Chapter 10 Social Work and Services for the Elderly

1. Chapter 10 Social Work and Services for the Elderly

2. Pg 317 International Perspectives: “Global Graying” • 3 Key Issues Facing the World as People Age • Graying will bring greater dependence as a result of greater longevity accompanied by chronic ill health. • There will be inadequate supply of caregivers because of smaller family sizes and women’s involvement in paid employment. • State finances will be inadequate to support the increasing dependence of older people. • 3 Strengths that Social Workers Bring with Them: • Emphasize self-determination and the achievement of autonomy. • Focus on changing the environments encompassing the individual. • Build plans that stress existing strengths.

3. People of color represented about 17% of U.S. elderly in 2000. This is projected to increase by 25%. The population of people of color age 65 and over is 41% male and 59% female. The average life expectancy for women is almost 80, and for men just over the age 74. What does that mean for women? Almost 75% of the elderly are poor in the U.S. are women. Pg 318-319 Demographic Characteristics of the Elderly Population: Race, Gender, and Social Class

4. Pg 319-322 Common Problems Facing Elderly People Ageism – harboring negative images of and attitudes toward people simply because they are older. Examples of ageism?? Discrimination in Employment – National Council on Aging - 50% of employers surveyed believed that older workers cannot perform as well as younger workers. In 1967 Congress passed the Age Discrimination in Employment Act (ADEA) that prohibited discrimination against people age 40-65. Employers can not advertise for workers “who are under 30”. Employers can still reject older people on the basis of being “overqualified”.

5. All elderly people are burdened with multiple physical complaints and are riddled with disease Old people are unattractive and smelly, have no teeth, and can barely see or hear. Old people sleep all the time. You can’t teach an old dog new tricks; old people are set in their ways. All old people are senile. Pg 320-321 Confronting Myths About the Elderly

6. Money that workers contribute today is being spent to pay benefits to retired and other workers, as well as other government expenses. Tomorrow’s beneficiaries must depend on tomorrow’s workers. Who’s going to pay for Social Security when you retire? It is predicted that Social Security will start going into the red as early as 2018. To address this problem some propose privatization of Social Security, whereby workers have the option of investing part or all of their wages. Pros and cons to this idea. Pg 322 – 323 Saving Social Security

7. Pg 324-326 Saving Social Security—Concerning raising the retirement age: Because people tend to live longer, should the retirement age be raised? Said to raise to 67 by 2022. If so, to what age? When would you like to be able to retire? If you haven’t thought much about this, when would your parents (or grandparents) like to retire? Social Security Act of 1935 established 65 as the age of retirement.

8. Pg. 326 Does Social Security Discriminate Against Women? How is it discriminatory? Should the system be further reformed to make it more equitable? If so, how should the contributions of homemakers be measured? What about those who take time off to bear and raise children?

9. Constitution of the Bolivarian Republic of Venezuela, ratified in 2000 Article 88 states that "The State guarantees the equality and equitable treatment of men and women in the exercise of the right to work. The state recognizes work at home as an economic activity that creates added value and produces social welfare and wealth." Homemakers are entitled to Social Security in accordance with law, and other guarantees include the right to work, the right to housing, education and health care. Information taken from: http://www.now.org/nnt/summer-2006/venezuela.html Social Security in Venezuela

10. Pg. 326-327 Health Care – Most rely on Medicare as a major source for insurance. Medicare only pays for 80% of expenses. Elderly are forced to either endure high medical bills or purchase a supplemental insurance to cover the remaining 20% of the bill. Living Conditions and Family Variables – many elderly prefer to live on their own or with family. Relatively few elderly people need around the clock nursing care. Most only need when they have a debilitating chronic illness.

11. Page 327 Elderly Abuse

12. Includes physical abuse, emotional abuse, taking advantage of elderly people financially or neglecting them (ignoring the fact that medical treatment is needed). Estimated 1.5 million cases of physical abuse occur in the U.S. each year. Abuse occurs in residential facilities, nursing homes, and private homes. Perps are spouses, caregivers, adult children, or other relatives. Case study: 1999 report of a man who sexually assaulted his 74-year-old mother-in-law. The victim’s dtr refused to make a big deal of it or to allow her mother to report. Mandatory reporter. Page 327 Elderly Abuse

13. Pg 327 – 328 Transitional Issues Losses experienced Retirement, spouse, health, independence, sight, hearing, mobility, etc. “Gayging”(gay aging) and Invisibility – highlight 10.2, pg 328 Lesbian, gay, and bisexual (LGB) people experience invisibility. LGB pple do not enjoy the legal and social support systems taken for granted by heterosexuals. Examples? SW can help to advocate and support elderly LGB. Change language when soliciting information, etc.

14. Pg 328-335 Contexts for Social Work Practice with the Elderly Long-Term Care Through Home-Based and Community Health Services – health, personal care, & social services delivered over a sustained period of time to persons who have lost or never achieved some capacity for self-care. Provide care in least restrictive environment. Home-Based Services – assistance provided to pple in their own homes. Includes, homemaker, cooking, home maintenance, laundry, home health, transportation, etc. Can be provided by informal or formal support networks Community-Based Services – services provided outside of the home in the community. Examples on page 331, adult day care, senior center, etc.

15. Pg 332 Discharge Planning in Hospital Settings – primary function of hospital social workers. SW conduct a comprehensive assessment of patient’s abilities and needs, the development of a plan to facilitate that patient’s transition out of the hospital and back into a community or agency setting, and how to implement this plan. Requires SW to work closely with the patient, family, and other health care providers. Advocacy on patient’s behalf is also required. Service Provision in Nursing Homes – residential centers that provide extended maintenance and personal nursing care for people who can’t take care of themselves. The vast majority of elderly do not reside in nursing homes. Four characteristics of nursing home population: 75% are female 2) 66% are widowed 3) 89% are white, and 4) majority have serious illnesses or disabilities that interfere w/ their ability to care for themselves daily. Services offered: Dietary, Activities, Nursing, Social Services, Housekeeping, Medical staff.

16. Pg. 336-337 Empowerment for Diverse Populations of Elderly People Concepts and Strategies in Empowerment Adaptation – to new experiences issues, and even losses. Emphasize how people use their strengths to survive, adapt to new experiences, and learn to appreciate the positive aspects of new experiences. Competence – help elderly pple focus on what they can do and not what they can’t do. Relatedness – work to strengthen elderly people’s r/ts w/ others. Autonomy – helping people live as independently as possible.

17. Pg 339-340 Empowerment of African American Grandparents Who Become Primary Child Caregivers – Grandparents Who Care Mezzo Practice Perspectives: established support groups to provide information, emotional support, and practical advice. Board of Directors made up of grandparents, citizens, and health care professionals. Macro Practice Perspectives: Expanding Influence Grandparents were trained as group leaders to go out and form new groups, thereby extending support to grandparents elsewhere. Grandparents Who Care undertook political advocacy and lobbying. One problem addressed the legal difficulties grandparents experiences in receiving foster care payments. As relatives they did not technically qualify.

18. Pg 340-342 Appreciation of Spirituality and Empowerment for Navajo Elders in a Nursing Home A Focus on Traditional Navajo Values – elders are referred to as “grandparents”. When imbalance occurs, a person may become sick, which can be attributed to “infection by animals, natural phenomena, etc.”. Preventive ceremonies can address the root of the illness. Primary traditional value is the importance placed on the extended family, referred to as clan. Culturally Competent Treatment of Elderly Navajo People Chinle Nrs Home – six areas 1. Communications – few Navajo grandparents are fluent in English, need to use translator. 2. Clan assoc. & social structure – Clan very important. May have many visitors from clan. 3. Personal space, modesty, privacy, & cleanliness – grandparents value personal space. 4. Traditional food – Staff try to accommodate traditional foods and allow others to bring food in. 5. Dying and death – traditional Navajo do not discuss death, believing that discussing death may bring it to you. 6. Cultural rituals – area constructed for Navajo to hold cultural rituals.