feelings of helplessness and isolation and psychological stress. Older individuals who have been abused also have a lower life expectancy than those who have not been abused even in the absence of chronic conditions or life-threatening illnesses.

Shari Brotman, Bill Ryan and Robert Cormier from the McGill School of Social Work wrote an article exploring the experience and realities of gay and lesbian seniors and their families in accessing a broad range of health and social services in the community. It recommends that older lesbian and gay individuals would benefit from homophobia being included in the definition of elder abuse. Also, the article articulates the definition of elder abuse should be expanded to include sexual harassment based on sexual orientation. Individuals often experience intimidation, harassment, humiliation, or shame as a result of identifying as an older lesbian and gay individual, and this discrimination is heightened in elderly individuals living in long-term care facilities.

Lesbian and gay individuals, especially lesbian and gay seniors, have a long history of discrimination and marginalization as a result of identifying as a lesbian or gay individual. Incorporating homophobia into the definition of elder abuse would greatly benefit older adults as it would help them to be further integrated in society instead valued based on their sexual orientation. It would also introduce freedom of harassment and/or reduce injury when sexual orientation is seen as a right.

Although there is a need to include homophobia in the definition of elder abuse, there currently is not a well-developed universal definition of elder abuse. Stigma is embedded within identifying as a lesbian and gay individual but also with being an aging individual.

Therefore, before this policy change can occur, a universal definition of elder abuse should be developed. Policy makers should also consider incorporating ageism as well as oppression against LGBTTQ seniors in the definition of elder abuse as well.

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.

Power of Older Adults vs. the Supreme Court Hobby Lobby Decision

What century is this? I have been obsessed lately with the retrograde decision made by the Supreme Court in the Hobby Lobby case. Not only is it an outstanding example of the ongoing abasement of women and women’s health needs, it is a blow to the entire concept of democracy. This decision rips the fabric of our Constitution’s Establishment Clause and the division between church and state that this country was founded on. Additionally, it represents the continuation of the constant humiliation and oppression of over half of this country’s citizens.

images (51)The Hobby Lobby decision also reintroduces the antediluvian concept of women as children unable to make decisions about our own bodies. Not since the abolition of slavery have men had the right to own women’s bodies. Yet the men who serve on our country”s highest court and who voted to allow the erosion of our constitution, are determined to take us back to a very dark time in history and many people don’t understand why?

Perhaps, the most perverse dimension of this decision is that it gives control of our bodies to corporations. The thought of it makes me want to throw up! If this isn’t a call for single payer health insurance, I can’t think of an another example that so clearly illustrates why the concept of health insurance being tied to ones employment is no longer a viable option. In this age of technology, international commerce, and the rise in freelance and “permalance” employment, it is an arrangement that has seen its time. (“Permalance” is a vehicle used by employers who do not want to provide benefits, including healthcare, at all.) Now, added to this is the privilege given to employers by our Supreme Court to be able to determine the healthcare needs of their employees.

Several of my friends and acquaintances have asked me, “what can we do?” The expected outcry against this violation of human rights is from women of child bearing age. And, they should be screaming from the rooftops. We, as aging boomers and seniors, need to use our voices too. More important, however, is using our right to vote while we still have it to demonstrate how disgusted we are with those in power who would like us to be irrelevant. Seniors, both men and women, represent the highest voting demographic in the United States. We need to leverage this statistic wisely.

Our uteruses may no longer be fertile. Our minds, however, are more fertile than ever before. We now possess years of accumulated wisdom, and it is our responsibility to share. This, along with our determination as voters, enables us to exhibit a strength and power that we have shown before…during the Civil Rights Movement, the Feminist Movement (We did do that once, didn’t we?), the Anti-War Movement, and the Gay Rights Movement. We started those movements in the 60’s, and now we are in our sixties. We can’t quit now. If we want our daughters and granddaughters to know that they have to be vigilant in order to be free, we need to lead by example. How? First, by using our voices, and second by using our vote. Or, maybe it’s the other way around.

Yes, we are stuck with this Supreme Court shaped by George W. Bush during his second term in office which doesn’t mean that the tide of public opinion evidenced by who we vote for will not have a role to play as we move forward. As social workers, citizens, and long time members of our society, our individual and collective consciences demand we lead the way. We are not divested of our responsibility to society as we grow older; it’s the other way around. By virtue of our lives lived, the experiences we’ve had, and the wisdom we have gathered, it is incumbent upon us to take a leading role when speaking up for social injustices wherever we see them.

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

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