National Nurses United

Aging:Final 9/4/07 4:06 PM Page 15 when and what you eat. On shower days you are stripped naked, wrapped in a towel, placed in a shower chair, and dragged down the hall to the shower room." Brunner agrees that avoiding institutionalization is important. "How do we set up a social support system and infrastructure to help old people get services at home and keep them out of nursing homes?" he asked. ROBERT COHEN/ST. LOUIS POST-DISPATCH/NEWSCOM Finding solutions will not be Approach, argues that "the problems of older people require addressing things that some people think of as falling outside the realm of healthcare," such as the design of cars and houses. Creating a friendlier environment for senior health, he says, means pulling city planners and building contractors into the mix. "How do we design more walkable communities? Can we build communities that have short distances to walk to stores, supermarkets where [elders] can purchase fresh fruits and vegetables?" Since up to 70 percent of diseases that afflict seniors have behavioral, not genetic, roots, this is not just a matter of providing people better cuisine. Eating properly and exercising by walking in safe, well-lit parks is part of the formula for what Satariano calls "adding life to years, not just years to life." Satariano's "ecological" approach argues for creating living conditions that are senior friendly. "Houses should be designed with a minimal number of steps, bathroom walls should be reinforced for attaching supports, and doors made wider for wheelchairs." Wallace said that the same approach to improving elder health should be applied to planning entire communities. Reflecting roofs, cooling trees, and parks—so-called "heat islands"—would reduce hot weather deaths. City planners and zoning boards should encourage the building of "granny units" so family can live nearby. He says these initiatives should be no more controversial than putting fluoride in the water to reduce tooth decay: "You just do it!" "The core problem is that we don't need more medicine, we need to set up communities so that people can become more active," said Wallace. "Instead of thinking what we need to do to keep people in their homes—where 90 percent of older people want to be— long-term care gets caught up in cross currents and ideological debates where free market advocates see privatization as a solution to everything." Martin, the NP, also touches on the human upsides of helping elders live better in their own homes. "There is a huge emotional and physical toll to being institutionalized," she said. "There is a complete loss of privacy, dignity, and control over your life. You are told SEPTEMBER 2007 easy and challenges a cohort of powerful lobbyists that run the gamut from pharmaceutical companies to insurance behemoths. On the other hand, the political power of seniors has grown over the past decade, and local and state governments, as well as the medical establishment, are coming under increasing pressure to respond to demands for improving elder care. At least the outlines of a solution are out there. One is to end health disparity. "Everything links back to growing income inequality," said Brunner, and Satariano agreed that "the issue of disparity is critical." Kay McVay, RN, and president emeritus of the California Nurses Association, says income is directly related to the quality of elder care. If patients don't have the money, they can "end up tied to a gurney or strapped in a wheelchair and stuck in the back of a facility." Two is to create a nationwide healthcare system that coordinates care. "Single-payer healthcare would end the idea that you can make big profits off of old people," said McVay. "It establishes one standard of care for everyone, whether you are in an acute care facility or a long-term care facility. The only criteria should be: 'What does the patient need?'" Three is to improve training. "Medical schools must train students to treat older Americans," said Brunner. "We have a right to make demands on our institutions," said Satariano. As Landau bluntly put it, "You have to teach geriatrics." Four is designing communities and programs that take into account the ecology of aging. "When you are elderly you need not just medical attention and medications," said McVay. "You need good nutrition and exercise and things that challenge your mind. Otherwise it is just warehousing. It shouldn't be that way and needn't be that way." Mobilizing the medical profession; pushing federal, state, and local governments to stop turning a blind eye to the problem; and neutralizing the lobbying power of the "medical-industrial complex" will be a formidable task, and yet given the size of the constituencies involved, one that may not be as difficult as it initially looks. In the end, it will also take a sea change in our attitude about elders, "who are not exactly revered," as Landau pointed out. "I know it sounds sort of corny, but you have to have love and empathy. Aging is about loss—loss of independence, loss of mobility, eyesight, hearing, cognition. You need an approach that allows people to deal with loss in a collective, supportive way," she said. I Conn Hallinan is a foreign policy analyst for Foreign Policy in Focus and a columnist for the Berkeley Daily Planet. Carl Bloice is a freelance writer based in San Francisco. W W W. C A L N U R S E S . O R G REGISTERED NURSE 15

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