Posted: Fri Aug 03, 2007 8:34 am Post subject: THE ELDERLY
MHI in his Irshad Mubarak expressed concerns about large numbers of seniors getting lonely with increasing life expectancy and reducing age of retirement. This thread is dedicated to the issues facing the old aged and hopefully that will raise awareness of this issue . The following article explores the changes in the outlook and attitudes towards the old since last century.
August 3, 2007
Being Old, Then and Now
By DAVID BROOKS
Last week, while driving from a campaign event in Keene, N.H., I stumbled upon a used bookstore that I hadn’t seen since I was a teenager. I stopped in — even though I was rushing to catch a plane — and came upon a sad book published anonymously in 1911.
The book is called “Autobiography of an Elderly Woman,” and it’s a description of what it was like to be old a century ago. The woman begins by recalling the stages of her life: the misty days of girlhood; the precious years when she was raising her young; the rewarding times when she and her children were adults together and companions.
But then something changed.
“I do not know when the change came, nor do they, if indeed they realize it at all,” she writes. “There was a time when I was of their generation; now I am not. I cannot put my finger on the time when old age finally claimed me. But there came a moment when my boys were more thoughtful of me, when they didn’t come to me anymore with their perplexities, not because I had what is called ‘failed,’ but because they felt that the time had come when I ought to be ‘spared’ every possible worry. So there is a conspiracy of silence against me in my household.”
She describes how her children baby her. They offer to give her rides in the carriage to run errands when she could just as well walk. They try to prevent her from doing normal housework on the grounds that it’s too taxing. “You count the number of your years by the way your daughter watches your steps; and you see your infirmities in your son’s anxious eyes.”
She describes living in a different dimension. She sees and understands, but her counsel is never sought and she has no ground upon which to act. “We have learned then that we can’t help our children to lead their lives one bit better. There is not one single little stone we can clear before their feet.”
Though writing in the age of the gas lamp, she understands what the latest scientific research is now concluding. “Very soon your children slip from between your fingers. They develop new traits that you don’t understand and others that you understand only too well, for, like weeds, your faults come up and refuse to be rooted out ...
“There came a time when I realized that every child on the street my child stopped to talk with had its share in bringing up my sons and daughters. One week in school was enough to upset all the training of years.”
The book is a lament from a person put on a shelf, bound by convention and by the smothering concern of others not to exert any power on the world, even while seeing more clearly than ever the way power can and cannot be exerted.
It’s a remarkable little book, and when I did some research, I was surprised to learn it wasn’t written by an old woman. It was written by 37-year-old Mary Heaton Vorse, using the voice of her own mother.
Vorse was a bohemian and a radical journalist who wrote for The Masses, hung around Eugene O’Neill, John Reed and Louise Bryant, and she helped found the Provincetown Players.
Using her mother’s perspective, Vorse wrote a sort of “The Second Sex” for the elderly of 1911. It is about a class of people unable to exercise their capacities.
And what she described was real. In “Growing Old in America,” the historian David Hackett Fischer writes that age was venerated in early America. But starting in the first half of the 19th century, youth was venerated and age was diminished.
Thoreau wrote that the young have little to learn from the old. The word “fogy,” which had once meant a wounded veteran, acquired its current meaning. Dinner table seating was no longer determined by age but by accomplishment. Scientific knowledge gained prestige over experience.
Women, who had once rarely lived much past their youngest child’s marriage, now lived on with no clear role. The character in “Autobiography of an Elderly Woman” is a victim of all this.
I don’t know how many of her opinions will ring true to today’s oldsters. Now, elderly are richer, more active and more engaged than their cohorts of a century ago, but are they still living in a different dimension?
Is it now a dimension of their own choosing?
Last edited by kmaherali on Thu Dec 11, 2014 1:09 am, edited 1 time in total
That is why it is so critical to reach out to the aged population in our jamat. Language barriers are apparent and therefore, it is important for the younger members in our jamat to acquaint themselves with our wondeful heritage -the language, culture, religious traditions.
I find it rewarding to just make a simple phone call to a brother or a sister in our faith no matter what their age is and just see how that person is doing....
It may not be shocking to know loneliness dees no boundaries and happens in all ages and gender more so in the aging population.
August 14, 2007
A Grass-Roots Effort to Grow Old at Home
By JANE GROSS
WASHINGTON — On a bluff overlooking the Potomac River, George and Anne Allen, both 82, struggle to remain in their beloved three-story house and neighborhood, despite the frailty, danger and isolation of old age.
Mr. Allen has been hobbled since he fractured his spine in a fall down the stairs, and he expects to lose his driver’s license when it comes up for renewal. Mrs. Allen recently broke four ribs getting out of bed. Neither can climb a ladder to change a light bulb or crouch under the kitchen sink to fix a leak. Stores and public transportation are an uncomfortable hike.
So the Allens have banded together with their neighbors, who are equally determined to avoid being forced from their homes by dependence. Along with more than 100 communities nationwide — a dozen of them planned here in Washington and its suburbs — their group is part of a movement to make neighborhoods comfortable places to grow old, both for elderly men and women in need of help and for baby boomers anticipating the future.
“We are totally dependent on ourselves,” Mr. Allen said. “But I want to live in a mixed community, not just with the elderly. And as long as we can do it here, that’s what we want.”
Their group has registered as a nonprofit corporation, is setting membership dues, and is lining up providers of transportation, home repair, companionship, security and other services to meet their needs at home for as long as possible.
Urban planners and senior housing experts say this movement, organized by residents rather than government agencies or social service providers, could make “aging in place” safe and affordable for a majority of elderly people. Almost 9 in 10 Americans over the age of 60, according to AARP polls, share the Allens’ wish to live out their lives in familiar surroundings.
Many of these self-help communities are calling themselves villages, playing on the notion that it takes a village to raise a child and also support the aged in their decline. Some are expected to open this fall on Capitol Hill; in Cambridge, Mass.; New Canaan, Conn.; Palo Alto, Calif.; and Bronxville, N.Y.
“Providers don’t always need to do things for the elderly,” said Philip McCallion, director of the Center for Excellence in Aging Services at the State University of New York at Albany. “There are plenty of ideas how to do this within the aging community.”
Although not a panacea for those with complicated medical needs, the approach addresses what experts say can be a premature decision by older people to give up their homes in response to relatively minor problems: No way to get to the grocery store. Tradesmen unwilling to take on small repairs. The isolation of a snowy winter.
As these small problems mount, sometimes accompanied by pressure from adult children, experts say, the elderly homeowner is caught off guard. Remaining at home without sufficient help is frightening. But moving to an assisted-living center is often an overreaction that can be avoided or postponed.
“A few neighborhood-based, relatively inexpensive strategies can have an enormous effect,” Mr. McCallion said. “If people don’t feel so overwhelmed, they don’t feel pushed into precipitous decisions that can’t always be reversed.”
For inspiration, the nascent groups looked to Beacon Hill Village in Boston, which pioneered the approach six years ago. Beacon Hill’s 400 members pay yearly dues — $580 for an individual and $780 for a couple, plus ŕ la carte fees — in exchange for the security of knowing that a prescreened carpenter, chef, computer expert or home health aide is one phone call away.
Experts in aging say the self-help approach provides a sense of mastery, often lost with the move to an institution or even an adult child’s spare bedroom. That can-do spirit is attractive to baby boomers like Alisia Juarrero, 59, who is a board member of the Allens’ group, which spans the Palisades neighborhood, an enclave of single-family houses northwest of Georgetown, and Foxhall, an adjacent area of attached Tudor homes.
Ms. Juarrero is mindful of the future because of the struggles of her 89-year-old mother and 92-year-old aunt in Coral Gables, Fla. “This is where we’re all headed,” she said. “If I help set this up, it’ll be there when I need it.”
So far, most of the villages are in places where residents are well connected and skilled in finance, law, medicine and philanthropy as a result of their own careers. That raises the question of whether the model is viable only in neighborhoods of privilege. But experts point out that most care for the elderly is already out of reach for all but the wealthy.
The amenities of an assisted-living center are far more expensive than a village’s membership fee. Medicare does not pay for long-term care, and private help is costly. Only the destitute are protected in old age because Medicaid pays their nursing home fees.
A few villages are cropping up where low-income families live, such as in the Richmond District of San Francisco, with its recent wave of Russian immigrants; Falmouth, Mass., where year-round residents struggle when the summer crowd is gone; and in pockets in Westchester County, like Yonkers, with diverse populations.
In such locations, social service organizations are likely to organize the project, instead of the older residents, and they rely on volunteers or bartered services to keep fees down. One member fixes another’s faucet, banks the time and in exchange gets a ride to a medical appointment.
Groups also share expertise online and at local and national conferences, including several this past spring. Some have access to regional resource centers that help with matters like hiring an executive director or buying liability insurance.
In terms of government support, New York State is at the forefront, with a 20-year-old model known as a NORC, or naturally occurring retirement community. Since 1995, the state has financed social services, including nurses and case managers, in many apartment buildings with a concentration of residents over 60. Last year, it added a few suburban neighborhoods, so-called horizontal NORCs.
On the federal level, Congress authorized experiments in aging in place in the 2006 Older American Act but did not finance them.
The sprawl of suburbia presents challenges to the elderly once they cannot drive. Amid the rolling hills of Fairfax County, Va., one group is grappling with how to serve prospective members in a place with a single general store and five-acre lots. Taxi vouchers may be too costly when running errands can take hours. Recruiting volunteer drivers from 118 home owners’ associations and 17 churches presents liability issues.
“The question is distance and time, and the money that relates to that,” said William Cole, 77, the founder of the group. Mr. Cole anticipates yearly dues of $1,000, which may be prohibitive for neighbors who are real estate rich but cash poor. One likely service, Mr. Cole said, will be advice about reverse mortgages.
Many of the villages are concerned about whether they can provide adequate support once the founding members, who tend to be vigorous regardless of age, decline either physically or cognitively. In this regard, the New Canaan group, with annual dues of $360 and $480, may be less vulnerable than most. The suburb already has a home health care agency, an assisted-living center and a nursing home, thanks to years of advocacy by a local physician, an 87-year-old board member.
Because of that, “we have the confidence to live without these problems getting the best of us,” said Tom Towers, 69, the board president of the group, Staying Put in New Canaan. “And if they do, we can take care of it right here.”
The first village in the Washington area is expected to be on Capitol Hill. When it opens for business on Oct. 1, annual memberships will be $750 for a couple and $500 for an individual.
Among those eager to join are Marie Spiro, 74, and Georgine Reed, 78, who share a rambling house that they insist they will only leave “feet first.” Between them, Ms. Spiro, an emeritus professor of art history and archaeology, and Ms. Reed, a retired designer of museum exhibits, have already endured three knee replacements and an array of other ailments.
Ms. Spiro describes huffing and puffing while grocery shopping; Ms. Reed is increasingly reluctant to visit friends across town. Both women, who are childless, would already welcome help with meals, transportation and paperwork. If they need home care, Capitol Hill Village will be able to organize that.
“I’ve never had to rely on other people, and I never wanted to,” Ms. Spiro said. “But I’d rather pay a fee than have to ask favors.”
Members of all these groups share an independent streak — and the willingness to plan for the future. Those characteristics were on view recently in a living room in Hollin Hills, a post-World War II development in Alexandria, Va., where a half-dozen neighbors who once organized baby-sitting co-ops are now organizing for their final years.
Now, in their 70s and 80s, they still drive, play tennis and travel the world. None has yet lost a spouse, but they fear what will happen to the one left behind.
“The vast majority of people don’t have the capacity to be realistic,” said Ruth Morduch, 71. “We don’t know what’s going to happen in X number of years, but we know we’re going to need help. In my own home, that’s less likely to be humiliating. And an organization like this gives me a sense that we’re all in this together, our last grand adventure.”
--- In Batunimurid@yahoogroups.com, Hasan Essa <hasniessa@...> wrote:
> Dear Shaila,
> As senior I am glad to hear you are putting together
> an article on lives and struggles of our senior community.
> To be a senior, specially for those who live in developing
> countries is no fun because, most of them never seem
> to plan and know how to enhance their life when they
> reach their retiring age.
> Unfortunately, despite our leaders trying their best to
> inspire them most of our seniors refuse to change their lifestyle
> and participate in social activities, other than just socialize
> among themselves in groups and eat and be merry.
> I am sure you have listened to our Imam expressing His
> concern for our seniors during His speech at Aiglemont
> that He is worried, and advised our leaders to look into
> plight of our seniors and work out some plan how to enhance
> their remaining years to make it fruitful.
> For many, retirement is a time to pursue dreams; a time to
> travel, volunteer, try new things, and enjoy the company of
> family and friends.The reality however, is not always as rosy
> as the dream.After enjoying a few months of freedom, many
> retirees find themselves asking, "What's next ?" Figuring out
> what to do with your retirement is a process.From the time
> you are little ,you always know what's next.After first grade,
> it's second grade.After high school is college, then job.
> It's all one step in front of the other..... and then we retire
> and except for the fact that, hopefully,you put some money
> aside, almost no one plans for the social and psychological
> implications of what's next at this stage.
> What's next ? we' ve all known people who, without a clear
> path to follow, find themselves overwhelmed and instead of
> jumping onto a new path, retreat to the sofa in front of the
> TV set.What's next ? is all about making the second half
> of life as dynamic and fulfilling as the first half.
> Sincerely, Ismaili community is not yet equipped to handle a
> rapidly aging population.It's going to be a complete paradigm
> shift in the next few years, and people are going to have to
> wake up and understand that growing older isn't a bad thing.
> It's life.We need to learn about aging and jump in with both
> feet.Starting the process is daunting, as seniors are
> encouraged to step outside their comfort zone and try something.
> But, it's never too late to start.
> Experts offer advice on health and wellness, learning skills,
> relationships,volunteer and career opportunities, and just
> generally give people tools to create a life filled with
> meaning and joy.
> I am a semi-retired Ismaili enjoying my senior life with gusto,
> running a small business which has reference library,computer
> and a television, which keep me busy in my business, readings,
> and writings on internet.For information on seniors, I would write to
> what'snext@... ,and for readings, go to www.ericksontribune.com,
> which has wealth of senior news for you to gather.
> Hope you'll find above news of mine something to go by
> in your project.
> Best regards
> Hasni Essa
> Shaila Abdullah shailaabdullah@... wrote:
> To: Batunimurid@yahoogroups.com
> From: "Shaila Abdullah" shailaabdullah@...
> Date: Thu, 16 Aug 2007 10:23:48 -0500
> Subject: [Batunimurid] Need help on an article for seniors
> I am putting together an article about the lives and struggles of
> senior members in the USA jamat. I would love to hear from people on
> this list who are over the age of 50 who would like to be interviewed.
> Please feel free to contact me directly with any questions you might
> Shaila Abdullah
> Author: http://www.shailaabdullah.com
> Designer: http://shailaabdullah.com/houseofdesign/
> Hasni Essa
> Peace & Pluralism
The world's population is aging at a rate without parallel in human history, says a new United Nations report. And the "irreversible" demographic changes under way, it warns, will have major consequences for all facets of human life.
Since 2000 alone, the number of people age 60 or older globally has jumped by 100 million, to more than 700 million, says a report by the UN's population division.
About 11 per cent of the world's people are now over 60.
That percentage is expected to double by 2050, when the over-60 population is projected to hit two billion.
Already, there are more people over 60 than children under 15 in the developed world.
In developed regions of the world, one in five people is already over 60, a proportion that's expected to rise to one in three by 2050.
In the developing world, by contrast, older persons currently constitute just eight per cent of the population, though that will rise to 20 per cent by mid-century.
But rapid aging in developing nations means that will also be true globally for the first time by 2047, the report says.
Today's median age of 28 is projected to rise to 38 by mid-century, when the median age of South Korea and Macao will reach 54 years.
The increase in average ages is pervasive, affecting nearly every country, the report says.
It's being driven mainly by reductions in fertility that have become virtually universal.
"Because fertility levels are unlikely to rise again to the high levels common in the past, population aging is irreversible," the report says.
"The young populations that were common until recently are likely to become rare over the course of the 21st century."
Globally, the number of those 60 and older is growing by 2.6 per cent per year, more than twice as fast as the population as a whole. "Such rapid growth will require far-reaching economic and social adjustments in most countries," the report says.
Population aging will have an impact on economic growth, savings, investment, consumption, labour markets, pensions, taxation and inter-generational transfers, it says. It will also influence family composition and living arrangements, housing demand, migration and health care. And it may shape voting patterns and political representation.
The UN report also ranks the world's 192 nations using the "aging index," which represents the number of people 60 or over per 100 persons under age 15.
By that measure, Japan again ranks first, with an aging index of 201, meaning there are two Japanese 60 or older for every child under 15. Canada's aging index is 110.3. Niger, with an aging index of 6.6, ranks last.
Posted: Sat Aug 18, 2007 5:11 am Post subject: Jalal ad-Din Rumi's poetry of AGING
RUMI’S POETRY OF AGING
By HARRY R. MOODY
Subscribe to Aging Today
Jalal ad-Din Rumi (1207–1273) was, by common assent, the greatest poet in the history of Islam. He wrote in Farsi and his work is known and loved throughout the Islamic world and beyond. More recently, according to Publisher’s Weekly, Rumi has become the most widely read poet in America.
In many poems, Rumi deals with aging and old age. In “A Man Talking to His House,” reproduced on page 9, Rumi opens with a message, a sweeping statement that the “caravan” of life, or succession of generations from young to old, is actually a pilgrimage of sleepwalkers. No one is fully “awake” to the human condition and to the possibilities for higher consciousness, which would entail “waking up” to a different reality. The mystical branch of Islam is known as Sufism, and one of the goals of Sufism is to “die before you die”: that is, to “wake up” right now, in this life.
LIFE UPSIDE DOWN
Harry R. Moody
Rumi is telling us that our ordinary picture of life is upside down, which is of course a difficult message to express as well as to receive. In Rumi's allegory, ordinary life is like sleepwalking, and while we sleep, a “thief” proceeds to steal what is most precious to us. The poet understands that his message is not likely to be well received and he states flatly, “You're angry at me for telling you this.” At this point the poem abruptly shifts tone. Having risked angering his readers with bad news, the poet now proceeds with a joke: The human body is compared to a house that is constantly breaking down, and Rumi imagines a man speaking to his house, which is his body.
Despite recently diminished disability among the young-old, those in their 60s or early 70s, more people than ever now survive to advanced ages, when the body will remind them of their mortality in stages of deterioration. In effect, the body says, “I'm leaving; I'm going soon.” Rumi's final warning, therefore, is once again blunt and serious: “Don't hide from one who knows the secret.”
Rabbi Harold S. Kushner wrote an inspiring book titled When Bad Things Happen To Good People , reissued by Anchor Books in 2004. But Rumi turns Kushner's idea upside down by inviting us to consider so-called bad things as a message, a wake-up call. In another poem, “The Guest House,” Rumi expands on this theme:
This being human is a guesthouse.
Every morning a new arrival.
A joy, a depression, a meanness,
some momentary awareness comes
as an unexpected visitor.
Welcome and entertain them all!
Even if they're a crowd of sorrows,
who violently sweep your house
empty of its furniture,
still, treat each guest honorably.
He may be clearing you out
for some new delight . . .
Be grateful for whoever comes,
because each has been sent
as a guide from beyond.
Rumi's metaphor of the mind as a guesthouse gives readers another way of thinking about negative states of mind. Think of this “crowd of sorrows” as perhaps “clearing you out” for something greater. But how do we make this transition in thinking? Contemporary culture puts roadblocks in our path; the American emphasis on cheerfulness makes it ever more difficult to accept the inevitable losses and sorrows of later life. Consider the depth of shadows conveyed so profoundly, for example, in the late self-portraits of Rembrandt. What both Rembrandt and Rumi understood is what may be called a transpersonal approach to sorrow. For Rumi, this approach is suggested by the technical distinction between the “ego” ( nafs ) and the “spirit” ( ruh ). The ego represents a limited dimension of selfhood and conceals a transpersonal spirit, which is much more vast.
In the second half of life, people may find themselves discovering that things are not what they seem, a realization that can give rise to disillusionment and depression. Alternatively, this realization can stimulate us to a quest for something greater in our lives. The psychologist Viktor Frankl, a survivor of the Holocaust, called this process self-transcendence in his book Man's Search for Meaning .
The final lines of Rumi's poem “The Guest House” offer a clue as to what the shift to self-transcendence entails. Not only should we see our changing states of consciousness as temporary “guests,” we should cultivate an attitude of gratefulness “for whoever comes.” A transpersonal perspective reminds us that each of these “guests,” even sorrowful or troublesome ones, can be appreciated “as a guide from beyond.” An attitude of transcendence ultimately depends on our affirming something that is “beyond.”
Self-portrait of Rembrandt, 1658, at age 52.
Another of Rumi's poems is a very explicit account of old age:
Why does a date-palm lose its leaves in autumn?
Why does every beautiful face grow in old age
Wrinkled like the back of a Libyan lizard?
Why does a full head of hair get bald?
Why is it that the
Lion's strength weakens to nothing?
The wrestler who could hold anyone down
Is led out with two people supporting him,
Their shoulders under his arms?
“They put on borrowed robes
And pretended they were theirs.
I take the beautiful clothes back,
So that you will learn the robe
Of appearance is only a loan.”
Your lamp was lit from another lamp.
All God wants is your gratitude for that.
Note Rumi's utterly unsentimental attitude toward aging. There is no optimistic sense here of “Grow old along with me, the best is yet to be!” as in Robert Browning's “Rabbi Ben Ezra.” Rumi understands the losses of aging. He poignantly describes the aged wrestler whose power has ebbed and who has become utterly dependent on others. The picture bears no resemblance to the modern celebration of one's “locus of control” or the idea of “decrement with compensation.” What one might ordinarily choose to celebrate as successful aging, Rumi saw as just one more version of sleepwalking. The losses associated with age, like the guests in the guesthouse, are important, even necessary reminders to us of who we really are.
In Rumi's poem, the images of loss each begin with a question: Why, why, why? Can caregivers for the very old and frail escape asking this question? The accomplishments of our lives, so arduously built up in the first half of life, begin to diminish with age. But were these accomplishments ever ours to begin with? In Rumi's account, these accomplishments and strengths were really “borrowed robes” which, later on, God takes back. Those who see life otherwise are, like the travelers in the caravan, “asleep.” When those borrowed robes are taken from us one day, we will know the true nature of our relationship to God.
A LEARNING OPPORTUNITY
Rembrandt and Rumi understood what may be called a transpersonal approach to sorrow.
Rumi's final point in this poem is that the whole of life was only a kind of learning opportunity, a chance to wake up before we die. The second half of life, from midlife to old age, is a series of reminders that the lamp of our consciousness was actually “lit from another lamp.” In this phrase, Rumi invokes an image from the Koran's “Verse of Light,” where transpersonal consciousness is depicted by analogy to an oil lamp (Koran 24:35). What does the world look like when this lamp of higher consciousness has been lit? In a single word: gratitude.
In Rumi, for those of us who work with elders, is a message that is practical and very relevant to helping those who have experienced great loss. None of us can take away the pain of loss for another person. But each of us, in our own lives, retains a capacity to wake up and reframe the experience of our lives, as Scrooge did in Dickens' A Christmas Carol . In Scrooge's act of life review, the old man experiences a transpersonal breakthrough, a shift in perspective that the gift we have comes from another lamp.
Rumi's message is not unique or limited to the Sufis but is echoed by great mystics and spiritual teachers the world over. For example, the great Christian mystic Meister Eckhart put it this way: “If the only prayer you say in your lifetime is ‘thank you,' that is enough.”
Harry R. Moody is the director of academic affairs at AARP.
A MAN TALKING TO HIS HOUSE
By JALAL AD-DIN RUMI
I say that no one in this caravan is awake
and that while you sleep, a thief is stealing
the signs and symbols of what you thought
was your life. Now you're angry with me for
telling you this! Pay attention to those who
hurt your feelings telling you the truth.
Giving and absorbing compliments is like
trying to paint on water, that insubstantial.
Here is how a man once talked with his house,
“Please, if you're ever about to collapse,
let me know.” One night without a word the
house fell. “What happened to our agreement?”
The house answered, “Day and night I've been
telling you with cracks and broken boards and
holes appearing like mouths opening. But you
kept patching and filling those with mud, so
proud of your stopgap masonry. You didn't
listen.” This house is your body always
saying, I'm leaving; I'm going soon. Don't
hide from one who knows the secret.
September 23, 2007
More Profit and Less Nursing at Many Homes
By CHARLES DUHIGG
Skip to next paragraph
Analyzing the Data
For this article, The New York Times analyzed trends at nursing homes purchased by private investment groups by examining data available from the Centers for Medicare and Medicaid Services, a division of the Department of Health and Human Services.
The Times examined more than 1,200 nursing homes purchased by large private investment groups since 2000, and more than 14,000 other homes. The analysis compared investor-owned homes against national averages in multiple categories, including complaints received by regulators, health and safety violations cited by regulators, fines levied by state and federal authorities, the performance of homes as reported in a national database known as the Minimum Data Set Repository and the performance of homes as reported in the Online Survey, Certification and Reporting database.
Habana Health Care Center, a 150-bed nursing home in Tampa, Fla., was struggling when a group of large private investment firms purchased it and 48 other nursing homes in 2002.
The facility’s managers quickly cut costs. Within months, the number of clinical registered nurses at the home was half what it had been a year earlier, records collected by the Centers for Medicare and Medicaid Services indicate. Budgets for nursing supplies, resident activities and other services also fell, according to Florida’s Agency for Health Care Administration.
The investors and operators were soon earning millions of dollars a year from their 49 homes.
Residents fared less well. Over three years, 15 at Habana died from what their families contend was negligent care in lawsuits filed in state court. Regulators repeatedly warned the home that staff levels were below mandatory minimums. When regulators visited, they found malfunctioning fire doors, unhygienic kitchens and a resident using a leg brace that was broken.
“They’ve created a hellhole,” said Vivian Hewitt, who sued Habana in 2004 when her mother died after a large bedsore became infected by feces.
Habana is one of thousands of nursing homes across the nation that large Wall Street investment companies have bought or agreed to acquire in recent years.
Those investors include prominent private equity firms like Warburg Pincus and the Carlyle Group, better known for buying companies like Dunkin’ Donuts.
As such investors have acquired nursing homes, they have often reduced costs, increased profits and quickly resold facilities for significant gains.
But by many regulatory benchmarks, residents at those nursing homes are worse off, on average, than they were under previous owners, according to an analysis by The New York Times of data collected by government agencies from 2000 to 2006.
The Times analysis shows that, as at Habana, managers at many other nursing homes acquired by large private investors have cut expenses and staff, sometimes below minimum legal requirements.
Regulators say residents at these homes have suffered. At facilities owned by private investment firms, residents on average have fared more poorly than occupants of other homes in common problems like depression, loss of mobility and loss of ability to dress and bathe themselves, according to data collected by the Centers for Medicare and Medicaid Services.
The typical nursing home acquired by a large investment company before 2006 scored worse than national rates in 12 of 14 indicators that regulators use to track ailments of long-term residents. Those ailments include bedsores and easily preventable infections, as well as the need to be restrained. Before they were acquired by private investors, many of those homes scored at or above national averages in similar measurements.
In the past, residents’ families often responded to such declines in care by suing, and regulators levied heavy fines against nursing home chains where understaffing led to lapses in care.
October 23, 2007
The Elderly Always Sleep Worse, and Other Myths of Aging
By GINA KOLATA
As every sleep researcher knows, the surest way to hear complaints about sleep is to ask the elderly.
“Older people complain more about their sleep; they just do,” said Dr. Michael Vitiello, a sleep researcher who is a professor of psychiatry and behavioral sciences at the University of Washington.
And for years, sleep scientists thought they knew what was going on: sleep starts to deteriorate in late middle age and steadily erodes from then on. It seemed so obvious that few thought to question the prevailing wisdom.
Now, though, new research is leading many to change their minds. To researchers’ great surprise, it turns out that sleep does not change much from age 60 on. And poor sleep, it turns out, is not because of aging itself, but mostly because of illnesses or the medications used to treat them.
“The more disorders older adults have, the worse they sleep,” said Sonia Ancoli-Israel, a professor of psychiatry and a sleep researcher at the University of California, San Diego. “If you look at older adults who are very healthy, they rarely have sleep problems.”
And new studies are indicating that poor sleep may circle back to cause poor health. At least when it comes to pain, a common cause of disrupted sleep, a restless night can make pain worse the next day. Then with worse pain, sleep may become even more difficult — a vicious cycle common in people with conditions that tend to afflict the elderly, like back pain and arthritis.
The new view of sleep emerged from two parallel lines of research. The first asked what happened to sleep patterns when healthy people grew old. The second sought to uncover the relationship between sleep and pain.
To find out what happens with aging, some investigators, including Dr. Vitiello, studied older people who reported no sleep problems. They actually make up a large group — nearly half of people over 65. Were these people somehow spared age-related changes in sleep?
They were not. Their sleep turned out to be different from sleep in young people: it was lighter, more often disrupted by brief awakenings, and shorter by a half hour to an hour. Dr. Vitiello reasoned that the age-related changes in sleep patterns might not be an issue in themselves. Something else was making people complain about their sleep.
Dr. Vitiello and his colleagues also asked what normally happened to sleep over the life span. It had long been known that sleep changes, but no one had systematically studied when those changes occurred or how pronounced they were in healthy people.
With analysis of 65 sleep studies, which included 3,577 healthy subjects ages 5 to 102, the investigators had their next surprise. Most of the changes in sleep patterns occurred when people were between the ages of 20 and 60. Compared with teenagers and young adults, healthy middle-aged and older people slept a half hour to an hour less each night, they woke up a bit more often during the night, and their sleep was lighter. But after age 60, there was little change in sleep, at least in people who were healthy.
And even though sleep changed during adulthood, many of the changes were subtle. Middle-aged and older people, for example, did not have more difficulty falling asleep. The only change in sleep latency, as it is called, emerged when the investigators compared latency at the two extremes, in 20- and 80-year-olds. The 80-year-olds took an average of 10 more minutes to fall asleep.
Contrary to their expectations, the investigators found no increase in daytime drowsiness in healthy older people. Nor did aging affect the time it took for people to start dreaming after they fell asleep.
Instead, the biggest change was the number of times people woke after having fallen asleep.
Healthy young adults sleep 95 percent of the night, said Dr. Donald Bliwise, a sleep researcher at Emory University. “They fall asleep,” he said, “and don’t wake up until the alarm goes off.”
By age 60, healthy people are asleep 85 percent of the night. Their sleep is disrupted by brief wakeful moments typically lasting about 3 to 10 seconds. “There is some aspect of sleep that isn’t going to be as good as when you were 20,” Dr. Bliwise said. But he added, “When that crosses the threshold and becomes a significant complaint is difficult to say.”
The real sleep problems, he and others say, arise when people have any of a number of conditions that make them wake up in the night, like sleep apnea, chronic pain, restless leg syndrome or urinary problems. That, of course, describes many older people.
“The sheer number of challenges to maintaining solid sleep in old age is just huge,” Dr. Bliwise said. “You come out with the question, Well, what is normal? What should I expect?”
The new frontier of what to expect, and what to do about it, involves studies of the relationship of sleep to pain. It’s no surprise that pain can disrupt sleep. But what is new is that a lack of sleep can apparently increase the sensation of pain.
Michael T. Smith, the research and training director of the behavioral sleep medicine program at Johns Hopkins School of Medicine, reached that conclusion with a study of healthy young people. One group slept normally for eight hours in the hospital. Another was awakened every hour by a nurse and kept up for 20 minutes. Their sleep pattern was meant to mimic the fragmented sleep of elderly people. A third group was allowed four hours of solid sleep.
Comparing the second and third groups allowed Dr. Smith to tease apart the causes of the problems that arise from fragmented sleep: were they because of the short total sleep time, or because of the disrupted nature of the sleep?
Fragmented sleep, he found, led to severe impairments the next day in pain pathways. The subjects felt pain more easily, were less able to inhibit pain, and even developed spontaneous pain, like mild backaches and headaches.
Timothy Roehrs, director of the sleep disorders research center at Henry Ford Hospital in Detroit, also found that healthy young people became exquisitely sensitive to pain after a night of fragmented sleep.
And getting more sleep, Dr. Roehrs found, had the opposite effect. His subjects were young healthy people who said they were chronically sleepy, just not getting enough time to sleep at night. Dr. Roehrs had them stay in bed 10 hours a night. The extra sleep, he said, reduced their sensitivity to pain to the same degree as a tablet of codeine.
Now, Dr. Smith says, he and others have markedly changed their attitude about sleep problems and aging.
Of course, he said, sleep is different in 20-year-olds and 70-year-olds. But he added, “It’s not normal to get a clinical sleep disorder when you get old.”
Posted: Tue Oct 23, 2007 9:38 pm Post subject: The old aged
I get really cross when I see the elderly being called "the old aged" because I am a pensioner myself and feel it an insult to be addressed as the old aged. Surely everyone KNOWS that the old are of an age but why the need to emphasis this fact?
Wouldn't it be more respectful and nicer for us to be addressed as "The Elderly" or "Senior Citizens".
So how about it?
Can we make a bit of an effort here, please?
--- In Batunimurid@yahoogroups.com, jrdavis <from_alamut@...> wrote:
> It seems that you have identified an important social problem which did not exist when your families were extended. living together closely locally and family took care of their edlerly/disabled. Other faiths have recognized these problems and deal with them appropriately. The Chrisians have always had a long tradition of visiting the sick and visiting non-relatives who are ill or alone.
> Now that you have Identified this problem now what are you going to do? Leadership in religious organizations are usually very slow and conservative to move fast if at all. I would suggest setting up a lay organization and survey your community for those who are in need of visitors. Read up on what the Christians do with visitations and adapt that to appropratiate Ismaili traditions. And then tap the resources of your youth who usually are looking for more interesting things to do than just attending worship services.
--- In Batunimurid@yahoogroups.com, "nas115" <nas115@...> wrote:
> Ya Ali Madad,
> Yes! can you emagine this forgotton man is still a father, a
> husband,a son, a brother, was a successful business man and a
> contributing member of the family, a society and the jamat. The
> wisdom he has gained through life experiances and how valuable this
> wisdom is for the upcoming generations. Even If we consider nothing
> else he is a living breathing human being who has become invisible
> with no fault of his own.
> This problem of abondonment of invalids, the elderly is universal and
> not just attached to third world countries. I think its more painful
> to be forgotton in countries like Canada because of the harsh winters
> that people cannot go out even if they chose very hard to help
> themselves. The depression, the lonelyness is killing. Social life is
> almost non existent for some; its a rat race and if you are immobile
> you become the case of "out of site is out of mind." This forgotton
> man and many others like him had no opportunity to celebrate Golden
> jubilee of Hazar Imam (His Highness Prince Karim Agakhan IV)
> At times its hard for families to avoid leaving their loved ones in
> the Nursing home but there is no excuse to not to visit them. If no
> one is visiting in the nursing homes they are considered abondoned
> and become a target, a punching bag for physical and emotional abuse.
> In my opinion Ismaili institutions has greater responsibilities
> towards Ismailies in crisis to provide them emotional and spiritual
> support on a regular basis weather they have families or not. They
> should not wait for people to approach them because at times these
> people in crises are going through shock, shame, fear and blaming
> themselves for being abondoned, to protect the identity of their
> loved once or any other reasons so cannot reach out for help. They
> have lost the sense of belonging which all of us need as humans. The
> jamat should provide unconditional, unthreatened , discreet,
> confidential support and help bring families in crisis together.
> I would appreciate if you all could forward this mail to as many
> people as you can to make it an urgent issue for Ismaili councils to
> bring these ismaili in crisis some relief. Remember, atleast in
> Canada some funding is there by the government but these people need
> directions, emotional and spiritual support from the communities they
> belong to.
> Thankyou for your time and support for this cause !
> "Where you are I used to be, where I am you will be "
> --- In Batunimurid@yahoogroups.com, mehboob laljee
> mehbooblaljee@ wrote:
> > I thought this was the fate of invalids in developing countries. It
> commes to me as a shock and am not prepared to beleiev that even in a
> country like Canada this is thereality.
> > Mehboob
> > nas115 nas115@ wrote:
> > Ya Ali Madad,
> > For the first time ever I visited an old age nursing home today,
> > in Toronto, Canada. One man perticularly caught my attention. As I
> > talked to him I realised he is an Ismaili and the only Ismaili
> > He was telling me that he is in the nursing home for over a year
> > has NEVER LEFT its doors once. His right leg is amputed and dont
> > much strength in the left leg. His upper body seemed week too. He
> > a manual wheel chair which is hard for him to go around. He has
> > applied for an electric wheel chair but its taking time to come so
> > have no choice but to stay indoors at all times. He doesnt have
> > help, He hardly ever have any visitors. At times he had been beaten
> > badly at the nursing home by some care givers and had no soap for
> > showers or even sufficient water to clean. Inspite of these
> > I saw calm on the man's face, he wasnt miserable about what was
> > happening to him,seemed like he had accepted his fate and that he
> > to live on which made it even more difficult for me to bear.
> > While we were celebrating fifty years of Imamat this man was
> > isolated, sick and suffering emotionally, physically and
> > and forgotton. It made me wonder if Ismaili Council is reaching out
> > to Ismailies in crisis. Even if they are aware of such cases, there
> > are ismailies who are totally abondoned. This Man has not seen
> > jamatkhana in more than twelve months just because he is not mobile
> > and has no help available to him. He is also unable to approach
> > people for help for some reason.
> > I hope the Ismaili Council of Toronto Canada has a reporting centre
> > so they can aid these Ismailies in crisis and provide them as much
> > support as possible in confidence.
> > "Where you are I used to be, where I am you will be "
Canada's seniors need more help
With an urgent demand for geriatric specialists, you'd think students would be lining up to fill the spots. They're not
CanWest News Service
Thursday, November 08, 2007
At a time when Canada's aging population means that seniors are Canada's fastest-growing population group and the fastest-growing segment is 85-plus, Canadian medical schools are barely turning out a handful of geriatric specialists every year.
Even young people are having trouble finding a family physician.
Where, then, does that leave the elderly, often with complicated medical issues that require much more time than the fee-mandated few minutes of an office visit?
The elderly often find a visit to the doctor's office virtually impossible, and instead end up rushed by ambulance into overcrowded emergency departments when a health crisis hits.
Once in hospital, the situation can go from bad to worse. During a week in a hospital bed, they can go from being mobile to being unable to stand, let alone get themselves to the bathroom or do any of the things that were so vital to their independence.
The fortunate ones have family to help navigate their way through the medical system.
But that takes its toll, with caregivers burning out. One elderly Ontario woman recently had to sleep in her car overnight while her husband was being treated for the after-affects of a stroke. They simply lived too far from the only centre that could provide the rehabilitation he needed, and she couldn't afford a hotel room.
The stress can bring out old grievances and sibling rivalries as the debate rages over just how to care for Mom or Dad. As one doctor points out, if your kids didn't get along when they were 16 and 17, they'll still be fighting at 50.
Medical care for seniors doesn't stop with the doctor. Best practices suggests it takes a team, with nurses and social workers involved with doctors and specialists who get to know the patient and their circumstances and liaise with family or other caregivers. But unless you're fortunate enough to live in a centre that has the services, plus live long enough to get to the top of the waiting list, you might be out of luck.
Faced with such an urgent demand for geriatric specialists, you'd think students would be lining up to fill the spots. They're not. Geriatrics is a poor cousin to the more lucrative specialties like cardiology or neurology. Students graduating with crippling loans haveto maximize their incomes to pay them off -- not see one patient in the same time their cardiology colleague sees six.
Yet while students are steering away from a geriatric specialty, the reality is the average doctor will see more seniors than anyone else.
"Except if you are a pediatrician, the classes graduating now will spend 50 per cent of their time with people over the age of 65," said Dr. Laura Diachun, a geriatrician, associate professor of medicine at the University of Western
Ontario and co-author of a study pointing to a shortage of doctors who practice geriatric medicine.
Dr. Janet Gordon, a professor in geriatric medicine at Dalhousie University, did a survey of medical schools across Canada and found that students were exposed to anywhere from seven to 200 hours of geriatrics.
"In medical school, people do close to two years or more of classroom learning and then clerkship, on-the-floor clinical learning," Gordon said. "Only half the schools have people do geriatrics even though all have them do pediatrics."
Gordon said in problem cases set for medical students at her university, she found only seven per cent of the cases had patients over the age of 65 and none included patients over 70.
"I think there is a belief geriatrics is too complicated to teach them early on," said Gordon.
Geriatrics is a complex and challenging field. It's not like a 40-year-old landing in emergency with a heart attack or pneumonia. Treat the problem in the younger patient and chances are the patient will be up and on his or her way.
For an 80-year-old, one ailment may be complicated by other conditions. Is the confused patient suffering dementia or is the confusion coming from an infection and dehydration? If he's sent home, is there someone there to ensure he eats? Takes medication?
In medical school, students spend days and weeks gaining pediatric experience. They spend only hours with the elderly.
"The bottom line is this is not a sexy place to be," said Lynn McDonald, director of the Institute for Life Course and Aging and a professor in the faculty of social work at the University of Toronto. "It is not glamorous like brain surgery or saving children who are dying from leukemia.
"We live in an ageist society; there is the feeling, 'who cares?' They are going to die anyway. . . There is no prize, no glory.
"It is hard, hard complicated work and it is work that requires many disciplines. It is an interdisciplinary team approach. Older people don't just have one problem, they have many problems, it is very complicated and there is a special knowledge base."
McDonald said when she first went to work in gerontology in 1970, no one even knew what the word meant. "Society is catching up, but not fast enough in my opinion. I think it was in 2001, seven doctors went into geriatric medicine in all of Canada -- we need hundreds."
Geriatrics is also lacking in nursing training, McDonald said, but the curriculum is so stretched there is little room for geriatric medicine.
"Maybe we get three or four nurses in the program a year," she said of a multidisciplinary program at U of T in aging, palliative and supportive care.
"That's not very many when you think most old people end up on the medical wards in hospitals and they end up in long-term care.
"Who's looking after them? People off the street -- that's who is looking after them, with a nurse in charge if you are lucky."
McDonald says in the United States, the John A. Hartford Foundation, dedicated to improving health care for older Americans, is putting millions of dollars into training professionals in nursing and social work in geriatric medicine.
"They know they are going to have an age wave," she said. "They are preparing and they are throwing money at the problem big-time, and it works.
"If you start to pay students for doing it, they are a lot happier than if they are doing it because it is noble."
Drawing on the Hartford example, McDonald wrote a proposal for a national centre of excellence in aging focused on the three professions that provide social, psychological and physical care to Canada's older population, the National Initiative for the Care of the Elderly.
"We were shocked when we got this letter saying 'congratulations,' " said McDonald of the success of her proposal.
But the dollars are not lavish. While Hartford is pouring $25 million into a single profession -- nursing -- McDonald said that in Canada, by the time overhead is paid, there will be $1.6 million left for four years.
The centre has put together academics and practitioners working with older people and is focusing on best practices, with the aim of providing community agencies and institutions across Canada the tools they need to work with them.
"That's turning out to be a big winner," she said. "People don't have that information in one spot."
The institute also has a mentorship program for students in gerontology from the three professions, and it pays their way to an annual knowledge exchange.
McDonald said one way to get people involved is to offer scholarships and money for students to do research.
"Once you start to do it, you love it," she said. "People who are in gerontology and geriatric medicine love it.
"It really is a challenge -- it is really exciting when you can make a difference for an older person and their family."
How Scientists Hope to Shrink Aging Effects
• DISCOVER -- DECEMBER
Scientists are increasingly hopeful that controlling inflammation will allow them to turn back the clock on aging, writes Kathleen McGowan in Discover magazine.
Inflammation is already a well-established predictor of many chronic illnesses, such as diabetes, atherosclerosis and Alzheimer's disease. It is a part of the body's essential immune system, and it protects us from biological invaders and damage from wounds. In inflammation's most noticeable form, it promotes clotting to stop bleeding and the spread of germs.
But as the immune system becomes less efficient with age, acute episodes of disease-fighting inflammation can turn into low-level chronic inflammation. As it simmers undetected in the body for years, inflammation increases risks for a range of debilitating and life-threatening diseases. While few scientists believe that inflammation is the sole cause of aging -- human bodies are much more complex than that -- an increasing amount of research suggests that it plays a major role in the process by precipitating many of the most debilitating afflictions associated with old age.
Many prominent gerontologists reason that if these chronic diseases are the product of an overactive immune system, then they can be countered with the right anti-inflammatory drug. Scientists are tantalized by the prospect that they could not only extend lives, but that they could also increase the quality of those final years by reducing the incidence of disease.
"The research is really to prevent the chronic debilitating diseases of aging," says Nir Barzilai, a molecular geneticist and director of the Institute for Aging Research at the Albert Einstein College of Medicine in New York. "But if I develop a drug, it will have a side effect, which is that you will live longer."
I have been reading comments on the Elderly and their care by families and communities, in this column.
I reside in the U.S. but my mother was in a home in Calgary. Ismaili volunteers are very much engaged in taking care of our seniors in homes. Families and volunteers brought Indian food and snacks and brought the Ismaili residents together at meal times
On good days they took the residents outside the home in the garden in wheel chairs and sat with them and talked to them.
I know of a young man who brought the residents together in the afternoon and evening and they recited prayers before lunch and after dinner. He and others made sure the residents ate and often they themselves fed the residents.
On Idd days, families and volunteers brought special meals for the residents and helped feed those who could not feed themselves.
My mother was taken by handi bus every Friday to JK and on all other religious days/functions. She had dementia and could not speak but people knew her and would come over to say hello to her. Sometimes she acknowledged them and sometimes she did not.
Our relatives and friends visited her often and two cousins visited her daily. May Mowla Bless my these two cousins in both the worlds. My mother was well taken care of and so were the Ismaili residents who benefited a lot from the daily visits of the families of other residents and Ismaili volunteers. They all felt like a big family.
Mukhis and Kamadias visited residents on Fridays and Chandrat (beforeer Jamat Khana ceremonies) and gave Chantas. Some volunteers brought Niyaz and sukreet on Fridays for seniors who could not attend Jamat Khana.
When my mother was in the hospital, Mukhi Kamadias came to visit all the sick Ismailis on Fridays and Chandrat and volunteers brought sukreet and niyaz.
Some abled bodied seniors also visited the less fortunate seniors in hospitals and homes and brought fruits and sweets.
So, the picture is not so grim. In fact I was surprised to read that Seniors in Canada were neglected!
Also, Hazar Imam had expressed concern about our seniors during his 2005 visit to Canada and I believe he is definitely going to do something for them very, very soon. He is more concerned about them than us.
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