Put yourself in these old shoes!

Let’s say you are 88 and you have lived in your farm house for 50 years. For the past 15 years you have lived there alone, after your spouse passed away. Now, you are moving to an assisted living facility. You will have three rooms; a bedroom, living room and kitchen. You know no one in the facility you are moving too. Part of the decision to move was based on your children’s concern that you may reach a point when you need extra care. Although you can take good care of yourself you do see the benefit of having some meals cooked for you, and other activities available at your finger tips. Also, you want to make your children happy.

Is it comparable to other life transitions?

Do we as professionals truly understand how it is to make this type of move. We may have done it ourselves when we went to college, particularly if you moved into the dorms and lived away from your family on campus. You had to make a transition, that others your age were also going through. Maybe an upper class-man helped you find a classroom when you were lost, or offer suggestions for the best bar close to campus. Now, you are 88 and moving again into a community of those your age and in very similar situations as you. Maybe your new neighbor who has lived there for 5 years reminds you that it is dinner time and helps you find the dining hall by walking with you. Then, someone you met at bingo suggested you attend the movie nights, because she is in charge of the movie committee and guarantees the flick will be good.

Are these experiences similar? I would argue that they do share a lot of similarities, but there is a very big piece that is different for the 88 year old. At 88 you have experienced so much more than when you were 19 going to college. You raised a family, established yourself in a career, and perhaps can even found out who you are in the process. At 19 you may have been on a self discovery path, but at 88 could you still going down that same path? These are some interesting questions, that may help us as geriatric professionals truly understand this transition.

Can we REALLY understand this experience?

Steve Gurney, age 43 and author of Guide to Retirement Living SourceBook, a resource that provides families with detail regarding senior living options, is now living this very transition. He has moved into an assisted living facility, and is now journaling his experience. His focus is on his emotions regarding this hard transition.

This sounds like a very interesting and excited experience to put yourself through as a professional. It is the ultimate, “walk in their shoes” type of project. However, Gurney is 43, he is not 88. He has not necessarily had the full life experience many of the residents in these facilities have had. He may not have the physical disabilities many residents have, or the constant concern that his memory is going bad. There may be some benefits to noting the transition into a community that you are new to. However to improve our professional understanding of this type of transition, perhaps it is better to ask ‘real’ new residents to journal their own emotions and experiences as they make this transition. Hhere are some notable differences between what Gurney is experiencing and what real residents may go through…

• Gurney choose to go into this facility- many others have had the influenced of their family make this decision.
• Gurney can leave and go back to his four bedroom house, other residents may permanently downsized never to see many of their belongings again, also some may feel this is where they will inevitability die.
• Many residents may feel abandoned by their family, yet Gurney is at the age where he can raise a family, and meet his grandkids.

I am definitely going to keep my eyes on this project. What are your thoughts?

Read more about Steve Gurney’s project at 43 year old in retirement community.

Picture courtesy of Zsuzsanna Schreck. View more of her photos at Rocketcat.blogspot

This study found that only half of all nursing homes employed degree social workers. Even further, 61 percent of nursing homes in this study did not have a social worker with a license. Read more at Nursing Home Standards. For me it is  this is a pretty upsetting issue. When I try to critically think why this is happening in our nursing homes, I wonder, could this really all be about money? As the report suggests for-profit nursing homes are 31 percent less likely to hire a degreed social worker. Do nursing homes just want to find the cheapest way to meet the federal standards without regard for qualified employees? Or, is it that nursing home execs to do not see the necessity of Social Workers? Or perhaps both?

Let’s talk about who social workers really are. Social Workers are trained professionals with an understanding of the personal experience. Social Workers examine all aspects their clients be it  an individual, family, group or community. Each aspect is important in understanding the whole. Many social workers have training in mental health with the ability to identify depression, anxiety, risks for suicide, etc. Social workers understand how to handle a crisis, a major life transition, and family dynamics. Social Workers understand the growth of an individual, the life course. Social workers examine the physical, the emotional, and the social experience of their clients, and can identify the links between each of those aspects.

A call for standards for nursing home social workers is most definitely in order. Not only must nursing homes provide for their residents a social worker with a degree, but these social workers should be licensed. Nursing home social workers should have a case load that offers them a chance to work with each resident as much as needed, in order that all the needs of the older adults are met. This may mean that other qualified staff must also be apart of the social service department to assist the qualified social worker complete all the necessary paper work and reports needed for our overseeing government. With more qualified social workers nursing homes may see a change in their residents qualify of life, standards of living will be raised. But now the question is, will the federal regulators see this importance, and or will nursing homes see the importance themselves?

Picture courtesy of Zsuzsanna Schreck. View more of her photos at Rocketcat.blogspot

When looking around the interweb for what the aging community has thought about the ranking system, I stumbled upon a Elder Abuse Lawyer’s website, where this new system was discussed. I begin reading this Elder Abuse blog and article after article the endless cases of abuse in nursing homes was discussed. It hurt so much to read that information. I would have thought that through my training and experience I would have been a little less surprised at the poor quality of nursing homes. But, still, it hurt to read. Then I thought how must it feel to be a family trying to decide to move their loved one in a facility. The fear that their loved one will be hurt and humiliated in a facility that is suppose to CARE for them. Or, the older adult who fears the nursing home for many real reasons that may include a fear of their own safety while in the care of under trained, overworked, and underpaid staff.

I would hope that the Internet’s ability to reach so many homes will help spread the word that there needs to be an over all change in the way we view and establish nursing homes in order for the quality and care to improve. Look nationwide, this map shows how poor the nursing homes are laid out across the country.

National Nursing Home Rankings

ScienceDaily (Nov. 24, 2008)  For many of the elderly, the golden years are anything but. Faced with health problems, financial issues and the death of a spouse or loved one, many adults 65 years and older suffer from depression. While research is emerging to help this group understand and treat the problem, another group – centenarians – has been left largely in the dark.

“Centenarians are still rare, and depression hasn’t been studied thoroughly in this group,” said Adam Davey, a developmental psychologist in the College of Health Professions at Temple University. “We’ve found that it’s a very under diagnosed condition among people over 100 years old, yet it’s one of the most easily treated forms of mental illness.”

…more than 60,000 people in the U.S. are 100 years old or over, and as baby boomers start to hit their 100-year mark, that number is expected to more than quadruple to 274,000. …a group of researchers have been studying this group more and more to learn about successful late-life aging…..Based on responses … by a sample of 244 centenarians, … more than 25 percent showed clinically relevant levels of depressive symptoms, yet only 8 percent reported having a current diagnosis of depression.

Davey notes that … a number of factors, including poor nutritional status, urinary incontinence, limited physical activity and past history of anxiety. “People who suffer from depression tend to have a high risk of mortality, so it’s puzzling to see higher numbers among the oldest old,” he said….researchers found that centenarians living in a community setting were found to have higher levels of depression than their younger counterparts. …it is important for doctors, nurses and even family members to focus on the larger picture to ensure a better quality of life.

“Caregivers often focus on the physical part of health,” he said. “Or, when they look at they mental health of older adults, they focus more on dementia. But depression is important to consider too – it’s not just something that younger people suffer from.”…

To read the complete article go to http://www.sciencedaily.com/releases/2008/11/081124080810.htm

MY COMMENTS:

When I came across this article I was oddly pleased. I was happy to see that the scientific community is taking interest in the oldest old, a population that is commonly forgotten. We talk so much about baby boomers, and forget that there are plenty of older adults here and now that need assistance with issues associated with aging. As this article is suggesting, more focus is needed on the oldest old for mental health issues that are appearing to be more prevalent then once thought.

Many times, I think, the underdiagnosis of depression occurs in not only those 100 years of age, but from 75 up. At this point, the older adult is experiencing a lot of changes physically, which is affecting them socially and functionally. They may be losing sight of their independence as they suffer physically, emotionally, and socially. The medical community comes in contact with this population more than any other. They should be able to pick up on signs of depression, right? I feel that the reason this is not the case, is the stigma faced by this population. The medical community may look at them, and think, “Well, their old, and in pain, why wouldn’t they be sad.” Ok, maybe, but this snap judgment of the sad, old age folks cannot be a part of the very vital medical evaluation these patients need.

Let’s take our time and view our clients as not an old person who has every reason to be sad, but as a person who may be severely affected by their mood changes. These changes may very well be connected to their current experiences as they age, though depressed should not be viewed as a normal part of aging.

The family, I will argue, is the most complex aspect of the older adult client. The family comes with a history of dynamics that has taken years to develop, and will take just as many years to completely understand. The family is very frequently in the front lines of the aging process. The family sees and feels the affects of their loved one’s aging, either through illness, grandparenthood, finances, wisdom, etc. The only preparation the family has had is what they may have seen with the older generations of the family. But each family is different due to the varying and ever changing;  social, emotional, religious, political, and relational dynamics.

As the world changes so too does the aging process. Lives last longer as healthcare advances. Internationally and domestically norms are redefined. Some groups are more excepted while others are still disenfranchised. The economy continues to flux and nothing will ever look like it did yesterday. These qualities allow for little to no preparation for the family, whose responsibility is to the well being of parents, aunts/uncles, and grandparents. People, who at one time, were viewed to be very capable to perform as societies standards are now viewed as ineffectual.

When I began writing this entry I intended to touch on the difficulty many adult children face when they are required to step-in for their parents. But, instead I have spoken in a more broad sense of the ever changing world, and the idea that the individual is only a one piece of a very large pie. Also, I have challenged theorists to approach clinical work with older adults through a more definitive, descriptive, and user friendly approach. Older adult issues and specific interaction with family and community are reasonably different from other age groups. As such, I hope that Geriatric social workers and other professionals understand and account for such differences.

Picture courtesy of Zsuzsanna Schreck. View more of her photos at Rocketcat.blogspot