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!

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.