tag:theconversation.com,2011:/id/topics/elder-care-41726/articleselder care – The Conversation2024-03-05T14:01:43Ztag:theconversation.com,2011:article/2235212024-03-05T14:01:43Z2024-03-05T14:01:43ZMichigan Gov. Whitmer proposes a caregiver tax credit − an idea many Americans support<figure><img src="https://images.theconversation.com/files/578799/original/file-20240229-24-loeyq2.jpg?ixlib=rb-1.1.0&rect=0%2C10%2C2302%2C1285&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">As the population of older adults in the U.S. grows, more people need care.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/comforting-hand-on-shoulder-of-man-royalty-free-image/1576851402?phrase=elderly&adppopup=true">seb_ra/via Getty Images</a></span></figcaption></figure><p>People caring for elderly or disabled relatives need a break – and, in Michigan, Gov. Gretchen Whitmer has a proposal to give them one.</p>
<p>Whitmer’s <a href="https://www.bridgemi.com/michigan-government/whitmer-seeks-5000-tax-credit-michigan-caregivers-how-much-will-it-help">recently proposed US$5,000 tax credit</a>, the Caring for MI Family Tax Credit, is part of a growing trend of public subsidies for families shouldering the responsibilities of caring for family members. </p>
<p>Americans strongly endorse the idea that families, not the government or other organizations, are responsible for providing care for family members. They especially endorse <a href="https://www.pewresearch.org/social-trends/2023/09/14/family-responsibilities/">adult children</a> providing care for their aging parents. </p>
<p>That may help explain why family members are the main and sometimes only <a href="https://www.aei.org/wp-content/uploads/2020/11/Paid-Leave-for-Caregiving.pdf">caregivers for older adults</a> and others with <a href="https://www.aarp.org/caregiving/home-care/info-2023/caregiving-for-your-adult-disabled-child.html">long-term care needs</a> in the United States.</p>
<p>We are researchers who study <a href="https://scholar.google.com/citations?user=ytD3n0IAAAAJ&hl=en&oi=ao">families</a> and <a href="https://scholar.google.com/citations?user=ruC6veMAAAAJ&hl=en&oi=ao">caregiving</a>. Our <a href="https://doi.org/10.1177/23780231231225574">recent study</a> finds that when given a choice between family, government or other care providers, many Americans think family should provide care but the government should pay for it.</p>
<p>Caregiving costs can be substantial. On average, a caregiver in Michigan can expect to spend over <a href="https://states.aarp.org/michigan/supporting-family-caregivers-in-michigan">$7,000 out of pocket</a> per year. One study estimates the cost of care for a person with dementia are even higher, ranging <a href="https://doi.org/10.1111/j.1525-1497.2001.10123.x">from $3,000 to $17,000</a>, depending on the severity of the disease. Another estimate that accounts for the total impact of caregiving, including costs such as lost wages and the impact on caregiver’s health, puts the personal expense of caring for a loved one at roughly <a href="https://ldi.upenn.edu/our-work/research-updates/a-comprehensive-measure-of-the-costs-of-caring-for-a-parent-differences-according-to-functional-status/">$90,000 a year</a>. </p>
<p>Despite this steep price, <a href="https://doi.org/10.1111%2F1468-0009.12567">few federal governmental programs</a> address caregivers’ financial burdens. </p>
<p>In response, states have begun to pass their own policies, like <a href="https://www.ncsl.org/labor-and-employment/state-family-and-medical-leave-laws">paid leave</a> in states such as California, Washington and Massachusetts, and, increasingly, <a href="https://www.taxpolicycenter.org/taxvox/are-tax-credits-best-way-subsidize-long-term-care-costs">tax credit policies</a> like Whitmer’s proposal in Michigan.</p>
<h2>Helping to offset, reduce costs</h2>
<p>Currently, <a href="https://ltsschoices.aarp.org/scorecard-report/2023/dimensions-and-indicators/state-caregiver-tax-credits#:%7E:text=Six%20states%20(Georgia%2C%20Missouri%2C,one%20activity%20of%20daily%20living.">six states</a> – Montana, North Dakota, Missouri, Georgia, South Carolina and New Jersey – offer a tax credit to offset <a href="https://doi.org/10.1080/08959420.2022.2127599">the costs of caregiving</a>. </p>
<p>The credit can be used to cover home modifications such as ramps or bathroom grab bars, assistive devices such as a cane or walker, or to pay a professional care worker.</p>
<p>Whitmer’s proposal is generous compared with other states. For example, <a href="https://support.taxslayer.com/hc/en-us/articles/360015705352-Georgia-Qualified-Caregiving-Expense-Credit">Georgia’s caregiving tax credit</a> reimburses up to 10% of costs, with a cap of $150.</p>
<h2>A needed break</h2>
<p>The proposed Michigan tax credit would support counseling, transportation and nursing or respite services that pay a caregiver to come help so the family caregiver can have a break.</p>
<p>These types of services <a href="https://doi.org/10.1017/s1041610218000686">delay transitions into nursing homes</a>, which helps <a href="https://doi.org/10.1093/geroni/igz040">keep costs down for Medicaid</a> and individual <a href="https://doi.org/10.1016/j.jamda.2023.09.010">monthly out-of-pocket spending</a>.</p>
<p>Respite care use has become <a href="https://doi.org/10.1093/geront/gnx093">more common over the past two decades</a>, especially among families providing care for older adults with dementia. However, many caregivers are unable to access these services. One barrier is <a href="https://doi.org/10.1093/geront/gnz095">the cost</a>, which averages <a href="https://www.genworth.com/aging-and-you/finances/cost-of-care.html/">$29 per hour</a>. </p>
<h2>Public support for caregivers increasing</h2>
<p>Recent polls show that a majority of Americans want Medicare, the federal program that provides health care to people over 65, to help cover <a href="https://www.longtermcarepoll.org/visualizing-support-for-greater-government-role-in-health-care-for-older-adults/">the cost of long-term care</a>. </p>
<p>In terms of what supports should be made available to caregivers, <a href="https://doi.org/10.1177/0164027501233004">tax credits</a> receive the greatest public support relative to other programs, such as unpaid time off. </p>
<p>A recent AARP study of registered voters ages 50 and older found 8 in 10 people support a $5,000 annual <a href="https://www.aarp.org/research/topics/care/info-2021/caregiving-tax-credit-in-home-care-bipartisan-support.html">caregiver tax credit</a>. Another study of voters of all ages found similar support for expanding the <a href="https://economicsecurityproject.org/resource/polls-support-for-eitc-with-automatic-filing-caregiver-credit/">earned income tax credit</a> to include family caregivers.</p>
<p>Evidence suggests that tax credits implemented in Arizona and Idaho in a three-year test of the program in the early 1980s had the desired effect – <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195118/">more care by family members</a> and a reduced use of formal care. Paid leave in California is also associated with a reduction in <a href="https://doi.org/10.1002/pam.22038">nursing home usage</a>. </p>
<p>The benefit of the Caring for MI Family Tax Credit will depend in large part on the details and design of the policy. A refundable tax credit will provide greatest benefit to low-income households.</p>
<p>A similar federal bill, the <a href="https://www.congress.gov/bill/117th-congress/house-bill/3321">Credit for Caring Act</a>, has been introduced in Congress. If passed, the legislation would provide a federal tax credit for working family caregivers to cover 30% of expenses incurred above $2,000. </p>
<p>And other <a href="https://www.ftb.ca.gov/tax-pros/law/legislation/2019-2020/AB2136-021020.pdf">states such as California</a> are also considering introducing tax credits to help offset the cost of caregiving. </p>
<p>The population of <a href="https://www.census.gov/library/stories/2019/12/by-2030-all-baby-boomers-will-be-age-65-or-older.html">Americans over 65 is increasing</a>, <a href="https://aspe.hhs.gov/reports/most-older-adults-are-likely-need-use-long-term-services-supports-issue-brief-0">meaning more people</a> will need caregiving in the near future.</p>
<p>The introduction of these bills reflects Americans’ growing support for new solutions to defray the costs associated with providing care to a loved one.</p><img src="https://counter.theconversation.com/content/223521/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah E. Patterson receives funding from the National Institute on Aging (NIA). She volunteers with the Alzheimer's Association in Michigan. </span></em></p><p class="fine-print"><em><span>Ariana Reyes receives funding from the National Institute on Aging (NIA). </span></em></p>Michigan Gov. Gretchen Whitmer’s proposed tax credit is part of a trend toward public support for family caregiving.Sarah E. Patterson, Research Investigator at the Survey Research Center at the Institute of Social Research, University of MichiganAdriana Reyes, Assistant Professor of Public Policy, Cornell UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2130222023-10-11T13:42:31Z2023-10-11T13:42:31ZMale domestic workers in South Africa – study sheds light on the experiences of Malawian and Zimbabwean migrants<p>An estimated <a href="https://journals.uj.ac.za/index.php/The_Thinker/article/view/2672/1644">800,000 people work as domestic workers</a> in South Africa. Most are black women from marginalised backgrounds. It’s therefore not surprising that the bulk of the literature about domestic work focuses on females performing cleaning, cooking and care work. What’s missing in debates about domestic workers’ job-related experiences and relationships with their employers is the experiences of men performing domestic work, a job traditionally linked to <a href="https://www.jstor.org/stable/24713312">femininity</a>. </p>
<p>However, paid domestic work in South Africa hasn’t always been dominated by women. In the 1880s when the <a href="https://books.google.co.za/books/about/New_Babylon_New_Nineveh.html?id=DiDtAAAAMAAJ&redir_esc=y">mining industry</a> was being established in Johannesburg, black men, rather than women, were the preferred servants in white households. Known as <a href="https://books.google.co.za/books/about/From_Servants_to_Workers.html?id=ha_3GUYK6FwC&printsec=frontcover&source=kp_read_button&hl=en&redir_esc=y#v=onepage&q=houseboy&f=false">houseboys</a>, they cooked, cleaned, nursed and cared for white colonial families.</p>
<p>But over the next decade the landscape of domestic work underwent significant changes. This was due to a few factors, among them:</p>
<ul>
<li><p>a scarcity of labour in the mines, which drew black men away from domestic roles to join the <a href="https://www.sahistory.org.za/article/brief-history-domestic-service-south-africa">mining sector</a> </p></li>
<li><p>the increasing <a href="https://www.sahistory.org.za/article/brief-history-domestic-service-south-africa">urbanisation of black women</a> </p></li>
<li><p>racial stereotypes about black men as <a href="https://www.jstor.org/stable/2637313">sexually aggressive or promiscuous</a>.</p></li>
</ul>
<p>A small proportion of men still work as domestic workers, however. Some are <a href="https://www.ilo.org/wcmsp5/groups/public/---africa/---ro-abidjan/---ilo-pretoria/documents/vacancynotice/wcms_789648.pdf">migrants</a>. Due to South Africa’s relative stability and economic opportunities, there has been <a href="https://www.migrationpolicy.org/article/south-africa-immigration-destination-history">an increase in migration</a> from countries like Eswatini, Lesotho, Malawi, Zimbabwe and Mozambique since apartheid ended in 1994. The migrants come seeking education, employment and improved livelihoods. They rely on friends and family already in South Africa <a href="https://link.springer.com/chapter/10.1007/978-3-030-92114-9_2">to find jobs</a>. </p>
<p>While African migrant women from poor backgrounds often find work in <a href="https://unctad.org/system/files/official-document/edar2018_BP1_en.pdf">domestic service or the hospitality sectors</a>, most migrant men work as <a href="https://www.sahistory.org.za/sites/default/files/2019-05/20767_mangezvo_xenophobic_2015.pdf">gardeners, painters or security guards</a>. Some Malawian and Zimbabwean male migrants work as <a href="https://www.sahistory.org.za/sites/default/files/2019-05/20767_mangezvo_xenophobic_2015.pdf">waiters or domestic workers</a>, jobs that are traditionally associated with women. </p>
<h2>Exploring unfamiliar territory</h2>
<p>As a researcher of domestic work in South Africa, I noticed that few studies had focused on male migrants performing domestic work in South Africa. Consequently, such work is commonly viewed as an employment arrangement involving affluent female employers and black female domestic workers from marginalised backgrounds. The intersections of race, class and gender between employers and domestic workers often lead to <a href="https://repository.up.ac.za/bitstream/handle/2263/74795/Masterson_Domestic_2019.pdf?sequence=1">unequal power relations and economic exploitation</a> entrenched within the employment relationship. </p>
<p>In my study, I examined <a href="https://journals.uj.ac.za/index.php/The_Thinker/article/view/2677">the experiences of migrant male domestic workers in Johannesburg</a>, with the aim of shedding some light on their duties and working conditions. </p>
<p>A male Malawian domestic worker employed by an acquaintance referred me to other male domestic workers in Johannesburg. Interviews were conducted with six male Malawian and four male Zimbabwean domestic workers employed by affluent white employers in Johannesburg. All had been employed for more than five years. </p>
<p>Migrant men’s experiences add a new layer of complexity to the study of domestic work, where complex intersections of class, race and gender occur. </p>
<h2>Migrant male domestic workers in South Africa</h2>
<p>My study showed that domestic work offered a viable employment path for men. </p>
<p>They faced similar challenges to their <a href="https://www.academia.edu/13215366/_Help_somebody_who_help_you_The_Effect_of_the_Domestic_Labour_Relationship_on_South_African_Domestic_Workers_Ability_to_Exercise_their_Rights">female counterparts</a>. These included long working hours, a paternalistic employer-employee dynamic, and a marginalised job status.</p>
<p>The respondents said they had an array of indoor and outdoor responsibilities. Indoors, their tasks encompassed cleaning and tidying their employers’ residences. They also handled laundry and ironing, alongside duties such as grocery shopping and meal preparation.</p>
<p>Outdoors, their responsibilities extended to garden maintenance, swimming pool upkeep, pet waste disposal, cleaning outdoor grilling areas (braais), and sweeping driveways. They were also entrusted with securing the homes and taking care of pets when their employers were away. </p>
<p>The daily life of male live-in domestic workers was much the same as <a href="https://www.ilo.org/wcmsp5/groups/public/---ed_protect/---protrav/---travail/documents/publication/wcms_230837.pdf">live-in female domestic workers</a>. The working day started at 06:30, preparing breakfast for employers. Once employers had left for work, they cleaned the house, prepared lunch, did laundry and attended to the garden.</p>
<p>The long working day often ended at 20:00 after dinner was prepared for employers. Most weekends were spent on additional piece jobs, working as gardeners or painters for others.</p>
<p>While the homes of employers were opulent, male domestic workers, just like their female counterparts, lived in small rooms in the back yard, hidden away from the employers’ gaze, as other researchers have <a href="https://www.jstor.org/stable/3514408?seq=1">also found</a>. The one-room accommodation was often equipped with basic furniture, differing little from the <a href="https://books.google.co.za/books?hl=en&lr=&id=c89wfLEahEIC&oi=fnd&pg=PR9&dq=living+quarters+of+domestic+workers+apartheid&ots=oumA3GgaGq&sig=Cjco7oSLcK6vGAgKpM_kgF0HTzQ&redir_esc=y#v=onepage&q=living%20quarters&f=false">squalid living quarters of domestic workers during apartheid</a>.</p>
<p>The men said they considered their wages reasonable. They earned on average between R5,000 (US$260) and R8,000 (US$416) a month. This was much higher than <a href="https://personal.nedbank.co.za/learn/blog/domestic-workers-minimum-wage.html#:%7E:text=The%20minimum%20wage%20for%20domestic%20workers%20in%202023&text=Employing%20someone%20for%20more%20than,with%20the%20Department%20of%20Labour.">the minimum wage of R4,067</a> (US$216) for a domestic worker working eight hours a day, five days a week in South Africa. Most said they could engage in wage negotiations, which enabled them to improve their wellbeing and that of their families.</p>
<p>None of the male domestic workers in this study had written employment contracts with their employers, or were members of a trade union, such as the <a href="http://www.sadsawu.com/">South African Domestic Service and Allied Workers Union</a>. Work contracts need to be renewed every few years, which is costly and time consuming. Job security is precarious. </p>
<h2>The recurring issues of domestic work</h2>
<p>In South Africa, domestic work continues to be associated with <a href="https://journals.uj.ac.za/index.php/The_Thinker/article/view/2672/1644">marginalised black individuals</a>, perpetuating a historical and societal imbalance. </p>
<p>Paid domestic work continues to occupy a low-status position. No formal qualifications and little specialised expertise are required. Domestic workers’ contributions to the functioning of households are essential but frequently taken for granted, as other studies have <a href="https://muse.jhu.edu/book/42905/">also confirmed</a>. </p>
<p>Despite the <a href="https://www.pulp.up.ac.za/edited-collections/exploited-undervalued-and-essential-domestic-workers-and-the-realisation-of-their-rights">legislation</a>, domestic workers work long hours and perform physically demanding work. While male domestic workers in this study could negotiate better working conditions and pay, others might not be successful, and might remain in a precarious working environment. </p>
<p>Job security is not assured, a vulnerability most <a href="https://www.ilo.org/wcmsp5/groups/public/---ed_protect/---protrav/---migrant/documents/publication/wcms_535598.pdf">migrant domestic workers</a> experience. </p>
<p><a href="https://www.ilo.org/wcmsp5/groups/public/---africa/---ro-abidjan/---ilo-pretoria/documents/vacancynotice/wcms_789648.pdf">Practical protection remains constrained</a>. For instance, migrant domestic workers often encounter difficulties when seeking healthcare.</p>
<p>To safeguard this group from exploitation and elevate their overall livelihoods, regulators, enforcement agencies and trade unions must protect and recognise all domestic workers, including migrants, in South Africa.</p><img src="https://counter.theconversation.com/content/213022/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David du Toit does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Paid domestic work has a low status in South Africa. The labour of domestic workers is often undervalued and unrecognised.David du Toit, Sociology Lecturer, University of JohannesburgLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2101542023-08-08T12:29:52Z2023-08-08T12:29:52ZOlder ‘sandwich generation’ Californians spent more time with parents and less with grandkids after paid family leave law took effect<figure><img src="https://images.theconversation.com/files/541049/original/file-20230803-27-xpn12q.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4535%2C2841&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Nearly a dozen states have enacted these policies so far.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-taking-care-of-old-woman-in-wheelchair-royalty-free-image/970176900?adppopup=true">Westend61 via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>A California law that mandates paid family leave has led to adults in their 50s, 60s and 70s spending more time taking care of their parents and less time being their grandkids’ caregivers.</p>
<p>The law requires all employers to allow eligible workers to <a href="https://edd.ca.gov/en/disability/Am_I_Eligible_for_PFL_Benefits/">take up to six weeks of paid leave</a> to care for newborns, newly adopted children or seriously ill family members.</p>
<p>From 2006, two years after the law went into effect, to 2016, <a href="https://ca.db101.org/ca/situations/workandbenefits/rights/program2c.htm">this policy led to older adults’ spending 19 fewer hours</a> per year caring for their grandchildren, a 17% decrease. They spent 20 additional hours on average helping their own parents, a 50% increase. </p>
<p>The effect was most striking for people with newborn grandchildren and parents in need of help, but the law also benefited Californians with older grandchildren and those who don’t have parents requiring their assistance.</p>
<p><a href="https://doi.org/10.1080/08959420.2023.2226283">These findings</a> are from research I conducted with <a href="https://scholar.google.com/citations?user=yWNlAzcAAAAJ">Marcus Dillender</a>, a fellow economist. They suggest the law had effects through two channels. It enabled older adults to take paid leave to care for relatives with medical needs and it reduced the need for older adults to care for their grandchildren by granting paid parental leave to these children’s parents.</p>
<p>To assess how older adults spend their time, we analyzed data for people between the ages of 50 and 79 from the Health and Retirement Study, a <a href="https://hrs.isr.umich.edu/">longitudinal study of approximately 20,000 Americans</a>.</p>
<p>The survey asks respondents in that age group how much time they spend taking care of their grandchildren and helping their aging parents with basic personal activities like dressing, eating and bathing. We compared outcomes for people who lived in California with what happened to Americans in other states before and the law’s enactment.</p>
<p>We also looked into what happened for people who had different combinations of caregiving obligations – grandchildren less than 2 years old or older grandkids, or parents who need help or no parents requiring assistance.</p>
<h2>Why it matters</h2>
<p>The U.S. is the only wealthy country that <a href="https://www.oecd.org/els/soc/PF2_1_Parental_leave_systems.pdf">doesn’t require employers to provide paid family leave</a>. California was the first state to implement its own policies; <a href="https://www.ncsl.org/labor-and-employment/state-family-and-medical-leave-laws">10 others and the District of Columbia</a> have followed suit so far.</p>
<p>These policies can significantly affect older adults, who spend substantial time caring for their relatives.</p>
<p>Caregiving has become a more urgent policy issue because of the growing number of Americans who feel that they belong to a “<a href="https://www.michiganmedicine.org/health-lab/sandwich-generation-study-shows-challenges-caring-both-kids-and-aging-parents">sandwich generation</a>” of people who have to take care of their children or grandchildren and their parents at the same time. </p>
<h2>What other research is being done</h2>
<p>Other research has found that California’s paid family leave policy doubled the overall length of maternity leave by new mothers, <a href="https://doi.org/10.1002/pam.21676">increasing it from an average of three weeks to six weeks</a>. It also upped the likelihood that <a href="https://doi.org/10.1002/pam.22030">fathers take parental leave</a> following the birth or adoption of a child by 46% – although <a href="https://doi.org/10.1002/pam.21894">fathers take less leave on average than mothers</a>.</p>
<p>According to some of the many other studies conducted so far, California’s paid family leave law helped workers with caregiving responsibilities stay employed by allowing them to take time off with reduced financial risk and increased job continuity, <a href="https://doi.org/10.1093/workar/waab022">including for those ages 45 to 64 with a disabled spouse</a> and <a href="https://doi.org/10.1093/geront/gny105">middle-aged female caregivers</a>. The law has, in addition, reduced the share of elderly people using nursing homes by <a href="https://doi.org/10.1002/pam.22038">facilitating more informal care</a>.</p><img src="https://counter.theconversation.com/content/210154/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joelle Abramowitz receives funding from the National Institute on Aging, the Social Security Administration and the National Science Foundation. </span></em></p>The law changed older adults’ caregiving behavior because their children became more able to take paid time off work to care for their own newborns.Joelle Abramowitz, Assistant Research Scientist at the Survey Research Center, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2047662023-05-17T13:23:14Z2023-05-17T13:23:14Z91% of sub-Saharan African workers don’t save for old age: why that’s a problem and how to fix it<figure><img src="https://images.theconversation.com/files/523614/original/file-20230501-28-ys3s45.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sub-Saharan Africa has the lowest level of pension savings in the world</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/nigerian-naira-notes-pension-jar-elderly-759556243">Shutterstock</a></span></figcaption></figure><p><em>Less than 10% of the workers in sub-Saharan Africa save for old age, <a href="https://www.ilo.org/wcmsp5/groups/public/@ed_protect/@soc_sec/documents/publication/wcms_849597.pdf#page=32">the lowest</a> rate for any region in the world. That implies most of the breadwinners today won’t be able to afford basic items after retirement. A pension plan is meant to commit employers to make regular savings so that employees will continue to earn after retirement. The Conversation Africa asked Owen Nyang'oro, a financial economist, about Africa’s pensions and why they need to be fixed.</em> </p>
<hr>
<h2>What’s the state of sub-Saharan Africa’s pension savings?</h2>
<p>In a <a href="https://www.wider.unu.edu/sites/default/files/Publications/Working-paper/PDF/wp2022-95-pension-funds-in-sub-saharan-africa.pdf">recent study</a> of retirement savings in sub-Saharan Africa (other than the francophone countries), we established that the continent’s pension funds are diverse in architecture, coverage and performance. But they mostly lag behind in reforms compared to other regions. Pension savings are also low compared to other regions. Only 19.8% of people above statutory retirement age receive a pension in sub-Saharan Africa, and just 8.9% of the labour force <a href="https://www.ilo.org/wcmsp5/groups/public/@ed_protect/@soc_sec/documents/publication/wcms_849597.pdf#page=32">is covered by pension schemes</a>. This is much lower than the global average where 77.5% of people above statutory age and 53.7% of workers have pension coverage. </p>
<p>Pension schemes in sub-Saharan African countries are characterised by low contributions due to low earnings, high informality, high financial illiteracy levels and lack of proper information about the benefits of adequate contributions for future pension withdrawals.</p>
<p><a href="https://www.oecd.org/daf/fin/private-pensions/Pension-Markets-in-Focus-2022-FINAL.pdf">Market data</a> shows that South Africa, with pension fund assets valued at about US$330.3 billion in 2019 (latest country update), is the continent’s top performer in absolute terms. Nigeria, which had assets worth US$32.6 billion, Kenya with US$13.7 billion and Namibia with US$13.3 billion were the <a href="https://www.oecd.org/daf/fin/private-pensions/Pension-Markets-in-Focus-Preliminary-2021-Data-on-Pension-Funds.pdf#page=2">other top pension savers</a> in 2021. </p>
<p>Countries with low pension savings at the end of 2021 included Mozambique with US$224 million, Zambia (US$745 million) and Angola (US$861 million). </p>
<p>But in proportion to the <a href="https://www.oecd.org/daf/fin/private-pensions/Pension-Markets-in-Focus-2022-FINAL.pdf#page=11">size of the economy</a>, the best performers in 2019 included Namibia (95.4%), South Africa (82.6%) and Botswana (51.9%). Angola, Mozambique, Zambia, Nigeria and Ghana trailed with pension assets below 10% of their gross domestic product.</p>
<p>Generally, Africa’s pension assets are very small compared to the 2021 retirement funds of say, the United States (US$40.0 trillion) or the United Kingdom (US$3.8 trillion). </p>
<h2>What’s peculiar about Africa’s population?</h2>
<p>The majority of the population is young and <a href="https://data.worldbank.org/indicator/SP.DYN.TFRT.IN?locations=ZG">fertility rates</a> are high. The old-age dependency ratio (the number of elderly people for every economically active person) is low compared to other regions, averaging <a href="https://population.un.org/wpp/Download/SpecialAggregates/EconomicTrading/">5.5 in 2022</a>, and the ageing population is small but increasing. The annual population growth rate in sub-Saharan Africa was 2.5% in 2022, which is more <a href="https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/wpp2022_summary_of_results.pdf">than three times the global annual average of 0.8%</a>.</p>
<p>With much <a href="https://www.un.org/ohrlls/news/young-people%E2%80%99s-potential-key-africa%E2%80%99s-sustainable-development#:%7E:text=Africa%20has%20the%20youngest%20population,to%20realise%20their%20best%20potential.">younger populations</a> and relatively <a href="https://data.worldbank.org/indicator/SP.POP.GROW?locations=ZG">high population growth rates</a>, the number of dependants in sub-Saharan African countries is increasing at a slightly faster rate, and over time the numbers of elderly people needing social support will also rise. It is projected that the number of elderly persons in the region will grow at <a href="https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/wpp2022_summary_of_results.pdf#page=20">annual rates above 3% between 2022 and 2050</a>. </p>
<p>The concern is that <a href="https://www.ilo.org/global/research/global-reports/world-social-security-report/2020-22/lang--en/index.htm">only one in five</a> people of pensionable age receives an old-age pension compared to over three in four people globally. </p>
<p>High levels of unemployment and the large <a href="https://theconversation.com/yes-africas-informal-sector-has-problems-but-the-answer-isnt-to-marginalise-it-188234">size of the informal sector</a> – which <a href="https://www.ilo.org/global/publications/books/WCMS_626831/lang--en/index.htm">accounts</a> for over 89.2% of the labour work force – mean that the elderly will continue to face income challenges. Households are also becoming smaller and changing from multi-generational (made up of grandparents, parents, children and grandchildren) which offer social support to the elderly, to skipped-generation (where grandparents live with grandchildren in the absence of parents) or one-generation (where the elderly live by themselves). </p>
<h2>What are the benefits of a good pension system?</h2>
<p>The primary goal of pension savings is to provide income and livelihood in old age. However, pension savings can also be mobilised to finance productive activities and improve living standards.</p>
<p>The continent’s annual infrastructure funding gap (the difference between resources required and what’s available) is <a href="https://www.afdb.org/fileadmin/uploads/afdb/Documents/Publications/African_Economic_Outlook_2018_-_EN.pdf#page=16">estimated</a> at between US$68 billion and US$108 billion. Resources to meet the infrastructure gap could be mobilised from pension funds. This requires good governance and removal of any regulatory obstacles. Pension funds can also support development of capital markets and improve ease of trade in the capital market through their investment activities.</p>
<p>Pension funds can also reduce public borrowing, and improve efficiency of the labour market by creating incentives for formalisation of businesses.</p>
<h2>How should countries improve pension savings?</h2>
<p>African governments can boost pension savings in four ways:</p>
<ul>
<li><p>Increase pension participation and coverage by including the unemployed and those in the informal sector. This could be achieved through a targeted universal pension scheme and greater financial literacy. The countries should have a mix of universal schemes and schemes with payroll deductions and employer contributions.</p></li>
<li><p>Bundling pensions with other products. Bundling pensions with other products such as life insurance cover, and even matching contributions to encourage greater participation and long-term savings in pension funds. Favourable tax considerations can also enhance the growth of contributions and assets of pension funds.</p></li>
<li><p>Use of technology. Leverage innovations in digital technology to increase pension savings. The region <a href="https://www.gsma.com/sotir/wp-content/uploads/2022/03/GSMA_State_of_the_Industry_2022_English.pdf">accounts for 53% of active mobile money accounts in 2021</a>. Use of digital technology could increase coverage, especially in the informal sector. It can make enrolment and contribution to pension funds easier.</p></li>
<li><p>Review regulatory frameworks of the pension sector to open it up to the unserved population. There is also a need to streamline management of pensions and minimise costs of administration, especially for private pensions. This will allow pension funds to extend investments to other assets, including foreign ones, to improve returns.</p></li>
</ul>
<p>Sub-Saharan African countries are likely to gain from a well-developed pension system that provides adequate income to the elderly. This will in turn reduce the need for social protection, provide financing for infrastructure development, and support the development of capital markets. </p>
<p>All this calls for deliberate reforms to facilitate growth of pension savings. Countries should prioritise pensions within their development plans, address informality in the labour market and take advantage of technological advancements and the youthful population.</p>
<p>A well-developed pension system will improve the region’s financial stability through reduced budgetary strain as funds become available for development. It could also open up capital markets and improve the labour market, thus leading to growth.</p><img src="https://counter.theconversation.com/content/204766/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The article is based on a study prepared within the United Nations University World Institute for Development Economics Research (UNU-WIDER) project: "The domestic savings shortfall in developing countries - what can be done about it?" which is part of the Domestic Revenue Mobilisation programme financed through specific contributions by the Norwegian Agency for Development Cooperation (Norad).</span></em></p>The number of elderly people in need of support in Africa is projected to grow at annual rates above 3% up to 2050.Owen Nyang'oro, Lecturer, University of NairobiLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2050172023-05-15T00:20:29Z2023-05-15T00:20:29ZHome support work in NZ is already insecure and underpaid – automation may only make it worse<figure><img src="https://images.theconversation.com/files/525771/original/file-20230512-43136-ssuj49.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5599%2C3732&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Getty Images</span></span></figcaption></figure><p>The number of number of people aged 65 years or older living in New Zealand is likely to hit one million by 2028, <a href="https://www.stats.govt.nz/news/one-million-people-aged-65-by-2028/">according to the latest statistics</a> – up from under 300,000 in 1980. Caring for this ageing population will become increasingly important.</p>
<p>Research has shown New Zealanders prefer to <a href="https://www.msd.govt.nz/about-msd-and-our-work/publications-resources/journals-and-magazines/social-policy-journal/spj27/ageing-in-place-the-views-of-older-homeowners-27-pages128-141.html">retain independence</a> for as long as possible with the help of home-based care. Yet home support workers (HSWs) – those who assist older people, as well as people with disabilities and long-term conditions – have been underpaid and underappreciated for decades. </p>
<p>This is affecting the long-term sustainability of the workforce. According to a <a href="https://workresearch.aut.ac.nz/document-library/survey-reports/latest-survey-reports/the-new-zealand-care-workforce-survey-2019-report">2019 survey</a>, over 35% of care workers were aged 55-64. Only 11% were aged 25-34. In other words, care workers are getting older too.</p>
<p>Partly to address this, care provider companies (predominantly for-profit) are introducing platform technologies – or “care apps”. The rationale is that these empower care workers, create efficiencies for cost-conscious government agencies, and offer autonomy for clients.</p>
<p>It’s been claimed automation in the homecare sector will lower overhead costs and allow for staff pay to increase. Provider companies say it will also streamline the management of timesheets, salary payment, leave applications and access to client notes.</p>
<p>Our <a href="https://carecca.nz/research/care-home-support-workers-project/">research</a> and <a href="https://www.youtube.com/watch?v=_zbDe2s4YQE&ab_channel=CAREMassey">recently launched report</a> critically interrogates these claims, as well as the broader impact of these platform technologies on the working lives of HSWs, and their resulting ability to provide dignified care. </p>
<p>Rather than support claims of empowerment and efficiency, our interviews and focus groups with HSWs suggest the care apps, as they are currently used, are exacerbating pre-existing systemic failures. These lead to disempowering underpayment, declining professional autonomy and alarming health and safety risks.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1600521556148760578"}"></div></p>
<h2>Trust and communication</h2>
<p>Our interviewees’ experiences describe four broad themes: </p>
<p><strong>Digital frustration:</strong> a lack of input into the design of the technology affects not only worker wellbeing, but also the quality of care that can be provided. </p>
<p>For example, one participant described how sudden changes to her roster made through the app disrupt the client trust she has established over time. This affects her ability to provide tailored care based on detailed knowledge of the client’s needs and personal circumstances, as well as contributing to a feeling of having little professional autonomy or control:</p>
<blockquote>
<p>Sometimes [the app] doesn’t work that well because suddenly they change your roster. So I can ring my clients I’ve had the night before and say, yep I’m coming, I’ll see you around about 10 o'clock. And then the next day suddenly your roster has changed and that person now is not on your roster.</p>
<p>You now don’t have the phone number, so you can’t ring them to say my roster’s changed, I’m not going to come now, and then they’re gonna get somebody else turn up unexpectedly.</p>
</blockquote>
<p><strong>Precarity:</strong> care apps add to the already significant burden of unpaid labour, while cementing trends towards deskilling and loss of professional autonomy. One participant described how she had to log into the app four times for a single client. Another described how she would have to phone a call centre and explain if she forgot to log in. </p>
<p>Care workers are paid per client in a piecemeal way. Rather than receiving a salary, they don’t get paid for time spent on these other activities. </p>
<p>Several participants described how the requirement to log in often interrupted their ability to provide client care, taking focus away from often urgent tasks, as well as the skilled work of building a trusting relationship.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-coronavirus-crisis-shows-why-new-zealand-urgently-needs-a-commissioner-for-older-people-139383">The coronavirus crisis shows why New Zealand urgently needs a commissioner for older people</a>
</strong>
</em>
</p>
<hr>
<p><strong>Communication inequality:</strong> care apps (and smart phones more broadly) mean HSWs are always accessible to employers who can track their location with GPS technology. They can also add, remove and change clients with minimal notice (often causing distress to HSWs and their clients). </p>
<p>Meanwhile, participants described a lack of access to decision-makers, with local offices often having been closed and centralised into call centres. Functions for contacting managers or payroll departments through the app were often broken. As one participant said:</p>
<blockquote>
<p>It’s difficult to get through to them […] You’ll ring the call centre, ask them to do something, or you leave a message […] and it just doesn’t happen. These are huge breakdowns in communication.</p>
</blockquote>
<p><strong>Health and safety:</strong> communication inequality exposes HSWs and their clients to undue risks, made even greater in the context of COVID-19. On top of insecure working conditions during the pandemic and difficulty getting adequate personal protective equipment, HSWs lacked access to up-to-date information about the COVID status of their clients, or access to expert support during medical emergencies.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/voiceless-and-vulnerable-nzs-gig-workers-faced-more-risk-with-fewer-protections-during-the-pandemic-178747">Voiceless and vulnerable, NZ's gig workers faced more risk with fewer protections during the pandemic</a>
</strong>
</em>
</p>
<hr>
<h2>Incorporating workers’ voices</h2>
<p>According to the HSWs we interviewed, there is little recognition by their employers of the highly skilled work they do. Their valuable knowledge of the mechanics of providing care in the community has not been incorporated into the design of the care apps.</p>
<p>To ensure the new technology contributes to a sustainable workforce and to high-quality care in future, significant improvements to home care in general must be made. </p>
<p>Currently there are <a href="https://www.psa.org.nz/our-voice/crisis-in-home-support-demands-urgent-government-overhaul/">significant concerns</a> about how home care is funded, delivered and accounted for. The lack of professional control, autonomy or trust experienced by workers, as well as the piecemeal pay system, must be addressed as part of the development of care apps if they are to be truly empowering.</p>
<p>This would deliver real improvements for clients and workers. Our evidence suggests that care apps imposed on a workforce without their professional input cannot be a magic bullet that solves the long-term challenges of demographic change and systemic inefficiency.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/after-covid-why-we-need-a-change-in-care-home-culture-156264">After COVID: why we need a change in care home culture</a>
</strong>
</em>
</p>
<hr>
<h2>Protecting the vulnerable</h2>
<p>Home care is complex and messy, and things can change from minute to minute. Worker and client voices should be actively incorporated in both the design and evaluation of the technology. </p>
<p>This will protect their interests and ensure the right balance is struck between privacy protection and the provision of up-to-date information on client needs. Any data that are extracted and stored must also uphold the principles of Te Tiriti o Waitangi.</p>
<p>Ensuring the voices of HSWs and their unions inform the technological parameters of their work will help prevent the worsening of their already fragile workplace conditions.</p>
<p>Ultimately, failure to ensure the sustainability of this vital workforce would be a collective failure to care for our most vulnerable people.</p><img src="https://counter.theconversation.com/content/205017/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Leon Salter receives funding from MBIE/Royal Society.</span></em></p><p class="fine-print"><em><span>Lisa Vonk has received a scholarship from the HOPE Foundation for Research on Ageing. </span></em></p>The introduction of ‘care apps’ has been sold as improving efficiency and even pay rates for homecare providers. But a new study suggests it may only be exacerbating existing problems in the industry.Leon Salter, Postdoctoral Fellow, Center for Culture-Centered Approach to Research and Evaluation, Massey UniversityLisa Vonk, Doctoral Candidate, School of Humanities, Media and Creative Communication, Massey UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1737502022-01-21T13:42:57Z2022-01-21T13:42:57ZConflicts between nursing home residents are often chalked up to dementia – the real problem is inadequate care and neglect<figure><img src="https://images.theconversation.com/files/440793/original/file-20220113-23-w6ed7m.jpg?ixlib=rb-1.1.0&rect=42%2C18%2C3977%2C2621&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Conflicts between residents with dementia occur often in long-term care settings.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/assistant-in-the-community-center-giving-advice-to-royalty-free-image/653495116?adppopup=true">CasarsaGuru/E+ via Getty Images</a></span></figcaption></figure><p>Frank Piccolo was a beloved high school chemistry teacher in Ontario, Canada, until his retirement in 1998. “His trademark was to greet all of his students at the door at the start of class to make sure everyone felt welcomed there,” <a href="https://www.saultstar.com/2013/02/21/remembering-frank-piccolo--oconnor">wrote a former student</a>. “He had extensive knowledge of his subject matter, passion for his craft, and empathy for his students.” </p>
<p>But after Frank’s retirement, he developed dementia. When his condition declined, his family moved him to a Toronto nursing home. One evening in 2012, another resident – a woman with dementia – entered Frank’s bedroom. She hit Frank repeatedly in the head and face with a wooden activity board. Staff found Frank slumped over in his wheelchair, drenched in blood. He died three months later. </p>
<p>The Ontario Ministry of Health and Long-Term Care investigated. It found that the woman had a history of pushing, hitting and throwing objects at staff and other residents. But the nursing home didn’t address the woman’s behavioral expressions for weeks before the attack on Piccolo, <a href="https://s3.documentcloud.org/documents/21048374/inspection-report.pdf">the agency determined</a>. “There were no interventions implemented, no strategies developed,” the report stated. </p>
<figure class="align-right ">
<img alt="Frank Piccolo and his wife, Theresa, standing near each othe, on vacation, with a hillside village and the sea behind them." src="https://images.theconversation.com/files/440940/original/file-20220115-27-vtyb52.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/440940/original/file-20220115-27-vtyb52.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/440940/original/file-20220115-27-vtyb52.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/440940/original/file-20220115-27-vtyb52.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/440940/original/file-20220115-27-vtyb52.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/440940/original/file-20220115-27-vtyb52.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/440940/original/file-20220115-27-vtyb52.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Frank Piccolo and his wife, Theresa, traveling together in Italy in 2001.</span>
<span class="attribution"><span class="source">Theresa Piccolo</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>As a gerontologist and <a href="http://dementiabehaviorconsulting.com">dementia behavior specialist</a>, I’ve <a href="https://www.healthpropress.com/product/understanding-and-preventing-harmful-interactions-between-residents-with-dementia/">written a book</a> on preventing these incidents. I also co-directed, with dementia care expert Judy Berry, a documentary on the phenomenon called “<a href="https://terranova.org/film-catalog/fighting-for-dignity-a-film-on-injurious-and-fatal-resident-to-resident-incidents-in-long-term-care-home">Fighting for Dignity</a>.” The film sheds light on the emotional trauma experienced by family members of residents harmed during these episodes in U.S. long-term care homes. </p>
<h2>Reporting and stigmatizing</h2>
<p><a href="https://doi.org/10.1111/j.1532-5415.2008.01808.x">Resident-to-resident incidents</a> are defined by researchers as “negative, aggressive and intrusive verbal, physical, material and sexual interactions between residents” that can cause “psychological distress and physical harm in the recipient.” </p>
<p>These incidents <a href="https://doi.org/10.7326/M15-1209">are prevalent</a> in U.S. nursing homes. But they are <a href="https://www.statnews.com/2021/11/29/resident-to-resident-incidents-hidden-source-nursing-home-harm/">largely overlooked</a> by the Centers for Medicare and Medicaid Services, the federal agency overseeing care in approximately 15,000 nursing homes across the country. Consequently, such incidents <a href="https://doi.org/10.1080/08946566.2017.1333939">remain untracked</a>, <a href="https://doi.org/10.1016/j.jamda.2015.10.003">understudied</a> and largely unaddressed.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/440941/original/file-20220115-18-1qy7een.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An elderly man with severe injuries, including cut marks and bruises, across his face and forehead." src="https://images.theconversation.com/files/440941/original/file-20220115-18-1qy7een.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/440941/original/file-20220115-18-1qy7een.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/440941/original/file-20220115-18-1qy7een.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/440941/original/file-20220115-18-1qy7een.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/440941/original/file-20220115-18-1qy7een.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/440941/original/file-20220115-18-1qy7een.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/440941/original/file-20220115-18-1qy7een.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Frank Piccolo sustained severe injuries to his face and head after a woman with dementia entered his bedroom and hit him repeatedly with an activity board.</span>
<span class="attribution"><span class="source">Theresa Piccolo</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>These interactions don’t just result <a href="https://doi.org/10.1001/jama.291.5.591">in injuries</a>
<a href="https://doi.org/10.1177/0733464819863926">and deaths</a> among residents. They also leave behind devastated families who then must <a href="https://www.washingtonpost.com/business/2021/08/20/nursing-home-immunity-covid-lawsuits">fight for answers</a> and accountability from nursing homes.</p>
<p>Making matters worse, <a href="https://www.gao.gov/products/gao-19-433">government reports</a>, <a href="https://doi.org/10.1017/S0714980815000094">research studies</a> and <a href="https://doi.org/10.1177/1471301220981232">media coverage</a> commonly describe these episodes with words that stigmatize people with dementia. Researchers, public officials and journalists tend to <a href="https://www.startribune.com/when-senior-home-residents-are-abusers-minnesota-rarely-investigates/450625693/">label the incidents as “abuse</a>,” “violence” and “aggression.” They call a resident involved in an incident a “perpetrator” or an “aggressor.” News outlets described the attack on Piccolo by the woman with dementia as “aggressive” or “violent.” And when reporting on <a href="https://www.thestar.com/news/gta/2013/02/09/more_than_10000_canadians_abused_annually_by_fellow_nursing_home_residents.html">the phenomenon</a> in Canada, the Toronto Star called it “abuse.” </p>
<h2>Getting to the root of the real problem</h2>
<p>Most incidents, however, do not constitute abuse. A growing body of evidence suggests the true cause of these injuries and deaths is inadequate care and neglect on the part of care homes. Specifically, there is a lack of the specialized care that people with dementia require. </p>
<p>Two of every three residents <a href="https://doi.org/10.1016/j.jamda.2021.02.009">involved in these incidents</a> have dementia. One study found that the rate of these episodes was nearly <a href="https://doi.org/10.1001/jama.291.5.591">three times higher</a> in dementia care homes than in other long-term care homes. A recent study also found <a href="https://doi.org/10.7326/m15-1209">an association</a> between residency in a dementia care home and higher rates of injurious or fatal interactions between residents. </p>
<p>But for these residents, the conflicts occur mostly when their emotional, medical and other needs are not met. When they reach a breaking point in frustration related to the unmet need, they may push or hit another resident. My research in the U.S. and Canada has shown that <a href="https://doi.org/10.1080/08946566.2018.1474515">“push-fall” episodes</a> constitute nearly half of fatal incidents. </p>
<p>Another U.S. study found that as residents’ cognitive functioning declined, they faced <a href="https://doi.org/10.1001/jama.291.5.591">a greater likelihood</a> of injury in these incidents. Those with advanced dementia were more susceptible to inadvertently “getting in harm’s way,” by saying or doing things that trigger angry reactions in other residents. </p>
<p>The Centers for Disease Control and Prevention has stated that what it calls “aggression” between residents <a href="https://www.cdc.gov/violenceprevention/pdf/ea_book_revised_2016.pdf">is not abuse</a>. Instead, the CDC noted that these episodes may result when care homes fail to prevent them by taking adequate action. And a study on <a href="https://doi.org/10.1177/0733464819863926">fatal incidents</a> in U.S. nursing homes has shown that many residents were “deemed to lack cognitive capacity to be held accountable for their actions.” </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/gk5iEo-s_6M?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">An undercover yearlong investigation into nursing homes in Ontario, Canada, revealed shocking instances of abuse and neglect by staff members.</span></figcaption>
</figure>
<h2>How incidents often occur</h2>
<p>In one study, researchers examined <a href="https://doi.org/10.1177/1054773813477128">situational triggers</a> among residents with cognitive impairments. The strongest triggers involved personal space and possessions. Examples include taking or touching a resident’s belongings or food, or unwanted entries into their bedroom or bathroom. The most prevalent triggering event was someone being too close to a resident’s body. </p>
<p>That study also found that crowded spaces and interpersonal stressors, such as two residents claiming the same dining room seat, could lead to these episodes. <a href="https://doi.org/10.1177/1471301213502588">My own work</a> and a different <a href="https://doi.org/10.1177%2F0733464820955089">Canadian study</a> came to similar conclusions.</p>
<p>Other research shows that when residents are bored or lack <a href="https://doi.org/10.1177%2F153331750502000210">meaningful activity</a>, they become involved in <a href="https://doi.org/10.1177%2F1471301213502588">harmful interactions</a>. Evenings and weekends can be particularly dangerous, with fewer organized activities and fewer staff members and managers present. <a href="https://doi.org/10.1080/08946566.2018.1474515">Conflicts between roommates</a> are also common and harmful. </p>
<figure class="align-center ">
<img alt="With a smiling staff member looking on, two nursing home residents enjoy conversation while having coffee." src="https://images.theconversation.com/files/438566/original/file-20211220-49721-z6ev8m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/438566/original/file-20211220-49721-z6ev8m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/438566/original/file-20211220-49721-z6ev8m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/438566/original/file-20211220-49721-z6ev8m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/438566/original/file-20211220-49721-z6ev8m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/438566/original/file-20211220-49721-z6ev8m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/438566/original/file-20211220-49721-z6ev8m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Residents with dementia who are meaningfully engaged in activities are less likely to become involved in harmful incidents with other residents.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/caretaker-with-senior-people-in-nursing-home-royalty-free-image/489582967?adppopup=true">Morsa Images/DigitalVision via Getty Images</a></span>
</figcaption>
</figure>
<p>A growing body of research suggests that most incidents between residents are preventable. A major risk factor, for example, is lack of adequate supervision, which often occurs when staff are assigned to caring for too many residents with dementia. One U.S. study found that <a href="https://doi.org/10.7326/M15-1209">higher caseloads</a> among nurses’ aides were associated with higher incident rates. </p>
<p>And with <a href="https://doi.org/10.4137/hsi.s38994">poor staffing levels</a> in up to half of U.S. nursing homes, <a href="https://doi.org/10.1080/08946566.2018.1474515">staff members do not witness</a> many incidents. In fact, one study found that staff members missed the majority of unwanted <a href="https://doi.org/10.1080/13607863.2016.1211620">bedroom entries</a> by residents with severe dementia. </p>
<h2>Residents with dementia are not to blame</h2>
<p>In most of these situations, the person with dementia does not intend to injure or kill another resident. Individuals with dementia live with a serious cognitive disability. And they often must do it while being forced to share small living spaces with many other residents. </p>
<p>Their behavioral expressions are often attempts to cope with frustrating and frightening situations in their social and physical environments. They are typically the result of unmet human needs paired with cognitive processing limitations. </p>
<p>Understanding the role of dementia is important. But seeing a resident’s brain disease as the main cause of incidents is inaccurate and unhelpful. That view ignores external factors that can lead to these incidents but are outside of the residents’ control.</p>
<p>Frank’s wife, Theresa, didn’t blame the woman who injured her husband or the staff. She blamed the for-profit company operating the nursing home. Despite its revenue of $2 billion in the year before the incident, it failed in its “<a href="https://www.thestar.com/news/gta/2013/02/09/more_than_10000_canadians_abused_annually_by_fellow_nursing_home_residents.html">duty to protect</a>” Piccolo. “They did not keep my husband safe as they are required to do,” she said.</p><img src="https://counter.theconversation.com/content/173750/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>I am a founding member and board member of Elder Voice Family Advocates in Minnesota. </span></em></p>Research shows that violence between patients is prevalent, often overlooked and largely unaddressed.Eilon Caspi, Assistant Research Professor of Health, Intervention, and Policy, University of ConnecticutLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1736142022-01-10T13:36:42Z2022-01-10T13:36:42ZEnd-of-life conversations can be hard, but your loved ones will thank you<figure><img src="https://images.theconversation.com/files/439730/original/file-20220106-23-1if8ay.jpg?ixlib=rb-1.1.0&rect=44%2C0%2C2028%2C1381&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">You can start these conversations simply, like saying, "I need to think about the future. Can you help me?"</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/senior-couple-holding-hands-royalty-free-image/200447695-001?adppopup=true">Richard Ross/The Image Bank via Getty Images</a></span></figcaption></figure><p>Death – along with taxes – is one of life’s few certainties. Despite this inevitability, most people dread thinking and talking about when, how or under what conditions they might die. </p>
<p>They don’t want to broach the topic with family, either, for fear of upsetting them. Ironically, though, talking about death “early and often” can be the greatest gift to bestow on loved ones.</p>
<p>As a <a href="https://www.bu.edu/sociology/profile/deborah-carr/">sociologist</a> who has studied end-of-life issues for more than two decades, I’ve learned that people know they should talk about death honestly and openly, but surprisingly few do. In fact, <a href="https://doi.org/10.3928/02793695-20171219-03">one 2021 study</a> showed that while 90% of adults say that talking to their loved ones about their end-of-life wishes is important, only 27% have actually had these conversations.</p>
<p>It’s frightening to think about our own suffering, or our loved ones’ distress. But everyone should talk about and prepare for death precisely because we want to minimize our own suffering at the end of life, and soften the anguish of loved ones left behind.</p>
<h2>No time to plan</h2>
<p>These conversations are more urgent now than ever, as the COVID-19 pandemic has <a href="https://doi.org/10.1001/jama.2021.5469">changed how Americans die</a>. </p>
<p>For the past several decades, most adults have died from <a href="https://www.cdc.gov/injury/wisqars/LeadingCauses.html">chronic illnesses</a> like heart disease, cancer and lung disease. The time between diagnosis and death for people with these conditions can be months or even years. That gives patients and their families ample time to share their feelings, resolve unfinished business, and make practical preparations for death – including <a href="https://theconversation.com/online-tools-put-will-writing-in-reach-for-most-people-but-theyre-not-the-end-of-the-line-for-producing-a-legally-binding-document-173569">estate planning</a>, <a href="https://www.nia.nih.gov/health/advance-care-planning-health-care-directives">advance care planning</a> and even planning a celebration of life that bears the dying patient’s creative imprint. </p>
<p>But when the pandemic struck in 2020, COVD deaths began to occur quickly and unexpectedly, with many patients <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/928729/S0803_CO-CIN_-_Time_from_symptom_onset_until_death.pdf">dying just days</a> after they felt their first symptoms. Their families were <a href="https://doi.org/10.1080/08959420.2020.1764320">robbed of final moments together</a> and often had no documents in place to guide the <a href="https://doi.org/10.1080/08959420.2020.1824540">patient’s health care</a> or the distribution of their possessions. This suddenness, isolation and lack of preparedness all are hallmarks of a “<a href="https://doi.org/10.1080/08959420.2020.1764320">bad death</a>” for both the patient and their family.</p>
<h2>What to cover</h2>
<p><a href="https://doi.org/10.1093/geroni/igx012">Advance care planning</a>, which typically involves <a href="https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/living-wills/art-20046303">a living will</a> and <a href="https://www.tuftsmedicalcenter.org/patient-care-services/patient-rights/health-care-proxy-medical-decision-making">a health care proxy</a>, allows people to articulate which medical treatments they want or don’t want at the end of life.</p>
<p>A living will formally articulates preferences for care, such as whether to use comfort measures like <a href="https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care">hospice and palliative care</a>, or more invasive measures like <a href="https://www.caregiver.org/resource/advanced-illness-feeding-tubes-and-ventilators/">feeding tubes and ventilators</a>. Documenting these preferences when the patient is still able to make those decisions helps to ensure they die on their own terms – a cornerstone of the “<a href="https://pubmed.ncbi.nlm.nih.gov/12866391/">good death</a>.” </p>
<p>Appointing a <a href="https://doi.org/10.1177/002214650704800206">health care proxy</a> when still relatively young and healthy gives people an opportunity to decide who will be tasked with their end-of-life decision-making. It also clarifies loved ones’ responsibilities and can fend off arguments that could arise around the deathbed. Having these discussions early also prevents panicked choices when someone’s health takes a dramatic turn for the worse. </p>
<figure class="align-center ">
<img alt="A woman and her older mother sit on a porch, drinking coffee." src="https://images.theconversation.com/files/439737/original/file-20220106-27-4gzo21.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/439737/original/file-20220106-27-4gzo21.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/439737/original/file-20220106-27-4gzo21.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/439737/original/file-20220106-27-4gzo21.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/439737/original/file-20220106-27-4gzo21.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/439737/original/file-20220106-27-4gzo21.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/439737/original/file-20220106-27-4gzo21.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">End-of-life conversations can ease suffering for families, not just patients.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/senior-mother-and-adult-daughter-having-coffee-on-royalty-free-image/1311072998?adppopup=true">MoMo Productions/DigitalVision via Getty Images</a></span>
</figcaption>
</figure>
<p>End-of-life discussions also help you to <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1751-9004.2011.00416.x">construct your own legacy</a>. In “<a href="https://www.worldcat.org/title/death-and-identity/oclc/2318294">Death and Identity</a>,” a classic book in death studies, sociologist Robert Fulton observed that “preserving rather than losing … personal identity” is a critical aspect of the dying process. Being treated <a href="https://doi.org/10.7326/0003-4819-132-10-200005160-00011">like a “whole person</a>” is a core component of a good death, and honest discussions are a key to maintaining your unique identity, even at the end of life.</p>
<p>Conversations also help us share how we’d like to be celebrated after we’re gone. This might be as simple as dictating the music, food, and photo or video displays for a memorial service; where to spread ashes; or charities for mourners to support. Some people take more ambitious steps at leaving behind a legacy, such as penning an autobiography or leaving behind videos for relatives. Creating a “post-self” that lingers years after the body has died can be a cherished gift to families.</p>
<h2>Getting started</h2>
<p>Broaching these conversations can be awkward or unnerving, but it doesn’t have to be. Death is a natural and inevitable part of life and should be approached as such. <a href="https://knowablemagazine.org/article/health-disease/2019/end-of-life-care">I have argued</a> that the end of life is a <a href="https://www.annualreviews.org/doi/abs/10.1146/annurev-soc-073018-022524">stage</a>, just as childhood, adolescence and old age are.</p>
<p>Each stage teaches lessons for the others that lie ahead.</p>
<p>Children learn skills in school that they’ll need to enter the workforce. Teens learn how to navigate romantic relationships as preparation for the future. Adults of all ages can learn about hospice and end-of-life medical care, make preparations for passing on their inheritance and discuss how they’d like to be honored in death. These steps can help attain an end of life marked by peace and self-directedness, rather than strife and the loss of autonomy.</p>
<figure class="align-center ">
<img alt="An older Black woman writes as she sits at a dining room table in front of a china cabinet." src="https://images.theconversation.com/files/439857/original/file-20220107-33826-eklb4c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/439857/original/file-20220107-33826-eklb4c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/439857/original/file-20220107-33826-eklb4c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/439857/original/file-20220107-33826-eklb4c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/439857/original/file-20220107-33826-eklb4c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/439857/original/file-20220107-33826-eklb4c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/439857/original/file-20220107-33826-eklb4c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Recording memories and ideas for a memorial service can help you craft your own legacy.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-working-at-home-royalty-free-image/1062487638?adppopup=true">Lauren Mulligan/Moment via Getty Images</a></span>
</figcaption>
</figure>
<p>Ample resources are available to guide these conversations. Organizations like <a href="https://theconversationproject.org/wp-content/uploads/2017/02/ConversationProject-ConvoStarterKit-English.pdf">The Conversation Project</a> – not related to <a href="https://theconversation.com">The Conversation</a> – have created guides for productive end-of-life discussions. Advance care planning documents ranging from <a href="https://www.aarp.org/caregiving/financial-legal/free-printable-advance-directives/">living wills</a> to the “<a href="https://fivewishes.org/">Five Wishes</a>” program, which helps clarify people’s values about how they’d like to spend their final days, can be a good starting point.</p>
<p>A simple introduction like “I need to think about the future. Will you help me?” is a good icebreaker. And the first conversation eases the path to future chats, because changes in physical health, family relations and mental sharpness may necessitate revisions in end-of-life plans.</p>
<p>By discussing these issues during calm times, such as after a holiday get-together or birthday dinner, we can feel prepared and empowered as we and our families approach the inevitable.</p><img src="https://counter.theconversation.com/content/173614/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deborah Carr has received research funding from Borchard Foundation, Department of Labor, National Institutes of Health, and RRF Foundation for Aging.
</span></em></p>When you prepare to talk about end-of-life decisions and the legacy you want to leave behind, try thinking about them as gifts you bestow to family and friends.Deborah Carr, Professor of Sociology and Director of the Center for Innovation in Social Science, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1718552021-12-27T11:39:21Z2021-12-27T11:39:21ZRetirement communities: ageism exists even among the elderly – new research<figure><img src="https://images.theconversation.com/files/437191/original/file-20211213-10093-16x1gsw.jpeg?ixlib=rb-1.1.0&rect=143%2C350%2C5685%2C3341&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/elderly-couple-hugging-each-other-love-1466009171">shutterstock/supermao</a></span></figcaption></figure><p>“We don’t want to be tripping over Zimmer frames all the time,” said John*, 73. He clearly felt frustrated and had a strong objection to the older, more frail residents in his retirement village. John and his wife, Jean, had moved to the retirement village about a year ago. They were clearly not expecting to encounter really elderly people when they moved in. “It’s depressing,” he continued, “to see these people, who really ought to be in a nursing home, or in care.”</p>
<p>In our research – published in <a href="https://academic.oup.com/gerontologist/advance-article/doi/10.1093/geront/gnab164/6420440">The Gerontologist</a> – we carried out 80 in-depth interviews with older people about their experiences of living in retirement villages across the UK and Australia. We were particularly interested in why people sought out retirement living and how their needs matched or contradicted those of other residents. We did not expect to find such high levels of resentment among residents – but we did.</p>
<p>Retirement living is big business. <a href="https://www.arcouk.org/sites/default/files/ARCO%20Retirement%20Communities%20Fact%20Pack_ONLINE%20aw4_0.pdf">It is estimated</a> that around 5% of Australians, 6% of Americans, and 1% of UK citizens over 65 live in a retirement village. <a href="https://academic.oup.com/gerontologist/article/52/3/357/580905">Researchers</a> have argued that one of the problems with retirement villages is that they tend to treat “older people” as a homogeneous category, as more or less “the same” simply because they are over 60. The reality is that residents have extremely diverse needs and span up to three decades – from 60 to over 90.</p>
<h2>Contrasting and conflicting needs</h2>
<p>Some of the people we talked to (we called them the “Peter Pans”) clearly chose retirement living to keep the perils of old age at bay and prolong midlife for as long as they could. David, 76, and his wife, Pam, 73, had moved to a retirement village in the midlands because they wanted to maintain a sense of being active, fit, healthy and independent. David told us:</p>
<blockquote>
<p>We are still reasonably fit, you see. We’ve got a strong stable background of family and friends. We hope this is a place which will be easy to live in and where we can do the things we want to and feel fit and healthy. </p>
</blockquote>
<p>In contrast, others chose the same retirement village because they were concerned about increasing frailty and deteriorating health and sought a community that they felt could support them in these challenges.</p>
<p>Peter, 78, and his wife Sue, 76, had moved to the village to cope with Sue’s increasing dependency due to a dementia-related illness. Peter told us: “Well, it all stems really from Sue’s illness… and the problems that have occurred, and we thought this would be the answer… I was under the impression that’s what we would find by moving here.”</p>
<h2>Ageism in the ‘old’</h2>
<p>These contrasting sets of needs were often in conflict. People who had moved to retirement villages to prolong midlife and to feel part of an active, independent community, were not always accepting of frailer residents.</p>
<p>Jane, 72, from a UK retirement village, suggested that “the older people make you feel older. They can’t do as much… we do help them, but we can’t be living our life around them.”</p>
<p>Paul, 74, called for a more selective sales process. He told us: “I don’t think the people [here] are vetted enough. I think the main criteria is you’ve got the money. I don’t necessarily think there ought to be more support – I think there ought to be less people who require support here.”</p>
<p>Some people who had moved to feel more supported in their vulnerability and frailty sometimes felt marginalised and unsupported. Peter told us, tearfully, that it hadn’t turned out as he and his wife had hoped. “In some ways, now, I just feel she’s a bit like a leper really – because no one actually wants to get close to her here,” he said.</p>
<p>But there were others who demonstrated a more accepting attitude towards older residents. Ralph, 72, recognised that he might be more frail himself in the future and welcomed support from fellow residents: “We are currently the people to whom the neighbours say, ‘can you help with this or do that?’ Take me somewhere or do that?‘ But I think one day it will work the other way round. I think maybe when we get older, we will become dependent on others here too.”</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/loneliness-loss-and-regret-what-getting-old-really-feels-like-new-study-157731">Loneliness, loss and regret: what getting old really feels like – new study</a>
</strong>
</em>
</p>
<hr>
<p>Cultural geographer, Kevin McHugh <a href="https://www.sciencedirect.com/science/article/abs/pii/S0890406500800183#!">has argued</a> that retirement communities reflect and sell compelling narratives about successful ageing. These narratives, he argued, are “defined as much by the absent image (old, poor folks) as by the image presented: handsome, healthy, comfortably middle-class 'seniors’, busily filling sun-filled days”. </p>
<p>A lot of these retirement communities are often so vaguely defined that they appear to offer all things to all people. But they can only be a desirable model if they recognise and accommodate the diverse needs of that community. </p>
<p>As Swedish gerontologist, Håkan Jönson, <a href="https://academic.oup.com/gerontologist/article/53/2/198/559791">has argued</a>, it makes little sense to resent more frail, vulnerable older people – why should we resent a percentage of the population that we will probably be part of in the future?</p>
<p>*<em>All names have been changed to protect anonymity.</em></p><img src="https://counter.theconversation.com/content/171855/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sam Carr receives funding from Guild Living. </span></em></p>Retirement villages tend to treat older people as a homogeneous group when the reality is they have a hugely diverse range of needs.Sam Carr, Senior Lecturer in Education with Psychology, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1737822021-12-21T13:46:34Z2021-12-21T13:46:34ZHome for the holidays and worried about an older relative? Make observations, not assumptions<figure><img src="https://images.theconversation.com/files/438493/original/file-20211220-18663-1h14guy.jpg?ixlib=rb-1.1.0&rect=31%2C0%2C2086%2C1365&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If you're worried about older loved ones' ability to care for themselves, try starting a conversation with nonjudgmental questions.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/adult-woman-and-senior-mother-talking-on-front-royalty-free-image/1209969659?adppopup=true">MoMo Productions/DigitalVision via Getty Images</a></span></figcaption></figure><p>With the second holiday season of the pandemic upon us, many people will have the opportunity to rejoin family and friends for celebrations. The pandemic has kept many of us apart longer than expected, and it may have been months since we’ve visited with our loved ones. In addition to enjoying food, folks and fun, there may be some not-so-pleasant surprises. </p>
<p>As <a href="https://uvahealth.com/findadoctor/profile/laurie-r-archbald-pannone">a geriatrician</a>, I often see patients whose families voice concerns about their health or well-being. This can be especially heightened if they haven’t seen each other in a while. The holidays can be an opportunity to not just <a href="https://theconversation.com/the-magnificent-history-of-the-maligned-and-misunderstood-fruitcake-173201">enjoy the fruitcake</a> but observe how your aging parents, grandparents or great-grandparents are doing at home. Objectively observing their functioning and memory can uncover warning signs that more evaluation is needed.</p>
<p>This can lead to uncomfortable situations and often feels like role reversal. Maintaining older adults’ <a href="https://doi.org/10.1186/1472-6955-7-11">autonomy and dignity</a> needs to be the core of all of these conversations. If you are concerned about someone’s health, approach the conversation with an open mind and genuine curiosity to listen to their thoughts. Don’t assume you understand their situation. Make observations, not assumptions.</p>
<p>To take a step back for a moment, I would emphasize to not form conclusions about anyone’s ability to care for themselves based on age. Many people do quite well taking care of themselves and remaining independent well into their 90s or more, while other people may <a href="https://cgjonline.ca/index.php/cgj/article/view/93">need more assistance</a> with self-care earlier in life.</p>
<h2>Everyday functioning</h2>
<p>Take a look around the house. Have loved ones been able to keep up with basic care of the home or yard? If not, these can be signs that someone may need more help at home. Sometimes that could mean simply hiring someone to clean the pool or shovel the snow. Other times, it may be a sign of limited physical function: Maybe they can’t move around as well or bend over to pick things up.</p>
<p>But if basic cleaning isn’t happening, that could also be a sign of limitations in cognitive function – perhaps they forget to remove the trash from the kitchen for weeks or don’t remember to go to the store for basic needs. Other times, it’s just a sign that they were too busy to mow the yard before your visit. Again, don’t make assumptions, make observations – and always see them in the larger context.</p>
<p>Watch how your loved one is moving around the house. If they have been told to use a cane or walker before, are they? Is their balance bad? Are they getting by with “furniture surfing,” holding on to furniture or walls while walking?</p>
<figure class="align-center ">
<img alt="A girl chats with an older woman as she walks through a home with a walker." src="https://images.theconversation.com/files/438494/original/file-20211220-19-1h30nmn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/438494/original/file-20211220-19-1h30nmn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/438494/original/file-20211220-19-1h30nmn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/438494/original/file-20211220-19-1h30nmn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/438494/original/file-20211220-19-1h30nmn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/438494/original/file-20211220-19-1h30nmn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/438494/original/file-20211220-19-1h30nmn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It’s not about age but skills, like how comfortably someone can move around their home.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/granddaughter-supporting-grandmother-using-mobility-royalty-free-image/1183554271?adppopup=true">FG Trade/E+ via Getty Images</a></span>
</figcaption>
</figure>
<p>What about driving? If you have concerns, remember there are many factors that may be playing a role. It’s about skills, <a href="https://theconversation.com/how-old-is-too-old-to-drive-111596">not age</a>. <a href="https://icsw.nhtsa.gov/people/injury/olddrive/arthritis/index.htm#:%7E:text=Having%20arthritis%20can%20make%20your,to%20check%20your%20blind%20spot.">Arthritis</a> in the neck might make it hard to look at crossing traffic. <a href="https://doi.org/10.3390/ijerph17207416">Vision problems</a> can cause blurring, especially at night. <a href="https://doi.org/10.1590/S1980-57642009DN30400004">Limitations in cognition</a> can also cause trouble, such as getting lost while driving somewhere familiar – like the grocery store or a friend’s house.</p>
<p>[<em>3 media outlets, 1 religion newsletter.</em> <a href="https://theconversation.com/us/newsletters/this-week-in-religion-76/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=religion-3-in-1">Get stories from The Conversation, AP and RNS.</a>]</p>
<p>If you notice signs of unsafe driving, it’s important to get loved ones evaluated for their own safety, as well as that of others on the road. Have an open and honest conversation with their health care clinician to review these concerns. There are also community resources to help navigate these difficult conversations, such as <a href="https://www.alz.org/help-support/caregiving/safety/dementia-driving">the site alz.org</a> for concerns about dementia and driving.</p>
<p>If you notice changes in your relative, remember too that the pandemic has put extra stress and anxiety on many people. Over the past two years, some of us have not just been social distancing but also experiencing <a href="https://theconversation.com/social-isolation-the-covid-19-pandemics-hidden-health-risk-for-older-adults-and-how-to-manage-it-141277">social isolation</a>. Feeling cut off from our community can lead to serious health problems. The <a href="https://www.nia.nih.gov/health/loneliness-and-social-isolation-tips-staying-connected">National Institute on Aging</a> has great resources to understand the difference between being lonely and being socially isolated, and <a href="https://theconversation.com/a-geriatrician-offers-4-tips-for-seniors-to-stay-connected-during-coronavirus-outbreak-133233">how to identify and act on these concerns</a>.</p>
<h2>See something, say something – with care</h2>
<p>The holidays can bring chaotic schedules. Many people can be overwhelmed by their commitments, or forget important plans, and it’s not necessarily <a href="https://theconversation.com/does-forgetting-a-name-or-word-mean-that-i-have-dementia-144565">a sign of dementia</a>. Anybody can forget to bring home cranberry sauce or which exact yogurt the grandkids like. </p>
<p>When it may be <a href="https://www.cdc.gov/aging/dementia/index.html">a sign of something more significant</a> is if memory loss affects daily life – especially things like eating, dressing and hygiene. If you notice that there may be <a href="https://theconversation.com/does-forgetting-a-name-or-word-mean-that-i-have-dementia-144565">more than typical forgetfulness</a>, then it is time to talk.</p>
<p>You can ask open nonjudgmental questions to start the conversation. Avoid making assumptions – something like “Why didn’t you tell us that you’re not safe at home?” won’t start a useful conversation. Instead, start by describing your observations: “I saw that you just stumbled in the hallway. Is that something you have noticed before?” Allow space for reflection and insight. Don’t tell other people how they “should” be feeling, but listen for their own thoughts and observations. </p>
<p>See if your loved one would allow you to join them at an upcoming clinic visit to discuss whether there is an issue and, if so, how to make things better. If so, be there primarily as an observer or to add in details when asked. If you are not able to attend, you can consider writing a letter to describe your observations, which the patient could share with their team at the next visit. </p>
<p>Getting together at the holidays is intended to be a reunion of family and community to enjoy the season. Nobody wants to focus on problems, but be observant. If you see warning signs that things may not be going well, say something – thoughtfully.</p><img src="https://counter.theconversation.com/content/173782/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laurie Archbald-Pannone does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In tough conversations, show your respect for loved ones’ autonomy and dignity.Laurie Archbald-Pannone, Associate Professor of Medicine, Geriatrics, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1699352021-11-18T19:46:57Z2021-11-18T19:46:57ZTeaching university students to be ‘age-conscious’ could help address our elder care crisis<figure><img src="https://images.theconversation.com/files/432271/original/file-20211116-17-1vf9b3d.jpg?ixlib=rb-1.1.0&rect=74%2C202%2C4917%2C2956&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What it's like to get older? A course on the psychology of aging helped students gain empathy and curiosity.
</span> <span class="attribution"><span class="source">(Shutterstock) </span></span></figcaption></figure><p>How does systemic ageism affect our society? <a href="https://www.theglobeandmail.com/canada/article-systemic-ageism-to-blame-for-covid-19-deaths-in-quebec-care-homes/">A coroner’s inquest into COVID-19 deaths in long-term care homes in Québec</a> recently heard that ageism was a contributing factor. </p>
<p>This is one of many recent examples of the ways ageism is entrenched into our institutional and social structures, and negatively impacts people and systems.
The pandemic brought the critical consequences of ageism to the forefront, as <a href="https://doi.org/10.1080/08959420.2020.1764319">older people’s basic human rights were dramatically affected</a>. </p>
<p>Sarah Fraser, a professor in the Interdisciplinary School of Health Sciences at University of Ottawa, and global colleagues, documented how some public reporting throughout the pandemic has misrepresented <a href="https://doi.org/10.1093/ageing/afaa097">and undervalued older people</a>. For example, they highlight that “younger adults who have died from complications of COVID-19 throughout the world have often generated long and in-depth media reports, while the deaths of thousands of older adults have been simply counted and summarized” and “the failure of the public authorities in France to report mortality figures for older adults in nursing homes.” </p>
<p>Significant health ramifications, social isolation and the <a href="https://www.nature.com/articles/s41598-021-83040-3">loss of millions of older lives</a> around the world followed.</p>
<p>In 30 years, <a href="https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf">one in six people will be over 65</a>. How do we better safeguard systems against discriminatory practices towards older adults and ageism? </p>
<p>Alongside my colleagues Éric R. Thériault and Amber Colibaba, I recently examined how our society can tackle ageism, starting <a href="https://doi.org/10.1017/S0714980821000246">in university classrooms</a>. </p>
<figure class="align-center ">
<img alt="People stand outside a long term care home next to a long banner." src="https://images.theconversation.com/files/432287/original/file-20211116-25-11awqt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/432287/original/file-20211116-25-11awqt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=392&fit=crop&dpr=1 600w, https://images.theconversation.com/files/432287/original/file-20211116-25-11awqt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=392&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/432287/original/file-20211116-25-11awqt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=392&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/432287/original/file-20211116-25-11awqt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=493&fit=crop&dpr=1 754w, https://images.theconversation.com/files/432287/original/file-20211116-25-11awqt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=493&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/432287/original/file-20211116-25-11awqt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=493&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People place a sign translating to ‘protect our seniors’ outside Maison Herron, a long-term care home in the Montréal suburb of Dorval, in April 2020.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes</span></span>
</figcaption>
</figure>
<h2>Changing negative archetypes</h2>
<p>Common societal archetypes of aging in the West are <a href="https://www.routledge.com/Handbook-of-Prejudice-Stereotyping-and-Discrimination-2nd-Edition/Nelson/p/book/9781848726697">predominantly negative</a>, embodying the repulsive, the deteriorating and the irrelevant. </p>
<p>Though the implications of ageism are dire, concerns about ageism outside of those working with or caring for older people are often quieter. Youth are the next generation of adults who will be interacting with, working with and caring for older people. </p>
<p>The language of ageism as a “<a href="https://doi.org/10.2105/AJPH.2019.305123">global crisis</a>” underlines the urgent need to understand and disrupt ageism, and to advocate for critical, supportive resources for changing cultural attitudes toward older lives.</p>
<h2>Teaching young adults about aging</h2>
<p>Research suggests that <a href="https://doi.org/10.1111/ggi.12894">increased exposure to and interactions with older adults</a> can reduce ageist views among college students.
While a <a href="https://doi.org/10.1080/03601277.2015.1059139">gold standard of inter-generational learning</a> can be achieved through service learning — when students and older people actively work together on an activity or project — this is often infeasible. </p>
<p>Many universities laud “<a href="https://cou.ca/wp-content/uploads/2015/05/COU-Experiential-Learning-Report-2014.pdf">experiential learning</a>,” yet the onus may fall upon individual faculty members to implement applied inter-generational activities. In an era of limited-term faculty appointments, stretched faculty members and budget trimming, the capacity to fund service learning and develop the required community relationships is limited. </p>
<p>Our study sought to understand how undergraduate students’ attitudes towards older adults and the aging process could shift after completing a lecture-based undergraduate course, that involved no service learning, about the psychology of aging. We analyzed student respones to two similar classes at two Canadian universities between 2019 and 2020.</p>
<h2>Reducing fear</h2>
<figure class="align-left ">
<img alt="Two younger women stand beside an older woman in the middle." src="https://images.theconversation.com/files/429755/original/file-20211102-27-ilvtil.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/429755/original/file-20211102-27-ilvtil.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=670&fit=crop&dpr=1 600w, https://images.theconversation.com/files/429755/original/file-20211102-27-ilvtil.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=670&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/429755/original/file-20211102-27-ilvtil.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=670&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/429755/original/file-20211102-27-ilvtil.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=842&fit=crop&dpr=1 754w, https://images.theconversation.com/files/429755/original/file-20211102-27-ilvtil.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=842&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/429755/original/file-20211102-27-ilvtil.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=842&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Danielle Willette (left) and Amber Allen (right), graduating Trent psychology students, with class visitor Ruth Greenley.</span>
<span class="attribution"><span class="source">(Elizabeth Russell)</span></span>
</figcaption>
</figure>
<p>In 2017, my class welcomed Ruth Greenley to speak with us, however more recent classes, including those involved in the study, did not include older visitors.
Without interacting with older people, students learned about the theory and research of aging from an intersectional lens that considered determinants of health such as socio-economic status. Voices of older 2SLGBTQ+ and racialized community members were woven throughout each section of the course. </p>
<p>After taking the course offered at Trent University and Cape Breton University, two undergraduate student cohorts at each of these schools participated in semi-structured focus groups/interviews. </p>
<p>Our data showed that simple, lecture-based courses focused on the psychology of aging can facilitate the development of an age-conscious student — those who are not ageist, do not fear aging and are attuned to the aging process.</p>
<h2>Course learning</h2>
<p>Most students taking the course, early on, viewed older people in one of two problemantic ways: critically (as irrelevant) or patronizingly (as dependent). One student summarized this as putting older people “<a href="https://doi.org/10.1017/S0714980821000246">in the ‘boomer remover’ camp or the ‘I really like my grandpa’ camp</a>.”
“Boomer remover” was a phrase that emerged early in the pandemic <a href="https://www.newsweek.com/boomer-remover-meme-trends-virus-coronavirus-social-media-covid-19-baby-boomers-1492190">as a kind of cruel shorthand for COVID-19</a>. </p>
<p>After finishing the course, many students reflected that both of these previously held polarized views were equally harmful and ageist. Students were more age-conscious and demonstrated greater awareness of varied experiences of aging.</p>
<p>One student said:</p>
<blockquote>
<p>“Learning about the difficulties that different marginalized groups face when they are older … it was something that I never thought about because it’s not a visible issue.”</p>
</blockquote>
<p>Students also connected personally with aging and, importantly, become less ageist. It was surprising — or, in their words, “eye opening”, “shocking” and “outlook-changing” — that despite health challenges, older people can lead fulfilling and impactful lives. Such insights prompted empathy toward
older adults. </p>
<figure class="align-center ">
<img alt="Two dapper older men smiling with their arms around each other, one Black and one white." src="https://images.theconversation.com/files/432286/original/file-20211116-25-puwhrh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/432286/original/file-20211116-25-puwhrh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/432286/original/file-20211116-25-puwhrh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/432286/original/file-20211116-25-puwhrh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/432286/original/file-20211116-25-puwhrh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/432286/original/file-20211116-25-puwhrh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/432286/original/file-20211116-25-puwhrh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some students found it surprising that despite health challenges, older people can lead fulfilling lives.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>One student commented:</p>
<blockquote>
<p>“I keep going back to this whole like, deaf and losing your eyesight as you age … that just surprised me so much and it was so impactful. You always think, ‘Oh, the grumpy old man.’… But no. He can’t hear so he can’t talk to you, he can’t listen to his favourite music. I’d be grumpy too.”</p>
</blockquote>
<h2>Universities’ role in reducing ageism</h2>
<p>Our research shows that attitudes can be changed and that universities can play a leading role in developing age-conscious youth. Post-secondary courses focusing on aging in any relevant department offer one way to achieve this. Critically, this study shows that age-consciousness can develop within standard, lecture-based courses focused on aging. </p>
<p>Ageism was present long before the devastating impacts of the pandemic. However, simple interventions to improve inter-generational interactions are needed now more than ever to develop more socially conscious citizens. People may be more willing to speak out against the stigma of aging, and to work towards developing the necessary resources to support growing older with dignity.</p><img src="https://counter.theconversation.com/content/169935/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth Russell received funding from SSHRC (SSHRC Explore Grant). </span></em></p>Universities can have a role forming age-conscious students: those who aren’t ageist, don’t fear aging and are attuned to the aging process.Elizabeth Russell, Associate Professor, Department of Psychology; Director, Trent Centre for Aging & Society, Trent UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1667042021-08-26T13:25:40Z2021-08-26T13:25:40ZWhat 18th-century suicide inquests tell us about growing old in Georgian England<p>In 1803, John Braithwaite was a very elderly man. A gentleman farmer, once influential in his community, he was now struggling with a deteriorating mind. According to his doctor, Braithwaite complained particularly “of an uneasiness and confusion in his head and giddiness and want of recollection”, and he often had “a vacant stare as if he did not immediately recollect” his friends. </p>
<p>One day, he went fishing with his companion at a nearby lake. After returning, he became extremely confused, and could not remember where he had left his horse. On another occasion, when playing cards, Braithwaite again became muddled and distressed. He “broke out into a most violent frenzy without any cause given and cursed…most violently and behaved in so frantic a manner” that his neighbour had to take him home.</p>
<p>Those who have cared for a loved one with dementia might find some of Braithwaite’s behaviour and emotions familiar. While the language of these sources is old-fashioned, and the scenarios so clearly from a different time, Braithwaite’s visceral distress and anger <a href="https://www.alzheimer-europe.org/Living-with-dementia/Caring-for-someone-with-dementia/Changes-in-mood/Anger">feel so recognisable</a>. </p>
<p>Braithwaite would kill himself later in 1803. An inquest after his death found that he had said: “He thought it hard that the almighty [should] afflict him in that manner”. He had also told his surgeon that “death [would] be a blessing to him”.</p>
<p>When I began using <a href="https://www.londonlives.org/static/IC.jsp">18th century coroners’ inquests</a> to research the history of suicide, I did not expect to find so many stories like these. Stories of old men and women struggling with age-related problems, like frailty and mental decline. In fact, in 18th century England, it is thought that around 40% of suicides were in the <a href="https://academic.oup.com/shm/advance-article/doi/10.1093/shm/hkab048/6333539">over-50s age group</a>, even though they represented less than 20% of the general population.</p>
<h2>Growing old with limited support</h2>
<p>Looking at 100 inquest hearings from archives in London, Kent, Cumbria, Essex, Suffolk and Bath, I built up a picture of suicide in the elderly during the Georgian period. </p>
<p>From the testimonies of friends, family and colleagues, what I found was that many were seriously concerned about loneliness, memory loss, financial vulnerability and becoming burdens upon those they loved. They also experienced a lot of sickness and pain at a time when medical care was limited at best. </p>
<p>Thomas Norman, an older gentleman who killed himself in 1771, was “upon every (new) illness…effected by a great dejection of spirits”, as if each new bout of sickness represented another aspect of his inevitable decline. Illness and infirmity were not, however, just experienced in the body. They were experienced socially, and within a society that offered fairly limited care for its elderly members.</p>
<figure class="align-center ">
<img alt="A painting of a work room in a workhouse" src="https://images.theconversation.com/files/418037/original/file-20210826-21-85ft33.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/418037/original/file-20210826-21-85ft33.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=447&fit=crop&dpr=1 600w, https://images.theconversation.com/files/418037/original/file-20210826-21-85ft33.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=447&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/418037/original/file-20210826-21-85ft33.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=447&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/418037/original/file-20210826-21-85ft33.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=561&fit=crop&dpr=1 754w, https://images.theconversation.com/files/418037/original/file-20210826-21-85ft33.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=561&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/418037/original/file-20210826-21-85ft33.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=561&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A workhouse in the Georgian period.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/File:Workroom_at_St_James_Workhouse.jpg">Wikimedia</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>A major concern for the elderly was that infirmity would prevent them from working. <a href="https://www.londonlives.org/static/Parishes.jsp">Parishes</a> (the smallest unit of local government) provided some security in the form of <a href="https://www.cumbriacountyhistory.org.uk/sites/default/files/county-info/the_poor_law_ccht.pdf">outdoor-relief</a>, which was the provision of food, money and clothing for people living in the community. </p>
<p>Alternately, parishes took the elderly into workhouses. These were institutions that housed the destitute in return for their labour. But these options often represented a decline in living standards and independence. </p>
<p>Cuthbert Cousins, who died in 1772, was “about 60 years of age and infirm, and unable to work and maintain himself as he had done”. As Cousins lay dying, those around him wanted to know why he had attempted suicide. He simply replied that “being an old man and out of work, he did it for want”. In other words, he did it because his final words were an unequivocal statement about this relationship between old age, unemployment and poverty.</p>
<h2>Being a burden</h2>
<p>There’s sometimes this idea that in the “olden days”, the elderly were better looked after by their families. But while some people were cared for by children and other family members, many also struggled to take care of their older relatives and elders experienced feelings of abandonment and loss.</p>
<p>Sarah Fenwick had previously been living with her adult daughter, but she “several times told her mother that her family was large” and eventually “perswaded [sic] her to go into the workhouse”. Like many other elders, Fenwick hated being in the workhouse and wanted to live with her family. Of course, workhouses no longer exist, but fears about being neglected or cut off from one’s family are familiar to some older people today.</p>
<p>It is also common for old people to worry about being a burden to those around them. Again, my sources revealed a long history of such concerns. </p>
<p>William Richmond, an “old carpenter”, was particularly anxious about “encumbering” his children. When his landlord’s wife “advised him to apply to his son” for help, he simply “said he hoped he should be better and should wish not to trouble his son”. In an age long before universal pensions, being forced to rely on family could be distressing for once self-reliant people.</p>
<p><a href="https://books.google.co.uk/books?id=kAJAAAAAMAAJ&q=macdonald+and+murphy+sleepless+souls&dq=macdonald+and+murphy+sleepless+souls&hl=en&newbks=1&newbks_redir=0&sa=X&redir_esc=y">Research</a> has argued that throughout the 18th century, suicide was reinterpreted as an act driven by medically-rooted “insanity”. But many old people who ended their lives did not feel that they were so-called “lunatics”. </p>
<p>Many understood their actions as a rational response to the prospect of ageing grimly in the society in which they lived. For some, like Braithwaite, memory loss and frailty were at the root of their distress. What he experienced would now clearly be diagnosed as dementia but in the 1700s there was little understanding of the condition and, as a result, little support.</p>
<p>For others, age was made unbearable because societal failures threatened their social and financial security. Standards of living dropped along with independence and the only options for survival were either the workhouse or to depend upon family members – adding to their financial concerns and feeling like a burden upon them. </p>
<p>This reminded me of the <a href="https://www.ageuk.org.uk/our-impact/campaigning/care-in-crisis/">poor provision</a> of social care we sometimes see today and the financial stresses of looking after elderly family members. It also, perhaps, holds lessons for how we should treat the elderly in our society.</p><img src="https://counter.theconversation.com/content/166704/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ella Sbaraini receives funding from The Wolfson Foundation. </span></em></p>The quality of life for the elderly in Georgian England was so bad many chose suicide.Ella Sbaraini, PhD Student in History, University of CambridgeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1645222021-07-18T12:28:07Z2021-07-18T12:28:07ZDon’t try to replace pets with robots — instead, design robots to be more like service animals<figure><img src="https://images.theconversation.com/files/411515/original/file-20210715-25-581fyu.jpg?ixlib=rb-1.1.0&rect=11%2C11%2C3982%2C2646&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Robot pets can be useful, but won't replace the love and companionship of a living animal.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Robopets are <a href="https://doi.org/10.1186/s12877-020-01641-5">artificially intelligent machines created to look like an animal</a> (usually a cat or dog, but they can be any animal). There are numerous robopets on the market right now, being sold to consumers as “pets” or companions. There is an especially fervent effort being made to <a href="https://tombot.com/pages/story">set caregivers’ minds at ease by buying these robopets for older adults to replace their deceased or surrendered companion animals</a>.</p>
<p>Animal lovers will tell you they would rather have nothing than have a robot for a pet. While a robopet can be programmed to simulate the actions of a real animal, people know it is fake.</p>
<p>There should be a pivot from the companion-based marketing strategy for robopets — which has deep ethical issues associated with replacing emotional bonding between living beings — to address the needs currently being met by service animals.</p>
<p>In my research on the effects of the human-animal bond on human health, participants point out the reciprocal nature of their relationship with pets. The human showers the animal with love, yummy food, cuddles, scratches and pats, and the animal, in turn, responds with unconditional love. The vast majority also say that <a href="https://theconversation.com/how-the-coronavirus-pet-adoption-boom-is-reducing-stress-138074">the non-human animals in their lives are family members, integral to their happiness and well-being</a>.</p>
<p>It is condescending to present an adult with a robot and suggest that it will take the place of a loved one — whether that loved one is human or non-human.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/e9VhTA-TgKM?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Tombot robot dogs are marketed as helping elderly people with dementia.</span></figcaption>
</figure>
<h2>New markets</h2>
<p>However, there is a huge and, as of yet, untapped market for robopets and other social robots to perform the role of service robots. Let’s call them Serv-U-Bots. These <em>personal</em> service robots are different from those <a href="https://doi.org/10.1108/JOSM-04-2018-0119">developed to replace humans in some manufacturing and service sectors</a>.</p>
<p>Serv-U-Bots would be much like a robotpet — small, portable and intended for personal use — and would employ many of the technologies already built into social robots. These onboard sensors could include cameras for observation, microphones for audio recording, temperature sensors, communication technologies and even autonomous motion, moving around based on programnming rather than human input.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/robopets-using-technology-to-monitor-older-adults-raises-privacy-concerns-132326">Robopets: Using technology to monitor older adults raises privacy concerns</a>
</strong>
</em>
</p>
<hr>
<p>Serv-U-Bots would be programmed to replace service animals, which are currently raised and trained to support human mobility and independence. However, this is an expensive endeavour.</p>
<p>Many organizations that provide service animals have breeding programs, training facilities and huge budgets that are subsidized by donors or get charged back to governments, insurers or families. The Canadian Guide Dogs for the Blind graduates approximately 23 dogs per year from its training program, <a href="https://www.charityintelligence.ca/charity-details/713-canadian-guide-dogs-for-the-blind">at an average operating cost of more than $74,300 per dog</a>.</p>
<p>These dogs are not considered pets by the organizations that breed and train them. They are service dogs, <a href="https://www.guidedogs.ca/path-becoming-guide-dog/">trained to provide assistance</a>. If their current placement ends due to death of the person they were helping or for other reasons, they are generally returned to the organization for another placement. </p>
<h2>Robots as service animals</h2>
<p>But what about replacing service dogs with Serv-U-Bots: social robots that are programmed to perform service related functions? We have the technological know-how to create Serv-U-Bots that can increase independence through programming that can provide an alert if the toast is burning, the kettle boiling, the doorbell ringing and so on. They could even take on the functions of medical alert dogs which can <a href="https://www.akc.org/expert-advice/training/service-dog-training-101/">detect medical issues such as a seizure or low blood sugar, or alert the user to the presence of allergens</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/411518/original/file-20210715-13-1oioz4q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A robot takes a dog for a walk" src="https://images.theconversation.com/files/411518/original/file-20210715-13-1oioz4q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/411518/original/file-20210715-13-1oioz4q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/411518/original/file-20210715-13-1oioz4q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/411518/original/file-20210715-13-1oioz4q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/411518/original/file-20210715-13-1oioz4q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/411518/original/file-20210715-13-1oioz4q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/411518/original/file-20210715-13-1oioz4q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Service robots can support people with caring for their pet companions.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Serv-U-Bots could even support older adults to continue to enjoy the companionship of animals by feeding them, checking that they have water and even cleaning the litter box. </p>
<p>If an <a href="https://www.theguardian.com/business/2021/apr/28/us-automakers-rules-auto-driving-cars-fatal-crashes">automobile can be programmed to drive itself, avoiding obstacles and life forms</a>, why not program a Serv-U-Bot to guide people around the city? They could also be programmed to facilitate actual interactions with living beings. This technology can save and enrich lives and help people to be mobile. </p>
<p>Serv-U-Bots would be able to support the independence and mobility needs of humans without exploiting non-human animals.</p><img src="https://counter.theconversation.com/content/164522/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>L.F. Carver does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Robot pets are marketed as substitutes for living animals. Rather, we should use existing technologies to design robots that provide other services, like health care and lifestyle support.L.F. Carver, Assistant Professor, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1546212021-05-13T15:28:44Z2021-05-13T15:28:44ZIn early media coverage of the COVID-19 pandemic, older adults in rural areas were neglected<figure><img src="https://images.theconversation.com/files/400377/original/file-20210512-19-kpec1.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3100%2C2065&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Older racialized and low-income adults in rural British Columbia were initially left out of the media's early COVID-19 coverage.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>British Columbia has ranked fourth among Canadian provinces in <a href="https://www2.gov.bc.ca/gov/content/safety/emergency-preparedness-response-recovery/covid-19-provincial-support/bc-restart-plan">reported COVID-19 cases since the pandemic began</a>. Public health measures have required citizens to help prevent the spread of COVID-19 through good hygiene, physical distancing, staying home and self-isolating.</p>
<p>The COVID-19 pandemic has <a href="http://doi.org/10.1111/jrh.12463">exacerbated pre-existing inequalities</a> and has <a href="https://doi.org/10.1093/ageing/afaa093">primarily affected older adults</a>. Early epidemiological data for B.C. indicated that about 60 per cent of cases were adults aged 50 or older, <a href="https://globalnews.ca/news/6713670/coronavirus-bc-data-cases/">half of whom were over the age of 70 years</a>. </p>
<h2>Focusing on the rural</h2>
<p>Prevention efforts initially focused on large urban areas due to <a href="https://experience.arcgis.com/experience/a6f23959a8b14bfa989e3cda29297ded">their population density and higher concentration of cases</a>. Several months into the pandemic, attention was finally paid to the impact on <a href="https://medicalstaff.islandhealth.ca/sites/default/files/covid-19/rural-and-remote/rri-covid-19-framework.pdf">rural, remote and Indigenous communities</a>. </p>
<p>Research indicates high risk of COVID-19 contraction and complications for <a href="http://doi.org/10.1111/jrh.12505">Indigenous people</a> and the likelihood of higher COVID-19 death rates for racialized older adults.</p>
<p>Given that older adults living rurally are known to experience <a href="http://doi.org/10.1017/S0714980819000540">inequities in health and access to health care</a>, COVID-19 can exacerbate health-care inequities facing this population. </p>
<p>The pandemic has had different effects on older adults, including <a href="http://doi.org/10.1093/ageing/afaa093">experiencing neglect, displaying atypical COVID-19 symptoms and being affected negatively by social distancing policies</a>.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/lBdNfNRR6gU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The pandemic has revealed disparities in internet access between rural and urban populations.</span></figcaption>
</figure>
<h2>Reporting on COVID-19</h2>
<p>The news media has been the primary source of information during this pandemic, and so we conducted a media analysis to determine the extent of coverage of older adults and rural and remote communities. </p>
<p>Our analysis began with <a href="https://news.gov.bc.ca/releases/2020HLTH0010-000102">the first media release by the B.C. government on the “novel coronavirus”</a> risk, issued on Jan. 21, 2020. We continued until April 4, 2020 — on that day, <a href="https://www.who.int/news/item/29-06-2020-covidtimeline">one million cases were confirmed worldwide</a> and provincial health officer Dr. Bonnie Henry announced that <a href="https://www.cbc.ca/news/canada/british-columbia/covid-19-bc-timeline-1.5520943">B.C. was flattening the curve</a>. </p>
<p>We sourced media (news articles and press releases) through the Google News database using a combination of the following search terms: <em>rural</em>, <em>remote</em>, <em>British Columbia</em>, <em>BC</em>, <em>COVID-19</em> and <em>coronavirus</em>. This search yielded 199 records, which we analyzed to determine key messages and whether or not older adults, rural and remote communities, and diversity were considered.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/keeping-covid-19-out-of-rural-canada-proving-more-difficult-as-variants-spread-155266">Keeping COVID-19 out of rural Canada proving more difficult as variants spread</a>
</strong>
</em>
</p>
<hr>
<h2>Referencing older adults</h2>
<p>Surprisingly, only 70 articles — 35 per cent — mentioned older adults, with 27 of these being about care homes. Twenty-five articles that addressed older adults were news releases from the Ministry of Health (MOH), stressing the need to protect older adults through physical distancing. After <a href="https://news.gov.bc.ca/releases/2020HLTH0052-000356">the first case of COVID-19 in an older adult on Feb. 29</a>, the MOH referenced <a href="https://news.gov.bc.ca/releases/2020HLTH0056-000365">older adults and care homes consistently</a>. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/400383/original/file-20210512-19-3vc82l.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A table detailing the media analysis" src="https://images.theconversation.com/files/400383/original/file-20210512-19-3vc82l.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/400383/original/file-20210512-19-3vc82l.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=565&fit=crop&dpr=1 600w, https://images.theconversation.com/files/400383/original/file-20210512-19-3vc82l.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=565&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/400383/original/file-20210512-19-3vc82l.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=565&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/400383/original/file-20210512-19-3vc82l.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=709&fit=crop&dpr=1 754w, https://images.theconversation.com/files/400383/original/file-20210512-19-3vc82l.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=709&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/400383/original/file-20210512-19-3vc82l.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=709&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">COVID-19 Media analysis findings.</span>
<span class="attribution"><span class="source">(Authors)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Ten articles talked about rural and remoteness, half of which mentioned older adults, recognizing their vulnerability and the need for testing; four of these articles focused on businesses yet only to the extent to which they were impacted; and three articles mentioned Indigenous communities. </p>
<p>The latter were concerned with the common phrase “flatten the curve” and anxiety for survivors of residential schools, sanitoriums and hospitals related to an early release of a vaccine to rural, remote and First Nation communities, with people asking “<a href="https://www.ctvnews.ca/health/coronavirus/first-nations-health-authority-tailoring-its-messaging-about-covid-19-1.4865490">is it like it’s being tested on us first to make sure it’s safe?</a>”</p>
<p>The initial public health messaging on television and online was highlighted as being unlikely to reach rural and remote areas; <a href="https://www.ctvnews.ca/health/coronavirus/first-nations-health-authority-tailoring-its-messaging-about-covid-19-1.4865490">a “community-driven way” was called for instead</a>. <a href="https://www.cfnrfm.ca/">Canada’s First Nations Radio (CFRN)</a> — the only provider of commercial radio to 42 First Nations communities in Central and Northern B.C. — took up this challenge, <a href="https://www.ctvnews.ca/health/coronavirus/first-nations-health-authority-tailoring-its-messaging-about-covid-19-1.4865490">broadcasting ads in 17 Indigenous languages and dialects</a>.</p>
<p>Thirty-three (17 per cent) articles addressed diversity in some way, with two-thirds focusing on the languages and dialects of COVID-19 materials, including Chinese languages, Punjabi, Farsi, French, Tagalog and 17 Indigenous languages and dialects. Six articles focused on Indigenous communities, with three being about the letter between the MOH and Union of BC Indian Chiefs and others expressing concern about their risk and calling for outreach. </p>
<p>One article was about faith communities, and another on deaf and hard of hearing people. The former indicated that outreach plans had been made, including a meeting between public health officials and 128 faith leaders across the province to ask for their assistance with <a href="http://doi.org/10.1111/jrh.12432">getting the word out and limiting large gatherings</a>. </p>
<figure class="align-center ">
<img alt="Premier John Horgan, centre, Provincial Health Officer Dr. Bonnie Henry, left, and Health Minister Adrian Dix" src="https://images.theconversation.com/files/400376/original/file-20210512-17-1pa4hkt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/400376/original/file-20210512-17-1pa4hkt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=393&fit=crop&dpr=1 600w, https://images.theconversation.com/files/400376/original/file-20210512-17-1pa4hkt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=393&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/400376/original/file-20210512-17-1pa4hkt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=393&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/400376/original/file-20210512-17-1pa4hkt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=494&fit=crop&dpr=1 754w, https://images.theconversation.com/files/400376/original/file-20210512-17-1pa4hkt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=494&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/400376/original/file-20210512-17-1pa4hkt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=494&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Premier John Horgan, centre, Provincial Health Officer Dr. Bonnie Henry, left, and Health Minister Adrian Dix take part in a conference call with B.C. faith leaders about COVID-19 during the early days of the pandemic.</span>
<span class="attribution"><span class="source">(THE CANADIAN PRESS/Dirk Meissner)</span></span>
</figcaption>
</figure>
<p>Other articles that addressed diversity were about people living on the street and prison populations, with both groups characterized mainly as disease vectors. On March 21, 2020, the day the ban on evictions was announced, attention was also paid to those who are housing-insecure or live on the street; however, no additional support for this population was reported. Further, the ban on evictions and the rent freeze did not include <a href="https://bc.anglican.ca/news/covid-19-coronavirus-update">assisted living facilities</a>. </p>
<p>One-third of those articles that mentioned diversity were also about older adults. This pattern is similar to that seen in global media where, despite the focus on care homes in the media coverage of COVID-19, not one article mentioned dementia. </p>
<p>Forty-eight percent of the articles included public health messages about risk and prevention, such as washing hands, maintaining distance and self-isolating. There was no mention of specific risk factors for rural older adults like continuing to provide care to grandchildren, as happens frequently in rural areas, and <a href="https://doi.org/10.1007/s12603-020-1366-8">loneliness and social isolation</a>. </p>
<p>Media articles during the review time span paid no attention to the challenges likely to arise from having to self-isolate, such as getting groceries and medications, maintaining family and social connections, receiving primary and community care (virtual medical appointments, no home care), and other “<a href="https://www.cabhi.com/blog/cabhi-gathers-real-time-insights-from-older-adults-living-under-covid-19/">basic needs for daily living</a>.” </p>
<h2>Protecting older adults</h2>
<p>Although it became evident that older adults were the most susceptible, the media did not identify special protective measures for older adults nor <a href="https://doi.org/10.1093/ageing/afaa093">their atypical case presentation</a>. Further, those older adults living in the community and aging rurally and remotely were overlooked in the messaging with the primary focus being groups considered vectors of disease, including those living in care homes. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/instead-of-jumping-the-covid-19-vaccine-queue-try-acting-your-age-159170">Instead of jumping the COVID-19 vaccine queue, try acting your age</a>
</strong>
</em>
</p>
<hr>
<p>In line with social distancing, community groups and programs for persons with dementia have been suspended or moved online, with the latter including <a href="https://www.alz.co.uk/news/adi-releases-position-paper-on-covid-19-and-dementia">peer support groups for persons living with dementia</a>. Given the longstanding issue of <a href="http://doi.org/10.1017/S1041610220000708">broadband access in rural and remote regions</a>, older adults with dementia and their carers residing rurally and remotely are at particular risk of social isolation during the COVID-19 pandemic if the only options for connection and support are virtual. </p>
<p>Early media coverage portrayed older adults as in need of protection. At the same time, the media neglected the impact of the pandemic on older adults. The protection came in the form of classic public health measures, but the challenges arising from this protection and the differential impacts on older adults as a group were overlooked.</p><img src="https://counter.theconversation.com/content/154621/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Wendy Hulko receives funding from MSFHR, CIHR, Interior Health, Interior University Research Coalition, Alzheimer Society of Canada, SSHRC, BC Medical Services Foundation. She is affiliated with the Centre for Seniors Information (board member) and the International Indigenous Dementia Research Network (member). </span></em></p><p class="fine-print"><em><span>Noeman Mirza receives funding from Interior Health (IH), Michael Smith Foundation for Health Research (MSFHR), Interior University Research Coalition (IURC), and the Social Sciences and Humanities Research Council (SSHRC).</span></em></p>Older adults in rural areas in Canada are more vulnerable to the effects of COVID-19, including related ones like social connections and public health information outreach.Wendy Hulko, Associate Professor, Social Work, Thompson Rivers UniversityNoeman Mirza, Associate Professor, Nursing, University of WindsorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1469032020-09-25T12:20:07Z2020-09-25T12:20:07ZVideo: How will society change as the US population ages?<figure><img src="https://images.theconversation.com/files/359911/original/file-20200924-18-1okkh81.jpg?ixlib=rb-1.1.0&rect=20%2C30%2C6689%2C4436&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Families are still the primary caregivers for older Americans.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/adult-woman-and-senior-mother-talking-on-front-royalty-free-image/1209969659">MoMo Productions/DigitalVision via Getty Images</a></span></figcaption></figure><p><em>Editor’s note: Even as <a href="https://www.aafp.org/news/health-of-the-public/20181210lifeexpectdrop.html">average life expectancy</a> has started to trend downward in the U.S., Americans <a href="https://www.nia.nih.gov/about/aging-strategic-directions-research">65 and older are living longer</a>. The change toward longer old age will have profound effects on health care needs, families and what it means to be old. Marcia G. Ory, founding director of the Texas A&M Center for Population Health and Aging, explains why all Americans will be affected by a bulge in the graying population.</em></p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/c7nKMmp0sq0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<h2>What are the demographic trends in aging in the U.S.?</h2>
<p>As baby boomers age, society in America has aged. Back in 1900, about 3 million older Americans were defined as people 65 and older. Now it’s over <a href="https://acl.gov/sites/default/files/Aging%20and%20Disability%20in%20America/2019ProfileOlderAmericans508.pdf">50 million adults</a> that are 65 and older. But the <a href="https://www.nia.nih.gov/about/aging-strategic-directions-research">fastest-growing population in this age group</a> is not just those people 65 and older – it’s the people 85 and older, 100 and older.</p>
<h2>What are the main reasons that Americans are living longer?</h2>
<p>If you look at why people are living longer, it’s really a combination of three or four things. It’s certainly a little bit of our genes. We used to think that was the biggest factor, but that’s not the biggest factor at all. It’s about how we live, meaning our <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3270406/">health behaviors</a>. It’s having a good diet. It’s being physically active. These are the kinds of behaviors that will make a difference.</p>
<p>But the third leg of that is really where we live. We’re now understanding that there are a lot of <a href="http://files.kff.org/attachment/issue-brief-beyond-health-care">social determinants of health</a>. Even your <a href="https://www.rwjf.org/en/library/interactives/whereyouliveaffectshowlongyoulive.html">ZIP code</a>, where you live, can be as powerful a predictor of mortality and morbidity as something that we think of traditionally, like smoking or obesity.</p>
<h2>What are the implications of population aging from a public health perspective?</h2>
<p>Older people are more likely on average than younger people to have chronic conditions. And those chronic conditions will put a demand on health care services. The <a href="https://www.businessinsider.com/aging-population-healthcare#:%7E:text=The%20aging%20population%20in%20the%20US%20is%20causing%20problems%20for%20our%20healthcare%20costs&text=By%202030%2C%20every%20Baby%20Boomer,of%20healthcare%20in%20the%20future.">cost of health care</a> will go up as a nation as a whole as we get older. Also, as the population gets older, there will be more people who have <a href="https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pdf">Alzheimer’s or related dementias</a>, which will create an increased burden on care. It’s still primarily families who care for older Americans, so we’ll have an increased burden on families who are already stretched really thin. We’ll also have increased <a href="https://www.centerforhealthjournalism.org/2020/03/06/will-there-be-enough-healthcare-workers-take-care-our-growing-and-graying-population">demand on health care workers</a> to the point where there are not going to be enough health care workers to meet the needs of our aging population. </p>
<p>When the average life expectancy was in the 60s, you probably didn’t spend much time in retirement. But now you’re going to spend huge amount of time between the average age of retirement, which is still in the 60s for both men and women, and <a href="https://data.oecd.org/healthstat/life-expectancy-at-65.htm">living approximately 20 more years</a>. That means we need to think of meaningful roles for older people. They can <a href="https://www.nationalservice.gov/pdf/healthbenefits_factsheet.pdf">volunteer</a> and give back to the community, and a lot do. They can also go back to school. It used to be that you thought about college as only for 18- to 24-year-olds. But if you look around college campuses today, more people are in what would be called <a href="https://en.wikipedia.org/wiki/University_of_the_Third_Age#:%7E:text=The%20University%20of%20the%20Third,accepted%20model%20for%20the%20U3A.">“the third age”</a> who are doing education at 60 or 80. You often hear about people wanting to get their B.A., but keep putting off their college degree. But now at 80, they can finally do something they’ve always wanted to do. So we have to rethink the roles and responsibilities of older people and society as a whole.</p>
<h2>What are some ways that people and society can adapt to this demographic shift?</h2>
<p>If you have a bigger focus on chronic disease prevention and management, if you can affect those modifiable factors – that is, the lifestyles and the living conditions – people could be reaching older age at a healthier stage, and <a href="https://palliative.stanford.edu/overview-of-palliative-care/compression-of-morbidity-theory/">“compressing their morbidity”.
</a>
From a societal point of view, we can encourage and support older adults who want to stay in the workplace. We can encourage and support family members who want to care for their loved ones who might need some additional assistance. And we need to think about policies that will make it easier for older people to remain and age in place. Most older people want to live and stay at home. </p>
<p>There’s a very positive movement called <a href="https://www.aarp.org/livable-communities/network-age-friendly-communities/info-2014/an-introduction.html">“age-friendly cities.”</a> How can you have a city more friendly toward the needs of older people? For example, consider transportation. If you’re in a place like I am in Texas, and you don’t drive, you’ve really lost your independence because there’s very little public transportation. So it’s important to think about what society can do to make environments where you live more age-friendly.</p>
<p>With the higher number of people with dementia, there’s also a whole movement that’s called “<a href="https://www.aarp.org/livable-communities/network-age-friendly-communities/info-2016/dementia-friendly-communities.html">dementia-friendly communities</a>” that’s making sure that an older person can be treated with respect, can navigate their environment, and there’s a valuable and appropriate workforce to deal with the needs of older people. </p>
<p>What the aging demographics really call upon is for all of us to be thinking in advance. We don’t want to wake up one day and realize that there are more older people and we don’t have the infrastructure or the systems to help support them. We should see population aging as an opportunity for positive change in all of our sectors rather than a harbinger of doom and gloom. </p>
<p>[<em>Get the best of The Conversation, every weekend.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklybest">Sign up for our weekly newsletter</a>.]</p><img src="https://counter.theconversation.com/content/146903/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marcia G. Ory does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Americans 65 and older are living longer. The change toward longer old age in the U.S. will have profound effects on health care needs, families and what it means to be old.Marcia G. Ory, Regents and Distinguished Professor of Environmental and Occupational Health, Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1323262020-03-19T20:16:07Z2020-03-19T20:16:07ZRobopets: Using technology to monitor older adults raises privacy concerns<figure><img src="https://images.theconversation.com/files/321759/original/file-20200319-22636-6e3h6h.jpg?ixlib=rb-1.1.0&rect=0%2C14%2C4872%2C3172&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Robotic pets could increasingly provide social companionship and health monitoring in elder care.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Social isolation and loneliness are <a href="https://healthjournalism.org/blog/2017/03/social-isolation-loneliness-negatively-affect-health-for-seniors/">concerns for many older adults</a>, and can be triggered by the need to transition to a condo, rental accommodation, long-term care facility or retirement home. </p>
<p>Sometimes, the only thing standing between an older adult and loneliness may be a beloved pet. This reciprocal relationship of affection and attention between human and non-human animal translates into physical and mental health benefits. However, in many cases, pets can’t move with their older adults since <a href="https://doi.org/10.3390/ani8030032">very few jurisdictions guarantee the right to bring an animal into a rental unit or condominium</a>.</p>
<p>My research asks: what are the factors that impact well-being in older age? I explore the impacts of technology on privacy, autonomy and well-being, as well as the effects of the human-animal bond on health and well-being. I am also interested in whether social robots, including robopets, can produce the same effects. </p>
<h2>In-home surveillance</h2>
<p>Whether moving to a long-term care facility or a smaller home, many older adults find themselves subjected to increasing surveillance. Well-meaning family and caregivers install cameras, sensors and other devices to monitor independent older adults. </p>
<p>Social robots are <a href="https://doi.org/10.1111/soc4.12585">new tools in the care of older adults</a>. Some provide health-related services such as <a href="https://elliq.com/pages/features">medication reminders</a>, but most try to make up for the absence of human and animal companionship. These robots have artificial intelligence (AI) that is designed to interact with and provide comfort to the user.</p>
<p>For example, ElliQ is a small table-mounted device that interacts with a screen to enable “<a href="https://elliq.com/pages/features">family members to easily check in</a>.” It also interacts with the user, suggesting activities, responding to their voice or touch or look. ElliQ is always on, collecting data on the user that is transmitted to the manufacturer.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/Bsf1LsuH4k4","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p>Jennie is a robot dog <a href="https://tombot.com/pages/meet-our-puppies">controlled by voice commands and through a smartphone app</a>. Robot pets, like other social robots, are designed to respond to the user’s emotions and, to do so, it engages in constant surveillance. </p>
<p>The responsiveness of social robots and robot pets relies on sensors to detect emotional responses, record emotions and forward this information to be analyzed by algorithms that inform the robot’s response. The results of the data analysis prompt the robot to smile or <a href="http://www.parorobots.com/">purr or snuggle</a>. In the case where a health response is required, some <a href="http://www.giraffplus.eu/">robots can inform the caregiver of elevated blood pressure</a>.</p>
<h2>Collecting personal data</h2>
<p>Every step of this data process involves personal and sensitive information about an individual. For example, <a href="https://doi.org/10.1109/TMM.2018.2882744">user identification data might be leaked</a> at the sensing layer or in the cloud where the data is analyzed to determine the right response. User profiles contain not only identifying information such as name and address, but also <a href="https://doi.org/10.1109/TMM.2018.2882744">data gathered on user moods, behaviours and habits</a>. </p>
<p>Between the potential for data exploitation and “<a href="https://doi.org/10.3390/s18051530">the ubiquitous use of cameras and voice monitoring equipment in a home environment, there are privacy concerns that can affect human mental health</a>.”</p>
<p>Older adults are not always aware of the extent of the monitoring, which can lead to feelings of shame and humiliation if, for example, a person is caught on camera singing, dancing, engaging in sexual acts or crying. It is not that older adults don’t realize that there is monitoring equipment, it is the 24/7 always-on aspect that may be unfamiliar to them. While enabling older adults to live with less human or animal contact, these monitoring systems and robots can increase their exposure and vulnerability. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/321669/original/file-20200319-22590-126n3ca.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/321669/original/file-20200319-22590-126n3ca.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/321669/original/file-20200319-22590-126n3ca.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=451&fit=crop&dpr=1 600w, https://images.theconversation.com/files/321669/original/file-20200319-22590-126n3ca.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=451&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/321669/original/file-20200319-22590-126n3ca.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=451&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/321669/original/file-20200319-22590-126n3ca.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/321669/original/file-20200319-22590-126n3ca.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/321669/original/file-20200319-22590-126n3ca.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sony’s AIBO was the first commercially available robopet.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Peer networks</h2>
<p>The increasing number of surveillance-based options for providing care and companionship to older adults also ignores the reality that there are often other older adults who want to contribute meaningfully to their community. Using technology to build opportunities for human-to-human or human-to-animal interactions is one way to increase well-being without sacrificing privacy. For example, during virus season, technology could be used to develop something as simple as a telephone tree so that people can check in and connect in times of social distancing. </p>
<p>For older adults who are comfortable with technology, there are programs like <a href="https://www.peacearchnews.com/community/seniors-health-give-back-to-community-by-lending-others-a-hand/">Tech Buddies, which offers basic tech tutorials, including lessons on iPads, tablets, computers, laptops, smartphones and overall features of social media</a>. And of course, the internet can be used to find <a href="https://www.canada.ca/en/employment-social-development/corporate/seniors/forum/core-community-supports.html">services available to assist seniors with tasks around the house, to find nursing care or even friendly visitors</a>.</p>
<p>Other internet-based programs have been developed to support older adults to “<a href="https://www.nia.nih.gov/health/aging-place-growing-older-home">age in place</a>” with their companion animals. For example, <a href="https://www.calgaryseniors.org/volunteer-programs">Pet Assist</a>, in Calgary, Alta., will help older adults manage pet-related tasks at home. </p>
<p>After all, patting a robot dog is not the same as cuddling with a beloved pet. And a real dog will never tell anyone that you danced around the house in your underwear.</p><img src="https://counter.theconversation.com/content/132326/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>L.F. Carver does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Older adults are using social robots and apps, but what does it mean for issues of surveillance and privacy?L.F. Carver, Adjunct assistant professor, Sociology, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1202082019-07-24T19:28:20Z2019-07-24T19:28:20ZWebcams in nursing home rooms may deter elder abuse – but are they ethical?<p>Mary Ann Papp’s daughter Lisa was worried about her 75-year-old mother. </p>
<p>A foot infection seemed to be going untreated, leading Lisa to fear that her mother’s nursing home wasn’t providing proper care. </p>
<p>So Lisa did what any concerned child might: She bought a US$199 webcam from Target and put it in her mother’s room.</p>
<p>But she found that nursing home staff kept pointing the camera away from Mary Ann’s bed or unplugging it. Eventually, Lisa bolted it to a piece of furniture and brought a formal complaint against the facility. </p>
<p>In May 2017, the Minnesota Department of Health <a href="http://www.startribune.com/minnesota-maltreatment-finding-is-a-victory-for-granny-cams/423931753/">decided in the Papp family’s favor</a>: The nursing home had to allow a camera in Mary Ann’s room. </p>
<h2>A web of privacy issues</h2>
<p>Papp’s fight to monitor her mother’s care reflects a reasonable fear. More than <a href="https://www.kff.org/other/state-indicator/number-of-nursing-facility-residents/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D">1.3 million</a> Americans live in nursing homes, and elder abuse can be a <a href="https://www.ncbi.nlm.nih.gov/pubmed/29333999">killer</a>. </p>
<p>Every year, <a href="https://www.cnn.com/2017/03/17/health/nursing-home-sex-abuse/index.html">news reports</a> surface about nursing home staff <a href="https://abcnews.go.com/WNT/video/hidden-camera-captures-michigan-nursing-home-employee-allegedly-53661394">physically</a> or <a href="https://www.cnn.com/interactive/2017/02/health/nursing-home-aide-rape-charges/">sexually assaulting</a> patients. Physical and <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2013.1261">cognitive vulnerabilities</a> may make it <a href="https://www.nejm.org/doi/10.1056/NEJMra1404688">difficult for residents to report abuse</a> or to have their reports taken seriously.</p>
<p>Web-enabled digital cameras offer one solution. Evidence suggests that ever more people are putting <a href="https://www.mcknights.com/news/momentum-grows-for-in-room-cameras-at-nursing-homes/">cameras</a> in a relative’s room to detect and deter abuse, though exact numbers are unknown as the practice is often done covertly. Seven states have passed <a href="https://theelderlawjournal.com/2019/02/18/levy-kilgour-and-berridge/">laws</a> enabling families to monitor the care of aging relatives this way. </p>
<p>But nursing home surveillance has significant <a href="https://theelderlawjournal.com/2019/02/18/levy-kilgour-and-berridge/">legal</a> and <a href="https://www.tandfonline.com/doi/full/10.1080/23294515.2019.1568320">ethical</a> implications, according to two multidisciplinary studies we published in 2019.</p>
<p>Chief among them is privacy. The most intimate care activities are conducted in view of the camera: washing, using a bedpan, changing underwear. Sensitive conversations with visitors, from clergy to romantic partners, may also be recorded. </p>
<p>“Is this really what the resident would want to have recorded about themselves?” asked one respondent to our <a href="https://www.tandfonline.com/doi/full/10.1080/23294515.2019.1568320">survey on webcams in nursing homes</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/285397/original/file-20190723-110166-qk8vh2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/285397/original/file-20190723-110166-qk8vh2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/285397/original/file-20190723-110166-qk8vh2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/285397/original/file-20190723-110166-qk8vh2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/285397/original/file-20190723-110166-qk8vh2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/285397/original/file-20190723-110166-qk8vh2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/285397/original/file-20190723-110166-qk8vh2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Small, cheap and reliable webcams allow people to keep an eye on elderly relatives.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?u=http%3A%2F%2Fdownload.shutterstock.com%2Fgatekeeper%2FW3siZSI6MTU2MzkyNzU3NCwiYyI6Il9waG90b19zZXNzaW9uX2lkIiwiZGMiOiJpZGxfMTM2NTE4ODQzOCIsImsiOiJwaG90by8xMzY1MTg4NDM4L2h1Z2UuanBnIiwibSI6MSwiZCI6InNodXR0ZXJzdG9jay1tZWRpYSJ9LCJPQTdXOEk2ejVaNUJZVmNZZXRHbUx4R0h1S2MiXQ%2Fshutterstock_1365188438.jpg&pi=33421636&m=1365188438&src=UqFi3fBbDazJjXJv9x011A-1-11">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Recorded without permission</h2>
<p>Consent is another tricky issue.</p>
<p>While state laws regulating camera use require consent from the patient, roughly half of U.S. nursing home residents <a href="https://www.cdc.gov/nchs/data/series/sr_03/sr03_038.pdf">have dementia</a>, according to the Centers for Disease Control and Prevention. These residents are unlikely to be consulted about camera installation, because they lack, or are perceived to lack, capacity for consent. </p>
<p>In these cases, children often act as parents’ legal proxy to give consent on their behalf.</p>
<p>Even when parents are capable of consenting, we found, children may simply want to avoid <a href="https://www.ncbi.nlm.nih.gov/pubmed/31102442">conflict with a parent</a> and judge it easier to install an always-on camera without discussion. </p>
<p>Since nursing home rooms are <a href="https://www.ncbi.nlm.nih.gov/pubmed/24352532">usually shared</a>, the consent and privacy of roommates presents an ethical problem, too. Inevitably, roommates’ conversations will be recorded, and they will be filmed when passing through a camera’s field of vision. </p>
<p>All of the <a href="https://theelderlawjournal.com/2019/02/18/levy-kilgour-and-berridge/">states that allow in-room cameras require that roommates or their legal representative be informed</a> of surveillance and allowed to require that the camera be pointed away from their bed. </p>
<p>But that’s no guarantee of privacy. Dementia or lack of familiarity with technology may mean roommates cannot adjust cameras to protect their privacy. And because nursing homes and assisted living facilities in the U.S. are dangerously <a href="https://www.nytimes.com/2018/07/07/health/nursing-homes-staffing-medicare.html?module=inline">understaffed</a>, their caretakers may be unavailable to offer tech assistance when needed.</p>
<h2>Negative impacts on care</h2>
<p>Webcams are a consumer response to the United States’ inadequate long-term care system.</p>
<p>Long-term care in the United States is <a href="https://academic.oup.com/innovateage/article/2/suppl_1/224/5169878">poorly funded</a>, primarily by Medicaid. <a href="https://www.medicare.gov/coverage/nursing-home-care">Medicare</a> covers acute but not <a href="https://www.nytimes.com/2019/05/13/business/washington-long-term-care.html">ongoing services and supports</a>. Most Americans <a href="https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05233">can’t afford</a> the care they will <a href="https://www.nytimes.com/2019/05/10/health/assisted-living-costs-elderly.html">need</a> as they age.</p>
<p>As a result, the nursing home staff trusted to do this demanding and fraught work receive <a href="https://phinational.org/wp-content/uploads/legacy/phi-nursing-assistants-key-facts.pdf">low pay</a> – on average, making <a href="https://www.bls.gov/oes/2017/may/oes311014.htm">$27,470 a year</a>. Turnover is particularly high among caregivers who provide <a href="https://phinational.org/wp-content/uploads/legacy/phi-nursing-assistants-key-facts.pdf">the most hands-on</a>, intimate care in American nursing homes. </p>
<p>For these staff, the same in-room cameras that ease families’ fears often produce anxiety.</p>
<p>Respondents to our <a href="https://www.tandfonline.com/doi/full/10.1080/23294515.2019.1568320">survey of 273 staff at American nursing homes and assisted living facilities</a> said that surveillance could create a culture of mistrust. Ubiquitous webcams make eldercare workers feel that they aren’t seen as capable of professional, moral behavior. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/285399/original/file-20190723-110149-iqd7dl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/285399/original/file-20190723-110149-iqd7dl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/285399/original/file-20190723-110149-iqd7dl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/285399/original/file-20190723-110149-iqd7dl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/285399/original/file-20190723-110149-iqd7dl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/285399/original/file-20190723-110149-iqd7dl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/285399/original/file-20190723-110149-iqd7dl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/285399/original/file-20190723-110149-iqd7dl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Kevin Perez, 19, assists resident Belle Bishop, age 93, with her cellphone at the Hebrew Home at Riverdale, New York, May 25, 2017.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Nursing-Home-High/dcb72299607041edae707e93a39c5872/176/0">AP Photo/Richard Drew</a></span>
</figcaption>
</figure>
<p>“It feels like … having a supervisor or someone breathing over your shoulder at all times,” one nursing home worker said, adding that cameras “take away employees’ confidence.”</p>
<p>That, in turn, has a chilling effect on the relationship between patients and their caregivers.</p>
<p>“There are no advantages that outweigh the concerns and the kind of culture you create by doing this,” one respondent asserted.</p>
<p>Additionally, while media coverage of elder abuse typically focuses on abuse by nursing home staff, <a href="https://www.ncoa.org/public-policy-action/elder-justice/elder-abuse-facts/">studies</a> show that in almost 60% of elder abuse and neglect incidents, the perpetrator is a family member. </p>
<h2>Investment needed</h2>
<p>The demoralizing effects of in-room cameras, coupled with the ethical and privacy concerns that they raise, indicate that webcams are not the solution to preventing abuse in elder care facilities.</p>
<p>Our work points instead to the need for <a href="https://www.nytimes.com/2017/06/13/opinion/youre-probably-going-to-need-medicaid.html">more U.S. government investment</a>. </p>
<p>With better pay and working conditions, nursing homes could attract more direct-care staff who would stay in their jobs longer and be more invested in their workplace. Nursing assistants could get to know residents, and keep a better eye on them. Enhanced training on recognizing and reporting abuse would also promote accountability.</p>
<p>Such improvements will only become <a href="https://phinational.org/news/new-research-7-8-million-direct-care-jobs-will-need-to-be-filled-by-2026/">more critical</a> as the U.S. population ages, further straining the <a href="https://phinational.org/wp-content/uploads/2017/11/workforce-shortages-phi60issues01.pdf">care workforce</a>.</p>
<p>National efforts like the “<a href="https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2009.0966">culture change</a>” movement – an attempt underway since the 1980s to make nursing homes more home-like with more privacy and individual care – are already empowering staff and residents and bettering the <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.12987">quality</a> of <a href="https://www.ncbi.nlm.nih.gov/pubmed/30234764">care</a>.</p>
<p>According to one <a href="https://www.ncbi.nlm.nih.gov/pubmed/23514674">2014 study</a>, in states where Medicaid rewarded culture change practices through “pay-for-performance” reimbursement policies, nursing homes were far more likely to employ these practices. </p>
<p>More public investment could expand these promising efforts, giving families real peace of mind about their older parents’ safety and ensuring Americans get quality care in old age. </p>
<p>[ <em><a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=thanksforreading">Thanks for reading! We can send you The Conversation’s stories every day in an informative email. Sign up today.</a></em> ]</p><img src="https://counter.theconversation.com/content/120208/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors of this story received an Academic Research Grant from the Borchard Foundation Center on Law and Aging. A portion of Clara Berridge's time was supported by a T32 Department of Health and Human Services, National Research Service Award.</span></em></p><p class="fine-print"><em><span>Karen Levy does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Ever more Americans are using digital cameras to keep an eye on elderly relatives who live in nursing homes. This surveillance may violate patients’ privacy and demoralize their caretakers.Clara Berridge, Assistant Professor, School of Social Work, University of WashingtonKaren Levy, Assistant Professor, Department of Information Science, Cornell UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1095892019-01-29T14:18:06Z2019-01-29T14:18:06ZWe all want increased choice in elder care – but neoliberal health policies make this difficult<figure><img src="https://images.theconversation.com/files/255174/original/file-20190123-135148-171r2pu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/home-caregiver-helping-senior-woman-get-482413720?src=c6XgwqZfzicioPa4YsbqEw-1-24">DGLimages/Shutterstock.com</a></span></figcaption></figure><p>We can all agree that older people should have the choice to stay at home, and be cared for there, if that is what they wish to do. But the push for choice in elder care comes at a time where many <a href="https://homecaredirect.ie/blog/2018-home-care-tender-an-opportunity-for-much-needed-change/">governments</a> are disinvesting in home-care public services.</p>
<p>With the view of reducing healthcare costs – and under the pretext of increasing choice – the UK and Irish governments have outsourced a great proportion of their home care services to for-profit providers. This is having several implications: no meaningful choice, increased loneliness among older people, a dissatisfied and sometimes <a href="https://www.theguardian.com/commentisfree/2017/feb/20/horror-stories-care-worker-employers-care-slots-five-minutes">exploited care work force</a> and poor quality care.</p>
<p>While governments pay lip service to the notion of choice, their disinvestment in public home care services means that older people and their families often have no choice but to “choose” for-profit home care providers, as these are becoming the norm for elder home care. In the past decade, there has been a change from government-operated public facilities into private, autonomous facilities and services, organised for profit.</p>
<p>And there are further problems with this situation, beyond transformation of care into a commodity. Home care is not a typical product on a supermarket shelf. Care is a complex bundle of activities, tasks and interactions. Home care is a high involvement purchase, which requires considerable time and emotional investment. But people in need of care might not have all the necessary information, skills or time required to navigate intricate care markets. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/255176/original/file-20190123-135151-17o908v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/255176/original/file-20190123-135151-17o908v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/255176/original/file-20190123-135151-17o908v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/255176/original/file-20190123-135151-17o908v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/255176/original/file-20190123-135151-17o908v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/255176/original/file-20190123-135151-17o908v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/255176/original/file-20190123-135151-17o908v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">What does ‘choice’ actually mean?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/disabled-man-suffering-loneliness-old-age-262066235?src=2IRVUXoQsRmf5ypPTE9nUQ-1-97">Photographee.eu/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>In the course of our <a href="https://www.socatel.eu/">research</a> into the needs of the growing ageing populations in Ireland, social workers admitted that clients have little information on home care agencies. The little information they have comes from marketing communication activities, not from an objective source. But this might not matter anyway, as participants told us that good care was down to the individual carer: “You couldn’t say one home care agency is better than the other, it’s all about the actual person” delivering the care.</p>
<h2>Market-driven</h2>
<p>The increased view of home care as a product has led to the reduction of care as a set of clearly defined units of work (such as showering, washing, dressing, toileting and cleaning) leaving little time for companionship and meaningful engagement with clients. In the UK between 2010 and 2013, more than half a million care <a href="https://www.telegraph.co.uk/news/health/news/11302534/Revealed-more-than-500000-home-care-visits-last-less-than-five-minutes.html">slots lasted five minutes</a> or less. In Ireland, participants told us that a 30-minute slot is now the norm. Carers spoke about the disappointment service users experienced as they hurried out the door to the next client. </p>
<p>Paradoxically, many home care agencies promote themselves on the <a href="https://www.youtube.com/watch?v=BCjF7A2UnJE">emotional capacities</a> of care workers and the potential friendships that can be formed. But older adults told us about feeling lonely and wishing that carers spent more time with them. The carer is the only person many clients see all day. </p>
<p>Loneliness is a major problem among older people that can lead to <a href="https://www.nhs.uk/conditions/stress-anxiety-depression/loneliness-in-older-people/">depression and can have a serious effect on health</a>. Many participants agreed that providing “companionship time” should be part of the home care package, but this is not generally seen as a productive and efficient use of resources.</p>
<h2>The carers</h2>
<p>There is also a dark side to today’s market promotion of choice for care workers themselves. When profits and efficiency are prioritised, there is pressure to keep costs down. </p>
<p>Agency directors told us that unfortunately the tender process, whereby governments invite bids from home-care agencies, is a race to the bottom as price is an important criterion to secure a contract. Low costs have created a system characterised by casual and zero-hour contracts and low wages. The insecurity and low wages in the sector causes recruitment and retention problems.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/255177/original/file-20190123-135154-l1wd3x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/255177/original/file-20190123-135154-l1wd3x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/255177/original/file-20190123-135154-l1wd3x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/255177/original/file-20190123-135154-l1wd3x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/255177/original/file-20190123-135154-l1wd3x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/255177/original/file-20190123-135154-l1wd3x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/255177/original/file-20190123-135154-l1wd3x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">What about the carers themselves?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/nurses-pushing-seniors-wheelchair-thru-nursing-332263271?src=sAvo4-xjLQkBg8a5DlL2ZA-1-1">Kzenon/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Care managers complained about capacity problems and the difficulty in attracting people to the profession. Since care markets deliver efficiency at the expense of workers’ pay and conditions, care workers tend to be drawn from vulnerable groups in society: traditionally women and increasingly <a href="http://www.mrci.ie/wp-content/uploads/2015/09/Migrant-Workers-in-the-Home-Care-Sector-Preparing-for-the-Elder-Boom-in-Ireland.pdf">migrants</a>, who have few job opportunities. Carers in our research told us they do not feel valued or trusted and wished for better working conditions and a better funded sector.</p>
<h2>Questioning choice</h2>
<p>So what can we do? We need to question the extent to which choice should be the most important characteristic of a care model. Not because choice isn’t intrinsically good, but because the current neoliberal environment, in which governments are seeking to disinvest themselves of care responsibilities, makes such an ideal unattainable. </p>
<p>In his well-known book <a href="http://atulgawande.com/book/being-mortal/">Being Mortal: Medicine and What Matters in the End</a>, the surgeon Atul Gawande asks us to think about what brings the most meaning and purpose to our lives and fill our days with those things, to the best of our ability, until we die. In principle, choice is a good thing, but it is only valid if we are able to choose among meaningful alternatives. </p>
<p>And maybe choice should not be the most important factor in elder care. Guaranteeing good quality care that includes companionship, independence and safety for all older people should be what matters the most. We need to think further about what we want good quality care to mean. Determining how people can be properly cared in a way that exploits no older person or carer is a profound challenge of our society.</p><img src="https://counter.theconversation.com/content/109589/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This project has received funding from the European Union’s Horizon 2020 research and innovation programme under GA No 769975.
The author also wishes to acknowledge the Irish research team that took part in the project: Professor Virpi Timonen (Principal Investigator, Trinity College Dublin), Austin Warters and Anne McDonald from the Health Service Executive.
</span></em></p>Why choice should not be the most important factor in elder care.Luciana Lolich, Research Fellow in Social Work and Social Policy, Trinity College DublinLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/831232018-03-02T11:44:55Z2018-03-02T11:44:55ZWhy the daunting economics of elder care are about to get much worse<figure><img src="https://images.theconversation.com/files/208342/original/file-20180228-36680-8cr35i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Most caregivers today are assisting their relatives. What will happen in the years ahead?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-young-holding-hands-259508237?src=LasTclyhpt_6kBoSL1T1sg-1-42">ChaiyonS021/Shutterstock.com</a></span></figcaption></figure><p>My sister Carol loves movies, but she hasn’t been out to see one in years. When she tries to watch one at home, she’s frequently interrupted. She shrugs this off, saying “Who needs to see movies when you’re living one?” </p>
<p>You see, my sister is living the plot from the movie “<a href="http://www.imdb.com/title/tt0107048/">Groundhog Day</a>.” She takes care of our mother, who suffers from dementia. Our mom asks the same questions over and over and only wants to watch a handful of classic TV shows, like “<a href="http://www.imdb.com/title/tt0088526/?ref_=nv_sr_1">The Golden Girls</a>” reruns. For this my sister earns nothing.</p>
<p>I marvel at how hard my sister works and how much she contributes to our mother’s quality of life and yet how little our society recognizes the scope of what family caregivers like her are contributing. As an economist, I also see in her predicament a microcosm of a much bigger problem. Just as our family <a href="https://www.ncbi.nlm.nih.gov/books/NBK396402/">can’t expect my sister to keep this up</a> indefinitely, nor can our society count on unpaid caregivers to perpetually tend to the growing needs of the nation’s elderly. </p>
<h2>Valuing unpaid elder care</h2>
<p>Carol belongs to an army of more than <a href="https://www.caregiver.org/caregiver-statistics-demographics">43.5 million people</a> who provide their loved ones with what <a href="http://www.aarp.org/ppi/info-2015/valuing-the-invaluable-2015-update.html">AARP estimates to be US$470 billion worth of care</a> – an amount that exceeds the <a href="http://data.worldbank.org/indicator/NY.GDP.MKTP.CD?view=map">gross domestic product of 170 of the world’s 195 nations</a>.</p>
<p>Because no money changes hands, economists don’t count unpaid caregiving when they tabulate GDP – the sum of all economic activity. But this work does count tremendously in terms of the well-being, economic and otherwise, of the elderly and the disabled and their relatives. </p>
<p>Expecting that everyone in my mom’s predicament will have adult children able and willing to care for them is becoming increasingly unrealistic. Demographers expect that <a href="http://www.prb.org/Publications/Media-Guides/2016/aging-unitedstates-fact-sheet.aspx">the number of Americans over age 65 will more than double</a> in less than 50 years, rising from 46 million in 2016 to 98 million in 2060. The many seniors with <a href="https://theconversation.com/were-not-ready-for-the-silver-tsunami-of-older-adults-living-with-cancer-72242">one or more chronic conditions</a> will require professional and informal assistance. </p>
<p>Who will take care of all these additional seniors? </p>
<p>The <a href="https://populationeducation.org/content/us-fertility-rate-19-children-woman-2016">average number of children</a> women have has declined, falling to 1.9 in 2016 from 3.7 in the 1960s. That leaves fewer children to care for the growing number of elderly parents. And since the <a href="https://www.bls.gov/spotlight/2017/women-in-the-workforce-before-during-and-after-the-great-recession/pdf/women-in-the-workforce-before-during-and-after-the-great-recession.pdf">share of women who earn a living</a> in the paid workforce rose from about 1 in 3 in the mid-1950s to more than 1 in 2 by the 1980s, grown daughters have become less available to care for their parents at a time when the <a href="https://www.caregiver.org/caregiver-statistics-demographics">majority of people providing for seniors are still women</a>. For example, <a href="http://crr.bc.edu/wp-content/uploads/2017/06/IB_17-11.pdf">sons caring for a parent did 16 percent of this unpaid caregiving</a> while daughters did 31 percent, in 2011.</p>
<p>Caring for elderly and disabled family members takes a <a href="https://www.ncbi.nlm.nih.gov/books/NBK396402">big financial toll</a>, including hundreds of thousands of dollars in lifetime earnings if it means <a href="https://www.fidelity.com/viewpoints/personal-finance/caring-for-aging-parents">retiring early</a> to do it, according to Fidelity, the investment company.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/208343/original/file-20180228-36674-2pycn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/208343/original/file-20180228-36674-2pycn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/208343/original/file-20180228-36674-2pycn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/208343/original/file-20180228-36674-2pycn1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/208343/original/file-20180228-36674-2pycn1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/208343/original/file-20180228-36674-2pycn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/208343/original/file-20180228-36674-2pycn1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/208343/original/file-20180228-36674-2pycn1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">U.S. women are having fewer kids, making big families less common and creating consequences down the line for elder care.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?src=6nqXJ1FBCQ2SKl1pSxVZdA-1-21">Dasha Petrenko/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Paid caregivers</h2>
<p>When no relative steps up to serve as an unpaid caregiver when the need arises, families <a href="https://www.payingforseniorcare.com/longtermcare/paying-for-home-care.html">hire paid caregivers</a> or move their loved one into a <a href="https://www.genworth.com/about-us/industry-expertise/cost-of-care.html">nursing home</a>, where a private room may cost $100,000 or more per year. <a href="https://www.medicare.gov/what-medicare-covers/part-a/paying-for-nursing-home-care.html">Medicare rarely covers nursing home stays</a>, and eligibility for <a href="https://www.caring.com/articles/medicaid-nursing-home">Medicaid coverage is limited</a>, so institutional care like that is generally out of reach for all but the wealthiest Americans or those with <a href="https://www.aarp.org/health/health-insurance/info-06-2012/understanding-long-term-care-insurance.html">long-term care insurance</a> – which also <a href="http://www.aaltci.org/long-term-care-insurance-rates/">costs a lot</a>.</p>
<p>The <a href="http://www.bls.gov/emp/ep_table_103.htm">Bureau of Labor Statistics</a> predicts that caregiving jobs will be among the fastest-growing in the years to come, with the number of home health aides <a href="https://www.bls.gov/ooh/healthcare/home-health-aides-and-personal-care-aides.htm">increasing by 41 percent from nearly 3 million in 2016 to more than 4.1 million</a> within a decade.</p>
<p>However, many states already face a <a href="https://khn.org/news/severe-shortage-of-home-health-workers-robs-thousands-of-proper-care/">shortage of these workers</a>. Partly that’s because these jobs pay very little – <a href="https://www.bls.gov/ooh/healthcare/home-health-aides-and-personal-care-aides.htm">averaging $22,170 per year</a> in 2016 for home health aides – and offer scant benefits. Compensation is so low that about <a href="http://phinational.org/resource/paying-the-price-how-poverty-wages-undermine-home-care-in-america/">half of paid caregivers rely on some form of government assistance</a> to make ends meet. </p>
<p>The industry’s low pay helps explain why roughly a <a href="https://iwpr.org/wp-content/uploads/wpallimport/files/iwpr-export/publications/I924_.pdf">quarter of home health workers are immigrants</a>. Until now, foreign-born labor has narrowed this labor gap. The Trump administration’s efforts to crack down on <a href="http://money.cnn.com/2017/08/03/news/economy/trump-immigration-policy-job-market/index.html">undocumented immigration</a> and reduce the number of immigrants with legal status, therefore, are sure to make it harder for families seeking someone to care for an aging relative to hire workers.</p>
<p>I believe any serious debate over immigration policy should <a href="https://iwpr.org/wp-content/uploads/wpallimport/files/iwpr-export/publications/I924_.pdf">consider the growing need for paid caregivers</a> and establish more ways for immigrants willing and able to do this work with a path to citizenship. There are specific visa programs for <a href="https://www.uscis.gov/working-united-states/temporary-workers/h-2a-temporary-agricultural-workers">agriculture</a> and <a href="https://www.immigrationlawyerblog.com/2017/11/work-visas-hospitality-industry.html">hospitality</a>. Why not caregiving?</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/ColFFPNgtK4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Ai-jen Poo, an advocate of expanding the care workforce and improving its labor conditions, explaining at TEDxMiddlebury why she co-founded the Caring Across Generations campaign.</span></figcaption>
</figure>
<h2>What else might help</h2>
<p><a href="https://www.nytimes.com/2017/01/04/upshot/why-men-dont-want-the-jobs-done-mostly-by-women.html">Men are often hesitant to take jobs in caregiving</a> due to gender stereotypes. If those attitudes were to change, the pool of potential caregivers both paid and unpaid would expand. However, transforming gender attitudes is a difficult and long process.</p>
<p>In the meantime, Medicaid and Medicare can make caregiving more financially rewarding by increasing the rates they pay for elder care, spurring the kind of <a href="https://www.vox.com/2017/7/3/15872260/health-direct-care-jobs">salary growth for home health aides required</a> to make the profession more attractive.</p>
<p>And to ease the financial burden of caregiving all around, <a href="https://www.kff.org/medicaid/state-indicator/home-health-services-includes-nursing-services-home-health-aides-and-medical-suppliesequipment/">Medicaid</a> and <a href="https://www.medicareinteractive.org/get-answers/medicare-covered-services/home-health-care-benefit-part-a-and-b/when-medicare-pays-for-home-health-care">Medicare</a> could ramp up benefits for care delivered in the home and in institutions and extend coverage to more people.</p>
<p>Another way to ease this financial burden would be to adjust the tax code.</p>
<p>Congress appears to be inching in that direction. Several members, including Sens. Shelley Moore Capito, a West Virginia Republican, and Tammy Baldwin, a Wisconsin Democrat, introduced <a href="http://www.aarp.org/caregiving/financial-legal/info-2017/credit-for-caring-act.html">the Credit for Caring Act</a> in 2017. The measure, which didn’t make it into the tax code overhaul, would give Americans who earn at least $7,500 a year and also care for relatives with specific disabilities a <a href="http://thehill.com/policy/healthcare/341845-bipartisan-group-pushes-caregivers-tax-credit">tax credit worth up to $3,000</a>.</p>
<p>If enacted, this would mark a step in the right direction. But I believe much more needs to be done to prepare for the coming wave of elderly Americans, millions of whom will require assistance. </p>
<p>This legislation would do nothing, for example, for people like my sister who do unpaid caregiving work full-time and arguably need the most help.</p><img src="https://counter.theconversation.com/content/83123/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Patricia Smith does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The demographics, which include declining numbers of adult children free to step up and potentially fewer immigrants, suggest that this big problem society faces will get bigger.Patricia Smith, Professor of Economics, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/857242017-10-24T22:29:54Z2017-10-24T22:29:54ZHow Canada can end energy poverty and winter cut-offs<p>Energy poverty is a surprisingly common problem in Canada, with vulnerable communities most harshly affected by cut-offs when they fall behind on bill payments.</p>
<p>Despite this being a longstanding issue, Canada’s public discourse on energy poverty is just beginning.</p>
<p>Energy poverty isn’t just a different facet of living with low incomes. My work shows that <a href="https://open.library.ubc.ca/cIRcle/collections/ubctheses/24/items/1.0351974">while 35 per cent of people in energy poverty have low incomes, the majority don’t</a>. Conversely, 58 per cent of people who have low incomes are not in energy poverty. </p>
<p>This means that many lower middle-class people who own their homes experience energy poverty in Canada. That’s because housing quality and energy prices — and therefore housing and energy policy — are important factors.</p>
<p>Both the <a href="https://www.fraserinstitute.org/sites/default/files/energy-costs-and-canadian-households.pdf">Fraser Institute</a> and the <a href="https://www.policyalternatives.ca/sites/default/files/uploads/publications/BC%20Office/2011/09/CCPA-BC_Fighting-Energy-Poverty.pdf">Canadian Centre for Policy Alternatives</a> — think tanks on opposite sides of the political spectrum — use the same definition of energy poverty despite ideological differences. </p>
<p>But they borrowed it from an old U.K. definition. My research at the <a href="http://ires.ubc.ca/">Institute for Resources, Environment and Sustainability</a> suggests a more appropriate definition of energy poverty in the Canadian context.</p>
<p>Energy poverty occurs when a household has a hard time meeting energy needs. “A hard time” can be translated into a quantitative definition if we think of energy poverty and affordability the same way we think about housing affordability. </p>
<h2>Cost of energy a burden</h2>
<p>In Canada, households that spend more than 30 per cent of their income on securing shelter are said to lack <a href="https://www.cmhc-schl.gc.ca/en/inpr/afhoce/afhoce_021.cfm">affordable housing</a>, according to the <a href="https://www.cmhc-schl.gc.ca/en/">Canadian Mortgage and Housing Corp</a>. The cost of household energy is included, but will be shown as its own measure here. </p>
<p>That 30 per cent threshold is based on what most Canadians spend on housing. A disproportionate amount spent on housing means less money for food, transportation or education relative to other households. </p>
<p>We may define a household energy affordability threshold similarly. <a href="https://open.library.ubc.ca/cIRcle/collections/ubctheses/24/items/1.0351974">Most Canadians spend three per cent or less of their income on energy</a>. The median value for percentage of household expenditure on energy was 2.9 per cent, according Statistics Canada’s 2011 Survey of Household Spending. </p>
<p>So we can say households that spend more than twice this value face disproportionate energy burdens, which puts the energy affordability threshold at about six per cent of household income. </p>
<p>That offers a working figure of 21 per cent, or about 2.8 million Canadian households in energy poverty.</p>
<h2>Energy poverty as a relative problem</h2>
<p>While six per cent may seem like a small portion of a household’s income, two factors belie that assumption: Poverty is fundamentally a relative problem and energy poverty has severe consequences.</p>
<p>If everyone in Canada was constantly cold, we would think of it as a low standard of thermal comfort — a technical problem — and find a technical solution such as inventing a new kind of insulation for our homes. </p>
<p>Being cold would become a form of poverty only when some people could get insulation to improve their thermal comfort and others couldn’t — a social problem. </p>
<p>That is what the six per cent figure represents: Some people can get warm relatively easily and others have to spend a large part of their income to warm up.</p>
<h2>Severe consequences to energy poverty</h2>
<p>The consequences of being in energy poverty are also not small: Households that find paying for energy difficult may keep their homes at lower temperatures, which has health implications, especially for children and the elderly. </p>
<p>Studies have documented <a href="https://www.eagacharitabletrust.org/app/uploads/2016/03/natcendynamicsfullreport.pdf">higher rates of respiratory health problems for children</a>, as well as <a href="http://pediatrics.aappublications.org/content/118/5/e1293">lower weight gain and more susceptibility to illness for infants</a> as a consequence of being in energy poverty.</p>
<p>For adults, the best-documented effect is on <a href="http://www4.shu.ac.uk/research/cresr/warm-front-better-health-health-impact-evaluation-warm-front-scheme-0">self-reported mental health</a>: People in energy poverty are constantly under stress. </p>
<p><a href="http://jech.bmj.com/content/57/10/784">Excess winter mortality</a> — the number of deaths in winter compared to the summer, in which colder indoor temperatures are a factor — is well-documented and particularly worrisome for older people.</p>
<p>In addition to these serious health and wellness implications, living with higher energy burdens is inconvenient, particularly when service disconnections occur. And convenience matters: When most people have access to conveniences and others don’t, we start calling them essential services.</p>
<p>Being disconnected from utility service means loss of access to heat and other amenities. For many, having no heat means no hot water. For those with electric heating, disconnection also means no refrigeration and lighting. </p>
<p>These interruptions to hot water or refrigeration service are important primary manifestations of energy poverty because most disconnections happen in spring, when heat is less of a concern. Once disconnected, many households face high reconnection fees and lose access to equalized bill payment, which deepens their energy poverty.</p>
<h2>What causes energy poverty</h2>
<p>My work focuses on the ways in which energy policy decisions and energy planning processes create energy poverty for Canadians. </p>
<p>Since energy policy is primarily set by provinces, these processes differ across the country. In British Columbia, for example, the government has courted the liquefied natural gas (LNG) industry for a decade, creating a discourse of “energy plenty” — meaning the province has copious supplies of natural gas ready for exploitation and export, as well as cheap, abundant electricity for the LNG sector. </p>
<p>That electricity was to be made available by constructing a $9 billion dam without public review to power <a href="http://www.iea.org/Textbase/npsum/MTGMR2016SUM.pdf">an industry that would likely not materialize in British Columbia</a> due to the global supply glut of natural gas. With a change in government, this dam is now under review.</p>
<p>The cost of this manufactured energy abundance was passed on to public utility customers who have seen a 20 per cent increase in their electricity costs over the past three years. Had the new government not frozen rates, utility customers were to see a 45 per cent increase in electricity rates over a decade. </p>
<p>These price increases have been devastating for customers who were already struggling to meet their energy needs and pushed new households into energy poverty.</p>
<h2>How to reduce energy poverty</h2>
<p>I have five broad suggestions to reduce energy poverty and its impact on people’s lives:</p>
<ol>
<li><p>Increase welfare rates and the minimum wage to help improve the lives of the 36 per cent of people in energy poverty who also have low incomes.</p></li>
<li><p>Create programs that make energy retrofits available to people in energy poverty (many of whom are not low-income). This should be a key part of federal and provincial energy policies. Deep retrofits, which include changes to heating systems, insulation and air-sealing, are shown to reduce energy expenditure or improve thermal comfort.</p></li>
<li><p>Mandate winter disconnection moratoriums to prevent some of the worst consequences of energy poverty. Complement these moratoriums with winter fuel subsidies, access to lifeline energy regardless of season, easier reconnection procedures and lower fees.</p></li>
<li><p>Focus on people in energy poverty when designing policies that raise energy prices, including carbon taxes. For example, taxes can be designed to compensate the most affected households. Energy price increases can be paired with implementing Recommendations 2 and 3 to reduce the taxes’ negative impact on people.</p></li>
<li><p>Make energy policy and planning more open and deliberative by strengthening utility review commissions and creating processes that gather a broader range of perspectives and include those in energy poverty when setting rates, building mechanisms to address the problem, or developing new energy projects.</p></li>
</ol><img src="https://counter.theconversation.com/content/85724/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Maryam Rezaei works for Community Power. Her research work at the University of British Columbia has received funding from the Social Sciences and Humanities Council and the Peter Wall Solutions Initiative.</span></em></p>Energy companies routinely cut off service to vulnerable people who experience energy poverty. Here’s how to fix the problem.Maryam Rezaei, PhD student, Institute for Resources, Environment and Sustainability, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/835432017-09-08T00:24:00Z2017-09-08T00:24:00ZWhy more grandparents are raising their grandchildren<figure><img src="https://images.theconversation.com/files/184972/original/file-20170906-9875-1rj6j07.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Grandmother and child walking in the park.</span> <span class="attribution"><span class="source">www.shutterstock.com</span></span></figcaption></figure><p>Sunday, Sept. 10, 2017 is <a href="http://grandparentsday.org/">Grandparents Day</a>. Many grandparents will receive loving cards, calls and emails from their grandchildren.</p>
<p>However, a significant number of grandparents – <a href="http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2016/11/02/why-more-grandparents-are-raising-children">approximately 2.9 million</a> – will do exactly what they do every day. They will make their grandchildren breakfast, organize their activities and help with homework in the evening. </p>
<p>So-called “custodial grandparents” have primary responsibility for raising one or more of their grandchildren. As researchers and health and social service professionals, we know that this is a <a href="http://www.pbs.org/newshour/rundown/more-grandparents-raising-their-grandchildren/">growing group of often invisible caregivers</a>.</p>
<p>Grandparents Day is a fitting moment to take a closer look at the social contribution grandparents are making and the impact of unexpected caregiving – often in later stages of life.</p>
<h2>Not a new phenomenon but a changing one</h2>
<p>Custodial grandparents are represented in all races and ethnicities. However, grandparents in racial and ethnic minority groups <a href="https://www.census.gov/library/visualizations/2016/comm/cb16-ff17_grandparents.html">are overrepresented</a> in the population of caregivers. It’s also worth noting that 67 percent are younger than age 60, and 25 percent <a href="https://www.census.gov/content/dam/Census/library/publications/2014/demo/p20-576.pdf">live</a> in <a href="https://www.healthcare.gov/glossary/federal-poverty-level-FPL/">poverty</a> despite the fact that about <a href="https://census.gov/library/visualizations/2017/comm/grandparents-support-grandchildren.html">half of custodial grandparents are in the labor force</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/184992/original/file-20170906-17089-kwc1tz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/184992/original/file-20170906-17089-kwc1tz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/184992/original/file-20170906-17089-kwc1tz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=384&fit=crop&dpr=1 600w, https://images.theconversation.com/files/184992/original/file-20170906-17089-kwc1tz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=384&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/184992/original/file-20170906-17089-kwc1tz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=384&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/184992/original/file-20170906-17089-kwc1tz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=483&fit=crop&dpr=1 754w, https://images.theconversation.com/files/184992/original/file-20170906-17089-kwc1tz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=483&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/184992/original/file-20170906-17089-kwc1tz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=483&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Barack Obama with the grandparents who raised him.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/senorglory/3219359111/">Senor Glory</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Grandparent caregiving is not a new phenomenon: Kin care has historically been part of family life. Former President Barack Obama <a href="http://www.penguinrandomhouse.com/books/123909/dreams-from-my-father-by-barack-obama/9780307383419/%22">chronicled</a> his early life experiences being raised by maternal grandparents. In a <a href="https://www.harpercollins.com/9780062300546/hillbilly-elegy">bestselling book</a>, JD Vance writes about his childhood in Appalachia being raised by his “Mamaw.”</p>
<p>While it’s not a new trend, the reasons for and experience of raising grandchildren have changed over recent decades.</p>
<p>Consider, for example, the African-American community. In her 2010 Pulitzer Prize-winning book, <a href="http://isabelwilkerson.com/the-book/">“The Warmth of Other Suns</a>,” Isabel Wilkerson documents the great migration of African-Americans from the South to other regions of the United States between World War I and the 1970s. During this time, grandparents and other relatives served as substitute parents as families resettled and secured employment. In this <a href="https://www.naswpress.org/publications/children/caregiving-care-sharing.html">care-sharing tradition</a>, grandparents and other families were available during times of transition and relocation.</p>
<p>Since the mid-1990s, several social conditions have caused the number of grandparents who are raising their grandchildren to increase.</p>
<p>Addiction and incarceration, child abuse and neglect, and economic factors all have contributed to a rise in the number of custodial grandparents. A recent <a href="http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2016/11/02/why-more-grandparents-are-raising-children">Pew Trusts report</a> documents how the current opioid epidemic is contributing to this trend. <a href="https://www.cdc.gov/drugoverdose/pdf/pubs/2017-cdc-drug-surveillance-report.pdf">According to the CDC</a>, drug overdose deaths in the United States have more than tripled from 1999 to 2015, and often leave children parentless. </p>
<p>The number of <a href="https://www.nytimes.com/2017/01/16/opinion/young-victims-of-the-opioid-epidemic.html">children placed in foster care</a> has sharply increased, partially fueled by opioid and other drug use. When children are removed from their birth parents, federal law requires that state child protective services give preference to placement with relatives who, more often than not, are the grandparents.</p>
<p>Additionally, increased incarceration rates for women have changed family life. In the 1990s, female incarceration rates <a href="http://www.bjs.gov/content/pub/pdf/iptc.pdf">skyrocketed</a> compared to the rate for fathers. Incarceration, addiction and neglect are often interconnected.</p>
<h2>How caregiving affects health</h2>
<p>In addition to dealing with the challenging dynamics of child care, many of these grandparents are starting to experience their own age-related changes in <a href="http://onlinelibrary.wiley.com/doi/10.1002/jclp.22272/full">health and functioning</a>.</p>
<p>Compared with noncaregiving peers, grandparents who are raising their grandchildren have more extensive health problems. When there are limited resources – whether financial, time or energy – grandparents <a href="http://onlinelibrary.wiley.com/doi/10.1002/nur.21542/abstract">prioritize their grandchildren over themselves</a>. This situation can lead to undiagnosed health problems, untreated chronic diseases and undesirable health practices such as poor nutrition and lack of exercise.</p>
<p>In addition, grandparents can experience depression and anxiety from the stress of child care. In <a href="http://onlinelibrary.wiley.com/doi/10.1002/nur.21542/abstract">one study</a> of grandmothers raising grandchildren, approximately 40 percent scored in the clinically elevated range on measures of psychological distress.</p>
<p>In spite of these challenges, grandparents report rewards and joys that give them a sense of purpose. One grandparent <a href="http://familiesinsocietyjournal.org/doi/pdf/10.1606/1044-3894.177">put it this way</a>:</p>
<blockquote>
<p>“And she’ll come around once in a while and she’ll say, ‘I’m so glad. I’m so lucky I have you and Grandma.’ And I’ll say, ‘We’re lucky we have each other.’”</p>
</blockquote>
<p>Keeping grandchildren in their own cultural community is another important motivation for many. For example, <a href="http://familiesinsocietyjournal.org/doi/pdf/10.1606/1044-3894.40">research</a> has demonstrated the historical commitment to care-sharing in African-American families:</p>
<blockquote>
<p>“Because I came from a bonded family, a really bonded family… We always pitched in and took care of each other. My mother, my grandmother took care of me. Let me see. There was my nannie, my nina, my mother, my uncle and aunt. We all lived together…”</p>
</blockquote>
<h2>Grandparents and policy</h2>
<p>From a policy perspective, grandparents provide the safety net for children who might have otherwise entered the foster care system. Nationally, it is estimated that grandparents and other kinship care providers save the government more than <a href="http://www.gu.org/Portals/0/images/Infographic/12-grandparent-infograph-full.jpg">US$6 billion annually</a>.</p>
<p>But in caring for these children, grandparents <a href="https://www.hindawi.com/journals/cggr/2015/630717/">pay a high price</a>, especially those who are raising the children alone.</p>
<p>What can be done to support these grandparents?</p>
<p>Because of increased recognition of both the prevalence and urgent needs of grandparents raising grandchildren, many communities have created grandparent support groups and “<a href="http://www.nysnavigator.org/">kinship navigator</a>” programs that help identify and access much-needed public and private resources.</p>
<p>Programs such as <a href="http://phg.snhp.gsu.edu/">Project Healthy Grandparents at Georgia State University</a> offer support and health interventions to help grandparents remain healthy and effective care providers. Support includes home visits, early intervention services for children with developmental disabilities (which are often related to prenatal substance abuse exposure) and support groups and parenting classes. Other programs are growing such as Grandhousing, which provides apartments specifically for grandparent-headed families.</p>
<p>Programs for grandchildren are also crucial. In one initiative that replicates our Atlanta-based model in rural Georgia, a van transports the children to an activity day so they can be with others who are are cared for by grandparents. As the driver pulled up to the second house, the two sisters already in the van exclaimed:</p>
<blockquote>
<p>“Look – those girls are being raised by their grandma, too!”</p>
</blockquote>
<p>Clearly, seeing other children in families like theirs was surprising and important to the sisters!</p>
<p>For many, Grandparents Day is celebrated one time per year. And grandchildren’s visits <a href="https://www.naswpress.org/publications/children/caregiving-care-sharing.html">are a “delight”</a> lasting just a few hours. But for about three million children, being with grandparents is a daily fact. </p>
<p>We believe it is time for these families to be recognized more formally by policymakers and service providers. Without more extensive official responses, grandparents may receive little or no support until they experience a physical or mental health crisis.</p><img src="https://counter.theconversation.com/content/83543/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Millions of American children are being cared for by grandparents. To honor Grandparents Day we ask: What are the social and health impacts of this often unexpected turn of events?Nancy P. Kropf, Dean and Professor of Social Work, Byrdine F Lewis College of Nursing and Health Professions., Georgia State UniversitySusan Kelley, Associate Dean and Chief Academic Officer for Nursing and Director, Project Healthy Grandparents, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/821222017-08-10T00:08:05Z2017-08-10T00:08:05ZWhy Medicaid matters to you<figure><img src="https://images.theconversation.com/files/181451/original/file-20170808-28656-1ru15jh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">As more and more seniors need care, their budgets will be strained. As a result, they may rely on Medicaid.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/african-nurse-assisting-elderly-man-walker-577126336?src=u-MYQeKxls4Ds_4JAAM_JQ-1-2">gagliardiImages/Shutterstock.com</a></span></figcaption></figure><p>Efforts to repeal and <a href="http://www.cnn.com/2017/07/25/politics/senate-health-care-vote/index.html">replace Obamacare</a> have been suspended for the time being, and many Americans are breathing a sigh of relief. But Obamacare is far from safe, and the same is true for one of the key programs – Medicaid – that the law used to expand health care coverage for millions of Americans.</p>
<p>While many people may think of Medicaid as a government program that helps only the nation’s poor, that is not accurate. <a href="https://longtermcare.acl.gov/medicare-medicaid-more/medicaid/index.html">Medicaid helps pay for</a> – and is indeed part of estate planning strategies for – nursing home care and other forms of long-term care. Since all Americans live in communities with elderly people, will grow old themselves or have aging parents, long-term care and how to pay for it is a matter that affects us all, even if we do not realize it.</p>
<p>I am a professor of law and bioethics who sits on a hospital ethics committee in Cleveland and has researched aging and long-term care extensively for my <a href="http://scholarlycommons.law.case.edu/faculty_publications/1471/">scholarship</a>. I have learned a great deal about the cost of care and the importance of Medicaid, which not enough people appreciate.</p>
<h2>A rising expense, a growing population</h2>
<p>Long-term care in the United States is extraordinarily expensive. The median annual cost of a private room in a nursing home is over <a href="https://www.genworth.com/about-us/industry-expertise/cost-of-care.html">US$92,000</a>, and a shared room costs over <a href="https://www.genworth.com/about-us/industry-expertise/cost-of-care.html">$82,000</a>. These prices will only increase in the coming years, as costs have risen by almost <a href="http://www.modernhealthcare.com/article/20160510/NEWS/160519999">19 percent</a> since 2011. </p>
<p>The median price for care in an assisted living facility, which provides residents with meals and other forms of assistance but not with skilled nursing care, is over <a href="https://www.genworth.com/about-us/industry-expertise/cost-of-care.html">$43,500</a>. Those who want to remain at home with the help of an in-home aide from a home care agency will pay approximately <a href="https://www.genworth.com/dam/Americas/US/PDFs/Consumer/corporate/131168_050516.pdf">$20</a> an hour, which translates into $175,000 per year for round-the-clock care.</p>
<p>According to the U.S. Department of Health and Human Services, “<a href="https://longtermcare.acl.gov/the-basics/who-needs-care.html">70 percent of people turning age 65 can expect to use some form of long-term care during their lives</a>.” It is important to understand that despite its high cost, long-term care is generally <a href="https://longtermcare.acl.gov/the-basics/who-pays-for-long-term-care.html">not paid for</a> by Medicare, the government program that covers seniors, or by private health insurance policies.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/181455/original/file-20170808-22949-8icqr2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/181455/original/file-20170808-22949-8icqr2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=364&fit=crop&dpr=1 600w, https://images.theconversation.com/files/181455/original/file-20170808-22949-8icqr2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=364&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/181455/original/file-20170808-22949-8icqr2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=364&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/181455/original/file-20170808-22949-8icqr2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=457&fit=crop&dpr=1 754w, https://images.theconversation.com/files/181455/original/file-20170808-22949-8icqr2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=457&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/181455/original/file-20170808-22949-8icqr2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=457&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Nursing home care is extraordinarily expensive, and its costs are projected only to grow.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/552635602?src=e0bScTO4aHgp6tiDQGmX0A-1-24&size=small_jpg">Lighthouse/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>So are most Americans financially equipped to pay on their own for nursing homes and other types of assistance when they are elderly? The answer is a resounding “no.” </p>
<p>A 2015 U.S. Government Accountability Office report found that “<a href="http://www.gao.gov/assets/680/670153.pdf">about half of households age 55</a> and older have no retirement savings (such as in a 401(k) plan or an IRA).” </p>
<p>The National Institute on Retirement Security concluded that American households had a median retirement savings account balance of just <a href="http://www.nirsonline.org/storage/nirs/documents/RSC%202015/final_rsc_2015.pdf">$2,500</a>, and the median for those nearing retirement was a mere <a href="http://www.nirsonline.org/storage/nirs/documents/RSC%202015/final_rsc_2015.pdf">$14,500</a>. Such meager savings make it extremely difficult for retirees to cover their out-of-pocket medical costs for co-pays, deductibles, and noncovered items such as hearing aids, which often reach <a href="http://www.urban.org/sites/default/files/publication/28361/412026-Will-Health-Care-Costs-Bankrupt-Aging-Boomers-.PDF">several thousands of dollars per year</a>. A prolonged period of long-term care on top of these costs is certainly not in most people’s budgets.</p>
<h2>Medicaid and seniors</h2>
<p>Enter Medicaid. While many may think Medicaid primarily covers poor people, about <a href="http://www.kff.org/medicaid/report/medicaid-and-long-term-services-and-supports-a-primer/">28 percent of its overall budget</a> is spent on long-term care. </p>
<p>That money is vital to seniors and to the nursing homes they live in. In 2014, Medicaid paid for <a href="http://www.kff.org/medicaid/report/nursing-facilities-staffing-residents-and-facility-deficiencies-2009-through-2015/">62 percent</a> of nursing home residents. Increasingly, it covers <a href="https://www.payingforseniorcare.com/medicaid-waivers/assisted-living.html">assisted living</a> and <a href="http://www.kff.org/medicaid/state-indicator/personal-care-services/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D">in-home care</a>, which many elderly people prefer. </p>
<p>Medicaid is still a program that serves only financially disadvantaged individuals and has strict <a href="https://longtermcare.acl.gov/medicare-medicaid-more/medicaid/medicaid-eligibility/">eligibility requirements</a>, but people who need long-term care, including some who were <a href="http://khn.org/news/in-the-end-even-the-middle-class-would-feel-gop-cuts-to-nursing-home-care/">middle-class</a>, end up “<a href="https://www.eldercaredirectory.org/medicaid-long-term-care.htm">spending down</a>” their money by paying for nursing homes or other assistance out of pocket and then qualify for Medicaid. This includes many who worked hard and supported themselves and their families their entire lives but simply did not have enough retirement savings to cover the exorbitant costs of medical care and long-term care. Those who spend down are <a href="https://www.forbes.com/sites/howardgleckman/2013/04/24/do-seniors-hide-assets-to-get-medicaid-long-term-care-benefits/#1a2b434a4298">very rarely wealthy</a>, with about 85 percent barely hanging on economically before “spending down.” </p>
<p>Republican proposals to repeal and replace Obamacare targeted Medicaid for significant cuts that <a href="https://www.nytimes.com/2017/06/24/science/medicaid-cutbacks-elderly-nursing-homes.html">would have affected</a> seniors receiving long-term care. Many in Congress still <a href="http://www.foxnews.com/politics/2017/07/28/conservatives-hold-out-hope-on-obamacare-repeal-as-gop-leaders-move-to-tax-reform.html">hold out hope</a> of eliminating Obamacare, and this should make all of us worried.</p>
<h2>Medicaid and all of us</h2>
<p>What might happen if frail and elderly people cannot receive needed care? Some will have to turn to loved ones for extra support. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/181456/original/file-20170808-17173-1dni5p6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/181456/original/file-20170808-17173-1dni5p6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=381&fit=crop&dpr=1 600w, https://images.theconversation.com/files/181456/original/file-20170808-17173-1dni5p6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=381&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/181456/original/file-20170808-17173-1dni5p6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=381&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/181456/original/file-20170808-17173-1dni5p6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=479&fit=crop&dpr=1 754w, https://images.theconversation.com/files/181456/original/file-20170808-17173-1dni5p6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=479&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/181456/original/file-20170808-17173-1dni5p6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=479&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Family and friends try to step in and take care of a senior in need, but often at great costs.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/horizontal-view-caring-about-old-person-302485955?src=ADF0tcAe378MJu1_56wt-g-1-24">Photographee.eu/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Family and friends already bear much of the burden of caring for the elderly. According to the <a href="http://www.alz.org/documents_custom/2016-facts-and-figures.pdf">Alzheimer’s Association</a>, over 15 million Americans tended to dementia patients in 2016, supplying an estimated 18.1 billion hours of unpaid care. Overall, <a href="https://www.caregiver.org/caregiver-statistics-demographics">older adults receive $470 billion worth of unpaid care</a> each year. Without Medicaid, the elderly will often need to ask more of their relatives or even to move in with them. </p>
<p>Caring full-time for someone who is physically disabled or has dementia can be <a href="https://www.caregiver.org/caregiver-health">emotionally exhausting and can lead to anxiety, depression and other mental and physical health problems</a>; create conflicts within families; and be financially draining, especially if it affects caregivers’ ability to work outside the home.</p>
<p>Other elderly people will try to continue living independently without the help they need. This can create dangers for other members of their communities. They may have to drive in order to get groceries and supplies, and this can lead to more car accidents. Indeed, The American Medical Association and National Highway Traffic Safety Association state that <a href="http://www.aarp.org/content/dam/aarp/livable-communities/plan/transportation/older-drivers-guide.pdf">“on the basis of estimated annual travel, the fatality rate for drivers 85 and older is nine times higher than the rate for drivers 25 to 69</a>.” They will cook alone and perhaps forget to turn off the oven or burners, which can cause fires. And they will be at high risk of falling and needing care in emergency rooms. As more patients flood emergency rooms, the wait times for everyone will increase, and already <a href="https://www.scientificamerican.com/article/widespread-understaffing-of-nurses-increases-risk-to-patients/">understaffed hospitals</a> may provide less attentive care.</p>
<p>These problems will only grow in the future. In 2015, <a href="https://www.census.gov/newsroom/facts-for-features/2017/cb17-ff08.html">14.9 percent of the population, or 47.8 million people</a>, were 65 and over. The number of seniors is projected to expand to almost 73 million by 2030 and to represent over <a href="https://www.census.gov/content/dam/Census/library/publications/2014/demo/p25-1140.pdf">20 percent</a> of total U.S. residents. Society will not be able to ignore their needs.</p>
<p>We will all be affected if elderly members of our communities cannot get needed care. Moreover, many of us will find that long-term care is unaffordable for our own loved ones or for ourselves. None of us knows whether we will develop dementia or another serious chronic condition that requires intensive care for many years.</p>
<p>Medicaid is not just about the poor. It is about all of us, and we should all care deeply about maintaining and strengthening it for the future.</p><img src="https://counter.theconversation.com/content/82122/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sharona Hoffman received financial support from Case Western Reserve University for publication of her book "Aging with a Plan: How a Little Thought Today Can Vastly Improve Your Tomorrow" (Praeger 2015). </span></em></p>Medicaid, a state-federal entitlement program that people associate only with the poor, pays for care for more than six in 10 nursing home residents. That could be you, or someone you love.Sharona Hoffman, Professor of health law and bioethics, Case Western Reserve UniversityLicensed as Creative Commons – attribution, no derivatives.