and resources to explore various cultures by traveling to different countries. She feels that age 68 is entirely too young to be unproductive and plans to pursue her bachelor’s degree in psychology on a part-time basis. She’s also interested in developing a career, fully understanding she is getting off to a late start. Her excitement and enthusiasm is contagious, and she is fully supported by her family and friends.
At present, managed care is the most prevalent payer model in the health care arena. Called “managed cost” by some of its critics, it has been troubled by managed Medicare debacles and a failure to deliver on preventive services that address the unique, interrelated health care (physical and mental) needs of the aging (Ronch & Goldfield, 2003). Limits on mental health benefits combine with an inadequate network of expert providers to limit access for those aging people in need of state-of-the-art care. As these models confront their economic and conceptual limits, the number of aging people continues to grow rapidly. The result is increasing pressure on the current system of care that appears to be unprepared to answer the call for the health- and wellness-oriented system that would likely be the most beneficial and least costly in the future (Ronch & Goldfield, 2003). Additionally, public policy in the coming decade will face tensions between cost containment and facilitation of integrated models of care (Karel, Gatz, & Smyer, 2012).
In the acute care arena, older people turn first to their primary care providers when they have a mental health problem. More than 50% of those who seek mental health care receive it from primary care physicians, because it carries fewer stigmas than going to a mental health provider, insurance plans encourage use of the primary care provider, and the care is usually more accessible (Karel et al., 2012; Ronch & Goldfield, 2003). However, many primary care providers are not adequately trained in mental health problems of the aging and tend to use psychotropic drugs as their first or only line of treatment. Pressures from managed care economics also result in briefer physician visits, often averaging 8 minutes in duration. Also because of their coexisting physical conditions, older adults are significantly more likely to seek and accept services in primary care versus specialty mental health care settings (Institute of Medicine [IOM], 2012). More desirable collaborative service models that coordinate mental and physical health services in primary care are being investigated (Ronch & Goldfield, 2003).
While the baby boomers were growing up, the needs of these young families were a high priority in community development, with particular concern for family-friendly housing, parks, and schools. Now, their needs are shifting. Most baby boomers would like to stay in their own homes, or at least in their own communities, as they age. Nearly three-quarters of all respondents of an AARP survey felt strongly that they want to stay in their current residence as long as possible (Bayer & Harper, 2009). The image that most elders will move to a retirement village away from their communities is the exception rather than the rule. Most people will not have the resources or the inclination to move to Florida or its equivalent (the Sunbelt states); therefore, communities cannot rely on “exporting” to meet the needs of an aging population. If communities want to be successful in caring for their aging population, they will have to make significant, yet feasible, changes in housing, health care, and human services (Knickman & Snell, 2002).These changes can create stronger communities with healthy, long-living seniors.
Rethinking the Value of Aging
While it might be difficult to change culture and the way elders are viewed in society, there are practical steps that communities, employers, and individuals can begin to take to prepare for a society with greater numbers of healthy elders. First, it is worth reassessing the responsibilities and assets of elders. All ages need roles in life. According to Erik Erikson (1959), the hallmark of successful late-life development is the capacity to be generative and to pass on to future generations what one has learned from life. The elderly can be viewed as “America’s one growing resource,” and aging can be viewed as an opportunity to be seized (Freedman, 2002). More than half of all older adults volunteer their time, and more opportunities are available to contribute to their communities.
Firms are integrating workforces through programs of “unretirement” or by rehiring retirees as temps, consultants, and part-time workers. Surveys suggest that the 60-year trend of a decreasing number of elderly working has reversed itself as baby boomers reconsider their financial needs for retirement as well as how they want to spend more than a third of their adult life (Walsh, 2001). Most forecasters project this trend to continue as more elderly work longer for economic, social, and personal reasons; employers become more flexible and aware of the needs and benefits of older workers; and the labor market remains tight, with a smaller number of available younger workers.
The sheer size and energy of the baby boom generation has led to other dramatic social shifts, and experts hope that a new imagery for aging is possible. A growing interest in “age integration”—a process that takes advantage of the broadened range of accumulated life course experiences in society—has occurred over the last few decades. In an age-integrated society, changes made to bring older people into the mainstream could simultaneously enlarge personal opportunities and relieve many other people who are in their middle years of the work–family “crunch” (Uhlenberg, 2000). Actual physical integration can also take place. Although some towns have seen a trend toward senior-only housing, others are exploring options in integrated apartment buildings. Some older persons prefer a mixed-age neighborhood over one restricted to people their own age. Some community centers are integrating senior centers with childcare centers, facilitating cross-age interaction and conserving space and resources (Knickman & Snell, 2002). Cultural change is also possible with regards to one-on-one relationships. Baby boomers have made an art of enjoying and taking pride in caring for their children, even managing to pay for college tuition. The needed cultural shift is for children and communities to find more enjoyment and pride in providing for the care of parents and neighbors. The ultimate intangible goal is to recognize the reciprocity within all aspects of society. Everyone can benefit when the elderly are fully integrated into a caring society (Knickman & Snell, 2002).
It is clear that the process of aging, societal influences, organizational dynamics, and lack of adequately trained practitioners will influence the therapeutic work needed by older clients. Helping professionals and those in training have enormous opportunities to not only provide services to older adults, but to act as change agents within the larger society. Helping professionals will need to strongly advocate on behalf of their elderly clients and advocate against the institutional policies that impede full participation.
Many baby boomers express a desire and a need to continue with employment, though only a small number of employers are genuinely interested in utilizing their services. Helping professionals who understand and can promote the strengths, abilities, and competencies of the older worker to employers will prove extremely valuable in this process. Educating different constituents in society will dispel myths and erroneous information regarding the aging process and potentially open doors to various opportunities for older persons. Helping practitioners are in a good position to assist elderly clients with navigating personal, societal, and organizational barriers that might interfere with their well-being.
The real challenges of caring for the elderly in 2030 will involve (1) making sure society develops payment and insurance systems for long-term care that work better than existing ones, (2) taking advantage of advances in medicine and behavioral health to keep the elderly as healthy and active as possible, (3) changing the way society organizes community services so that care is more accessible, and (4) altering the cultural view of aging to make sure all ages are integrated into the fabric of community life (Knickman & Snell, 2002). If these challenges can be addressed, the quality of life of all individuals can be vastly improved.
Keystones
Negative perceptions that stereotype older adults pose barriers to their personal and professional development.
Employers
