Term Paper on "Aging in Alaska Options for In-Home Support"

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[EXCERPT] . . . .

Aging in Alaska Options for in-Home Support

DIRELY NEEDED but INADEQUATE

The Aging Population Swells

population aged 65 years and older was projected to increase from 35 million in 2000 to roughly 71 million in 2030 (Goulding & Rodgers, 2003; Gelfand, 2003; Gillespie & Sloan, 1990). Those aged 80 and over were expected to increase from 9.3 million in 2000 to 19.5 million in 2030. In those years, the older population among racial minority groups would increase from 11.3% to 16.5%.These minority groups are the Blacks, Indian/Alaska Natives and Asian/Pacific Islanders. The bloating of the aging American population aligns with that of the world population. The global decline in fertility, the 20-year increase in the average life span in the second half of the 20th century and the increase in fertility among countries in the two decades after World War II combined account for the massive increase from 2010 to 2030. The resulting average life span is likely to extend to another 10 years by 2050 (Goulding & Rodgers, Gelfand and Gillespie & Sloan).

Profile of Aging Alaskans

Up to 1995, Florida had the largest share of the aging population at 19% (Goulding & Rodgers, 2003). That population in Florida was projected to increase at 26% by 2025. Up to 1995, it accounted for 15% of the aging population in 48 States, except Alaska and California (Goulding & Rodgers). But the trends changed. From 1995 to 2000, Alaska had the largest net outflow of seniors among all States at -39.4 (HSS, 2007). Recent statistics show that 76% of them are Whites and 67% of them live in the rural areas. Their life expectancy is below the median at 76.7 years. Suicide rates are also comparatively higher among older Alaskans than seniors anywhere else in the U.S. (HSS, Gouilding & Rodgers).

Recent health statistics reveal that about 80% of all persons aged 65 and older have at least one chronic condition, half of them with at least two (Goulding & Rodgers, 2003). One chronic condition is diabetes, which afflicts one in five seniors or 18%. This means that the incidence of diabetes will worsen as the population ages. Studies show that the incidence is highest among those 75 and older. As American adults live longer, their likelihood of developing Alzheimer's disease doubles every 5 years after age 65. About 10% of those 65-84 and 47% of those 85 and older suffer from Alzheimer's disease. These chronic diseases lead to disability, reduce quality of life and exact increased healthcare costs. Improved public health care measures have increased life expectancy and have thus prolonged life. But with these consequences among older adults, public health programs must be improved and intensified to respond to greater challenges. These include chronic illnesses, injuries, disabilities, and the future of care-giving and healthcare costs (Goulding & Rodgers).

In-Home State Programs Poorly Managed

The situation was so bad that the State had to go under a moratorium until improvements could be made, according to the Federal Centers for Medicare and Medicaid Services (Demer, 2009). The 5-6 months' moratorium was to affect approximately 1,000 older Alaskans, some of them dying. About 227 of them did while waiting for a nurse reassess their needs and another 27, while waiting to know about their qualification for help. These programs were to provide in-home assistance to thousands of aging Alaskans in all forms from medications to meals. These were intended to keep the older Alaskans at home instead of being placed in nursing homes or other institutions. Medicaid paid for the services rendered to the poor and the disabled. The state Division of Senior and Disabilities Services supervised them. Qualification was based on income and need. The average cost of the programs was $250 million and 61% was shouldered by the federal government. The programs came under two broad categories. The first covered only personal care. The second covered a broader range of services, such as home health care. The first served 3,200 at one time and the other, about 3,800. Some seniors were able to obtain both types (Demer).

Division officials admitted having serious administrative problems (Demer, 2009). A backlog of as many as 2,000 in assessing the services needed was one such serious problem. Their response was to temporarily stop admitting more people into the programs to relieve the backlog. Private agencies that could provide similar services through grant funding were said to have limited services. The State division also faced 8 class lawsuits filed by the Northern Justice Project, apparently for the incompetent running of the programs. The complaint said that the seniors and disabled Alaskans were not being provided the services they needed and were legally entitled to. The chief of programs for seniors and disabilities services attributed the backlog to about 40% of vacant nurse positions. The State responded to this problem by allowing other types of professionals to perform the assessment. Officials said a new project manager had been appointed to create and oversee needed improvements and to update the data collection system (Demer).

Despite claims of improvements by State officials, physicians and other healthcare professionals wrote to the Centers for Medicare and Medicaid about the lack of response by the officials (Demer, 2009). They never investigated the causes of the deaths and chronic health issues. In response, the State began conducting "focused reviews" of the fatalities and morbidities (Demer).

Ritualized Elder Abuse in Nursing Homes

Private nursing homes with long-term facilities supposed to provide care for senior Alaskans are a catastrophe in themselves. Ulsperger and Kottnerus (2010), in their book on elderly abuse in nursing homes, reveal how these facilities' organizational dynamics and daily rituals have resulted directly or indirectly in the neglect and abuse of senior residents. The book describes the different types of nursing home maltreatment to which the residents are subjected. It is a useful basis for interventions that will reduce maltreatment in settings such as these (Ulsperger & Kottnerus).

In their research on the subject, Ulsperger & Kottnerus (2007) found that everyday life in nursing homes is bureaucratic in nature. Ritualized symbolic practices or RSP in bureaucratic settings facilitate the physical neglect and maltreatment of the elders who reside there. Of the many kinds of bureaucratic RSPs, those which attract the greatest concern are staff separation and hierarchy, especially in non-profit nursing homes. Workers perform duties only if these are their specific responsibility. Staff members are highly segregated and devise their own norms. Those in the higher levels may see acts of abuse or neglect but avoid dealing with them because they do not happen to their level. Strong loyalty to units caused by strong staff separation then leads to cover-ups of neglect or abuse when the act is committed by someone in their level. Staff separation, then, in both profit and non-profit nursing homes facilitates maltreatment and neglect of residents (Ulsperger & Knottnerus).

The rituals of documentation and efficiency involve paperwork and repetitiveness (Ulsperger & Knottnerus, 2007). This creates a situation in which staff members perceive the resident as objects of work to be accomplished rather than as persons. Personal acts become quantitative and impersonalized. Under these circumstances, maltreatment becomes likely. Efficiency induces the staff to finish their tasks as quickly as possible regardless of how this is done. A nursing home promotes poor care of senior residents intentionally or not if it is run bureaucratically and support RSPs as interaction patterns. RSPs for neglect are observable more among non-profit nursing facilities. Some of these do not buy the medicines for the residents and their aides bring in from home what the residents need. The study also revealed that staff members in these facilities overuse medications. This happens in cases when staff members or aides control residents who do not perform their duties as they are told. They may even be labeled as deviants if they cannot be restrained (Ulsperger & Knottnerus).

Busy aides likewise often fail to clean residents up properly or deliberately omit to do so because of their duties (Ulsperger & Knottnerus, 2007). At other times, they neglect the residents' personal care in order to punish them for being difficult. There too is the ritualistic failure to clear the surroundings. Residents perceive these omissions as unworthiness of good care on their part. Aides also inflict bodily harm or physical abuse on residents out of vindictiveness. Aides claim that residents abuse them. Physical abuse or harm on the residents may take the form of hot baths, unnecessary restraint, locking up or some punishment. Aides justify these acts as punishments for the elders' disruption of workflow. They also justify restraint as an effective way to cut down on costs. If the working staff is not big enough, tying the residents down allows work to be performed. And the facility's structure influences behaviors that may induce bodily harm. The study concludes that bureaucratic RSPs shape the mindset and behaviors of nursing home workers. These, in turn, lead to the maltreatment of residents (Ulsperger & Knottnerus).

Providing Care for Older Alaskans --… READ MORE

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