Urban Institute Summary on the CLASS Act

I haven't had the chance to watch this yet, but wanted to tag it for future viewing. All of the health care changes in the pipeline are so confusing. I hope this sheds some light on one of the changes!

The Health and Human Services Department has until October 2012 to finalize plans for a new government-run, long-term care program called the CLASS Act. In the January edition of the Program on Retirement Policy video series, Howard Gleckman discusses the rationale behind the program’s creation, the implementation and political challenges it faces, and ultimately the tough choices facing potential long-term care consumers.

http://www.urban.org/retirement_policy/url.cfm?ID=500204

Must See: Ken Dychtwald's Keynote Address at the 2010 ASA/NCOA Conference

Ken Dychtwald covers so much important territory in this keynote address at the June, 2010 American Society on Aging / National Council on Aging joint conference. If you're interested in being alive over the next century, regardless of how you feel about aging, older adults or anything else, you have a vested interest in this speech. Dychtwald is an engaging speaker and this 15 minutes flies by.

Exciting Book! "The Making of an Elder Culture"

This new book by Theodore Roszak looks intriguingly on target for a lot of the things I believe Marsha's been talking about in our social policy class. I can't wait until inter-term to have the time to read it!

The Making of an Elder Culture: Reflections on the Future of America's Most Audacious Generation

The Making of an Elder Culture reminds the boomers of the creative role they once played in our society and of the moral and intellectual resources they have to draw upon for radical transformation in their later years. Seeing the experience of aging as a revolution in consciousness, it predicts an “elder insurgency” where boomers return to take up what they left undone in their youth. Freed from competitive individualism, military-industrial bravado, and the careerist rat race, who better to forge a compassionate economy? Who better positioned not only to demand Social Security and Medicare for themselves, but to champion “Entitlements for Everyone”? Fusing the green, the gray, and the just, Eldertown can be an achievable, truly sustainable future.

Ellen Langer = Brilliant.

I first stumbled across Ellen Langer in the article I quoted about Ageism and Health Outcomes. in an effort to hunt down the root of her quote, I came across this review of Langer's latest book, "Counterclockwise: Mindful Health and the Power of Possibility," in The Situationist.

Here are some of the main points from The Situationist article I like:

...we are all victims of our own stereotypes about aging and health. We mindlessly accept negative cultural cues about disease and old age, and these cues shape our self-concepts and our behavior. If we can shake loose from the negative clichés that dominate our thinking about health, we can “mindfully” open ourselves to possibilities for more productive lives even into old age.

---

Most people try to dress appropriately for their age, so clothing in effect becomes a cue for ingrained attitudes about age. But what if this cue disappeared? Langer decided to study people who routinely wear uniforms as part of their work life, and compare them with people who dress in street clothes. She found that people who wear uniforms missed fewer days owing to illness or injury, had fewer doctors’ visits and hospitalizations, and had fewer chronic diseases—even though they all had the same socioeconomic status. That’s because they were not constantly reminded of their own aging by their fashion choices. The health differences were even more exaggerated when Langer looked at affluent people: presumably the means to buy even more clothes provides a steady stream of new aging cues, which wealthy people internalize as unhealthy attitudes and expectations.

We are surrounded every day by subtle signals that aging is an undesirable period of decline. These signals make it difficult to age gracefully. Similar signals also lock all of us—regardless of age—into pigeonholes for disease. We are too quick to accept diagnostic categories like cancer and depression, and let them define us. . . . [W]ith a little mindfulness, we can try to embrace uncertainty and understand that the way we feel today may or may not connect to the way we will feel tomorrow.

This Proves My Point on Ageism

This proves my point, right now, about ageism.

A search for "Ageism" on Google pulls up a shocking low return of 652,000 references.

As a point of comparison - "Sexism" on Google presently garners 4,230,000 results, and "Racism" on Google gets a whopping 23,000,000 returns.

No matter what your race or gender, all people are born with the potential, if they're lucky enough, to be aged. Yet, the discourse around ageism is minute compared to that of other biases and cultural prejudices.

In our Social Policy class, a few of us are working on a project about Language, Ageism and Policy. Essentially, we're researching ways that raising awareness about the usage of negative or positive labels regarding the older population can have a cultural impact. The fact that there's such minuscule discussion about the topic of Ageism as a whole confirms that this is a "hidden" problem, though it's hidden in plain sight.

My point is - let's get talking about "talking about" aging and stereotypes!

Now, how can we utilize Social Policy to get that going?

Schools Should Include Housing & Community Services for Elders

William Thomas (thank you Nancy for the introduction to his work!) is the proponent for the term "Elder," and many, many notions that flow from that concept.

I thought this was brilliant as it relates to Francie's theme of promoting inter-generational melding:

For thousands of years, relationships between young and old have made life better for both groups. In Eldertopia, all school construction and remodeling projects would include housing and community services for elders.

From "What is Old Age For?"

Grandperson?

I kind of like the ring of it.

From this article on language, children and ageism.

Wow.

Wow. That's all I have to say. I just had to clip this response in total from the article on "Older Workers Need Not Apply" in the NY Times.

This is just a part of what Laurence J. Kotlikoff wrote. What do you think???

Pay the Aged Less

The solution?

First, modify the Age Discrimination Act by establishing a national age-productivity reference profile that employers can use to defend pay cuts they feel they need to impose on their older workers in order to retain them.

Second, scrap employer-based retirement programs in favor of a Personal Security System under which all workers would invest 8 percent of pay in a global stock/bond index fund. The government would split contributions between spouses, match contributions by the poor, convert balances at retirement to inflation-adjusted annuities, and guarantee that retirement balances equal at least what one contributed adjusted for inflation.

Third, scrap employer-based health care in favor of a Medical Security System under which all Americans receive an annual voucher to buy a basic health plan for the year. The size of the voucher would equal one’s expected costs under the basic plan. So those with pre-existing conditions would receive larger vouchers. The aggregate voucher budget would be set at 10 percent of G.D.P., which means the country won’t go broke.

Fourth, scrap the current tax system in favor of the “FairTax” plan, which is equivalent to a very low, flat-rate wage tax plus a one-time tax on wealth plus a monthly “demogrant.” This “right-wing” proposal is something every Democrat should love. The tax is implemented by taxing all retail sales. In my version, I’d tax the consumption services (called imputed rent) from living in your own home. Such a broad-based FairTax would have a very low rate. Indeed, most older, as well as younger, workers who move from paying roughly 40 cents of every dollar earned to Uncle Sam to only 18 cents.

This will give older workers plenty of incentive to stay on the job.

Thoughts???

Older Workers Need Not Apply

This article in the NY Times got a lot of hefty response.

Here's some of the gristle:

How can I supervise someone who has more experience than I have, how do I motivate them when they are less concerned about the carrot of promotions or the stick of being fired? Managing older workers in fact doesn’t require rocket science, but it does require a more collaborative approach that respects their expertise and engages their interests.

Another interviewed expert:

Older workers are desperate. Their 401(k) plans are devastated, and they realize they do not have enough to retire. My guess is that they are clinging to their jobs. If we had data on quit rates — which we don’t — I bet the rate for older workers has dropped sharply. And long tenure and anti-discrimination laws make it hard to fire older workers... But older workers without jobs are a different story. No law can really prevent the “not hiring” of older workers.

The International Longevity Center

Nancy sent me this great article on ageism, though I agree with her comment that it's a little too hoo-rah, swinging to the opposite end of the spectrum on what's expected in aging.

The article led me to the International Longevity Center site because the ILC's founder, Dr. Robert N. Butler,coined the term "ageism" in 1968.

I thought Karen's group would be particularly interested in the work that the ILC is doing related to aging and corporate America. I also like the consistent messaging of the "Age Boom" and "Longevity Revolution" on the site. Very positive. It turns the notion from "aging" to "living longer."

The National Academy for Teaching and Learning About Aging

While researching a class project ageism and how it's played out in our language, I came across the NATLA site. The broad subject of our project for the social policy class is to combat ageist attitudes in language usage via a social policy program. NATLA fits neatly with that, in that it's entirely about teaching to counteract ageism.

What Do You Call Older People?

The study by the AARP referenced in this article is an example of a Research and Development project on ageism.

This site is just a treasure trove of good info. This is a list of the key understandings that the National Academy for Teaching and Learning about Aging is trying to get into school curricula.

"Public Option" Option Not Yet Dead in the Water

This speaks to the power of the press and perception. The Huffington Post published two articles yesterday that covered the same issue - where the Public Option option stands in Congress.
Robert Creamer's interpretation is upbeat, as he figures that the 'near miss' of a passage connotes a "Growing Momentum for Public Option." On the same day, the aptly named Ryan Grim reported that the "Public Option Amendments Fail in Senate Finance Committee." I suppose it's all in how you look at it.

Thoughts?

White House Conference on Aging

Yesterday, we had a great lecture about the Aging Network, which touched on the history of the AOA, Administration on Aging. The AOA, which oversees the Aging Network, was created as a result of the passage of the OAA, the Older American's Act in 1965. According to the site, the OAA:

The original legislation established authority for grants to States for community planning and social services, research and development projects, and personnel training in the field of aging.

Ever since the passage of the OAA and subsequent creation of the AOA in 1965, there has been a once-a-decade White House Conference on Aging. President Bush was notoriously absent from the most recent White House Conference on Aging, which was held in December, 2005. Instead of having a speaking at the conference, as all of his predecessors have done since its inception, President Bush was stumping the successful passage of the Medicare Part D law.

The website for the White House Conference on Aging is pretty thin on info... essentially a splash page that doesn't so much as highlight successes of conferences past. It does, however offer a webcast of the most recent conference... I find it more than mildly disturbing that the webcast is hosted via "Kaisernetwork.org." Can you say "conflict of interest" anyone?

The main takeaway from the White House Conference on Aging site is the executive summary the most recent, 2005, conference, which was entitled "The Booming Dynamics of Aging." Here's the direct link, should you prefer to copy and paste:

http://www.whcoa.gov/Final_Report_June_14nowater.doc

TR Reid Commonwealth Club

In our class discussion yesterday, someone mentioned TR Reid's September 14, 2009 speech at the California Commonwealth Club, entitled "Can We Really Fix US Health Care?"

I haven't listened to it yet - I like to download podcasts and listen to them on my commute in to class! Here's the direct link, if you prefer to copy and paste.

http://castroller.com/podcasts/CommonwealthClubRadio/1232943

Second Bill of Rights

I haven't seen Michael Moore's new movie yet, on Capitalism, but I guess it makes reference to FDR's idea of creating a Second Bill of Rights.

Here's a quick quote:

In our day these economic truths have become accepted as self-evident. We have accepted, so to speak, a second Bill of Rights under which a new basis of security and prosperity can be established for all—regardless of station, race, or creed.

Among these are:

The right to a useful and remunerative job in the industries or shops or farms or mines of the nation;

The right to earn enough to provide adequate food and clothing and recreation;

The right of every farmer to raise and sell his products at a return which will give him and his family a decent living;

The right of every businessman, large and small, to trade in an atmosphere of freedom from unfair competition and domination by monopolies at home or abroad;

The right of every family to a decent home;

The right to adequate medical care and the opportunity to achieve and enjoy good health;

The right to adequate protection from the economic fears of old age, sickness, accident, and unemployment;

The right to a good education.

All of these rights spell security. And after this war is won we must be prepared to move forward, in the implementation of these rights, to new goals of human happiness and well-being.

America’s own rightful place in the world depends in large part upon how fully these and similar rights have been carried into practice for our citizens.

Also, here's a clip (audio, but hosted on YouTube) of Roosevelt' speech.




This is unbelievably powerful. If Roosevelt had succeeded, what would things look like now? In order to make these "rights" realities, we would have had to have made some hard choices... One of my first thoughts is that we certainly couldn't have globalized our markets nearly as much as we have. Secondly, in order to secure "the right of every businessman, large and small, to trade in an atmosphere of freedom from unfair competition and domination by monopolies at home or abroad," we must have limited corporate power to some extent. Finally, and unpopularly, it seems that in order to provide many of these rights, we would have had to limit our population growth, which would have meant further immigration quotas than already exist.

Thoughts?

The Effectiveness of Smoking Bans

I saw this article about how effective smoking bans have been. I wanted to put it here because it relates to a pet interest of mine - High Fructose Corn Syrup (HFCS), or, more specifically, how it's in everything.

Clearly, the success of the smoking ban is largely due to reductions in second-hand smoke deaths, and there isn't a correlative "innocent bystander" in eating, but the study does demonstrate that banning substances can have a big impact on public health.

Unrelated Example of the Power of the People

We spend a LOT of time in our Social Policy class discussing the present debate over a national health care plan. It's pretty grim, the stakes are very high, and I, personally, have small faith that Congress is going to do the right thing. I'm sure some bill will pass, that it will be sweeping and effect major change... only... I don't think that the "change" will ultimately benefit we, the people.

When the discussion becomes dour, our esteemed professor rallies us with the notion that we can influence Congress via letters, phone calls and educating our peers. After all the readings we're doing, which are pretty rife with references to how large the system is, and how the government is increasingly controlled by institutions, not people, it's hard muster faith that individuals have power in the US, much less voices.

I read this article today - it's totally unrelated to Gerontology, but quite uplifting as a story of people effecting chance on Congress:

http://www.marinij.com/ci_13416510?source=most_viewed

NYT Article on People Leaving Nursing Homes

A great deal of the reading we're doing in the Social Policy class talks about how the present structure of public policy tends to force elders into institutions and poverty (if they weren't already impoverished to begin with). Recently, some states have been working on ways to redistribute Medicaid money so that more people can stay at home rather than nursing homes.

This article from the New York Times (linked here in the mobile version, which has less banner ads, etc), does a pretty decent job of going over some of the high-level pros and cons of these "Money Follows the Person" programs.

Some main points:

• PRO: people are thrilled, thrilled, thrilled to escape having their final days in a nursing home
• PRO: it looks like people moving out of nursing homes costs less money
• CON: the "less money" part is most likely due to family members doing labor that is paid for in nursing homes. The article implies that this is a problem, or at least potential hardship for family members, but doesn't delineate that most of the burden of care falls on... you guessed it... women.
  

The article is very good also because it touches on how devastating things can be in older age - a slip and fall can rapidly lead to being shuttled into a nursing home and never getting to go home, much less wrap up your possessions. Life is so very fragile.

Finally, the article mentions:

A recent study by researchers at the University of California, San Francisco, found that home care costs taxpayers $44,000 a year less than a nursing home stay - though this number cannot be used to estimate total savings, because often home-based services replace family care, not nursing home care.

I'd bet that Carroll Estes is somehow related to that study!

(the article noted in this post is "Helping Elderly Leave Nursing Homes for a Home" by John Leland)

Social Structures

Estes mentions the term "social structures" a number of times in the second chapter of Social Policy and Aging. Here's a specific quote:

A more recent dimension of this theory is the concept of structural lag, wherein social structures (e.g. policies of retirement at age 65) do not keep pace with changes in population dynamics and individual lives (such as increasing life expectancy).

Social Policy and Aging, p 30

Wikipedia has a good definition about it here:

Social structure is a term used in sociology and anthropology to refer to relationships or bonds between groups of individuals (e.g. societies). Whereas 'structure' refers to "the macro", "agency" refers to "the micro". (See also: Structure and agency)

In a general sense, the term can refer to:

• entities or groups in definite relation to each other,
• relatively enduring patterns of behaviour and relationship within a society, or
• social institutions and norms becoming embedded into social systems in such a way that they shape the behavior of actors within those social systems.

By the 1930s, the term was in general use in social science^[1], especially as a variable whose sub-components needed to be distinguished in relationship to other sociological variables.

Wikipedia

It looks like Estes is using the term in the third sense here - that of "social institutions and norms becoming embedded into social systems in such a way that they shape the behavior of actors within those social systems. I think she also means it in a bigger sense, that social structures can be institutional - such as companies having a standard retirement age of 65.

Self-efficacy

Estes mentions self-efficacy here:

...more recent studies focus on understanding the process of aging from the perspective of the life course and the relation of coping, social support, personal control, self-efficacy, and focus on the behavioral dimensions of aging.

Social Policy and Aging, p 28

Wikipedia has a really clear-cut description of "self-efficacy:"

The concept of 'self-efficacy' is an important one in the self-management of chronic diseases because doctors and patients often do not follow best practice in using a treatment. For instance, a patient using combined oral contraceptive pills to prevent pregnancy may sometimes forget to take a pill at the prescribed time; thus, while the perfect-use failure rate for this form of contraception in the first year of use is just 0.3%, the typical-use failure rate is 8%

Wikipedia: self-efficacy