Introduction

The aging populations' answers to this question are of significant importance as Kentucky prepares for the baby boomer population turning 60. The Kentucky Elder Readiness Initiative survey responses from the Kentucky River and Kentuckiana Regional Planning and Development Agency (KIPDA) areas were analyzed to obtain results from an urban and rural area on what respondents perceived about their current and future quality of life. The purpose is to provide rural and urban communities information about factors associated with good quality of life and future needs among their aging residents.

Study Method

• 640 randomly selected households in each Area Development District received surveys.
• KIPDA (urban) had 224 surveys returned.
• Kentucky River (rural) had 189 surveys returned.
• Secondary analyses of the data collected were used to measure responses to the questions about their quality of life.

Results

• When asked "I think that my quality of life is most determined by" top responses were:
• 1.  KIPDA "my happiness" and "my faith";
• 2.  Kentucky River "my faith", "my happiness" and “having enough income".
• Current Quality of Life: KIPDA responses for good to excellent were at 88%; Kentucky River responses for good to excellent were at 76%.
• Expectation for quality of life in 10 years: get worse; remain the same; or improve. Most expected it would remain the same.
• KIPDA respondents felt more confident in their ability to financially support themselves in retirement.

Conclusions

• KIPDA showed a slightly higher percentage of satisfaction in all areas analyzed.
• Access to transportation and job opportunities are two issues potentially impacting the differences in responses.
• Financial resource options need to be explored as levels of confidence was less then 70% in both regions.

Kentucky River Communities in Action

Jenkins City Planning Committee:

In Jenkins, Kentucky (Letcher County) a group of citizens are working together to ensure the future of the city. A major task on the group's agenda is to find funding for an Assisted Living Facility. It is hoped that by working with the local government, schools, health care facilities and other community organizations individuals can be educated about the aging population and find ways they can become involved.

Hazard Perry Wellness Program:

A combined effort of Hazard Perry Senior Citizens Center, Perry County Fiscal Court, Hazard Perry County Community Foundation and UK Center for Excellence in Rural Health a variety of exercise programs and equipment has been purchased. The wellness program was established at the senior citizens center and is open extended hours for seniors in the community. The hope is that by ensuring services are available to seniors it will promote a better quality of life.

What Is the Kentucky Elder Readiness Initiative?

KERI seeks to develop information and provide support to Kentucky's communities so that elders and their families are provided with the opportunity to age in place and enjoy the highest possible quality of life for the longest time. For more information on KERI go to: http://www.mc.uky.edu/keri/

Kathy Black, PhD, MSW, MPH, MSG. es Hartford Geriatric Social Work Faculty Scholar y Profesora Adjunta en la School of Social Work – campus Sarasota-Manatee – University of South Florida. Las áreas en las que la Dra. Black posee experiencia incluyen la planificacin de cuidados avanzados en los últimos años de vida, las directivas anticipadas, la comunicacin profesional sobre los cuidados de la salud y el envejecimiento-en-casa.

P:  ¿Qué es el Envejecimiento-en-Casa?

R: El Envejecimiento-en-Casa se refiere a la gente que envejece en sus propios "hogares", o en el lugar donde ellos viven y desean seguir viviendo allí. La mayoría de los adultos mayores desean seguir viviendo en las casas en las que han vivido la mayor parte de sus vidas y muchos lo hacen; de hecho, la mayoría de personas de 65 años y más viven en lugares no institucionales y son dueños de sus propios hogares.

P:  ¿Como puedo lograr Envejecer-en-Casa?

R: La posibilidad de seguir viviendo en el hogar generalmente depende de varios factores. Hazte las siguientes preguntas para ver si estás listo para envejecer-en-casa: 

1. Estado personal de salud y necesidades:  ¿Posee limitaciones mentales o físicas que afecten tu habilidad para manejarte en casa?  ¿Eres capaz de satisfacer tus necesidades de salud en casa? 
2. Familia y otras ayudas informales (como amigos, la iglesia, etc.):  ¿Quién te cuidará si es necesario en algún momento?  ¿Es esa persona capaz de brindarte los cuidados que necesitas? 
3. Circunstancias econmicas (incluyendo finanzas y seguro):  ¿Tienes suficiente dinero para pagar los cuidados que puedas necesitar en tu hogar? Los servicios de cuidado en el hogar suelen ser caros y generalmente no son cubiertos por el seguro. Ten en cuenta que Medicare provee cuidados de salud en el hogar por un período limitado de tiempo bajo circunstancias específicas y que el Seguro de Cuidados a Largo Plazo probablemente no pueda satisfacer tus necesidades de cuidado en casa. 
4. Ambiente físico domiciliario:  ¿Eres capaz de moverte por tu casa? Las escaleras y la falta de baños puede afectar la posibilidad de que te quedes en casa. Aunque estén disponibles, las modificaciones para agregar una rampa o un baño en tu hogar pueden ser costosas. También importante a tener en cuenta:  ¿Puedes mantener tu hogar? Las reparaciones del hogar pueden ser costosas, difíciles o inseguras.  ¿Has considerado a donde te mudarías si no pudieras quedarte en tu hogar? Muchas instalaciones con asistencia y otros lugares para recibir cuidados poseen listas de espera. 
5. Servicios ofrecidos por tu Comunidad:  ¿Qué servicios ofrece tu comunidad para ayudar a la gente que decide envejecer en su hogar? Las comunidades tienen diferentes servicios disponibles; algunos pueden ser gratuitos, de bajo costo o cubiertos por seguros como Medicaid, mientras que otros no; muchos poseen listas de espera. El gobierno local y tu Estado podrían brindarte algunos servicios, mientras que otros pueden ser privados o comerciales. Los requisitos para esos servicios también varían.

P:  ¿Qué servicios hay disponibles para ayudarme a envejecer-en-casa?

R: Hay una gran variedad de servicios para apoyar el envejecimiento-en-casa; sin embargo, la disponibilidad de dichos servicios dependerá del lugar donde vivas. Generalmente, los servicios que se ofrecen para ayudar a que la gente envejezca en su hogar incluyen: 

• Cuidado básico del hogar: una persona que cocinará algo para tí o limpiará la cocina; 
• Cuidados médicos en el hogar: una persona que te brindará cuidados personales o cuidados médicos especializados; 
• Mantenimiento del hogar: podrás contratar a una persona para que cuide del jardín; 
• Transporte: transporte para ir y volver de la consulta con el médico; 
• Comidas entregadas en el hogar: comidas gratuitas o de bajo costo entregadas en tu hogar.

Necesitar varios servicios no es poco común, sin embargo a menudo es difícil conocer, acceder y controlar el rango de servicios que podrías necesitar. Los supervisores de casos geriátricos son profesionales empleados por organizaciones públicas o privadas para que te ayuden a acceder y controlar los cuidados que podrías necesitar. Puedes conseguir un supervisor de casos público a través de varios programas gubernamentales ofrecidos en tu área.

Puedes conseguir un supervisor de casos geriátricos privado a través de organizaciones como la National Association of Professional Geriatric Care Managers, 1604 N. Country Club Road, Tucson, Arizona 85716, de 8:00 a.m. a 4:30 p.m., MST Hora Estándar de la Montaña (durante todo el año; Arizona no tiene horario de verano), Lunes a Viernes, excepto feriados. El número de teléfono es (520) 881-8008; el número de fax es (520) 325-7925. El correo de voz te permite dejar mensajes durante 24 horas al día, siete días a la semana, o por medio de la página web: http://www.caremanager.org/  

Para saber más acerca de los servicios de tu comunidad, contacte la Administracin del Localizador de Cuidados para Adultos Mayores "Administration on Aging's Eldercare Locator" para comenzar tu búsqueda de servicios que te ayuden a permanecer independiente en tu comunidad. Puedes contactar a una persona especializada en dar informacin sobre el Localizador de Cuidados para Personas Mayores llamando a la línea gratuita 1-800-677-1116 en días de semana, de 9:00 a.m. a 8:00 p.m. (ET). Hay personas especializadas en dar informacin que hablan español. También puedes acceder al servicio usando Internet a través del siguiente link: http://www.eldercare.gov/Eldercare/Public/Home.asp.

• Para localizar a un trabajador social en tu área para que te ayude con asuntos respecto del envejecimiento, por favor pulsa aquí.

John D. Weaver, LCSW, BCD, ACSW is a founding partner of EYE OF THE STORM, Inc., a private consultation and education group practice specializing in disaster mental health, crisis intervention, and risk management related training and support. Weaver has been an active volunteer with several organizations including the Mental Health Association and the American Red Cross (ARC). He has assisted at several local and national disasters.

Q.  I’m about ready to retire but I’m not sure if I should go now or stay on a bit longer, to pad my retirement savings a bit more. Any advice?

Folks generally reach a point in their careers when they realize they have retirement open to them as a serious option. Some clues that you’re there? Work you once loved and/or tolerated well is not as appealing to you. Paperwork is becoming overwhelming. It is harder than ever to leave work and/or thoughts about work at work. You are having trouble relaxing and unwinding. Work stress is starting to take a physical and/or emotional toll on you and your family. You find yourself checking your retirement nest egg more often. Bottom line – you will know when it is time to go.

Q. But I can’t go, I love my job (most of it anyway). I’d miss ______ (fill in all the good stuff). What will I do with myself all day?

Retirement gives you extra time to do the things you enjoy (e.g., read, travel, exercise, socialize, watch TV, garden, visit family, cook, enjoy recreational sports, etc.). At the same time, it gives you more time to do things that aren’t always fun (e.g., cut the grass, clean, paint, get that surgery you’ve been putting off, visit family, and other things you’ve been putting off). As long as you are able to strike a balance between time spent having fun and time spent doing things you have to do, you’ll be fine.

Q. My partner tells me that, when I retire, I can’t just hang around the house all day. I guess that would drive us both crazy, right?

Right! Both of you need to keep busy, sometimes together and other times by yourselves. The list above contains a nice mix of things that can be done solo, done with friends, and/or done with your partner. Also, consider working part time (if you need some extra money) and/or volunteering.
Either way, it will keep you busy and that will keep you from getting tired of each others company.

To find a social worker in your area who can help you with retirement issues, please click here.

Kathy Black, PhD, MSW, MPH, MSG. is a Hartford Geriatric Social Work Faculty Scholar and Associate Professor at the School of Social Work, University of South Florida Sarasota-Manatee campus. Dr. Black's areas of expertise include advance care planning throughout the end-of-life, advance directives, healthcare professional communication, and aging-in-place.

Q: What is Aging-in-Place?

A: Aging-in-place refers to people getting older in their "home," or the place where they live and wish to continue to reside. The majority of older adults wish to remain in the homes they have lived most of their lives and many do; in fact most people age 65 years and older live in non-institutional settings and own their own homes.

Q: How can I Age-in-Place?

A: The ability to remain at home generally depends on several factors. Ask yourself the following questions to see if you are prepared to age-in-place: 

1. Personal health status and needs: Do physical or mental limitations affect your ability to manage at home? Are you able to get your health needs met at home? 
2. Family and other informal supports (such as friends, church, etc.): Who will provide care for you if and when needed? Is the caregiver capable of providing the care you need? 
3. Economic circumstances (including finances and insurance): Do you have enough money for care that you may need to stay at home? Home care services can be expensive and are generally not covered by insurance. Know that Medicare provides limited short term home health care at home under specific circumstances and that Long Term Care Insurance may not meet your home care needs. 
4. Physical home environment: Are you able to get around in your home? Stairs and the lack of bathrooms may impact your ability to stay at home. Although available, home modifications to add a ramp or bathroom can be costly. Also important to consider: Can you maintain your home? Home repairs can be costly, difficult, or unsafe. Have you considered where you might move to if unable to stay at home? Many assisted living facilities and other care settings have waiting lists. 
5. Broader community of services: What services does your community offer to help people age-in-place? Communities vary in available services; some services may be free or low cost or covered by insurances such as Medicaid, while others are not; many have waiting lists. Your state and local government may provide some services, while others are private or for-profit. Eligibility for services also vary.

Q: What services are available to help me age-in-place?

A: There are a wide range of services to support aging-in-place; however, the availability of services will depend on where you live. Generally, examples of services to help remain at home include: 

• Basic homecare: having someone in to make a meal or clean the kitchen; 
• Home healthcare: having someone come in to provide personal care or specialized medical care; 
• Home maintenance: hiring someone to take care of the lawn; 
• Transportation: accessing a ride to and from a doctor's visit; 
• Home-Delivered Meals: free or low cost meals delivered at home.

Needing a variety of services is not uncommon, however it is often difficult to learn about, access, and manage the range of services you might need. Geriatric case managers are professionals employed in public and private settings to assist you in accessing and managing the care you might need. You can access public case managers through many of the governmental programs offered in your area.

Private geriatric case managers can be reached through such organizations as the National Association of Professional Geriatric Care Managers, 1604 N. Country Club Road, Tucson, Arizona 85716, 8:00 a.m. to 4:30 p.m., Mountain Standard Time (all year round; Arizona does not observe Daylight Savings Time), Monday through Friday, except holidays. Telephone number is (520) 881-8008; fax number is (520) 325-7925. Voice mail allows you to leave messages 24 hours a day, seven days a week, or via the Web site at: http://www.caremanager.org/

To learn more about services in your community, please contact the Administration on Aging's Eldercare Locator to begin your search for services to help you remain independent in your community. You can reach an Eldercare Locator information specialist by calling toll-free at 1-800-677-1116 weekdays, 9:00 a.m. to 8:00 p.m. (ET). Spanish-speaking Information Specialists are on duty. You may also access the service via the Internet using the following link, http://www.eldercare.gov/Eldercare/Public/Home.asp.

• To learn more about aging-in-place, click here to read the New York Times story “A Grass-Roots Effort to Grow Old at Home.”
• To locate a social worker in your area to help you with any aging issues, please click here.

Introduction

A great deal is written about how to age well. The following ideas are simple and easy to learn. Try to incorporate a few of these ideas and see what a difference it may make in your everyday life.

Keep Your Life Rich with New Ideas and Experiences

To stay vital our minds need new information to chew on and digest, which is easier to do when we are young. Family, schools, and communities all have a hand in providing enriching experiences, but as we grow older, more of the decision making falls upon ourselves. 

Some people begin to lose ground in this area as young adults because they let life happen rather than taking an active role. You want to challenge yourself even when new things make you feel a bit uneasy. Try to think of that feeling as excitement.

Push ahead in spite of your reluctance and you will feel positive results. Take a class at the community center or take the train to the city for the day. Step out of your regular routine as often as you can, you may be happy you did. 

Adjust Your Mind Set

When a person's life is going well, there may be little need to do any reexamination. When younger, people tend to be more open to discussing thoughts and plans. As one gets older, this process, for some reason, slows.

Talk more about life goals and objectives. During those times when things are going well take the opportunity to think and make adjustments. Tackle an old problem from a new angle or decide to speak up about a situation that has been troublesome. In doing so, people often develop some new ways to look at the world and better ways to cope. 

Maintain the Highest Level of Functioning Possible

Do as much for yourself as possible and stay active using personal physical resources. Internal strength comes when physical abilities are maintained. It is empowering to manage daily tasks and be a help to someone else. Human bodies adjust to individual activity levels. 

Work Toward Accepting Your Limits and Focus on Your Strengths

Everyone is unique. During the aging process, more losses are experienced and it is important to stay as positive as possible given personal circumstances. Everyone has limitations and burdens. Deciding how to deal with them is a personal choice each day.

Make a conscious choice to focus on good things. Some days are harder than others but people are only given one day at a time with which to deal. Limit your worrying and use thought-stopping techniques to get negative thoughts under control. Distracting activities such as calling a friend, reading or listening to music can often help limit worrisome thoughts. 

Have Meaningful and Purposeful Activities in Your Life

Everyone needs a reason to get up in the morning and move forward with a positive heart. Running on auto pilot each day creates a rut. If unhappy, ask why. Ask yourself "If I could change one thing, what would it be and why?"

The changes can be small but even small changes can make a difference. Consider helping a friend with a project or call the local food pantry to schedule time to help sort and stock shelves. 

Maintain Connections with One's Family, Friends, Faith Community, and Work or Volunteerism

Only few meaningful connections are needed in life. Prioritize how time and energy is spent. Time is precious. Many times, what was once meaningful, now feels burdensome. Feeling positive is important about activities in life. If the activities are not engaging, make a change. 

Find Time to be Quiet Each Day

Take time to just “be” every day. Practice positive self-talk. Every thought is self-talk. We consciously talk to our subconscious mind.

Be grateful. Try to sit quietly or take a walk each day. This is not the time for negative thinking. If it is a struggle with being alone this may be a sign that all is not well. Speak to someone you trust or a professional. 

Focus on What Matters

Worrying over little things may be a warning sign that something might be wrong. Take a step back and evaluate what is going on. Everyone knows someone who complains when a dog barks too much or when the neighbor's leaves blow in the yard. Worrying over trivial matters wastes energy and valuable resources. Cluttering one's mind with these little annoyances can cause a person to be cut off from the world.

How Social Workers Can Help

Social Workers are trained to listen. They provide a wonderful sounding board to validate thoughts and feeling. In addition, they are able to give feedback about your life which may help with life choices . Social Workers can help identify areas to change and help set goals. They can also be invaluable in helping learn about community happenings and resources.

Conclusion

Try to keep these tips in mind. When able to work some of these ideas into life, there may be a difference. Have a better sense of self and know more about what gives individual days meaning. This is a personal journey and so many ways to make it  better.

Related Articles:

• About Vital Aging
• Vital Aging Current Trends
• Vital Aging: Your Options
• Vital Aging: How Social Workers Help
• Vital Aging Tip Sheets
• Resources for Vital Aging
• Vital Aging Real Life Stories

	What Is a Social Adult Day Program?
	How Does a Social Model Differ from a Medical Model?
	Factors to Consider and Questions to Ask
	Final Considerations

What Is a Social Adult Day Program?

A social adult day program provides structure, support and stimulation to older adults living in the community, as well as a break for their caregivers. Social adult day programs, when coordinated with additional supportive services, often enable older adults to remain in their homes for as long as possible.

How Does a Social Model Differ from a Medical Model?

In a social model, medical services are not provided, and there are no medical personnel on-site. In the event of an emergency, social programs call 911. Social programs cannot administer medication but can cue a client to take medication independently. Medical models are more appropriate for clients who require medical attention throughout the day, for example, a diabetic client who needs an insulin shot every few hours.

Factors to Consider and Questions to Ask when Selecting a Program:

• Population:  What is the composition of the group? Some programs are designed strictly for people who have been diagnosed with dementia; other programs serve people who are physically frail but cognitively intact, while others serve a mixture of the two. Even groups with the same type of clients may serve participants in varying stages of a certain condition.

  Ask the program staff for population specifics prior to your first visit so you know what to expect. You may also be interested in the program's gender ratio, ethnic and economic diversity, and languages spoken.

  You definitely want to know how many people the program accommodates per day. Programs vary in size. There are benefits to both smaller and larger groups, but ultimately it is a matter of personal preference. 

• Schedule:  What time does the program start and end? The length of a day program often replicates that of a typical work day, and for many participants, this schedule elicits familiar feelings of productivity. Ask if there are there a minimum number of hours a participant must stay or a minimum number of days a participant must commit to. Generally, programs are open during the week, but some programs may be open or may offer special trips on weekends. 

• Affiliation: Is the program affiliated with a larger organization?  For example, is it affiliated with a hospital, settlement house, or senior center? What additional services are provided by the overarching entity? Some organizations serve as "one-stop shopping centers," offering services such as case management, caregiver support, legal assistance, and/or home care. 
• Funding:  Who funds the program? A program that is publicly funded (even partially) must comply with standards set forth by the governing body (usually state or city) issuing the funds. Privately funded programs must comply with standards set forth by the funding foundation; however, these standards vary from foundation to foundation. 
• Environment:  Where is the program held? Factors that facilitate an optimal environment include ample natural light, a separate room specifically devoted to the program, sufficient space between participants, supportive chairs with arms, minimal audible distractions, and a home-like rather than institutional feel. Programs specifically designed for people with dementia should have a locked door to inhibit wandering.
• Programming:  Programming distinguishes the exceptional from the mediocre group. Get a copy of the schedule and ask questions about anything that may be unclear. The program's goal is to provide social stimulation and to reduce social isolation. You want to find out how this goal is actualized. Schedules range from highly structured to extremely flexible. You want a program that best suits a participant's needs and temperament. Ideally, each day should blend physical, cognitive and social activities.

  Additionally, you want the majority of activities to require active rather than passive participation. Active programming facilitates interaction between participants. Examples include low-impact exercise, expressive therapies (i.e. art, music, drama, or animal-assisted), and cognitive challenges. An example of a passive activity is watching a movie.

  Programming should focus on capabilities rather than deficits, and all activities should be failure-free. In a good program, participants will find new opportunities for creativity and will develop alternative standards of productivity. Perhaps most importantly, day programs can provide participants with a renewed sense of purpose and belonging during later life.

• Staff:  How many full-time, part-time, and per diem staff members are there? What educational and professional training does the staff have? What is the ratio of staff to clients? Does the program utilize volunteers or students, and if so, in what capacity? You should meet as many staff members as possible to ensure you are comfortable with the program's leadership.
• Personal Care:  What personal care needs does the program address? Personal care refers to assistance with one or more of the following: eating, toileting, transferring out of a wheelchair, and walking. If the prospective participant requires additional assistance, inform the staff and inquire if they are able to meet the specific need.
• Home Attendants:  Some programs welcome privately-employed home attendants to sit, and in some cases, participate in activities. Other programs do not allow home attendants to be present.
• Fees:  How much does the program cost per day and what is included in that cost (i.e.: meals, transportation, trips, etc.)? Are there subsidies available for clients demonstrating financial need? How and when will you be billed? Some private long-term care policies will reimburse you for the fees; find out if social adult day programs are covered under your policy.
• Transportation:  Is transportation offered to and from the program? Is the vehicle wheel-chair accessible? Does the driver have a Commercial Driver's License (CDL)? In addition to the driver, is there a bus monitor/escort to assist clients with boarding and disembarking the bus? When and where is the client picked up, and how long is the bus ride?

Final Considerations

Day programs provide critical assistance to both consumers and caregivers, but remember that not all programs are created equally. Visit several so you can compare and contrast, and make an educated decision. Don't hesitate to ask questions and to raise any concerns. Ask if a caregiver can accompany and remain with a participant if he or she appears extremely anxious in the beginning.

Keep in mind that the length of time needed to acclimate to the group setting varies from person to person. Some people may never have been comfortable in groups so this may be a completely unfamiliar experience. Others may have always been at ease in groups but may have become withdrawn due to current physical or cognitive difficulties.

You may need to visit a program a few times before you can determine if it is a good fit. If, after numerous attempts, a day model does not seem appropriate at this point, don't lose hope. Keep the program's contact information because you can always try again later.

Related Articles:

• About Vital Aging
• Vital Aging Current Trends
• Vital Aging: Your Options
• Vital Aging: How Social Workers Help
• Vital Aging Tip Sheets
• Resources for Vital Aging
• Vital Aging Real Life Stories

	NASW Observes Older Americans Month
	Additional Funds Needed for Older Americans Act
	Funding Sought for New Respite Care Act
	Mental and Emotional Health — A Vital Component of Overall Health
	Social Work’s Role in Aging and Mental Health
	Aging and Mental Health Resources at NASW
	Positive Aging Act Seeks Expanded Mental Health Services
	Expanding Social Work Services to Nursing Home Residents
	Take Action on Behalf of Older Adults

Introduction

During the month of May, NASW observes Older Americans Month, sponsored by the Administration on Aging. This year's theme—Older Americans: Making Choices for a Healthier Future—highlights the changes needed in health care and long-term care to enable current and future generations of older adults to live independently and with dignity. Social workers are striving to bring about these changes, such as increased access to 

• Health information, including information about cost-effective preventive practices that improve quality of life and reduce risk of disease, disability, and injury; 
• Affordable, gerontologically centered health care; 
• Long-term care information that enables older adults and their families to meet current needs and plan for the future; 
• Flexible, affordable home- and community-based services that maximize older adults' choices and support family caregivers; 
• Residential long-term care settings that promote self-determination and meet residents' emotional, social, and medical needs; and 
• Affordable mental health services, designed to meet the unique needs of older adults.

Additional Funds Needed for Older Americans Act

The Older Americans Act (OAA), enacted in 1965, supports a variety of services that enhance the health and well-being of older adults. Additional funding is needed in FY08 to continue and expand programs essential to older adults' independence and dignity. Social workers and consumers play a crucial role in advocating for OAA funding. Click here to learn more or take action: www.socialworkers.org/advocacy/alerts/2007/050107.asp

Funding Sought for New Respite Care Act

Support for family and other informal caregivers is key to helping older adults remain in their homes. As a member of the Lifespan Respite Task Force, NASW lobbied for the Lifespan Respite Care Act of 2006, which was signed into law in December. This act will expand access to respite care for family caregivers and improve local coordination of services. NASW and the Task Force are advocating for appropriation of funds to implement this legislation in FY08.

Mental and Emotional Health—A Vital Component of Overall Health

Recognizing both the importance of mental health in aging and social workers' pivotal role in providing mental and emotional health services to older adults, NASW continues its partnership with the Older Women's League (OWL) and other organizations in promoting Older Americans' Mental Health Week (May 21-27). The goal of the week is to raise awareness about the mental health needs of older adults. For the 2007 observance, OWL conducted a poll to assess the knowledge and attitudes about mental health and aging among nursing assistants, physician assistants, and physical therapists. The results indicate the need to educate these health care professionals—especially for nursing assistants, who have the most contact with older adults in their practice and who also held the most misperceptions—that 

• Depression is not a normal part of aging; 
• Mental health treatment does not become less effective as people age; 
• Suicide rates are highest for adults over the age of 75; and 
• Depression, suicide, and substance use are not signs of weakness.

OWL's poll also found that most nursing assistants, physician assistants, and physical therapists do not feel confident in their ability to recognize or address signs of mental health problems in their patients. While these professionals are most likely to refer patients with signs of mental health disorders to primary care physicians, many also refer to mental health professionals, including social workers.

Social Work's Role in Aging and Mental Health

With their training in mental health assessment and treatment, their skills in collaboration, and their close proximity to other health and allied health professionals in health and long-term care settings, social workers are well positioned to educate other professionals about mental health and aging—and to provide mental and emotional health services to older adults. In a 2004 study of licensed social workers nationwide, NASW's Center for Workforce Studies http://workforce.socialworkers.org ) found that almost 75 percent of social workers provide services to adults 55 and older, regardless of the practice setting or focus. This number will likely increase as the U.S. population ages. Among the 12 percent of social workers who specialize in aging practice, psychosocial issues, mental illness, and grief and bereavement issues rank among their clients' top concerns.

Aging and Mental Health Resources at NASW

NASW has developed a number of resources to educate older adults and their families about mental health and aging issues and to enhance the skills of social workers serving older adults. This list is included in OWL's Older Americans' Mental Health Week toolkit, available in print and CD-rom formats. Click here to view NASW's list of aging and mental health resources for consumers and social workers: www.socialworkers.org/practice/aging/agingBroch0507.pdf

Positive Aging Act Seeks Expanded Mental Health Services

Many older adults don't use mental and emotional health services because those services are inaccessible. The Positive Aging Act of 2007 (S.982/H.R.1669) was reintroduced in both the House and the Senate in late March. This bipartisan legislation is designed to integrate mental health services for older adults in primary health care settings and to expand community-based mental health services. NASW is working with mental health and aging groups to increase the number of cosponsors for the bill.

Expanding Social Work Services to Nursing Home Residents

NASW is also supported by Senator Barbara Mikulski (D-MD), one of the 10 social workers in Congress, in promoting the Clinical Social Work Medicare Equity Act of 2007 (S.1212), which was reintroduced in late April. This bill would expand mental health services to nursing home residents by allowing clinical social workers to bill Medicare Part A directly for psychotherapy services provided in skilled nursing facilities—a privilege already enjoyed by psychologists and physicians. Click here to learn more: www.socialworkers.org/advocacy/alerts/2007/0501072.asp

Take Action on Behalf of Older Adults

NASW urges people of all ages and social workers to plan, promote, and participate in activities during Older Americans' Mental Health Week, Older Americans Month, and throughout the year that enhance the independence and dignity of older adults. Please check this site for updates regarding policy and practice issues affecting older adults and social work practice in aging. For more information regarding Older Americans' Mental Health Week—including locating activities sponsored by OWL chapters across the country—please visit www.owl-national.org  

©2007 National Association of Social Workers

Ideally, all Americans should have equal access to physicians, hospitals, and medical tests in their communities. The fact is that large disparities exist in access to U.S. health care services based on race, ethnicity, socioeconomic status, and education. The elderly, minorities, and low-income individuals are most likely to experience various obstacles to receiving quality health care services.

Given the changing demographics of American society and the link between high quality health care and quality of life, health care disparities are likely to soon become a pressing problem in communities across the country.

Consider these facts: 

• One-fourth of older adults have no supplemental insurance coverage for their health care needs, while 16 percent of Americans under age 65 have no health insurance coverage. 
• Preventive health screening rates are particularly low for minorities, low-income individuals, and older adults. 
• Health care facilities are often not accessible or do not have the necessary equipment to serve people with disabilities.

Americans now live longer than ever before. Medical advances have boosted the life expectancy from less than 50 years to more than 76 years and have greatly improved the overall health of Americans in the past century. Since people are living longer, however, the number of individuals who experience higher rates of illness and disability is expected to increase dramatically.

By 2030, there will be roughly 70 million Americans age 65 years or older, which is more than double the number of age 65+ Americans in 2000, according to the Federal Interagency Forum on Age-Related Statistics. In 25 years, the number of people age 85 or older is expected to double, while the number of people age 100 or older is expected to triple.

Older adults experience the effects of health care disparities more dramatically than any other population group. They are particularly at risk because they are more likely than younger people to have chronic illnesses, make frequent visits to medical facilities, and live in poverty.

Disparities in Clinical Trials

While a disparity certainly exists between older adults and those under age 65 in access to medical professionals and services, there is also an age disparity in medical research practices. Older adults are markedly underrepresented in clinical trials.

Despite the fact that the imbalance in study participants has been recognized for years, the disproportionate lack of older people participating in clinical trials still exists. Yet, finally this trend appears to be shifting as both the research community and policy groups have begun to emphasize the inclusion of older adults in clinical trials.

Public Policies

Improving access to health care services for older adults has been an important public policy objective for decades. Many policy initiatives, such as Healthy People 2010 and Medicare reform, call for eliminating disparities in health care to foster better qualify of life for current and future older Americans.

Community governments, social service agencies, health care facilities, and other entities will need to prepare for the increasing older adult population to ensure that older adults' health needs are addressed and that quality medical services are readily available. The social work profession is dedicated to addressing the health care disparities issue and is promoting equal health care access, especially for vulnerable populations that need health care services the most.

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• Vital Aging Current Trends
• Vital Aging: Your Options
• Vital Aging: How Social Workers Help
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• Vital Aging Real Life Stories

Staff Photo by Corey Perrine Denise Levesque looks outside her apartment window in Nashua while reading Friday. Levesque, who has been clinically depressed since 1992 , uses therapy and Trazadone to help ease her condition. “When I’m depressed I don’t like to be around people; I isolate myself,” Levesque said. “I’ll stare out the window for long periods of time.” Order this photo

NASHUA – Alice Cassidy loves to tell the story about the elderly nursing home patient who used to spend her days sitting at the nurses' station crying before finding happiness again.

When a psychiatrist visited the facility and saw the woman crying, he asked to interview her. Afterwards, he prescribed a low dose of a common antidepressant medication.

"And a few weeks later, after he made a return visit to the nursing home, the woman was happily traveling up and down the halls in her wheelchair, cell phone to her ear, talking with her grandchildren," Cassidy said.

To Cassidy, director of elderly services at Community Council, a public behavioral health agency, the story is an inspiration. It's also an example how treatable late-life depressive illness is."Elder depression is common, but it is not a normal part of aging," Cassidy said, noting that up to 20 percent of people over the age of 65 suffer from depressive illness.

Cassidy is a licensed clinical social worker specializing in geriatric mental health. She said that older people suffering from depression are at higher risk of dying by suicide than younger ones.

Elders are also less likely to seek help, having come of age in a time before psychology, support groups and more effective psychiatric medications. In addition, older people often believe the myths handed down through the generations that paint aging as a downward spiral and depression as a character flaw.

Dealing with depression

"There's a lot of it out there," said Pat Francis, executive director of the Senior Activity Center in Nashua, of depressive illness among older adults. "I think it's there, and I hear it through other agencies."

Francis said she is less likely to see depression than some of her peers: Most of the older adults who participate in programs at the senior center are active and involved.

"I see the ‘well' side of aging; people who have a desire to keep busy, give of their time and their talents," Francis said.

But when depressed elders come to the center, they usually arrive with adult children hoping their parents will snap out of it.

"You ask, ‘How are you?' and they say, ‘Fine,' and that's the end of the conversation," Francis said.

It's difficult, if impossible, Francis said, for anyone who hasn't experienced depressive illness to understand it.

The senior center executive said in the past she has urged older adults "to keep busy and don't dwell upon what ifs," sound advice for the normal ups and downs of life, but not particularly helpful for someone who is depressed.

"Having not been there, it's easy to say, ‘just move on,' " Francis said.

Physicians specializing in caring for older adults have a different perspective. Dr. Ken Dolkart, an internist and geriatrician at The Center for Healthy Aging at Southern New Hampshire Medical Center, routinely checks for depression.

"It's not a natural part of aging, but it's a very common phenomena," Dolkart said. "There are more losses experienced and health issues, but the origins of depression are complex. They have to do with spiritual, emotional, psychological and biological aspects of life."

Not a weakness

Dolkart said elders and their families often wrongly believe that depression is a "moral weakness" when in fact it is a "real medical phenomena." Patients and their families also frequently fail to appreciate the effect depression has on other medical conditions. A depressed person with osteoarthritis, for example, may experience greater pain levels than someone who is not depressed.

"Treating depression is one of the best tools to enable a patient to deal with other health issues," Dolkart said.

He said warning signs of depression include sadness, loss of pleasure, lack of energy, frequent crying and ideas of suicide. In diagnosing depression, moreover, a physician must first rule out other conditions, he added.

When depression is confirmed, however, Dolkart recommends counseling, saying it is one the best medicines.

"Seniors are often uncomfortable or don't understand," he said. "Counseling gets short shrift."

Suzanne Keller, director of the 55 PLUS program, a resource for older adults run by Southern New Hampshire Medical Center, agreed.

"I know it's a big problem and often misunderstood or completely ignored," she said, adding that she tries to help educate people about depression by bringing classes and programs to the hospital.

Keller said older adults are often eager to talk with her when they visit the 55PLUS offices and frequently talk about their losses: the death of a spouse or the loss of friends and independence are common topics of conversation.

"They say, ‘They call it the Golden Years and you have all these losses,' " Keller said. "Nobody addresses it as much as with teens or new moms."

Hattie Bernstein can be reached at 594-6439 or at hbernstein@nashuatelegraph.com.