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Elizabeth Isele p. 10 | A tireless advocate for economic, social change.
GRACE at AiA19 p. 15 | Growing GRACE: a quest to expand the eldercare workforce.
Covering advances in research, practice and policy nationwide www.asaging.org
SEPTEMBER–OCTOBER 2019 volume xl number 5
the bimonthly newspaper of the American Society on Aging t i t l f t i i t i
Learning Collaborative jump-starts CBO−MA plan partnership potential
In this issue
FORUM California prepares for population aging page 3 AGINGWITH OPTIONS The evolving role of male family caregivers page 5 IN FOCUS The business of aging: spinning gold from the “silver” economy pages 7–11 A fall reading list: new titles in aging page 13 Opening up and honing resilience in later life page 16
E ditor’s note: The John A. Hartford Foundation, the Administration for Community Living and The SCAN Foundation fund the Aging and Disability Business Institute (www.aginganddisabili tybusinessinstitute.org) , led by theNational Association of Area Agencies on Aging (n4a). The mission of the Aging and Disability Business Institute is to build and strengthen partnerships between aging and disability community-based organizations (CBO) and the healthcare system. As a part- ner of the Aging and Disability Business In- stitute, ASA is collaborating with n4a on a series of articles and case studies in Aging
Today that prepare, educate and support CBOs and healthcare payers to provide qual- ity care and services. Since April 2019, the National Council on Aging (NCOA) and the Aging and Dis- ability Business Institute (the Business Institute) at the National Association for Area Agencies on Aging (n4a) have hosted the Medicare Advantage Learning Col- laborative (MALC), a six-month webinar- CBOs had concerns about how well-prepared they were to partner with MA plans. based training program for community- based organizations (CBO) looking to acquire the necessary knowledge and skills to pursue partnerships and con- tracts with Medicare Advantage (MA) plans to provide home- and community- based services and supports.
“We created this curriculum in re- sponse to the 2018 call letter from CMS to MA plans that described broader oppor- tunities for utilization of supplemental benefits,” said MALC lead faculty Sharon Williams, founder and CEO of Williams Jaxon Consulting. “In early 2019, when CMS published standards for special supplemental bene- fits that provided a broader scope of ex- pectations … we received lots of feedback from CBOs, with ongoing concerns around how well they would be prepared
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The 2019 MindAlert Award winner: bringing joy and connection back to older adults with dementia
Hacking longevity market trends and consumer preference By Lori Bitter T here now is heightened interest in serving the longevity market, as evidenced in The Business of Aging’s 2018 study, Hacking Longevity: A Three Generation Look at Living a 100 Year Life ( tinyurl.com/yxdsle49 ), which painted a landscape of opportunity for companies that can speak authentically to older con- sumers, and help them navigate later life. Many companies have built products for different generations of older consumers. Though the needs of and opportunities to serve this consumer cohort are recog- nized and well-researched, some compa- nies steadfastly chase the youth market, assuming more money and opportunity lie there. Also, new companies and tech- nologies tend to target wealthier older consumers—thosewho can pay regardless
T he Birdsong Tablet is the winner of ASA’s 2019 MindAlert Award . The award is given to a mental fit- ness program developed by a nonprofit or- ganization that serves the general popula- tion of older adults. Ben Unkle, president and CEO of the senior living community Westminster- Canterbury on Chesapeake Bay in Vir- ginia Beach, Va., wanted to find a way to help the people in the memory and nursing care sections of his community to “have more engagement and en- tertainment options suited for their interests.” Thus, he envisioned and com- missioned a tablet device, similar to an iPad, called the Birdsong Tablet ( www. bird songlife.com ). The tablet, which is pre-loaded with curated, wide-ranging content meant to appeal to older adults, such as word games, travel sites and lifelong learning, features an uncomplicated interface, with a larger screen and bigger function but- tons, and is easy to read and navigate. At Westminster-Canterbury, the tablets are attached to bedside tables and are part of
of insurance reimbursement. Companies’ offerings could (and should) have more wide-ranging social impact and greater results with low-income adults, particu- larly those of more diverse backgrounds who may be managing multiple chronic conditions, who are more at risk for social isolation and who may not have technolo- gy to assist in their care. Nonprofit organizations can partici- pate in these marketing opportunities by educating young companies about the re- alities of older adults’ lives, and by work- ing with for-profit companies to provide distribution and pilot programs, bringing new products and services to more vul- nerable older consumers. Many companies claiming to target older adults have built and marketed products to at least two different genera-
the daily lives of residents in the assisted living and skilled nursing areas. Unkle says Birdsong has markedly helped their residents with dementia to re-engage with life, and the tablet is now offered to other retirement communities as well as the public at large. A Product Grounded in Compassion— and Research Spurred by his desire to help residents battling dementia, or seeking brain thera- py to avoid dementia, to re-engage, Unkle had been reading about the brain and the George Henrich experiments with the Birdsong Tablet as his wife, Helen, looks on.
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Aging Today September–October 2019
smooth process, as with all things techno- logical, there were a fewhiccups along the way, and we truly appreciate how mem- bers handled the change and had patience with us throughout the process. If you still find yourself running into troubles with Impexium, please contact Keith Kuo at 415-974-9604 ( kkuo@asag ing.org ) or Jutka Mandoki at 415-974- 9630 (j firstname.lastname@example.org ). As always, staff will be available to assist on our cus- tomer service line at 800-537-9728 or at email@example.com . Our customer support business hours are 8:30 a.m. to 8:30 p.m. (Eastern). Atlanta to Host AiA 2020 I am excited as we gear up for the 2020 Aging in America (AiA) Conference, to be held inAtlanta, Ga.,March 24–27 (which is Tues.–Fri.), at the Hyatt Regency Atlanta. As a minority-majority city (according to 2018 Census statistics, Atlanta’s popu- ASA’s new strategic plan will multiply ASA’s impact as the ‘go to’ national organization for professionals in the aging services sector. lation is 52.3 percent African American versus 40.1 percent white), Atlanta is a particularly apropos city to host our next Conference, as the 2020 theme is “Aging 2020: Examining the Needs of Today’s Diverse Older Adults.” This thriving me- tropolis will put our work into historical perspective, demonstrating how far we have come as a nation and as a field, but also highlighting the path ahead to better serve diverse elders. AiA 2020 will highlight issues that af- fect America’s increasingly diverse older adult population, and examine social con- structs such as ageism, racism, sexism and heterosexism. It will highlight inno- vative programming, practices, proven business models and global ideas that make life better for the elders we serve. This should be an inspiring confluence of location and population in which to host our Conference. Despite the recent media frenzy over the citizenship question, Census 2020 will happen, and will help to focus attention on America’s changing demographics. Then there’s that other event happening in 2020, namely the presidential election, which, along with the Census, will offer ASA a chance to elevate policies, legisla- tion and agendas beneficial to older adults. Please plan to join us in Atlanta, and while you’re there, use the new hashtag, #Aging2020 , and use it liberally when on social media at or after the Conference. Conference registration opens Oct. 1 and the best rates possible will be available in that month, so sign up early! n Today articles and to guest commentar- ies, which present the opinions of their authors and not necessarily those of the American Society on Aging. Letters should be no more than 350 words long. We also welcome ideas for articles you would like to see in future issues of Aging Today . mail Aging Today, “Letters” 575 Market St., Suite 2100 San Francisco, CA 94105-2869 fax (415) 974-0300 e-mail firstname.lastname@example.org WRITE TO US We welcome your responses both to Aging
American Society on Aging www.asaging.org Aging Today (issn 1067-8379) is published bimonthly by the American Society on Aging. Articles may be reproduced by those obtaining written permission. Postmaster: Send address changes to Aging Today, ASA, 575 Market Street, Suite 2100, San Fran- cisco, CA 94105-2869. Phones: editorial (415) 974-9619; advertising (415) 974-9600; or visit www.asaging.org/publications . For membership or other information about ASA, call (415) 974-9600, fax (415) 974-0300 or visit www.asaging.org . Subscription Price: individual non- members: $74.00/year (included with annual membership); nonmember institu- tions/libraries: $110.00/year. Subscription Aging Today is indexed in the Cumula- tive Index to Nursing and Allied Health Literature and the Areco Quarterly Index to Periodical Literature on Aging. Printed in the U.S.A. © 2018 American Society on Aging. All rights reserved. The American Society on Aging (ASA) is the essential resource to cultivate leadership, advance knowledge and strengthen the skills of those who work with, and on behalf of, older adults. Chair, Robert Espinoza, Vice President of Policy, PHI, Bronx, New York Immediate Past Chair: Robyn L. Golden, Director of Health and Aging, Rush University Medical Center, Chicago, Illinois Donna Benton, Director, USC FCSC/ LACRCA, Los Angeles, California Diane Brown, Executive Director, Medicare Strategy & Operations, Kaiser Permanente Northern California, Oakland, California Paul Greenwood, Elder Abuse Expert Witness and Teacher/Consultant, San Diego, California Anne Montgomery, Deputy Director, Center for Elder Care & Advanced Illness, Altarum, Washington, D.C. Kathy Sykes, Retired, Senior Advisor for Aging and Environmental Health, U.S. EPA, Washington, D.C. Laura Trejo, General Manager, Los Angeles Department of Aging, Los Angeles, California Peter Whitehouse, Professor of Neurology, Case Western Reserve University; and President, Intergenerational Schools International, Shaker Heights, Ohio agency rate (institutional rate only): $94.00/year. ASA Interim CEO: Cynthia D. Banks ASA Board Chair: Karyne Jones Editor: Alison Hood Senior Editor: Alison Biggar Design & Production: Michael Zipkin | Lucid Design EDITORIAL ADVISORY COMMITTEE
ASA transitions and Atlanta, here we come!
menting the recently adopted Strategic Plan. It is meant to multiply ASA’s impact as the “go to” national organization for professionals in the aging services sector and the older adults they serve by expand- ing ASA’s leadership role in the field, growing ASA membership, being a leader in diversity and inclusion and establishing ASA as a leading policy advocacy voice for older Americans. My hope is that this transition is both smooth and productive, in that I can be guiding ASA staff in doing their impor- tant work to support older adults and ASA members, while assisting Board of Direc- tors Chair Karyne Jones and Chair-Elect Michael Adams, who heads the Search Committee, to find and select a newPresi- dent and CEO for ASA. Speaking of transitions, also in late May ASA transitioned to a new association management system called Impexium. The new system is designed to manage all membership and education program- ming, as well as other business activities. The user interface is simpler and more user-friendly for members, and transac- tions are quicker, easier, more reliable and better able to accommodate multiple elec- tronic devices. Although it was a relatively AssociationManagement System Up and Running
By Cynthia D. Banks | ASA Interim CEO A lthough times of transition can be trying, I’m
honored to have been asked this past May to step in as ASA’s Interim CEO, upon Bob Stein’s departure after 12 years at ASA’s helm. Recently
retired after 15 years from my position as Director, Los Angeles County Depart- ment of Workforce Development, Aging and Community Services, I also served as a Board of Supervisors appointed member-at-large for the San Bernardino County Workforce Investment Board and, in 1995, received the West End YWCA Woman of Achievement in the area of womens rights. Having served on the ASA Board of Di- rectors and chaired its Strategic Planning Committee, and having worked with ASA for six years during my 15 years in the aging sector—it is a privilege to help ASA through this time. Also, Stein continues on temporarily in an advisory capacity to help with the transition. I look forward to assisting the talented ASA senior staff, such as Chief Operating Officer Robert Lowe and Vice President of Education Carole Anderson, in imple-
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Aging Today September–October 2019
California’s Master Plan for Aging: putting the Golden State’s aging population front and center
able future. A successful Master Plan will anticipate and respond to needs from a human perspective, engaging both public and private sectors in systems-based solu- tions that touch all major areas of life ex- perience (e.g., health, human services, housing, transportation and more). Instead of a traditional planning exer- cise that prioritizes the needs of a cur- rently fragmented system, this Master Plan can reframe system organization, funding and service delivery, based on what matters most to the people the plan serves—placing older Californians, their families and their caregivers at its center. The SCAN Foundation ( thescanfounda tion.org ), West Health ( westhealth.org ) and Archstone Foundation ( archstone. org ) uphold the following five elements as critical to the Master Plan’s success, ensuring that it fully reflects what matters most to older Californians and their families. Older Adults Thriving = Health, Finances, Self-Worth, Environment and Community . Californians’ ability to thrive while aging with dignity and inde- pendence reflects the intersection of basic human needs, such as health (physical, psychological and social well-being); fi- nances (financial well-being); self-worth (purpose and empowerment); environ- ment (supportive services, housing, food and transportation); and community (family and friends). A successful Master Plan will recog- nize the interdependence of these needs and develop approaches that recognize and address all of them. People First. Older adults should have access to systems that are responsive to the individual as a whole—not idiosyn- cratic systemparts based on their funding source, the administering agency or the local oversight entity. A successful Master Plan will ensure that individuals can readily access the information and ser- vices they need, when they need them— regardless of eligibility distinction, income level or place of residence. Cross-SectorCollaboration. It is time for aging issues to be addressed outside the traditional spheres of health and human Five Critical Elements of the Master Plan
By Bruce Chernof , Shelley Lyford and Christopher Langston O n June 10, 2019, California Gov. Gavin Newsom issued Executive Order N-14-19 ( tinyurl.com/ y6pusmaw ), calling for a California Mas- ter Plan for Aging (Master Plan). In his Executive Order, Newsom outlines the broad framework for a Master Plan pro- cess, including state-level input, stake- holder engagement and a firm deadline of October 1, 2020, for completion. The process is well underway, and vot- ers—nearly half of whom are providing care, or have provided care to an older adult or person with a disability—are READY. A survey ( WeStandWithSeniors. org/july-survey-results/ )—commissioned by the nonpartisan campaign We Stand With Seniors ( WeStandWithSeniors.org ) and conducted in July showed that more than 75 percent of voters support Gov. Newsom’s Executive Order and will hold the state accountable. This crosses politi- cal parties and geographic regions, is nearly identical across all age groups and is high among those with differing ethnic backgrounds. The significance of the Executive Order cannot be understated: at no time in the past has a California governor committed leadership and resources to whole-scale systems planning tomeet the needs of Cal- ifornia’s aging population. As heads of three organizations that have steadfastly dedicated their time to educating Califor- nia’s policymakers on the critical need for a Master Plan, we applaud Gov. Newsom for his visionary leadership and expedient, aggressive goals for creating and imple- menting a Master Plan. This marks a his- toric milestone on the road to overcoming system-related challenges facing older Californians and meeting their needs through a thoughtful, comprehensive and outcomes-oriented strategy. While a major first step, the Master Plan is only one stride on the long path ahead. To succeed, California’s Master Plan must have a singular focus: to design systems to answer the needs and experi- ences of older adults and the families who stand by them, now and into the foresee-
services, or as solely the responsibility of the state or public sector. Many state agencies—along with a wide range of pri- vate entities—contribute greatly to the experience of aging in California; these entities include housing, transportation, higher education and veterans affairs, among others. All stakeholders need to be equally engaged, with strong leadership from the governor to ensure a holistic solution to California’s infrastructure and care sys- tem challenges. A successful Master Plan will establish a framework that draws in new partners and spurs collaborative in- novation across public, private and inde- pendent sectors. This will mean equal This Master Plan could affect how society thinks about, plans for and responds to aging. accountability for all entities to creative- ly and comprehensively address Califor- nia’s aging population’s needs, through a sound financing structure, now and into the future. Care Coordination. California’s sys- tem of care is frequently fragmented and poorly coordinated. All too often, health services are disconnected from equally important social support services; hospital-based care is detached from homecare; and critical wellness needs such as oral health, behavioral care and nutrition fall through the cracks. Exam- ples of systems we should look to as mod- els for scaling include the following: √ Age-friendly hospital emergency departments: Emergency departments designed for older adults’ needs conduct comprehensive health assessments with an interdisciplinary team and coordinate services for home- and community-based aftercare. √ PACE (Programs of All-Inclusive Care for the Elderly): For low-income
older adults, these programs are the gold standard of comprehensive, coordinated care for people whowant to age in place in the communities they love. As we plan for the future of aging in California, we must keep care coordination at the front and center of our discussions. Aging: It’s All of Us. Negative stereo- types and fears of aging have historically pushed aging issues into the background. This Master Plan has the potential to re- imagine aging—affecting how society thinks about, plans for and responds to the life changes that comewith aging. The planning process should initiate a re- freshed conversation about aging, as these issues are not limited to individuals older than a certain age, but also affect young people, families and communities. As Gov. Newsom noted, the Golden State is graying rapidly. All of us, young and old, share a stake in planning an age- friendly future. A Master Plan that en- ables older Californians to age well at home enriches all of our communities, and the lives of the diverse individuals who live in them. The SCAN Foundation, West Health and Archstone Foundation stand ready to work with Gov. Newsom, his administra- tion and the legislature, alongside leaders across public, private and philanthropic sectors to develop aMaster Plan for Aging that will well serve Californians for gen- erations to come. n Bruce Chernof is president and CEO of The SCAN Foundation in Long Beach, Calif. Shelley Lyford is president and CEO of San Diego–based West Health and a commissioner on the California Commis- sion on Aging. Christopher Langston is president and CEO of Archstone Founda- tion in Long Beach. For updates about Cali- fornia’s Master Plan for Aging, please see the online version of this article at www. asaging.org/blog/californias-master- plan-aging-putting-golden-states-aging- population-front-and-center . in Las Vegas to become Rennie’s and Rudy’s guardian. As Rennie left the courtroom, she said she felt as if “a rope around my neck has been removed.” By January 2019 Rennie faced anoth- er battle. This time, health problems pre- vented her from seeing April Parks being led out of a Las Vegas courtroom in hand- cuffs upon receiving a prison sentence of between 16 and 40 years, imposed by Judge Tierra Jones. Two months earlier, Parks had pled guilty in two separate cases to three counts of elder exploita- › continued on page 4
The rocky guardianship debate: does it prevent or perpetrate abuse?
Victims described losing their life savings and their dignity. Rudy and her daughter Julie Belshe. At that time, April Parks, a private fidu- ciary, had been appointed by a court With that brief exchange, Judge Steel terminated the guardianship that had since 2013 haunted Rennie, her husband
By Paul Greenwood S o you don’t really need a guardian?” asked Judge Cynthia Dianne Steel, Eighth Judicial District Family Court, of Rennie North during a June 2015 hearing in Nevada. “True,” replied North. “Do you want a guardian?” the judge probed. “ No ,” North emphatically responded.
Aging Today September–October 2019
dictums, “use it or lose it,” and “use it and regain it.” He also saw “Alive Inside,” a documentary that chronicled the effects of music on dementia patients, and re- searched neuroplasticity. His hope was to help slow the brain’s decent into deep de- mentia, or to ward it off for longer. “Why not do more with technology, for people who need us the most, and create an opportunity for engagement?” Unkle asked. “Engagement is the common de- nominator for any dramatic impact on brain health.” Unkle is frustrated by the common long lag time between dementia research findings and implementation in the aging services sector. “At the Aging in America Conference, I heard someone say that it generally takes 18 studies and 10 years be- fore any findings from research get ad- opted,” he said. “Well, we can’t afford that delay!” He saw a product similar to Birdsong at a conference years ago, and found the funding to do a double-blind study on put- ting a flat screen at each bedside. Study re- sultswere positive, showing improvements in cognitive functioning on the Montreal Cognitive Assessment, a lessening of de- pression on the Geriatric Depression Rat- ing Scale, improvements in psychological well-being from the Affect Balance Scale and a dramatic lowering of caregiver stress. Unkle sought a partner who could produce such a tablet at a more reasonable price, but was unsuccessful, so he hired a designer and developer to make an afford- able product and connected with France’s Tmm Groupe to have it mass-produced and installed in every resident’s room in the nursing care section of his community. At first, aides and Unkle thought resi- dents would passively watch and listen to the devices, but instead a much greater Guardianship and abuse › continued from page 3 tion, two counts of theft and one count of perjury. At the sentencing hearing, multiple victimsmade impact statements. They de- scribed losing their life savings and their dignity. Rudy North compared Parks to Hitler and told the court, “This lady should be banished.” Another victim, Barbara Ann Neely, described how Parks had isolated her from family and friends. “She was not a guardian to me; she did not protect me. As each day passed, I felt like I was in a grave, buried alive,” said Neely. These chilling accounts of how a private guardian and her co-defendants were able to seize control of the lives and the assets of numerous older adults have caught the attention not only of advocates but also of Billie Mintz, a film producer and director. In May 2018, he released an investigative documentary called “The Guardians.” I have watched this film twice, and I am now urging every probate court judge, every elder law attorney and every Adult Protective Services case worker in the United States to make this mandatory viewing. I have been a lawyer for more than 40 years, both in the U.K. and in California. For 25 years, I was a prosecutor at the San Diego District Attorney’s office, where for Egregious Abuse Exposed in Documentary MindAlert Award winner › continued from page 1
‘Our need to be relevant and purposeful never leaves us.’ He and the aides soon noticed that some previously non-verbal residents were beginning to speak after interacting with Birdsong. One woman, who was originally from Germany, found the ca- thedral (with help from aides) where she was married, and discovered apps like Google Earth and Google Street View to see other sites in her native country. She became so excited shewanted to teach her aides and others around her how to speak German. “It shows that our need to be rel- evant and purposeful never leaves us,” said Unkle. Staff at Westminster-Canterbury were enthusiastic about Birdsong, as were the residents, because it sparked joy. Residents’ families agreed, because it became much easier to engage with spouses, partners and parents—loved ones they thought had been lost to them. Using Birdsong, a resi- dent could be part of a wedding held far away, or meet great grandchildren living on different continents. They could laugh with visitors over quirky cat videos or rem- inisce about their overseas travels. One Greek resident shunned the tablet until the staff found him a Greek music website and an online Greek newspaper. Now, when his wife visits, she complains of having to com- pete with Birdsong for his attention! Birdsong Flies into aWider World As soon as he was convinced of Birdsong’s ability to improve the lives of people with dementia, Unkle released a cloud-based percentage than they had imagined spent time exploring topic categories, especially travel and lifelong learning. “It shamed me a bit that we were so off in our expec- tations,” Unkle says. The sad reality is that for too long guard- ianship abuse has been a hidden secret in this country, despite the best efforts of victims and their families to tell their sto- ries. And it would benefit us all if we could find the right balance in seeking a remedy. In my experience, there appears to be a widening gulf between advocates who de- scribe guardianship as evil and defenders of guardianship who refuse to accept that 22 years I headed up the Elder Abuse Pros- ecution Unit. I have heard many shocking tales of elder abuse during that assign- ment, including homicides, but rarely have I been so shocked or moved as I was by what I learned from the Parks case. Thus, I ask this question wherever I speak across the country: “Could there be an April Parks working as a guardian or conservator in your jurisdiction?” For example, in June 2019, William S. Harris, the husband of the former presi- dent of the now-defunct Ayudando Guard- ians—one of New Mexico’s largest non- profit guardianship firms—pled guilty to conspiracy to defraud vulnerable and spe- cial needs clients in a federal U.S. District courtroom in Albuquerque, before Judge Jerry H. Ritter. As part of his plea agree- ment, Harris will receive a seven-year prison sentence. A September 2019 trial date has been set for three other defen- dants. What happened in Nevada and New Mexico is occurring in every other state. Guardianship: Evil or Under-Regulated?
‘Elder law attorneys need to be ever vigilant.’ On the other hand, I also have seen a fiduciary take full advantage of their posi- tion to fleece a victim. In one notable case out of San Diego, Teresa Laggner, a pri- vate fiduciary who was part of the San Diego County multidisciplinary financial abuse specialist team and who prepared the booklet, “How to Choose a Caregiver,” was convicted in federal court of stealing thousands of dollars from client trust ac- counts in order to feed her secret gam- bling addiction. She was sentenced to 18 months in prison. Significantly, several states have intro- duced legislation that marks a shift away from the last resort concept of guardian- ship and toward a supported decision- making process. Such a trend is consistent with Article 12 of the United Nations Con- vention on the Rights of Persons with Dis- abilities, which states that such persons have the right to make their own deci- tablet for home and community use. Sold via the Internet and distributed through CDW, it can be used in any English-speak- ing country. This tablet is for adults who want to stay connected to family and friends while enjoying hours of stimulat- ing entertainment and improving their brain health. It’s geared toward older adults, and still has the larger buttons and simple navigation. Its offerings include games, travel information, lifelong learn- ing, movies, music and videos. Unkle says that other senior living communities wanting to cultivate similar engagement and joy in their residents can customize their group of tablets with that community’s name, and sermons from local churches. the current system unchecked lends itself to opportunities for exploitation. During my career, I have seen exam- ples when a victimhas benefitted frombe- ing conserved by a probate court. I have witnessed professional guardians inter- vene on behalf of an exploited older adult by rapidly involving law enforcement, as- sisting in freezing a suspect’s bank ac- count and testifying at trial.
“Our mission is not to make a ton of money—we’re a nonprofit—our mission is widespread adoption to ‘bend the curve’ on this dreadful condition [dementia]. If we can … provide moments of entertain- ment and joy to a ton of people, then mis- sion accomplished!” said Unkle. Unkle believes that winning the ASA MindAlert Award will help to spread the word. “The right thing is to get it adopted; as more and more are sold, we can keep … lowering the price so more [people] can benefit,” he says. “As a nonprofit, you are owned by society; we ought to be [using] this opportunity to do the greatest good for the greatest number—the whole mis- sion is widespread impact to help a lot of suffering people.” n Paul Greenwood recently retired fromhis position as deputy district attorney in San Diego, Calif. He is spending his post retire- ment time providing trainings for law en- forcement and prosecutors around the country on how to put a criminal case of elder abuse together. He serves on the Aging Today Editorial Advisory Committee. sions and that governments have the obli- gation to support them in doing so. It is my hope that as the guardianship abuse debate heats up we can find some middle ground that will provide a mea- sure of greater protection for our most vulnerable populations that may be in danger of being exploited—whether by scammers or guardians. Our probate courts need more training and resources. Judges should be encour- aged to look for appropriate supported decision-making alternatives and dis- courage an atmosphere of familiarity. Professional conservators and guardians should be more carefully held to account. Law enforcement and prosecutors must understand that allegations of guardian- ship abuse are not “just civil matters.” And elder law attorneys need to be ever vigilant on behalf of their clients to ensure that another April Parks is not lurking, ready to pounce. Describing the impact of what Parks did to him and his family, Rudy North said, “Our souls were scarred.” And he has chal- lenged us all with this rallying cry: “What we want to do is bring this terrible, horrific racket down. We want it to stop.” n
Older Adults and Access to Justice Charles P. Sabatino, Guest Editor From a human rights perspective, “access to justice” has been defined as: “The ability of people to seek and obtain a remedy through formal or informal institutions of justice, and in conformity with human rights standards.” While the United States prides itself as a just society, one access to justice index, developed in 2014, gives the 50 states, plusWashing- ton, D.C., and Puerto Rico, an average score of only 39 out of 100, with scores ranging from a low of 15 inMississippi to a high of 68 inWashington, D.C. This poor performance must give us pause in addressing access to justice needs for society as a whole, and especially for older individuals who may be economically or socially isolated. TheWinter 2019−20 issue of Generations will take on this subject in a practical way and contains three sections: The first examines several common situations where the rights of older persons are vulnerable and what professionals in the field of aging need to know about pursuing effective avenues of redress; the second addresses the ups and downs of policy impacting access to justice; and the third showcases models for better access. Generations
COMING UP IN Winter 2019–20
Aging Today September–October 2019
AGING WITH OPTIONS
The evolving role of male family caregivers
Men represent four out of ten unpaid family caregivers in America. In the process, these men are breaking stereotypes and misconceptions—not only in taking on the caregiving role, but also in the specific tasks they perform. Contrary to popular belief, male family caregivers are not just managing finances or helping with housework. They also are assisting with dressing, bathing and toileting, as well as performing medical and nursing tasks such as injections, tube feedings, wound care, administrating medications and handling medical equipment. Such roles are not exclusive to male care- givers, of course. In 2012, the AARP Public Policy Institute released a groundbreak- ing report that found the role of family caregivers (regardless of gender) has ex- panded dramatically. The report, Home Alone: Family Caregivers Providing Com- plexChronicCare , revealed that these care- givers were performing medical–nursing tasks once provided only in hospitals, and often with little support or guidance sity, the army of family caregivers provid- ing care across the country. Caregivers PerformComplex Care, with Little Training
By Jean C. Accius E ditor’s Note: This column, “Aging with Options,” is sponsored by the AARP Public Policy Institute. Col- umn content will focus on innovative solu- tions to change systems and empower individuals and their families to thrive at home and in community. AARP has long studied and supported family caregivers and the important role they play in helping family members age with dignity, independence and purpose. Being a family caregiver—providing un- paid care to a parent, spouse, partner, friend or other adult loved one—is hard work. It can also be rewarding. In the United States, family caregivers play a central role in the healthcare sys- tem. They also deliver supportive services for individuals with a chronic, disabling or serious health condition. While the “typical” family caregiver is a 49-year-old woman, caregivers on the whole are becoming as diverse as America’s popula- tion. Men, a group traditionally not recog- nized for performing caregiving tasks, are rising to the challenge. Men represent four out of 10 (or 16 million) of the more than 40 million Americans who are unpaid family caregivers ( tinyurl.com/ y35vxpk5 ). These husbands, brothers, sons, sons-in-law, partners, friends and neighbors are joining, by choice or neces-
from health professionals ( tinyurl.com/ y6f6qf ps ). The report uncovered short- comings in how hospitals passed the ba- ton to family caregivers at the time of discharge, including the lack of training family caregivers received given the scope and complexity of themedical and nursing tasks they were tasked with performing. In response to this major finding, AARP created a model state-level bill called the CARE (Caregiver, Advise, Re- cord, and Enable) Act to support the mil- lions of family caregivers in America who are performing complex medical–nursing tasks with very little to no training. The CARE Act is now law inmore than 41 states and territories, calling for hospi- tals to record the name of family caregiv- ers at the time of a loved one’s admission; to provide family caregivers with ade- quate notice prior to hospital discharge; and to provide basic instruction on the medical tasks they will be performing when their loved one returns home. Family Caregiving, Re-Examined Building on the landmark Home Alone study, AARP recently released Home Alone Revisited , which seven years later re-exam- ined the issue by taking a deeper look into the role of family caregivers in performing these medical and nursing tasks and their experiences with doing so ( tinyurl.com/ y5fd55nn ). This study examined the issue through a series of lenses, including gen- der, generational and multicultural. The Home Alone Revisited study found that 40 percent of family caregivers per- forming medical and nursing tasks were men. As part of its focus on the experience of specific demographic groups, the report further revealed that while male and fe- male family caregivers were doing similar medical–nursing tasks, men reported that they struggled more with certain tasks, such as managing pain, helping with in- continence and preparing special diets. It also found thatmen aremore likely to indi- cate that they would be helped by receiv- ing additional instruction at home. These notable findings shed light on the daily struggles and complexities of male family caregivers, as follows: √ Male family caregivers performing medical and nursing tasks experienced challenges preparing food for special diets largely because they didn’t understand what to do (12 percent compared to only 1 percent of females who indicated having the same issue). √ Slightly more than two in 10 male family caregivers (20 percent) reported
Men are less likely to receive post-discharge instruction on performing complex care tasks. Such findings point to the reality that caregiving is not easy for any caregiver, men included. Particularly with the CARE Act now in place in many states (with states at varying stages of imple- mentation), hospital officials say they are recognizing the need to instruct all family caregivers on how to perform complex care before discharge, and many are do- ing so. But the data from the 2019 Home Alone Revisited study underscore that many family caregivers still need help. Male family caregivers are among those who feel most unprepared and, in their case, even uncomfortable in taking on certain tasks, perhaps as the result of tra- ditional male roles and stereotypes. The bottom line is that family caregiv- ers are invaluable members of the health- care team, and our understanding of who is a family caregiver must expand. Recog- nizing that men constitute a major seg- ment of family caregivers is a key part of that new awareness. n Jean C. Accius, Ph.D., is senior vice pres- ident of Thought Leadership and Interna- tional Affairs at AARP, in Washington, D.C. Learnmore about resources to support family caregivers who are performing med- ical and nursing tasks by visiting the AARP Public Policy Institute Home Alone Alli- ance site: www.aarp.org/ppi/initiatives/ home-alone-alliance/. they experienced difficulty getting pre- scriptions for pain medications, a higher reporting number than for female care- givers (14 percent). Men administering prescription medications also were more likely than women to be concerned about giving their family member either too lit- tle (22 percent for men vs. 16 percent for women) or giving too much (31 percent vs. 25 percent) of a medication. √ Significantly, when their care recipi- ent is hospitalized, men are less likely to receive instructiononhowtoperformcom- plex tasks after discharge. More than one- third (36 percent) ofmale family caregivers who had a family member hospitalized in the last 12months received no instructions for any medical/nursing tasks that had to be performed at home, compared to 23 percent for female family caregivers. Growing a More Accurate Vision of the Family Caregiver
ASA Leadership Awards
Awards Open to All Professionals in the Field of Aging • Hall of Fame Award (preference may be given to current ASA members) • Graduate Student Research Award • MindAlert Award Awards Open to ASA Members Only • ASA Award • Gloria Cavanaugh Award for Excellence in Training and Education • Mental Health and Aging Award (MHAN) • Award for Excellence in Multicultural Aging (NOMA) • Award for Religion, Spirituality and Aging (FoRSA) Nominations will be accepted until October 18, 2019. Recognizing Leaders in Aging ASA takes pride in recognizing leaders in the field who contribute to the success of ASA and the field at large. Nominate yourself or a colleague for one of the awards below! Awards will be presented at the 2020 Aging in America Conference, March 24-27, 2020, in Atlanta. Visit www.asaging.org/awards for information and to submit a nomination.
Aging Today September–October 2019
Aging Today September–October 2019
The business of aging: spinning gold out of the “silver” economy This In Focus on the “business of aging” explores the consumer marketplace targeting older adults—a competitive arena that could grow products and services to boost older people’s well-being and enjoyment. The value proposition is not just dollars—the “gold” is a happier, healthier population of older adults. Lori Bitter scopes the potential value of the longevity economy for businesses and consum- ers alike; Paul Irving addresses the dichotomy between the corporate sector’s demand for talent versus how companies perceive and treat older workers; Kezia Scales demonstrates how the homecare indus- try must support—and retain—its workers; Lucy Theilheimer and John Feather use Meals onWheels America as a case study in how In a competitive economy, experience should take center stage
CBOs can succeed when partnering with health plans; Anoopa Sun- dararajan outlines the concepts of human-centered product design; Julia Randell-Khan profiles entrepreneurship guru Elizabeth Isele; and Michael Hodin highlights trends in the global “silver” economy.
adults. Not only are they increasing in numbers, they are a growing source of ex- perience and know-how. Research sug- gests ( tinyurl.com/y2obshqd ) that older adults’ contributions and emotional stabil- ity enhance work environments. Their complex problem-solving skills and nu- anced thinking lend to effective workforce teams ( tinyurl.com/y2k45cqk ). Discrimination, AgeismPersist Yet despite their qualifications, older adults are repeatedly turned away from job opportunities. Companies focus atten- tion on the recruitment and retention of younger workers, who, according to recent polling (tinyurl.com/y3x27en8 ) , often view older counterparts in a negative light. Job postings still reference a maximum num- ber of years of experience. According to a generations. From adventure travel to food and wine to family vacations, older adults prefer to share experiences instead of gifting “things.” They also share these experiences via social platforms or within family circles. This sharing impetus ex- tends to exploring family history and heri- tage, hence the growth of genealogy sites and DNA testing. A preference for “little luxuries.” The new older adult appreciates not just peak experiences, but also top products— luxuries that span from gourmet ice cream to homewine cellars to designer bifocals to a meal in a celebrity chef’s restaurant. In- herent in all things experiential is sharing the experience on social media. Home maintenance has created an in- dustry of gig workers who provide services older adults are unwilling to do or can’t do. Angie’s List, HomeAdvisor andTaskRabbit all cater to thismarket. The segment of this home services economy ripe for innovation is the home organization–de-cluttering business. Organizations do exist, e.g., the National Association of Senior Move Man- agers, but this is a fragmented industry. Young families don’t want their parents’ furniture, collectibles and memorabilia. And, as older adults downsize and want to get rid of possessions, there is enormous (and growing) market opportunity. Home is the center of care. As thema- jority of older adults plans to age in their homes, professional homecare providers
By Paul Irving T he demographic age shift is gen- erally understood by now. In the United States, about 10,000 peo- ple turn age 65 each day; by 2035, Ameri- cans of retirement age will for the first time outnumber those who are younger than age 18. There is an awareness that population aging will have a profound ef- fect on institutions of all types—none more so than companies feeling the im- pacts of shifting workforce and consum- er demographics. American companies are in a war for talent as they search for advantages in an intensely competitive economy. Workforce shortages are already a challenge in much of the developedworld. One solution is hid- ing in plain sight: hire and retain older tions of older consumers and-or caregiv- ers, likely the Greatest and Baby Boom generations. But members of these co- horts differ in how they age—and in how they perceive their aging. Thus, it is criti- cal that companies access key consumer insights, especially because people, as they age, can’t always relate to the brands they once valued, thinking that these brands no longer speak to their needs. Market Opportunities and Trends Solutions for the Greatest Generation were designed for a “birds of a feather flock to- gether” mindset—think suburban living and resort-style senior living—whereas baby boomers require curation: they value individuality and specialized approaches. The personal health and fitness con- sumer category is growing . While older generations prefer group programming, the newer generations of older adults pre- fer personal trainers, individualized meal programs and customized vitamin and supplement regimes. With high rates of obesity and diabetes, companies in this space are poised for growth. Experiences areking. The Baby Boom Generation ushered in the “age of experi- ences,” and technology has enhanced this trend’s growth. Sometimes the language of experience is “memory-making,” espe- cially when it involves a family’s multiple Longevity market trends › continued from page 1
› continued on page 8 showed that the Baby BoomGeneration is understandably stressed about having enough money as they age. There is inno- vation around annuities and reverse mortgages, but these products have re- ceived mixed reviews, so selling any new versions is difficult. Consumers need more education to understand these prod- ucts’ uses and value. Cannabis andCBD for painmanage- ment. The biggest category of consumer interest over the past two years is canna- bis and CBD. As states legalize medical and recreational cannabis, older adults are embracing it for pain management, help with sleeping and more. CBD prod- ucts have flooded the market with little evidence of efficacy for all of the claims made. This category has a Wild West feel to it, as start-ups appear daily; there is no clear market leader, but revenue projected by 2022 stands at $32 billion. Companies in these trending catego- ries seek partners, just as they do inves- tors. While it can take for-profit and non- profit businesses time, imagination and key consumer research to create valuable partnerships, consumers benefit most from a careful development process. n Lori Bitter is a marketing, research and development consultant, speaker and au- thor in the Bay Area, and author of The Grandparent Economy: How Baby Boom- ers Are Bridging the Generation Gap (Ithaca, NY: Paramount; 2015). adults slow economic momentum by remaining in the workforce too long. Per- vasive ageism is exacerbated by age segre- gation in business and the broader society. Many still believe that young people should be in school, middle-age people
The cannabis market has a Wild West feel to it. recent AARP study ( tinyurl.com/y4x4w 6du ), more than 60 percent of respondents older than age 45 reported witnessing or experiencing age-based discrimination in the workplace. Why does this disconnect remain? There is still a widely held view that older seek innovative ways to deliver care and services supporting the daily activities of older adults and their family caregivers. Applications for voice-activated devices (e.g., Amazon Echo and Google Home) that enable aging in the home are increas- ingly popular, as are services such as gro- cery delivery, medication reminders, care support and rides. Products that have been used in the home for years are being re-engineered for aging at home. Consumers and care- givers are thinking about toileting and cleaning, maintaining odor control and keeping the home clean and infection- free. Expect robotics to assist with mun- dane in-home tasks. Pet ownership is on the rise . The Baby Boom Generation has the highest divorce rates and themost aging singles. Pet owner- ship, as ameans to avoid social isolationand loneliness, is more prevalent in this cohort. This indicates soaring sales of high-end pet food, pet insurance and accessories. This market also has created a service economy around in-home grooming, dog walking and sitting, veterinary services andmore. Financial services. The 2018 Hacking Longevity study revealed elders’ lack of understanding of financial products for retirement saving and, like other studies,Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16
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