Where to start . . .

Breathe deeply and slowly. Just walking in the door can cause an onset of anxiety: You know the telephone message light is on indicating needs and wants of others; clients are lined up back-to-back; there’s a webinar you really need to view and you forgot your lunch on the kitchen counter. Stop, take a moment to slow down with intention, take a deep breath: It all, always, get’s done, and anxiety only stands in the way of mental functioning and reason.

Appreciate your colleagues’ gifts

Coworkers can sometimes seem to inhibit rather than encourage productive work flow; higher-ups seem to be unaware of the pressures of the job in the field. Resolve to look at your partners in the workforce through rose-colored glasses during 2012 (or at least in January!), embracing the idiosyncrasies and uniqueness of each. Benefit? Discovery of ways in which others really give to your organization, ways that they may serve as an additional resource to your work. Be kind to each other. Acknowledged: Sometimes here, too, a deep breath is required, but this exercise will both open up new doors to your understanding and enhance your daily experience on the job. I promise! See Christina Pesoli’s suggestions on ways to improve your coworkers view of you in her blog at http://austin.culturemap.com.

Organize!

I know, I know, we should all have the extra time to read through the piles of literature, information sheets and personal notations. I suggest to you that setting aside ten minutes a day to begin weeding through the papers is not an impossible request. You’ll find rather quickly that much of the pile can be tossed as it has already become obsolete. Other items are in the pile for reasons you can no longer remember. Still more sheets of paper seem to have little to do with anything now relevant. Just like at home, simply starting the process of organizing your space wields such a good feeling, you’ll wonder why you don’t do it more often. Remember this in March when the pile begins to grow again. The blog www.Unclutter.com can get you started.

Treat yourself like a client

As I sit across the desk from an anxious couple with a multitude of issues to be sorted and addressed, my intention is to actively listen, cut through the emotion and seek the most urgent matters needing attention. How about the empty chair exercise? Why, really, has this coworker exchange left me angry? What are the things I must accomplish before day’s end (recording client notes) and what can wait (logging onto my email box yet again)? If I assure my clients that their well-being is my goal, does it make sense that I cannot direct the same within? As Glinda, the Good Witch, advises: Dorothy has the power within her all along. Read the Chicago Bridge Blog article “Self Care Made Simple EvenThough We Know It Isn’t” for additional information

Resolve to be a better student

Consider monthly, or more often if time allows, to learn something new. Perhaps you need to improve your PowerPoint skills, or you can benefit by seeking education through lectures, webinars or workshops. Commitment to create and meet goals will not only improve self-discipline but may serve to enhance your engagement in your work, particulary when burn out is such a factor in the field of social work. Pick a target and get on it!

These suggestions merely scratch the surface in self-treatment as we look forward to a new year. On a personal note, we resolve to eat better, drink less and move more – perhaps these intentions have already fallen to the wayside and can use recharging (see Jenn Pedde’s graphic at for inspiration!). We spend approximately 2,080 hours a year at the workplace, and our vocation is both honorable and challenging in the best of times: Today’s world has most certainly made our work increasingly complicated, even disheartening from time to time. The more we embrace the entirety of the job from a fresh, healthy standpoint, the better we can continue in our mission to serve and the more rewarding our career in aging will be.

 **Thanks to Seanbjack for sharing the picture used in this post

Scott Talans was the Chicago Bridge Editor of this article.

Caregivers have many names: sister, friend, husband, wife, daughter, son, neighbor, etc. November is National Caregiver Awareness Month, we should all find a way to consider the caregiver issues in our everyday work, and family.

The Caregiver Transformation

You are not born a caregiver, you become a caregiver. This transformation of becoming begins by first playing a role in a family system. The new role of caregiver often falls to the family member who is closest in connection or in proximity to the individual who is need of care.

Caregivers Come In Many Forms

If we break down the word caregiver, it is simple to define. Caregiver is someone who gives care to others. There are many types of caregivers. Mothers and fathers care for their young children until the children are able to care for themselves. In some cases when a child has a developmental or cognitive disorder, parents find themselves caring for children throughout adulthood.

In the field of disability, spouses and children often care for their parents or a sister may care for her brother. These may be developmental, physical, traumatic, or cognitive disabilities.

Many caregivers are providing support to an older adult with multiple health-related needs that have made it difficult for the individual to care for his or her own needs.

Am I a Caregiver?

Some people don’t know or consider themselves with the title of caregiver when they provide support to another close to them. Some spouses may feel this is their duty or responsibility as a spouse and that they deserve no other title. Some adult children who care for a parent at a great distance feel that because they are not local and their parent does not live with them therefore they are not a caregiver.

Benefits of Identifying as a Caregiver

It could be argued that identifying as a caregiver is going to serve to benefit the individual caregiver and the care receiver.

If the caregiver does think of his or herself as a CAREGIVER, this person may see the change in their role as it once was with the care receiver. Instead of being a daughter who found support from her father, she is now the daughter who cares for her father. Although this conflict may not seem great, it could potentially lead to conflict in the relationship. If the daughter does not see herself as an important piece of her father’s care there may be a higher chance that all of his care needs are not met. Also the daughter may not feel she needs the support that we know benefit s caregivers.

Caregivers have many jobs:

1. Assist or complete the basics needs including food, hygiene and medical care of the care receiver
2. Take care of home maintenance including cleaning, and home modifications
3. Manage and maintain financially security and needs including bill payment
4. Provide companionship, emotional support and meaning to the care receiver who otherwise may have been challenged to do so independently
5. Make difficult decisions regarding health care and personal care of the care receiver; this may include decisions for the person to move to a new care setting
6. And many other tasks and duties

The Cost of Caregiving

Many family and non paid caregivers have this role as the only option. This may mean the person needs care that could be met by a private agency, but due to high cost of ongoing care, many families are not able to choose this type of care. In addition many caregivers feel a great responsibility to do their best on their own to care for the person they are often emotionally close to and have a long term relationship with. But at what cost to the caregiver.

“Put your oxygen mask on before you assist others”

Many caregivers I have met, have been told that they must take care of themselves. Some laugh at this, some are concerned by this and others take this very seriously.

Those who laugh often feel that the goal of taking care of themselves is unnecessary or unattainable when compared to the high needs of the care receiver. This person may be overwhelmed by the guilt of caregiving.

Those who become concerned are those who may feel this goal is unattainable and that they may suffer as a result. This caregiver is often already very stressed and noticing changes within him/herself. They may feel that this is yet another task on the very long list of responsibilities.

The person who takes this very seriously has already set goals for respite on a regular basis and works through the feelings of guilt as a caregiver to manage his or her own needs.

No matter what the caregiver response to respite and support, we need to find a way to support the caregiver. What has worked for you as a caregiver? How have you stayed healthy and happy? If you work with caregivers, what do you recommend for caregivers?

Thanks to Heidi Enriquez for editing the post. Also thank you to Rosie O’Beirne for sharing her picture with us!

All Careers are Careers in Aging

There will come a time, and that time is soon, when to work will be to work with older adults.  1 in 5 people in the United States will be over 65 by the year 2030.  The ratio of younger workers to workers over 55 will be 2 to 1, compared to 5 to 1 right now.  1 in 5 drivers will be 65 or older.  4 out of 5 of older adults will be homeowners.  By the year 2030 – and sooner – we will all be facing aging issues in the workplace, from plumbers and mechanics to bankers and lawyers to cashiers and consultants.  We will all have careers in aging, whether we encounter it first in others or in ourselves.

Eldercare Workforce Shortage

Yet, despite that, we as a nation face a shortage in trained eldercare workforce.  Geriatrics or gerontology has become a specialty rather than the mainstream, even though older adults will be the mainstream.  At schools of higher education across the nation, a small segment of the student body is choosing to focus on aging over hipper, sexier topics.

But the truth is, when the Baby Boom is here, we will all be working on aging issues, whether we are trained to face them or not.  Our professionals will not know what makes an older adults’ situation special or unique or challenging.  They won’t know about the robust aging network for meeting older adults’ needs.  They won’t know why medications need to be prescribed differently for older patients or why substance abuse can be particularly harmful for this population.  They won’t know how to make the paradigm shift required to treat for comfort rather than cure.  They won’t know unless we move aging from a specialty to a common topic integrated into every class, every training, and every job held in this nation.

Older Adults’ Contributions to Society

When it comes down to it, this is a matter of human rights, and that’s why it matters that we get it right. The United States is a nation built for the young and the mobile, but both youth and mobility are subject to change. Even as we record that change happening through projections and graphs, the evolution of our spaces, our systems, and our stereotypes have not kept pace with the evolution of our aging population.  We are not ready for the reality of aging Boomers, a population redefining what it means to be “old.”

Insufficient preparation and perpetuation of increasingly inaccurate stereotypes build obstacles for all older adults, whether they fit our visions of aging or not.  In a nation where human value is measured in contribution to the bottom line, those perceived as not producing in a traditional sense – the aging – are seen as a drain.  A waste of resources.  But when we measure contribution in relationships and knowledge and hard-earned perspective, we begin to see that older adults never stop giving.  They never stop producing.

Isn’t it time we give back just a portion of what we get from our older population?  Isn’t it time we remove the barriers we’ve inflicted by turning aging into a special interest topic rather than a part of the lifespan integrated into every aspect of daily life? Isn’t it time we recognize that each and every one of us works in the field of aging?  So, with that, I wish everyone – working in the “field of aging” or not – a Happy Careers in Aging Week.

Special thanks to Arlene Wanetick, Chicago Bridge Blog Editor. And thanks to marymuses for sharing your picture with us.

1. “They are suffering from Alzheimer’s disease”

Yes, people do suffer from Alzheimer’s disease and related disorders; it can be painful in many ways. But we have to consider that many people are diagnosed in earlier stages and are still able to remain independent in various ways. Many people with a diagnosis of any dementia are able to laugh, enjoy their day, meet new people, spend time with their family, etc. By labeling these individuals as sufferers, we are not factoring in the life they are living. We have to consider how this statement feeds into the stigma. For that reason, we should consider saying, “living with” Alzheimer’s, not “suffering from.”

2. “Grandma has a touch of dementia” or “Grandpa has flow-blown Alzheimer’s”

These are two descriptive statements that people often use to share how affected an individual is by the disease. The problem with these descriptions is that we are not considering that when dementia is identified it is and will always be dementia from the start to the end. Consider someone who is pregnant. When the woman finds out she is pregnant, although she is in the first trimester, we don’t often hear people saying, “she has a touch of pregnancy.” With dementia, we know there are stages of progression. Some people in the early stages of the disease process can live more independently and are not as impaired. In the later stages, a person becomes more dependent on others to care for their daily needs. For this reason, we should consider saying, “Grandma is in the earlier stages of dementia” or “Grandpa is in the later stages of Alzheimer’s disease.”

3. “Thank god they don’t have Alzheimer’s, they have dementia”

When I hear this statement, I often spend some time explaining what the terms dementia and Alzheimer’s mean. Because Alzheimer’s disease is the most common and well known form of dementia, we often hear this. But it is important to understand that Alzheimer’s disease is one of many various forms, or types, of neurodegenerative diseases or dementias. To learn more about the different types of dementia, read the article “Discussions in Alzheimer’s care”

4. “She is 85 so it makes sense she is forgetful, right?”

Wrong, a person’s age does not determine if they have a neurodegenerative disease like Alzheimer’s. Yes, the older your age the higher your risk factor is to having a dementia. But, there are many people who are living in their 70s, 80s, and 90s without dementia. There are normal changes to the brain that come when we age, but not all older people will develop this disease. If someone is forgetful and it is impairing their functioning they should be evaluated by a doctor.  If a doctor turns someone away and tells them, “You are getting older so memory loss is normal,” it may be time to go to a specialist who can evaluate the whole picture and find out what is causing the memory changes. Read more about early diagnosis of Alzheimer’s disease.

5. “Although my Dad has dementia, he is not wandering, so I am not worried about that…”

Wandering is a very scary part of memory loss and confusion caused by dementia. Persons in the earlier stages may have times where they become lost in familiar environment, but are still able to ask a stranger for help. But a person in the middle stages of a dementia may venture out into a cold winter night with the set belief that they need to get home, or get to work, or go to find their daughter. Such determination, mixed with confusion and lack of judgment, are a bad combination. We cannot predict when this type of behavior will surface, but the Alzheimer’s Association has stated that 60 percent of people with Alzheimer’s disease wander at one point in the disease.

So as best we can, we should work to protect the person by preventing this behavior. A common trigger for wandering behavior is increased confusion. Some people with Alzheimer’s or other dementia may not recognize their own home, or the people taking care of them. This may make them feel unsafe and the person may desire a place of comfort. You may see how this level of confusion can cause this person to seek out a place of comfort and leave that place they do not feel safe. The number one way to prevent wandering is supervision. There are also devices and alarms to help prevent. And there are products to help find a person. Keep in mind, although your Dad may not have wandered, it doesn’t mean he is not a risk.

Clearing the Water

I hope I may have helped to clear the water on what you may hear when people speak about Alzheimer’s disease and related dementia. It is so important to take the opportunity to educate ourselves, our families, our clients and the community about these types of brain diseases as they are so complicated.

*This article was edited by Heidi Enriquez

Thanks to WagsomeDog for sharing this picture!

Let’s start from the beginning

Alzheimer’s disease and other related dementias (Lewy Body, Vascular dementia, and Frontotemporal dementia) have historically been difficult for clinicians to detect. However, advances in neuro-imaging, neuropsychology testing, and our increased understanding of the disease have made it somewhat easier to detect. For a more confident diagnosis, clinicians might wait to see if and how the person with cognitive changes progresses. In other words, does the person continue to get worse? If the answer is yes, the progression likely indicates the disease to be a dementia. It can be difficult to say which form of dementia is likely, but often, if there are cognitive deficits, if it is progressive, and if there are no other causes then it is often called dementia. This may be why we hear, quite often, that a person was diagnosed with dementia in a general sense. Technically dementia is not a diagnosis, but a description of symptoms. Alzheimer’s disease, Dementia with Lewy Bodies, Vascular dementia, Frontotemproal dementia are examples of dementia diagnoses.

For many people, multiple visits to a physician and other types of professionals including neurologists, geriatricians, neuropsychologists, and geriatric psychiatrists are common when dealing with memory loss, unexplained visual/perceptional changes, personality or judgment changes, and the inability handle one’s life as previously accomplished. Before individuals step into the doctor’s office they or their families have an indication that something has changed- whether it be memory loss, behavioral changes, language changes or other cognitive deficits- that provoked them to call the doctor. The first call is often made to the primary physician (PCP). Some PCPs are able to diagnosis a form of dementia in their own clinic with the help of smaller versions of cognitive testing, access to neuro-imaging, and blood work labs. However, it is also common for the PCP to refer to a specialist who can spend more time looking into the symptoms and noted changes by ruling out other causes for the cognitive issues.

The Early Bird Gets the Worm

Early detection. It is a phrase we hear a lot today in our health conscious world. Early detection of breast cancer, have a mammogram starting around age 35. Early detection of cervical cancer, stay on top of your scheduled Pap smear. After age 50 we should begin making plans for regular colonoscopies to detect colon irregularities. Many of these detection screenings are recommended after the age of 50.

Will Alzheimer’s disease and related dementias become a part of this wave? Should you add the dementia screening to your annual plans after you turn 50, maybe even 40? When can we begin to detect different forms of dementia? What do we do once we detect it? There is not a pill we can take or surgery we can administer to eliminate a dementia’s progression, just as the same is true for many cancers.

To many people it is worth going to get your mammogram done because you know that if they find a lump, there is often a treatment plan and likely if found early enough, you can survive and live many more healthy years. This of course is very troubling, but there are tested and proven treatments. These treatments give credit to the early detection, and thus the mammograms.

When is too early to detect, if there is no treatment to stop the progression? When asking to detect a disease that we have no treatment for, where does that lead us? It may be hard now, because there is no cure, but there are good reasons for the early detection push.

What about research?

Research- clinical trials, neuro-imaging studies , non -pharmacological therapies- is a large reason why early detection is so important in the world of Alzheimer’s disease and other dementias. The earlier we can find out that a dementia is present in the brain, the better able we may be to stop it before too much damage has already been done. First, we need to know more about the basics of the disease. What happens in the brain, when and how does the disease start? These are questions researchers have been battling for over 30 years. In order to run clinical trials to find out which medication is most affective, we need more people in clinical trials who have an early diagnosis. In my opinion, this is a very good reason to improve our diagnostic process and push it to the earliest possible time. In other words, one way to look at the push for early detection is as a stepping stone to more research, which will lead us to a more effective treatment.

Take it with a grain of salt

We have to be careful how we interpret what we hear and what we read about. This applies to all subject matters. Alzheimer’s disease related issues take no exception. I am constantly reading the latest in Alzheimer’s disease news. It feels like every day we inch closer toward knowing how to better diagnosis the disease.  What concerns me as a reader is when it appears we are making such great strides towards detecting the disease before we even know what causes it, where it comes from, how it moves, how it thinks, etc, etc. How can we know what we are detecting? Does it really matter that we don’t understand the basics of the disease yet? Whatever you read related to Alzheimer’s disease research advances, take time to applaud the hard work of the scientists and the funding of important donors and grantees, but also consider what implications the advances have.

How to get tested?

If you are concerned that you or someone you know is experiencing cognitive changes including memory loss, word finding problems, or behavioral changes it is important to speak with a doctor. A primary physician may be able to run preliminary tests to uncover the cause for your changes, but often a referral to a specialist is needed. If you are interested in an Alzheimer’s Disease Research and Diagnostic Center you can find one of the 30 locations in the country nearest you.

Article edited by Bridget Murtha

Picture by Bottomless Padding Pool

Increase in “at risk” households

A recent study by the Center for Retirement Research (CRR) at Boston College determined that 61% of households in the U.S. are “at risk” of not being able to maintain their standard of living in retirement.

Home equity will be the cornerstone of funding retirement in the future

Even though the real estate market is down, home equity is still a major asset that is available to seniors to fund their retirement. According to CRR, using a reverse mortgage can reduce the number of “at risk” households by 10%.

Although many seniors are concerned about leaving an inheritance, CRR stated that preserving home equity for their heirs may be a luxury that future retirees won’t be able to afford.

The most common age of those applying for reverse mortgages has recently fallen to just over the minimum qualifying age of 62. This seems to indicate that Baby Boomers are more accepting of using a reverse mortgage to help fund their retirement.

Reverse mortgage vs. home equity line of credit

Other than selling their home (which most seniors don’t want to do), the two ways of unlocking money from a house is through a traditional home equity line of credit (“HELOC”), or through a reverse mortgage.

The two are very similar. While a HELOC is a great loan for those who are younger and still in the workforce, it is not necessarily best for older adults.

A reverse mortgage is essentially a HELOC that has been specifically tailored for those aged 62 and over. Just like a tailored suit is going to fit better than one that is off the rack, a reverse mortgage usually fits older adults better than a HELOC for two main reasons: there are no income or credit qualifications, and no monthly payments.

Need to qualify

Those seeking a HELOC need to qualify based on their income and credit score which many seniors are not able to do. Many retirees are on a fixed income which may be too low for a bank to approve a HELOC. This low income may also cause them to be late paying their monthly bills, resulting in black marks on their credit report. A low credit score may also prevent a senior from qualifying for a HELOC.

With a reverse mortgage, the lender doesn’t care about income or credit history.

Monthly payments

Even if a senior qualifies based on their income and credit score, the HELOC will require monthly payments to be made. For a “house rich, cash poor” senior looking for help making ends meet each month, the last thing they need is another monthly bill.

Reverse mortgages do not have monthly payments. Instead, the interest on the loan is accumulated over time – like having a running tab on the house. When the home is sold, either because the senior has moved permanently to a nursing home or died, the balance owed on the reverse mortgage is repaid from the proceeds.

Conclusion

If you are working with a client who needs in-home care, home repairs, or can no longer afford their “regular” mortgage, you should look at a reverse mortgage and HELOC side by side. When the reverse mortgage is fully understood (see AARP’s webcast for a fair, balanced, and informative discussion of this unique loan) it is often a better solution for seniors than the traditional HELOC.

Photo courtesy of  jtyerse on Flickr.

This article was edited by Abby Smith.

Nursing Home Culture Change

The movement that is sweeping the United States is the concept of a household model of nursing home care, otherwise known as “nursing home culture change”. Culture change is marked by a client-centered model of care, where the person living in the nursing home is given more freedom and choice.  In this model, residents are encouraged to live how they want to. For example: to get up when they want to, and to eat when they want to.  Even the  physical environment is more like the home they used to live in and less like a sterile hospital setting.

Culture change is important because it still allows a person who has been placed in a nursing home to be able to continue to grow and develop their minds, bodies, and souls. They are given the opportunity to continue to live their life the way they choose to, to the fullest extent possible. Also, all residents benefit from the culture change model. It does not matter if the resident has dementia or is there for rehabilitation or what insurance they have.

Culture Change: a Reality In Illinois

Two places in Illinois are working to change the way their nursing homes are run. One, The Mather Pavilion, is a facility that has nursing care and rehabilitation, as well as memory care. Residents are allowed to walk the halls if they wish. Family and friends are encouraged to visit the resident and fun activities that challenge the resident’s whole person are always happening. Residents benefit physically, spiritually, mentally, and psychologically from a variety of activities to choose from. Some examples include:

• a visiting music therapist who plays guitar,
• a visiting Girl Scout Troop,
• a celebration of Haitian culture, or
• time spent outside in the lovely garden doing an activity.

The Mather Pavilion  does things that affirm each residents’ abilities, needs, and personality.

Another facility, Three Crowns Park, provides independent living, nursing care and memory support. Their memory care  and skilled nursing support is divided up into “houses”.  The residents and their families are allowed to choose how they wish to decorate their rooms and it can be personalized: painted and carpeted to meet their needs. The call lights are hidden behind wall sconces and if a resident needs something, nurses carry pagers and when a resident has a request, the nurse will see it on her pager.  There are no nursing stations, just tiny cabinets that hide charts and a computer monitor. When the staff is not helping a resident, they sit and spend time with the residents while they are charting. They have private showers and the shower rooms are decorated like spas.

The Benefits of Culture Change

I think that it is important for nursing home administrators and all staff at nursing homes to embrace nursing home culture change. Nursing homes that embrace culture change stress that it is not just the nurses’ job to make culture change happen. It is everyone’s job. When the entire staff responds to residents’ needs as they happen, then residents will feel better, as their needs are being comprehensively addressed. I think culture change should continue to be implemented because it results in better mental health for both the residents and the staff. The residents are in a better mood, which results in less depression, anger, anxiety, or agitation for them.

Residents living in a culture change nursing home are also more likely to want to participate in activities because they decide what they want to do and when. Staff show the residents that their thoughts, participation and ideas truly matter by allowing them to make choices and reading the resident’s verbal and nonverbal cues.  If you’ve never visited a nursing home dedicated to culture change, set up an appointment, they will inspire you for what nursing home culture change can be!

Thank you to ECRCMasterNaturalist on Picasa Web Albums for the photograph.

This article was edited by Mark Schmidt.

On Wednesday, September 15th, Rush University Medical Center’s Older Adult Programs hosted Chicago Bridge’s panel discussion about transitional care. Older adults face unique challenges when moving across care settings. The increased prevalence of chronic conditions, functional and cognitive limitations, polypharmacy, social isolation, and other factors make older adults particularly vulnerable to poor transitions. The results can be which can be dangerous and costly for older adults, their families, and the national health care system as a whole as one in five Medicare beneficiaries return to the hospital within thirty days of discharge. Event panelists offered practical methods for addressing this critical issue.

The speakers represented transitional care from multiple different perspectives:

• Michele Packard, Enhanced Discharge Planning Program Social Worker at Rush University Medical Center, opened the forum with a presentation about her work as a clinician in a hospital-based telephonic short-term care coordination model utilizing master’s prepared social workers as transitional care managers.

• Caroline Ryan, Manager of the Aging Resource Center at Adventist LaGrange Memorial Hospital, described her unique program which integrates a community-based agency into a hospital to minimize delay in services and ensure linkage into appropriate community resources post-discharge.

• Claudia Cook, Eldercare Consultant at LivHOME, Inc., shared information about the role of private geriatric care managers in supporting older adults across transitions between care settings, such as from hospital to home, from hospital to skilled nursing facility, and from skilled nursing facility to home.

• Kristen Pavle, Policy Analyst with the Health and Medicine Policy Research Group, brought the audience up to date on current health care literature around transitions. She also educated the audience about efforts of the Illinois Transitional Care Consortium, a collaboration of community and hospital-based providers working to develop a transitional care model for the state of Illinois.

Presentations on each project were supplemented by a lively discussion with meeting attendees. All sixteen Bridge members present shared their professional and personal experiences with care transitions and swapped resources for supporting clients. The discussion also turned to the role of health care reform in bringing about change, particularly in relation to preparing for changes in Medicare reimbursement for readmissions within thirty days of a prior hospitalization.

Resources Available to Support Older Adults

Attendees were also encouraged to use resources available to support older adults across transitions, even if they do not work with a formal transitional care program. Such resources can be found online through organizations such as the National Transitions of Care Coalition, National Coalition on Care Coordination, and the United Hospital Fund’s Next Step in Care initiative. The Chicago Bridge is grateful for the opportunity to learn about this important topic from such passionate and knowledgeable colleagues.

Here’s what we already know:  older adults are staying in the labor force longer, and younger adults are staying out of it longer.  Pew Research Center cites a government estimate whereby 93% of the growth in the U.S. labor force from 2006 to 2016 will be among workers ages 55 and older.

The same Pew report tells us that 87% of older people prefer part-time work.  A study highlighted by Retired Brains and Workforce Management found that 73% of employers anticipate some level of increase in their contingent (i.e., not full-time) workforce by late 2010, with nearly 35% planning increases of 50% or more.

Increase in reduced-hour jobs + Increase in mature workers who want reduced-hour jobs = match made in heaven, right?  Ideally, but not so fast.

The First Frontiers

Integrating mature adults into the workplace has its benefits (scroll down to “Myth of the Deficient Older Employee”).  Yet much of the growth in older adult employment stems from mature workers exiting the workplace and reentering as their own bosses in the form of entrepreneurs and consultants.

An article from AARP recognizes that there are both “push” and “pull” factors that lead older workers to self-employment.  Stockpiles of experience and resources combined with a flexible schedule may “pull” older workers away from more traditional wage and salary jobs while lay-offs and compromised health may “push” some older adults into self-employment.

Older adults who lack the connections or skills to start their own business are too often directed to positions such as store greeters, a job considered to be genteel at its best and mundane at its worst.  While we are beginning to see more mature adults working as event staff and caregivers, we need to identify more alternatives for the 60% of older adults ages 55+ who are not in the labor force (Bureau of Labor Statistics).

The Next Frontier:  Bring in the Reinforcements

Just about any organization from hospitals, to schools, to offices has peak demand loads that are best served by procuring resources on a contingent basis.  We are just beginning to think of ways to outsource jobs, and mature workers, often more reliable than younger generations, are well suited to meet these needs.

A recent report sponsored by MetLife Foundation and Civic Ventures finds that despite the slow economy, there will likely be more jobs than people to fill them within ten years.  Healthcare and education jobs lead the way with opportunities in nursing, teacher’s aides, and child care workers.

Rather than struggle to find last-minute replacements for your daycare or reception area, build a staff of semi on-call reinforcements who are trained to respond to your business needs.  If your organization is too small to maintain its own contingent staff, secure help through a staffing agency.  Also consider supporting full-time employee caregivers who need time off through job sharing with your corps of mature worker “reinforcements.”

Bringing mature and younger workers together not only enhances the output, it enhances quality of life.  A Cornell study revealed that working older adults were 3.5 times more likely to report the highest quality of life ratings compared to older adults who did not work.  Taking advantage of the skills of mature workers will not only support economic productivity, it improves that worker’s well-being.

“A Long Bright Future”

We may not want spend all of these “new” 30 years of longevity working full-time traditional jobs, but a complete exodus of mature workers robs society of critical talent and mature workers of a full spectrum of forums for contribution.

In her book, “A Long Bright Future,” Dr. Laura Carstensen resolves that in an ideal world we would experience an “autumn crescendo” of working at will.  It is now time to populate that crescendo with work opportunities that span sectors, socioeconomic status, and formats.

This post was edited by Heidi Enriquez.

Photo courtesy of Julie70 on flickr.com.

When we arrived in Haiti and entered Port Au Prince, I was immediately struck by the indescribable damage everywhere. But more than that, I was amazed at how people were continuing to live their lives, trying to make a living amongst the devastation and destruction. This was my first insight into the resilience and perseverance of the Haitian people.

Asile Communal

We began our work at the Asile Communal (which means “community asylum” in Creole). This is the municipal nursing home in Port Au Prince, whose structure was destroyed by the quake. Consequently, patients were relocated to the outside area in front of the old building, on cots and in tents. Nursing home residents are interspersed with other displaced persons, who are living on this property as one of the many “tent cities” around Port Au Prince. One can only imagine the chaos that has ensued with this mix of populations.

Red Tape Frustrations

When we arrived to this site, we immediately encountered red-tape with the administration of Asile Communal. In fact, throughout our time in Haiti, we experienced many instances of possessiveness and power-struggles amongst the local government officials and relief organizations.

Everyone is malnourished and dehydrated, and the worst part is that there is plenty of food and water in Haiti right now, but everything is so disorganized that it’s not being distributed properly. When supplies are being distributed, the elderly are at a significant disadvantage as they have a harder time getting to lines or standing in lines and waiting, as well as being more vulnerable to having their rations stolen. Even for healthy individuals, the conditions in Haiti are truly deplorable. As noted by Anderson Cooper of CNN, they are nearly unbearable for the frail elderly.

Much Needed Care Delivered

We were finally able to set up a little clinic with a table, some chairs and our supplies (medicine and first aid supplies which we brought from the States). By word-of-mouth, the older residents came over to get a check-up. We had created an intake form with basic social and medical information so that we could not only assess each patient in an orderly fashion, but also gain useful census information for HelpAge’s initiative of relocating the residents to safer and more supportive living environments.

During that first day of clinic, we saw approximately 25 patients, and returned two days later to see the remaining 30 older residents. Most of the maladies in the older patients we encountered were hypertension, pain, and intestinal issues. We saw a considerable amount of patients with low-vision or complete blindness, and many with dementia. A lot of the patients complained of “all-over pain”, likely due to somatization of the trauma they’ve experienced. In general, it seemed that patients were dealing with stress-related or pre-existing conditions exacerbated by stress.

Many of them chose to sleep in tents, even if a building was available to them, because they’re so frightened of being in a building that might collapse on them. Older residents stated that they could not sleep at night because of young people staying up all night, making noise and trouble. People were in a constant state of hyper-vigilance. Unfortunately, HelpAge is still working on securing a safe environment to transfer many of these patients to; however, there is red tape at every turn. So while we were there, the work was mainly about addressing the older adults’ needs in the setting they were in, and making sure their care providers were better equipped to care for them.

Other Locations

When we weren’t at Asile Communal, we spent time visiting other sites, such as local hospitals and tent-cities, to evaluate the older residents/patients who were in need of geriatric medical care. In sum, we saw a total of approximately 150 patients in the 10 days that we were there.

We also had the opportunity to visit alternative senior living environments, such as a home that someone turned into a long-term assisted living environment. We visited a rural nursing home run by nuns, for elderly as well as mentally and physically disabled persons, on a beautiful piece of land surrounded by mango trees.

Finally we visited the “crème de la crème” of senior living in Port Au Prince. This was a beautiful retirement/nursing home for the more affluent elderly in Haiti. In American dollars, the cost was between $1,000-1,600/month – far below what is standard in the States. Nonetheless, the level of care was truly outstanding. Being able to see these various environments was quite enlightening for us. We saw the most deplorable conditions to truly the best, and everything in between.

Lessons Learned

In just 10 days, I learned a lot about Haiti; it’s colorful culture, tumultuous and traumatic history, and the incredible people who’ve overcome more than most people have in a lifetime. The older Haitians are truly a strong group of individuals who contribute much to their society. They are often the backbone of the family system, caring for grandchildren while their children are working, or in many instances, that middle generation has disappeared completely, for reasons such as HIV. They also continue to work, often in the outside street markets, likely much longer than older Americans work, thusly contributing on an economic level as well.

Despite these strengths, there is very little infrastructure to support the older Haitians. HelpAge International is planning to be in Haiti for 3-5 years, and will be working on creating sustainable programs and supportive services for just that reason. In my short time there, I was able to lend my knowledge of older adult programs here in the States, to help guide their work out there.

Seek Volunteer Opportunities

While I was only able to see a small fraction of the many elderly who need psychosocial support and medical care, I am so grateful for the experience and have obtained a first-hand look at life for an older person in a third world country, while amidst a humanitarian crisis. I strongly encourage anyone who is interested in this type of work to look into volunteer programs, both in Haiti and around the world. Working internationally with older populations can only serve to enhance our knowledge and understanding of older adults in general. The cultural aspects vary widely, but I think we’ll find that on a basic, fundamental level, they all need and desire the same essentials in life.

Ways to donate:

1. Red Cross
2. Clinton-Bush Haiti Fund

Photos from Relief Mission