Abstract
This report entails a review of the available resources and programs in terms of support services for the aging persons in the State of Indianapolis with the aim of providing practical recommendations in which additional services and alternative approaches to these services are discussed in detail. A total of five local support service providers in Indianapolis are assessed according to the services offered to the elderly and the aging individuals. The service agencies surveyed include Area IV Agency on Aging and Community Action Program; CICOA Foundation Incorporation; Indianapolis Senior Center, Joy’s House; and the Visiting Nurse Services Incorporation. These agencies provide a variety of services through their developed programs thereby ensuring continuation of quality life for the aged and the physically challenged, promoting their needs, offering meals, providing information regarding the aging in the society, and provision of recreation activities among a host other services.
In addition, the report reviews available demographic data and literature in addition to the interview reports of the older adults and one of the agency’s representatives with the aim of assessing the current needs and trends concerning the aging and their needs. Two interviewees aged 65 and 80 years old were interviewed in this case together with the CEO of the Central Indiana Council on Aging (CICOA). Lack of awareness among the elderly about the existence of the support services is cited as the main cause of limited access to such services in Indianapolis. Another reason identified regarding this problem is lack of funding for the support services. Additionally, the literature sources reviewed confirmed the findings of these interviews. This report thus recommends that Indiana needs a lot more support for the different cultural groups as well as all seniors, creation of awareness and provision of funds to run the available support services among other interventions.
Introduction
Overview of the paper’s focus
Aging involves the accumulated changes that occur in an organism over a long period of time, usually 65 years and above for most human beings. These changes in human beings are categorized into physical, psychological, biological, and social changes. In addition, the changes may involve expansion or reduction of some portions and physiological functions of the human body such as the response/ reaction time, which may declines with time. On the other hand, aging may contribute to the expansion and development of human knowledge and life experiences. Thus, aging does not only involve biological changes as perceived by many, but it also entails social and societal changes in the life of an otherwise normal human being (Stuart-Hamilton, 2006, p. 13).
Despite that aging forms an important part of the human life; research studies indicate that approximately 100,000 aged individuals in the world die of aging-related complications. Most of these deaths are caused by a variety of chronic diseases associated with aging while others are as a result of social, psychological, and environmental factors. Additional studies indicate that it was only until recently that most families and societies were so close together that the elderly felt loved and cared for by a family comprising of three generations. With the emergence of social revolutions such as divorces, war, materialism, and feminism, it is unlikely to find a family comprising of the grandparents, parents and their children living together. This has forced the elderly and the aging into leading a life of seclusion and solitude (Stuart-Hamilton, 2006, p. 15). Moreover, most elderly and aging persons feel useless, unwanted, and sad. Psychologists cite these feelings as being part of the reasons behind the increased rates of depression, suicide and alcoholism among the aged in most societies.
Furthermore, the situation is worsened with the increasing number of persons aged 65 years and above. Studies indicate that between the years 1870-2000, the number of the aging individuals increased by 30 times in the United States. Moreover, the same studies indicate that the population of the aged persons is increasing at a greater rate than the other population groups. Additionally, it is projected that the total population of persons aged 65 years and above will be roughly above 20% of the total population of the United States by the year 2030 (Stuart-Hamilton, 2006, p. 20). These changes have seen the emergence of the support service agencies with the aim of caring for the elderly in the society.
This report entails an in-depth assessment of the available support services and programs for the aging in Indianapolis with the aim of providing practical recommendations concerning introduction of additional services to support the existing ones. This is achieved through analysis of the cultural, social, and environmental factors affecting aging in human beings. It also entails discussions on how the family and the community’s perceptions affect the provision and utilization of support services and medical interventions among the elderly.
Literature Review
As noted in earlier discussions, the aging population is increasing at a higher rate as compared to other population groups in the United States. Moreover, due to improvements in a variety of demographic factors, life expectancy in the United States has increased from 47 years in 1900 to about 77 years by the year 2000. Additional demographic data indicates that over a century ago, the total population of the elderly persons was about 4% as compared to the current population, which is approximately 13%. The population continues to increase as time goes by and it is estimated that by the year 2030, the population of individuals aged 65 years and above will be more than 20% of the total population in the United States (Cummings & Galambos, 2004, p. xv). This calls for introduction of support services and programs to cater for the needs of this expanding population.
Relative to the increasing population rates of the aging persons, the government and social support service providers have developed a number of successful services and programs for the elderly populations in the United States. For instance, the CICOA Aging & In-Home Solutions has developed a program aiming at delivering meals to homes and neighborhoods of the elderly persons in Indianapolis (CICOA, 2010, par. 3). Through this program, the group strives to maintain the health and welfare of the aging besides providing information and resources on the availability of services and programs for the aging and disabled persons in Central Indiana. The group incorporates a variety of service groups, individual volunteers, and agencies in providing support services. Through CICOA, the elderly persons in Central Indiana can access meals, home-based healthcare services, referrals, and home care services among other services (CICOA, 2010, par. 6). In addition, CICOA serves 3,750 individuals annually besides providing about 1,500 caregivers to nursing homes across Central Indiana.
Additionally, a number of practical approaches to care-giving for the elderly are notable in a number of services and programs available in the United States currently. According to Gelfand (2006, p. 23), a variety of federal legislations are in place in order to ensure that support services and programs are availed to the aging populations. This is provided in the Older American Act. Through this act, the elderly can access maintenance income and health care insurance services. Moreover, the act provides for availability of programs such as social security, Medicaid, and Medicare to the elderly.
Despite the existence of a number of support service providers and programs for the aging in the United States particularly Indianapolis, various problems still exist, which require urgent intervention. According to the American Association of Homes (AAHSA, 2010, par. 1), the major issue hindering support service provision among the aging is diversity of the aging populations especially in Indianapolis. This population of elderly individuals is diverse in terms of ethnic groups, education, income earnings, and religion. Besides these diverse factors playing a role in building certain strengths notable among the elderly, they also bring about various challenges and psychosocial needs, which should be addressed by the care-givers (Cummings & Galambos, 2004, p. 26). It is indicated that the ratio of aging individuals of the Hispanic origin to that of other Americans is about one to five. This has seen the number of nursing homes for Hispanics increase steadily. The main problem involved in this case is that the service providers would find it hard to adjust their services in such a way that they fit the needs of these diverse groups. Moreover, the studies indicate that the elderly populations are at a constant disadvantage in that they cannot access good health care services particularly the minority elderly populations. Additionally, the same studies indicate that the aging populations are facing major disparities in healthcare provision in most health facilities in the United States.
Still on the case of minority elderly populations, research studies indicate that there exists a variety of economic and cultural trends which influence their living arrangements. Due to the increased differences in economic, cultural, ethnic, and social characteristics of persons aged 60 years and above, it is almost impossible to consider these individuals as a concrete block defined by their age. For instance, major differences are noted in the living arrangements of the minority elderly persons based on their gender. Despite the presence of approximately 1.5 million bed spaces in nursing homes for the aging persons in the United States, less than 5% of these individuals prefer living in these homes. About 30.8% of the remaining individuals live alone, which includes over 39.7% of women and 18.8% of men (Gist & Hetzel, 2004, p. 4). These differences are important when it comes to policy development that affects the provision of support services in that different policies are required in addressing the needs of the aging within the minority groups (Bicket & Miltra, 2009, p.1057).
In addition, lack of awareness and limited education among the minority elderly concerning the existence of support services and programs has been cited as being part of the factors hindering service delivery to the minority populations. According to Bryd et al. (2007, p. 51), the minority elderly are facing the risk of being disabled or dying due to lack or disparities in healthcare service provision. Moreover, the prevalence, mortality, and incidence rates of certain diseases affecting the elderly are relatively high among the minority elderly. In all the cases surveyed, disparities in service provision were cited as the major reason influencing the statistical data observed above.
Caring for the Aging in Indianapolis
The Vulnerable Populations
From the above discussions, aging has been defined as changes that occur in a human being at the age of 65 years and above. According to the research studies conducted in 2000, this group of individuals represents approximately 12.4% of the total population in the United States. This is about 35 million people of which 53% are individuals aged 65-74 years old; 35% represents individuals aged 75-84 years; and the rest are those aged 85 years and above. In addition, women exceed men in this population category, which comprises of 20.6 million women and about 14.4 million men (FSSA Division of Aging, 2007, p. 2). The studies further indicate that the sex ratio for the aging persons is much lower than in other population categories according to the statistics released in 2000.
Furthermore, about a half of the aged persons surveyed were married indicating that 56% of individuals aged 65 years and above are married. The same group also comprised of 32% of individuals who were previously windowed and about 7% who had divorced. 5% of the elderly population was reported to have never married. Approximately 28% of elderly persons live alone as compared to less than 10% of individuals in the other population categories. Still in the same studies, it is indicated that more than 11% of the people aged 65 years and above are foreign immigrants who had been naturalized by the time the statistics were being collected. Further, research studies show that the fraction of Latinos and Black Americans has been growing since the beginning of the 21st Century and it is expected to grow further (FSSA Division of Aging, 2007, pp. 2-4). As a result, the number of minority elderly Americans is projected to be one-quarter of the total population of persons aged 65 years and above by the year 2030.
It is worth noting that the population size and characteristics of each ethnic and cultural group is bound to influence support service delivery in many aspects as indicated in the subsequent discussions.
Factors influencing Service Delivery among the elderly persons in Indianapolis
Socio-economic factors
According to the United States census results of 2000, 18% and 19% of men and women aged 65 years and above respectively were in the labor force as compared to about 71% and 58% of men and women respectively in other population fractions. This shows that the percentage of elderly persons in the labor market declines with age. This is even much of a problem considering that most minority elderly persons and those of foreign origin have limited education (Gelfand, 2006, p. 3). This forces most of these individuals to hold blue-collar jobs until their retirement. Since most of these blue-collar jobs are low-paying, the financial resources available to these individuals are minimal or absent at old-age. The same is also the case when it comes to provision of social security benefits, healthcare insurance, and pensions. Moreover, more women than men are employed in part-time or irregular jobs, which do not give them the chance to apply for social security benefits.
Therefore, since most elderly individuals are unable to pay for services provided currently, disparities in service provision are bound to occur. However, with the existence of programs such as Medicare, Medicaid, food stamps, and Supplemental Social Security, which are run by the government, most elderly persons are able to satisfy some of their needs (Gelfand, 2006, p. 13).
Education
Most elderly persons in the United States have minimum education, which acts as an impediment to service delivery. According to the census report of the year 2000, about 13% of persons aged 65 years and above are proficient in other languages more than English and they are bound to use these languages at their homes quite often. Within this group, only 6% of these individuals knew English very well and they could use it occasionally. The languages which are mostly used by the elderly who never speak English include the Indo-European languages except Spanish (FSSA Division of Aging, 2007, p. 6). Moreover, the studies indicate that over 70% of persons aged 65 years and above have high school qualifications of which 18% possess basic college or University education. An additional 15% have attained full bachelor’s degree and above. However, it is worth noting that the percentage of elderly persons with basic education varies with age with those aged 65-74 years showing a higher probability of possessing bachelor’s degrees or higher compared to those aged 75 years and above (FSSA Division of Aging, 2007, p. 7).
The limited writing, reading, and verbal communication skills among a large number of the elderly persons implies that social support programs that entail general reading and writing may not be appropriate for these groups. More importantly, service providers should be aware that most of these individuals with limited reading skills may find it challenging to follow and understand instructions especially those concerning medical dosages (Howard & Gazmararian, 2006, p. 857).
Cultural Backgrounds
In 2000, the United State census report indicated that approximately 30 million Americans were of foreign origins. Moreover, about 10% of the United States population is comprised of foreign-born naturalized Americans aged 65 years and above. In addition, these studies indicate that the median age for the naturalized Americans is relatively above 52. Besides, these foreign-born Americans represent diverse ethnic and cultural affiliations. They include the Latinos of Central Americas, Asians, Caribbean Islanders, and Haitians (FSSA Division of Aging, 2007, p. 8). The same is also the case in most States in the United States, Indiana included. These diverse ethnic and cultural backgrounds make it difficult to deal with the existing cultural stereotypes and provision of services that are acceptable to all cultural groups. The problem associated with these groups, which also hinders support service delivery, entails the diverse cultural stances to aging and service utilization in addition to the limited educational backgrounds particularly in spoken and written English. These factors culminate into huge problems especially when the service providers are trying to implement universal social support programs for the aging (Howard & Gazmararian, 2006, p. 859).
Living Patterns
Research studies indicate that the aged persons are bound to remain in their places of birth or communities for long periods as opposed to the youthful populations. A look at the number of elderly persons staying in nursing homes further confirms the statement. Research studies indicate that there are more than 1.5 million beds in nursing homes in America, which are occupied by less than 5% of individuals aged 65 years and above. It is also noted that most of the elderly persons are leading lonely lives or they are maintaining their own homes. However, the percentage of elderly persons living alone varies with age, race, gender, and ethnic groupings (FSSA Division of Aging, 2007, p. 9).
The studies further indicate that women aged 75 years and above are more likely to live alone than their male counterparts. By the year 2003, approximately 30.8% of elderly persons who were not in nursing homes were staying alone in their homes. This includes 39.7% and 18.8% of women and men respectively. These statistics also mirror the influence of the family in care-giving to the elderly. Research studies indicate that poor families are bound to stay nearer to their aged family member more than rich families. In addition, the family income has been shown to be directly related to the utilization of long-term nursing services and homes. Since most poor families are unable to access the expensive services offered by nursing homes, they prefer staying with their elderly members (Cummings & Galambos, 2004, p. 28).
Additionally, most remote States such as Indiana, Missouri, Iowa, and Arkansas are experiencing a high number of elderly individuals living alone because the greatest proportion of the youthful population has moved to urban centers (Cummings & Galambos, 2004, p. 29).
Political Factors affecting delivery of support services for the aging in Indianapolis
As shown in the discussions above, the State of Indiana is composed of people from different ethnic and cultural backgrounds. Therefore, the political goodwill is imperative in ensuring that all these people receive equal and quality services. However, disparities can be noted between the whites, African Americans and Hispanics in terms of service provision. The political factors influencing these disparities are those associated with the involvement of all stakeholders in matters to do with delivery of equal services to all citizens (Gelfand, 2006, p. 23).
From the report’s findings, it is worth noting that there is an obvious absence of government agencies, healthcare professionals and the general public in the process of delivering services through local support service agencies identified. Most importantly, the African Americans and Hispanics face most of the disparities in healthcare and support service provision because of their underrepresentation in the healthcare field and the decentralized government. In that case, those groups with greater representation in the government and the healthcare field are bound to enjoy improved and quality services unlike the underrepresented cohorts (Gelfand, 2006, p. 33).
The Organizational Factors affecting Service delivery to the aged in Indianapolis
The major factors recognized for their role in influencing disparities in healthcare and support service delivery among the elderly persons are those associated with the organizations involved in service provision. Disparities are notable between the whites and the minority groups in Indianapolis due to differences in the attributes of the organizations involved (Gist & Hetzel, 2004, p. 45). These organizations are defined by their management, staffing strategies, locations, available resources, organizational culture and the complexity of the services provided. Other organizational factors influencing the disparities include the degree of coordination in policy formulation and implementation, the continuity of services and the degree of awareness and comprehensiveness of the services provided by all key players (Gist & Hetzel, 2004).
Among the minority groups unlike the whites, the level of illiteracy is notably high. And as stated earlier, this impedes the processes of service delivery in that lack of comprehensiveness and awareness of the support services means that the services may not be fully utilized by these people. In addition, most organizations and healthcare facilities are responsible for provision of quality services to those who need them. Therefore, the organizational culture is important in terms of creating or eliminating disparities in service provision. This then calls for development of culturally-sensitive services, which also include self-management services that cater for the diverse populations in Indianapolis (Gist & Hetzel, 2004, p. 65).
Available Support Service Resources for the Aging in Indianapolis
Research studies indicate that the coming decades will see the United States population skewed towards the older and middle-aged generations. This calls for urgent implementation of policies and programs that will ensure the safety and welfare of the expanding populations. In line with these changes, a number of support service agencies and programs have been put in place across the United States and Indianapolis in particular. The agencies offering services in Indianapolis include Area IV Agency on Aging and Community Action Program, CICOA Foundation Incorporation, Indianapolis Senior Center, Joy’s House, and Visiting Nurse Services, Inc. The services offered by these agencies include promotion of the needs of the elderly, frail, and the physically challenged. Moreover, corporations such as CICOA offers care management and meals in addition to developing strategies that advocate for elderly-friendly societies in Central Indiana. On the other hand, Indianapolis Senior Center provides educational facilities, health, and recreation facilities to the elderly. Other agencies such as Joy’s House are committed to ensuring that the elderly lead comfortable and safe lives. Finally, the Visiting Nurse Services, Inc., strives to meet the health needs of the elderly in most communities in Indiana.
Recommendations
From the above discussions, it is quite evident that the support service agencies and government programs available for the aged persons in the United States and Indiana in particular have managed to satisfy some of the financial, health, and psycho-social needs of the vulnerable populations. However, due to their reliance on the universally acceptable strategies and approaches in service delivery, a number of shortcomings and weaknesses are notable. These weaknesses include lack of awareness of the available services and programs for the elderly and limited funding for the available service providers among other issues. It is therefore recommended that:
Awareness of the services and programs available for the elderly persons should be increased particularly among the low-income minority populations. As indicated in the discussions above, there exists a variety of complex programs and services for the elderly to choose from, however, lack of proper guidelines and development strategies leaves many individuals confused. Therefore, there is the need to educate the consumers of these services about the goals and target population groups for the available services and programs (Hebblethwaite, 2006). This can be achieved through incorporating the local community leaders such as church leaders in informing their followers about the availability and the importance of support services for the elderly. Additionally, local events can be sponsored, which will bring people of different age-groups together. Through such gatherings, information about the support services and the importance of cared for the elderly can be communicated particularly to the youth.
Sufficient funds should also be availed to existing service providers in order to allow them to carry out their operations effectively. From the preceding discussions, it is indicated that there is great potential in the available resources in terms of catering for the needs of the elderly, but because of limited funds, it becomes almost impossible to implement some of the proposed policies. Funds can be raised through organization of charity walks and from other community service programs.
The low-income minority population groups should be empowered economically in order to access the available nursing home care services. As noted in the above discussions, most minority groups are aware of the available services and programs, however, there low income and lack of sufficient social security denies them access to these services. Therefore, empowering them economically will allow them equal access to the available services (Hebblethwaite, 2006). This can be in terms of encouraging more people to seek higher education, which will guarantee them better jobs and good salaries. Additionally, local communities can organize self-help groups, which can provide financial support to the disadvantaged among them.
The available service providers should develop culturally sensitive services and programs for all citizens. It is evident that the United States population is made up of diverse ethnic and cultural groupings. In order to satisfy the needs of each of these groups, there is the need to develop policies that take into consideration the cultural diversity of the American people. This includes development of self-management programs that give each individual to take control of his/her life at old age.
Educational services should be provided to those elderly individuals with limited educational backgrounds in order to ensure efficient and effective delivery of services. The discussions above indicate that limited educational backgrounds among most foreign-born naturalized Americans hinder communication between the service providers and the elderly persons. Therefore, through provision of educational interventions, these individuals will be given a chance to experience quality services just like their native counterparts (Hebblethwaite, 2006). This is achievable through encouraging more elderly people to join adult classes in order to improve their communication skills in English, which is mostly employed by all service providers.
Conclusions
This report entails a review of cultural, social, environmental, familial, and the community-based issues that affect aging and utilization of social support services and programs for the aged. This is achieved through an extensive assessment of the current needs and trends of the aging persons through analysis of a variety of literature resources and demographic data. Additionally, the report analyzes the statements of interviewees on their stand concerning the available services and programs and their delivery.
From the discussions above, a number of services and programs are identified particularly in Indianapolis some of which have been successfully executed and provided positive results. However, due to lack of awareness of the services and programs for the elderly especially among the minority population groups, service delivery has been unsuccessful in some cases. Other factors hindering the process of delivering services to the vulnerable groups include lack of funding to support service delivery and existence of diverse ethnic and cultural groupings. Additionally, limited educational backgrounds characterizing most foreign-born naturalized Americans means that most essential services are inaccessible to the greatest number of these individuals.
Therefore, it is recommended in this report that the stakeholders should develop programs and services that take into consideration the diverse cultural affiliations of all Americans. These services should also be clearly defined in order to ensure that they are understood by their consumers. On the other hand, there is the need to provide educational facilities and economic empowerment to the foreign-born naturalized Americans and the minority populations respectively in order to ensure efficient and maximum utilization of the available services.
Reference List
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