Wednesday, June 13, 2018

World Elder Abuse Awareness Day and Reaching Out to Socially Isolated Older Adults

June 15th is World Elder Abuse Awareness Day - the National Council on Aging is working to raise awareness about the different kinds of abuse that older adults experience.

Most cases of elder abuse are unreported and untreated. A report on elder mistreatment from the National Institutes of Health estimates that only 1 in 14 cases of elder abuse are reported. That's less that 10%.

Lately, I have been interviewing service providers in my area who work with older adults, and they are confirming what we see in the literature about elder abuse.  That the most prominent factors that put seniors at risk of abuse are social isolation and mental impairments like dementia.

Nationally, in about half of reported incidents of elder abuse and neglect, the person responsible for the abuse is a family member, usually a spouse or adult child. The research also indicates that the abusing party is often the only source of care or support the victim has, and so they are reluctant to tell anyone what is happening, for fear that the will lose that relationship and end up completely alone or in a nursing home.  This is certainly what my interviews are reporting so far.

So, how do we identify older adults around us who are socially isolated, and how do we break that isolation?  The National Council on Aging suggests 4 steps:

1. increase communication with isolated older adults - if they are family, reach out to them more than you have been; if they are neighbors, make an effort to get to know them, invite them out for coffee or a meal, or ask if you can help them with yard work or accompany them on a walk; engage other neighbors in reaching out to them as well

2. offer to accompany them to social activities at a local church or senior center

3. explore their interests and hobbies - are they a gardener? maybe you can ask their advice about your garden or invite them to help pick out plants for you at a local garden center; are they a reader? you can ask them to join a book club with you;

4. help them identify opportunities for support whenever they need it - if they are online, they can access a support community through Mental Health America; if the prefer talking on the phone, give them the number for The Friendship Line: 1-800-971-0016. This is a nationwide 24/7 warmline and also a crisis intervention hotline, that specifically serves older adults or adults living with disabilities.  They also reach out to their callers on a regular basis, to monitor their health and well being.

In addition to these ideas, you may want to reach out to the person or persons who are caring for an isolated older adult. Sometimes they are just as isolated, and it is that stress and isolation that can lead to some kinds of elder abuse.

If they are family, what can you do to assist them in caregiving? Are there ways you can offer them respite, or time off from their caregiving responsibilities? Can you stay with the older adult while they take time for themselves or run personal errands? Is there a way to help them take a vacation? Can you connect them with services through your local Office or Aging or Alzheimer's Association chapter? Perhaps they would benefit from learning about challenges faced by other caregivers - this can be accomplished by attending a caregiver support group relevant to their loved one's condition, or they could access online resources like Caregiver Matters of CNY, where I provide links to articles and resources related to caregiving, or videos about issues faced by caregivers.

If they are not family, perhaps you can introduce yourself to them as a neighborly resource, interested in helping them and their loved one. Offer to put some of the above ideas in place for their loved one, or ask them if there is anything specific that you can do for them. Maybe you can help with mowing the lawn or shoveling their snow; perhaps you can offer to check in on grocery days to see if they need anything from the store. After establishing trust by proving yourself to be reliable and consistently engaged, you may be able to offer them opportunities for respite as well.

Sunday, April 29, 2018

Who Said Life Was Fair?

Nobody who has ever had cancer, that's for sure. Or who has loved someone who had cancer. Or lost someone to cancer.

Today I found out that a friend who has been incredibly successful at surviving longer than medicine  originally predicted he would may not be with us much longer...

I don't know why some of us get cancer and some do not, or why some who get cancer get to have a "curable" cancer and others do not. Or why good people die and bad people don't, or some people with children and grandchildren to love and watch grow die, and some do not.  I have lost a beloved mentor to the same cancer I had, I have lost friends to the same cancer I had, and I don't know why I was able to survive it and they were not.

Everyone diagnosed with cancer, any cancer, is given their odds - odds of a cure, odds of survival, odds of recurrence.  Odds. Statistics. Numbers. Numbers that may mean something, or may not. And you have a choice, fight the odds or believe that they dictate your future. Statistics may not reflect individual experience. Unless they do.

After my first biopsy in 2002, I was given excellent odds - very small chance that the atypical tissue they found would be breast cancer. Except that it was. Early stage, DCIS, but there it was. Once you have DCIS, you are at risk of getting it again. But not necessarily of getting invasive cancer. Unless you do. Which I did in 2007. Again, the odds of getting it were lower than the odds of not getting it, but the odds betrayed me.  Now, I live with incredibly small odds of recurrence, and because I did everything I could to lower even those small odds, according to the medical understanding at the time, I work at training my brain not to worry about it.

I think most of us, when first diagnosed, feel hopeless. Maybe we believe the odds are too great. Maybe we consider the treatment too frightening. The future in front of us is suddenly uncertain, or we are just painfully aware of how uncertain the future really is. What if we can't beat it? What if we can? What if it comes back? What if it doesn't?

When my friend was first diagnosed, he almost didn't fight because he was told his odds of survival, even with treatment, were incredibly low. But then he decided to fight, for his kids, for his wife, for their future. Treatment made him so sick, he almost gave up. But then he didn't. And after months of chemo and radiation, he bought himself years of survival that the statistics said he would not have.

Some of us beat it, and some of us don't. There is no way to know which we will be. And beating it once doesn't mean it won't come back or that you will beat it again if it does. Some people who develop late stage or metastatic disease can enjoy long periods of remission after treatment, but not everyone. And nobody seems to be able to predict who will fall into which group.

For the patients and their loved one, this uncertainty can be unbearable. Or you find a way to bear it.

And then some other damn thing like an infection finds it's way in to your body because of the treatment that has been keeping you alive. And there it is. Suddenly you are losing the fight, and it's the fighting that makes you lose. You can follow all medical advice, and take every possible precaution, and there's nothing you can do to predict if or how it will happen. It ambushes you, it ambushes your family. All are powerless in the face of it. No matter how brave you are, or how determined, or how loved, or how worthy. Even knowing  this a disease that can kill you, there is no way to really be prepared for losing the fight. It's maddening, maddening and heartbreaking. 

It is heartbreaking knowing that the world is going to lose someone who is a good person, who has children and (soon) grandchildren to love and watch grow up, who has fought bravely and beaten horrible odds to live this long.  Heartbreaking and infuriating.  And unfair.

Tuesday, January 30, 2018

Foster Kids and State Support for Tuition

Wisconsin aims to become the 29th state to offer some form of tuition support to foster youth.
 
I hope they are able to pass the legislation. Research shows that between 31% and 46% of foster kids experience some period of homelessness between "aging out" of foster care at 18 and their mid-twenties. They either live on the street, in homeless shelters, or "couch surf" in their friends homes. 
 
College gives foster kids (my siblings and I entered foster care system when I was 13) a chance to develop as independent young adults, to be competitive in the job market, and in many cases, to rise above the poverty we grew up in. According to the Education Commission of that States, there are now 28 states that offer foster kids varying levels of financial support for college (tuition waivers, grants, or scholarships), and New York is one of them through the Foster Youth College Success Initiative established by McKinney's Education Law section 6456. This bill provides grants to SUNY schools (and CUNY schools in the NYC area) to cover tuition, fees, books, transportation, housing, and summer college prep, including advising, tutoring and academic assistance. So financial and academic support, to better ensure their success.

These supports were not available when I graduated from high school in the early 1980s. The rare foster kids who dared pursue a college education (of the 75 kids who lived with my foster mother during her career as a foster parent, only 3 of us went to college, and only my brother and I graduated from college) back then had to make our own way. Our family was rare; three of us were still in foster care when we graduated from high school and we all went on to college. All of us relied on some combination of scholarships, financial aid, student loans to pay for school. 
 
To apply for financial aid back then, foster kids had to provide financial data from their parents, even if they had no relationship with them or access to that information or access to those resources. In my case, my parent's poverty helped me get some financial aid I might not otherwise have gotten, so it worked in my favor that I had enough of a relationship with them to get that information. But they only gave me a total of $75 towards my college expenses, so not much financial support there.
 
I was 17 when I graduated high school, so unlike many foster kids, I would have been able to continue in foster care until the next fall when I turned 18.  That might have been enough time to get a job and save some money so I could afford a place to live, but for many foster kids, it isn't enough. Which is how they end up homeless or in jail. However, I didn't have to find out what would happen to me if working and being on my own at 18 was my only option, because I was able to go to college. 
 
The Big Breaks That Allowed Me To Succeed
Because I went on to college, my Medicaid coverage was extended from my 18th birthday until my 21st birthday, and my foster mother got her monthly stipend for my room and board until I was 21. Legally, that money was hers, but every month college was in session she deposited it into a shared checking account so that I could use it for expenses at school. My first, and perhaps most important, big break. Without that extra money, I don't know what I would have done. And because she was still getting that stipend, she also allowed me to continue to stay with her during college breaks and summers, although I had to bring everything I owned with me back and forth to school, or store it in a barn while I was away. And everything stored in that barn became water-damage by my junior year.

I turned 21 during the fall of my senior year of college, and that's where my health insurance and my foster mother's support stopped. I had minimal coverage through the health center on campus, so I didn't really notice the loss of health insurance. But without that monthly stipend, I had to pick up a second job to help cover my rent. I was already doing 20 hours a week at a work study job. The second job did not last; it was too much to keep up with school work and my first job, my social life, and also get enough sleep, so I was fired for missing a mandatory, unpaid staff meeting at the second job on one of my days off. Retail - horribly abusive to their employees. As a result of not being able to manage a second job, I fell behind in rent. 
 
My second big break was that two of my brothers were able to loan me some of the money I needed to keep up with my rent the first half of senior year. Even so, by the end of senior year, I was five months behind in rent.  
 
This was where I got my third big break - my landlord let me carry that debt until I had a full-time job and could pay her back.  She even rented to me again for the following year, deferring the required first month's rent and a security deposit until I found a job, so that I had somewhere to live after graduation. I paid her back in full as soon as possible that first year.
 
Without these big breaks, I don't think I would have finished school or had anywhere to live senior year. In other words, I would have become homeless. And that possibility was always there in my mind during my early 20s, when I was living paycheck to paycheck, paying back my debts from senior year, and barely scraping by. But instead, because a handful of people were willing to provide needed financial support, I was able to finish school and find a job, and become successful.

And now, in 28 states across the country, foster kids have a chance to do just that, without having to hope that the people around them will come through in a crisis. This is good news for foster kids in those 28 states, but we need the rest of the country to catch up.