The Hispanic Paradox

The growing numbers of ethnic seniors throughout the U.S. continue to experience a litany of problems when accessing services. Among them, language and cultural barriers, a fragmented service delivery system and a lack of properly trained bilingual staff with heavy case loads. But they have a big advantage – longevity despite their lack of access to healthcare, lack of health insurance, lack of education, acute poverty and obesity and diabetes rates that hover at epidemic levels, they live longer than any other group in the U.S. Hispanic men live an average of 80 years, 2 years longer than their white counterparts and Hispanic women live to be 85 years, 7 years longer than any other group. 33% of them have lower mortality rates from heart disease and 36% lower incidences of cancer.

Over one million individuals in Florida, that are over the age of 60, are Hispanic. An advantage of catering to Hispanic elders is what it is commonly called the “Hispanic” paradox. Hispanics, despite their socio-economic hurdles and lack of access to healthcare, live longer than blacks by seven years and whites by five years. Overall, Hispanic seniors are much healthier than expected. The reasons for this paradox are still a matter of debate. Many suggest that factors such as diet, comprised mostly of beans, rice, fruit and vegetables; lifestyle choices and strong social-support networks are key to understanding Hispanics’ better-than-expected health.
However, these benefits, that they bring with them, gets weakened in the U.S. Second generation Hispanics do not benefit from this longevity. Many argue that the reason is the fact that being in the U.S. produces a change in their diets and exercise routines. Researchers in the U.S. are perplexed about this phenomena but at the same time, they are studying the factors responsible for the longer life expectancy in the hope to arrive at a set of principles that will reduce disease rates for all racial and ethnic groups.

I do not fit in that pigeon hole

I have always had a problem with how we arbitrarily place individuals in neat categories for the sake of understanding them. With time stereotypes are developed and when we speak about a certain individual what we remember is the stereotype. I believe in the timeless relevance of people, whatever their age, whatever their background. I am more relevant to others today at age 67 than I was when I was 25 years old, and yet, most people think that I should retire, that I have completed my life cycle. This is a shame. Individuals like me have so much to contribute given their life experience. Although we have made great progress in changing the way others see older adults there is still much to be done. Ageism, a phrase used to denote prejudice against older adults, is alive and well in this country and others. Recent articles present us as selfish and greedy. I take great exception to Joel Kotkin’s article in Newsweek, Are Millennials the Screwed Generation? (July 16, 2012) in which he claims that we have screwed the young generation by taking away jobs by not retiring when we ought to. In my case, the opposite is true.

I am still working and do not plan to retire anytime soon. I created my own company fifteen years ago. The last ten years have been the most productive years of my life. I have been able to better provide for my family, create hundreds of new jobs, change the way we care for low-income seniors in this country and improved the lives of thousands of seniors by providing affordable housing and services to them. I feel more relevant and satisfied than ever before. But make no mistake, I am not exceptional. Thousands of individuals like me are changing the world so that the next generation has it better than us.

In 2006 I was awarded the first Purpose Prize, an award given to those over the age of 60 that have made great contributions to society. Every year since then, awards have been granted to those who have made unique contributions to the welfare of children, young disabled adults, service men returning from wars, reversing climate change, opening the doors to young adults to go to college, among others. It is an impressive group of individuals wishing to leave their mark on this world for the betterment of others. Being among them makes you wonder why we are so vilified and unrecognized. I must conclude that it has to do with the historical phenomena global aging. Never in the history of our world have seniors outnumbered teenagers two to one. Because we have limited resources, this event has pitted young against old.

It is time to set the record straight and the media can do so much. I welcome the New York Times’ recent Boomers website (Booming, Living Through the Middle Ages; http://topics.nytimes.com/top/features/timestopics/series/booming/index.html) where we can begin shattering stereotypes and think of life as having no age but timeless relevance.

Housing is the Platform to Improve Health

For several years our firm has advocated providing support services at home to ensure improved well-being and cost savings. In doing so we have run into the silo mentality that exists in most government organizations. The US Department of Housing and Urban-Development (USHUD) insisted until recently that housing was just a roof, whatever happened under that roof was not an issue for them. In 2003, with several successful projects under our belt, we approached both USHUD and the Department of Health and Human Services (HHS) to collaborate so that appropriate services could be combined with housing. It took several years for them to accept that this concept was vital to serving the very individuals for whom they existed. A recent article published by USHUD speaks of housing as the platform to improve health and that stable housing was essential in addressing the health needs of chronically homeless individuals. What a novel idea!

The article highlights several programs undertaken in Boston, New York and Chicago. In Boston it was revealed that health issues impeded the ability of residents to obtain and retain housing. New York Common Ground organization found that in order to meet the needs of the homeless population a partnership between health and services was essential. The Chicago project demonstrated that a strategy to marry healthcare and stable housing was successful and cost-effective by reducing unnecessary hospitalizations and emergency calls.

All of the collaborating institutions, however, realize the difficulty of establishing collaboration and integration among disparate systems, programs and organizations. They call for a focus on individual needs, system reforms and elimination of existing barriers to collaboration and integration. All is well you may say. However, in our experience there is a chasm between identifying the issues and doing something about them. Time will tell if we can do it right.

Do I want to live forever?

I’m not alone when I say that I would like to live long enough to see my grandchildren become young adults, but only if I am in good health. There are many in my generation that feel the same way. Much has been written about the potential longevity of the baby boomer generation and the effects it will have on entitlement programs like social security and Medicare. However, recent studies present a different picture. According to a University of Illinois study baby boomers will not live longer than their parents have despite the healthcare improvements, new drugs and the long 20th century experience of ever-rising life expectations; the culprit – factors like elevated rates of obesity, cancer and suicide.

Another study by Rice University claims that it would be a mistake to project longevity gains of the last century throughout this one. Health status of the baby boom versus the preceding generation reveals that they are in worse shape. There is a higher propensity to suicide particularly for those in their 40′s, a time when those rates typically head down. And then there is the ‘Big C’. The post war generation has a higher rate of cancer at younger ages than the previous generation. Women of this generation are the heaviest smoking cohort in U.S. history and they are now suffering its effects.

Obesity among boomers is linked to rising disability and serious health problems like diabetes and heart disease. However, the true impact on longevity that obesity has cannot be seen until we get older. Socioeconomic factors will also significantly impact longevity. It is a well-known fact that rich people live longer than poor people do. We know that the gap between rich and poor keeps widening in this country and that the impoverishment of individuals keeps creeping up. The most at risk, of course, are Latinos and Blacks who swell the ranks of those living under the poverty level. They will see drastic declines in health status over the years.

The moral of the story is that in order to live longer we must have been blessed with good genes and the absence of major health problems, a socioeconomic position that allowed us to have access to preventive healthcare and live healthier lives, otherwise it makes no sense to live forever.

Do you believe everything you hear or read?

Can you believe that 80% of readers/viewers in the U.S. were well versed on Tom Cruise’s divorce but had no idea of the impact that the Affordable Care Act would have in their lives? And among the 20% that had read about the Act, most were uninformed about its implications. I know that many times information we receive is biased and censored forcing me to be skeptical of the source and to always read the other side of the story. While my views are biased in regards to the Affordable Care Act, given the fact that I have lived in a country, Australia, that had universal healthcare and I believe in it, some of the arguments we are hearing are predicated on lies. The Affordable Care Act, in its entirety, is a HUGE victory for seniors, strengthening Medicare, improving community long-term care, providing additional transparency protections against abuse and neglect and lowering costs of medications, among others.

However, what we are hearing during this election year is that the Act that was formulated and approved by Congress, now called Obamacare, will kill 800,000 jobs, is bad for the economy and worse it is a federal takeover. Recently, Congress spent $50 million of our taxpayer’s money drafting a bill to roll back the Act. But let us examine these statements to get to the bottom of the arguments.

According to the Congressional Budget Office 800,000 workers will now retire because they will have healthcare insurance. I assume that those jobs will then be open to others who are seeking employment. So in a sense, it is not a loss of jobs but perhaps the creation of new job opportunities. Let’s face the fact that we cannot afford to continue with the spiraling healthcare costs. In the last three months my husband has had four MRIs, each costing around $4,000 each. He is in perfect health but doctors insist that to be sure nothing has changed he must have another one. Reigning in the growth of healthcare costs is one of the priorities of the Act. Moving dollars away from expensive fee for service Medicare is good for the economy. Experts have concluded that after 10 years of the Act our healthcare system will cost half a trillion dollars less than today. The last argument that this is a federal takeover is a complete undiluted lie. Would you say that delivering 30 million new customers to private insurance companies is a federal takeover? Liberals in fact agree that the Act should have created a more robust public option but that did not pass muster with the strong lobbying arm of the private insurance companies. Seven other states, including Massachusetts, have in the past passed laws offering coverage to all. All but one has failed because the law did not mandate that everyone must be covered. Only Massachusetts mandated that and was the only one that became succesful.

My advice to you is that you must seek the truth, always consider the source of information and use common sense to make your own conclusions. Be skeptical of all you read and hear.

Someone has to pay

As states begin to provide more home and assisted living services to seniors the number of nursing home beds begins to decline. A study done by Harvard Medical School found that a 10% increase in assisted living capacity led to a 1.4% decline in private pay nursing home occupancy. Most nursing home residents pay privately for nursing home care thus don’t affect the occupancy in Medicaid beds. In order to decrease the number of nursing home Medicaid beds, states must make an effort to increase funding for Medicaid clients living in nursing homes that want to receive services at home or in a Medicaid funded community care (assisted living) facility. To this day, the private assisted living industry takes Medicaid eligible residents only if they have an occupancy problem. They prefer not to deal with the complexities of billing the government and the excess of monitoring and reporting that goes with having a Medicaid resident. However, state Medicaid agencies are hard pressed to reduce the number of individuals in nursing homes paid by Medicaid if they are going to see reductions in their Medicaid long-term care budgets.

Although this move benefits clients who wish to remain at home, it drastically impacts the financial viability of nursing homes across the U.S. With less private paying clients nursing homes will start cutting back essential services to an ever growing number of very frail clients. What is more, some states like Pennsylvania are billing family members for the cost of nursing homes. The Pennsylvania law stipulates that family members of nursing home clients are ultimately responsible for the cost. Some families have been billed some $96,000 for the care provided to a family member residing in a nursing home.

At the end someone has to pay, either a family member or us, the taxpayers. What the story tells us is that long-term care in the U.S. is broken and needs to be reformed soon. One answer will be for states to continue to rebalance their long-term care program, provide more community care and make it easier for providers to want to work with the government.

Change is Underway

In the beginning we felt a moral obligation to change the way we care for those less fortunate in our society, the poor elderly and disabled. We soon realized that by changing living conditions, we were improving the health of those individuals, cutting healthcare costs, reducing Medicaid spending, creating new jobs and economic activity, revitalizing neighborhoods and increasing the affordable housing stock. This was the argument we used in convincing government to invest in our project.

Global aging is a historical phenomenon impacting all segments of our society, work, retirement, entitlement programs and healthcare among others. The demographic tsunami of the baby boomer generation will only compound this crisis. Tackling the challenges of global aging must be a priority of all countries. We need to keep seniors healthier, away from institutions, working and engaged because our society drives when everyone in it does. Yet we continue to segregate the elderly, not to be seen or heard. We know so little about them, no wonder our younger generation does not see them as role models.

However, it is going to be hard to continue to ignore seniors in this country. Those of us who belong to the “boomer generation” will be demanding changes. After all we are known for our activism, a trait that has not diminished as we age. We have not given up on changing the world, we are more adamant than ever that we can.