“It is suggested that the elderly themselves have
bought into an elderly mystique which holds that the potentials for growth,
development, and continuing engagement virtually disappear when disabled. The energy of formal and informal providers
is directed toward maintaining activities of daily living and keeping the
elderly person out of a nursing home. This
results in a perception of little or no choice by the elderly themselves, and
hence diminished exercise of autonomy.”
–Elias S. Cohen, JD, “The Elderly Mystique: Constraints on the Autonomy of the Elderly with Disabilities,” The Gerontologist (June 1988).
Many
older adults avoid association with disability, fearing stigma that may take
away their autonomy so they end up institutionalized. Yet individuals age 85 and older are at
highest risk for disease and disability. As a gerontologist advocating for
community living, I look to disability culture for inspiration: strength, wellness, peer support, community integration, full
participation, resilience, choice, access, independent living, etc.
One
of the most aging + disability friendly places is our San Francisco Public
Library, which hosted many forums for aging + disability community engagement
this month! Access Services Librarian Marti Goddard organized a series of ADA
Legal Assistance to the Elderly (LAE) housing
attorney Tom Drohan (bearded man in photo above; also appeared as rock star
bassist in earlier
blog post) presented on Reasonable
Accommodations in Housing for People With Psychiatric and/or Developmental
Disabilities, a public awareness seminar hosted by People With Disabilities
Foundation at Koret Auditorium. Tom mentioned how LAE provides accommodations to meet clients where they are, including making home visits,
providing communication access, and collaborating with support services.
We
were treated to performances by Dance Generators,
an intergenerational dance company based out of University of San Francisco (USF)
MC
Mary Twomey said they were not able to get Tony Bennett and the pianist was
delayed, so she gave us Rat Packer Sammy Davis, Jr. singing a cappella with the audience: “San Francisco
Family
Service Agency’s Senior Services Director Cathy Spensley talked about friendly San Francisco joining the WHO Network of Age-Friendly Cities and AARP’s Livable Communities last year.
Keynote
speaker John Feather, CEO of Grantmakers in Aging,
pointed out that the aging of America is permanent because Millennials
(those born after 1985) are now the largest generation in U.S.
When he said he liked slide photo of a person hunched over in wheelchair
using a long-handled cultivator on dirt ground, Joanna Fraguli of Mayor’s
Office on Disability took exception to this “one size fits all” and
suggested raised-bed garden + paved pathway might be more accessible to wheelchair users. Combating ageism +
ableism are necessary to making San Francisco
Next,
audience broke out into small groups to Imagine an Aging and Disability
Friendly San Francisco in the following areas: Technology, Social
Participation, Housing, and Health & Long Term Supports. I chose housing, which is so essential to
aging in place. My action idea to
improve housing was to offer tax incentives for developers to build healthy
homes free of harmful chemicals, based on Ecology House model (mentioned in my blog post last month).
Still fresh in
my mind was the prior evening’s panel discussion on Chemicals Without Harm by Ken
Geiser. As part of Breast Cancer Awareness Month, Campaign for
Safe Cosmetics launched its latest campaign, Anti-Aging
Secrets Exposed: Chemical Linked to Breast Cancer Found in Skin Care,
which reports three
anti-aging creams from household name brands contain PFOA, a toxic chemical
linked to cancer. In this case, anti-aging = anti-health. The
proposed Federal Personal
Care Products Safety Act (S.
1014) would expand FDA authority over cosmetics.
Community
Living Campaign Director Marie Jobling talked about bridging the digital divide
to reduce isolation through SF Connected initiative providing free computer classes and Internet Essentials Senior Pilot
Program providing low-cost internet ($9.99 per month) + low-cost computer
($149.99) for seniors at least 62 years old who receive state and/or federal
assistance.
Mary
continued to engage us with Rap Along!: “LTCCC
making San Francisco
On
behalf of San Francisco Municipal Transportation Authority, Board Chairman Tom Nolan
accepted Friendly SF Champion Award for establishing Free Muni for low and
moderate-income seniors and people with disabilities!
In SF Examiner's “Being older in a youthful San Francisco”, Boomer Sally Stephens wrote about how San
Francisco is being planned by millennials for people in their 20s and 30s,
without taking a long-range view for older San Franciscans in areas like
restricting cars in favor of bikes, consolidating bus stops for faster transit
– and I would add this is done without looking out for persons with
disabilities with similar concerns about getting around.
San
Francisco Sheriff’s Department presented Senior
Summit to address the unique health and social needs of San Francisco
- Dr.
Brie Williams, UCSF geriatrician and founding Director of UC Criminal Justice & Health Consortium, talked about her recent visit to Norway where motivational interviewing is used to improve offenders’ re-entry into the
community as “better neighbors.” She
also suggested a “therapeutic environment” for prisoners, like the humane prisons of
- Frank Williams,
Director of the Senior Ex-Offender Program (SEOP) at Bayview Hunters Point Multipurpose Senior Services, Inc., explained
that SEOP concept in 2002 came from Elderly Ex-Offender Program developed
by late George Davis while he was working on his dissertation at SFSU, but
“Elderly” replaced with “Senior” denoting a “higher rank.”
- Tanya Mera, LCSW,
Director of Jail Behavioral Health and Reentry Services (JBHRS), talked
about need to improve system of care for geriatric inmates.
- Jeffrey Washington, 57-year-old (considered “elderly” at age 55 because age-related health problems occur early in life for prisoners), shared his experience of being released from SF County Jail and linked to case management with SEOP, which led him to employment at Goodwill and studying to be an alcohol and drug counselor at City College of San Francisco.
- Steve Good, Executive
Director of
Prisoners of Age at Alcatraz exhibition: “You see the frailty, the forgetfullness, the universal
problems of old age."
Back to school
SFSU Gerontology Celebration honored Professor Brian De
Vries, who will begin FERP (Faculty Early Retirement Program),
phased retirement that allows him to continue teaching part-time. Center for Age-Friendly Excellence (CfAFE) Program Director and Professor Anabel Pelham, who began her FERP two years ago, got everyone chuckling when she recalled
someone suggesting that she marry Brian to help resolve his problems with immigrating
from Canada
In
appreciation, Brian got a standing ovation and chocolate cake! I actually had
to stand in line to personally thank him for inspiring me with his scholarship
and commitment to social justice, plus chocolates in his office! While
Brian’s position as policy advisor to AARP is drawing to a close after 5 years,
he recently joined a committee of the American
Association of Medical Colleges working to ensure inclusion of sexual
minorities in medical school curriculum.
USF
School of Nursing and Health Director Kathy Raffel moderated a discussion on Improving Care at Home: Challenges and Opportunities at Fromm Institute of Lifelong Learning.
- Family Caregiver Alliance Executive Director Kathy Kelly talked about expectations of unpaid
caregivers are greater now and growing due to increased life expectancy,
increased complexity in health care and costs (now done in home), more
women in workforce, and decreased number and sizes of families.
- San Francisco IHSS Public Authority Executive Director Kelly Dearman talked about independent
living movement’s influence in starting consumer-directed IHSS in 1973. Today 22,014 low-income seniors and adults with disabilities in San Francisco are served by IHSS workers (majority family and friends) who earn $12.25
per hour minimum wage, with overtime under FLSA effective November 12,
2015. Starting January 2016, SF
IHSS Public Authority will require 48 hours of basic training for caregivers through Homebridge.
California hospitals required to keep caregivers in the loop
ReplyDeleteBy Anna Gorman, Kaiser Health News
POSTED: 12/27/15, 5:37 PM PST
…California SB 675, which goes into effect in January, requires hospital staffers to involve a family caregiver during the hospitalization and discharge process, which supporters say will improve patients’ overall health and reduce their chances of readmission.
…A new California law, SB 675, requires hospital staffers to involve a family caregiver during the hospitalization and discharge process, which supporters say will improve patients’ overall health and reduce their chances of readmission.
The law, sponsored by state Sen. Carol Liu, (D-La Cañada Flintridge) mandates that hospitals give patients an opportunity to identify a caregiver; notify that caregiver when the patient is to be discharged; and provide information and instruction on the patient’s needs and medications following the hospitalization. Hospitals still must follow privacy laws and aren’t required to release information if the patient doesn’t give consent.
California is one of 18 states to pass such laws during the past two years; other states including Arkansas, New Hampshire, Oregon and Virginia have similar laws. It’s part of a growing awareness among policymakers and legislators that family caregivers play an important role during and after a patient’s hospitalization.
How hospitals communicate with caregivers is expected to become more important as the population ages and the number of unpaid family caregivers continues to increase. An estimated 40 million Americans have cared for a relative during the past year, according to a 2015 study by the National Alliance for Caregiving and AARP.
The changes are largely being driven by AARP, which is leading a campaign to reduce barriers for family caregivers. The impetus comes from the organization’s 2012 survey, which found that 46 percent of caregivers perform medical tasks such as giving injections, most without any training or guidance from medical professionals. AARP crafted model legislation known as the Caregiver Advise, Record, Enable Act — or CARE — and is promoting it around the nation.
Elaine Ryan, AARP’s vice president of state advocacy and strategy, said the legislation is designed to improve caregivers’ competency and give them peace of mind.
“A piece of paper can’t really educate people how to fill a syringe or clean a PICC line,” Ryan said, referring to a catheter inserted into a vein in a patient’s arm. The laws “make sure that family caregivers have all the information they need to safely care for their loved one at home.”
…Around the country, however, some hospital associations say their members already include caregivers in the discharge planning process and that adding specific requirements only adds more work. At the same time, hospitals are facing increased pressure from the Centers for Medicare & Medicaid Services to keep patients from being readmitted, and some recognize that improving communication with family caregivers can’t hurt….
Currently, hospital staff members often make incorrect assumptions about who the caregivers are or how much they know, said Donna Benton, associate research professor of gerontology at the University of Southern California. They send people home without knowing whether food is in the house or if the patient has someone to get their medication or bring them to a follow-up appointment.
“This is a very important bill,” said Benton, co-director of the Los Angeles Caregiver Resource Center. “This really puts the pressure on the hospital to actually identify the caregiver and try to meet with them according to their schedule.”
http://www.dailynews.com/health/20151227/california-hospitals-required-to-keep-caregivers-in-the-loop
Aging in Place
ReplyDeleteBy JANE E. BRODY
May 2, 2016 5:45 am 124
…I suspect that most people are reluctant to think about changing where and how they live as long as they are managing well at the moment. Lisa Selin Davis reports in AARP magazine that “almost 90 percent of Americans 65 or older plan to stay in their homes as they age.” Yet for many, the design of their homes and communities does not suit older adults who lack the mobility, agility and swiftness of the young.
For those who wish to age in place, the authors of “70Candles: Women Thriving in Their 8th Decade,” Jane Giddan and Ellen Cole, list such often-needed home attributes as an absence of stairs, wide doorways to accommodate a walker or wheelchair, slip-resistant floors, lever-style door knobs, remotely controlled lighting, walk-in showers, railings, ramps and lifts. Add to these a 24-hour help system, mobile phone, surveillance cameras and GPS locaters that enable family members to monitor the well-being of their elders.
In many communities, volunteer organizations, like Good Neighbors of Park Slope in Brooklyn and Staying in Place in Woodstock, N.Y., help older residents remain in their homes and live easier and more fulfilling lives.
…growing number of empty-nested retirees are now moving to city centers where they can access public transportation, shop on foot for food and household needs, and enjoy cultural offerings and friendly gatherings without depending unduly on others.
One reason my friends and I are unwilling to even consider leaving our Brooklyn community is our ability to walk…and get virtually everywhere in the city with low-cost and usually highly efficient public transportation. No driving necessary.
…Throughout the country, communities are being retrofitted to accommodate the tsunami of elders expected to live there as baby boomers age. Changes like altering traffic signals and street crossings to give pedestrians more time to cross enhance safety for people whose mobility is compromised. New York City, for example, has created Aging Improvement Districts,…to help older people “live as independently and engaged in the city as possible,” Ms. Giddan and Ms. Cole wrote. In East Harlem, for example, merchants have made signs easier to read and provided folding chairs for seniors who wish to rest before and after shopping.
In Philadelphia, a nonprofit organization, Friends in the City, calls itself a “community without walls” designed to bring members closer to the city’s resources and to one another. It offers seniors a daily variety of programs to suit many cultural and recreational interests.
Also evolving is the concept of home sharing, in which several older people who did not necessarily know one another get together to buy a home in which to live and share responsibilities for shopping, cooking, cleaning and home repair. For example, in Oregon, Let’s Share Housing, and in Vermont, Home Share Now, have online services that connect people with similar needs, Ms. Giddan and Ms. Cole report…
http://well.blogs.nytimes.com/2016/05/02/aging-in-place/
THE PHOENIX PROJECT: FINDING OUR BEAUTY IN OLDER AGE
ReplyDelete6/09/2016
ELLEN SIMON
…“The Phoenix Project” is the work of NYC-based dance organization Dances for a Variable Population. DVP artistic director Naomi Goldberg Haas says her work is focused on the ways that older bodies can use memory, expectation and power to reveal the surprising beauty of age.
Dance is a physical language — its moves and gestures embody attitudes, ideas and feelings. No surprise, then, that the way “Phoenix Project” dancers talk about dance can sound like a philosophy on aging. These “legends,” as Haas refers to them, have been using their bodies to express themselves, even as they’ve physically changed over the years. They’ve had not only to keep themselves in shape but also to live in the moment, accept limitations and creatively adapt — a lesson for us all.
“I tell people, you can’t get frustrated over something you can’t do,” says Rita Carrington. The retired executive director of the Central Harlem Senior Center, Carrington is one of three accomplished amateur dancers who were invited to participate in the project. “If there’s something you can’t do, put something else in its place.”
Dances for a Variable Population’s free year-round programming, called Movement Speaks, puts younger dance professionals together with older non-dancers for weekly workshops, culminating in performances. The Movement Speaks participants are the corps de ballet for the “Phoenix Project” performances.
Over the past several months, Haas has been working with the senior dance legends on the project, which is informed by where the members are in their lives and inspired by their creative impulses. “We approach everything with an awareness of celebrating age, celebrating the beauty of age,” she says. “This year we were thinking, where is the beauty?”
The participants looked for beauty inside older people as well as at the locations where they’d be performing: a Queens community, the Hudson River and the New York Botanical Garden.
Older Dancers — Living in the Moment
…Alice Teirstein, 87, who has been a choreographer, artistic director and teacher in New York since the 1970s…
“I’m beginning to realize there are some limitations,” says Teirstein, who takes a daily class. At the barre recently, “things didn’t move the way I wanted them to. I called my son and said, ‘I didn’t know it would happen so suddenly.’”
But the next day, the movement was back.
…Jim May, 72, is artistic director of the Sokolow Theatre Dance Ensemble…become a better dancer with age. “I’ve now clarified what I want to do as a dancer. I did ballet. Then I did Broadway. Now I do me.”
“Age forces them to really expose who they are. Age makes you more who you are,” Haas says.
We asked Haas whether working with these older dancers has changed the way that the younger company members see themselves and what lies ahead. “For the younger dancers,” she says, “It’s really an experience of how to be more. Just how to be more.… They have to really absorb who they are as performers, as human beings. Through the process of working on the piece with these older dancers, they become better. They become better performers in all ways. There’s an essence in performing that is something an older dancer really understands. The seniors in our Movement Speaks program are also really learning that.”
George Faison, 70, a former Alvin Ailey dancer who won a Tony Award winner for his choreography of “The Wiz,” choreographed a section of the “Phoenix Project” to “Everything’s Coming up Roses.”
“You watch the youth and say, ‘I’ve done that,’” Faison says. “The value of older people is the history, the legacy they carry. Movement is our gateway. It’s great that we dance together. This is a way to being younger, living longer, being happy.”
“Dancing together, you communicate without really saying anything,” he says.
http://seniorplanet.org/what-is-beauty-in-older-age/
As world grays, seniors step up to create an 'age-friendly' future
ReplyDeleteSara Miller Llana
JANUARY 2, 2017 MANCHESTER, ENGLAND
By 2020, for the first time, there will be more people on earth age 60 or older than under age 5. By midcentury, the World Health Organization (WHO) estimates that 2 billion people – 22 percent of the global population – will be 60 or older, up from 900 million today.
…says Mr. Irving…key to the future is “purposeful aging” that empowers older people themselves as the agents of change.
…In Manchester, older people are volunteers and cultural champions. They oversee urban planning and sit on an advisory board that examines city policies through the eyes of senior citizens. “Having older adults in decisionmaking roles ... means the community is able to draw on their skills and experience,” says Ms. Officer.
…The “graffiti grannies” have not stopped with spray paint. After shopkeepers denied an older man who uses a wheelchair access to the bathroom – he ended up wetting himself – the group launched the “Caught Short” campaign. Some of them in their 80s, they knocked on dozens of shop doors and asked who would say “no” next time. Then they published and handed out a leaflet, essentially a “where-to-go” guide, complete with information about wheelchair accessibility.
“These are tiny little things,” says Natalie Turner, senior program manager for Localities at the Center for Aging Better in London. “But it makes a big difference. It is the difference between having people [get] out, and having to stay home.”
…If older people do not find it easier to engage in their communities and stay active, they will end up more dependent, and more expensive, argues Turner. “We need to keep them employed, volunteering, caregiving,” she adds. “We need them.”
Developed Western countries are focusing mostly on aging cities. The government in China is more concerned by an aging countryside.
...“There’s often a perception that older people are vulnerable, frail, and irrelevant to what happens to young people, but we know that in reality the lives of older and younger people are closely linked – there is a skills and knowledge transfer there that needs to happen for society to function,” says Isabella Aboderin, a senior research scientist at the African Population and Health Research Center in Nairobi, Kenya.
…UNICEF estimates that half of Africa’s 132 million orphans live with their grandparents.
…intergenerational living. Studies have shown that social isolation and loneliness among the elderly are killers; contact with younger people is good for their health.
…The idea for an intergenerational nursing home came from Gea Sijpkes, the Humanitas director, who was searching for solutions amid government cuts to both elderly care and student aid. She offered rent-free rooms in her care home to local students in return for 30 hours a month of being a “good neighbor.”
With people living longer, researchers are uncovering many upsides to cross-generation cooperation. “The wisdom and judgment and balance that come with age, combined with the energy and healthy risk-taking characteristics and creativity of youth, represents a really powerful opportunity for companies and countries,” says Irving, the expert on aging at the Milken Institute…
http://www.csmonitor.com/World/2017/0102/As-world-grays-seniors-step-up-to-create-an-age-friendly-future
Who Will Care for the Caregivers?
ReplyDeleteDhruv Khullar
JAN. 19, 2017
…According to AARP and the National Alliance for Caregiving, the typical family caregiver is a 49-year-old woman caring for an older relative — but nearly a quarter of caregivers are now millennials and are equally likely to be male or female. About one-third of caregivers have a full-time job, and 25 percent work part time. A third provide more than 21 hours of care per week. Family caregivers are, of course, generally unpaid, but the economic value of their care is estimated at $470 billion a year — roughly the annual American spending on Medicaid.
A recent report from the National Academies of Sciences, Engineering and Medicine suggests that society’s reliance on this “work force” — largely taken for granted — is unsustainable. While the demand for caregivers is growing because of longer life expectancies and more complex medical care, the supply is shrinking, a result of declining marriage rates, smaller family sizes and greater geographic separation. In 2015, there were seven potential family caregivers for every person over 80. By 2030, this ratio is expected to be four-to-one, and by 2050, there will be fewer than three potential caregivers for every older American.
This volunteer army is put at great financial risk. Sixty percent of those caring for older family members report having to reduce the number of hours they work, take a leave of absence or make other career changes…
Even worse, perhaps, is the physical and emotional toll of extended caregiving. Family caregivers are more likely to experience negative health effects like anxiety, depression and chronic disease…
As overworked and underappreciated as family caregivers are, health systems, under pressure to reduce costs, increasingly rely on them to manage illness at home.
…medical professionals can do to improve the way we engage, support and educate them. Family caregivers aren’t always clearly listed in the medical record, and even when they are, we often fail to include them in important decisions about a patient’s treatment plan — despite expecting them to carry out that plan at home. We assume they’re able to perform complex medical tasks — administering injections, changing catheters, dressing wounds, starting tube feeds — but fewer than half of family caregivers receive the training to perform them.
…several measures that could help. First, simply identify caregivers, assess their abilities and anticipate challenges they’re likely to encounter. The United Hospital Fund has developed a tool to understand caregivers’ existing home or work duties, as well as what training they’ll need to perform new caregiving tasks and any concerns they have about the treatment plan.
…counseling and support services …respite programs ... And clinicians could be trained in how best to educate family caregivers, and to better meet their emotional and physical needs…
Policy makers can help caregivers, too. More than 30 states have passed versions of the Caregiver Advise, Record, Enable (CARE) Act. The act requires hospitals to identify family caregivers, inform them when patients are being discharged, and provide them with basic education on the tasks they’ll be expected to perform. Other policy changes might strengthen financial support for caregivers by increasing the amount of available paid leave and encouraging employers to offer more flexible work hours.
Caregivers… speaking up about their needs, and asking for information on services available in their area. …support groups …government’s Eldercare Locator … local Area Agencies on Aging can help connect patients and caregivers to the services they need. Employers might consider “time-banking” programs to share leave among employees. And, of course, we can all call to check in on a caregiver, and volunteer our time to give them a break.
…while patients’ needs come first, illness is often a family affair.
https://www.nytimes.com/2017/01/19/upshot/who-will-care-for-the-caregivers.html
In search of age-friendly health care facilities: There’s plenty of room for improvement
ReplyDeleteBy Kaiser Health News Sep 19, 2019
Judith Graham
…For older adults, especially those who are frail, who have impaired cognition, or who have trouble seeing, hearing and moving around, health care facilities can be difficult to navigate and, occasionally, perilous.
Grab bars may not be placed where they’re needed. Doors may be too heavy to open easily. Chairs in waiting rooms may lack arms that someone can use to help them stand up.
Toilets may be too low to rise from easily. Examination tables may be too high to get onto. Lettering on signs may be too small to read. And there may not be a place to sit down while walking down a hallway if a break is needed.
“Most hospitals and clinics have been designed for 40- or 50-year-olds, not 70- or 80-year-olds,” said Dr. Lee Ann Lindquist, chief of geriatrics at Northwestern University’s Feinberg School of Medicine in Chicago. “Additional thought has to be given to seniors who have functional disabilities.”
What changes could be made to better accommodate older adults’ needs?...
Parking
Handicapped parking needs to be plentiful, clearly marked and as close as possible to entrances of hospitals and health care facilities. Valet parking should also be an option for seniors and handicapped patients/visitors to medical centers if possible.
…The University of Florida’s Senior Care Clinic has a solution: valet services…
Signage
All too often, easy-to-read signs indicating where patients should go can’t be found, either inside or outside medical centers. For older patients, this can lead to confusion and unnecessary wandering, accompanied by pain, fatigue and annoyance.
…Now, signs in the parking lot and outside the medical center are bigger, with larger type. Inside the medical center, large signs have been placed at bathrooms, showing clearly if they’re accessible to those with disabilities. And the staff is creating a comprehensive map of the hospital campus — a handout — to help patients find their way more easily…
Appointment cards …print phone numbers in large type on cards for seven geriatricians at its senior clinic.
Getting Around
…parking lots be on the same level as medical buildings and that sidewalks around facilities be kept in good shape to minimize older adults’ risk of falling.
…examination tables are wider than usual and their height can be adjusted electronically.
…Something as simple as having a hook to hang up a cane can be a thoughtful touch. “You see this a lot: An older patient sits down, there’s nowhere to put a cane, and it falls on the floor,” said Dr. Diana Anderson, a geriatric medicine fellow at the University of California-San Francisco, who’s also a board-certified architect.
Doors
Many patients are faced with doors that require manual operation instead of automatic open/close buttons, which impedes their access to medical facilities…
Seats
Ashkenaz has another pet peeve: chairs in waiting rooms with seats that are too low or without arms that she can grab to push herself up into a standing position.
…chairs that are 4 inches taller than usual, with arms, for older patients.
…exam rooms at the clinic are large enough to accommodate chairs for multiple family members...
https://chicago.suntimes.com/2019/9/19/20863766/age-friendly-health-care-needs-facilities-updating-handicapped-access