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SOC3100 Gerontology Portfolio

Richard J. Riggs

Spring 2013


Most Pressing Issues/Problems in Gerontology Today Public Policy Impacts

I see the most pressing issues currently confronting our older population today threefold and
intertwined. The three I consider to be the most pressing and will have the most impact on the
older population are as follows: 1) the uncertainty of the public policies that could change and
affect Medicare/Medicaid as well as Social Security benefits; 2) the continued rise of healthcare
annually in relationship income for individuals on fixed incomes; and 3) the ability of the
system to provide doctors and caregivers to meet the Affordable Care Act demands of an
additional 32 million individuals in addition to those becoming retirement age during the initial
implementation stage. (Stalk, 2011) (Hooyman & Kiyak, 2009)
To further emphasize the impact these unresolved public policy issues have on the aging
population one needs to look no further than why the authors of our textbook updated to the
current edition, the economic status of older adults has been profoundly affected by the 2008-
2009 worldwide recession. (Hooyman & Kiyak, 2009) Individuals nearing retirement age now
have had the bulk of their savings tied up in home ownership. For decades this was a sound
investment; however, in the past five years during this downturn in real estate values in their
home that now maybe worth less that the mortgage owing on it. These upcoming boomers in
many cases had planned to downsize into smaller homes in their retirement years using the
equity from selling the larger home and be mortgage free. This recession is now turning their
plans upside down. We now see these individuals continue to work longer in hopes that the real
estate market will improve enough to get out of being under water in their mortgages. Their
Golden Years Dream has turned into a nightmare.


Now consider combining the uncertainty of public policy on the future of healthcare, the decline
in the housing market and working into what was to be your retirement years and one can easily
see the stresses that public policy makes in an individuals life.
One could argue that the more individuals paying into the healthcare system will in time bring
down the overall costs of healthcare over time. The key here is over time since many older
individuals will need to utilize the new system prior to the savings being realized. As with any
new policy there are growing pains just like the donut hole in the Medicare Prescription Drug
Program known as Part D that was fixed by the Affordable Care Act there is a lag between
acknowledging the need for a fix and implementing it. The aging population will be attempting
to use the policy before all the kinks are worked out and before the costs have come down.
Lets address a very large kink in the Affordable Care Act that our policy makers have yet to
address; it is the government control on educating physicians. Currently the government has
controls on the number of medical schools and the number of graduates and their licensure that
have and negative impact on meeting the number of physicians available to meet the greater
demand brought into the system by the additional 32 million covered. Prior to the Affordable
Care Act implementation there is a shortage of General Physicians to meet the existing needs.
This shortages will continue to grow due to demand will place in the early implementation years
causing overload to the system and the overall quality of care as the resources will be stretched
and unable to accommodate the influx of newly covered individuals. The government has
imposed central planning over the natural demand and supply side in our healthcare system and
has not addressed those controls as it pertains to the changes in the upcoming growth to the
existing system. These controls will be need to be lifted to allow for the supply side economics


to factor in, but this will take time and the short term effect will have severe consequences to the
older person until the shortage is resolved. (Stalk, 2011)
Doctors are not the only shortages that will have to expand to meet the additional demands.
Caregivers from all areas of the healthcare provider network, i.e. social workers, nurses,
physician assistants, therapists, and administration as well as facilities will need to revamp
causing delays in care in many cases until the system is fully equipped and can meet the new
Many employers are dropping healthcare insurance coverage due to the rising costs of providing
coverage. Many more employers will be restructuring the employer-sponsored health benefits
once the Affordable Care Act takes effect making the 32 million numbers further rise to an
undetermined number. (Stanley Feld, 2011)
As with any change there are growing pains. Our system needed these changes to cover as many
as possible and in turn bringing down the overall costs of providing healthcare. It is my concern
that those entering into their elder years during this transition phase in period will be
overwhelmed and short changed. It is daunting enough tasks for younger individuals to wade
through the vast benefits and coverage that currently exist. The tasks for the older individual in
the upcoming foreseeable future on keeping abreast of the changes to benefits, educating
themselves for being their own advocate in many cases will be too much for them to undertake.
The older person currently has concerns of increased deductibles on healthcare insurance
premiums, continued increases of co-pays for doctor and prescriptions and in many cases out of
pocket deductibles tie to the co-pays, i.e. out of pocket amount has to be met prior to co-pay for
prescription drug coverage kicks in.


If the concerns of policy changes in Medicare & Medicaid coupled with the roll in of a new
healthcare system is not enough the older population also needs to be concerned of the Social
Security income shrinking due to the change in the CPI. Changing the current policy that
calculates the Cost of Living increases know as COLA are also being considered by our
lawmakers. The Social Security CPI (Consumer Price Index) being revamped for long term
stability of the overall system would nearly eliminate cost of living increases making it even
more difficult to meet the rising costs of healthcare. (John & Reno, 2012)
One cant address any of the above areas without being very much aware of the effect on the
other. These public policy issues are viewed daily in what seems to be a never ending news
cycle emphasizing heated debates on funding social programs versus balancing the debt for
future generations. Not only do these issues remain unresolved the constant negative dialog
instills fear in the older individual. This uncertainty in many in some cases will keep the
individual for asking for help due to not wanting to be a financial burden on the family. The
current climate is unsettling to us all and even more so to the older individual on the cusp of
making decisions that will have an impact not only socially, physically and emotionally but also
financially in the near future.
Can one expect the older population to keep pace with the changes that are currently pending?
The new terminology being introduced in some of the restructuring of patient care models from
horizontal care to lateral or coordinated care models, changing the pay structure from fee based
to the Mayo or the Geisinger Health System salary based model will have impact on what the
overall understanding of what the older population have grown to know and are accustom to
having provided from their healthcare. (Legere, 2009)


In conclusion, it is my hope there is an raised awareness in the healthcare community that not
only providers will feel the stresses of the upcoming changes and workload, but those that are
entrusted in our care are also struggling with trying to understand how the growing pains for the
system is equally and often beyond the comprehension of those in which we care for daily. As
caregivers we need to be advocates for those within our care beyond that of their medical issues.
Often times the social and public policy values are at odds with those that we care for and that
too we must respect. I have always felt the elderly had a lot to contribute and one could learn
from their years of vast experiences. It is both a privilege and the responsibility I accepted when
entering into an occupation caring for the elderly and aging population. Every day I ask for the
patience to treat them with the respect they deserve. With renewed insight and upcoming
challenges I will continue to leave the end of each day knowing I have given them my best and
with the hope I made someones day brighter.
Hooyman, N. R., & Kiyak, H. A. (2009). The Social Context of Aging . In N. R. Hooyman, & H. A. Kiyak,
Social Gerontology - A Multidisciplinary Perspective - 9th Edition (Preface, p. 717-718). Boston,
MA: Allyn & Bacon.
John, D. T., & Reno, V. N. (2012). AARP Public Policy Institue. Retrieved from AARP Perpectives:
Legere, L. (2009, August 3). Geisinger Becomes National Model for Better Health Care. Retrieved from
Stalk, D. R. (2011, 11). The Looming Doctor Shortage. Retrieved from Washington Policy Center:
Stanley Feld, M. i. (2011, 6 26). Employers Are Dropping Healthcare Insurance Coverage. Retrieved from
Better Health:


Social Supports Persistence of Myths Regarding the Aging Family in Our Culture
I would like to outline some of the ongoing myths that persist about the aging family in our
culture and attempt to explain the factors that continue to contribute to these myths.
The worlds population on average is growing older. Individuals over 60 years of age now
comprise the fastest growing population internationally and in some parts of the world, persons
over 80 year of age represent the most rapidly expanding generation.
In the United States alone, individuals over 65 years old accounted for 12.7% of the population
in 1998. By 2020, according to the Bureau of Census, 1999, it is projected that this figure will
reach 16.5%. It is my opinion, with the growing elderly population in our country there will be
an increased understanding about our aging population to better and accommodate their needs
and benefit from their abilities.
There is a perception that the older population has decreased physical abilities, mental capacities,
and overall decreased productivity. This perception includes psychological distress, i.e. having
more depression than younger adults, being less satisfied with their lives, and decreased social
interaction. In addition; older adults are also portrayed as being alienated from their families.
These are a few of the myths about the older population that simply are not true. In adult
children a common myth is that they are alienated by their parents.
Stereotypes are the persistent cause of these myths. As the population of older persons continues
to grow and expand into aging families, it is important to examine the evidence before jumping
to conclusions about their lives.


The aging family culture cannot be adequately captured by any stereotype. Contrary to the
prevailing myths, the picture painted by todays society of the aging family shows that older
adults who are contented and happy, satisfied with life, in close contact with relatives, sexually
active, and connected to social networks. (Hooyman & Kiyak, 2009)
With the availability of the internet the older population is no longer limited to family, neighbors
and friends as their sole support to provide information and resources for assistance in daily
living tasks prior to having to seek formal assistance. There is a wealth of information sharing
through The American Association of Retired People (AARP) and various online magazines
such as Baby Boomer Magazine that are gear their articles to those subjects that are of interest
and pertain meeting the needs of this older population. The wide array of subjects covered in
Baby Boomer Magazine includes online shopping, financial and legal matters, selection of long-
term care facilities and insurances. (Daryl Burns, 2013)
As the population in the United States and the rest of the world continues to age, we must
continue to refute negative myths and stereotypes; they are both unfair and cast a false
understanding of the older population. I work with older individuals 5-6 times a week for at least
8 hours a day and aside from any physical or mental issues any of us could encounter, the elderly
population/aging families I witness have the same capabilities for productive and enjoyable
lifestyles when given the opportunity away from societys judgments.
Daryl Burns, V. M. (2013, 04 17). Retrieved from Baby
Hooyman, N. R., & Kiyak, H. A. (2009). The Social Context of Aging . In N. R. Hooyman, & H.
A. Kiyak, Social Gerontology - A Multidisciplinary Perspective - 9th Edition (p. 340).
Boston, MA: Allyn & Bacon.


Living Arrangements and Social Interaction Response Essay
This essay addresses the various aspects to consider in the person-environment congruence with
older people that relocate to from home to long term care facilities. Of all the topics in which to
choose, this is the one that most interest me personally to gain more knowledge in regard to the
challenges that my residents face that I may be unaware when they decide to move into a long
term care facility full-time.
Person-environment congruence is defined as matching of the older individual's abilities, needs,
and interests with a physical and social/cultural environment. Anyone that has ever moved from
one place to another understands the changes environmentally, socially, and the physical
demands that one experiences.
Older individuals that experience a move to long term care facilities will require longer amounts
of time to adjust. The stress associated with the change is a major challenge when leaving a
familiar environment of several years requires a longer time to adapt for older individuals. The
individual must adjust to new schedules, meals, floor plans, possibly having a roommate or a
different bed that all contribute to a longer adjustment period as well during this transition.
When selecting an appropriate long term care facility for older individuals there are several
aspects to consider. It is important to include the individual moving in the decision making
process if at all possible based on their ability to make decisions at the time. Some of the social
aspects to consider are, is the facility close to family, friends, church and civic organizations so
that the individual can still be involved in these areas of their life? Physically the facility needs
to meet the level of assistance required for daily self-care tasks while allowing the older
individual to be as independent as possible while still maintaining a safe environment is of


upmost importance. Other aspects to be considered during the decision making process is to
choose an environment that is clean, adequately staffed, one that provides meals that are
acceptable to the persons taste and health concerns, equipped with comfortable furniture with
adequate storage, and have rooms that are not cluttered or cramped. It is also important for that
the facility allows the older person to keep personal possessions are important for a smooth
transition from home, i.e. family photos, favorite quilt. (Hooyman & Kiyak, 2009)
Working in long term care for several years Ive experience many people making the change
from living at home to living in a long term care environment. Some adjust better than others
and there is no set timeframe. As with everything in life every person is different and the time
for adjustment differs by individual. Some never adjust fully for various reasons ranging from
family issues, anger, and depression over loss of physical and/or mental capabilities that have
taken away their ability to be at home and continue to be independent. The end result for any
older person making a change from home to a long term care environment should be a
safe/clean/comfortable environment, promotes independence, and allows the individual to
socially experience areas of life they enjoy while being close to the people they love.
Hooyman, N. R., & Kiyak, H. A. (2009). The Social Context of Aging . In N. R. Hooyman, & H. A. Kiyak,
Social Gerontology - A Multidisciplinary Perspective - 9th Edition (p. 453). Boston, MA: Allyn &