Visiting Nursing Homes With Chiquita Smith

Last week I visited two nursing homes in Brooklyn and Queens with Chiquita Smith. Previous interns have been on similar visits before me, but they went to different places. Chiquita Smith is quite an interesting person. She devotes a lot of time to defend the rights of nursing home residents. To find out about residents’ living conditions, she travels to different nursing homes every couple of months. She brings interns from Global Action on Aging to see how poor elders live in such nursing homes. Chiquita lost her vision a number of years ago due to diabetes.

Our first stop was at Cobble Hill Health Center. This nursing home is located in downtown Brooklyn, a big building in the middle of an urban jungle. It is a non-profit nursing home and has a total of 570 beds available. When I first walked in, I could not decide if it felt like I walked into a school or a hospital. The big dining room and the wall decorations reminded me of my old elementary school back in Sweden. Soon enough I realized I was not in a school but in a nursing home.

When we arrived, it was time for the residents to have coffee in the 'common room'. Quiet music was playing in the background. Slowly, one resident after the other joined us. We sat down with Chiquita’s good friend to talk. Chiquita told me she has two main concerns when it comes to nursing homes: whether the residents get a chance to go outside when the weather is nice, and if they get help to vote during elections. We were told that the Cobble Hill seniors used to go out. But no longer, unless they are capable of going outside by themselves. During elections there is some assistance available. I looked at their weekly entertainment schedules which suggested that indoor activities had been planned for them every day of the week. This is good, since social interaction is important at any age. However, three things bothered me. The first one was how residents and employees interacted. I felt that a lot of the caregivers were talking 'over the head' of the residents or as if they were not there. In the middle of coffee time the fire alarm went off. It took a very long time until it was turned off. The sound was very loud. As this was going on, an employee of the nursing home said to me:

- ”Thank God for the paycheck.”

At first I was not sure I heard her right. I thought that this comment was highly inappropriate. Not only is it troubling hearing this ironic remark from a person who is working with human beings that are depending on them, but it also confirmed my observation about poor communication and apparent disrespect toward the residents. We read about understaffed nursing homes all the time. We know that understaffed nursing homes can lead easily to abuse and neglect of the elderly. Almost 50 percent of all nursing homes in the United States are short-staffed; this situation leads to employee burnout and stress. Why is nothing done? Is the answer as simple as money? Unfortunately, most nursing homes are for-profit businesses; one of the easiest ways to increase profits is to reduce staffing costs.

The second nursing home we visited is located by the ocean, in Far Rockaway, Queens. The Bezalel Nursing Home is rather new and has 120 beds, smaller than the average in New York City. The ride to get there took about 1 hour. The closer we got, the lower the landscape became. After a while, you could even smell the salty fresh air from the sea. We arrived around lunchtime which made it seem a bit chaotic. The dining room was on the main floor. All the seniors were on their way back to their rooms. This made the line to the elevator very long.

Meanwhile, waiting for Chiquita's friend to finish his lunch, I took a look around and discovered a nice outdoor area where some seniors were sitting. Even though we arrived during a busy hour, the dynamic between the residents and the care givers seemed good. We also got the chance to see the room of Chiquita’s friend, Frank, which he shared with one other person. Chiquita wanted to know how Frank liked living at Bezalel Nursing Home. He told us that the staff is friendly and he gets to go outside. The only thing he complained about was that he did not get any help during election campaigns in order to exercise his right to vote. Except for the last detail, I got a pleasant and warm feeling about the atmosphere in Bezalel Nursing Home.

After visiting these two nursing homes, I think I got a good introduction to how elder-care can look in the United States. I can only compare it with my experience in Sweden; and it looks very similar. The biggest difference is that you do not share your room with anybody and when you move into a room in a Nursing Home, you bring your own furniture. The exception is the bed since the nursing home wants a special hospital bed.

The two nursing homes were lacking one thing each: Cobble Hill did not offer opportunities to go outside, while Bezalel Nursing home failed to assist during elections. Perhaps the location had something to do with this situation. Helping seniors to vote is easier when you are in the city, but all the traffic and the lack of space might make it hard to find nice outdoor areas. Going to a nice area requires more time. And while a nursing home located close to the beach might make it easier to help seniors to go outside, the distance to the city might make it harder to assist them during an election. I don’t think the main responsibility lies on the nursing homes, but that does not mean they shouldn’t make the effort to ensure their residents human rights. This should not be an issue since there are laws that handle this. The Voting Accessibility for the Elderly and Handicapped Act of 1984 generally requires polling places across the United States to be physically accessible to people with disabilities for federal elections. Where no accessible location is available to serve as a polling place, a political subdivision must provide an alternate means of casting a ballot on the day of election. This law also requires states to make available registration and voting aids for disabled and elderly voters.

Sanna Klemetti
s.klemetti@globalaging.org

Demographic Changes Challenges Sweden

After attending the first session of the UN’s Open-Ended Working Group on ageing I wanted to take a closer look Sweden. The reason why is not just because it’s where I’m from, but also because I have experience working with what we in Sweden call Home Help. This program, Home Help, is a part of the public health sector. It makes it possible for older people to keep living in their own homes and receive the individual help they might need-, such as cleaning, cooking, shopping, or to accompany the older person to the dentist or doctor. As I worked in this job, I learned how older people live Sweden.

Sweden has a fairly small population of about 9.3 million people. Around 19 percent are aged 65 or older; few other countries have such a large proportion of elders in the population. Sweden has one of the world’s longest life expectancies and one of the lowest birth rates. As the 1940’s baby boomers age, these numbers are expected to grow faster and in greater numbers than ever before. Up until now, Sweden has been able to manage and provide well for its older citizens. For instance, in 1982 the Social Services Act stated that all individuals have the right to public services at all stages of life. Everyone who needed help with his or her daily life had the right to claim assistance if they were unable to meet their needs in any other way. The Swedish welfare policy provides an “old age pension.” Everyone who has reached the age of 65 years, regardless of income, gets a certain amount of a state allowance. Now, the current demographic developments are challenging this policy.

Mats Thorslund, Professor in Social Gerontology, at Karolinska Institutet, a medical university in Stockholm, has researched the trends in the living conditions and health of the older population. Thorslund’s studies outline some of the biggest problems Sweden faces as the number of older persons increases. He argues that the government is failing to look at the numbers in a realistic way. As the aged increase in the population, the government does not have sufficient programs available for those who need care. People with dementia are always a first priority. But if the existing facilities are filled, there will be no spots left for the rest. This implies that the Swedish communes will need to hire more people to work in this field. The government needs to set priorities A rarely mentioned problem is the low wages in the health care field as well as the need for workers who have sufficient at the salary in this field is low and the job requires physical strength. Women dominate this field and often end the career with a worn out body.

Thorslund also found that there are visible gender and class differences. Social status and class correlate with health and functional capacity. This is more visible among men than women. When facing dependency, the majority of old men receive care from spouses, while old women rely on relatives or public care. Men have higher odds of receiving care. A 2002 study showed that elders’ health has worsened. This information contradicts data from other parts of the world. How can this can be possible? What does this indicate? Could it have something to do with the fact that a lot of the Swedish older people live by themselves?

During my job with Home Help, I discovered that older people who lived by themselves often felt lonely; my visit was the highlight of their day. Some of them had families who would come and visit, some of them did not. I always felt sad that I was on a tight schedule and could only offer limited time to them. Because I worked in the countryside, I noticed that the resident felt more isolated; there was a lot of space in between the houses and most of them were very limited as to how much they could move outside their own homes. Although Sweden has social programs and events for older persons, I noticed that the government cuts the older persons’ programs first; this is where it hits hard.

Thorslund and his research team have finished a number of research studies but the results have not been used in the best way possible. Need no longer determines policy; rather it’s the economy. Some theorists suggest that the needs of the increasing number of very old Swedes will change the government’s model of the welfare state. No longer, they say, will Sweden provide its older citizens with care and support on equal terms. In 1970 Sweden reached its highest level of service and care for the old. If Swedes want to stay in this position, it will have to examine where the national resources are going—to the wealthiest? To the best connected to the government? Banks? Industrial profits? A Monarchy? Other? Older citizens have been aging for more than 60 years and more will come. Swedish citizens will have to decide where they want their taxes to go. This challenge faces not only for Sweden, but many nations.

Sanna Klemetti

s.klemetti@globalaging.org

Observations from the First Session of the Open-ended Working Group

On April 18, I attended the meeting of the first working session of the Open-Ended Working Group at the United Nations Headquarters. Speakers and UN Delegations focused their attention on the current status of human rights of older persons around the world.

If you’ve not heard about the Open-ended Working Group, the General Assembly created this forum on December 21, 2010, with Resolution 65/1862 on December 21, 2010. UN delegations addressed elder rights in their countries and regions but also learned from each other and experts about the effectiveness of such protections. Later on, they will vote to decide whether a human rights instrument that is binding on countries is required to strengthen the protection of human rights of older persons.

After the session opened, national delegations that wanted to make a statement did so. As I listened, I began to understand where they currently stand on a convention to protect older persons’ rights. I recognized some trends from different regions. The European Union had negotiated its position earlier; it was presented by Hungary on behalf of the EU. Hungary, France, United Kingdom, Switzerland, Sweden and Denmark all pointed out their already existing protections that they claimed were already protecting the human rights for older persons. Denmark focussed on healthcare, saying that universal social protection – both in terms of cash transfers and social services – is a key component of the Danish welfare model. And the Danes said that their social service meets individual needs. I noticed that they failed to note the older people in our societies that are not in need of healthcare but do suffer from economic exclusion, isolation and discrimination. These individuals are more invisible than the ones who need direct medical help. I am not surprised by this, coming from a Scandinavian country myself. I know most responses are based on the individual. While this is often a positive approach, the downside is clear. If older person are not in direct need of help, they are easily forgotten.

The United Kingdom did not make a very long statement. The UK promotes active aging, with most of the responsibilities on the individual. Switzerland pointed out that they have had a long history of social services and protection for their older citizens. Poverty is not a problem in Switzerland. France was the first and only country that specifically addressed older women.

The only two nations that made it clear they wanted a convention were Argentina and Chile. Argentina emphasized that there is (1) no legal binding international protection for older persons, and that (2) the only other convention that directly refers to elder rights is the Convention on the Elimination of all forms of Discrimination against Women (CEDAW). Argentina also pointed out that the majority of older people do not have disabilities so the rights in the Convention on the Rights of Persons with Disabilities cannot be applied to them.

The United States’ spokesperson shared a lot of its ongoing programs and protections for the older people. It appeared that the US does not see any major ongoing problems in the country. But, it recognized that older people around the world continue to experience discrimination and violations. The US recommended continuing discussion on aging rights.

From a less individual perspective, Syria, Qatar and Pakistan spoke. They cited the importance of the family as the foundation in society, instead of the individual, with a critical position toward the idea of universal human rights. This is when China’s approach became interesting. China put a lot of emphasis on the importance of the fact that countries are diverse in terms of economical and social conditions, as well as historical and cultural traditions.

China argued that Member states should address the aging issue on the basis of their national conditions and different development levels. I was not surprised by China’s statement. It seemed that China favored a regional solution. It is also important to keep in mind that China values its sovereignty. I believe that China will play a huge role in the outcome of this proposed convention.

On the whole, all countries claimed they were interested in participating in the upcoming debate regarding human rights for older persons. They all agreed that world citizens now face the fact that humans live longer and that pressure to meet the challenges of aging will become greater. The regional trends are visible, and as we can see, the world is divided at present about approaches to this new challenge. The Open-ended Working Group’s Chairman, H.E. Mr. Jorge Martin Aguello, (Ambassador of Argentina), was indeed correct when he said that this mission is ambitious. Meanwhile, as we wait for the second OEWG session that is coming up in August, NGOs must target those nations that seemed the least open to the idea of a convention and persuade them to find useful ways to protect the human rights for older persons.

Sanna Klemetti
S.Klemetti@globalaging.org

News from the Open-Ended Working Group

The UN launched its long-awaited Open-Ended Working Group on Aging today at the UN. The Argentine Ambassador presided over the meeting. Some 17 Member States gave short speeches outlining their aging rights policies. Diplomats from Denmark, Sweden, China, Chile, South Korea, Canada, Switzerland, Argentina, Japan, the UK, Syria, Qatar, Pakistan, United States, and France offered short summaries of their perspectives.

What were their views about a human rights instrument? It’s too early to tell clearly. Most diplomats described programs that were working well in their nations and almost all acknowledged the anticipated upsurge in the proportion of older people in their population. Argentina and Chile spoke eloquently about the need for human rights for older persons. The Arabic-speaking countries stressed family supports for older persons. Unfortunately, no speaker from Africa was present.

On the NGO side, Bridget Sleap (HelpAge International) and Susan Somers (International Network for the Prevention of Elder Abuse) and Jane Barratt from the (Coalition to Strengthen Older Persons Rights) offered the perspective of their organizations. GAA is a member of the latter group. Jane laid out the long list of documents that the UN had already adopted but were not binding on nation states. The result? Slow progress. She urged the Open-Ended Working Group to press forward with a binding human rights instrument.

The OEWG meets again tomorrow. We’ll be back with more reports on what’s happening.

Susanne Paul for Global Action on Aging