"The Ugly Truth About Ageism: It's a Prejudice Targeting Our Future Selves"

  ©   Imelda Maurer, cdp  September 17, 2018

This blog title is that of an article in The Guardian recently.  I certainly cannot improve on the concepts or the writing, so I include just a few paragraphs from an informative and thought-provoking piece. The entire article can be accessed here.

"We love the elders in our lives and we all hope to grow old, so why does this personal interest not translate into public policy?"  (My own editorializing here ---  it could read, 'why does our love for our elders so rarely translate into environments, policies, procedures, programs and practices that make this love and respect  visible and self-evident to our elders as well as to any observers or visitors to these communities?')

"You see them in most aged-care facilities, seated on pastel-colored lounges, being babysat by a TV they are mostly not watching. Some are asleep, some are sedated, some are cognitively impaired. Seeing them like this, it’s hard to remember they were once young, vital and independent. What’s harder is thinking that it might one day be you."

"So why have we failed to do better by our elderly needing care? Why do we settle for conditions that leave many of them bored, lonely and poorly fed in a way we would never tolerate for ourselves?"

"One underlying cause could be deeply entrenched ageism. It often begins with the language we use. According to writer Ashton Applewhite, if we diminish our regard for the senior members of our society verbally, we are likely to do the same when it comes to the way we frame policy – removing their dignity and sense of agency in condescending generalizations that assume vulnerability and dependence instead of resilience and independence."

"Unlike other prejudices such as racism and sexism, which are manifestations of fear of the other, ageism is unique in targeting our future selves."

 “No prejudice is rational,” says Applewhite. “But with ageism, we have internalised it. We have been complicit in our own marginalisation and it will require active consciousness-raising to correct that, just as the women’s movement did."

Are we ready to engage in active consciousness-raising around issues of ageism?  For my readers who are women religious, there is an urgent call here for us to engage on this issue for the social justice issue that it is! 

Culture Change: Let's Not Make it a Cliché

Wednesday, November 7, 2007

Reissued September 5, 2018

There is a wonderful revolution taking place in (albeit all too few) nursing homes across the country. As long as there are parents who say to their children, ‘Promise me you’ll never put me in a nursing home,” or any of us groan to think that we may spend our last days in a medical institution that is foreign to any feel or sense of “home” with all its deep and deeply personal implications, then there is need for this revolution, this transformation, to spread.

It goes by several names: Culture Change; Transformative Nursing Homes: Resident-Centered Care; Person-Centered Care; Green House Model; Household  Model, Wellspring

What all these terms have in common is a philosophy that holds to the following values and attitudes:

•           The resident is put back into the driver’s seat, making as many choices about his/her daily life as possible. One implication is that activities and care revolve around the resident as much as           possible, as contrasted with an institutional model where schedule and staff convenience take precedence.

•           It is an environment that honors the culture of aging as life-affirming, satisfying, humane and meaningful.

•           The place has the feel and look of HOME. Just two evidences of change in the environment:
            No medical carts rumbling down the hallways.
            No centralized  nurses' station

Although the culture is not transformed by merely instituting programs, or doing away with a centralized nursing station, studies have shown that in communities where the culture has transformed to a resident-first culture, certain practices/programs are present. That information can be used as somewhat of an evaluation of how far along on the journey of culture change a community has come. It is accessible at this link:   http://www.artifactsofculturechange.org/ACCTool/  .

Once on that page, scroll down to the "Artifacts of Culture Change Downloadable Version".

Culture change is a deep, challenging transformation of attitudes and values which is dependent on strong, knowledgeable leadership. The leader must have a deep belief in these transformative values and the leadership ability to shape staff so that these values permeate every cell of their being. Anything short of this is not transformative change and the result will not be ‘culture change.’

The win-win part of culture change is that this transformative mode of operation costs no more than traditional, institutional care. In fact, there are many reasons why the cost is probably lower. That’s a topic for another day.

Steve Shields, CEO of a transformative community in Manhattan, KS speaks of what made it possible for him and his staff to move forward in their journey of transformative change. He is quoted in Beth Baker's book, Old Age in a New Age:  When Action Pact consultants first introduced the concepts of culture change, "The vision was painted so strongly and in front of everybody that it became holy. Truly."

I spoke with Steve about that quote and asked him what he meant by saying that culture change is ‘holy.’ He said simply and straightforwardly, “It is holy because it liberates our elders and returns hope to them.”

Interpreting What We See

Sometimes the very field we are in as caregivers or advocates under one broad definition or another can lend a bias to our observations that is not always in the best interests of those we love and serve. Our conclusions may not reflect what  choices they may rightfully make or want to make.

We may think we know better because of our professional background, or because of our position or status. We may be acting from a conscious desire to keep the ones we love and serve safe from making poor decisions.

Sonya’s experience described below and what she took from it spoke to me strongly of just one example of implicit bias that exists in all good people. It was her Facbook entry posted earlier this morning

Sonya Barsness Consulting

It happened again today. Blue the Elder Dog (Chief Executive of Cuteness and Herding for Sonya Barsness Consulting) and I went for a walk. He walked very slowly and wobbily, breathing heavily. He didn't make it around the block. I picked him up and carried him into the house. As I sat processing this, he came up to me and started barking, nudging his ball towards me. 

Wha????
And it hit me - he is reserving his energy for what is important to him.
How often do we make assumptions about what our beloveds need and want? Do we notice what brings them to life?
And so we played.
Blue the Elder Dog has been promoted to Senior Chief Executive of Wisdom.

"I just wanted a little sun."

A couple of Sundays ago our St. Louis region was under a heat wave advisory. After returning from an early morning Mass, I changed clothes and went out to water the flowers before it got too hot.

I saw my neighbor whose back yard is just catty-corner from my own. Rita was sitting in the shade on her patio. I waved and she waved back. I've always liked and appreciated my friendship with Rita for her warmth, intelligence and her almost-92-years of life experience.

"Did you give up on the air conditioning?" I asked.

"No, I just wanted a little sun."

I wished her a nice day and got on with my watering. Working in the yard always provides an ambiance for thoughtful reflection.

How simple a thing, and how satisfying, this going out and sitting on the patio because you want a little sun.  How nice that Rita can do that – just step outside and find your favorite chair. Get up and go in when you've had enough sun. One can do that when one lives at home. 

Coincidentally, the following day or so, Penny Cook, Executive Director of the Pioneer Network, posted a piece on Facebook about transforming the culture of aging. She noted that with all of the changes that we have seen, we still have far to go.  One such item Penny mentioned was this: "We continue to build communities without easily accessible areas for people to independently spend time outside."

The present, traditional system of aging services which too many people - who don't live there - are satisfied with because  "they get good care there"  needs to be turned on its head so that getting good physical care is no longer enough.  It must be QUALITY OF LIFE that is the benchmark standard resulting from choice, dignity, autonomy, privacy, relationships. 

It would include easy outdoor access so that all the Ritas who live there could spend time outside independently-- just getting a little sun.

"Diminishment" is a terrible word to use to descrie older adults.

'The winter season of our prayer life is a mixture of blessing and diminishment that also describes the winter season of our life.' Those are words from the Retreat Director I heard just this morning.

This prayerful woman has been leading a group of almost 50 Sisters in a retreat whose theme has been "The Seasons of Our Life". Of course I cringed when I heard her use that "D" word. It was another instance of how all of us are exposed to the prejudices of ageism, how we internalize them, absorb them absent any evaluation, and in cases like this, further propagate these internalized prejudices to other victims.

What pained me most in hearing that "D" word used as allegedly describing later life was for my other Sisters gathered there, all of us clearly in the second half of life. At a subconscious level, at least, taking such words in without evaluating them results in a sense of "being less"; it may also generate unexamined feelings of shame for being "diminished", for being old.

The GOOD NEWS, the whole truth about the aging process is waiting to be preached!  The solid data from the fields of gerontology and of the psychology of aging MUST be used as the grounding for a spirituality for all of us in the second half or second third of life. This grounding is the only approach that will provide a spirituality of aging that holds integrity.

Without a marriage of sound gerontological and psychological data with a paired grounding  in  Scripture, we are left with messages about aging and spirituality that, at their worst, are harmful to our self-concept of our future selves  (and therefore harmful to our well-being along several dimensions), and, at best, offer only pious piffle.

Where is that person who is going to preach the GOOD NEWS, that is, the WHOLE TRUTH to my sisters?

About the 'Yikes' in a Previous Post

In my last post, I stated that I had been asked to be assessed for the right to hold and use my driver's license solely because I had reached a certain chronological age. I responded with "YIKES!"

Many of my peers don't react visibly that way. For whatever reason. Here is why I did.

Let me share the following story told to me by a Latina woman.  She grew up in El Paso, Texas in the 1950's. Each year on the first day of school, the Mexican children – only the Mexican children – were taken from the classroom to have their heads checked for lice.

Let that settle in.

Racism blatant enough to cause an audible gasp. How could such a thing happen?  It doesn't happen today because, thank God, society is sensitized to the prejudice of judging others on the sole basis of ethnicity.

School officials in El Paso did not set out to ostracize or alienate their Mexican students, I feel sure. They were seeking the common good. The presence of head lice is a public health issue and the schools have a responsibility to ensure a safe, healthy environment.  The way they attempted to ensure this common good, however, was racist, based, quite obviously, on the premise that lice infestation is more likely among Mexicans. Epidemiology tells us such assumptions are patently false. So to act in the way these school officials did, was simply racist.

The laudable goal of assuring a healthy environment should be sought. It just has to be done in a way that is not racist, in a way that does not denigrate any class of persons because of their ethnicity.

The connection with requiring a driving test on based on age?  I hope it is obvious. To make assumptions about anything, or to demand certain procedures to be followed, based solely on chronological age is ageist.

Do we want to keep drivers and all those whom they might encounter when they are behind the wheel safe?  Of course we all do. We just have to do it in a way that is not ageist. Can we do that? Of course we can! When there is an awareness of how vicious and self-harming ageism is to all of us, we will look for another way.

I hope it is soon.

"Don't Say 'Still'"

I just blurted it out.  It wasn't angry or belligerent; it was just an instinctive and immediate response delivered with certitude and confidence.  The setting: a representative of an insurance company testing my 75+ year-old cognitive skills prior to a driving test required for me to keep my driver's license.  That aspect of my story is for another day. Let me just say here that the required test had nothing to do with my perfect driving record. It was purely age-based. YIKES!

This personable woman was giving me the results of a simple cognitive test and explained that my score meant I could still --- and I interrupted her right there. "Don't say 'still'. When you use that word it implies that I surpass expectations for a certain capability expected for someone my chronological age."  The examiner responded very positively, saying she had never thought of that meaning in use of the word "still" and she clearly caught my meaning immediately. She went on to say that she was presenting a training for employees of an adult day care center that evening at a local site her employer insured. The topic was customer service and she would use this new knowledge with her class.

When I found a geriatrician here in the St. Louis area soon after my relocation here, she asked me three questions on my first visit:

1. Have you fallen within the last six months?  Good question. Persons over the age of 65 are at risk for serious consequence when a fall is sustained.

2. Do you live independently at home? Good question. It gives some general indication of the level of my physical/cognitive functions.

3.  Do you still drive?  OH NO! My geriatrician flunked on that question.  Still?  The implication is that someone of my chronological age may surely have lost the complex interplay of skills that driving requires.

Not to be repetitious, but we use the word "still" when we are describing something seen as beyond the time line society determines.  If you smile when you see this picture below, you get it. Bring it to your level of consciousness when dealing with what society has told all of us about aging and older adults.

For the most part, what we absorb from our culture about what aging is and what to expect as a result of the aging process is so false and so detrimental to each one of us.  It's way past time to start learning the real facts about aging and life in our later years!  In fact, the more you know the whole story about aging, the better aging looks!

LIFE IN A WHEEL CHAIR

This poem was written by Sister Janet Thielges, OSB and posted on her monastery's website.  https://sbm.osb.org   It speaks for itself and can serve as a wake-up call about some of our unconscious assumptions or biases.

Life in a Wheel Chair

I fell

and injured my back.

I can see, hear and talk

and my mind is as sharp as a whistle.

Ninety.

Wheelchairs.

Bring on changes.

They minimize visits.

“Can anyone who can’t walk, talk?”

Seems not.

Shopping. 

With companion. 

Person I knew came by. 

Greeted only my companion.

Ah well! 

Today.

A gent “gets” it.

“Did she fall?” asked a lady.

“Ask her. She can talk,” said the gent.

I’m real!

I smiled. 

It made my day. 

The wheelchair’s a helpful thing;

but I never stop being a person.

Thank you!

Janet Thielges, OSB

How We Use Our Words

US News and World Report writes often about nursing home-related issues.  Angela Haupt is Assistant Managing Editor of Health at U.S. News and has written a series of such articles around "Activities" in nursing homes.  I read one such article this morning in which she noted pet therapy and therapeutic cooking in some nursing homes as examples of innovative "activities".  I responded to Angela and share that letter here.

Dear Angela, 

Thank you for your articles on some of the wonderful things happening in nursing homes to make life better for those who live there and who work there. Because our choice and use of words is so important, I am asking you to reconsider your use of the words "therapy" and "therapeutic" when referencing activities in a nursing home. When one refers to pet therapy or to therapeutic cooking, it medicalizes a normal human activity. 

If I may expand, a little -- when I sit down in the evening after a hard day's work, and my cat jumps into my lap, there is a rush of endorphins and my blood pressure goes down. I am content and serene and it shows on my face.  Yet, the next morning at work I never say to my peers that I engaged in pet therapy the previous evening (!)

The same is true for other activities. Sometimes I go into the kitchen and cook or bake something just for the pure pleasure and sense of relaxation it gives me. Yet,when I share those cookies, for example, I never share them as the result of "therapeutic cooking".

Medicalizing events in a nursing home reduces elders to their medical conditions.  I know that was never your intention, and that you most assuredly learned these terms in the very nursing homes that are engaged in these innovative enrichment events. Your pen is so powerful, Angela.  I trust that you will continue to use it to transform the culture of every nursing home in our country.  Thank you!

Imelda Maurer, LNHA

Proud to be a Guide at the 2018 Pioneer Network Conference in Denver. Want to know more? Ask me or check out the Pioneer Network website:   https://www.pioneernetwork.net/conference/

Imagination

Karen Schoneman gifted me with a copy of her recently published book,"Working in the Light". It is a book of daily reflections, coming from the perspective that "as we move forward on our spiritual paths, we are light workers, letting God's light flow through us and out to where it is needed - in ourselves and in our world."

Last week one of the reflections was about the Tool Library in Berkeley, CA. How innovative to have a central source to borrow needed tools when they are no longer so commonly found in our own garage or our neighbor's -- if we even know our neighbors.

Karen ended her reflection with the suggestion that today we "applaud all those who are using the divine characteristics of imagination to see new solutions to problems and new ways to serve each other."

Today I applaud and thank God for all those individuals working with elders who have used and continue to use their imagination to see aging and supportive aging services in a new light. It is in this light of new understandings of aging that imagination can romp and dance like a child in the sunlight, bringing new solutions to failed and inadequate views of aging and aging services. 

This work is called transforming the culture. Culture Change.

They are going to “let" my brother stay with him for two nights.

Take this as a case study.

Those words from Betty’s text jumped out at me and I instinctively dialed her cell phone number. Her father is in the nursing home. Some time ago he broke his ankle in a fall at home and was hospitalized for surgery. After surgery he moved to this nursing home for care and therapy with the expectation of returning to his own home.

The surgical incision didn’t heal. We’ll leave the finger-pointing aside here. The lawyers can do that. Suffice it to say that the picture I saw of the open incision made me gasp. Once again this 86-year-old man was hospitalized. This time, because of exacerbating chronic conditions, the surgery was an amputation of the affected leg below his knee.

Think about it. An older adult, living independently, falls and breaks his ankle. It results in surgery and subsequent nursing care that raises serious questions. Subsequently, this man who initially just broke his ankle ends up losing part of that lower limb.

Those of us who work with older adults, and/or who read about older adults being hospitalized, and,  under general anesthesia, know the dangers of delirium in such instances. Exacerbating factors are new environments. Carolyn’s dad’s situation fits the bill on all counts.

The family is close-knit and one of Betty’s brothers asked if he could stay overnight in his dad’s room because of his dad’s confusion. The nursing home’s response was, as Betty related in her text, “They are going to let (emphasis mine) my brother stay all night with my dad for a couple of nights.” Thus my instinctive phone call to Betty with a few words about nursing home regulations, and a few  about  staff or management using the word“let”.

What do we need to take from this?  Consumers (those who use the services of a health care institution) and their family members MUST know what the minimum standards of care are in a nursing home so that they can be advocates, either for themselves or for their family member.

Consumers must be encouraged by advocates to speak up for the rights of those nursing home residents, to trust and act on their instincts about whether something is amiss.

Those of us who are not yet in a nursing home cannot deny the possibility that we may one day find ourselves there.  Does not the motive of self-interest prod us to eliminate the status quo of traditional nursing homes and fight for a place called HOME?

Or do we think we won’t ever be old, or frail, or disabled.  Are we part of the American culture that views aging much like ethnicity?  Once Irish, always Irish; Once Italian, always Italian, Once young, always ------- ?