AgingToday_NovDec2019

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Remote Caregiver program p. 3 | Caregivers for Minnesota’s rural veterans get respite and relief.

Help for hoarding p. 15 | Signs, symptoms and routes to recovery.

Aging

Covering advances in research, practice and policy nationwide www.asaging.org

NOVEMBER–DECEMBER 2019 volume xl number 6

the bimonthly newspaper of the American Society on Aging t i t l f t i i t i

Suicide prevention in long-term-care facilities

In this issue

FORUM Immigrants and LGBT elders—what do they have in common? page 3 AGINGWITH OPTIONS The future of work is still powered by humans page 5 IN FOCUS America’s veterans: their

ed living care or board and care, this means approximately 2.5 million older adults reside in long-term-care facilities ( tinyurl.com/y3qwxdz9 ). In a recent study, over a 13-year period, approximately 2.2 percent of suicides among adults ages 55 years and older were associated with long-term-care settings in some manner ( tinyurl.com/y3hecrp3 ). But for many older adults, the opportunity to live in a caring, Too often long-term-care facilities ignore their older adult residents’ mental health and social needs. well-staffed senior living facility may provide the necessary well-being and connectedness that often is absent when elders live independently. Decrease Suicide Risk, Increase Protective Factors In following the public health approach for suicide prevention, the Education

By Jerry Reed

I n 2017, slightly more than 8,500 older adults older than age 65 died by sui- cide. Put another way, 16.85 percent of suicide deaths were older adults ( tinyurl. com/y6sjjy9j ). Without a concentrated ef- fort, and given the growth of America’s older adult population, what is a serious problem nowwill surely escalate. On July 30, 1996, the U.S. Senate Spe- cial Committee on Aging held a hearing on Suicide and the Elderly: A Population at Risk ( tinyurl.com/y6gzntmj ). As a senate staffer for Sen. Harry Reid (D−NV), I at- tended that hearing. At that time, Sen. Reid shared with me and the public that he had lost his father to suicide many years earlier; thus, he wanted to champi- on suicide prevention, especially older adult suicide—both then and now a major unaddressed public health issue. With 5 percent of people ages 65 and older in the United States living in nursing homes, receiving congregate care, assist- America’s veterans—the truths and realities of the military legacy By John Rowan T he truism about lies—there are lies, there are damn lies and there are statistics—is relevant in un- covering reliable numbers about veterans of the U.S. Armed Forces. In Washington, D.C., the figure cited by legislators and media for the number of living war veterans is 21 million. Yet ac- cording to the National Center for Veter- ans Analysis and Statistics in the Depart- ment of Veterans Affairs (VA), there were just over 20million living veterans in 2015 and 20.4 million in 2016, as more of those who served in the Global War on Terror traded in their uniforms for civilian garb (the year cited by the VA is the federal fis- cal year, Oct. 1–Sept. 30.) The figures given by the VA, however, tend to be somewhat higher than the totals from the U.S. Census’ American Commu- nity Survey, which numbered the veteran population in 2016 at 18.5 million. This is the same total from the VA for 2017, the last

Development Center’s (EDC) aim is to decrease suicide’s modifiable risk factors and increase protective factors. Risk fac- tors for all older adults include access to lethal means (most often firearms), de- pression and other mental health prob- lems, substance abuse and misuse (including with prescription medica- tions), physical illness, disability, pain and social isolation ( tinyurl.com/yx am2z4 ). Protective factors include care for men- tal and physical health problems, social connectedness and skills in coping and adapting to change ( tinyurl.com/ y3qv5emw ).

lives and legacy pages 7–11

ENGAGED AGE One teen’s mission to stem elder isolation page 11 The 4Ms? Not a confection,

but a movement to improve eldercare pages 13–14

› continued on page 16

2019 FORSA Award winner Marita Grudzen: a fierce proponent of spirituality and aging

A SA’s Religion, Spirituality and Aging (FORSA) Award recog- nizes outstanding individuals, programs and services in religion, spiritu- ality and aging, in an effort to inspire more spiritual exploration within the field of ag- ing services. The 2019 FORSAAward recip- ient is Marita Grudzen. Marita Grudzen was drawn to religion early on—as a preteen she dreamed of be- ing a nun. She fulfilled this dream in 1959, and although her spiritual path has evolved considerably since then, she is no less passionate, at age 78, about employing her beliefs in service to others, particular- ly older adults. As a nun in the Maryknoll Order, Grudzen spent eight years in formation and then serving poor and disenfran- chised people, and also caring for the Or- der’s older sisters. In the 1960s, wanting more flexibility from the Church in how she did her work, Grudzen, along with a group of her fellow sisters, opted to leave the Order. She eventually met and mar- ried a former seminarian; they have been married for more than 51 years and have

Marita Grudzen

two grown daughters and three grand- children.ThecoupleoftenvisitsGrudzen’s former fellow sisters, traveling overseas to assist them in their charity work. The Stanford Years Now retired after 28 years as a founding member and deputy director of the Stan- ford Geriatric Education Center and as a course coordinator at Stanford’s Center for Education and Research in Family and Community Medicine, Grudzen’s work has focused on spirituality in aging and at the end of life, including ministering to residents in long-term-care facilities and training these facilities’ staffs. In the early 2000s, Grudzen and Stan- ford physician Dr. Bruce Feldstein re-

year for which there are “reliable” figures, although the VA projected that there were 19.6 million living veterans as of the end of July 2019. Of these, women number 1.9 million, or 9.7 percent of the total. Older Veterans—a Fast-Growing Cohort The oldest old—ages 85 and older—com- prise the fastest growing segment of the population. Just about all of our nation’s remaining WWII and Korean War veter-

› continued on page 7

› continued on page 4

Aging Today November–December 2019

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Update

Aging

A longer-term goal is to define and im- plement a diversity, equity and inclusion vision and strategy for the ASA Board, staff and membership. By 2024, ASA wants to train 70 percent of staff, the Board and Constituent Group leaders in this curriculum. To further bolster ASA’s role and voice as one of the nation’s leading aging-sector advocates, ASA will expand member en- gagement in public policy development and advocacy; and further shape the ad- vocacy message and mission via member input and Public Policy Committee work- group efforts. ASA also will continue to partner with other organizations on pub- lic policy pushes. See this space for regular progress up- dates on the Strategic Plan—we are com- mitted to and energized about moving ASA into a brand-new era of service, edu- cation and advocacy! Summer 2019 saw numerous calls for ac- tion and other advocacy pushes emanat- ing from ASA’s Public Policy Committee, co-chaired by Serving Seniors President/ CEO and ASA Board member Paul Downey and Director of Health Policy, West Health Policy Center, Amy Herr. The Committee urged ASA members to write to their elected officials in Con- gress, asking them to sign the Affordable Housing Credit Improvement Act—legis- lation to encourage developers to build much needed affordable, rent-controlled housing that could create or preserve 1.3 million affordable homes across the com- ing decade. The Committee also asked ASA members to contact legislators about reauthorization of the Older Americans Act, a vital support of many programs that help to maintain elders’ well-being and quality of life. ASA has joined SAGE in speaking out against the erosion of healthcare civil rights put forward by the Trump Admin- istration with its proposed altering of ACA regulations around gender, limited- English proficiency and disabilities. Ac- cess to healthcare is critically important for older adults and, because ASA opposes discrimination of any kind against any community, its Public Policy Committee is against these rule changes. The Committee publicly thanked Sen. Chuck Grassley (R−IA) for his intention to introduce legislation that would update and extend the Elder Justice Act. Elder mistreatment affects 1 in 10 older adults in America and ASA is gratified to have Sen. Grassley’s support in this area. As ASA staff, Board and volunteers work diligently to implement the new Strategic Plan, I salute all our members who have taken a stand on advocacy is- sues, and who will continue, with civility and respect, to fight the good fight! n WRITE TO US We welcome your responses both to Aging 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 ahood@asaging.org A Busy Summer for Public Policy Action

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

A new era: ASA standing stronger than ever for diversity and advocacy

and staff five years to complete goals cen- tered on leadership, membership, diversi- ty, equity and inclusion, and public policy and advocacy. What follows are some of the goals and intended outcomes, keeping in mind the Plan is, as of this writing, a living document. Under the leadership rubric, ASA will continue cultivating and strengthening the skills of leaders in the field of aging. Using its network of experienced leaders for inspiration, ASA will tell their stories in Aging Today and on our website (members will be surveyed for their sug- gestions on these leadership profiles). The goal, to be completed in 2019−20, is to achieve a minimum 10 percent increase in members’ knowledge of leadership attri- butes and skillsets. ASA also will develop alliances with traditional and non-traditional aging or- ganizations, including first responders and private-sector leaders, with the aim of aligning organizational goals to better serve older adults. The ASA membership model will be enhanced, modernized and reframed to championandconveymessages andcauses to attract broader membership diversity. The intent is to develop a solid value prop- osition for ASA’s business model—one that will demonstrate ASA’s ability to promote and support careers in the aging sector.

By Karyne Jones

T he topic of Ame­ rica’s increasing diversity figures large in the nation’s news media and politics. Which means ASA’s 2020 Aging in America (AiA) Conference theme, “Ex- amining the Needs of

Karyne Jones

Today’s Diverse Older Adults,” is on point. This important annual gathering will be held in Atlanta, a city known for its diver- sity, and as the birthplace of Martin Lu- ther King, Jr. Beyond racial and cultural diversity, AiA, which runs from March 24−27, will highlight the social constructs of ageism, racism, sexism and heterosexism, plus outlooks on positive and creative aging. The Hyatt Regency Atlanta (on famous Peachtree Street) is AiA’s conference headquarters, and I hope to see you all there (before you go, and while attending, please use hashtag #Aging2020). ASA’s New Strategic Plan Takes Off The ASA Board in March approved its Strategic Plan for Oct. 1, 2019, to Sept. 30, 2024, giving the Board, ASA leadership

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Union Bug

Aging Today November–December 2019

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FORUM

LGBT older adults and immigrant care workers: what do they have in common?

By Michael Adams and Jared Renteria T he generation of people in the LGBT community that helped (or watched) the Stonewall uprising shatter many limits society had imposed upon them now are aging in communities focused largely on youth and youth cul- ture. As members of this generation plan for the future, and the aging services sec- tor prepares to address their care and ser- vice needs, unique aspects of their experi- ence must be considered—particularly their need for paid caregivers, who often are immigrants. Estrangement from biological family is common in the LGBT community, with nearly four in ten LGBT adults in the Unit- ed States reporting that they have been “re- jected by a family member or close friend because of their sexual orientation or gender identity” ( tinyurl.com/y4b5cgn2 ). A chosen family, typically consisting of ac- cepting or LGBT friends and former and current partners, fills the vacuum created by this loss. As chosen families often thin with age, neighbors and other less connect- ed individuals sometimes help out, but the dwindling of this caregiver pool is happen- ing more often, as studies show that LGBT elders are twice as likely to be single and to live alone, and four times less likely to have children than their heterosexual counter- parts ( tinyurl.com/y5urygqg ). Partly a legacy of the solidarity formed during the height of the HIV/AIDS crisis, caring for one another in illness and in old- er age amongLGBTelders is prevalent: One study shows that 54 percent of LGBT elder- care recipients receive care from a partner, and 24 percent receive care from a friend ( tinyurl.com/y67o6e9n ). Though these ar- rangements can be mutually supportive, discrimination, caregiver burnout and iso- lation pose significant hurdles. Thus, LGBT older adults rely disproportionately on pro- fessional care. Depending upon circum- stances, professional care can alleviate iso- lation, provide respite and allowLGBTcare recipients to benefit from caregiving pro- vided by trained professionals.

cially to LGBT older adults, it also is seri- ously undervalued in the United States. Despite the work’s value, and the risks as- sociated with it (e.g., homecare workers’ high injury rates), the median hourly wage for direct care workers is only $11.03 ( tinyurl.com/y4kuol59 ). Many of these underpaid workers are immigrants. PHI estimates that “[I]n 2016, 25 percent of the direct care work- force were immigrants”—people who face significant hurdles under the best of cir- cumstances ( tinyurl.com/y262ldjq ). The percentage of direct care workers who are immigrants is growing, making those needing eldercare increasingly reliant on individuals not born in the United States. The immense challenges facing immi- grant direct care workers are well-known: One in two direct care workers leave the job within 12 months because of low wages, lack of benefits and opportunities to advance, and the work’s high demands ( tinyurl.com/y262ldjq ). Also, these workers nowmust copewith hostility from the fed- eral government—executive orders, immi- grant raids, draconian border policies and streams of anti-immigrant rhetoric. The current administration has wreaked havoc among immigrants from source countries of many direct care workers, ordering temporary bans on en- try of people frommany Muslim-majority countries; ending the Temporary Protect- ed Status programs covering Haiti, El Salvador, Nicaragua and Honduras; and imposing harsh policies at our southern border. Such an anti-immigrant posture has cost the workforce: 11,000 U.S. direct care workers are from “Muslim ban” countries, 34,600 are from Temporary Protected status countries and 69,800 are fromMexico. While many LGBT people, communities and organizations rightly oppose the fed- eral government’s anti-immigrant cam- paigns on humanitarian grounds, there are additional reasons to fight these poli- cies. The interdependence of LGBT elders and immigrant communities creates pow- erful reasons to work together on mutu- ally supportive policies, and to encourage aging services providers to do likewise. Proactive Policy Needed for All Caregivers

The nation’s population of people ages 65 or older will more than double by 2050, and diversity will increase in this cohort from one in five older adults being a per- son of color to one in three. As this occurs, immigrant eldercare workers may have more andmore in commonwith their care recipients. LGBT older adults have strong reasons to encourage policies that create better

and constructive communication be- tween employee and employer. Employers also can institute cultural competency trainings to help other em- ployees be sensitive to immigrant employ- ees and extend the welcoming environ- ment beyond training sessions. Providers can build connections with immigrant- supportive organizations in the commu- nity and connect immigrant employees to these organizations. To support these ef- forts most effectively, we need more data. More studies directly focusing on immi- grant direct care worker contributions, needs and prominence in serving LGBT older adults would benefit workers, elders and the aging services sector. LGBT older adults disproportionately rely upon paid caregivers as they age. Professional direct-care workers, who struggle with a devaluing of their con­ tributions and poor work conditions, are disproportionately immigrants. The rights and dignity of both LGBT elders and immigrant care workers are under assault by the Trump Administration and ascendant forces in America of big- otry and nativism. Given the intertwined interests of LGBT elders and immigrant care work- ers—and their common foes—these two communities should jointly oppose at- tacks on their well-being and collabora- tively advance policies and practices that allow LGBT older people to age with care and dignity, and to ensure that immigrant care workers are treated as the highly valuable professionals that they are. n Michael Adams is the CEO of SAGE, Advocacy and Services for LGBT Elders and Chair-Elect of the ASA Board of Direc- tors. Jared Renteria is a third-year law stu- dent at California’s Santa Clara University School of Law. tistics showing more than 9 million living U.S. veterans are ages 65 and older, with an estimated 4.7 million U.S. veterans overall living in rural areas ( tinyurl.com/ Participants reported improved health and quality of life, and reduced stress. yc7p8jb9 ), and a myriad combination of special considerations and challenges surfaces when it comes to caring for older veterans and their caregivers. › continued on page 4

‘LGBT older adults rely disproportionately on professional care.’

work conditions for all caregivers. One ex- ample is the federal RAISE Family Care- givers Act, which puts forth a national strategy to support family caregivers. Ad- ditionally, there are state-level Medicaid initiatives to expand data collection in or- der to increase workforce recruitment and retention, and to increase direct care workers’ reimbursement rates. It would invigorate the workforce to create new positions in the field, such as New York’s “advanced home health aide,” which expands the type of care paid professionals can provide, while offering workers access to a more robust profes- sional ladder. These kinds of policies not only are the right thing to do for workers, they also increase the quality and avail- ability of high-quality eldercare.

Moving Forward: Strategies to Support LGBT and Immigrant Communities

Employers of direct care workers should provide bilingual employee resources and trainings to facilitate better performance, higher retention rates, a welcoming envi- ronment and opportunities for effective

The Undervalued Immigrant Workforce

While professional eldercare is extremely important to society at large, and espe-

Collaborative employs “friendly” technology to care for older, rural veterans and their caregivers toll on a person,” he says. “Day by day, you are faced with tremendous loss.”

The troubling reality is that Jeff’s situ- ation is not unique, given our rapidly aging nation. By 2020, one in five U.S. adults will be older than age 65, repre- senting an “unprecedented” growth in the number and proportion of older adults, notes the Centers for Disease Con- trol and Prevention. Combine this with U.S. Department of Veterans Affairs sta-

By Charlotte Haberaecker J eff and Sheila married in 1977. Jeff, a Vietnam veteran who has battled post-traumatic stress, has cared for Sheila at home since her Alzheimer’s diag- nosis at age 56. He says the stress of caring for his wife is the hardest thing he has ever had to face. “It takes an emotional

Aging Today November–December 2019

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ceived a Templeton Grant to teach about spirituality and meaning in medicine. Grudzen saw that not every patient re- quired doctors to relate to them on a spiri- tual level, but “when [doctors] had a pa- tient with a challenging diagnosis or with mental health issues, or anxiety … religion and spirituality could be a source of sup- port,” she says. Thus, it was important that medical students be able to integrate a focus on spirituality, especially in serv- ing their older patients. It also had become clear to Grudzen, in working with elders—especially di- verse elders—that spirituality played a crucial role in aging, and that “[older adults] made decisions on healthcare ac- cording to their belief systems.” In subse- quent work with older immigrants and African Americans, in the field of what she and her collaborators later termed “ethnogeriatrics,” Grudzen was able to research and learn about culturally di- verse healing practices. “I was always interested in cultural diversity and was invited to be a founding member of an ethnogeriatric team in 1987, With the active engagement of more than 130 partners and stakeholders, the Collaborative’s Phase 1 (2016–2019), sup- ported by a national foundation grant of $2.5 million, led to improved health and quality of life of more than 1,100 vulnera- ble elders (many of whom were veterans) in more than 70 rural communities in Minnesota and North Dakota. 2019 FORSA Award › continued from page 1 Collaborative employs “friendly” tech › continued from page 3 Older rural veterans, like their civilian counterparts, often face isolation, demen- tia or limited financial resources. They may have unmet daily needs, such as transportation to medical appointments, companionship or help with challenging household tasks. A growing body of re- search ( tinyurl.com/y5dsyunl ) indicates that everyday social determinants like these—when compounded by struggles with wartime injuries or Post-Traumatic Stress Disorder—affect the health and well-being of countless older veterans. “Aging in Rural America,” a 2015 Health Affairs article ( tinyurl.com/y6g pa8vp ), found that rural adults “suffer dis- proportionately poorer health and worse outcomes” than do their urban counter- parts. A quantitative study in the Ameri- can Journal of Public Health ( tinyurl.com/ y2q4k28r ) found veterans living in rural settings had “significantly more physical health comorbidities” than their urban and suburban counterparts, and scored significantly lower in quality-of-life mea- surements. The same scholarly work ad- vised policymakers to “anticipate greater health care demands from rural popula- tions” as the U.S. population ages. Logic dictates, then, thatwithout factor- ing crucial social determinants into service programs serving older veterans—particu- larly those in rural locations—an opportu- nity to improve outcomes for them is lost. In response to this insight, we launched Lutheran Services in America’s Great Plains Senior Services Collabora- tive. This ongoing, multi-year project fo- cuses on developing and implementing sustainable solutions that enable older, rural adults to maintain autonomy, im- prove health and well-being and achieve a higher quality of life.

Help with technology has made more competent and more confident caregivers. We view this as a model that can scale na- tionally—but why? In addition to building in key social determinants, the Collabora- tive leverages a rural community’s as- sets—such as community centers, local churches and congregations, area veteran organizations or a community’s largest employer, such as its local nursing home. Also, the Collaborative recognizes the value of incorporating user-friendly tech- nological tools for veterans’ caregivers—a spouse or familymember who alsomay be a veteran—and benefits from independent evaluation of program design and results by North Dakota State University ( tinyurl. com/yyovhymp ). Consider the Collaborative’s Remote Caregiver program in rural Minnesota. It has made great strides in helping to improve the quality of life for rural veter- ans and their caregivers, serving more than 200 veterans or family members (representing a 50 percent increase in the number of people being assisted by the program). Roxanne Jenkins, associate vice presi- dent of Services for Older Adults at Lu- theran Services in America’s member organization Lutheran Social Service of Minnesota (LSSMN; www.lssmn.org/ ), notes the importance of including “caring for the caregiver” elements in LSSMN’s Remote Caregiver program, as well as forging strategic partnerships with area congregations and County Veterans Ser- which brought together my commitment to the medically underserved populations, cultural diversity and older people,” she says. The field of ethnogeriatrics involves a geriatrics focus that acknowledges the in- fluences of ethnicity and culture upon the health and well-being of older adults. She and Feldstein collaborated with another geriatrician, Washington, D.C.− based Dr. Christina Puchalski, who devel- oped a patient assessment instrument called FICA (Faith or Beliefs; Importance or Influence; Community; and Address). Through workshops they had helped bud- ding clinicians to identify emotions around crucial religious or spiritual expe- riences in their own lives, to better con- nect with older patients. Grudzen and Feldstein taught students the FICA tool and how to administer it respectfully, and also how to accept patients’ resistance to it, though Grudzen believes that “it’s a way of getting to know a patient before they’re in a critical situation.” Also beginning in the 1990s, Grudzen served on the advisory board of the Sunny ViewFoundation, based in Cupertino, and collaborated with pastor and administra- tor Ron Zielske of the Sunny ViewLuther- Specifically, 88.4 percent of partici- pants reported their health and quality of life had improved, 90.2 percent reported reduced stress and 98.6 percent said the program in which they participated was of high quality. Building on this early progress, the Collaborative earned an ad- ditional multi-year grant of $3.4 million for expanded efforts that began early this year, and now also will include Montana. AModel to Serve Rural Communities Nationwide

vice Offices (CVSO) to pro- vide additional services and supports. “By working together with CVSOs, we are able to bring more caregiver service supports to veterans and their fami- lies,” Jenkins says. User-friendly technolo- gy alsoplays akey role in the program and has been a central part of the pro- gram’s success. “Caregiver respite services are a critical part of our formula of help- ing both the veteran and his or her caregiver,” Jenkins said. “And by incorporating technology tools and the ac-

Rural Minnesotan Carol Crust (left) with Renee Ransom, a volunteer with the Remote Caregiver program.

care goals and needs, including spiritual needs, to ensure all of these would be met. TheWork Continues After retiring in 2015, Grudzen worked with San Francisco’s homeless population in the Tenderloin at The Healing Well, fa- cilitating a spirituality class in which she encourages participants to share their sto- ries, as awayof connectingwith themselves and one another. She also served as a “coach” for the homeless at First Baptist Church-San Jose, which houses the most homeless people of any church in that city. An ASA member for about 20 years, Grudzen reviewed Aging in America Con- ference proposals, made many AiA presen- tations (including a 2017 AiA presentation on cultural and spiritual diversity at end of life) and helped design AiA programming. Grudzen is honored to receive this award from ASA, as she believes that “the connection between spirituality and ag- ing is very important because we [older adults] have so much to contribute. I’m a fierce proponent of spirituality and aging, the world needs us right now, it needs val- ues and perspective and it needs to hear all our voices.” n Charlotte Haberaecker is president and CEO of the nonprofit Lutheran Services in America, in Washington, D.C.; www. lutheranservices.org . vice); and through Elderly Waiver and Alternative Care Grants in Minnesota, where people qualify for services and sup- ports based on care level and income. In making these investments in service de- livery for rural veterans, it is critical to note that by helping older veterans avoid hospitalization, rehospitalization or other expensive institutional care, the Collab- orative and its efforts offer more economi- cal solutions for families and for the healthcare system overall. In using Remote Caregiver’s respite care and caregiver counseling via the program’s user-friendly technology, Jeff sees great improvement in his days car- ing for Sheila. “It has made all the differ- ence in the world and I am coping much better,” he notes. “I don’t know where I would be without this program, and I am grateful.” “Through efforts like the Great Plains Senior Services Collaborative and its programs like Remote Caregiver in Minnesota, we’re shifting how we view caregiving challenges and solutions. … the more we can educate people about the im- portance of caring just as much for the caregivers as for the veterans, the better off countless rural veterans will be at the end of the day,” said Jenkins. n

Grudzen, at age 78, is ever passionate about being of service to others—especially older adults. an Retirement Community to develop spiritual resources and educational pro- grams for staff, residents and families. And Grudzen co-authored, with Julie Barton and Zielske, “Vital Connections in Long-Term Care: Spiritual Resources for Staff and Residents” (Baltimore: Health Professions Press, 2003), which emphasized not just person-centered care, but relationship-centered care— bringing into the equation administrator and patient relationships with staffmem- bers and highlighting the gifts of diverse people on the care team, particularly nurses’ aides. A longtime supporter of chaplains working in the medical system, Grudzen’s work around end-of-life care was similar- ly deeply developed, in that she trained chaplains, especially those working in emergency care, to perform assessments of critically ill patients to elicit their true Where Does the Funding Come From? Lutheran Services in America’s grants for the Collaborative help support many of the Remote Caregiver services; additional support comes from Title III Older Amer- icans Act funds; through Cost Share (based on a person’s ability to pay for ser- tive involvement of community partners, we help ensure self-care for caregivers.” Incorporating user-friendly technolo- gy tools into Remote Caregiver efforts— whether by connecting veterans with their caregivers while they’re at work via Skype or FaceTime, by saving time by or- dering groceries online, by holding sup- port group video chats or by providing step-by-step training to caregivers on how to use an iPad—all have translated into healthier, more competent and more confident caregivers who, as Jenkins said, will be able to care for their loved one “longer and stronger.” LSSMN created strategic partnerships with local and national entities that sup- port its goal of lending a hand not only to rural veterans, but also to the loved ones who care for them. One such Remote Caregiver partnership is with the Legacy Corps for Veterans and Military Families, part of the AmeriCorps federal service program. Legacy Corps volunteers spend several hours a week helping veterans, but also giving their caregivers much needed time off for self-care.

Aging Today November–December 2019

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AGING WITH OPTIONS

The future of work— (still) powered by humans

and training approaches and longevity and longer work lives.

By Ramsey Alwin 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. The world is witnessing a major trans- formation in how people work. According to the World Economic Forum’s report, “The Future of Work Jobs Report 2018,” 65 percent of children entering primary school today will work in jobs that don’t now exist ( tinyurl.com/y8attlph ). In addi- tion to the rapidly changing nature of work, the relationships between employer and employee are evolving, as longevity trends push individuals to want—and need—to work longer. To better understand such trends driv- ing the future of work, AARP embarked upon a listening tour, engaging the coun- try’s leading experts in conversations about the trends and implications for indi- viduals who are in mid-life and mid- career. A consensus on the biggest trends emerged from these conversations: glo- balization, automation and disruptive technologies, ever-changing employer− employee relationships, a rise in contin- gent work and the gig economy, increas- ing inequality, fast-changing education

Tech Is Re-Shaping Jobs and Organizations

‘There has been an increasing focus on what some call “The Fourth Industrial Revolution.” ’ Technology is fundamentally transform- ing jobs, from the types of tasks workers perform to company organizational struc- ture. In recent years, there has been an in- creasing focus on what some call “The Fourth Industrial Revolution” ( tinyurl. com/y3hw53oh ). Broadly speaking, this revolution is defined by the exponential pace of tech- nological advancement (e.g., artificial in- telligence and robotics), use of digital data and reliance on data-driven deci- sions, which all contribute to the rise of new industries and the inevitable decline of others ( tinyurl.com/yypgsb7d ; tinyurl. com/yyup58lb ). As business models adapt to this digital revolution, organizations are redefining their workforce hierar- chies and job roles ( tinyurl.com/y39rhds4 ). This evolution may change work as we know it. Meanwhile, less attention has been paid to another trend that may produce

equally profound changes. That trend is longevity. The Implications of Longevity By the middle of this century, adults ages 60 and older will represent 22 percent of the world’s population—double that share today. And a great many are re- maining in the labor force and creating a workplace that is more age-diverse than ever before. Today, four—even five—generations work side by side. For the modern global economy, the increasingly age-diverse workplace is new territory. Also, it is an opportunity waiting to be seized. Employ- ers who take the right steps can leverage this multigenerational workforce as a competitive advantage, toward a better understanding of the needs and desires of the full population at large. Given the depth of this transforma- tion, methods and strategies used in the past to navigate such changes will be no match for what’s needed to traverse the uncharted waters of the future. Many of the leaders AARP listened to believe that the future of work is bigger than just work—it involves how people will ap- proach income and wealth generation. Experts suggested a need for a new 21 st - century (and beyond) economic model, as current models and systems supporting world economies are largely based on the agrarian and manufacturing economies of the distant past. As the experts suggested, today’s eco- nomic system is far more complex than the one defined by those historic econom- ic drivers. It is time to construct a new economic model that better addresses in- come adequacy and productivity in light of significant changes ahead. In the 19th and 20th centuries, when the United States was industrializing and urbanizing, workers, businesses and civic leaders cooperated to adopt a series of pioneering social policies. Many of these policies and programs—including Social Security, unemployment insurance, work- ers compensation and healthcare coverage through Medicare and Medicaid—protect millions of Americans today. But changes that will define work’s fu- ture have implications for these policies and programs. What emerging risks should social insurance programs address as the nature of work changes? Is there a Social Insurance—a Relic of Another Time?

‘How might we leverage the changing nature of work to narrow income inequality?’ There are many benefits to the longevity trend, but to tap into them, we must now be proactive. Maximizing longevity’s ben- efits falls not only on the individual, but provides an opportunity for organiza- tions, social institutions and governments to re-evaluate the public, private and non- profit sectors’ roles in ensuring that eco- nomic prosperity and individual potential are maximized. To spur discussion about the implica- tions of longevity, AARP has teamed up with the World Economic Forum and the Organisation for Economic Co-operation and Development in an effort called “Liv- ing, Learning and Earning Longer.” Over the next two years, AARP will engage global corporations, establish the busi- ness case for age diversity and highlight best practices from around the globe. In addition to extensive research, AARP is planning a learning collabora- tive for employers and thought leaders that develops insights from workshops, site visits and case studies. This work will culminate with the release of a digi- tal learning platform at the 2021 World Economic Forum’s annual meeting in Davos, Switzerland. Employer engage- ment is vital to the success of this pro- gram. To learn more, visit www.aarp international.org/llel . n Ramsey Alwin is director, Thought Leadership–Financial Resilience, at AARP, inWashington, D.C. Readers can follow her on social media @ElderNomics . need to develop new economic and social policies to ameliorate risks that face fu- ture generations? And, how might exist- ing policies and programs be improved to address challenges confronting various communities and generations? How might the changing nature of work be lev- eraged to narrow income inequality? It is time to re-examine the social con- tract, as well as the earning and learning components of work, in light of the trends driving work’s future. To ensure econom- ic stability and growth, we must move to- ward and create the future by redefining roles for all—for employers, employees and members of society at large. Multi-Sector Engagement—a Proactive Path Forward?

Cultivate your leadership skills and expand your networks at ASA’s 2020 Leadership Institute March 23-27 in Atlanta Learn how you can make a difference while examining your leadership potential! The ASA Leadership Institute is a 5-day leadership development intensive that offers self-assessments of communication and leadership styles, presentations by recognized leaders in the field of aging, facilitated dialogue, networking opportunities, leadership literature and online learning. Program components are carefully designed to prepare the next generation

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Aging Today November–December 2019

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Aging Today November–December 2019

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America’s veterans: their lives, their challenges, their legacy People working and volunteering in the aging services sector often display a selfless, conscientious devotion to the cause. In compil- ing this In Focus about America’s veterans, we have realized that those qualities are amplified in individuals and organizations that work to support U.S. veterans. Veterans’ needs are great in scope—especially those of older veterans—but the determination of the people who advocate for them is greater. Vietnam Veterans of America’s John Rowan lays out the reality of the modern mili- tary legacy; Anica Pless Kaiser and colleagues from the VA Boston Healthcare System discuss older veterans and trauma; Blayne P. Smith and Caroline Angel of Team Red, White & Blue address how veterans can recover a sense of purpose; Amy Fairweather and Trauma exposure and PTSD among aging Vietnam vets

Megan Zotarelli of Swords to Plowshares examine homelessness among Vietnam veterans; Wounded Warrior Project’s Jennifer Silva details caregiving challenges for veterans with trauma; and Future Now’s Lauren Popper Ellis and Hannah Simon describe the potential power in a Veterans Bill of Rights.

Vietnam veterans constitute the largest cohort of veterans, with an average age of 73. This translates to a number of unique healthcare needs that theVAhas developed considerable expertise in addressing: trau- matic amputation of one or more limbs; paraplegia and quadriplegia; a litany of musculoskeletal injuries; health conditions associated with exposure to Agent Orange ( www.veteranshealth.net ); traumatic blind- ness; Post-traumatic Stress Disorder (PTSD); and an assortment of emotional andmental healthmaladies including anxi- ety, depression, bouts of irritability and out- bursts of anger. For thosewith families, this strains, andoftendestroys, family relations. Lengthy wars in Southwest Asia have led to extended and frequent deploy- ments, compounding the likelihood of ex- periencing the wounds of war. Some troops report having deployed to Afghan- istan and-or Iraq five, six, eight times. A Exposure to traumatic events is a nearly ubiquitous experience; 70 percent to 90 percent of the general population is exposed to psychological trauma (e.g., combat, assault, life-threatening acci- dents) at some point in their lives, with 5 percent to 15 percent developing Posttraumatic Stress Disorder (PTSD; tinyurl.com/yxzqaxgv ). Veterans and Risk for PTSD Veterans are at higher risk of trauma ex- posures and for developing PTSD. Many older veterans who served in a war zone during military service return home without experiencing significant war- related distress or associated problems. Others develop PTSD, seek treatment and recover. some point while serving in the military,” a 2011 FactTank article noted ( tinyurl.com/ y4kq6mz5 ). “[T]hree-quarters of those in- juries occurred in combat.” And a 2011 national Pew Research Cen- ter survey found that “formany of these 2.2 million wounded warriors, the physical and emotional consequences of their wounds have endured long after they left the military” ( tinyurl.com/yy86qnar ).

By Anica Pless Kaiser , Kelly O’Malley and Jennifer Moye P icture an active 70-year-old Viet- nam combat veteran who slips on winter ice, falls and breaks his wrist. The pain reminds him of an injury he suffered in Vietnam, which brings back more memories of combat. This scenario is not uncommon among aging Vietnam- era veterans, who make up 36 percent of the 18.2 million living U.S. military veter- ans ( tinyurl.com/yyoc5y6k ). As of 2017, 53 percent of male veterans were ages 65 or older ( tinyurl.com/y4z6fdve ). Given these numbers, and the aging of the Viet- nam veteran cohort, it is important to understand and plan for this group’s phys- ical and mental healthcare needs. America’s veterans › continued from page 1 ans, 1.7 million and 2.275 million, respec- tively, reside in this demographic. Of the 16 million men and women who served during WWII, only 500,000 are alive today. Their numbers decrease by 350 each day. Of the 8.75millionmen andwom- enwho servedduring theVietnamWar, the VA estimates between 6.8 and 7.4 million are alive. They constitute the largest cohort of veterans, with an average age of 73. Because Congress never determined an end date to the 1990–1991 Gulf War, it can be argued that Desert Shield/Desert Storm veterans, those who served but never deployed during the following de- cade, and those who deployed to South- west Asia in the wake of 9/11, comprise the largest share of veterans. Four out of five veterans today are white; 12.5 percent are black; Hispanics comprise 7.5 percent of this population; Asian/Pacific Islanders and American In- dians/Alaska Natives account for 2.5 per- cent; and “Others” number 3.6 percent (these numbers add up to 106.1, which is sometimes called “VA math”). The Challenges for Older Veterans According to the VA, just over 47 percent of the nation’s veterans are ages 65 or old- er. They face most of the same maladies as their non-veteran cohort, but with a sa- lient difference: “One out of every ten vet- erans alive today was seriously injured at

Conversely, some older veterans cope with PTSD symptoms chronically over the course of their adult lives. Others ex- perience an increase in symptoms as they face the challenges and changes related to aging, such as retirement, cognitive

› continued on page 8 mit suicide and what might be done to pre- vent it, we are no closer to a solution. A Truth About Military Legacy Today, 4.9 million veterans receive VA dis- ability compensation; more than 750,000 of them are rated as 100 percent disabled. Some 1.1 million veterans are compensated for PTSD. Some 250,000 indigent veterans get a small pension from the VA. However, the legislators in power have very little knowledge of the veteran expe- rience. Today, only a half of 1 percent of the adult population enlists in a branch of the military or in the Coast Guard, and there are fewer veterans in Congress— men and women who can be expected to understand the realities of life in a combat zone—than at any time since before the advent of WWI. Military service was once de rigueur for just about any candidate for public office. Not anymore, although more veterans of the Afghanistan and Iraq wars are run- ning for office—and getting elected. These, and many, many other veterans must con- tinue to grapple with health conditions that are a legacy of military service, a lega- cy that most Americans may sympathize with but can never truly understand. n John Rowan has been national president of the Vietnam Veterans of America (VVA) since 2005, and served in the Air Force’s 6990 th Security Squadron in Vietnam and at Kadena Air Base in Okinawa. VVA’s nation- al headquarters are in Silver Spring, Md. changes, losing family members or friends, experiencing role changes or decreased autonomy, or having increased physical health difficulties ( tinyurl.com/ y2daf7yl ). Aging-related stressors can

recently released Pew Charitable Trust survey illuminates the unique burden

‘At least two-thirds of these suicides were committed by veterans older than age 55.’ post-9/11 veterans have shouldered over the past 18 years ( tinyurl.com/y3zq35pl ). The Specter of Suicide The No. 1 issue over the past decade has been the specter of suicide, not only among veterans who served in a combat zone, but also among active-duty troops, reservists and National Guardsmen. Ac- cording to the VA, 20 veterans a day com- mit suicide. This statistic, made vivid by some highly publicized suicides in or near VA healthcare facilities, was bandied about as proof positive of the deleterious effects of combat. What was rarely noted, however, is that at least two-thirds of these suicides were committed by veter- ans older than age 55, the vast majority of whom hadn’t been in uniform or shot a rifle at an enemy in decades. According to the VA, 14 of the 20 were not patients in any VA medical center or community-based outpatient clinic. PTSD, untreated and-or chronic, often is cited as the genesis for these suicides. Although millions of dollars have been expended, in the wake of 9/11, on dozens of studies to determine why a veteran attempts to com-

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