Care Giving: A Major Occupation In The United States

Looking At The Numbers

• 70% of people turning age 65 can expect to use some form of long-term care during their lives. (U.S. Dept. of Health & Human Services)
• By 2030, the older population is projected to be twice as large as it was in 2000 – growing from 35 million to 71.5 million people. (2009 Long Term Care Insurance Sourcebook, American Association for Long-Term Care Insurance)
• The population 65 years and older is increasing as a percent of total population. Of the older population with long-term care needs, about 30% have substantial long-term care needs. Of these, about 25% are 85 and older, and 70% report they are in fair to poor health. (Long-term Care: Medicaid's role and challenges, Publication #2172, The Henry J. Kaiser Foundation)
• 40% of the older population with long-term care needs are poor or near poor (with incomes below 150% of the federal poverty level). (Long-Term Care: Medicaid's role and challenges, Publication #2172, The Henry J. Kaiser Foundation)

There are over 44 million caregivers, or one out of every five households, involved in care giving to persons 18 years of age or older. 34 million caregivers provide care to someone 50 years of age or older. (Caregiving in the U.S., National Alliance for Caregiving and AARP)

By 2050, the number of individuals using paid long-term care services in any setting – at home, residential care such as assisted living, or skilled nursing facilities – will likely double to 27 million people from the 13 million who were using long-term care services in 2000. This estimate is influenced by growth in the population of older people in need of care. (The future supply of long-term care workers in relation to the aging baby boom generation: Report to Congress, U.S. Department of Health and Human Services and U.S. Department of Labor)

We can heed the warning that's clearly in front of us or we can put our heads in the sand and believe we have other, more pressing problems and challenges.

Today we affect what we experience tomorrow. 

Those with loved ones in Long Term Care, be vigilant and be relentless in your observation, review and communication about your facility using technology as your ally and best defense when you cannot get the consistent quality of care and life for your loved one through going up the chain of command at a facility. 

Those who care for loved ones in their home or yours, you need assistance but you also need to ensure safety and well being. Do a thorough check and be vigilant. 

Remember: You/your loved one, is the customer/the consumer, whether direct pay or paid for through a group, organization or even Medicaid (we pay the taxes, it's money out of public pockets)

Mandate Prompt Public Release of Info on DHSS LTC Visits

The following entry was started in January 2014.

That was the month my Mom passed. 

My frustration and anger over the months preceding her passing, the failure of the facility to allow us to provide Hospice from an outside source as we saw her decline and realized time was most possibly short, was still filling my daily life.

There had been an incident of possible abuse involving touching inappropriately at Mom's facility  and another facility that had reached the news media.

Facilities depend on "good press", positive PR and place ads to secure residents; it's what determines their staying open -- residency stats.

I understand caution but we wanted a Hospice from a well recognized and highly respected medical facility. This wasn't a private company, or private individual.

We saw and knew the facility allowed "outside" Private Duty Nurses. 

Why did they deny Mom and our family "outside" Hospice?

Wiser, now, we've read the Medicare and Medicaid guidelines and saw how much the facility could lose in income if we had "outside" Hospice.

MONEY.  As always, it comes down to that one decisive "worldly" item. Sad. Sick, really. Not about a human life; not about dignity or choice. Self centered. Self focused. Or so it still seems.

It's now January 2016. Mom's passing has been two years. Husband's passing, five years. Both in January. Mom passed on the date of the day we interred my husband. Not a great way to remember.Time continues. Memories remain.

What's New?  What's Changed? Where are we two years later?

Unfortunately, not very far. 

A couple of States, as cited in this blog, have started to provide more specific and enlightening information on Long Term Care or whatever your State calls caregiving for individuals providing Medical Care along with various services and are specifically governed by State Regulations and State Review.

Here's what I wrote back then:

THERE NEEDS TO BE A LAW in this tech saavy age. 

States publish results of investigations including complaints/licensing of Skilled Nursing Facilities or Long Term Care Faciities on their websites several weeks and sometimes a month or more after the conclusion of an investigation.

Many do not list previous citations and few list descriptions and often cite only sections of laws without explanation or clarification. When there's a fine involved, there's usually not a detail of what the fine was based on in clear, concise and specific language easy to read and reference to see causes, effects and outcomes. 

When the DHSS or other authority goes in, they might find additional violations and they may choose to fine based on a "lesser cause". None of this is provided to the general public.

You and I remain in the dark about the real quality and safety of placing ourselves or a loved one inside the walls of care giving facilities who totally take over lives and determine the daily life of hundreds of individuals and the level of care they receive.

Recent investigation into my Mom's facility after two deaths believed to have been caused by incorrect procedures followed in her facility and other challenges to physical and emotional lives of several residents, has led me to voice this CALL TO ACTION:

WRITE YOUR STATE SENATORS AND REPRESENTATIVES. Let's get a five business day turn around for posting on line all findings of each investigation by our States regarding complaints or any other Department of Senior Services reports on Long Term Care Facilities. 

WHY? The AARP (previously the American Association of Retired Persons but now represents those aged 50 and beyond) has advised about 8,000 people A DAY turn 65. 

WHY?  My dedication to Senior Advocacy discovered several months ago the "oldest old", those aged 80 and above, represents the fastest growing segment of our older population, twice that of those 65 and over and growing at a rate of almost 4 times the total population.  It's estimated by 2050 to total over 19 million people.  http://transgenerational.org/aging/demographics

THE "SENIOR SENIORS"

"The nation's 90-and-older population nearly tripled over the past three decades, reaching 1.9 million in 2010, according to a report released today by the U.S. Census Bureau and supported by the National Institute on Aging. Over the next four decades, this population is projected to more than quadruple.

"Because of increases in life expectancy at older ages, people 90 and older now comprise 4.7 percent of the older population (age 65 and older), as compared with only 2.8 percent in 1980. By 2050, this share is likely to reach 10 percent.

"The majority of people 90 and older report having one or more disabilities, living alone or in a nursing home and graduating from high school. People in this age group also are more likely to be women and to have higher widowhood, poverty and disability rates than people just under this age cutoff.

"These findings come from 90+ in the United States: 2006-2008, which presents an overview of this age group and a comparative analysis of selected demographic and socio-economic differences between people 90 and older and their younger counterparts within the older population. Statistics for the report, which go down to the state level, come from the 2006-2008 American Community Survey 3-year estimates and 2008 1-year estimates, as well as census and projections data."

WHAT'S NOT MENTIONED:  Many of our "Senior Seniors" have outlived extended family and friends and often even immediate family members.  

They may have no one visiting, speaking on their behalf or there for them except those working in the facility and many who should speak up, try to do their best to keep their position and eventually leave because they cannot stomach what they see and hear.

MY OPINION:  Most residents of Long Term Care with Medicaid beds are on some form of Federal/State Assistance (Medicaid) or provided care by a Charitable Organization.

Having lived lives through many economic challenges, their "savings" were long ago spent on providing life's basic needs. 

We will most probably endure the same challenges if we live into those most Senior of years, 90 and beyond. 

Where is our value for those who went before us, those who paved the way for all we have today, those who sustained life through war and tried to keep the peace?

It's critical we raise our collective voices to ensure those who are entrusted with the care of this growing and very vulnerable population, especially those housed in Long Term Care, are afforded individual rights. 

We need to ensure the safety and well being of our National Human Treasures.

We must understand the importance of ensuring the amended Rules and Regulations to the Older American's Act, necessitated twenty six years ago by the Federal Government and entrusted to the DHSS and each State's division that are not fully practiced are revisted, revised and enforced!

If information on findings from regularly scheduled and consumer directed investigation can be provided to the Facility, it should be provided to the general public when decisions are made. 

We shouldn't have to wait until there's a "resolution" or "correction". A notation this is the initial finding and actions required should be noted.

My opinion is if the allegation was made, if the DHSS found evidence to make an investigation, there should be public advisory.

Anyone who can provide reason why this shouldn't be the case, please add your comments to this blog entry.

We, the general public, are who depend on information to often make immediate life changing decisions for ourselves, as caregivers or family members necessitated by physical or mental declines needing 24/7 care the family cannot provide for whatever reason.

We know from experience, decisions for life altering living arrangements don't always come with long time advance planning, especially for those not interested in going into "step up/step down" facilities where you move from Independent to Assisted to Long Term type care OR you find a severe medical challenge necessitates immediate decision making.

YOU, and those who you trust to make decisions about your living and life, deserve continual and immediate information about the quality of care, the violations current, past and ongoing, among facilities.

It's your life. It's our society's choices as to what we accept, what we tolerate and what we decide to change. 

Undue Influence Preys On Elderly and Families

Undue Influence is a predator.     It stalks and it strikes. 

It waits for opportunity then selects the weakest members to target.

The Elderly and their families.

Individuals who are isolated or confined, under stress and weakened physically, financially, emotionally and socially.

Knowing possible habits, behaviors and identifying possible descriptions of Undue Influence's actions may provide a higher rate of survival and hopefully an ability to avoid the entrapment and potential destruction of lives and relationship.

What is Undue Influence:

"Undue influence is the misuse of one's role and power to exploit the trust, dependence, and fear of another to deceptively gain control over that person's decision in a particular matter"  Read more at a great site, Center For Elders and Courts

Actions, words and/or deeds that seek to obtain financial gain, control or influence, power over another human being.

No one is exempt from this predator and you do not have to have great wealth or obvious assets to be targeted by those who practice Undue Influence.

Skillsets of the Undue Influence Predator Often Include

• Stepping in to offer help or becoming close to the victim
• Inserting themselves into the life of the victim 
• Blending in to their surroundings
• Usually less socially active and involved in organizations or groups unless membership or participation provides access to victim(s)
• Information is limited when you ask them questions and subjects are changed or they don't have time, rushing off to "help" someone else
• Managing time to control and create dependency through providing and removing their presence and attention; being late, forgetting to perform a task, provide a service or obtain a requested item
• Often in positions commonly given immediate trust and using those positions authoritatively 

For some, it fills a need in their lives, it provides control when someone feels a part or all of their life is not fully in their control. 

Sadly, this never ends as there is a need for this "fix" this "high" and once the Undue Influencer has accomplished their purpose, they must move on, they must find another victim.

It can also be a means of getting what someone has simply because of jealousy, envy or desire.

Be ever vigilent.

Dependency, Independence, Interdepence

A terminology used by the US Census in calculating percentages of the population aged 65 and over and their need for care giving -- dependency.

Ask anyone growing older and this is the biggest FEAR in their lives -- losing their independence and the costs, personal and financial, of this process.

Independence. Years are spent training and nurturing from birth onward to get humans to the point of taking care of themselves, those who have the physical and mental means and abilities.

We who are privileged with these capabilities and capacities, most often take them for granted. 

Many of us work to reduce, refine and redirect our capabilities and capacities, but we do not realize until we really start getting past our "growth" years that include self development, family and career, and head for those "golden years", this time is full of as many potholes, road blocks,detours, sudden stops and repairs along the way as those encountered at all the earlier life stages.

Interdependence.  The ability of a society to value all of its parts and to accept and work through the challenges of everyday life.

We work together to set aside "isms" and create an environment where value isn't measured by who you are or what you are but simply the fact that -- you are.

Overheard in a conversation where I work the other day:  
Older people don't take to the new technology. 
They don't "want" it. 
They're satisfied with what they know and have. 
They don't know how to use it.

By the way, this person was in their mid 40's. He should know he's considered "old" by tweens, teens and those in their twenties. 

He should know his "views" and his "ways" are considered "out of touch" and "old" and they probably characterize him in the same way he characterizes those older than he is.

Viewpoint depends on where you are in life, what your experiences have been, what you've been taught, what you choose to see. 

Life is far more challenging today than just last year and will continue to be. 

We're in the epicenter of a technological revolution where thought and practice are subject not to what you can access, but the tools you have and the way you can use them to gain and use information and its benefits.

Keeping up with technology is an investment in time and money. As we grow into the later years of life, those are usually limited resources. It's not about not wanting, it's about not being able or have the ways and means.

Aging is as significant an economic challenge as where a person lives, what level of education they have and what ability they have to move upward in their careers and the level of discretionary income they have and how they use it throughout life.

Today, technology makes systems obsolete and the costs of adding technology comes not just with a purchase price, but an increasing maintenance price. 

The US Census uses terminologies like "dependent" when referring to 65 and over who need care giving, however, every day we hear about men and women in their twenties and much younger with diseases and physical challenge.

The Baby Boomer generation is being portrayed as becoming a drain on our US economy. Isn't this easily said about any age with "special needs"?

Many people I know in the 65+ age group add to the economic recovery but no one talks about their contributions.

• They work -- some at more than one minimum wage type job
• They volunteer -- providing services and opportunities for less capable and less fortunate
• They donate -- time, money and skillsets to benefit individuals and communities.

Take a look at the birth year report by clicking here  

This data comes from the U.S. Department of Commerce, Bureau of the Census. These numbers refer to U.S. births only and is in millions/hundreds of thousands (rounded off).

1940	2,559	1955	4,097	1970	3,731	1985	3,761
1941	2,703	1956	4,218	1971	3,556	1986	3,757
1942	2,989	1957	4,300	1972	3,258	1987	3,809
1943	3,104	1958	4,255	1973	3,137	1988	3,910
1944	2,939	1959	4,245	1974	3,160	1989	4,041
1945	2,858	1960	4,258	1975	3,144	1990	4,158
1946	3,411	1961	4,268	1976	3,168	1991	4,111
1947	3,817	1962	4,167	1977	3,327	1992	4,065
1948	3,637	1963	4,098	1978	3,333	1993	4,000
1949	3,649	1964	4,027	1979	3,494	1994	3,979
1950	3,632	1965	3,760	1980	3,612
1951	3,823	1966	3,606	1981	3,629
1952	3,913	1967	3,521	1982	3,681
1953	3,965	1968	3,502	1983	3,639
1954	4,078	1969	3,606	1984	3,669

Take a close look. The "baby boomers" birth year starts in 1946 and goes through 1964. This was a time of rising births from 3,411 to 4,027.

Take a closer look.  1965's birth year was higher than 1946, but because there was a decrease from 1964, it's not seen as challenging. 

Moving forward, 1975 to 1990 were years of increasing population. And even though the population showed a decrease in the years from 1990 to 1995, the population level of above 400,000 (that's a figure of millions, by the way), is higher than the first eight years of the "baby boomer" era.

Two generations after the Baby Boomers, Gen X and Millennials. Each will encounter the same challenges if all choose not to face the present and provide for the future.

The question becomes whether the younger generations will care enough to cause change before it's their turn to experience the change and become --

DEPENDENT.

What's the general health of the younger generation?  We're led to believe this is the "safety net" generation; the one we rely on to offset the cost of healthcare insurance, for example.

That was the basis for the Affordable Care Act -- get enough of the "Gen Xers" and "Millenials" because they have fewer medical problems.

What we've seen is how this group faces their own medical challenges:  cancer, heart disease, Lupus, MS and more. We just never talked about these medical conditions as openly. 

It's time to realize Age Alone Doesn't Define Capability or Capacity. 

We live with diseases and medical challenges we're still trying to understand and control how they affect our lives.

Infants through the most Senior level of our population share challenges and can live with limitations and challenges from moderate to severe.

Let's pull together instead of pulling one another apart. 

Realize and recognize the potential and possibilities of all ages and stages of life. 

Be positive, think proactively and as always, work to protect those without the means to provide their own safety net.