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Weekly Overview

Week 3

Overview

How can you, help them? As future professionals in the aging industry or field, your credibility comes from understanding adult life transitions: marriage; family life; work life; retirement; leisure; caregiving; widowhood. To understand the demands of the aging population, be mindful about the integrations and blending of various stages of a person’s life and transitions. Design and environmental factors of housing are a significant part of this discussion. It matters where people live, and who they live with, because these factors impact a person’s health and mood.

What you will cover

1. Issues in aging

a. Examine the demographics related to adult life transitions.

1) Demographics

a) Retirement

1) Trends

a) In 1900 2/3 were 65+ in the workforce.

b) In 1950 46% were 65+

c) In 2001 19% were 65+

d) Historically men worked earlier and retired later; women entered later and retired earlier from the work force.

e) Currently women are entering the workforce earlier and men are entering the workforce later and retiring earlier.

f) Of those 65+ who work, 47% are male and 59% female work part-time.

2) Reasons for retirement

a) Poor health

b) Job loss

c) Solid income

d) Retirement of a spouse

3) Men and retirement

a) Currently, men who are 65+ can expect to live another 16.3 years.

b) Challenges of retirement

a. Age

b. Health care

c. Second career

4) Women and retirement

a) Currently, women who are 65+ can expect to live on the average 19.2 years longer than the male.

b) By age 85 and older the ratio of women/men is expected to be 39 (men); 100 (women)

c) Different career paths have altered retirement numbers for women compared with men.

a. Some work, raise the family, and go back to work.

b. Some work throughout.

c. Some never enter the work force.

5) Minorities and retirement

a) Patterns vary based on the minority group.

Patterns also vary within each minority group.

b) Patterns are altered based on income level.

2) Adult Life Transitions

a) Trends

1) Marriage

a) Women on average marry men 2.5 years older

b) Women therefore can expect to live 7.9years as widows.

2) Husband/Wife Relationship

a) Disenchantment

b) Most satisfaction in relationship/marriage: wives are influenced by birth and development of their children. Husbands say occupational experiences

b) Caregiving

1) Differences between male and female caregivers

a) Males gravitate towards administrative and managerial duties.

b) Females move towards personal care and moral support of the care receiver.

c) Males tend to set limits and feel less guilt.

d) Females have difficulty setting limits, thereby potentially increasing the level of guilt.

2) Burdens of the caregiver

a) Older people are living longer, increasing chronic issues, thereby causing more stress and burden on caregivers over a longer period.

b) Stress builds as tasks other than care giving increases.

c) Abuse by the caregiver can occur due to stress and frustration.

3) Rewards of the caregiver

a) Sense of accomplishment and being needed by the care receiver

b) Learned life lessons such as compassion, patience, and caring

c) Death of a spouse

1) Older spouse

a) May show less intense immediate grief response than younger counterparts

b) Has more intense denial and more physical symptoms of grief than many younger widows

2) Spouse who has died continues to influence the living in many ways

3) People sometimes talk to the dead spouse, asking for advice or try to imagine what they would do in a given situation.

d) Divorce

1) In 1990, less than 10% of people that divorced were 50+.

2) Today, 1 in 4 people divorce that are 50 years or older.

e) Remarriage: reduces the mortality rate for both men and women

f) Widowhood: Life for the remaining spouse

1) Second marriages

2) Spending and bills

a) Confronted with a variety of personal and familial problems

b) Wife’s share of the husband’s retirement income is often considerably reduced by the husband’s death

3) Social

a) Social support network is effective in softening a stressor like the death of a spouse

b) For women, death of a spouse is found to be psychologically easier since historically she has had a stronger dyad with parent-child relationships and or they were more connected to their community and seek them as a network of supporters to get them through the grief.

c) Men have a harder time if their wife was a homemaker and they now have to find an adequate substitute for environmental and intimate needs.

4) Biologically what happens

a) Health begins to fail

b) Rejuvenated

g) One spouse in a care facility

1) Both spouses can suffer loneliness and depression

2) Can lead to suicide.

a) Older adults who lost a spouse feel lonely

b) Social contact, animal assistance, therapy can help

c) Technology, access to the internet is also a resource

3) Resources

a) Research resources that help with adult life transitions

b. Identify living environment options for the aging population.

1) Independent

a) At home

1) Majority of older adults want to remain in their own homes and communities where they have an informal support system in place through friends, church, clubs, and so on.

2) Formal support services are available through private pay, or some insurance providers allow older adults to stay in their own home.

3) Aging in place

a) Allows older adults to remain in place while they age through the provision of services that allows for the greatest degree of independence

b) Most often, this takes place in the individual’s own home but it could take place in an institutional setting where more than one level of care is provided.

4) Spouses

a) Statistics of older noninstitutionalized persons living with their spouse

b) Statistics of older men versus older women living with their spouse.

c) Proportion of older adult living with their spouse versus age.

5) Alone

Women are more likely to live alone than men, especially after death of a spouse.

6) Caregivers (nonfamily)

Some state monies are available to pay for homemaker-type services that allow individual older adults to remain in their homes.

7) Home health care

a) Both non-profit and proprietary home care agencies provide specialized therapies

1. Occupational

2. Speech

3. Respiratory

4. Physical

b) There is a wide variety of funding sources with varying eligibility requirements for these services.

8) Home assessments/evaluations

a) General House Considerations

a. Furniture placement- make clear pathways

b. Cord or wire placement

c. Smoke and CO2

d. Food and Medication Safety

e. Weapons (knifes, guns, etc.)

b) Stairs-proper lighting, handrail, normal maintenance, obstructions (books, papers)

c) Kitchen- use of stools, height of objects used daily

d) Bathroom- anti-slip pads in showers/tubs, use of handrails

e) Bedroom- use of lights, pathway for use while in the dark

2) Dependent

a) Continuous care retirement community (CCRC)

1) Permanent housing and health care for older adult or married couple needing various levels of care

2) Require an entry fee plus monthly fees for different services

b) Board and Care homes – also called personal care homes

1) Offers boarding, including meals

2) Non medical supportive care

c) Residential foster homes

1) Regulated by each state, privately owned, but can be managed by community agencies such as social services

2) Non medical supportive care

d) Assisted living facilities (ALFs)

1) Offers amenities at a cost that can enhance stay

2) Non skilled care provided.

3) Hospice care

a) Medicare will pay for qualified hospice care

b) Home hospice services are provided in the home environment, allowing the person to die within familiar surroundings and with family.

c) Some people will spend their final days in an institutional setting such as a hospital or a nursing care facility because family is no longer physically or emotionally able to care for them.

d) Some locations are fortunate to have separate hospice facilities that provide care to only hospice patients.

4) Nursing care facility- Skilled care facilities or convalescent care

a) Last leg of institutional care with interdisciplinary scope of clinical services including physical therapy

b) Only living environment that will be reimbursed by Medicare. However, limited to the first 100 days and only for acute care needs. Long term stay after 100 days can be funded by Medicaid.

c) Patients must have a skilled need to be admitted to a nursing care facility.

1) Acute needs (such as rehabilitation for a broken hip)

2) Unable to perform activities of daily living (ADL) or instrumental activities of daily living (IADLs).

d) Because of the residents’ level of clinical need, there must be a 24 hour physician-supervised professional nurse in the facility.

e) One way to think about a “skilled” need is to ask yourself: does there need to be a RN to perform a task? Such as IV treatment; catheters; triages.

f) May be provided in a free-standing nursing care facility, a hospital-based nursing care facility (also called swing bed facility) and may include specialized therapeutic programs such as Alzheimer's units or AIDS units

g) Most people requiring some form of long-term care have functional disabilities in that they are unable to perform activities of daily living (ADLs) or instrumental abilities of daily living (IADLs).

5) Intermediate care facilities (ICFs).

a) Level between Assisted Living Facilities and Skilled Nursing Homes.

b) Thought of as the transitional facility from ALF to SNF.

c) Residents are able to ambulate without assistive devices for a minimum of 100ft in this level of care.

6) Nontraditional nursing care facilities

a) Eden Alternative homes

1) Developed by Dr. William Thomas in 1996

2) Concept to applied within nursing homes to relieve loneliness, helplessness and boredom

3) Introduced green, live plants and animals

4) Positive results

a) Relived loneliness and boredom

b) Few medications

c) Improved appetites

7) Personal reasons for moving

a) Fall risks due to declining health, such as arthritis and overall frailty

b) Medications that have side effects such as imbalance and instability, confusion or disorientation, and so on

c) Fear for home safety secondary to living in crime-ridden neighborhood, living alone, thefts, or mugging when out of home shopping

8) Costs

a) Expenses

1) Facility costs – May be out-of-pocket expenses, depending on the level of care

2) Out-of-pocket expenses

a) Home maintenance

1. Lawn care

2. Cleaning

b) Health care costs

1. Insurance – Includes supplemental health insurance to cover what Medicare does not pay for

2. Medications – Even though Medicare Part D pays for medications, individuals still must pay monthly premium plus a copay; if the individual reaches the coverage gap, they will pay 100% until they reach a certain amount when their plan picks up coverage again.

3. Caregiver - some people do not qualify for financial assistance so must pay out-of-pocket for a caregiver in order to remain in their home.

a) Alternative options for managing costs

1) Reverse mortgage

a) Home equity conversion plan

b) Allows older homeowners to continue living in their homes while receiving a regular income payment

c) Mortgage arrangement with repayment to the lender based on the value of the home

2) Life insurance buy out

a) The sale of a policy by the policy owner before the policy matures

b) Gives the owner an immediate cash settlement which is usually greater than the amount of premiums paid in

3) Long-term care insurance

a) Provides for long-term care beyond a specified period

b) Covering costs of care not paid for by Medicare or Medicaid

a. Analyze the family and provider challenges related to the aging population.

1) Role reversal

a) Spouse (husband versus wife)

Spouse may not be prepared to take over the role of the other spouse.

b) Sandwich generation (parent and child care)

Adult child may be taking care of an older adult parent as well as his or her own teenage children.

2) Informal caregivers are normally unpaid help.

a) Neighbors

b) Friends

c) Family

3) Formal caregivers are paid help.

a) Home health aid

b) Private pay care giver

4) Grandparenting

3) Taking care of grandchildren at an increased rate

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