The Third Rail: A Difficult Conversation About Aging in America

By Jaime L Roberts

There is no "magical" date to plan for your future, but rather a series of inevitable life events which force the conversation and raise the questions. What age should you plan for the unexpected? 

Through her years of experi

• Language: English
• Publisher: New Degree Press
• Release date: May 8, 2022
• ISBN: 9798885042000

Book preview

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The Third Rail

The Third Rail

A Difficult Conversation about Aging in America

Jaime Roberts, MPH

New Degree Press

Copyright © 2022 Jaime L. Roberts

All rights reserved.

The Third Rail

A Difficult Conversation about Aging in America

ISBN

979-8-88504-090-7 Paperback

979-8-88504-721-0 Kindle Ebook

979-8-88504-200-0 Ebook

For my daughters who make this life worth living and forever hold the keys to my heart—I love you more.

For my best friend and love of my life, Stephen. Without you, life would be so boring.

Thank you for being my forever plus one.

Introduction

Springtime in Arizona is magical. The sweet scents from the new orange blossoms spread throughout the Valley of the Sun, reminding us of the renewal of spring and the new opportunities and potentials to come. The sounds of laughter echo throughout the valley as families and friends enjoy the endless events that fill the spring calendar. You can hear the first sound of the bat hitting the ball at a spring training game or smell the scent of a perfectly manicured lawn as you play a round of golf. In the late afternoon, you can feel the Arizona sun kiss your skin while lounging at the pool for the first time in months. The sight of the majestic Sonoran Desert mountains with the magical wildlife accompanies the unmatched Arizona sunrise and sunsets.

In Arizona, March and April are the peak season for visiting snow birds, desperate to leave the frozen tundras in the northern environs to thaw out after a long winter. The idea of snow bird speaks to so many because it’s the dream of retirement on their terms, but ultimately, so many never actually get to retire on their own terms.

At the beginning of the year 2020, that positive energy was palpable. Although the calendar showed 2020, it could also be understood more abstractly as 20/20—as in the diagnosis for perfect vision. Thus, the spring of 2020 had the potential to be a year of change and new beginnings not only because it marked the start of a new decade, but also for the symbolic clarity with which we would see the world with a renewed accuracy. Yet, little did we know that as winter turned to spring, we would enter into a darkness, seismic in depth and resulting in a profound shift for humanity itself.

On February 26, 2020, a report from Seattle, Washington stated that a resident of Kirkland’s Life Care Center was infected with a severe respiratory illness. This became known as the first case of COVID-19 in a congregate setting in the United States, which we would later understand that the actual Patient Zero was likely reported to the Washington State Health officials two weeks earlier. The Life Care Center became ground zero for the COVID-19 pandemic and soon all senior residential facilities, along with their residents, would be characterized as super-spreaders of this dangerous and deadly disease. I remember being glued to cable news channels. I would stand in front of the television repeating to myself, This is not going to be good. This was not good for the senior living industry, but more specifically (and perhaps self-contentedly), this wasn’t going to be good for me, as a professional working in senior living.

It did not take long for the news reports to begin posting about who was to blame for the tragedy being played out in America’s nursing homes. Nursing homes, and the senior living industry in general, have always been looked at as the problem child in society. Some might even refer to the feudal system and rank senior living as the serfs of healthcare structure.

When was the last time you heard an elementary school student say, When I grow up, I want to work with older adults? My guess is, probably not that often, if ever. We are much more likely to glamorize careers like attorneys, physicians, real estate investors, money managers, or other professions. We have not yet arrived at the point in our society where the physical act of aging and the idea of working within the helping professions inside the senior community is something worth striving toward.

Perhaps, if we lived in a world that placed greater value on how we care about seniors, let alone working among them, the über focus of senior living communities and seniors as the scapegoats at the outset of the pandemic would have been a moot point. The public vilification of the blameless senior communities by the twenty-four/seven news cycle and armchair experts would have been dramatically different had there been a better understanding of the reality of the system itself. A system of institutional aging would have, perhaps, been contextualized as a symptom of the greater disease, which was acutely misdiagnosed in the first days of the COVID-19 pandemic.

To begin, it is fundamentally important to understand, within a historical framework, that we built institutions to care for our most vulnerable. Within these institutions came regulations, limitations, and prescriptive solutions that never really defined outcomes. We have arrived at the critical crossroads. We must decide whether to invest and build more understanding into our social structure to redefine all facets of aging, from the physical to the emotional, the psychological to the values we choose to place on those individuals who have lived the longest. Instead, we built a billion-dollar anti-aging industry that tells you how to stay young and not grow old because growing old is bad.

I will argue that the conversation we should have is about how society can, and must, redefine our understanding of aging and how to reframe our belief that institutions are the only societal response toward caring for the old, sick, frail, elderly, and vulnerable among us. The collective solution was to make the old, the unseemly, and the difficult disappear because of the negative feelings of seeing them suffer had on us, rather than the care they needed. Never has this been clearer than with people living with dementia. Up until recent years, the general school of thought around people with brain changes was to try to fix them so they can interact normally. In reality, if you want to help someone with brain changes, you are the one who needs to change, not them. That was our solution, but we can do better, and we should be better. We are a society with aspirations, and this includes both knowing and doing better than we have in the past, especially when talking about our vulnerable and aging populations.

This book is a call to action; to begin the difficult conversation about aging in America and the placement of this conversation in the collective conscience of our leaders, policy makers, family members, and ourselves. There is no magical date to plan for your future, but rather a series of inevitable life events that force the conversation and raise the questions. At what age should you plan for the unexpected? At what age should you create a living will or medical power of attorney documents?

As a senior living professional, I frequently draw on these difficult questions with families, and I engage in these conversations consistently with my own family and friends. In almost every single situation regardless of economics, health, lifestyle, or education, the lack of awareness and frustration that comes even with the idea of aging, in the abstract, is astonishing and can feel very overwhelming. As one looks toward the horizon, we find things are not getting easier and there must be a better way. Fundamentally, there is a desperate need for a new paradigm—a seismic shift within our society—toward confronting our greatest challenge of how to grow old in America.

There is also a much greater conversation to be had, a 30,000-foot perspective, which includes real-time and real-world challenges. Together, we will discover that among these challenges is the acute shortage of a workforce that is ready, willing, and skilled to care for our seniors. I will argue the importance of understanding, acknowledging, and creating solutions to our acute workforce shortage. This is no longer a provider problem or a problem of individual families attempting to care for their parents and grandparents. Rather, it is a collective crisis. As an example, not only is there a lack of focus on geriatric training for all disciplines in health care, but to make matters worse, there has been a mass exodus of healthcare workers since the COVID-19 pandemic—over one half of a million workers in just the past eighteen months have left the profession altogether (Yong 2021; Masson 2021).

This book will draw from historic patterns, as well as policies and societal viewpoints in an attempt to understand how we arrived at such an inflection point, (undoubtedly expedited by our experience with COVID-19) how we care for our seniors, and how this crisis both impacts and permeates our society as a whole. We will also seek solutions by utilizing research and firsthand experiences and accounts from experts within the industry, along with other aging service professionals. We will take a deep dive toward comprehending the current state of affairs within senior services. Most importantly, we will find the ways and means by which we can shift the paradigm to create more meaningful outcomes for our rapidly aging society.

It’s important to have the conversations about what type of life saving treatments you can tolerate or accept. This conversation should include a deep dive into different scenarios, one that walks you through the process along with your loved one. For example, if you are in a car accident and end up on a ventilator and all of your organs are failing, even if the medical team can keep you alive with the ventilator, is that what you want? Do you want to remain alive, but spend the rest of your life connected to a machine? Western medicine is amazing, but it is also confusing. Technology and medicine can allow one to live longer with supportive machines, but is that the life you want? Ultimately, it’s important for everyone in your support circle to understand your wishes.

The difficult conversation around aging in America includes topics focused on death and dying. What life saving measures do I really want? What if the lifesaving measures I decided on are not able to restore me back to my original state? What if the choices I made or the choices my family made (because I didn’t have this conversation with them) ultimately have me living in an assisted living, nursing home, or some other supportive living environment? What is it that we truly want as we age? This book will help you navigate the systems, as well as facilitate those difficult, but necessary, conversations with your loved ones. These are the conversations that matter, as well as the ones that will make a difference.

Chapter 1

Why Is Aging America The Third Rail?

Old people don’t matter in this country. And they never have.

—Lori Porter,

CEO

National Association of Health Care Assistants

I remember coming home from graduate school for the holidays and realizing that the sage advice my grandmother gave me years before was finally making sense. She told me there were certain topics of conversation that should be avoided at all costs in social settings and family gatherings. Her admonishment was that nothing good would ever come from conversations about politics, religion, money, or gossip. Although she was not opposed to the occasional off color jokes, she recommended I not share those at family gatherings either.

Her wisdom was often echoed by my parents, who frequently reminded me to always watch my words and verbalize ideas that would not embarrass me. They would quip that I should not say anything out loud that would later end up on the front page of the newspaper just in case I ever wanted to enter politics. Thus, it was part of our familial culture to avoid topics that were so controversial they could lead to significant damage or destruction of one’s reputation, career, or credibility. Luckily, these lessons preceded the social media where words are exchanged in nano seconds across the globe; that advice is truer today than it was during my upbringing.

In November of 2001, that solid advice went out the window. I just flew home from Chicago to Dallas to spend Thanksgiving break with my family. The emotions of 9/11 were still raw. The conversation during Thanksgiving turned into a tense exchange about what America should or should not do after 9/11, which was a conversation riddled with strife, struggle, and acute emotional intensity. We had touched the proverbial third rail, which was the kind of conversation my grandmother had warned me about in earlier times.

In the days and weeks to follow, I began to synthesize my grandmother’s admonishment and the conversation at the Thanksgiving table. As a Chicago resident at the time and daily passenger on the city’s infamous public transit system, otherwise known as the El, the reference to the literal third rail made sense to me. Although the third rail of the El describes a hidden rail adjacent to the train track (the voltage of the third rail will literally kill anyone who touches it), it is also commonly used as a euphemism for those things in life, including difficult or harsh topics that can be equally hazardous for those who engage in such conversations. Finally, my grandmother’s advice from so many years ago made sense; stay away from conversations that will not end well.

In these pages, we will explore a topic that can otherwise be understood as a Third Rail. We will engage in the difficult, painful, and oftentimes hidden conversation on aging and aging services in America. Throughout this book, we will explore how and why aging has become the third rail in our society. To lay the foundation of this argument, we begin with the conundrum of why aging services, the fastest growing sector of our healthcare system, is the least appealing for the American workforce. The area of Aging Services includes, but is not limited to, the following areas: care coordination, caregiving services, client services, disease prevention and health promotion services, in-home services, legal assistance, nutrition services, senior advocacy, and elder abuse prevention services.

Regardless of perception, aging services is a fascinating industry that continues to exponentially expand among all fields. Growth within aging services is inevitable because of the sheer number of aging Americans. For decades, we have known that the baby boom generation would eventually grow older. Thus, the need for a robust and expanding workforce is a necessity, albeit limited by both mindset (of society)