Graying of America, Gerontology, Aging, Caregiving

The Graying of America

by

Keith John Paul Horcasitas, LCSW, MHA

Over the last few decades, we’ve seen and heard about the graying of America. We are all growing older. The U. S. Census Bureau reported that in 1900 only one American in 25 was over the age of 65. Today, it’s one in nine. Projections are that by the middle of this century, one American in four will be 65 years of age or older. To accompany those numbers are many new programs and services available to older adults, such as AARP, Area Agencies on Aging, Case Management, Lifecare facilities, Nursing Homes, Home Health, Sitter and Companionship Care, etc.

More Than Economics

As if by the law of supply and demand, these services have sprung up to meet a growing market. But therein lay a danger: are we beginning to treat the elderly as commodities in an economic system rather than as people with dignity?

As a Jesuit Volunteer in central California in 1981, I worked at an outreach program for the elderly, both homebound and in nursing homes. My job was to coordinate volunteers to visit the elderly; and I conducted many visits myself. There I realized the incredible “market” that the elderly offered for human services work. But that was not my predominant concern. What made the year rewarding for me was the personal contact, especially when I would listen to and attempt to help a lonely widow or widower with huge medical bills trying to live on a fixed income. Or when, after making a presentation to a senior citizen group and feeling at ease with everyone, they would invite me to eat with them. I connected with these people; I felt one with them.

Denying The Reality

I followed my JVC year by studying gerontology at San Diego State University. The gerontology section of the School of social work was the smallest of the four divisions, with only 10 students. The students in the other social work divisions seemed reluctant, even fearful of working with the elderly. They were preparing for the fields of mental health, children and families and hospital social work. They wondered aloud why I would consider working with “that group.” They thought of working with the elderly as depressing; they were put off by the urine smells in nursing homes and by the death and dying. One student even shared a fear of “touching someone with wrinkles.” These feelings were shared honestly, and my fellow students were better suited to work with struggling families and children or in hospital settings.

Aside from my time studying the biological, economic and psychological aspects of aging, my school experience taught me that too often old age is hidden not just from our eyes but even more from our feelings. We not only tend to deny the reality of old men and women living in closed rooms and nursing homes, but also, as Henri Nouwen noted, the old man or woman who is slowly awakening in each of us.


Balancing Academics

During the “practicum” part of my academic program, I worked at an Area Agency on Aging. There I saw that despite the sincere efforts of my co-workers, there were still glaring gaps between services and unmet needs. Nutritional and social services initiated to enhance the lives of the aged could only go so far. Even at their best, these programs still do not resolve the problems of isolation and loneliness.

I had a personal experience of this during my graduate studies when I was a “live-in” for Lucille, a frail but feisty 83-year-old widow in San Diego. I would assist her with household chores and provide security in exchange for $ 10 a week rent. I was a also good friend with her 88-year-old “boyfriend” Herman, a retired truck driver/farm hand from the Midwest, who came every Tuesday and Saturday to water the lawn. They both became like family to me. Lucille allowed me to throw parties for my friends, and they both came to my MSW graduation. But despite the “good life” of independence and Social Security they enjoyed, they still felt lonely and misunderstood. I saw this especially in Herman who wore a hearing aid. People often mistook him for being “senile” because he didn’t hear well or they would yell at him to be understood.

Some Of The Real Problems

My professional work in New Orleans following graduate school involved advocacy and community organizing with Catholic Charities and working at the Council on Aging. This allowed me to focus greater attention on the larger problems faced by the elderly. As Carol Estes noted in her book, The Aging Enterprise, the root problem affecting older people is inadequate income to support their major expenditures – housing, food and medical care. Things like utility bills and medicines are considered burdensome. Health care is taken for granted by many: “Medicare will cover my medical needs!” Having worked in hospitals these past 16 years, I have seen this firsthand, as well as the tragedy of debilitating conditions such as Alzheimer’s disease. And caregiver’s needs are certainly being stretched to the limits.

Just in the past few decades, the elderly have seen large-scale changes in how they receive health care and social services. This has occurred due to their escalating population, increasing needs, and decreased funding. For instance, the cost effectiveness measures by Medicare per Prospective Payment Systems, such as DRGs (Diagnostic Related Groups) and RUGs (Resource Utilization Groups) are attempts to deal with the medical needs of the elderly in economic terms.

As a result, individuals are discharged earlier from the hospital setting to what is hoped to be along the “continuum of care.” In this State, the economic incentive for placement is usually for a nursing home. While such care is certainly an important consideration for 24-hour care needs, less of an emphasis is placed upon other care options, such as home health care, adult day health care, in-home care and other such services. Recently, MediCAID Waiver programs have been reviewed for expansion to address this.

Elders As Potential Resource

While the “bottom line” in service delivery systems is currently being measured in economics terms, the worth and dignity of every individual person must be preserved. Decisions should not be made for the elderly, but by them whenever possible. Seniors ought to be challenged and empowered to take responsibility for their lives and for the development of programs affecting them and the whole community. As many holistic programs emphasize, older people are a resource to enrich the community rather than a social problem to be solved. I have learned from Maggie Kuhn and the Grey Panthers that any kind of advocacy must be for the positive change that will benefit people of all ages.

Today’s Youth Are Tomorrow’s Elders

Perhaps my involvement in the field has secretly been for making preparations for my own aging in place. Whatever the case, I want to continue to fight against “ageism.” As gerontologist John Meyers noted, “ Nothing will affect the lives of tomorrow’s elders more than the attitudes of today’s youth; they are, after all, one and the same.”

Keith Horcasitas, LCSW, MHA, Prayer Care, khorcasitas.yahoo.com