Ethical Challenges in Gerontology: Preparing Our Future Leaders Maria Claver, PhD, msw melanie Horn Mallers, Phd department of Family & Consumer Sciences – Gerontology Program Ethical Challenges in Gerontology: Preparing Our Future Leaders



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Ethical Challenges in Gerontology: Preparing Our Future Leaders


Maria Claver, PhD, MSW

Melanie Horn Mallers, PhD

Department of Family & Consumer Sciences – Gerontology Program



Ethical Challenges in Gerontology: Preparing Our Future Leaders
Table of Contents

Introduction 4


Family Caregiving Responsibility

Summary/Literature Overview 6

Powerpoint Slides 9

Learning Objectives 16

Key Terms 18

Activities 21

Suggested Resources 23
Euthanasia & Assisted Suicide

Summary/Literature Overview 28

Powerpoint Slides 30

Learning Objectives 35

Key Terms 37

Activities 39

Suggested Resources 42
Rationing Health Care

Summary/Literature Overview 45

Powerpoint Slides 48

Learning Objectives 54

Key Terms 56

Activities 59

Suggested Resources 61
Appendices: See attached Powerpoint slides on enclosed CD-Rom.
Introduction

Overview
Gerontology is the study of the aging process. It includes the study of physical, psychological and social changes in older individuals and the investigation of societal changes resulting from the aging of the population. This field is also concerned with the application of this knowledge to policies and programs. Current population trends in the U.S. show that people are living longer and the number of older adults is rapidly increasing. Expanded career opportunities in gerontology are expected to arise in many disciplines and professions. Gerontology programs such as the certificate and masters program offered at CSULB are designed to prepare students from a multitude of backgrounds to develop aging-related programs, provide direct care via adult day and home care programs, to counsel, manage and to provide instruction in the field of aging. Ethical issues, as such, are a salient piece of this gerontological coursework.
The dramatic aging of our nation’s population brings with it an increased need for more focused consideration of issues pertaining to the well-being of this population. The challenges currently present in the field of aging lend themselves strongly to issues that require ethical consideration. Should families be required to care for their aging family members? Do older adults have the right to decide when to die? Should we ration limited health care and other resources based on age and health status? How will budding gerontologists deal with these issues as they move out into the workforce as practitioners and policy makers? Due to the relative “newness” of the field of Gerontology, many of the ethical debates regarding topics mentioned above are not settled, and providing the opportunity for students entering this field to enter the discussion is vital in order to work toward consensus and workable solutions.

Ethics and Gerontology

In the Coming of Age, Simone de Beauvoir states about aging:



It is the meaning that (people) attribute to their life, it is their entire system of values that define the meaning and value of old age. The reverse applies: by the way in which a society behaves toward its old people it uncovers the naked, and often carefully hidden, truth about its real principles and aims.

With the population growing older, we have a stake in developing a better understanding of gerontology and its related trends and issues. It is our responsibility to ensure that we create a society that values our aging members. Ethics, defined as a set of principles of right conduct, or a theory or a system of moral values, are critical to reevaluating our treatment and beliefs toward aging individuals.


According to the United Nations, we must appreciate the contribution that older persons make to their societies. We must create a world that provides to older adults independence (including access to safe environments, health resources and opportunities for personal growth), participation (including the ability to remain integrated in society and have a voice), care (care and protection, ability to maximize well-being, and enjoy basic human rights and freedoms), self-fulfillment (access to educational, cultural, spiritual and recreational resources) and dignity (freedom from exploitation and being valued independently of their economic contribution).
The goal of these modules is to prepare students to think more deeply about what is at stake in the gerontological-related issues presented below, as well as gain insight into how to be responsible leaders in an aging society. This requires an ability to respect the rights, dignity, and worth of all people, while striving to eliminate personal bias. We hope that by providing the facts, students will learn to engage in critical thinking and develop their own personal views, while remaining respectful to opposing opinions. We believe that inherent in this process is the ability to gain empathy: or the ability to “walk in someone else’s shoes” (Myrick & Erney, 1985) or to “transform personal assumptions about knowing” (Kitchner & King, 1990), in this case about aging and aging individuals.
With knowledge and compassion, we as a society, can make conscious, moral choices that have long lasting impact on both older adults and on the future of our children.
Family Caregiving Responsibility

Summary/Literature Overview


Family members and informal (non-paid) care providers (including friends, partners, and neighbors) commonly assist with the care of older relatives. Caregiving is often defined as the act of assisting someone who is chronically ill or disabled and who can no longer care for themselves. Family caregiving has become the norm. According to the National Family Caregivers Association, more than 50 million people provide care for a chronically ill, disabled or aged family member or friend during any given year. Currently, there are over four million family caregivers in California alone. Caregivers care for spouses (5%), and parents (40%) as well as grandparents, parents-in-law, other relatives, and friends (55%). Family caregivers are essential given that over 40% of U.S. primary care physicians think they don't have enough time to spend with patients and that family caregivers provide the overwhelming majority of long term-care services in the U.S. Furthermore, the majority of adults living in the community and in need of long-term care depend on family and friends as their only source of help.

While the need for care by older adults is increasing, availability is decreasing; people over 65 are expected to increase at a 2.3% rate, but the number of family members available to care for them will only increase at a 0.8% rate. Unfortunately, availability of care is a major factor in predicting whether or not an older person can remain at home (aging in place) versus being moved to institutionalized care. Furthermore, the services provided by family caregivers represent 80% of all home care services and are conservatively valued at $306 billion a year, more than twice the amount spent on paid home care and nursing home services combined. This is a serious issue given that women, who make up the majority of caregivers (oftentimes part of the “Sandwich Generation” – those caring for both older relatives and young children), are 2.5 times more likely than non-caregivers to live in poverty and five times more likely to receive Supplemental Security Income (SSI) and that caregiving families (families in which one member has a disability) have median incomes that are more than 15% lower than non-caregiving families. Furthermore, family caregivers comprise 13% of the workforce, but often lose wages and time from work due to caregiving and related role demands. In fact, 59% of family caregivers who care for someone over the age of 18 either work or have worked while providing care and 62% have had to make some adjustments to their work life, from reporting late to work to giving up work entirely. Ten percent of employed family caregivers go from full-time to part-time jobs because of their caregiving responsibilities. Overall, American businesses can lose as much as $34 billion each year due to employees' need to care for loved ones 50 years of age and older.

Research shows that while caregiving is assumed to be voluntary, and some do report it as personally fulfilling, at least a third experience stress, burnout and exhaustion, possibly resulting in depression. Specifically, family caregivers experiencing extreme stress have been shown to have decreased immune systems and increased morbidity. In fact, family caregivers report having a chronic condition at more than twice the rate of non-caregivers. Elderly spousal caregivers with a history of chronic illness themselves have a 63% higher mortality rate than their non-caregiving peers. Also, family caregivers who provide care 36 or more hours weekly are more likely than non-caregivers to experience symptoms of depression or anxiety.
One related question that has been posed is whether or not family members should be caregivers at all, and furthermore, if they should be financially compensated for their time. Conversely, should caregiving be considered familial duty and obligation? This is a heated debate because it has implications for policy and legislation, community health practices, work place productivity, respite care, family systems, technology and elder abuse, among other topics.

PROS OF PAYING FAMILY CAREGIVERS:



  1. It will expand capacity and supply of workers

  • Can hire family members not necessarily employable otherwise (deaf, mentally impaired)

  1. It will increase gender and family equity

    • Women will be paid for work they already do, “leveling the playing field”

    • Women are most likely to become impoverished in later years (especially low-wage minority woman). Compensation will deter this.

  2. It will increase elder’s satisfaction as a consumer

    • Outside agencies often impose rigid time schedules, and routines. Elders’ will be more satisfied if they have more control over their caregiver.

    • This may increase quality of care. A relative may understand ethnic and cultural preferences, speak same language, or understand food preferences. This may increase a sense of safety and comfort for the older adult. Family members also have longer tenure, providing sense of continuity.

    • Family caregivers have higher motivation; they are committed to providing care.

  3. It will decrease administrative and bureaucratic barriers

    • The caregiver is already in place. As such, costs traditionally used to place and screen formal caregivers can be eliminated; overhead costs (management) are decreased, as are turn-over rates. The latter is critical for quality of care.

CONS OF PAYING FAMILY CAREGIVERS:



  1. It will increase family exploitation

    • Caregiving should be out of obligation. Paying a family member encourages setting a dollar value on family. How do we do this?

  2. It will cause caregiver stress and strain

    • It is a major burden watching a loved one decline and feeling helpless. Caregiving is associated with a variety of negative outcomes-have poorer physical health and psychological well-being. It also disrupts responsibilities to other roles, e.g., parental and work, which causes increased family/society breakdown.

  3. It will lead to elder abuse and fraud

    • Strain will lead to elder abuse. Most common is financial. The likelihood that a family member lives off of or takes older person’s money is increased. Strain, especially coupled with poor training and skills required for proper caregiving, can also lead to psychological abuse, mistreatment, revenge, and functional incompetency of caregiver (passive neglect).

  4. It will incur increased costs

    • There are greater costs to train family caregivers to the level of care needed for long-term elder care. Costs to businesses due to lost time and productivity by their employees who are caregivers are also incurred.


In summary, when problems arise in old age, many older adults turn to their family and friends for help. And as stated above, a large majority of care is being provided by informal caregivers. But as the American family changes in conjunction with the increase in the aging population, families are facing new challenges regarding the ability to give care as well as the quality of care provided. As such, there is much debate regarding whether or not family caregivers should provide the care as well as whether or no they should be financially compensated.

Family Caregiving Responsibility

Powerpoint Presentation
























Family Caregiving Responsibility

Learning Objectives
The discussion topics and activities are listed here to demonstrate the connection of each with its corresponding course goal. Further detail about these discussion topics and activities will be provided in subsequent sections.
After completing the Family Caregiving Responsibility Module, the student should be able to:


Objective

Discussion Topic

Activity

Explore personal feelings about long term care placement

What factors can help determine if it’s time to place a loved one in a long term care facility?

Reflection journal

Quality of care and financial implications of caregiving

Who provides better care: informal or formal (paid) caregivers?
Should family members who provide care be financially compensated by state/federal policies and programs?

Debate using Pro/Con grid

View film: Complaints of a Dutiful Daughter and discuss financial compensation issue



Identify risk factors for caregiver burden

What qualities are most suitable for a caregiver?
What factors can help us assess potential for elder abuse
What services are available to assist caregivers?

Case Study

Compile a resource list for local resources for caregivers (begin with National Family Caregivers Support Program of 2000)



The challenges of the sandwich generation and its impact on women, the role of women in families, the workplace and society.

What are caregivers experiencing as a result of their caregiving role? What experiences, both positive and negative exist? How does caregiving impact their overall wellbeing?

Interview a caregiver

Availability of caregivers from a political, social, economic and individual caregiver perspective.
Learn more about The Family Medical Leave Act

Who is ultimately responsible for caregiving? Family or state?
Should family who don’t properly care for their older adults be penalized?

Working in small groups, draft legislation to address this topic.

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