Invisible older persons arise

Reading Joseph Coughlin’s The Longevity Economy. Some very interesting ideas, very interesting. He sees older persons as consumers and in a good way. The growing numbers, especially since many are baby boomers, means more change for the society. Up to this point, marketing people and tech people have pretty much ignored older persons as a group. Sure the retirement industry and the pharmaceutical industry are marketing to them, but in many cases, that is to the dependency of older persons. Coughlin sees them more as vibrant people who are fully engaged in a society that tries to ignore them despite their $8 trillion in wealth.
Mostly, Coughlin places the blame on the rampant ageism in our society, an ageism developed over a century as we, in Carroll Estes’s term, medicalized old age. We made it a separate stage of life and one that did not include a complete membership in the main society anymore.
His approach meshes with the focus of the Department of Gerontology here at VCU. Ageism, we are realizing, is the most pervasive discriminatory and belittling theme of American society. Prejudice to no other group is tolerated as much as it is regarding older persons.
But Coughlin hits this prejudice in a place that just might be able to make some changes: American business. In his opinion, they need to get with the idea that much of their future business, in so many sectors, will come from older persons. And the solutions that older persons are coming up with may disrupt existing industries and companies. For example, we know people love their homes and want to stay in them. If we can bring the services of assisted living into the home at a reasonable price (and through Uber, Instacart and other new options we can), then what will be the affect on these huge residential institutions?
In the coming weeks, I’ll be sharing more insights from this work and similar ones. In the meantime, let’s try and think more creatively about some of these ‘old age problems’ we have made.

Three issues for advocacy

Three things you need to know about aging issues this week.

First, Senator Bernie Sanders, I-Vermont, has proposed raising the cap on the amount of earnings subject to Social Security Payroll tax withholding. “If we apply the Social Security payroll tax to income above $250,000, we could immediately bring in enough revenue to the Social Security trust fund to extend it for decades and also be able to increase benefits,” he says. Currently the cap is wage income of $118,500. And it does seem unfair that middle class and lower class folks have to pay on ALL of their income while upper class folks only pay on a small portion of their income. It makes a certain sense although those paying these higher payroll taxes on their wages would not, under the current system, recoup much from changed Social Security benefits. Thus Social Security would be of even less benefit to those in the upper middle class and above. Wouldn’t you think this politically powerful group would then work to change Social Security into a means-tested program or even eliminate it? Still….

Second, Administration for Community Living issued the ‘final rule’ for the Long-Term Care Ombudsman Programs in the Federal Register. They have been working on this for years (actually, since 1975 when the program was first authorized in the Older Americans Act – 40 years or so should be perfect don’t you think?). Each state operates its ombudsman program a little differently and there is a beauty in diversity, but some consistency of approach is also helpful. After years of working with the states and other interested partners, official guidance is now available on how to operate a Long-Term Care (LTC) Ombudsman program. With the quality of Long Term Support Services still needing improvement, the demand for good LTC ombudsman can only increase. These programs are always looking for volunteers.

Third, the Senate Committee on Aging released a report on increasing the use of generics in Medicare Part D. You would think this would be a no-brainer that both parties could get behind. The Medicare Part D drug plans could do more to promote the use of generics; maybe some incentives are in order. But Medicare beneficiaries need education too so that they understand the safety and cost savings of using generic drugs. We probably need some ads on the History Channel and the Hallmark channel to counter the constant drug company ads. Oh, and then there’s the prescribers. But that’s a whole other post.

That’s it. Pick an issue. Do some advocacy!

How to Ignore Older Americans: Obama’s State of the Union Speech

Per the President, there is not much need to address issues around aging in this country. Nevermind that we are an aging society. Our changing demographics is one of the most important national (and global by the way) trends. But no need to address any issues around that.

Social Security provides the basic foundation of retirement income for older Americans. For 60% of those over the age of 65, Social Security provides a majority of income, in many cases, over 80% of income. Per the Social Security Trustees the Social Security Retirement Trust Fund (OASI) may run out in 2034. I know that is 20 years down the road and the President was looking at the next 15 years. Still this is the time to address the potential shortfall. Of course, he doesn’t want to bring this issue up. It is not one that he and the Congress are likely to find any common ground to make recommendations.

Access to health care was addressed and we have seen progress here. Ten million more Americans have access to health care. But Medicare faces a trust fund that may run out in 2030. Now this is an improvement, largely due to an improving economy, and I do give the President credit for steering us from the Bush era recession. Still, Medicare’s health spending continues to increase (some from more older persons, but mostly from more expensive health care). Something needs to be done soon. Like Social Security, changes to Medicare will require a lead time so future beneficiaries can adjust their expectations.

The President did speak to one key issue regarding older Americans – retirement. He offered a number of proposals to substantially expand workers’ access to retirement savings, mostly through new savings options through employers. More workers would be automatically enrolled in retirement savings accounts thus leading to better preparation for retirement. Although this does not benefit retired older Americans, it’s a good step in helping workers prepare for retirement in this new economy.

So Social Security and Medicare remain the ‘elephant in the room’ that we won’t discuss. The GOP Congress has opened the issue by voting to restrict transfers from the Social Security Retirement Fund to the Social Security Disability Fund. (That fund may be out of funds next year.) It’s not a good start, and the liberal side opposes it, but a change that stimulates controversy may also, one hopes, lead to a discourse that will improve Social Security and Medicare supports for all older Americans.

40 Issues for an Aging Society: A Guide for Students is Live!

</strong>Just in time for the fall semester, we have <strong>40 Issues for an Aging Society: A Guide for Students</strong>. This work introduces key issues affecting older persons and important challenges for the society. It’s available as a PDF (best bet is to use the link below and save it and then open it). It’s also available in the iBookstore for the iPad. The iPad version has more interactivity and includes short videos introducing many of the topics. Best news of all – both versions are FREE. Check it out. It’s the closest thing you’ll get to a free lunch today.

We give a little background on each of the 40 topics, and discuss the implications for the society. For most issues affecting older persons there’s a lot of information out there and we offer some websites to explore (links should be good for a few months – if they don’t work, try to Google the site). We also suggest some places for more research from academic sources where the student can obtain more scholarly information about the issue. Gerontology, as everything today, is about entrepreneurship and we present some brief thoughts on which business sectors may prove opportune for a career. The final section offers thoughts on policy and political controversies that may emerge around each of the issues.

The goal of the work is to help many people learn a bit more about older persons so that they can better work with elders to build a better society and  to assist those who need it. Enjoy. Let me know your thoughts.

PDF: 40 issues for an Aging Society: A Guide for Students

Aging and Gaming

Hi, my name is Jim and I’m a computer gaming addict. I’ve just spent hours playing the new Civilization game, Civilization V: Gods and Kings. It’s a wide sweep strategy game in which you start with a small city in 4000 B.C. and build a dominant civilization through the modern era. It’s one of those ‘just one more turn’ type of games where there is always just one more exciting task to complete, battle to fight, technology to discover.

A long history of this kind of play for me. I’ve been playing strategy games since I was a kid, first board wargames, then, since the early 1990s, strategy games on the computer  when the first Civilization game and others came out. Here I am in my 60s still at it. From a Gerontology point of view, I would say that shows Atchley’s Continuity Theory at work if I ever saw it. I expect I’ll want an internet connection and a computer forever.

This blog seemed like it would be a bit risky confessional. What 60 year old is still playing computer or video games? Turns out I’m not such a weirdo after all. One quarter, 25% of gamers, are over the age of 50. The average age of a gamer is 35 which means, given the number of teenage gamers, there is a good number of older gamers driving up that average. I suspect that there are quite a few like me who are ‘early onset’ gamers who have been doing it for their whole life. And there’s a whole bunch of ‘late onset’ gamers who are discovering the joy of gaming — a good portion of the Me generation is turning into the Wii generation. I think the number of older gamers will grow and here’s why.

Older people have more time, and gaming takes hours and hours. That’s why you don’t see teenagers for days (who’s complaining?). Older people who are working less and not dealing with their children’s crises all day have more time for gaming. Second, games cost money — around $50 for most new ones, but it’s increasing and should be at $75 soon. When I was young I had to save up that $ for a new game. Now, with a much improved bank balance and not much more than one click I can buy that game and download it. Third, the mental, and, in the case of Wii type games, physical challenge, of gaming is just about right for many older people. Keeps the mind sharp in Civ V to decide whether to attack Alexander the Great’s Greek civilization or build the Stonehenge Wonder.

So I’ll keep at it. Hope you are gaming or doing something stimulating and exciting. If you do game a lot, let me know. Otherwise, I’ll see you on the gaming discussion boards. Now I need to get back to building that Stonehenge Wonder.

Sid Meier’s Civilization V: Gods & Kings is available for PC  via download from Steam and in stores.

 

Hurray! The Affordable Care Act was upheld.

The Affordable Care Act was upheld in all but one of its provisions. I say Hurray! It will be hard to repeal and I hope gives a boost to those who advocate for universal health care. That said, what does it mean for older persons?

First, the law makes certain prevention activities free for older persons on Medicare, such as cancer screenings and cholesterol checks and the initiation of a personalized prevention assessment and plan. This means we can catch diseases sooner for older people, treat them sooner, and help older persons lead healthier lives.

Second, the Affordable Care Act begins to close the gap in prescription drug coverage known as the “donut hole.”

Third, insurance companies cannot deny coverage for pre-existing conditions. Aside from the relief this brings to parents and grandparents of those with health conditions, this is also helpful for older persons who continue to work past 65 years of age. This is especially important in these times when older workers are seeking jobs to cover retirement fund losses. Another benefit for children and grandchildren of older persons is the clause that allows dependents under age 26 to remain on their parents’ insurance plan. What a relief to know that your grandchild has some health insurance!

Other provisions, such as the stabilization of payments to Medicare Advantage plans should help reduce the draw on Medicare funds. The Medicare Advisory Board can begin to take a look at the Medicare program and make some rational recommendations (as opposed to the Ryan budget guttings) on where money can be saved. The Medicaid provisions on Money Follows the Person were not struck down, in my understanding, so I hope the rebalancing of state long-term care funds towards a greater emphasis on home and community-based services will continue.  Finally, a number of provisions encourage pilot programs and demonstrations about how to better integrate medical care for older persons.  With the increasing number of transitions of care between providers and settings, the older person’s care can get easily mucked up. This is an urgent need and the Affordable Care Act may help find a solution.

So, again Hurray! And Hurray! And Hurray! once more. A giant leap forward for the U.S.

Is aging the same as disability? Consolidation of agencies for aging persons and persons with disabilities

We’re consolidating agencies for aging and disability services. Is this a good idea? A little background: the Administration on Aging is now part of the Administration for Community Living. The new administration agency includes the AoA, the Administration on Developmental Disabilities and the Office on Disability. Secretary of Health and Human Services, Kathleen Sibelius, offered this: “”For too long, too many Americans have faced the impossible choice between moving to an institution or living at home without the long-term services and supports they need. The goal of the new Administration for Community Living will be to help people with disabilities and older Americans live productive, satisfying lives.”In Virginia, our Department for the Aging is merging with our Department of Rehabilitative Services and some elements of the Department of Social Services to form the Department for Aging and Rehabilitative Services.

As a former Director for Programs at VDA and an Associate Professor in Gerontology here at VCU, I have mixed reactions. On the one hand, we continue to struggle against the idea that aging means disability. Look around! The overwhelming majority of our aging population is not disabled. Older persons are our political and management leaders, our artistic mentors, our rank and file workers, our professionals, our pillars of caregiving. Furthermore, we want to encourage optimal aging – a time of life of physical and mental health that allows for vibrant, continuing contributions to the society. So the answer is a resounding ‘NO’. Aging does not equal disability.

Yet, chronic disease and disability often come in a time of advanced age. It’s a time when the metabolism of age can no longer keep the disease at bay. With enough disease comes disability. Help is needed to continue to age in place in the community or in a facility. Health and social services are needed. Older persons in this situation need similar services to those needed by persons with disabilities. So the answer to the question “Are services for chronically ill older persons very similar as those needed by persons with disabilities?” The answer is a definite ‘YES’. This consolidation of approach may open doors to collaboration and efficient use of resources to allow more persons, of any age, to receive needed services.

Back to my mixed reaction. As an older person with some chronic disease, I don’t consider myself a person with a disability and I don’t need any services. The new agencies would have little meaning for me. But I remember the dilemma I had while working at Southeastern Senior Services when a 59 year old person with a disability called and asked for a ride to the doctor’s. Because the Older Americans Act serves only persons over the age of 60, we could not help him. It seemed ridiculous that for the want of a few months of age we could not serve a man in need. My hopes for the consolidation are that each person in need of services will be able to access them regardless of age. And I would also expect many of those giving the services will be over the age of 60.

Books on Aging Issues I’d Like to See in 2012

Hurray for the New Year! What were the best books on aging and gerontology you read in 2011? Here’s the books I’d like to see be published in 2012.
1. How I learned to love Social Security and Medicare by John Boehner, Paul Ryan and The Republican Caucus of the House of Representatives. A change of attitude, a story of awakening and a growing heart, a tribute to a program that has kept our older citizens out of poverty and healthier than ever before.
2. Maggie Kuhn’s Legacy: The Return of the Gray Panthers. A biography of the activist and a description of the new, more militant advocacy arising among our elders.
3. Bismarck, Social Welfare and Capitalism: Lessons from the Iron Chancellor for the United States. Lessons in the importance of knowing that “those who are disabled from work by age and invalidity have a well-grounded claim to care from the state.”
4. Undaunted. Stories of how older persons made it through the Great Depression and how their lessons are helping their children survive the first Great Recession of the 21st century.
5. Through My Beard: A Biography of John Whittemore, the man who competed in athletic events up to his death at the age of 104. A tribute to those who strive forever.
6. Claude Pepper. An unabashedly fond tribute to a left-liberal.
7. The Emotional Intelligence of Aging. A discussion of how we live life more fully as we age due to our increasing ability to understand others’ emotions.
8. How Richard M. Nixon Saved Social Security by Raising Taxes and Increasing Benefits. A true story, often ignored. The title says it all, you Tea Party members.
9. Stopping Boomerang Kids: How to Make Your Children Independent Forever. A how-to book for elders who like their empty nest empty.
10. Mothers and Daughters, by E. Ayn Welleford. A gerontologist weighs in on the most important relationship in contemporary America.

Compressing Our Morbidity

It’s a great concept — that we will reduce our illness and our functional problems to a small period of time before death. We will live healthier lives and not live an old age of long years needing care or living in long-term care institutions. One of the more frightening aspects of older ages is the frailty and disability that we see in some older people. Having a stroke in your 70s and living until you are 85 is not our idea of the ‘golden years’ of retirement.
George Bernard Shaw lived to be 94 and died shortly after a fall that came while pruning an apple tree. It is the type of death we all aspire to – active into our later years and not debilitated.
We were hopeful for a while. It did seem to be that life expectancy increases were being matched by an increase in disease free years. A recent piece in the Journal of Gerontology: Social Sciences by Eileen Crimmins and Hiram Beltran-Sanchez suggests that, unfortunately, research indicates we are not experiencing fewer years free of disease and loss of function. They posit that “compression of morbidity may be as illusory as immortality.”
The good news is that we may be doing better handling the diseases we get than in previous years. We are identifying diseases sooner and thus initiating treatment sooner which is allowing us to live longer despite the presence of serious diseases. Diseases are ‘less lethal and less disabling.’ We have improved the ability of our environment to support our capacity to function. Most of us will take longer life if the diseases we have are manageable and we can function.
The bad news comes from two sides. The first is the increase in obesity at all ages and the potential effect of this on life expectancy and decrease in life functioning. This trend will compress mortality by shortening lives but may increase morbidity. The second source of bad news, at least for our wallets, is that those extra years we are enjoying with disease require more medical intervention than ever and disease care costs money. Witness the predictions about the ‘bankruptcy’ of Medicare and how the year that happens keeps getting closer.
The best action we can take? It’s the same old answer – exercise, eat right, stay connected with people. And maybe keep pruning those apple trees.

Virtual Youth

Last night I watched CSI Miami “How Could You”. It was a case of mistaken identity that went wrong. An older man, posing as a younger man, made a chat connection with a younger woman, who was really an older woman, posing as a younger woman. Are you still with me? Neither of the older persons was too happy when they finally met FTF, face-to-face, each presuming they would be hooking up with a younger person. Eventually, it led to murder.
But I was more struck by how, in age, the attentions of a younger suitor can be such a powerful force. Both of the older characters in the episode had attractive spouses, but they were carried away by the virtual thrill of ‘hooking up’ with a younger person. Those assignations in the chat room made them somehow believe that they were 18 again and the idea proved irresistible leading to doom for both of them. It brings to mind how often we do things, as we age, to recapture the thrill of youth. Part of that is due to how the society tends to view youth and old age. There is no doubt we are a youth-oriented culture. My students last semester, by a bare majority vote, did think the image of older people in the media overall was improving, but all agreed we are still youth-oriented. How sad that we have so few TV shows that offer us characters who are trying to act older than they are.
The other thought I had was how the Internet can mask our age. So if we are looking to combat some of the discrimination based on age, the ageism of our society, perhaps the Internet can be a tool to thwart that bias. In this case, it was not used to good effect, but I can see situations of consulting and contract employment where the anonymity that the Internet can provide could work in favor of older persons in this young society. The potential is there to judge proposals for work, and work itself, based on the outcomes and not on the person. I am not advocating that an older worker portray themselves as a younger worker when seeking jobs on the Internet. I do think the Internet may provide an ‘age-neutral’ environment which may limit age discrimination. Of course, that means that older people using it as such will have to master the tools of a younger generation and perhaps that does indeed make us younger.