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

Friday, July 12, 2013

Thursday, July 11, 2013

Sunday, June 16, 2013

Latin America's CORV calls for Rights of Older Persons and an end to Elder Abuse

Dear Global Action on Aging Friend,

Latin Americans are making vigorous efforts to end elder abuse throughout Latin America and the Caribbean.  I think you will be interested in reading their materials. . .wherever you live.  Here is statement that CORV prepared for the June 15th World Elder Abuse Awareness Day.
1. In our meeting as a civil society held in Costa Rica in 2012 we expressed that "the
rights of older persons continue to be violated. Actions in relation to older persons
and aging lack coherence between the speech that emphasizes these rights and the
compliance thereof. In this context, older persons continue to suffer from multiple
discrimination; different types of abuse and violence, poverty, and lack of access

to justice "  (Declaration of Tres Rios, par. No. 1).

2. One year since our meeting, in which we agreed to move from plan to action, we
MALTREATMENT OF OLDER PERSONS, recognizing health as a human
right and not a commodity. Each time attention is postponed, medication is not
provided, or access to required health services is denied, an assault is committed on
the lives of older persons and international agreements that demand priority and
proper and timely attention be given are violated. THE VIOLATION OF OUR
3.  The lack of income, low pensions, non-recognition or not granting of universal
pension and non-indexation of pensions to the cost of living is one of the worst
forms of discrimination and reproduction of poverty among older persons. It is
inconsistent that in legislative frameworks the aged over sixty years are
recognized, while for providing non-contributory pension the age is set at sixty-five.
In this case it is an abuse that comes from the political, administrative and
legislative institutions themselves, which is identified as STRUCTURAL ABUSE.

4.  It is a violation of the rights of older persons not to have an adequate standard
of living that guarantees them and their family, health, wellbeing, and in particular
food, clothing, housing, medical care, the necessary social services, the right to
security in the event of unemployment, sickness, disability, widowhood, old age or
other lack of livelihood in circumstances beyond their control. (Art 25. Declaration
of Human Rights).
If you wish to learn more or sign on to this Statement, contact Enrique Mac Iver in Santiago, Chile, at this phone number (56-2) 633 0032 in Chile or at E-mail: sociedadcivilpersonasmayores@gmail.com 


Coordinación Regional de Organismos de la Sociedad Civil
de América Latina y el Caribe sobre Envejecimiento, CORV


5. We note that our countries have already signed three international agreements aimed at full recognition of the elderly, which are the Regional Strategy on Aging
(2003), the Declaration of Brasilia (2007) and the Charter of San Jose on the rights
of older persons in Latin America and the Caribbean (2012). However, these
agreements have not been translated in facilitating real ways of participation of older personsand their organizations in decision-making at all levels, as indicated in the actions recommended in the Madrid Action Plan on Aging (2002) and reaffirmed in the cited agreements. The failure to consider the will and existence of older persons and civil society institutions, devoted to working for the rights of older persons, is a kind of discrimination that reveals another form of abuse, structural abuse.

6. On the occasion of World Elderly Abuse Awareness Day 2013 as theRegional Coordinator of Civil Society Organizations on aging and old
age, CORV, we express our solidarity and we encourage social struggles
of the organizations of older persons and of workers in the region for their rights
for decent pensions, for timely and preventive health and for integration and
exercise of all the rights, the real path of Good Treatment and of Good Living,
which is the cry of every voice, every face of older persons, and of all citizens.
June 2013

With thanks for your solidarity, Susanne Paul at Global Action on Aging


Wednesday, June 5, 2013

HIV in US Prisons

Of the 2.2 million people serving time in US prisons, around 1.5 % of those are living with HIV or AIDS. That number is about four times higher than the infection rate of HIV in the general population. Studies show that most HIV positive inmates are infected before they enter prison. Nevertheless, prison environments offer many opportunities to spread HIV. High risk behaviors such as injecting drugs, tattooing, body piercing and unprotected sex (consensual and rape) are not uncommon in a prison setting.

To give you an idea of the situation, I found a CDC (Center of Disease Control) study carried out in a Georgia State Prison between 1992 and 2005. It showed that 54 inmates (45 cases and 9 control persons) reported having male-male sex while in prison. Some 35 persons (78 %) of the case inmates and four (44%) of the nine control inmates reported no male-male sex after the first six months following incarceration. Among those who reported any male-male sex, 39 said they had consensual sex with other inmates. They exchanged sex for food, cigarettes, money, etc. Rape was also reported. When consensual sex occurred 34 (30%) reported using condoms or other improvised barrier methods (such as a rubber or plastic glove). In “exchange sex,” 21 % said they used improvised methods, but no condoms. No protection was used during rape.*

What has been done in the US about this situation?
Several bills have been introduced to attack this growing problem. It's been clear that the prison authorities must ensure a safe and humane treatment of prisoners who are HIV positive or are living with AIDS. Congresswoman Barbara Lee (CA) has introduced H.R 3053 – to Repeal Existing Policies that Encourage and Allow Legal HIV Discrimination Act (REPEAL HIV Discrimination ACT). And Congresswoman Maxine Waters (CA) has introduced H.R 3547, the Stop AIDS in Prison Act. This legislation calls for a comprehensive policy to provide HIV-testing, treatment and prevention measures for inmates in federal prisons and upon their reentry into the community. It would also require prisons to test inmates upon intake and offer counseling. It also requires frequent HIV/AIDS educational programs for all inmates.

Some state prisons have HIV positive people in separate facilities, arguing that such separation allows them to focus on medical care. The HIV positive inmates and HIV negative inmates mix for education, vocational training, religious and other prison programs. But is such segregation of HIV positive inmates really the solution?

As a matter of fact, separate facilities may well increase the already existing stigma. I believe that separate facilities may well be inhumane and degrading and may violate international law. Even if you are in prison, you should have the right to privacy. It should be the citizen’s right to decide whether to tell others of his/her health status. Laws and regulations that exist regarding HIV status should be the same in prison as in free society.

On the other hand, confidentiality of medical information in a prison setting is hard to maintain. Persons other than of medical staff members may handle medical records. Once such information is released, it travels fast. It has been argued that prisoners have a greater need for privacy than those outside because they live in a closed community where violence is common. Also, if prisons fail to keep medical records confidential, inmates might choose not to get tested, to avoid being victims of this double-sided problem. Prison officials also use HIV tests results to make decisions about housing (separate housing as one option in some prisons), work assignments, and visiting privileges. It's been common to ban HIV positive inmates from kitchen work.

Many inmates report difficulties getting the right medications and at the right time, or at all. To solve this problem, separate facilities might be a solution. Nevertheless, is it necessary to put HIV- positive prisoners in a separate facility simply to assure that they get the right medications at the right time? I am sure the prison system can do better than that. Besides, keeping people in different facilities does not reduce the spread of other sexually transmitted, opportunistic, and blood-borne infections. Such policies do not prevent transmission by inmates who are unaware that they are infected or by HIV-infected correction staff. There is no available data that show the effectiveness of separate housing for HIV positive inmates as an HIV – prevention strategy.

A better solution alongside education and volunteer testing would be to make condoms available in prisons and assure confidential patient care. Such a policy would focus on educating prisoners about how the virus is contracted. And it would demonstrate that HIV-positive people CAN work in a kitchen!

Sanna Klemetti

Learn more and see references at:

Tuesday, May 21, 2013

Dying in Prison - The US' Massive Prison Population is Getting Older

 Prisons across the USA are dealing with an aging group of people. According to a Human Rights Watch study made in 2010, some 26,000 inmates in the USA were 65 and older, and this trend is growing. A new report from the American Civil Liberties Union estimates that by 2030, the over -55 group will number more than 400,000. This projection amounts to about a third of the overall prison population.

More and more older women and men are dying in prison of natural causes. Some grow old and die in prison and some enter prison in such a poor health that they will die before they complete their sentence. According to the National Institute of Corrections, prisoners age 50 and older are considered “elderly” or “aging” due to unhealthy conditions prior to and during incarceration. A study by Brie Williams and Rita Albraldes published as a chapter in the book Growing older: challenges of Prison and Reentry for the Aging Population, found that in addition to the chronic diseases that increase with age, older offenders have problems such as paraplegia because of the legacy of gunshot wounds. Many have advanced liver disease, renal disease, or hepatitis. Still others suffer from HIV-AIDS, and many more endure the effects of drug and alcohol abuse. Living under prison conditions, they are more likely to get pneumonia and flu.

Cells and dormitories are starting to fill up with old, often sick, men and women. They get around in wheelchairs and walkers. They fill the prisons, assisted living wings and hospices faster than the state and federal government can build them. And since they will probably die in prison, they also fill up the mortuaries and graveyards.

Passing on in a Prison
Some prisons have created hospices to respond to the emotional as well as physical needs of the dying. The rules about visitors are usually more relaxed, so that family members can sit at their relative's bedside seven days a week and are permitted to hug and touch their loved one. The “staff” in a hospices are other volunteer inmates who complete a 50 hour training, as well as ongoing training as the need arises. These volunteers will read, pray and write letters for the dying; they also assist the nurses with certain tasks such as preparing baths and changing diapers.

Sadly, even though attempts to try to deal with this growing challenge, it is still far from well working. Most of the time, the care the aging inmate receives is grossly inadequate and very expensive. For the first time some states are considering releasing terminally ill and mentally ill prisoners before they complete their sentence. To me this seems like a good idea.

Compassionate Release?
Compassionate release is a legal system that grants inmates early release from prison sentences on special grounds such as terminal illness or a child in the community with an urgent need for his or her incarcerated guardian. Compassionate release can be mandated by the courts or by Internal Corrections Authorities. Unlike parole, compassionate release is not based on a prisoner's behavior or sentencing, but on medical or humanitarian changes in the prisoner's situation. Why should we let people out from prison?

It is unnecessary to keep the old incarcerated, since there is evidence that demonstrates that recidivism drops dramatically with age. For example, in New York, only 7% of prisoners released from prison at ages 50-64 returned to prison for new convictions within three years. That number drops to 4% for prisoners age 65 and older. In contrast, this figure is 16% for prisoners released at age 49 and younger. Further, the majority of aging prisoners are not incarcerated for murder, but are in prison for low-level crimes. in fact, many aging prisoners are incarcerated for nonviolent crimes.

Keeping people in prison is very expensive. The US spends approximately $77 billion annually to run the penal system. The incarcerated aging prisoners cost far more than younger ones. Specifically, it costs $34,135 per year to house an average prisoner, but it costs $68,270 per year to house a prisoner age 50 and older.

US Federal sentencing laws has been very harsh for a generation. Compassionate release is a humane and practical program and it saves money. Yet, it has not been used very much. In a lot of cases, prisoners and their families don't even know about this program.

Sanna Klemetti

For references and to learn more please read:

Friday, May 17, 2013

Why Cut Social Security while NOT taxing Wall Street?

Dear GAA Reader,

Dean Baker wrote an instructive article for the Huffington Post asking why older persons must endure possible cuts to Social Security while the Wall Street bankers who brought on the Wall Street collapse in 2008 smile easily as they rake in more money.

Baker says, "Since Social Security benefits account for more than 70 percent of the income of a typical retiree, President Obama's proposed Social Security adjustment would reduce benefits by an average of 3%."

According to Baker's research, "a wealthy couple earning $500,000 a year would see a hit to their after-tax income of just 0.6 percent from the tax increase that President Obama put in place last year." Small change for them!  While the rich have little pain, most US  seniors will feel the hurt as their Social Security check drops 3%.

Do you think that US seniors should pay for the current economic crisis?  If you say "no", then support Senator Tom Harkin's proposed legislation that would put a .03% tax on stock trades and other financial assets. Such as measure, Dean says, could raise $40 billion per year or over $400 billion over a decade once it went into effect.

If you think these are good ideas, share them with your colleagues, friends and family. Ask them to write their Congressional Representatives and urge them to enact legislation that Harkin proposes.

We older persons must stand up to support ideas and policies that assure fair,  just and adequate incomes for all of us.  We are many.  We can do it!

Have a good week!

Susanne Paul for Global Action on Aging

Monday, April 29, 2013

Immigrants to the US and Social Security: Ripe for Ageism and Disabilty Bias

New America Media reveals a new version of Old Bias:

SAN FRANCISCO--As the debate over immigration reform tugs predictably back in Washington, an undercurrent of ageism and disability bias has been flowing beneath more obvious racial and class implications.

Take, for instance, the recent USA Today op-ed co-authored by former U.S. Sen. Jim DeMint, R-S.C., now president of the conservative Heritage Foundation, which warned, “The truly enormous costs come when unauthorized immigrants start collecting retirement benefits.”

DeMint and his colleague continued, “Social Security, Medicare, food stamps and other entitlement programs already impose huge, unfunded liabilities on taxpayers.” The op-ed goes on to declare that “an amnesty” proposed for 11 million unauthorized immigrants will add significant taxpayer costs because unauthorized immigrants average only a 10th-grade education.

Doing the Right Thing

Rather than being a burden, however, according to the Social Security Administration’s chief actuary, those presumed drains on the system have been a boon. They add $15 billion a year to Social Security in payroll taxes, only taking out $1billion annually in benefits. In the long term, immigration reform would modestly cut Social Security’s deficit, not worsen it.

According to Pew Research, that’s partly because of future rising income and home ownership levels for those immigrants’ children.

“Those opposed to immigration reform have attempted to use vital programs, like Social Security, as an economic excuse to avoid doing the right thing,” said Max Richtman, president and CEO of the National Committee to Preserve Social Security and Medicare (NCPSSM).

In a policy brief last week, NCPSSM cited Edward Alden of the Council on Foreign Relations, who has said that immigration reform would actually lead to higher wages and allow immigrants to pay more towards Social Security.

"They’re going to pay more into the Social Security system. The CBO has run these numbers in the past, in the short-run there’s a big boost for the Social Security system," Alden said

White House and Senate ‘Roadmaps’

According to a new policy analysis by the National Hispanic Council on Aging (NHCOA) and National Council on Aging (NCOA), today’s approximately 11 million unauthorized immigrants include 1.3 million individuals ages 45-54, and another half million who are 55 and older.

NHCOA’s Jason Coates and NCOA policy analyst Joe Caldwell examined “roadmaps” to citizenship outlined so far by the White House and the Senate’s bipartisan “Gang of Eight,” with legislation to come in a few months.

Both proposals signal long waits before eligible immigrants could even apply for lawful permanent resident status (green cards) and citizenship. And their access to health care and economic security benefits, especially important to elders and those with disabilities, is in doubt.

Under the current proposals, unauthorized immigrants could end up waiting a decade or more to qualify for health care and other safety-net programs.

While the Senate plan would link the waiting period for being able to apply for green cards to some assurance of border security, the White House has proposed allowing undocumented immigrants provisional status for six-to-eight years before they could become permanent residents. (Both the administration and Senate frameworks would expedite the process for “DREAMers,” agricultural workers, and highly skilled immigrants with advanced degrees in such areas as science and technology.)

Once an immigrant waited through those years on provisional, or temporary status and qualified for a permanent status (the green card), he or she would begin the five-year process toward naturalization. During that time, the White House and Senate proposals would deny them access to federal benefits, such as Medicaid, Supplemental Security Income and the Supplemental Nutrition Assistance Program (food stamps). President Obama’s proposal would deny access to subsidies under the Affordable Care Act. People could have to wait more than a decade for assistance.

Older adults would also have to wait that long to access Medicaid, which is the primary payer of long-term care in the U.S. States can waive the five-year waiting period normally required once someone becomes a permanent resident, but only for pregnant women and children, not for individuals with disabilities or seniors.

Statistics show that six-in-ten undocumented Hispanics is without health insurance.

They would also have to wait another five years -- that is about a decade after starting on the path to citizenship -- to qualify for federal Medicare.

Many of those 11 million undocumented people are overrepresented in low-paying and often physically demanding occupations, frequently incurring high rates of work-related injuries, and contributing to high rates of disability and chronic conditions over time.

Looming Shortage of Care Workers

The NHCOA-NCOA report also calls on the government to strengthen and stabilize the shrinking direct-care workforce, such as the nursing aides who assist patients with such crucial daily activities as getting dressed, taking medication, preparing meals and managing money.

The advocacy groups say reforms should afford these workers the same streamlined and expedited visa process as those proposed for scientists, engineers and workers in other high-need areas, because the nation is facing a looming shortage of care workers.

The paper explains that as the U.S. population ages, U.S. demand for long-term care will leap from today’s 12 million to 27 million by 2050. The country will need 1.6 million additional direct-care workers by 2020 and 3 million by 2030.

Immigration reform is vital for meeting that projected need, say NHCOA and NCOA, because almost one in four current direct-care workers is foreign born. About half today are naturalized citizens and others have legal status, “but a significant portion is estimated to be unauthorized.”

Policy changes offering these workers authorized immigration status would improve the quality of care, says the paper, by allowing for improved background checks, providing workers opportunities for training and career advancement, building registries to assist individuals and find workers, and enabling workers to legally drive.

“Comprehensive immigration reform will help millions come out of the shadows. Many of the half million older adult immigrants [among them] have worked for decades and contributed millions to Social Security,” said NHCOA’s Jason Coates. Rather than begrudging them income and health security protections they have earned, he added, “We should reward their contributions to the to the United States.”

Tuesday, April 23, 2013

Global Action on Aging salutes NY Times for "Older, and Unafraid to Talk About It," (April 22, 2013)

Older, and Unafraid to Talk About It

Aging can be difficult, bringing along new challenges of declining health, loneliness and changes in lifestyles. More and more seniors are using therapists to help them cope with these changes. Here, three seniors speak about beginning to see a therapist later in life.

Oscar Hidalgo for The New York Times

Judita Grosz, 69

Finally Finding Herself
“Therapy has unlocked a lot of things that I never thought would have unfolded for me at this time in my life. I have learned to be more open with myself and others about who I am and what I am, and I've learned that I'm a fabulous person, which I did not know till now.”
Michael Kirby Smith for The New York Times

Marvin Tolkin, 86

Aging Is the Problem
“You can't do the things you used to do. You can't go where you wanted. People look at you differently. What psychiatry does is help you go through the problems and adjust your thinking.”
Oscar Hidalgo for The New York Times

Miriam Zatinsky, 87

“I always said that I would never be old, but I changed my mind when I got here. Because I'm surrounded by people who are old, and I had to come to grips with that.”

Wednesday, April 17, 2013

Aging in Prison

Recently I attended the monthly general meeting of the New York NGO Committee on Ageing. The topic was “Aging in Prison – a Human Rights Issue.” Two academics who have specialized on treatment of US prisoners presented some of their research. They were:

Tina Maschi, PhD, LCSW, ACSW, who is now Associate Professor at Fordham University Graduate School of Social Services (FUGGS); she’s also a Social Fellow at the New York Academy of Medicine, a Research Scholar at the Ravazzin Center on Aging, and Coordinator for the FUGGS Human Rights and Social Justice sequence. The second speaker, Deborah Viola, PhD., is Associate Professor and Associate Director, Doctoral Program, Department of Health Policy & Management at New York Medical College, and Research Scholar at the Center for Long Term Care Research & Policy.

General Facts
The US population makes up about 5 percent of the world’s population. About 10 million people are imprisoned world-wide. Surprisingly, 25 percent of those are “doing time” are held in US prisons. Among them, 16 percent of the 10 million are 60 years and older. The US exceeds all nations in the number of old people incarcerated in its prisons. At present, the older population is the most rapidly growing group in US prisons. In fact, the number of older prisoners is growing faster than the number of older persons in the US population. In the US, 756 human beings out of every 100.000 people are incarcerated.

Why are there so many people in US prisons?
One would think since the US has the largest prison population in the world that the nation must be home to very dangerous criminals who everyone would agree are “bad” people. But wait a minute, are they?

About three decades ago the US introduced a “tough on crime” policy. State and federal legislators adopted laws that increased the likelihood and length of prison sentences, by including mandatory minimum sentences and three strikes laws. It seems a bit strange that while the crime rate had declined since the 1980's; nevertheless the US prison population grew six-fold.

It is very interesting that the US has privately owned prisons. The two largest private prison companies combined to bring in close to $3,000, 000, 000 in revenue in 2010. Earlier in the 1980's, there were no privately owned prisons in the US. Since then the number of incarcerated people has exploded. It does not take a genius to see what is going on here.

Last year the largest private prison in the US, Corrections Corporation of America (CCA), received $ 74 million of taxpayers’ money to run immigration detention centers. There are numerous reports on human rights’ abuses in these private prisons. For example, when auditors visited one private prison in Texas, they “got so much fecal matter on their shoes they had to wipe their feet off on the grass outside.” The prisoners were literally living in their own excrement. To make a phone call to a lawyer or loved ones, the CCA charges its inmates $ 5 per minute, yet the prison only pays inmates who work at the facility $1 per day. To me, it looks like the more people the “justice system” can put behind bars, the more money the private prisons will make.

A lot of people go to US prisons because of drug crimes. Examining who actually goes to prison because of a drug crime speaks very loud. About 14 million whites and 2.6 million Afro-Americans report using an illicit drug. While five times as many whites are using drugs as African Americans, yet African Americas are sent to prison for drug offenses at 10 times the rate of whites. African Americans serve virtually as much time in prison for a drug offense (58.7 months) as whites do for a violent offense (61.7 months). Surely this is not “equal treatment under the law.” One out of every 12 Afro-American men of working age is in prison. These statistics tell us that if you commit a drug crime and are not white, you will go to prison. If you are white, it is considered a public health problem.

What are the problems facing an older population behind bars?
Prisons in general are designed for the young and able-bodied. For example, when people grow older they have different medical and health needs than the young. Older persons are more likely to develop disabilities that require the use of assistive devices such as glasses, hearing aids, wheelchairs, walkers and canes. As in the community, the elderly in prison suffer from falls, which contribute to hip fractures and high health costs. Even if these conditions are provided for, many elder inmates are confined in facilities that cannot meet the structural or programmatic needs of mobility-impaired persons. Because of their higher rates of illness and impairments, older prisoners incur medical costs that are three to nine times higher than those of younger prisoners. In general a younger prisoner costs about $22.000 per year while an older person can cost as much as $65,000 per year.

It is also documented that the older prisoners “age” about 15 years faster than people who are not incarcerated.

Sooner or later, one of two things will happen to an aging prisoner. Either he/she will die in prison, or will be released. Neither of these alternatives has gained that much attention. Reentry into society is very difficult for any former prisoner. Older persons face additional challenges. Older women and men find it extremely hard to find work, housing and transportation, as well as necessary medical and mental healthcare. Some have the assistance from former friends and family, but many have lost contact with their families because of the length of time incarcerated or the nature of their crimes.

As the number of older prisoners increases, so too does the number of men and women dying of natural causes behind bars.

For references and more information please visit:
Human Rights Watch's report “Old Behind Bars

Sanna Klemetti

Monday, April 15, 2013

Seniors! Are you taking one of the 110 most dangerous drugs for older people? Want to know? Read further!

The April 15, 2013, New York Times reports that US medical doctors are routinely prescribing drugs that can be harmful to older patients.  Medicare recipients in the US South are getting prescriptions that can hurt them seriously.  Apparently one in five older persons living in the South are taking drugs that are dangerous. Other US regions have fewer seniors who are taking such drugs regularly.

Are the patients poor? Do they lack education? Have unqualified doctors?  Are they persons of color? Researchers say that poor people are more likely to be taking these drugs.  As socioeconomic status declined, for example, the likelihood of being prescribed a high-risk drug increases.

New York Times reporters drew much of their information from medical experts who published their findings in the latest issue of The Journal of General Internal Medicine. "For the study, they referred to a list of 110 drugs to avoid in the elderly, compiled by the National Committee for Quality Assurance. Many of these drugs are widely used, often with few or moderate side effects in younger patients.  However, risks get bigger among elders.

On the list are anti-anxiety medications like Valium. This drug can be harder for older patients to metabolize.  It stays in the system and "can lead to prolonged sedation, and in turn potentially deadly falls and fractures." Several muscle relaxants and diabetes medications can also remain in elderly patients’ bodies for longer periods, causing complications.

Researchers examined records of more than six million older men and women in the US enrolled in Medicare Advantage plans. "Over all, they found that 1.3 million of those seniors, or roughly one in five, had been prescribed at least one high-risk medication in 2009 even though many of the drugs were available in safer versions. About 5 percent of the seniors in the study had been prescribed at least two medications from the list," the NY Times reports.

Using many medications, known as "polypharmacy," is a growing problem among seniors. Researchers found that the "average person over 65 takes at least four prescription drugs — a practice that can lead to dangerous and unexpected interactions."  Taking many drugs is creating a serious public health problem. . . and it affects seniors more than anyone else.

What drugs are you taking?  Check out their safety.  Now!

What can you do?  Talk to your doctor and your pharmacist to find out about the drugs that you are taking.  Are they safe?  What is their record?  If these resources are too busy to tell you, reporters  suggest using the internet to query the records and warnings of medications you are taking.

Protect yourself.

Susanne Paul for Global Action on Aging

Wednesday, April 10, 2013

How Does Depression Wreck Your Life?

All too often stereotypes cast older persons as “grumpy.” Many people think that being down and depressed is normal in old age. Attention!
It is NOT a natural part of aging. 

Depression can happen to anyone at any age and is common among older adults and seniors. Some 15 out of 100 adults over the age of 65 suffer from depression in the US. Who are these older adults and why do so many of them suffering from depression? Studies show that the disorder affects people in nursing homes and hospitals in even greater numbers. Recognizing depression among old persons is not always easy. Depressed elders may find it difficult to describe their feelings. Many fear revealing their sadness since they may associate it with being “crazy” or lacking self-control. In the youth of today’s elders, they learned that depression often was associated with being “crazy” or weak-minded. Today, we know hat depression is a fully treatable medical or biological illness.

The Movie Grumpy Old Men

Aging, HIV and Depression
Experts have discovered a link between HIV-positive older adults and depression. To find out more about this development, I met up with Stephen Karpiak to talk about HIV positive older adults and seniors. A PhD, Karpiak joined ACRIA (AIDS Community Research of America) in 2002, as Assistant Director of Research. He served as primary investigator at the agency's new behavioral research effort, including conducting groundbreaking Research on Older Adults with HIV(ROAH) study. Earlier, he had worked for over 20 years at Columbia University's Medical School as a research scientist in neurobiology and immunology. Karpiak also started a Phoenix, Arizona, project to provide housing for homeless people living with HIV/AIDS. Dr. Karpiak has documented over 250 articles in scientific journals and books, and has been holding lectures all over the world.

 Dr. Karpiak

Karpiak told me that the ROAH goal focused on understanding the situation of those over the age of 50 who are living with HIV. ROAH sought answers to identify their psycho-social needs and determine how to support them most effectively to live longer, healthier and happier lives. ROAH assessed a 1,000-person cohort in New York City, examining a comprehensive array of issues, including health status, stigma, depression, social networks, spirituality, sexual behavior, and substance abuse.

ROAH showed that stigma, isolation and depression are the major problems for this group. The stigma against HIV/AIDS and is usually associated with homophobia, racism, ageism, etc.

ROAH demonstrated that by repressing the immune system, depression may render people more vulnerable to infectious diseases. Stress and depression have a harmful effect on cellular immunity, including those aspects of the immune system affected by HIV. Body cell mass depletion is associated with significant increase in fatigue, global distress and depressive symptoms, and reduced life satisfaction. Elevated symptoms of depression associated with a faster progression to AIDS and a higher risk of mortality.

Stigma often leads to isolation, depression and loneliness. Older HIV positive adults who are depressed are more likely to have financial problems, have fewer people to turn to for support, lack critical HIV-related information, live alone, have thoughts of suicide, and experience greater levels of stigma related to HIV and aging as compared to older adults who are not depressed. Depression may also stop persons from getting treated, avoiding doctor visits, social activities and other relationships. ROAH found that aging HIV-positive adults experience significant levels of depression, at a rate at least five times higher than the general New York City population.

Dr. Karpiak and Sanna Klemetti

I asked Dr. Karpiak what has or can be done about this situation. As a matter of fact, successful projects exist. One example is the MacArthur Foundation Model that expects participants to make one phone call every week to ask the HIV affected person how he/she is doing. The effect of this simple and effective program has been great. Another ACRIA project is The Go 4 Part Program, funded by Mac AIDS fund. It's a two day HIV – aging training program. Around 25 educators visit about two cities per year, to bring AIDS, health and aging organizations together to educate them about these issues. They also introduce ideas on how to reduce the problems. They usually invite one person from the meetings to New York to see the work carried out at ACRIA.

More about ROAH

Sanna Klemetti

Will President Obama sell Out US Seniors and our children for a Deal with the Republicans?

Salivating Over Social Security Cuts

Dear Global Action on Aging Friends,

Wherever you live, please note the very real possibility that President Obama will seriously weaken or even destroy the Social Security Program for a "deal" with Republicans over the US Budget.  Not only will such action undercut the modest living standard of US elders but it also threatens young workers who have contributed to the program since they entered the workforce. 

Mind you, US citizens have already seen the Federal Government "borrow" from Social Security to support other programs--and failed to re-pay the debt.  Read excerpts from Robert Reich's Blog (April 10, 2013) for the full story:

ohn Boehner, Speaker of the House, revealed why it's politically naive for the President to offer up cuts in Social Security in the hope of getting Republicans to close some tax loopholes for the rich. "If the President believes these modest entitlement savings are needed to help shore up these programs, there's no reason they should be held hostage for more tax hikes,” Boehner said in a statement released Friday.
House Majority Leader Eric Cantor agreed. He said on CNBC he didn't understand "why we just don't see the White House come forward and do the things that we agree on” such as cutting Social Security, without additional tax increases.
Get it? The Republican leadership is already salivating over the President's proposed Social Security cut. They've been wanting to cut Social Security for years.
But they won't agree to close tax loopholes for the rich.
They're already characterizing the President's plan as a way to "save” Social Security - even though the cuts would undermine it - and they're embracing it as an act of "bi-partisanship.”
"I'm encouraged by any steps that President Obama is taking to save and preserve Social Security,” cooed Texas Republican firebrand Ted Cruz. "I think it should be a bipartisan priority to strengthen Social Security and Medicare to preserve the benefits for existing seniors.”
Oh, please.
And the day Ted Cruz agrees to raise taxes on the wealthy or even close a tax loophole will be when Texas freezes over.
The President is scheduled to dine with a dozen Senate Republicans Wednesday night. Among those attending will be John Boozman of Arkansas, who has already praised Obama for "starting to throw things on the table,” like the Social Security cuts.
That's exactly the problem. The President throws things on the table before the Republicans have even sat down for dinner.
The President's predilection for negotiating with himself is not new. But his willingness to do it with Social Security, the government's most popular program - which Democrats have protected from Republican assaults for almost eighty years - doesn't bode well.
The President desperately wants a "grand bargain” on the deficit. Republicans know he does. Watch your wallets.

GAA Readers:  Write the President and your Congressional Representatives to protest!  Organize a Demonstration (with your family and friends in your Community) demanding a stop to this disastrous plan to ruin US Social Security! Take action to alert citizens, young and old! 

Susanne Paul for Global Action on Aging