The document discusses poverty statistics for the elderly population in the United States, noting that two-thirds rely on Social Security for at least half their income and that Social Security lifts over 14 million elderly people out of poverty. It also examines definitions of equal opportunity and capabilities put forth by Amartya Sen, stating that elderly individuals need more than just income for normal functioning within their community. Several key issues are identified, including high rates of social isolation for those in assisted living facilities, neglect and abuse in nursing homes, housing and transportation difficulties for independent elderly, and food insecurity issues. Proposed solutions focus on increasing funding for improving quality in institutions and home care programs while shifting to a more person-centered model of support and community participation

1. A N G E L I C A
T I L L A N D E R

2. POVERTY STATISTICS
• By 2030, elderly population will more than double to 72 million.
• 2/3 rely on social security benefit of $15,168.36 for at least half of their
yearly income.
• 13 million elderly individuals brought above Poverty line by Social
Security
• Without Social Security, 14.5 million in poverty, 5x current rate
• 12.5% currently impoverished

3. • A capability is essentially
the ability to function
normally in society and
participate in the life of the
community.-Sen
• Sen links capabilities to
the “freedom to lead
different types of lives.”
• Health and financial
restrictions force elderly to
make undesirable
compromises.

4. DEFINING EQUAL OPPORTUNITY
• Opportunity is based on what is important at different stages
• In order to be a part of the community the elderly need more than just a
subsistence level of income,
• access to social interaction, houses of worship, transportation, and in
some cases flexible employment and volunteer opportunities.
• Equality of opportunity means that every member of society is given the
opportunity to play an active role in the community

5. • WHO: “a state of
complete
physical, mental
and social well-
being and not
merely the
absence of
disease or
infirmity.”

6. • 40% of those over
65 will eventually
enter a nursing
home.
• 3.2 million living
in nursing homes,
• More than 900,000
in assisted living
facilities as of
2008
• 10 million elderly
in need of help
with some task of
daily living.
QUICK FACTS

7. • Home: Allows them to
remain in community
• Not always an option
• Institutional care must
provide
quality, supportive care
that fosters normal
functioning
• Equal opportunity
requires that legitimate
choice be given

8. COSTS BREAKDOWN
• Assisted living facility is $3,293 per month,
• average cost of a semi-private room in a nursing home is $6,235 per
month.
• At the same time the costs for a home health aide is an average of $21
an hour

9. SOCIAL ISOLATION AND INSTITUTIONS
• Social isolation is defined as “the distancing of an
individual, psychologically or physically, or both, from his or her
network of desired or needed relationships with other persons.
Therefore, social isolation is a loss of place within one‟s group(s).”
• outside friendships seldom make it past the move
• one in three residents does not receive one visit in a twelve month
period.
• Medical and depersonalized feel of facilities
• Treated as patients first, people second
• Rate of social isolation for older adults varies from two to twenty
percent but is as high as thirty-five percent for those who live in
assisted living facilities

10. INSTITUTIONAL CARE ISSUES
• >50% of nursing home staff acknowledged mistreating residents
through physical violence, mental abuse, or neglect in the last year
• 44% residents admitted to being abused, and 95% said they saw
another resident get abused
• Over half of all nursing home residents have some form of dementia
• Stanley (pseudonym)
• 80 to 90% of care is provided by nursing assistants, they usually have
little training to work with this population
• Obligation beyond not harming
• Bingo-larger social impact.
• Harold (pseudonym)

11. HOME CARE ISSUES
• Condition/Cost of Housing
• More likely to live in run-down housing
• 26 percent pay more than 30 percent of their monthly income to housing
(cost burdened)
• Transportation
• Only half of the elderly have access to sufficient public transit.
• Social Isolation
• 43% of older adults experience some degree of social isolation
• Food Insecurity
• 18% of the low income elderly who live with others
• 12% alone

12. SENIOR CENTERS- PATH TO EQUAL OPPORTUNITY
• 11,000 senior centers
• Serve over one million seniors
• Poorer health conditions, lower income levels, and lack of access to
transportation were good predictors of high levels of participation in
senior centers
• Home Based Programs
• Telephone Reassurance Programs
• Senior/Senior Programs
• Meals on Wheels
• average recipient was 75 or older, income of $10,000 or less a
year, and needed assistance with one or more daily living activities
• Typically at least 50% of daily food intake

13. SOCIAL ISOLATION AND INSTITUTIONS
• outside friendships seldom make it past the move
• one in three residents does not receive one visit in a twelve month
period.
• Medical and depersonalized feel of facilities
• Treated as patients first, people second
• Rate of social isolation for older adults varies from two to twenty
percent but is as high as thirty-five percent for those who live in
assisted living facilities

14. MEALS ON WHEELS
• Benefits of Meals on Wheels:
• Visit from a case manager for an eligibility assessment, telephone follow
up,
• and additional home visits as necessary,
• a variety of hot and cold meals consisting of
proteins, vegetables, fruit, bread, and milk,
• additional benefits include daily contact with the volunteer who delivers the
food.
• Average recipient was seventy five years or older, garnered an income
of $10,000 or less a year, and needed assistance with one or more daily
living activities.
• Average cost $840 per year.
• Meals typically provided recipients with at least half of their daily food
consumption.
• Campus Kitchens “Backpacks”

15. CULTURE CHANGE
• Culture change is defined as the transformation of nursing homes from
an „acute care‟ medical model to a „person directed‟ model
• Focus on providing dignity
• Studies of facilities that adopt this approach have found decreased rates
of staff turnover, increased levels of occupancy, and higher rates of
resident satisfaction and quality of life versus the national average
• Additional $11.43 per bed per day for a 140-bed nursing home. This
translates to an additional $584,073 in revenue per year

16. ETHICAL WRAP UP
• Does not mean we want them to get jobs
• Those who can remain independent should be provided with the
financial and medical resources necessary to do so
• For those in institutions comprehensive programming available to them
in order quality of life
• Participation in society is the cornerstone of a democratic nation

17. ACAREFORMS
• detailed payroll, staff ratios, nursing hours, turnover and retention
rates
• staffing information, health inspections, penalties, and complaints to
the government‟s nursing home compare website
• grants to facilities to develop best practices that create a more home-
like, dignified environment for residents
• $2.25 billion for transition counseling
• $50 million for Aging and Disability Resources Centers
• Community First:
• 6 percentage points in their federal matching rate
• Must develop person-centered plan
• $500 million to support home visits

18. • More funding for
institutions to raise
quality
• Enforcement of
Accreditation Policy
• Food Insecurity-more
funding, culture change
around aid
• Facilities made to be
more home-like
• Strong Advertising