Dr. El

As I listened last week to a web event on confronting ageism in healthcare, I found myself nodding in agreement with the participants, who were all themselves nodding at the comments of their collaborators. 

The conversation, presented by the Kaiser Family Foundation’s Kaiser Health News and The John A. Hartford Foundation, was led by KHN’s Navigating Aging columnist Judith Graham and included panelists well known to the long-term care industry such as physicians Mike Wasserman and Elderhood author Louise Aronson, among others.

The discussion touched on many aspects of ageism in various healthcare environments and led me to consider where ageism might be present in long-term care. Unlike hospitals or clinics, LTC is all about elders, so theoretically we should be doing better than other healthcare settings.

In her recent column, ‘They Treat Me Like I’m Old and Stupid’: Seniors Decry Health Providers’ Age Bias, Graham defines ageism as “stereotypes, prejudice or discrimination because of their age” and describes multiple examples of ageism including the lack of recognition of elders’ needs and treating them as less valuable than younger people. 

Clearly, ageism was present early in the pandemic when resources were directed almost exclusively towards hospitals while nursing homes were being decimated by COVID-19. Low reimbursement rates and insufficient funding for staff reflect a lack of consideration of the needs of elders in nursing homes. 

Ageism is at work in our facilities when employees engage in “elderspeak,” talking down to older residents or when elders are viewed as diagnoses or cash cows and not as people. Another instance is the dismissing of resident concerns, so that elders need an advocate because their voices aren’t heard. With a growing number of “elder orphans,” who are potential residents without advocates, the costs of this problem will become increasingly apparent.

Other examples include a lack of accessible parking spots for visiting older relatives, the standard practice of prescribing medications that haven’t been tested in trials on older adults and insufficient staffing and routines to ensure that hearing aids, eyeglasses and dentures are utilized and well maintained. 

The panelists pointed out that heavier reliance on healthcare services and assistance with activities of daily living is appropriate for this phase of life, just as education costs are appropriate for youngsters and say, road maintenance, is needed for young adult and middle-aged drivers — but schooling and road maintenance is not begrudged and withheld like senior services. 

For an example within long-term care, consider that, unlike people whose completion of rehab leads to full mobility, older residents frequently need ongoing help when walking. The dearth of funding for assistance with daily exercise is ageism, with an underlying message that elders don’t need to maintain this aspect of their independence. 

The speakers remarked that the shortage of geriatricians in this country isn’t “written in stone.” As a society, we could and should be funding more geriatricians. (And, I’ll add, geropsychologists, since there’s a dearth of us too.)

We can tackle the ageism that’s present within our walls and our systems. The experts had many recommendations to promote change: make a ton of noise, speak truth to power, join groups and increase funding for home-based care and for SNFs. Include age in every equity, inclusion and justice conversation.

In the days following the presentation, a flurry of Tweets about ageism ensued. One of them included a link to ten free age-positive icons from a UK-based organization that also maintains a small, free, age-positive image library. I’m envisioning images like these for use on facility websites and in staff training materials, representing elders as fully engaged in life rather than as passive recipients of care. 

Once I started thinking more intently about ageism in long-term care, I realized that this “ism” is everywhere and that it will take collective awareness, effort and advocacy to change things. Thanks to outspoken experts such as those on the KHN event, the process is underway.

Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is a Bronze Medalist for Best Blog in the American Society of Business Publication Editors national competition andGold Medalist in the Blog-How To/Tips/Service category in their Midwest Regional competition. To contact her for speaking engagements, visit her at EleanorFeldmanBarbera.com.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.