Cultural Values Do Not Give Priority to Providing Services and Support for Older Adults

Cultural Values Do Not Give Priority to Providing Services and Support for Older Adults

Despite improvements in health care that have increased the life expectancy of persons throughout the world, aging is still viewed by many Americans with fear and trepidation.

Two of the most beautiful words in the English language–“nursing” and “home”–when put together in the term “nursing home” have become a symbol of fear, isolation, and suffering in the minds of many middle-aged and older persons. Life course planning in America is common in the financial planning arena, but has not been applied in the same way to lifelong improvement of self-care competency, and planning for learning the skills of relationships, care receiving, and caregiving. This lack of planning may be due to the dominant American cultural fear of aging. Unfortunately, this lack of motivation to make personal health-conscious decisions in early and mid-life may result in inadequate planning for lifelong meaningful activity, social support and living arrangements for later life. Thus, many older adults are not prepared for the natural occurrences of physical decline, loss, and grief.

The presence of strong elder bias in the American culture prevents the application of new scientific knowledge and ways of thinking to clinical practice in the care of older persons. Older adults may have a variety of risk profiles for poor health, from the robust to the frail elderly. Yet, most of the stereotypes of aging picture the frail and disabled. Thus, many health care providers do not think interventions to teach techniques for self-management of symptoms are worthwhile in older adults because they will not live long enough to justify the effort.

Wagner, Austin, and Von Korff (1996) have identified the conditions of the health care system necessary for the care of older adults with chronic disease and their families. These conditions in large part focus on “delivery by design” and include such features as having formal interest in the client’s feelings of self-efficacy, the presence of well-oiled outreach and monitoring activities, the capacity to provide personal, individual, and group coaching in behavior change, and overt attention to customization of standards of care to fit expressed preferences and family abilities. Unfortunately, these performance attributes have rarely been designed into health delivery systems. The primary model driving both formal care design and financing is care in urgent and emergent conditions, rather than preventive services or support for management of chronic conditions (Institute of Medicine, 2001).

Almost all financing schemes, including Medicare, are derived from methodologies directed at paying for acute care and procedure-oriented visits or hospitalizations. During the last fifteen years, significant reductions in hospital length of stay have produced a complex cascade of unintended consequences and burden for families caring for acutely and chronically ill elders.

Often, multiple transitions mandated by payment systems funding various levels of care (skilled care, intermediate, assisted living, and foster care) have produced extreme complexity, lack of coordination, and lack of assessment of the true needs of families for safe care in the home. Unfortunately this focus on “setting-specific” strategies rather than family-centered care planning that is coordinated through time, place, and person, has produced chaos, redundant costs, and unmet needs. Assisting families to uncover values and personal goals as they learn to interpret complex care regimens, self-care directions, and treatment orders is often not a part of routine care in formal health care organizations. Funding for basic group educational classes to coach families in growing self-care skills and competencies is not provided for in current billing provisions. The best practices for improving self-care skill that have been learned in patient education centers and large funded studies in managed care organizations have seldom been translated into Medicare, Medicaid or commercial business payment systems. 

In the American culture and value system, emotional and cognitive understanding of illness and health often are not congruent.

While elders and families are intimately involved in the emotional aspects of illness and disability, health care providers are likely to disregard emotional experiences and concentrate on logical solutions to treat or manage chronic disease conditions. Though medical anthropologists have described health and illness in terms of culture, health providers in clinical practice pay little attention to the “experience” of illness (Kleinman & Seeman, 2000). In the care of older persons, this lack of attention to the lived experience of chronic illness results in insufficient adjustment of care plans to fit with practical and financial realities of patients and families. 

Summary and Conclusion 

Older adults seek better quality of life in the later years. Quality of life has come to mean much more than just physical health or the absence of disease. It includes a general sense of happiness and satisfaction, meaningful activity, and the ability to express culture, values, beliefs, and relationships (U.S. Department of Health and Human Services, 2000).

Thus, the health care system’s current emphasis on physical health as the main component of quality of life has in part created an artificial and dysfunctional way of examining what needs attention. A better approach to improving quality of life would be to focus increased interest on understanding meaningful life issues in the home affecting physical, social, emotional, and financial health. 

Though quality of life is a complex and personal concept for each older adult, four crucial issues were discussed in this paper that affect the quality of life of many older Americans: insufficient resources to help individuals and families manage multiple chronic conditions, the lack of health care providers educated in broad-based geriatric care, the high cost of health care, and the lack of attention paid to the needs of older adults in American society. There are no easy answers to solving the problems associated with these issues, as the solutions would require establishing new priorities in the value system of American society. The challenge is not to increase the number of health care providers who are focused on diagnosing medical problems in older adults. Instead, the challenge is to place value on the full spectrum of helping older adults enjoy quality of life in old age. This change of values will only occur with a commitment to embrace the importance of aging issues by universities that educate primary health care providers, by health care organizations that decide what health care will be received by elders and their families and how much that care will cost, and by legislators who determine the budgets for national health priorities.