Tuesday, May 13, 2014

Age invaders reads The Economist ...

Birth rates in much of the world have declined steeply. According to the UN’s population projections, the standard source for demographic estimates, there are around 600m people aged 65 or older alive today.

In 2010 the world had 16 people aged 65 and over for every 100 adults between the ages of 25 and 64, almost the same ratio it had in 1980. By 2035 the UN expects that number to have risen to 26.

In rich countries it will be much higher (see chart 1). Japan will have 69 old people for every 100 of working age by 2035 (up from 43 in 2010), Germany 66 (from 38). Even America, which has a relatively high fertility rate, will see its old-age dependency rate rise by more than 7%, to 44. Developing countries, where today’s ratio is much lower, will not see absolute levels rise that high; but the proportional growth will be higher. Over the same time period the old-age dependency rate in China will more than double from 15 to 36. Latin America will see a shift from 14 to 27.The evolution of the economy will depend on the way policymakers respond to the new situation. It will be a world in which ageing reinforces the changes in  income distribution … (April 26, 2014. The Economist)

Tuesday, August 6, 2013

The Color of Care in Aging America/New American Media

The Color of Care in Aging America

The Color of Care in Aging America

This article is adapted from a story Matt Perry wrote as part of the MetLife Foundation Journalists in Aging Fellows program, a collaboration of New America Media and the Gerontological Society of America.  California Health Report/New America Media, News Feature, Matt Perry, Posted: Aug 05, 2013

Part 2. Read Part 1 here.

LOS ANGELES--During his first presidential campaign, Democratic hopeful Barack Obama famously claimed that Americans discussed racial conflicts honestly – behind closed doors. Some experts in aging say it’s now time to break open those same doors and look at America’s caregiving crisis — and its growing issues of race – just as honestly.

The country’s heralded melting pot is quickly becoming a complex racial stew at both ends of the nation’s caregiving spectrum: for those needing care--and for the family members and hired workers providing it.

Undocumented Caregivers in “Grey Market”

As of 2011, 20 percent of the country’s 4 million hired caregivers were foreign-born, according to the Paraprofessional Healthcare Institute (PHI), which represents direct caregivers – hired nurses, home health aides and personal attendants.

Yet that number doesn’t include the “grey market” of workers employed directly by families that include immigrants – among them undocumented workers. Some even suggest the actual number of immigrant caregivers is closer to 50 percent.

While race, culture and religion shouldn’t affect the care provided to older adults, the reality is simple: It does.

John Booker has seen it throughout his 35 years as a caregiver.

He recalls meeting an Orange County, Calif., woman whose son moved her from facility to facility hoping to find quality care. Finally, she was placed in the hands of Booker – who is African American.
“She needed help getting to the toilet, and she didn’t want a damn n----r to do it,” laughed Booker.

“After she attacked me, I knew my reaction was extremely critical at that point. I put my best professional face on.”

Afterwards, the tearful woman thanked Booker for his help, as did a young man standing outside the room who watched the interaction – her son was also an owner of the long-term care facility.

Overt racism, while rare, is indicative of the continued struggles Americans face when it comes to race – particularly in an intimate relationship like caregiving.

During his own long career, Booker noted, who founded the National Association for Direct Care Workers of Color, “I would say 40 percent of the time there was some initial friction [over race].”
Booker said his typically female colleagues – Latinos, Filipinos, Caribbean Islanders and recent African Immigrants – are acutely aware of race in the workplace.

“They will get some of the same racial slurs and looks,” he said. “You hold back your emotions and continue to give quality care.”

Cultural, Religious Impacts

A Stanford University researcher says that race and ethnicity are often linked to cultural and religious views – which may affect care. In fact, her study of multicultural nurses in long-term care settings found something shocking: During end-of-life care, some foreign-born Catholic nurses felt the dying experience shouldn’t be altered by using painkilling analgesics.

“They felt that experiencing pain and suffering at the [end of life] afforded the dying patient an important opportunity for spiritual redemption,” reads the small study of 45 Filipina nurses, led by V.J. Periyakoil, MD, director of palliative care education and training at Stanford’s School of Medicine. “None of the U.S.-born nurses endorsed this concept.”

Periyakoil – who admitted “we were pretty surprised” at the results – described the concept of “redemptive suffering” in this way: “Sometimes people feel that God is giving them these experiences, and part of their faith is to bear these experiences with as much patience as they can. How the religious beliefs of an individual nurse – or doctor – affects how they provide care is a bit of an unknown.”

She continued, “If I’m the nurse who believes in the concept of redemptive suffering. . . . I may not offer that [painkiller] to the patient, even if I see them in pain.” In fact, she said, some patients welcome this sense of redemptive pain, but nurses need to give a patient the choice.

In another example of the enormous influence of cultural and religious views on care, Periyakoil described the family of a Chinese American patient with esophageal cancer. He feared that if he died on an empty stomach “he would wander throughout eternity as a hungry ghost,” she said. He was given a feeding tube.

Periyakoil adds that cultural differences strongly influence caregiving behaviors.

Caregivers who acknowledge “familismo” and “respecto” within more collective, group-oriented Latino families will gain their trust. Conversely, Periyakoil said, more individualized cultures like Germans thrive on care that fosters patient autonomy and more direct, factual communication.

Compassionate Care Despite Language Limits

To many, cultural differences can actually prove beneficial.

Carla Troutner said her tiny 4-foot-11-inch mother had two homecare aides in the San Francisco Bay Area – one white, the other Haitian. While the white caregiver provided acceptable care, the Caribbean caregiver offered a uniquely calm disposition her mother adored.

“She just followed her around the house,” Troutner said of her mother.

Sadhna Diwan recalled a long-term care facility staffed almost entirely with Latino caregivers – some who spoke virtually no English.

“This became a real bone of contention between the families and the hired caregivers,” said Diwan, director of the Center for Healthy Aging in Multicultural Populations at San Jose University’s School of Social Work.

Yet the Latino workers’ compassionate care happily countered the language barrier. “The love and affection and care they show for my parents – even I don’t do that,” stated Diwan.

Some advocates in aging, though, claim ethnic differences in caregiving are being overstated – and education is leveling the playing field.

MariaElena Del Valle cautioned that ethnic differences in healthcare are slowly being filtered out. Training for today’s hired caregivers increasingly focuses on removing these cultural differences, she said. The goal: Don’t impose your belief systems – personal, cultural or spiritual – on the patient; ask patients about their preferences.

“When you’re meeting for the first time we ask you to be curious,” said Del Valle, an organizational-change consultant with PHI. “Active listening means that you focus on the perspective of the speaker, and that requires the listener to let go of cultural biases that come up.”

Del Valle has already seen the effect of culturally sensitive training for hired caregivers – both at home and at long-term care facilities.

“They’re already seeing results, and the home health aides are asking for more training,” she added.
PHI claims the United States will need another 1 million paid caregivers by 2020, and says personal care and home health aides are growing faster than any other profession. In fact, by the end of this decade the group predicts caregivers will be the largest occupational force in the country – topping both K-12 teachers and law enforcement personnel.

Since caregiving often requires no formal education – especially in the underground economy – these jobs are expected to go increasingly to immigrants – from Latin America, the Philippines, the Caribbean and elsewhere.

Cultural Competence

Diwan said the programs at San Jose State University focus on “cultural competence” in diverse populations – respecting the unique culture and needs of patients.

For families taking care of older adults themselves, cultural attitudes run deep. Diwan observed that many immigrants from traditional cultures see caring for their aging parents and grandparents as an important responsibility.

Yet this admirable reverence can have also have negative consequences, she said. “Often times [family] caregivers will burn themselves out because they feel like they have to do everything.”
In addition, ethnic adults are also aging, with Latinos on the fastest-rising curve. Stanford’s Periyakoil said America’s aging “silver tsunami” – over 8,000 citizens turn 65 each day – now has a new name. “People are actually talking about the silver-brown tsunami,” she commented.

With an aging ethnic population and more immigrant caregivers, Americans should prepare for a colorful future: Filipinos providing care for older Latinos, African-Americans helping aging Russians, and Asian caregivers assisting Afghani elders.

Del Valle said all of these complex issues of race need to be explored in the open. “I consider the very act of asking this question to raise awareness,” she said.

John Booker of the National Association for Direct Care Workers of Color agreed, “I would hope that it would disappear with the younger generations.
As a reader of Global Action on Aging's blog, will you comment by writing to www.globalaging.blogpost.com     Thanks, Susanne Paul at Global Action on Aging

Tuesday, July 23, 2013

China Requires Children to Care for their Aging Parents

 Dear GAA Blog Reader,

Do you think that your government should require children to care for their older parents?  Yes? No?    Well, China does!                              

In a Healthland Time.com article, the author says China’s government thinks so.  Why?  As the population of elderly in nearly every society starts to swell, such eldercare laws are becoming more common. But are they effective?
What kind of care and devotion is expected of adult children toward their aging parents? Not surprisingly, siblings can hold fiercely different positions about what they “should” do. Some make huge sacrifices of time and money to comfort and care for parents; others rarely show their faces even when parents pine for them. But if families can’t resolve these difficult issues, can governments do any better?

In China, a new law that went into effect this month requires children to provide for the emotional and physical needs of their parents, which includes visiting them often or facing fines and potential jail time. One woman who was found negligent in visiting her 77-year-old mother has already been charged under the Law on Protection of the Rights and Interests of the Elderly and was ordered to visit her mother at least once every two months, and on at least two national holidays a year.

Enforcing the law will certainly be challenging, and critics have raised the very real possibility that in an effort to alleviate some of the impending burden that 200 million people over the age of 60 represent for the Chinese government, the law may end up causing more familial strife and resentment toward elderly parents. While no government can legislate loyalty or love, more legislatures are finding it necessary to mandate responsibilities, especially those of the financial kind.
In Ukraine (and other former Soviet-bloc nations), says Katherine Pearson, a law professor at Penn State, children are “obliged to display concern and render assistance.” In practical terms, that translates to needy elderly being able to sue their children for financial support. And a sister can sue her brother for not paying his share of mom’s costs.

 Much closer to home, laws in 20 US states require family members, for the most part adult children, to support their financially needy relatives, which can include elderly parents who no longer have an income or disabled adult children who are unable to support themselves. Most of these statutes, which are among the original laws of the states, have not been in active use since the Great Depression. In fact, most states repealed them from the 1950s through ’70s when older people began reaping the benefits of Social Security and Medicare.

Since 1994, however, Pearson says lawsuits in Pennsylvania and South Dakota against adult children by a needy parent or a care provider like a hospital have required adult children to come up with the money for their parents’ care bills. Some nursing homes have used the laws to win judgments as high as $90,000 against adult children, says Pennsylvania elder-law attorney Jeffrey Marshall. “It’s a ‘gotcha’ law,” says Pearson, “because most people don’t know about it until after it goes wrong.”
Such statutes are a relic of the Elizabethan Poor Laws, which colonists from England introduced to America. They were enacted in the first half of the 20th century, at a time when it was more common for multigenerational families to live near each other, or even in the same house, and to be economically interdependent. Life expectancies were lower back then, however, so there were far fewer frail old people, and those few were usually cared for at home by a daughter.

The social revolutions of the 20th century changed this social landscape in the U.S. and in much of the world. Parents live much longer, often with chronic conditions for which they need medical care. Women as well as men are in the workplace, and adult children may live hundreds or even thousands of miles away from their parents. That’s what prompted the law in China; with so many of the younger generation seeking better employment and financial opportunities away from home, elderly parents are increasingly left behind to fend for themselves.

This collision of new realities with responsibilities to parents has struck even in Japan, a traditional Confucian society, where filial piety is a cherished value and the traditional role of a wife has been to care for her husband’s parents. But Japan has the world’s fastest aging population — nearly a quarter of the population is over 65, and in a sign that the silver wave is already washing over the nation’s shores, adult diapers are projected to outsell baby diapers by 2020, according to the Nikkei newspaper.
Huge numbers of caregivers are needed, but with traditional daughters-in-law now disappearing into the workforce, in 2000 the Japanese government created a universal long-term care program to help families pay for hired caregivers. And, despite the traditional reverence for elders, says AARP analyst Don Redfoot, women — many of them presumably daughters-in-law — lobbied against a provision that would have allowed the elderly to pay family members to care for them.

 More affluent European countries rely primarily on some sort of government support for eldercare, with varying degrees of potential family involvement. Norway provides universal long-term care to everyone. In France, the elderly receive a payment similar to Social Security, which increases according to the recipient’s income and care needs. In Germany, a social-insurance approach like Medicare helps pay for long-term care. Unlike in Japan, this money can be used to pay family members for care services.
But these insurance programs only provide financial support, and do little, if anything, to address what the Chinese call the “spiritual needs” of the old. China’s law, therefore, was intended to exert moral pressure on sons and daughters to attend to their parents — seeing retired parents, that legislation makes clear, is your job.

And what if that job becomes too burdensome, or even impossible to maintain? Even without laws, most children do feel some responsibility or even a positive wish to take care of their parents. The real problem, particularly in the U.S. and increasingly elsewhere, is that adult kids are caught between time, career, family and geographical demands that they can’t always resolve in favor of spending more time with grandma and grandpa.

That means that from China to South Korea to South Carolina, governments may create programs to mandate care for the elderly, but, says Lori Brown, a sociologist at Meredith College in North Carolina, they are often still isolated and alone. “And the most isolated elderly,” she says, “have the most depression, lower quality of life, and die earlier.”
If legislating such loneliness away isn’t the answer, what is? Some social programs reduce elders’ loneliness by visit from volunteers. Many children arrange for their parents to attend day programs for the elderly, where they will have the chance to interact with others and engage in activities to stimulate their social and cognitive skills. And they are increasingly hiring aides who not only can help older people perform daily tasks but serve as companions for them as well. In Japan, for example, companies that provide “companions” for the elderly are flourishing. Home Instead Senior Care’s Japanese franchises have grown at an average rate of over 10% since 2006. It’s no substitute for a child’s companionship, but the reality of current financial and social demands makes it an acceptable stand-in for many people. “We might not want to pass laws like the one in China, but we could certainly do with some awareness campaigns about caring for not only our family members who are older but everyone who is elderly,” says Brown. Especially if we remember that one day each of us will find ourselves in need of such societal support and attention.

 What do you think?  Please respond on our Blog.
Best, Susanne Paul for Global Action on Aging



Saturday, July 13, 2013