Empowerment Issues

      Nearly every society, past and present, creates a "social clock" as part of the normative behaviors of that culture. The simple statement "act your age" helps illustrate how a society orders its members along perceived appropriate behavior and production. The clock even creates "rites of passage" that the individual must follow to be considered "normal."

       Some parts of the clock are related to the natural biological aging of the species. Birth through death, as if it were a simple linear concept, is mapped out; at young ages you learn that at adulthood you marry and earn, and at advanced age you are to accept death with quiet dignity.

       Psychological aging is also mandated by the social clock. A person becomes deviant if their attitude is not "mature" at given stages of life. Yet it now seems that our society allows the retired elderly to become less responsible; for example, as it is illustrated by bumper stickers that say such things as "Recycled Teenagers."

       Functional aging seems to be the most feared aspect of aging in our society. Many of our citizens fight aging with exercise, diet, medical help, and any new product that comes on the market. Gerontological research shows that people are labeled "old" more for functional losses than calendar years. Much of the data on nursing home admissions is tied to the new resident's loss of functionality and the inability of the previous caregiver to cope with these increasing losses. The specter of not being able to care for oneself looms in the minds of most elderly Americans.

       Ageism, like any other form of prejudice, is based on the concept that all people of a certain age range will behave in the same manner. It negates the uniqueness of individuals by "pre judging" members of artificial categories to be nearly copies of each other. Even well intentioned relatives may become guilty of abuse by doing too much for the older adult. This is one are that teaching them the concept of empowerment can really serve the best interest of the older individual.

       Empowerment suggests teaching people to do for themselves what they can do. In Logan, Utah, there is a very fine nursing home called Sunshine Terrace. The manager is a life long student of human services and has taught the staff to help patients do for themselves, as much as possible and then to praise them for what they did. They try very hard to not make an issue out of what the patient is unable to do for themselves.

       Harris and associates (2004) devote a chapter to empowerment in theory and practice. They make it clear that “The purpose of human service work is to empower people.” In many ways, this is the opposite of the elderly helping industry today, as measured very often in the typical nursing home. Most new patients (or should they be called inmates?) loose their remaining zest for life and autonomy in just a few weeks. The typical nursing home is run similarly to a hospital rather than a residence and regiments the very lives of the clients. Yet in some progressive institutions such as Sunshine Terrace, an occasional marriage takes place after two people meet, become close, and encourage each other’s health and dreams. They often leave the Terrace in better health than they came in. It is that type of outcome that shows the possible results of empowerment.

Towards Better Service

      The human services professional recognizes that the client has many interests and that their life probably entails relatives, friends, and others. Part of responsible case management is to include those others in the evaluation and in the empowerment.

At the University if Utah Center on Aging, this author has done a good number of interviews with adult caregivers, mostly of patients with Alzheimer's disease.

       Besides the closed ended questions used in the 1 1/2 hour interview, the last question is open ended and asks the caregiver if they wished to express anything else about their experience. Not everyone responded to this request, but those who did had important feelings to unload.

       It seems that they feel very alone and that others do not really understand what they are going through. Our research suggests that in, some cases, the caregiver is going to wear out before the patient has died, leaving two people who now need to have care. Therefore our research has looked at the adult caregiver and what they do with any respite time (such as having the patient go to an adult day care center). We found that the respite time did refresh the caregiver somewhat as long as they did something that they wanted to do, not that they had to do. Being somewhat refreshed, they were able to do their caregiving in a more appropriate and loving way.

       When assessing the situation of an elderly shut-in, many things need to be accounted for, such as these questions:

-How often have the children visited their parents in a typical month? What are the possibilities of increasing visits? What about the grandchildren?

 -Have the children called Elder Locator to see what services might be available to help out their parents? What other local sources of help might be available?

 -Is the older adult able to make contact, relatively easily, with their loved ones?

      Wilke and Vinton (2003) make a strong argument that students being trained in gerontological social work must learn about domestic violence, even within the older population. Although this is a difficult subject to deal with, the statistics from Adult Protective Services show a large demand for intervention in the relationships of older adults with their caregiving children. Instrument rape, starving the elder to death, and cruel forms of murder are found in the data.

       This article proposes an increase in education about issues of power, control, gender inequality, and understanding the various types of abuse and neglect. The case manager should be familiar enough with the client/patient that tell tail signs of abuse are noticed and followed up on.   Of course medical professionals are trained in this area, but the human services worker needs a similar training to properly execute case management.