EQUAL OPP

ORTUNITY

AND

THE E

LDERLY

A N G E L I C A T I L L A N D E R

POVERTY STATISTICS

• By 2030, elderly population will more than double to 72 million.

• 2/3 rely on social security benefit of $15,168.36 for at least half of their yearly income.

• 13 million elderly individuals brought above Poverty line by Social Security

• Without Social Security, 14.5 million in poverty, 5x current rate

• 12.5% currently impoverished

CAPABILI

TY• A capability is essentially

the ability to function normally in society and participate in the life of the community.-Sen

• Sen links capabilities to the “freedom to lead different types of lives.”

• Health and financial restrictions force elderly to make undesirable compromises.

DEFINING EQUAL OPPORTUNITY

• Opportunity is based on what is important at different stages

• In order to be a part of the community the elderly need more than just a subsistence level of income,

• access to social interaction, houses of worship, transportation, and in some cases flexible employment and volunteer opportunities.

• Equality of opportunity means that every member of society is given the opportunity to play an active role in the community

HEALTH

• WHO: “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

• 40% of those over 65 will eventually enter a nursing home.

• 3.2 million living in nursing homes,

• More than 900,000 in assisted living facilities as of 2008

• 10 million elderly in need of help with some task of daily living.

QUICK FACTS

HOME CARE V

S.

INSTI

TUTI

ONAL CARE

• Home: Allows them to remain in community

• Not always an option• Institutional care must

provide quality, supportive care that fosters normal functioning

• Equal opportunity requires that legitimate choice be given

COSTS BREAKDOWN

• Assisted living facility is $3,293 per month,

• average cost of a semi-private room in a nursing home is $6,235 per month.

• At the same time the costs for a home health aide is an average of $21 an hour

SOCIAL ISOLATION AND INSTITUTIONS

• Social isolation is defined as “the distancing of an individual, psychologically or physically, or both, from his or her network of desired or needed relationships with other persons. Therefore, social isolation is a loss of place within one’s group(s).”

• outside friendships seldom make it past the move

• one in three residents does not receive one visit in a twelve month period.

• Medical and depersonalized feel of facilities

• Treated as patients first, people second

• Rate of social isolation for older adults varies from two to twenty percent but is as high as thirty-five percent for those who live in assisted living facilities

INSTITUTIONAL CARE ISSUES

• >50% of nursing home staff acknowledged mistreating residents through physical violence, mental abuse, or neglect in the last year

• 44% residents admitted to being abused, and 95% said they saw another resident get abused

• Over half of all nursing home residents have some form of dementia• Stanley (pseudonym)• 80 to 90% of care is provided by nursing assistants, they usually have

little training to work with this population

• Obligation beyond not harming• Bingo-larger social impact.• Harold (pseudonym)

HOME CARE ISSUES

• Condition/Cost of Housing• More likely to live in run-down housing• 26 percent pay more than 30 percent of their monthly income to

housing (cost burdened)

• Transportation• Only half of the elderly have access to sufficient public transit.

• Social Isolation• 43% of older adults experience some degree of social isolation

• Food Insecurity• 18% of the low income elderly who live with others• 12% alone

SENIOR CENTERS- PATH TO EQUAL OPPORTUNITY

• 11,000 senior centers • Serve over one million seniors

• Poorer health conditions, lower income levels, and lack of access to transportation were good predictors of high levels of participation in senior centers

• Home Based Programs• Telephone Reassurance Programs• Senior/Senior Programs• Meals on Wheels

• average recipient was 75 or older, income of $10,000 or less a year, and needed assistance with one or more daily living activities

• Typically at least 50% of daily food intake

SOCIAL ISOLATION AND INSTITUTIONS

• outside friendships seldom make it past the move

• one in three residents does not receive one visit in a twelve month period.

• Medical and depersonalized feel of facilities

• Treated as patients first, people second

• Rate of social isolation for older adults varies from two to twenty percent but is as high as thirty-five percent for those who live in assisted living facilities

MEALS ON WHEELS

• Benefits of Meals on Wheels:• Visit from a case manager for an eligibility assessment, telephone follow up,• and additional home visits as necessary, • a variety of hot and cold meals consisting of proteins, vegetables, fruit,

bread, and milk, • additional benefits include daily contact with the volunteer who delivers the

food.

• Average recipient was seventy five years or older, garnered an income of $10,000 or less a year, and needed assistance with one or more daily living activities.

• Average cost $840 per year.

• Meals typically provided recipients with at least half of their daily food consumption.

• Campus Kitchens “Backpacks”

CULTURE CHANGE

• Culture change is defined as the transformation of nursing homes from an ‘acute care’ medical model to a ‘person directed’ model

• Focus on providing dignity• Studies of facilities that adopt this approach have found decreased rates

of staff turnover, increased levels of occupancy, and higher rates of resident satisfaction and quality of life versus the national average

• Additional $11.43 per bed per day for a 140-bed nursing home. This translates to an additional $584,073 in revenue per year

ETHICAL WRAP UP

• Does not mean we want them to get jobs

• Those who can remain independent should be provided with the financial and medical resources necessary to do so

• For those in institutions comprehensive programming available to them in order quality of life

• Participation in society is the cornerstone of a democratic nation

ACA REFORMS• detailed payroll, staff ratios, nursing hours, turnover and retention

rates

• staffing information, health inspections, penalties, and complaints to the government’s nursing home compare website

• grants to facilities to develop best practices that create a more home-like, dignified environment for residents

• $2.25 billion for transition counseling

• $50 million for Aging and Disability Resources Centers

• Community First: • 6 percentage points in their federal matching rate• Must develop person-centered plan

• $500 million to support home visits

REFORMS S

TILL

NEED

ED

• More funding for institutions to raise quality

• Enforcement of Accreditation Policy

• Food Insecurity-more funding, culture change around aid

• Facilities made to be more home-like

• Strong Advertising