Category: Fresh Perspectives

Over the last week, we’ve heard reported the deaths of several celebrities who chose to take their own lives. One of the highest profile of these was Anthony Bourdain, famed chef and world traveler. He was 61 years old, squarely placing him in the Baby Boomer demographic. From early reports we’ve received, few people knew of Bourdain’s struggles with mental health. This highlights an issue in the world of aging services, and it is one we often do not like to talk about — the mental health of our Boomers and seniors.

An April 2016 issue of The Week magazine sums it up concisely, with a headline blaring “U.S. suicides have reached 30-year high, led by Baby Boomers.” The article notes that Americans age 45 to 64 have shown a massive increase in suicides, with women’s rates jumping 63 percent, while men climbed 43 percent. The author further notes that the Boomer generation has always suffered from abnormally high suicide rates, so it should come as no surprise that this trend has continued as they age.

Scientists and researchers, noticing this alarming surge in self-harm, started to research the root causes affecting Boomers. In a 2015 article in the American Journal of Preventive Medicine, Dr. Katherine Hempstead and Dr. Julie Phillips released the results of their study on this phenomenon. Their review of the data showed that suicide in the Boomer population tended to occur for a combination of three reasons.

1. External circumstances, such as the loss of a job, a personal financial crash or legal distress. They further discovered a correlation between the Great Recession of 2008 and Boomer suicide rates, which makes sense, as Boomers were unduly impacted by the 2008 financial crisis.
2. Boomers are feeling a loss of power as their generation leaves the boardroom and the workforce, which has been such a defining factor in their lives. Aging out of the workforce also means lower income, which for many Boomers can lead to credit and financial difficulties.
3. Last, and most pointedly to us, is the issue of retirement. As people age into their 50s and 60s, they suddenly realize that they haven’t saved properly for retirement. The stress of financial instability and the thought that some might never retire can certainly cause some extreme feelings of helplessness.

This begs the question: What can we, as aging services providers, do to help keep our residents mentally healthy? The best place to start is to simply talk openly and honestly about the issue. Remember — Boomers come from a generation in which mental health issues were stigmatized. The first step in bringing about awareness is to engage your residents on the topic. Ask them how they are doing, and listen to their responses with empathy. When they do share a concern, respond with reassurance and hope. If there is an available resource for support, put them in contact with that help. Finally, after your initial conversation, stay engaged. By building a long-standing relationship with a resident, you’re more likely to notice changes in his or her mental condition.

Coming to grips with Boomer suicide can be difficult. For younger people, Boomers often appear to be on top of the world. They have money, great careers, families and can soon retire from the workforce to pursue their passions. However, just under the surface, are issues that people don’t realize — a failure to adequately save funds, the death of loved ones, declining health and more. We, as a society, must face down our stigma of mental health among aging populations and provide them with the support they need.

Anthony Bourdain said, “I have the best job in the world. If I’m unhappy, it’s a failure of imagination.” Did his imagination fail him, or did we, as a society?

Sources:

http://theweek.com/speedreads/620136/suicides-have-reached-30year-high-led-by-baby-boomers

https://www.ajpmonline.org/article/S0749-3797(14)00662-X/pdf?code=amepre-site

LeadingAge Colorado celebrated it’s 50^th anniversary in style with this year’s conference and exhibition, under the theme “Looking Back, Leading Forward.” Part of the Varsity team was on hand for the event and we thoroughly enjoyed the program.

We were especially taken with the keynote speaker, Reggie Rivers, a former player for the Denver Broncos, who shared his sports experiences and related them to the leading of teams. Reggie’s wit and humor were infectious and his presentation was packed full of great lessons. We wanted to share three takeaways from Reggie that we think could benefit any leader of teams in the aging services space.

Establish a metric for success.

Organizations accomplish goals because they keep their eye on the proverbial prize. While each individual person, team or department in an organization may have goals; they should all be contributing to the ultimate metric of success. Every person within the group should be able to clearly understand how their work helps to accomplish the overall mission and advance the organization.

This point really struck home with us at Varsity. As partners with our clients, we are keenly aware of how our work directly aids a client in achieving their goals and pushing their organization forward. We will definitely be asking our future partners to articulate their “metric of success” and working to demonstrate how we are contributing to that goal.

Focus on your area of control.

Aging services is a big and complicated space to work in. Every day we are confronted with new challenges and opportunities. They could range from a disappointed family, to an unexpected survey, to celebrating a 100^th birthday. It can be easy to let ourselves get caught up in these moments and feel like we are constantly responding to issues instead of being proactive. To Reggie’s point, if we spend our time focusing on the items we can control, we’ll end up happier and closer to our goals.

Prepare to fail and instead focus on incremental wins.

If we succeeded one hundred percent of the time, the world wouldn’t need us. We must recognize, as people, that we are always learning and growing. We are going to fail our team. Our team is going to fail us. It’s how we respond to these failures that demonstrates our organizational culture, values, and understandings. On that same thought, we should also celebrate incremental wins. If your goal is 100% occupancy, don’t delay celebration until that number is hit. Instead celebrate every new resident and contract signed, as that’s an incremental win that is pushing you further towards your goal.

Reggie demonstrated the real world impact of these three points thorugh a story about the Broncos. The team shifted their philosophy for rewarding success and in doing so, made sure that EVERYONE “wins” when the team does well on the field. The leadership of the team made sure that every role in the organization understood how their job contributed to the overall team performance. This caused an absolute transformation in attitudes and, interestingly enough, the team went on to win several Super Bowls after numerous losses in the Big Game.

We congratulate LeadingAge Colorado on a successful conference and a productive half-century of advocacy for seniors in the State. Keep up the good work and we are looking forward to the 2019 conference!

During 2018, we have undertaken an ongoing blog series in which we take a look at the opportunities and challenges faced by the diverse groups of Boomers and seniors being served by today’s aging services providers.

For our first article in the series, we examined a rapidly growing population in the United States — Latino Boomers and seniors.

In this, our second article, we are looking at the challenges faced by LGBT Boomers and seniors as they age in a changing society.

It was early — almost too early, some would say — but I was interested in the topic, so I got up early for the 7:30 a.m. session at the LeadingAge California Annual Conference and Exhibition.

The speaker was from SAGE, an advocacy group for LGBT Boomers and seniors. His presentation was discussing how communities are adapting their policies and culture to become more welcoming to LGBT individuals. The audience was fuller than I expected, with approximately 20 people. They were clutching their coffees and wiping the sleep from their eyes. Such is the bane of the early morning presenter.

After the typical opening remarks, the presenter said something that caught everyone’s attention. “I guarantee you that there are LGBT individuals residing in your communities right now.” You could almost hear the wheels start to turn.

“Do you have two women that live together, who are lifelong friends?” he said. “Did you have two men move into the community at the same time who chose to live in separate apartments? How about Mrs. Jones down at the end of the hall, who was never married?” Then, like a sunrise, it dawned on the participants, including myself: LGBT individuals are at all of our communities. They just choose not to be out because of personal, societal or cultural reasons.

Admit it. As you read this, you probably thought of someone at your community who fits this description. That’s because the presenter was right — these individuals reside at all of our communities. We need to recognize it and, frankly, we need to do a better job of meeting their needs as they age.

According to SAGE, there are currently three million LGBT adults over the age of 50 in the United States. By 2030, that number is expected to grow to seven million. These individuals are twice as likely to be single or living alone, and four times less likely to have children. This is significant because, as we age, our families are often the first people we turn to for care. But, in many cases, LGBT seniors may not have that kind of support. This can lead to social isolation, with more than 60 percent of LGBT adults reporting feeling a lack of companionship, with more than 50 percent feeling isolated from others.

Obviously, there is a huge market for culturally competent aging services providers to provide care to these individuals. The key here is that the provider is truly culturally competent. Thirty-four percent of LGBT older adults fear having to re-closet themselves when seeking senior housing in order to be accepted or to fit into a community. This fear isn’t just in regards to the staff and administration; it also relates to the other residents who form the day-to-day life at the community.

What can you do, today, to become more culturally aware and competent in assisting LGTB Boomers and seniors?

We encourage you to look around your community and ask yourself if it is welcoming to LGBT individuals. Be realistic. Would you residents be accepting of an openly LGBT person? Would your team know how to address him or her respectfully? Could you accommodate his or her needs?

There’s a huge market being created right now for communities that can appropriately care for LGBT individuals. This could be your organization’s chance to get in on the ground floor of this movement. Not only will you be doing the right thing, but it could easily give you a leg up on your competition.

We encourage you to check out SAGE and engage its training program for your team — starting with your executives and working downward to your frontline associates. Becoming SAGE-certified is a great way to show that you’re taking the LGBT Boomer and senior community seriously and that you want to meet its needs.

Diversity has never been more important in senior living than it is right now. The fabric of American culture is changing. What people want from an aging services provider is changing. Providers can either adapt and welcome diversity or shun it and wither on the vine.

What path will your organization choose?

Source:

https://www.sageusa.org/resource-posts/the-facts-on-lgbt-aging/

Two weeks ago, on a whim, I wrote an article discussing how the reboot of the show “Roseanne” has been addressing issues related to aging. Since writing that article, another episode has debuted that touched on an issue that many Baby Boomers are struggling with — aging parents. Specifically, we’ll be reviewing season 10, episode 6, entitled “No Country for Old Women.”

In the show, Roseanne and her sister, Jackie, are confronted with how best to assist their aging mother, Beverly. Neither daughter wants to take full responsibility for her, as they are both leading complicated lives that leave little time for caring for an aging parent. It also doesn’t help that Beverly has a challenging personal outlook and worldview. Eventually, the sisters decide on “joint custody,” with the mother alternating where she lives every week. As one would suspect, Beverly isn’t very happy with this situation. After Jackie catches her mid-coitus with an older gentleman in Jackie’s apartment, Beverly half-heartedly threatens suicide. This moment helps Jackie to see the challenges her mother faces and how the whole situation makes her feel unwanted. Jackie concedes, and Beverly takes up residence with her.

In less than a half hour of television, this episode struck at the heart of a growing crisis in American families. As people live longer, their retirement funds are drying up, and their need for extended medical care grows. Families once took care of aging relatives at home, but that was usually for just a few years. Now, an aging parent might live for a decade or more, requiring additional care that children and grandchildren just aren’t able to render. Of course, the children don’t want to feel guilty by placing their parent in a community that the parent doesn’t want to go to. It’s a rock and a hard place, for sure.

In 2016, The Atlantic published an article called, “What Aging Parents Want From Their Kids.” In the piece, several families are interviewed about how they are handling aging, from both the children’s and parents’ point of view. It’s fascinating how the roles have reversed, with parents feeling the stress of being checked up on and feeling as though their life is under constant scrutiny. This can lead to parents trying to hide age-related health issues, such as memory lapses and difficulty with daily activities. On the other side of the coin, adult children are often afraid of their parents getting hurt, further encouraging their protective behavior. Welcome to the new normal for many families.

“Roseanne” adroitly manages to take a serious topic and find the humor in it. Yes, Beverly is a prickly individual that is hard to like, but she’s still a human being with feelings that can be hurt. Just because she’s aging doesn’t mean that she is bereft of value. Jackie and Roseanne are forced to confront their own behavior and how it impacts someone they love.

This issue is becoming all too common in our space. As caregivers to the aging, we must also care for a resident’s family, who can be just as scared as a new resident. The services that communities provide are felt well beyond the resident, and our ability to put the family at ease is often even more important than the direct care a resident might get.

Source:
https://www.theatlantic.com/health/archive/2016/03/when-youre-the-aging-parent/472290/

The LeadingAge California 2018 Annual Conference & EXPO is in the books! As always, the event was truly “extraordinary,” fitting with this year’s theme. From the PAC dinner on Monday evening to the continuing education classes and the exposition hall, the event was filled with opportunities for learning and networking.

Over the last year, we’ve built up an article series about our three takeaways from major events like “be extraordinary” by LeadingAge California. This gives me a chance to share some of the insight I’ve gained and, hopefully, provide some thoughts around what’s on the horizon for aging services organizations.

The sharing economy is here to stay.

Given the flood of Boomers who fall into a more moderate income category, expect the concept of sharing even more of their collective assets to continue, up to and including their homes. Brace yourself for groups of friends who want to move to your community to cohabitate — perhaps two or three to a home. Ride sharing continues to grow in this space as well. I had the opportunity to speak to several people who are using Lyft as a primary source of transportation at their communities, with much success. Other organizations are making shared vehicles, like Zipcar, available to residents. As individual assets continue to shrink, expect to see Boomers looking for creative ways to pool their resources to get the best experience possible.

In advocacy, there is power.

Advocacy remains vital to keeping the needs of our aging society in front of legislators; as a field, we must do more work in coordinating a common voice on behalf of those we serve. LeadingAge California is leading the charge by increasing its focus on developing its PAC and targeting specific legislators who have an interest in helping LeadingAge member organizations. It isn’t just investing in lobbyists, but also in causes that can make a big difference in the bottom line for communities across the state.

Technological advancements can’t replace social interactions.

Right now in our communities, we are seeing a technological revolution that is being driven by our residents. During the conference, we heard multiple stories of residents utilizing the Amazon Echo and Apple Siri products to augment their day and make it easier. Boomers and seniors are taking these devices and finding new and creative ways to apply them to their daily lives, especially for those who may have vision issues. Think about it — our society is incredibly driven by visual interactions; however, this new generation of device is best interacted with using our auditory senses.

All that being said, these advancements aren’t likely to replace human interaction. Attendees were cautioned on the consequences such devices can bring with them, like families who visit less often, a decline in face-to-face doctor visits and a desire to automate health. It’s a rabbit hole that we can easily fall down as we cut costs and stretch our staff farther. Remember, no piece of technology can beat the caring voice and the compassionate hand on the shoulder of a trained nursing professional.

We’d like to thank our friends at LeadingAge California for the opportunity to present two education sessions at this year’s event. Our team had an excellent time meeting and networking with communities from all over the Golden State, and we are already looking forward to next year!

On March 27, 2018, ABC aired the first episode of “Roseanne”’s 10th season. To say there was an appetite for the relaunch of this program is an understatement; more than 18 million people tuned in to watch the show, which was renewed for an 11th season within three days of the airing. Sure, nostalgia is driving interest in the production, but the stories being told are resonating with viewers, especially in the 18 to 49 demographic.

You might be wondering why we’re discussing a television show that is popular with an age group that doesn’t qualify as the “mature market.” It’s certainly a pertinent question! To answer that query, we point to season 10, episode 3, entitled “Roseanne Gets the Chair.” While every episode of the season touches on aging issues, this one brings them to the forefront.

As Roseanne has aged, her knees have gotten bad. Throughout the season, she quips about her joint pain and the challenges she faces getting around as she ages. To help this situation, Roseanne’s caring husband, Dan, installs a chair lift in their home stairwell to help Roseanne with her mobility issues. Dan says he got the lift from a neighbor who passed away, implying that someone much older than Roseanne up to this point used it. Naturally, Roseanne is resistant to using the lift because, in her words, “It makes me feel old.” At one point in the show, Roseanne gives in to using the lift, taking a seat and riding it up the stairs. As she does so, her granddaughter bounds up and down the steps, running past her, making her feel even more feeble and vulnerable. This interaction illustrates a point that is hitting close to home for that 18 to 49 audience — namely, the adult children that are now looking to care for their parents.

In real life, Roseanne is 65 years old, and it can be presumed that her character is roughly the same age. In the show, she and Dan struggle with keeping track of their prescriptions and dealing with age-related pain, as well as the challenges of living with their children and grandchildren all under one roof. Let’s face it: This is a common story in America today, which may be why the show has struck a cord.

People 18 to 49 are young enough to remember when “Roseanne” first aired, with a young, vibrant cast dealing with blue-collar issues. Now, that cast has aged alongside them and is facing the same life stage challenges as their families are. Adult children are watching as their parents endure joint replacements, manage medications and fight to stay active, even as their bodies begin to decline. This is especially apparent within blue-collar families, who may not be able to afford a retirement community and choose to stay in their own homes, depending on family care and resourcefulness.

In its own way, “Roseanne” is generating discussion and insight on the aging process in a manner that no other show is doing today. Rather than exaggerating the issues of aging for sport, the show reacts to them in a real way. This reaction is something that many adult children are facing as they watch their own parents age into their mid- to late-60s and early 70s. The desire for this group to remain active is routinely challenged by health, leading to adult children taking on caregiver roles — whether they are equipped or not.

Through our work with aging services providers, we know these challenges all too well. Previously in this blog, we’ve discussed the lack of middle class senior living options. Instead, our industry is bookended with affordable housing and luxury brands, leaving the middle class with few places to turn. We must ask ourselves: Where will the Roseanne’s of the world live in the next 10 years, and is our industry ready for those opportunities?

In the meantime, we will continue to tune in to “Roseanne” and laugh along with America — even as we look deeper into the aging issues that the show brings to life.

Welcome to the month of May!

It’s a time when we welcome blossoming flowers, warmer temperatures and the observance of Older Americans Month. In the next few days, aging services providers across the country will tip their hats to this annual event — perhaps going so far as to plan a promotion around it — yet we find that most providers don’t understand the history and true purpose of the celebration.

Older Americans Month was established in 1963 to support and recognize the small population of Americans aged 65 and over at that time. Fifty-five years later, if Older Americans Month were a person, it could join AARP and would probably start getting mailers about your communities and services. The impetus for the creation of the observance came from the National Council of Senior Citizens who worked with then-president John F. Kennedy to establish Senior Citizens Month, which has evolved over time into the annual event we know today. Starting with JFK, every president since has issued a formal proclamation, asking that the nation pay tribute to older Americans in some way — whether through a ceremony, a fair or some other activity.

The program is now under the purview of the Administration on Aging, in partnership with other agencies and entities. Each year, a theme is determined, with supporting materials provided to help community leaders recognize older Americans for their lives and service. The theme for 2018 is “Engage at Every Age,” which aims to emphasize that you are never too old (or too young) to take part in activities that can enrich your life. Specifically, the program is shining a light on mental and physical wellness this year, including traditional exercise-based ideas, as well as more unusual ones, like establishing a mentoring relationship.

We encourage you to explore the website for Older Americans Month and make use of all of the resources provided. The outline great ideas for programs that can help energize your residents and team members, as well as the greater community that your organization serves.

Click here to visit the website for OAM.

Remember: If you are posting about Older Americans Month on social media, use the hashtag #oma18! to share all of the great things you are doing!

This article is a guest post by Rebecca Evans of GeriatricNursing.org. As we approach Older American’s month, we thought it was an appropriate time to discuss one of the most challenging diseases that an aging adult might face – Parkinson’s. We thank Rebecca for her input and we hope you enjoy the piece!

I can hear you wondering: How is it hard to diagnose Parkinson’s Disease? After all, aren’t the characteristic symptoms rather distinctive?

Well…yes and no, unfortunately.

Yes, Parkinson’s disease symptoms are rather distinctive (for the most part, anyway; there are a few diseases and drug reactions that can mirror Parkinson’s symptoms)…but they take time to develop. In the early stages of the disease, in fact, it can be incredibly hard to diagnose.

After all, there are no precise tests for Parkinson’s. As often as not, it is mistaken in its early stages for another disease—which in turn delays appropriate treatment.

Most common diagnosis difficulties

For instance, there’s data that actually suggests that as many as 25% of Parkinson’s patients are misdiagnosed. That is, they may be receiving treatment for Parkinson’s, and not actually have Parkinson’s. Or they may be receiving treatment for something else, and actually have Parkinson’s disease.

A big part of this goes back to the fact that there is no precise test for Parkinson’s, and different diagnosing doctors treat different indicators differently. For instance, some of the most common tests given to potential Parkinson’s patients are CT scans, blood tests, urine samples, and more. None of these tests are definitive, however (remember, no precise test?), and so it is up to the doctors reviewing these tests to decide what to make of them.

For some doctors, inconclusive test results may cause them to lean toward a Parkinson’s diagnosis. For other doctors, those same inconclusive results may cause them to lean away.

So what are more accurate predictor tests?

In particular, because Parkinson’s is a neurological disorder, you probably want systematic neurological assessments to play a role in your diagnosis. For instance, neurologists familiar with Parkinson’s will know to test your reflexes, balance, muscular strength and responsiveness. Additionally, it is not uncommon for a neurologist looking at the possibility of Parkinson’s to say they aren’t yet sure. They want to run more tests, or want to run more tests in the future to see if your symptoms develop further. Parkinson’s is not an easy diagnosis to make. As such, neurologists familiar with the disease will likely not rush into such a diagnosis.

Similarly, there are a whole range of neurological disorders that can present many of the same symptoms as Parkinson’s. As a result, a neurologist may want to be careful to eliminate or rule out some of those other neurological disorders.

As a general rule, the more careful and thorough your neurologist is in testing you,  the more comfortable you can be in their diagnosis.

Please do note, however, that you can always get a second opinion from a neurologist you trust if you don’t feel comfortable with your original neurologist.

Why is appropriate and early diagnosis so important?

Quite simply, because it is the key to better treatment. When earlier caught, treatment can begin earlier, and adjustments can be made to help preserve independence and a high quality of life. This might mean developing an early exercise routine that works, finding the pharmaceutical regimen that gives best results, and determining what level of physical therapy works best for you and your current symptoms.

What diseases are most often confused with Parkinson’s disease?

In particular, if you suspect you or a loved one may have Parkinson’s disease, these are some of the other diseases that may regularly be confused with Parkinson’s. You will want your neurologist to rule them out in testing:

Benign essential tremor
Brain tumor
Huntington’s disease
Multiple sclerosis
Multiple system atrophy
Striato-Nigral degeneration
Supranuclear palsy

Other diseases may also be confused with Parkinson’s, obviously, but the above list is some of the most common.

So ask your neurologist to be thorough. It’s more important that you are appropriately diagnosed, so you can get the care you need, than that you are diagnosed quickly.

Multiple Sclerosis – An infographic by GeriatricNursing.org

This article is the third in a three-part series, offering a fresh perspective on a topic that aging services providers often overlook — older adults experiencing homelessness. For this series, we are interviewing Brother Damien Joseph of the Society of St. Francis. Damien Joseph works with people experiencing homelessness in California and offers some incredible insights.

You can read the first article here.

You can read the second article here.

In our last article, we discussed issues relating to the health of older adults experiencing homelessness. Are aged individuals more likely to seek assistance or less? Is there any discrimination in the services rendered? (Meaning that some shelters prefer to help young, homeless mothers — do they avoid the older population?)

I don’t know if there is a pattern in likelihood to seek assistance. I do know there is a sub-population of “chronically homeless” people, who by virtue of being defined as living on the street long term, are often older. This population is often less likely to seek assistance for a variety of reasons, including sheer weariness of trying to navigate a system of vastly inadequate resources.

Legal protections prevent most shelters from turning away an individual based on age. There are certainly specialized shelters for women with children and so on, but a shelter open to general populations may not consider age. What they MAY and DO consider is degree of medical need. If the shelter decides that a person potentially has more medical, mobility or assistance needs than it can accommodate, it does not have to accept that client. Obviously, older individuals are more likely to have these needs (especially if they’ve been experiencing homelessness) and, therefore, are more likely to be turned down. It’s legally not considered discrimination, but it has the same effect.

Just last week, I was with a group talking with the Episcopal chaplain at a large LA hospital. Looking at his current hospital census, he could quickly identify nine individuals who were admitted to the facility for a treatment lasting a couple of days but had now been there from three to nine months because their age and medical needs made it impossible to find shelter or program housing. This hospital, being a religious institution and committed to care over profit, will not put these individuals out on the street, but it has received no payment from Medicare or any insurer since the first few days of the hospitalization of these nine. Other hospitals would not be willing to take such a hit.

In San Francisco, a chronically homeless woman we knew well arrived at our door one chilly windy evening, barefoot, wearing only sweatpants and a thin T-shirt. She was heavily sedated by antipsychotics. The hospital where she had just been treated for pneumonia had discharged her with a taxi voucher bearing our address. Within half an hour, we had to call EMS again, and she was readmitted to another hospital for further care. If she had not knocked on our door, she might well have died that night.

Do you find that individual people are less likely to help an older person than a younger one?

I’m endlessly bothered by how much “compassion fatigue” I see in our cities. Most people walk past their unsheltered and needy neighbors as if they weren’t there. They don’t make eye contact, don’t speak to them and cross the street, if necessary. If it were possible to help less than “not at all,” then perhaps I could guess whether younger or older people were more likely to be ignored.

Are older homeless people more likely to have been homeless for a long period of their life and have just given up on finding a home? Or do they usually find themselves homeless later in life, through no fault of their own?

One of the most important truths of work with the community experiencing homelessness is that there is no typical story. There are as many stories and as many causes of homelessness as there are individuals experiencing it. It may have been common at one point for most older people living unsheltered to be among the “chronically homeless,” but I meet people in all varieties of situations.

Some have been chronically homeless. Many have been impacted by the ever-increasing cost of living and income gap. In cities like San Francisco and LA, where gentrification is rampant, many have fallen victim to developer greed, as building buyers find legal loopholes in rent control and force people out of places they’ve lived in for decades. Some have lost their retirement income to recent financial crises. Many were among the growing number of Americans whose full-time, honest work never left enough to save for retirement and now find that meager Social Security payments don’t go very far, especially in a city. Some have been made destitute by catastrophic medical problems, the onset of mental illness or addiction. Those who are new to being homeless as a senior are often especially at sea. Trying to navigate the system and compete for drastically insufficient resources is a huge and baffling adjustment. Many are just overwhelmed by it.

As we conclude our series of interviews with Damien Joseph, we must reflect on what we, as individuals and as organizations, are doing to help older adults that are at risk for homelessness. Each of our organizations can do something.

At Varsity, we’ve made a contribution to the Society of St. Francis to assist Damien Joseph with his ongoing ministry. If you’re interested in learning more about the work of the Society of St. Francis, you can visit the website at www.s-s-f.org.

If you’d like to make a donation to help the Society’s work, you can do so at http://www.s-s-f.org/give . There, you’ll find information about sending a check by mail or making an online donation.

This article is the second in a three-part series, offering a fresh perspective on a topic that aging services providers often overlook — older adults experiencing homelessness. For this series, we are interviewing Brother Damien Joseph of the Society of St. Francis. Damien works with people experiencing homelessness in California and offers some incredible insights.  

You can read the first article here.

There will be one more post in this series, so make sure to stop back next week as we complete the interview.

Many people think of the homeless as younger, or even middle-aged. From your experience, how many people experiencing homelessness are age 55+? What struggles might they face that the younger homeless population doesn’t?

Your point is well made. In most reports I’ve looked at, “young” is defined as under 25 or thereabouts. HUD reports to congress seem to use this division. The category of homeless seniors is often left out, but the older homeless population is growing alarmingly fast.

In my personal contact with individuals living directly on the streets, I am alarmed both by how many very young homeless there are and by how many older homeless there are. Increasing income disparity, cultural changes, individual social and moral attitudes and a deeply flawed social safety net are among many factors contributing to the fact that no age group is safe from homelessness.

The unique struggles for older homeless individuals are many. Many do use an age well below 55 or 65 to define “older” among individuals who experience homelessness, because the toll it takes on a person physically and emotionally is devastating and certainly reduces life expectancy. I’m often surprised when a person who has been unhoused for an extended period tells me his or her age. That “little old homeless man” you see wandering around your town may turn out to be 50, not 70!

I know that, even in middle age, I find that a night away with a lousy mattress is taxing. Imagine, as a senior, how uncomfortable it is, sleeping on hard surfaces like the ground, concrete, cots or metal shelter bunks! Plus, many are sleeping exposed to the elements. Even in shelters, temperature controls can be unpredictable, and leaks and dampness abound.

The “street” population explodes in numbers every day around 7 or 8 a.m. That’s the time that many, if not most shelters require most of their residents to leave for the day, returning again in the evening. During those daylight hours, folks will have to deal with whatever temperature, weather and air quality issues there are. Escape from the sun, heat, rain and so on may be possible, or individuals may be continually “moved along” by business owners and police who don’t want to see them hanging around. Many cities have been actively removing public seating areas, or at least designing them to make lying down impossible. In some cities, including in San Francisco, it is illegal to sit down or set down your property on a public sidewalk. In order to comply with this law, an individual would literally have to remain on the move, carrying all of his or her possessions all day long. Businesses increasingly install what activists call “violent architecture” or “anti-homeless measures,” placing raised or jagged structures on flat surfaces to prevent them from being used to rest.

Finally, we must address the lack of access to appropriate health care and medical treatment. While this affects all people experiencing homelessness, the older population is clearly hit hardest. Most are uninsured or underinsured. State/federal program coverage generally gives them access to care, but certainly not the best available care. Elderly individuals without stable housing may find great difficulty in receiving any medical care requiring privacy, storing medications in need of refrigeration or other special conditions, keeping track of times for dosages and so on. Add to this continual exposure to infection, trash, body fluids, vehicle exhaust, smog and so on, and it’s remarkable that older people in this context can ever be healthy.

Clinics that specially serve this population exist, of course, but the one where I volunteered in San Francisco was continually swamped with demand, had few providers (with high turnover) and lacked access to easy referrals, specialty equipment and procedures that would be readily accessible in a private practice. I performed routine record reviews for patients due for follow-up but often found that they had no phone or address at which to be contacted, or that, in the frequent instability of temporary housing, they had moved, and their Medicare now required them to start over with a new clinic. Consistent care is rare. Many, even the very ill, never seek medical treatment until they end up in an ER. I met an elderly unsheltered man last year who asked for help filling his prescription for an infection on his leg. He pulled up his pant leg to reveal his entire lower leg blackened and necrotic. Had he been a properly insured, or able to pay consumer rate, he would have been instantly hospitalized for so serious an infection. But somewhere, some provider gave him a prescription for some cream and told him to figure out how to pay to fill it. This really drove home the issues with health care for me.

Health care is such an important example of what aging services providers offer. It’s hard to imagine how anyone could survive for long without appropriate care from trained professionals. Assuredly, this is a problem for our whole society — one without an easy solution.

We hope you’ll join us next week when we conclude our interview with Damien Joseph and wrap up our discussion on the challenges faced by older adults experiencing homelessness.