Older People Are Happy?

As we've been learning throughout these blog posts, there is a huge stigma against older adults in our culture. Due to their age, many older individuals are unable to hold a job, are ignored, and are unable to receive the mental health services that they need. While many of these aspects are true for the older generations, this TED Talk provides compelling evidence that older adults might not be as unhappy as we perceive them to be... Take a look!

Food For Thought:

Did this information surprise you? Why or why not?

How does this evidence change the way in which we (as helping professionals) can advocate for this generation?

Fighting Ageism

After reading through our blog, you should probably have an understanding of what ageism is and how it can impact older adults (especially with regards to their mental health). But now, what can we do about this? Now obviously, the biggest way to enact change is through our legislative process and the creation of policies that benefit aging individuals. However, we all can also make changes in our personal lives to help fight against ageism. Making these kinds of changes is something that we can do here and now to impact the people in your own life. Be an example to others and help turn others away from perpetuating ageism.

Here are some practical ways to fight ageism that you can integrate into your life and way of thinking right now (these tips were pulled from a brochure from the Nash County Aging Department in Nashville, TN):

• Educate yourself and others about the aging process
• Get the facts on aging to combat stereotypes and myths about aging
• Teach children the concept of the life cycle with positive images of old age
• Accept aging as a natural part of life
• "Do no resent growing old. Many are denied the privilege." -Unknown

• Challenge yourself to recognize ageism in the things you say and do, then change your language and your actions
• Take notice of the advertisements you see and question why older adults are not represented
• Recognize ageist jokes and avoid using them
• "Be kind, for everyone you meet is fighting a hard battle." -Plato

For this information and more, check out: http://ssw.unc.edu/cares/sfc/ageism%20brochure.pdf

http://www.fightageism.net/#&panel1-1

The Commercial Said They Offered Therapy...

I have been seeing a television commercial for Brookdale Senior Living a lot recently.  (If you would like to watch it, please click on this link:  https://www.youtube.com/user/BrookdaleLiving).  At the conclusion of the commercial, a list of offered services pops up, and I was so excited to see "Therapy" included!  I decided to visit their website to explore a bit more, and I discovered that they provide three types of therapies to older adults who reside in their communities: 1) Rehabilitation, 2) Fitness, and 3) Education.  The webpage that denotes these types of therapies, originally listed as "Therapy" in the commercial and on the homepage (http://www.brookdaleliving.com/  -- Hover the mouse over "Senior Living Solutions" to see what I'm talking about), is actually entitled "Therapy & Rehabilitation" (See here: http://www.brookdaleliving.com/therapy-and-rehabilitation.aspx).  If I were providing care for my grandmother who suffered from Depression, Bipolar Disorder, or another mental health diagnosis, I would run to find the necessary support that I thought could be provided in a setting tailor-made with multiple types of therapies. 

Brookdale defines "Education Therapy" as a way their residents can learn more about aging healthily while also supporting their peers in the aging process.  It seems to me that this would be the perfect place to slip in some psychoeducation along with a therapist who specializes in older adult experiences with mental health.  This brings us full circle back to our blog post about Medicare.  Brookdale, and many other senior living facilities, accepts Medicare coverage.  Their website has a full breakdown of Parts A and B.  If you recall from our blog post (or you can view their page: http://www.brookdaleliving.com/medicare.aspx), Medicare Part B covers mental health concerns.  Education Therapy provides a good framework for mental health services, or talk therapy.  As my classmates and I have noted throughout our blog, there is a severe lack of specifically-trained therapists, facilities, and appropriate services available to the aging population.  Despite my initial disappointment, Brookdale appears to offer a small glimpse of hope towards the potential for future assistance. 

Eradicating Barriers

As discussed in earlier posts, the aging population faces an array of barriers when needing mental health services. For instance, Bartels (2003) discovered that although an overwhelming majority of older adults prefer to receive services either at home or in their local community, the current healthcare system is geared more towards providing services for this population in a hospital-type setting. Moreover, the majority of Medicare funds are meant for long-term stays in institutional care, such as nursing homes, but it is important to note that there is only a small percentage of older adults living in nursing homes (Bartels, 2003; R. Smith, personal communication, June 16, 2014).  Furthermore, Bartels (2003) uncovered another major barrier facing the aging population: fragmented care. Older adults are receiving care from multiple institutions, which is not time or cost-efficient for any of the parties involved.  In addition, this fragmentation of care may result in client falling through the cracks of care.

With these issues hindering this population from receiving the adequate care they need, I still consider the lack of cultural sensitivity and stigma surrounding mental illness to be among the biggest failings of the systems of care for older adults.  Many in the aging population will not seek services because American society views those with mental illness as being “weak” or “defective”. This cultural oppression means that shame often stops older adults from getting the mental health services needed to improve their quality of life.  Further, when these individuals do receive services, it raises another question of whether or not helping professionals have a high enough standard for cultural competence.  The Baby Boomers are a diverse population, thus the needs of older generations will continue to become more and more varied (R. Smith, personal communication, June 16, 2014).  So, you might ask: how do we go about eliminating the stigma surrounding mental illness while also increasing the cultural competence in helping professionals?  The first step is education!

Most helping professionals are required to take continuing education classes in order to stay current on social issues and increase their awareness of the role of helping professionals in the world. Thus, I suggest, on a policy level, that it be a requirement that at least one of those courses be focused on serving older adults. Moreover, relevant Public Service Announcements (PSA) that educate the general population about mental illnesses in the aging population could had a wide-reaching impact through means of commercials and billboards. In addition, fostering relationships between healthcare and social agencies allows a more integrative approach for reducing stigma and increasing awareness of unique barriers facing older adults from differing cultural backgrounds. 

Also, please remember: EVERYONE has a part to play in improving the aging population's quality of life.  Educate your friends, family, and colleagues about the powerful influence of words so that the language we use can be used to encourage  rather than perpetuate stigmas that bring about shame! 

image retrieved from 

http://www.co.shasta.ca.us/index/hhsa_index/mental_wellness/Communityeducationcommittee.aspx

Interested in taking some low-cost, easy access online classes to increase your skills when working with the aging population?  Check out this website, which offers CEUs focused on issues in aging: http://www.freestatesocialwork.com/?cat=5

References

Bartels, S. J. (2003). Improving the United States' system of care for older adults with mental illness: Findings and recommendations for the president's new freedom commission on mental health. American Journal of Geriatric Psychiatry, 11(5), 486-497.

Aging in a Youth Focused Society

The following video depicts a lovely couple, Richard and Alice, who chose to confront their aging process head on, and confront the fear and anxiety that it brings.

In today's society, youth does appear to be valued much more than older age, and that in itself can bring on depression and anxiety for the older adult.

This couple's beautiful story is truly inspiring!

Barriers to Treatment

As we've discussed, ageism greatly impacts the treatment that an older adult faces in seeking treatment for a mental health condition.

However, what are some of the other barriers that are keeping the older population from receiving vital services?  Here are some of the most common:

 

Overuse of institutions

Limited access to services

Uneven service quality in both institutions and the community

Very limited integration of mental health, health, and aging services

Very limited capacity to serve cultural minorities

Lack of adequate family support

Stigma, ageism, and ignorance about mental illness and its treatment

Workforce shortages

Vast financing problems – both of amount and of structure

Lack of readiness to meet the mental health challenges of the coming elder boom

Part of the challenge to the social work community will be to continue to advocate for a better integration of aging services and mental health services.  Expanded training programs for practitioners who want to serve the older population can help with both the issue of ageism and the issue of workforce shortages.  Also, I would suggest specialized training for staff in every institution.  Residents in nursing homes often have higher rates of depression, and staff are ill prepared to deal with the issues.

Where did all the programs go?

Seven Counties Services, Our Lady of Peace, and Norton’s Hospital are big names in the mental health field in Louisville, Kentucky.  Each institution is well-known for their psychiatric and clinical work in the community, but it may be lesser known that these companies at one time had programs that provided clinical services to the aging population.  But, why did these programs shut down when there is such a great need for this niche in mental health services?  The situations in which each institution closed their respective programs is not cookie-cutter, but there is one thing they have in common: lack of money (R. Smith, personal communication, June 16, 2014). 

The low reimbursement from Medicare does not give much income to such programs, and many older adults cannot afford services on their own dime.  Our Lady of Peace’s geriatric program was suddenly closed a little over two and a half years ago, leaving behind only a general adult mental health services unit that could serve the aging population.  However, adult mental health services does not comprehensively taken into consideration the unique position individuals in late adulthood operate.  With the aging population, there are likely confounding age-related physical health disabilities and problems that require special attention such as, helping professionals realizing the interactions between psychotropic medications and other medicines for physical ailments.  Furthermore, when Norton’s Hospital Landis Geriatric Psychology Center was closed, the University of Louisville Hospital stepped up to meet the need of this population by opening a similar unit with 20 beds and target population of older adults with psychiatric and behavioral concerns (Gordon, 2004).  Nevertheless, lack of funding and inadequate reimbursement from Medicare results in heavy financial pressures that often keep the remaining gerontology psychiatric units at capacity and understaffed (R. Smith, personal communication, June 16, 2014). 

What has happened and is still happening to psychiatric units for older adults in Louisville, Kentucky can be seen throughout the United States.  Professional social workers need to get out in their communities and advocate for improved mental health services for this population! On a national level, helping professionals can offer their support to the Positive Aging Act.  This bill has a long list of well-known, well-respected organizational supporters such as, the American Association on Aging, Gerontological Society of America, Alliance for Aging Research, American Association for Marriage and Family Therapy, etc. (American Psychological Association, 2013).  The Positive Aging Act seeks to improve the quality of the aging population’s mental health by requiring more mental health screenings, accessible and appropriate referrals and consultations, and additional grants for community-based mental health treatment facilities and researchers (American Association of Geriatric Psychiatry, 2012).  Read more about the bill at http://thomas.loc.gov/cgi-bin/query/z?c113:S.1119:

Above image retrieved from http://allianceonaging.org/advocate/

References

American Association of Geriatric Psychiatry. (2012). Positive Aging Act fact sheet. Retrieved from http://www.aagponline.org/index.php?src=gendocs&ref=FactSheetPositiveAgingAct&category=Advocacy

American Psychological Association. (2013). Positive Aging Act of 2013. Retrieved from https://www.apa.org/about/gr/pi/news/2013/positive-aging.aspx

J., Gordon. (2004). University Hospital opens geriatric psychiatry unit. Retrieved from http://www.bizjournals.com/louisville/stories/2004/06/14/story6.html?page=all

The Sandwich Generation

When it comes to thinking about how to best care for the aging population, we must also take into consideration the issues that their caretakers deal with and how to best support their needs as well. Sandwich generation caregivers have been on the rise over the past 2 decades and its about time that we give them some more attention and resources to deal with the challenges that come with this dual role lifestyle.

According to an article from the Huffington Post, about 1 in 7 middle-aged adults provides financial care to both their children as well as their aging parents (Dolgen, 25 July 2013). Dolgen states that this is not all that surprising considering the following: "While young workers are buried with student loan debt and low wages, the elderly face dual challenges in record-high life expectancy rates and declining retirement savings" (25 July 2013). And on top of this, roughly 40% of middle-aged adults report that both their grown children and aging parents rely on them for emotional support (Dolgen, 25 July 2013). Having to be the emotional and financial rock of the family can be a huge burden and creates a lot of added stress for these caregivers. It is important that this particular population doesn't experience burn-out because they are some of the front lines in caring for the older adults. That's why it is so important for us as social workers and clinicians to understand the issues and stressors for sandwich generation caregivers so we can give them the proper resources and support they need to care for the older adults in their lives.

Here are a couple of graphs that help give visualization to some of the statistics of the Sandwich Generation.









 

For more information regarding the general profile of sandwich generation caretakers, take a look at this article: http://www.pewsocialtrends.org/2013/01/30/the-sandwich-generation/


July is Sandwich Generation Month, so this is a perfect time to be doing a post on this particular subject. I came across another blog on aplaceformom.com where there was a post on "Honoring Caregivers" as a result of it being Sandwich Generation Month. The blogger, Stevenson, posted a few tips on how to ease caregiver burden that I wanted to share on here:

Tips to Ease the Caregiving Burden

Financially and emotionally, being a Sandwich Generation caregiver can be a source of strain, despite the intangible rewards. So what can caregivers do to manage their time, relationships and budget? Here are a few tips from the experts:
1. Hold family meetings.
Caregiving doesn’t have to be a one-person show. Today’s Caregiver magazine suggests splitting up the task list each week so everyone is clear on expectations and what needs to be accomplished. Setting an action plan for the future can really help, too, says Kiplinger.com — especially if there are prospective financial challenges to manage, such as selling an elderly parent’s house.
2. Ask for professional assistance.
Resources such as a local social worker, the Area Agency on Aging, or the U.S. Health and Human Services website, LongTermCare.gov, can help you figure out the logistics of caring for children and senior parents at the same time. Similarly, Kiplinger suggests getting in touch with a financial planner or accountant to figure out the realities of your budget. Doing this ahead of time, if you anticipate needing to care for elderly parents, can help fend off monetary difficulties down the road.
3. Plan ahead with your kids.
The Kiplinger website suggests getting children into the savings habit early. For adult children, they should make sure to contribute to a retirement plan, even if they are still relying on some support from you. When kids have to move back home, it can be difficult to think about charging them rent, but setting financial boundaries is key to managing a multigenerational household budget. Of course, an emergency is a different story, but if your children need long-term support, it’s time for another family meeting!
4. Don’t forget to care for yourself.
Caring for the caregiver is critical — staying healthy, eating right and getting enough rest means you’ll be in tip-top shape to care for your loved ones at home. But don’t be afraid to slow down, either, if your body is clamoring for a break. See a health care professional or look into a few days of respite care to enable yourself to recuperate.

References

Dolgen, E. (25 July 2013). The Sandwich Generation: Caring for Children and Parents. Retrieved from http://www.huffingtonpost.com/ellen-sarver-dolgen/the-sandwich-generation_b_3636774.html

Parker, K & Patten, E. (30 January 2013). The Sandwich Generation: Rising Financial Burdens for Middle-Aged Americans. Retrieved from http://www.pewsocialtrends.org/2013/01/30/the-sandwich-generation/

Stevenson, S. (1 July 2014). Honoring Caregivers: July is Sandwich Generation Month. Retrieved from http://www.aplaceformom.com/blog/2013-07-02-honoring-caregivers-sandwich-generation-month/