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Place and space and you and me and them

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I’ve been thinking a lot about place and space and how that shapes a lot about us, both individually and collectively. When we host students and colleagues from Finland they are struck by how big things are here – from buildings to cars to coffee mugs.  It makes sense I guess that given how much space we have compared to many European countries we would make things bigger.  At the same time, innovative Finnish design makes sense too.  If you have less space, you have more reason to design things that are efficient and functional and if you can make them beautiful at the same time all the better.

There are more insidious effects of place and space too as suggested in a recent article by Stone and colleagues on place as a predictor of health insurance coverage.

This article focuses on the county level in the United States.  That’s where a lot of care for the uninsured and underinsured takes place, but is not as often a focus in research as other levels of geography.

Some key findings:

  • A lot of variability in health insurance coverage within counties (ranging from 3% to 53%) as well as between them.
  • Lower rates of uninsured in metropolitan areas and counties with more people who have a high school education or more.
  • More people without insurance in counties with higher unemployment, more poverty, in metropolitan areas with more Blacks and Hispanics, and in counties where a higher proportion of votes were cast for Republican presidential candidates in the 1008 election.

About that Republican votes thing . . .

I keep coming up against ideology and how fundamental differences in our beliefs about the role of government versus market forces in providing fundamental services to our citizens are roadblocks that seem insurmountable (regardless of which side of the debate you fall on).

Some of us see things like health care and a broad social safety net as a right, something that as a people we should make sure everybody has access to, and that broad access ultimately benefits us all.  Universal insurance coverage and other re-distributive policies make sense from this perspective and are not antithetical to having a strong democratic capitalistic society.

Others of us see those who can’t afford these things as some how lacking in skills, drive, morals, gumption, pick the word of your choice.  The market will provide to those willing to do the work required.  And so of course, investing less in public services makes sense.

I’m sure it’s clear which side of this debate I fall on even if my complete bafflement at the stance of the other guys does not always come through as completely as it might. (Or maybe it comes through loud and clear, but believe me I could be much more outspoken!)

imagesI also realize that there are shades of purple in these arguments.  But still. I am quite sure there are plenty of us on both sides of the debate who regularly engage in a good face palm in utter amazement that the other side can’t see the plain facts staring them right in the face. (And back we go to that Republican vote thing).

Reading this article introduced me to literature on “critical social geography” that I hadn’t come across before or at least not in quite this way. Social geography looks at geographical differences in structure that foster inequities in resources and marginalize populations. Think uneven economic development so that already struggling neighborhoods don’t have any grocery stores. Or public transportation just conveniently not going from here (where there are people who need jobs and are willing to work) to there (where there are employers hiring).

I’ll keep mulling over this place and space stuff, but in the meantime, if you have thoughts on the subject, let me know.

Random New Year Musings

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I started composing this musing in my head during my morning meditation.  That tells you something about how the meditating goes.

A regular meditation practice is a habit I am forever (well for a year or two anyway) trying to cultivate so I suppose it is fitting that my meditation musings were about the debacle of New Year’s Resolutions.  I like to say that a long time ago I made the resolution to never make another New Year’s Resolution and it’s the only one I’ve ever kept.  Ba ba boom.

But that’s not entirely true.  It’s hard not to think of the new year as a new start.  A chance to do things differently and make big, bold changes.  Toss a few things out of the bucket list.  The problem is we make resolutions with this idea that we’re wiping the slate clean and starting from scratch (that would be me and the mouse in my pocket).  “I’m going to get fit and eat healthy this year”.  Good, good.  But I can’t erase the 46 years of bad (and not so bad) habits that came before.  In my favor – I have developed and kept rigorous fitness routines before, for years at a time even, so I know I can do it even if those routines may not be the same ones of two decades ago.  (Or maybe they should be and I’m using middle-agedness as an excuse to be lazy).  On the other hand, I can’t erase 46 years of chocolate – copious amounts of chocolate – and the ongoing and never ending wish for chocolate and hours of lazing on the couch with a good book, the boy cats, the girl dog, and more chocolate.  (And why should I? I have a towel that says “I was told I should quit eating chocolate, but I’m not a quitter”.)

There’s something about this time of year though.  The familiar lure of the week between Christmas and New Years.  A pause in the usual routine and anticipation and possibilities of the year ahead.

Except it’s a lie really.  My to do list is pretty much exactly the same as it was before Christmas with some variations on a theme. I’ll still be teaching, albeit a different class.  I’ll still be working on a big grant project, albeit more intensely.  I won’t be on a search committee (thankyouthankyouthankyouthankyou) but there will be other of those types of obligations to take its place. I’ll still be nudging doctoral students along and, of course, writing, writing, and more writing.

Given that my context won’t change (and I don’t want it to) why would I expect big brand new things in the year ahead?  And if I commit to big brand new things in a big vocal way and then I fail, as I inevitably will, how sucky will that be?

Wow, I had no idea I woke up on the pessimistic side of the bed this morning, but as the words flop onto the page it goes a long way to explaining the tightness I’ve been carrying around in my chest the last week or two. I was attributing it to still feeling a bit punky from the cold I got before Christmas, but I think I am actually suffering from resolutionus resistancia, or resistance to the societal pressure to be optimistic and set big goals for the year ahead (look it up).

Oh, I’ll ring in the New Year and take a moment or two to reflect on the ups and downs of 2015 and the possibilities of 2016, but no resolutions for me.  I’ll just keep doing what I’m doing, one little itty bitty baby step at a time, in my perfectly clean and organized house, 30 pounds lighter with nothing but solid muscle on my bones, while eating my delicious home-cooked meals night after night after night.

Happy New Year everyone.

Random musings

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I woke up this morning with voices in my head and I’m trying to figure out which ones are mine.  That’s a problem with listening to audiobooks. More so than reading a book I hear a character’s voice, or sometimes even the author’s voice, in my head. I fell asleep yesterday with Anne Lamott’s voice in my earbuds.  I like Anne Lamott even though she gets too full of god and jesus christ sometimes.  Her saving grace – ha! – is that she’s self-effacing about it all. She’s not trying to save anyone, but it’s so much a part of who she is that it can’t not come out, and it clearly saved her from alcoholism, and she’s so imperfect and struggling and let’s it all hang out, and she’s so liberal, too that I can listen without wanting to smash my fist into her face.  So it may be that these musing end up sounding a bit like Anne Lamott.

Not too long ago a couple of Seventh Day Adventists came by to try and save me.  I was working out front cleaning Suzy Subaru and when they pulled into the driveway I knew at once what they were here for.  They were nice enough, two women trying to spread the word in a way they thought might appeal to Ann Arborites I suppose although this isn’t really Ann Arbor.  “We’re talking to people in the neighborhood about our bible study and wanted to ask you, what do you think God thinks about war.”  I paused a moment and said, “Well, I’m an atheist so to me that’s not a very relevant or even particularly interesting question.”  Their eyes got very big and they backed away as they told me to have a good day.  Not even a blessed day. Harumph. What kind of proselytizers were they anyway?  I would have thought this would be a challenge they could sink their teeth into. A real notch in their Bible if they could do something with me. But like all Bible thumpers they were cowards at heart and turned tail and ran.

That sounds harsh of me I suppose, and I did have a momentary pang of guilt, but I have come to believe that religions, even the most benign versions, were created and continue out of fear.  That’s okay. We all have to cope somehow.  It’s when their coping infringes on the rights and lives of others that I get a bit tetchy and if you’re going door to door it seems to me you should be prepared to have difficult conversations.

It’s Christmas Day.  7:07 AM. The stockings are hung by the stovepipe with care and St. Nick has already been by to stuff them. He left a mug for me on the coffee maker.  I’m drinking out of it now. It’s emblazoned with a close up of Malcom X, fist raised in defiance, and a quote, “If you don’t stand for something you will fall for anything.” What is Santa trying to tell me?  Oddly enough he left Husband a mug on the coffeemaker too.  It has an etching of a Sasquatch silhouette. Clearly Santa’s sense of humor is a bit warped.

There’s a small Christmas tree with a few lights and a handful of the possible range of decorations hanging on it. Today or tomorrow it will be planted in the backyard and hopefully we’ll buck our trend of killing formerly live Christmas trees. Usually we wait too late to plant them, but this year I managed to dig the hole before the ground froze. Except it hasn’t.  It’s unseasonably warm and very brown and I keep forgetting it’s Christmas.

I dug the hole early, but the tree was only decorated last night, not because it’s some Toler-Woodward household tradition, but because we just didn’t get around to it until then. That’s2010-10-02 14.20.40 just the way we role. We wrapped lights around the porch posts last night too, but true to form, the two strands are different colors so we have a warm white post and a cool white post. Some days, like this morning, I’ve come to accept that we’re half-ass people. Yes, I got most of my shopping done early, but packages still won’t get mailed until after Christmas.  Happy New Year!  Some of those packages will include very late gifts from other occasions.  Happy Father’s Day!  And it will be good. Just hang in there.

Other days I gnash my teeth and try to be more Martha Stewart like. I’ll pull everything out of a closet and go looking for the perfect bins to organize everything and label the bins and then I lose interest and it sits on the floor for several weeks until one of us gets tired of stepping over the piles and tosses it all back in so that, if possible, it’s an even messier pile than it was originally.  I have to remind myself periodically that Martha Stewart has paid staff.  So as long as no one is injured when things fall out of the closet and the dust bunnies don’t line up for breakfast with the quadrupeds it’s all good.

And I guess in an odd way that’s kind of where I started these musings. I try on different voices and different ways of doing things and most of the time end up back in the one that’s comfortable, imperfect as it is, with maybe a small tweak or an adjustment or refinement here or there.

Malcom X needs a refill and the dust bunnies are mewing for breakfast so it’s time to wrap this up.  Happy Holidays everyone.  This blog will return to it’s regular programming at some undesignated point in the not so distant future.

Bigger is better, but what you do with it counts too

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Much of the research on welfare state development has argued  that economic prosperity (ie., GDP growth) is the key factor for expanding social policies.  Of course, economic prosperity is important. It doesn’t always, however, improve a population’s health.  The post-communist countries come to mind.

This suggests that wealth is necessary for improving health, but it is not sufficient. What countries do with their wealth is also important. Growth in GDP is not just about increases in money.  Over time, it’s one piece of larger scale modernization and development which could include (gasp!) changes and growth in the welfare state.

Today I am musing on a 2010 article by Olli Kangas that considers the issues of economic prosperity, the welfare state, and life expectancy.

Kangas is with the Social Insurance Institution of Finland, known in Finland as Kela.  Although the provision of services is the responsibility of the municipalities, Kela oversees the administration of family benefits, health insurance, rehabilitation, basic unemployment security, housing benefits, financial aid for students, basic pensions, disability benefits, conscripts’ allowances, and assistance for immigrants.

“To make a long story short,
money matters,
war kills,
and the welfare state is good for life expectancy”. (Kangas, 2010)

The punch line of the article is that bigger is better and not just in terms of the level and growth of GDP.  More importantly, a generous welfare state with broad coverage does more to increase a population’s life expectancy than economic prosperity alone.  Kangas uses a century of data (1900 to 2000) from 17 OECD countries, including Finland and the United States, to support his conclusions.

Here are some of the key findings:

  • Life expectancy almost doubled  from 1900 to 2000 while differences across the 17 countries countries decreased.  The increase continues, but at a much slower pace.
  • The variation across countries is greatest during the war years.  In the United States, for example, the effect of the war on life expectancy for men was a loss of about a year. In Finland, where the fighting against the Soviet Union was particularly devastating, male life expectancy lost 13.5 years in 1939 to 1940 and 11.6 years in 1934 to 1944. They also suffered losses during their civil war in 1918.
  • Higher life expectancy is associated with higher GDP, but only up to a point.  The effect of GDP levels off after a certain point. The United States is an outlier.  We have high prosperity, but relatively low life expectancy compared to other OECD countries.  (Hooray for American exceptionalism.)  Japan is also an outlier with moderate GDP, but the highest life expectancy.  This suggests that GDP is not the only important factor determining longevity.
  • The amount of money spent on social programs explains some of the variance in life expectancy across countries, but as with GDP the impact levels off after a certain level of spending.
  • Spending also doesn’t tell us anything about what is being done with the money spent.
    In some countries, a limited number of people get a lot.  Kangas calls this the Central-European cluster where there are “workers insurance” programs with high benefits.  In the Nordic model,  there are “peoples insurance” programs with good benefits for everyone, if not necessarily the highest.  In liberal regimes, very few people get only a little from the welfare state.
  • Life expectancy is higher in those countries with welfare systems that are both universal (where everyone gets something) and what everyone gets is generous.  This relationship is linear, meaning it doesn’t level off like the relationship with GDP or overall social spending.

I see this last point as good news in some ways because it suggests that perhaps systems can be improved over time without a complete (and politically contentious) overhaul.  Stealth policy, if you will, gradually expanding benefits to more people and increasing their generosity. (Shhh, don’t tell you know who).

It also suggests that it is better, in terms of overall population health, to give an adequate amount to everyone than to give lavishly to just a few.

Of course, that’s assuming that helping everyone be healthier is our goal and that we’re willing to spread the wealth more equitably to make it happen.

How many ways can we slice a finite pie?

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One way of thinking about social welfare spending is in terms of spending focused on older adults and the forces within a country that lead to a “pro-elderly bias”.  There is no doubt (or is there? another post for another day) that older adults have more power in some countries than others.  In terms of patterns of welfare spending, the United States, according to Pieter Vanhuysse, is one of the most “pro-elderly biased” among OECD countries while Finland is one of the least.  While many studies have looked at how population aging has influenced spending on particular programs, less attention has been paid to how the welfare state as a whole or how models of welfare spending evolve as the population ages.

To look at this Vanhysse and his colleague Markus Tepe have developed what they call the elderly/non-elderly spending share (ENSS).

(Be gentle with them, dear readers. They are economists by training.  And before one of you reminds me of my BA in Economics, I will point out that there’s a reason I didn’t continue down that path. Still, economists have their uses.)

The ENSS is the ratio of total spending on programs that are clearly targeted toward older adults (eg., pensions, survival benefits) to social welfare spending as a whole.  The higher the ENSS, the more “pro-elderly” the system.

The average ENSS from 1980 to 2003 for Finland is about 50 and for the US is about 75.  To put that in a broader context, the US is one of the most heavily “pro-elderly” biased countries in the OECD along with Greece, Italy, Germany, Austria, Portugal, Japan and Switzerland. The Netherlands, Belgium, Ireland, and the Nordic countries (which, of course, includes Finland) are among the least “pro-elderly”.

(I have to pause here briefly because I’m tired of putting quotes around “pro-elderly” (there I go again).  This is Vanhuysse’s term and it clearly means pro-elderly in a very specific and narrow way so I’m sticking with it for now – sans quotes – and will unpack issues of age-related biases, pro or otherwise, another time.  There are only so many hours in the day and I still have papers to grade).

Back to the initial question – does population aging lead to these differences?  The short answer – nope.

Aging populations has increased overall spending on pensions and related programs, but it’s also led to smaller individual benefits.  The pie may have gotten bigger, but  it’s cut into smaller and smaller unsatisfying pieces.  (You knew I’d get to the pie at some point, right?)  In fact, countries like Denmark, Finland, and Sweden have lower ENSS values than the US largely because they have made longstanding investments in family-friendly and active labor market policies that positively effect everyone, including older adults.  Long-term political and institutional processes explain so-called “pro-elderly” biases, not the proportion of the population that is over 65 or will be soon.

Vanhuysse gives some examples of generational policy processes to illustrate, two of which I mention here:

The alarm bells that are regularly ringing about the effect of aging on, in the US, Social Security and Medicare may forestall radical cutbacks.  That would be politically risky for politicians hoping for the votes of older adults in the next election.  It may, however, accelerate incremental changes so it looks like they’re doing something (hence the incredibly shrinking pie pieces, if not the incredibly shrinking pie).

Political efforts around narrow issues, like Social Security benefits, are only successful in democracies where there is solid organization of those who are effected (older adults) AND there is already a high level of pro-elderly spending.  Or consider the flip side, young families will have better luck demanding state provided childcare when there is intergenerational support for it AND there is already significant state spending in public childcare.

“In other words, generational policy models developed in the past can powerfully shape the generational policy expectations of young and old voters today”.  We come to expect certain things and advocate for (or vote for) more of the same.

humble_pie

ACA update – a look at a few outcomes

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My Blogiversary came and went without any acknowledgment from me. What can I say – I’m not very good at planning parties, or even remembering anniversaries (sorry Husband). Plus, as we like to say, time flies and it’s hard to believe I’ve been doing this for a year.

It’s not entirely true that I forgot. I was at the Gerontological Society of America annual meeting and had every intention of live tweeting my experience there and writing a daily blog. I learned (or maybe relearned) that I don’t multitask very well which means live tweeting doesn’t work. I also relearned that by the end of a conference day all I’m capable of doing is curling up with room service and a novel. So no Blogiversary GSA bonanza.

I did, however, spend some time thinking about what I wanted to do for the year ahead. A few things came to mind. One is to continue to work on being more consistent in my posting. I’d also like to connect more with you, dear reader. Who are you? Why are you reading this? And what topics would be useful and interesting to you in the year ahead? Finally, I started this blog announcing that I wanted to write a book. That’s still in the works, but my blog posts have not always been bookish. Over the next year, I hope to blog the book a bit more. Having said that, tangents are fun and what’s the point of this if I can’t do what I want and have some fun?

Today’s post, however, is not all about me and my blogging challenges. It’s about the Affordable Care Act and some of the changes that are occurring now that two enrollment cycles have come and gone. Overall, almost 12 million people have signed up for marketplace coverage and another 12 million enrolled in Medicaid and the Children’s Health Insurance Program. The rates of people without health insurance has significantly declined since early 2014. A July article in JAMA looks at these results a bit more closely.

The study is based on data from a national sample of over 500,000 adults ages 18 to 64 and focuses on being uninsured, having a personal physician, the ability to get needed medication, difficulties affording needed medical care, overall health status, and the percentage of days in the past month when activities were limited by poor health.

Here are some of the authors’ key findings:

Before the ACA, all of these six outcomes were getting worse. The number of people without insurance or a personal physician, who had a harder time getting medication or medical care, and had declining health status, and the number of days when activities were limited by poor health were all increasing.

By the end of the second enrollment period, all of these outcomes had improved. And, with the exception of health status, this improvement was large enough to reverse the pre-ACA trends.

There were some differences in gains across subgroups:

  • Changes in insurance coverage and access to medications were greater among racial and ethnic minorities.
  • Access to medication improved more for urban residents than for those living in rural areas.
  • The affordability of care improved more for men than for women.

Medicaid expansion has been one of the contentious issues of the ACA. Expansion makes Medicaid eligible to adults under 65 with income up to 138% of the federal poverty level ($33,465 for a family of four) and for the first time provides Medicaid coverage for low-income adults without children. The ACA provides federal support to cover the costs of this expansion, but states can opt out. As I write this, 31 states have adopted the Medicaid expansion, 3 states are under discussion, and 17 have not adopted expansion.

In the JAMA article, low income people in states with Medicaid expansion are doing significantly better than those in states who have opted out of expansion.

There is a whole stew of financial, political, and ideological aspects to the expansion debate and the ACA in general that I will continue to ponder as I compare the U.S. and Finland’s approaches to elder care. If you’re a nerd like me, the Kaiser Family Foundation has lots of good ongoing analysis for your bedtime reading.

Person-centered care

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Person-centered care is a current buzz word in health care. In one article, the core of person-centered care is described in this way: “patients are known as persons in context of their own social worlds, listened to, informed, respected, and involved in their care – and their wishes are honored (but not mindlessly enacted) during their health care journey.” In other words, health care is finally catching up to practices that have been at the core of social work for a long time. Huzzah!

I really don’t mean to be flippant or disrespectful. This focus on person-centered care is a good thing in my opinion and is not really new to health care either. There are articles in nursing journals, for example, about person-centered care as far back as the 1950s. But from my seat it’s still an interesting thing to watch unfold. I’m not by any means a neutral, unbiased observer, not only because of my perspective as a social worker, but because (full disclosure) I’m part of a research project funded by the Patient Centered Outcomes Research Initiative (PCORI). And measuring person-centered care and outcomes is, we are discovering, no easy task.

So I was interested to read the 2014 National Healthcare Quality & Disparities Report published by the Agency for Health Research and Quality (AHRQ).  One of the priorities of the National Quality Strategy developed as part of the Affordable Care Act is “person-centered care” defined as “ensuring that each person and family is engaged as partners in their care”. That means health providers need to communicate with patients about their health in meaningful ways, facilitate the patient’s involvement in their own care, and be able to spend the time with the patient that is needed to make these things happen.

The 2014 report includes some data around person-centered care that are interesting, even though they suggest to me that we’re not the only ones finding this measurement issue a challenge. Here’s a summary of some of these data for adults 65 and older (data are available for adults 18 and up as well as for children as reported by parents):

Among adults 65 and older who had a doctor’s office or clinic visit in the 12 months before the interview, 5% reported that their health provider did not:

  • listen carefully to them,
  • explain things clearly, or
  • show respect for what they had to say.

Among those with a usual source of care:

  • 4% reported health care providers did not ask them for help making treatment decisions, and
  • 7% reported health providers did not spend enough time with them

At the same time:

  • Ninety-five percent reported that health care providers explained and provided all treatment options.

It’s not immediately clear from the data how to reconcile these differences. There are data that suggest differences across racial/ethnic groups, by education, and other demographics that may help pull some of this apart, but that’s for another post.  Overall, these data seem pretty positive.

Most hospital patients had good communication with doctors and nurses defined as being treated with courtesy and respect, being listened to carefully, and having things explained clearly. The majority also had good communication about the medications they received in the hospital and about discharge information; however, 10% and 13% respectively did not. One goal of person-centered care is to help patients better manage their own care. Given that medications and post-discharge follow-up are points of difficulty that often lead to re-hospitalization, these are places where we have work to do.hosp pts who did not have good communication

When they first started home health care, the majority of patients were told what care and services they would get and about how to set up their home so they could move around safely. They also had a conversation about their prescription and over-the-counter medications and were asked to show the home health provider all the prescription and over-the-counter medications they were taking (an important step to make sure you know about them all).

first starting home health

In the previous 2 months of home health care, the majority of patients felt that the home health providers were well informed and respectful, treating the patient gently, letting them know when they were going to visit, listening to them and treating them with courtesy.

In terms of involving the patient in their care, however, at least around medications, many fewer patients reported that the home health providers talked with them about the purpose of medications, when to take them, or the potential side effects. In addition, only a quarter (26%) said they got the help or advice they needed when they contacted their home health provider and the majority (93%) reported having some problems with the care they received.

previous 2 mths of home health

Finally, among hospice patients, the experiences were positive with the majority being referred to hospice at the right time, the patients received the right amount of medicine for pain management, the right amount of help for feelings of anxiety or sadness, and care consistent with their stated end-of-life wishes.

 

 

 

 

Caregiver profiles – another way to slice the caregiving pie

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In previous posts I looked at cross country comparisons of caregivers, where caregivers get information about providing care, and gender differences in caregivers. These last two used data from the National Alliance for Caregiving and the AARP Policy Institute Caregiving in the U.S. 2009.

In this post, I share some information from the 2015 version of this report, in particular similarities and differences across different types of caregivers broken out by the report authors into a series of caregiver profiles.

The picture perhaps most of us have when we think about caregivers is profiled as The Typical Caregiver. This is a 49-year old woman who is caring for a 60-year old female relative. She spends 24.4 hours a week on average providing care like bathing, dressing, running errands, and managing finances. She also helps with medical or nursing tasks like dressing wounds, giving injections, and managing medications. She is usually employed, married or living with a partner, and in decent health. She has graduated from high school and had some college courses, but not completed a degree. She does not have help from other unpaid or paid caregivers. She reports little to no physical strain or financial strain from caregiving and moderate emotional stress.

The Higher-Hour Caregiver is similar to the typical caregiver in many ways although both she and her care recipient are older. As the name implies, she provides more care – on average 62.2 hours/week. She provides more types of care as well including advocating for the care recipient, monitoring the care recipient’s condition and adjusting care as needed, and communicating with care professionals. She is less likely to be employed than the typical caregiver and the care recipient usually lives with her. Not surprisingly, this caregiver experiences more physical and emotional stress than the typical caregiver.

About 7% of caregivers are aged 75 and older is caring for a spouse, sibling, or adult child. She has more education than typical or higher-hour caregivers. She feels she has little choice in providing care, but experiences little to no physical or financial strain and only moderate emotional stress.

A growing category is The Millenial Caregiver (about 25% of caregivers in this sample). Unlike other types of caregivers, the Millenial is equally like to be male or female. He is 27 years old and cares for a 59.6 year old female relative who is most often a parent or grandparent. In fact, grandchildren caring for grandparents – either as a primary caregiver or assisting someone else – is increasing.  This caregiver is more likely than others to report that their loved one has an emotion or mental health condition that requires care, not just a physical illness. He has taken some college courses, but not finished a degree and tends to have a lower household income than the national median. He is more likely than other types of caregivers to have help from other unpaid and paid caregivers.

The 2015 data also highlights racial and ethnic differences in caregiving. The African American/Black Caregiver (13% of sample) is younger than the typical caregiver and provides care for more hours a week. She is employed, not married, and has some college, but no degree. Her HH income is below the national median as well as the median for the average caregiver across all backgrounds. However, she reports no physical or financial strain, and only moderate to low emotional stress. The Hispanic/Latino Caregiver (17%) is similar although she spends more hours per week providing care than the African American/Black Caregiver and has less education – a high school degree or less. Unlike many of the other caregivers profiled, the Asian American/Pacific Islander Caregiver (6%) has help from other unpaid caregivers and has more education (a Bachelor’s degree or higher).

Finally, the Male Caregiver  (40% of all caregivers) is similar to the typical caregiver in many ways except that he has other unpaid caregivers to help him. He is employed and works more hours than other employed caregivers and has a higher household income.

So, just as with international comparisons, there are interesting similarities and differences across caregivers in the U.S. that have implications for policies and services. More on those another day.

In the meantime, do you see yourself or someone you know in these profiles? If not, what’s different?  This inquiring academic wants to know.

The Aging Workforce Revisited

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I’ve written about workforce issues in a previous post and have had it on the docket for more posts for awhile now.  Workforce development is an important – dare I say the most important? – challenge we face in providing quality care for older adults globally.

This infographic from Nursing School Hub is a lovely depiction of the issue. (My thanks to reader Deyanara Riddix for sharing it with me).

Did you know, for example, that the average American reaching age 65 today is expected to live another 19.3 years?

And that the number of older adults aged 85 and over will triple by 2040 from 6 to 14.6 million?

That’s a lot of people who will need care and, at least for medical care, nurses will be doing most of the work.  The expected growth in nurses will not be enough to meet this demand even though the job growth in this area will be higher than the overall average.

Plus nurses, like most health care and social service professionals, are aging too.  In 2008, just 30% of nurses were under the age of 40.  That means a wave of retirements just when a growing workforce with bachelor’s degrees or higher is most needed.

Not only is there a need for more nurses (and doctors and pharmacists and social workers and physical therapists), but they need to have training specifically in geriatrics – if not a specialty focus, at least geriatrics infused throughout the curriculum.

A 2012 article by researchers from the University of Kentucky looks at geriatric content in the curriculum of seven health care related fields (social work not included I’m sad to say).  Here are some things I found most interesting.

All of the programs mentioned integrating geriatric content throughout the coursework at some level.  This included content on age-related sensory and cognitive deficits and communication strategies to accommodate them, recognition of diseases common with aging, problems associated with taking multiple medications, prejudicial attitudes toward older adults, Medicare reimbursement, and the need for interdisciplinary perspectives and collaboration.

Only three offered stand-alone geriatric courses and five programs included experiential assignments.  The assumption (probably a correct one) was that students interact with older adults in clinical settings and learn some of this content there, but there is a different skill set that needs to be taught in the classroom as well.

Everybody interviewed valued the inclusion of geriatric content.  They talked about the growing older adult population, the disproportionate use of health care services by older adults, and the fact that no matter where students end up working they will interact with older adults at some point.

But valuing the content is not always enough.  One of the biggest barriers to adding geriatric content is simply time.  Students have only so many credit hours and if you add something you have to take away from somewhere else. I’m all too familiar with that in my own curricular efforts. There also aren’t that many educators with specialized geriatric training.  And a big concern (from my point of view) is lack of student interest.  Many students haven’t spent time with healthy older adults and then they are sent to work in a nursing home.  They walk away with a negative stereotype about older adults and the type of work that is involved.

All of these are barriers that can be overcome with some energy, resources (money and people power), and a bit of ingenuity.  But we’d better not wait too long.

Where did Amanda go?

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I knew I had fallen off the regular posting merry-go-round, but was horrified when I realized that it’s been over a month!  Is it a coincidence that my last post was titled “And so sabbatical ends”?

No, it is not.

I am happy to be back, but reentering the relatively more structured world of teaching, collaborative research projects, meetings, and commuting has required some adjustment.  My empty calendar is suddenly filled with overlapping, multi-colored commitments.  My to-do list expanded from one page to four and continues to grow.  The puppy is confused about having to spend more time alone and not having me at her beck and call when I’m home.  She watches me leave the house with her little brow furrowed.  When I’m home she glues herself to my heels and hauls her 55 pounds of solid muscle into my lap when I’m sitting at my desk.  It’s hard to take a good selfie under those circumstances, let alone get any work done.

2015-09-17 09.04.50But now we’re about a month into the semester and I’m settling into something as close to a routine as it’s possible to have in this job.

And that means the blogging begins again.

A few weeks ago, I went to my first ever writer’s workshop.  It was equal parts terrifying and inspiring. The inspiring part has led me to start working on a book proposal in a more focused way.  (Or maybe that was the terrifying part?)  At any rate, blog posts moving forward will focus even more on nuggets of book-related content (with, I’m sure the occasional tangent ’cause it’s my blog and I can write what I want to).

Upcoming posts will look at workforce issues in elder care, more about caregivers, quality of care including racial/ethnic disparities, and aging-related policy in the U.S.

As always, I welcome your comments, questions, and suggestions.

See you in the funny pages!