Signing off!

I’m making this post to announce that my time as a student at Swansea University has officially come to an end. I turned in my dissertation on September 25th, a full 5 days before the official due date. I made a post to my personal blog that day, discussing the end of my career as a student, but I wanted to wait to make a similar post here to give myself a bit more time to reflect. It’s now been two and a half weeks since I submitted my dissertation, and it still feels a bit strange to be done. All my life I’ve been a student, and I’ve now completed my final experience as a student for the foreseeable future. Of course, it’s not official until I graduate in January, but this will be my final post to this blog.

So much has happened in my year at Swansea and I have learned so much, it would be impossible to recap it all here. I couldn’t do the experience justice in one post, and each previous post has highlighted a piece of the experience. But the one thing I would like to say is how thankful I am that I made the decision to be a part of the Ageing Studies program at Swansea. When I decided to apply for the program,  I was looking for the opportunity to explore the research side of gerontology. The program at Swansea offered the opportunity to conduct my own research and to interact with and learn from researchers in the field. My experience certainly met these expectations. Prior to beginning this program, I knew how much I enjoyed working directly with older people and that I wanted a career that would allow me to help improve the lives of older people and improve the quality of services provided for them. Though that has not changed now, my experience in conducting my own research has opened my eyes to the importance of research towards service provision. Though I’ve always known of the strong need for evidence in order to have evidence-based practice, I didn’t expect to enjoy my evidence collection and analysis as much as I did. I know it helps that it was on a topic that I am passionate about, but even so I found the research process far more challenging and engaging in an enjoyable sense than I thought I would. Now as I’m looking for jobs, I find myself looking at nearly as many research-based jobs as service-based positions. In the long-term I think I would still find a career working directly with people more fulfilling, but in light of having just completed my own research and had a taste of that experience, I’m thirsty for more!

I’m not sure where I’ll end up in the next few months, what job, what city (or country, even!) but I’m glad to have been able to share my experiences at Swansea University on this blog, and I hope that you (my readers) have enjoyed as well or found something helpful here.

Hwyl Fawr–that’s goodbye, in Welsh!

Approaching the deadline!

Well, the countdown has begun! Last Friday was officially one month from when my dissertation is due–that seems CRAZY! It also blows my mind that I’ve been over in the UK for a year now. I’m in a good place when it comes to my dissertation; I still have a lot of work left to do but it will definitely be manageable in the time I have left. Shortly after my last blog post I met with my dissertation supervisor and we agreed that I could end my data collection and go ahead with my analysis and discussion. In the end I had a total sample size of 16 people, which is quite small considering I’m using quantitative data, but still workable as long as it’s framed in terms of a preliminary/feasibility study. I’m also getting to include something called reflexive analysis, which involves discussing the practical issues that emerged in terms of design, recruitment, ethics, and so forth. I’m really enjoying it! I’m hoping to turn it in a few days early, so my current self-imposed deadline is 25th September, but the actual due date is the 30th.

I’ve also begun looking for and applying for jobs here in Wales. It’s something I’ll focus on more and have more time for once I’ve finished my dissertation, but I figured that my deadline is close enough that I might as well begin now if jobs come up that I’m quite interested in, and there have been a few already.

Sorry I don’t have much more interesting things today, but my life has really been solely focused on my dissertation lately. As a bonus, here’s a really beautiful news story that I found via the Daily Mail, but that actually took place in my hometown!

I really recommend watching the video because it’s much more powerful that way, but it’s a bit long, so you can read the Daily Mail story here if you’d prefer. Hope you enjoy!

Portrayals of older people in films

Sorry I’ve been a bit quiet lately, but I’ve been quite busy with both leisure and academic stuff! A few weeks ago some friends and I went to the Warner Brothers Studio outside of London where they filmed much of the Harry Potter movies, and have now turned into an exhibit with tons of original props and set pieces. You can read about that over here on my personal blog if you like, and it’s a trip I’d definitely recommend for any Harry Potter fans! Other than that Josh has been chauffering me all around South West Wales to do my data collection for my dissertation, which is coming along all right. Tonight I’m going to talk about something a bit more fun though–representations of older people in television and films! Last night Josh and I watched Up, which is in my opinion the best Disney-Pixar film to be released in the past five years (although it’s a close tie to Toy Story 3). Then we watched Gran Torino, which also features an older man as the lead character. The choice of these films was pretty random and the decision to blog about them came afterwards, so I’m not touting them as the most relevant films about older people or anything like that, but I just thought I’d share some thoughts and observations on the characters.

I’m going to skip over summarizing either of these films in order to keep this short and to avoid spoiling them for anyone who hasn’t seen them, but I would highly recommend them both! Up is known for its amazing ability to make nearly anyone cry within the first 15 minutes, but overall it’s a fairly light film; Gran Torino is much more intense in its themes. Both of them feature an older man as the lead character. In Up this is Carl Fredricksen, a widower living alone in the house he shared with his wife for their entire life together. In his physical representation he is quite the stereotypical old man, with his age represented by his use of a walking stick, hearing aid, glasses, and his white hair. The main character of Gran Torino is Walt Kowalski is also newly widowed, but less the physical stereotype of age aside from the natural signs of age that Clint Eastwood was showing at the time. Both characters are portrayed as the stubborn, grumpy old man, which is another quite common character to appear in television and film, and both characters at the start of the film are portrayed as trying to ignore the massive changes going on in their neighborhoods and trying to maintain some sense of normality. Both characters are faced with the possibility of entering retirement homes early on in the films, and in both cases this is portrayed as the “solution” to what others perceive as the men needing assistance. In Walt’s case, his family, who seems oblivious to his feelings and desires and don’t take the time to listen to him, suggest that he moves into a retirement community to relieve him of the stress of taking care of his home on his own, not realizing how much he enjoys that. In Up, a misunderstanding and a mistake cause Carl to be deemed a “public nuisance”, and the court orders him to be admitted to a nursing home, basically as a way to get him out of the way. However, both Mr. Fredricksen and Walt Kowalski defy some of the stereotypes of ageing in their own ways. When approached by a young boy offering him assistance “across his yard”, Carl instead asks for assistance that leads the two on an epic adventure where he’s able to finally find the adventures he’s wanted since he was young, demonstrating that just because he’s old does not mean he is “elderly and infirm”. Walt Kowalski also defies the stereotypes of ageing by becoming a hero in his neighborhood and making friends with the teenagers next door, and teaching them that there’s more to him than meets the eye. This is something the two films have in common–the emphasis on intergenerational relationships, and on the fact that older people have their own stories and personalities. So often we put them in the box of the “old person” and forget that they’ve lived entire lives with their own successes, dreams, tragedies, and adventures, and this is what both of these films demonstrate. Both the characters share these things in unexpected friendships with young people, and as cliché as this might be, it’s an important message to remember.

Acknowledging client’s individuality

I loved this recent piece from The New York Times about the importance of acknowledging the patient’s desires in medicine, along with addressing the family. So often medical care can come to focus on solely achieving the best medical outcome, sometimes at the expense of the patient’s quality of life. The phrase “do no harm” can be taken to mean extending life as long as possible, preventing physical harm even when this may cause psychological harm to the individual or his or her loved ones. I’m not going to pretend to know much about navigating this treacherous ground. Finding a way to balance the needs and desires of the patient along with those of the family (in which different family members may not agree) and with the goals of the medical personnel is something I’m sure is never easy, and I would imagine it is very rare that all parties are satisfied. But what I admired about this piece of writing is that it acknowledges that everyone’s circumstances and perspectives are different and that it is important to take this into consideration when making a care plan, and this does not apply only to end-of-life care situations. Though in the given scenario the patient is unable to speak up for herself, acknowledging the individual’s needs and desires is just as important when the person is able to express these things, and I think it’s extremely important to remember this when working with people. Oftentimes the simple task of getting to know one’s patients or clients gets overlooked due to things such as understaffing or other “more important concerns”, but I think this should be recognized as one of the most important tasks in a care provision setting. The better that staff come to know their clients, the better they will be able to have meaningful interactions with them that can enhance their quality of life and help them to maintain personhood.

Caring in every language


Now more than ever in the past, we are living in a multi-lingual, multi-cultural world. Not only has technology made it easier for people from different countries and cultures to communicate (I wouldn’t be here if I hadn’t met my British boyfriend on the internet!) but it has also made it easier for people to leave their home countries, with the comfort of still being able to keep in touch easily with loved ones. In the UK, many international migrants are now being joined by their parents, increasing the proportion of older adults from other countries and cultures living in here. In 2008, 62 percent of international migrants to England and Wales were between the ages of 60 and 69. This is posing new challenges in the field of health and social care, particularly with older people, as some of these immigrants may not speak English or may prefer to speak in another language. At my former job in a US nursing home, we had a resident whose first language was Spanish, and as one of the few Spanish speakers in the facility I was often responsible for communicating with him when he could not communicate in English. It makes sense that at any age we may feel more comfortable communicating our needs in our first language, but additionally, some medical conditions, such as stroke and forms of dementia, can cause damage to areas of the brain that affect language, and for some older people this may mean that they will struggle with a second language they may have known in the past, and will need someone who can understand them in the language they started speaking from birth.

While immigration is a good example of this, in Wales this issue applies to more than just immigrants. The 2011 census found that the number of people speaking Wales has fallen in the last ten years. Carmarthenshire, where I’m living and hoping to work, is known as one of the heartlands of the Welsh language but has not been exempt from these changes, and this is something that will affect the care being provided for older persons. Older people who speak Welsh as their first language deserve to have care providers with whom they can speak the language they’re comfortable with. I enjoy learning languages, so I’ve been thinking that if I find a job with older people in Wales, I may start learning Welsh. Though I know it would take quite a while to be able to converse in it, I’d like to make the effort if I’m going to be working in settings that may require it, to show my clients that it’s important to me. So I was quite pleased to find out today that Swansea University’s College of Health and Human Sciences will be releasing an app to help workers in health and social care with learning Welsh. You can find out more about the app here if you’re interested. I definitely plan to check it out when it’s available. Thanks for reading–Diolch!

 

 

The needs of non-heterosexual older people

I am fairly open about my personal beliefs, and almost anyone who knows me is aware that I am a strong believer in equality, regardless of race, religion, gender, sexual orientation, or any other factor. I pay a lot of attention to and support the movement towards achieving equality for non-heterosexual people, but it wasn’t until a few years ago that I considered the implications of this in regards to older people. At the University of Iowa I attended a showing of the documentary Gen Silent, which follows the experience of six older people who are lesbian, gay, or transgender growing old in a heteronormative world. After seeing that film I was surprised the issue had never occurred to me, and I’ve been interested in it ever since, so for one of my essays this past year, I explored the needs of older LGB people in Wales and how their needs are being addressed in policy. There isn’t as much literature on this topic as I’d anticipated, but what I did find was all very interesting, so I thought it would be helpful to share here a (very) condensed version of that essay, to get my readers thinking about this topic.

Anyone who knows anything about the LGB equality movement is aware of the Stonewall Riots, which occurred in New York City in 1969. Stonewall symbolizes the beginning of the modern fight for LGB rights, not just in the United States but on an international level; the events were an inspiration to and empowered LGB people around the world. The UK has made significant progress in recent years towards achieving equality for LGB people, most recently with the Civil Partnership Act, the Marriage Bill, and the Equality Act. The Equality Act 2010 established sexual orientation as a protected characteristic alongside race, age, gender, and disability status, making it illegal to discriminate against someone due to their sexual orientation. However, changes in policy don’t always influence changes in services and practice immediately or directly. The UK social service system, like that of most developed countries, was established just after World War II based on a series of assumptions about family structure and gender roles, such as the assumption that women will stay home to provide care to children or older family members. Many elements of social care are designed to supplement support being provided by family members, but older non-heterosexuals are known to be far less likely to be receiving support from their family members, suggesting that they may rely on social care more heavily than heterosexual older people. There is also substantial evidence that older LGB people tend to rely more heavily on friends for support than heterosexual people do, but social care and policy does not acknowledge this. For example, benefits such as carer’s allowance are designed to be claimed by a single individual providing care, but LGB older people may rely on a larger social network, with each person providing smaller quantities of assistance, but these people would be unable to access any benefits or support for the care they provide. Friends and partners of LGB older people also experience problems when their loved one goes into care, such as being denied access to information regarding the person’s care or being denied the chance to be involved in decision making. LGB couples can also encounter difficulty when one or both need to enter sheltered accommodation or be admitted into care. They may not be given the choice to cohabit as a heterosexual couple would, and even when this option is available, some couples may still choose to live separately in order to avoid their relationship being recognized by other residents who may be uncomfortable with homosexuality. One option is LGB-specific long-term care options, and some have emerged in the United States, staffed by and exclusively for LGB people, but this raises questions of whether such segregation is really the right solution, as it risks furthering the isolation of LGB people from the community.

My review of health and social care policy in Wales and the UK found that the needs of LGB older people were barely addressed. This is because they represent a double minority. Policies directed towards the needs of older people rarely acknowledge sexual orientation, and policies directed towards the needs of LGB people tend to focus on issues faced by the younger cohort. Furthermore, sexual orientation is often not asked about by healthcare providers or in service assessments, so it cannot be addressed if it is not acknowledged. Some may argue that asking about an individual’s sexual orientation is a violation of their privacy, but the Equality and Human Rights Commission argues that not acknowledging it perpetuates the invisibility of homosexuality. Though recent research in Wales has acknowledged the need to address sexual orientation in health and social care assessments, nothing has been put officially into policy or practice to improve this, and the Welsh Government has shown a striking lack of activity towards consultation with and inclusion of LGB people in equality strategies. For example, The Thirteenth Annual Report on Equality 2011-2012 outlines the Welsh Government’s efforts towards achieving equality for all people, and the groups and policies consulted for the structuring of equality plans included the Faith Forum, the Migrant Forum, the Refugee Inclusion Strategy, the Wales Race Forum, and the Disability Equality Forum, with no mention of any groups including LGB people. The needs of any group cannot be met if they are not recognized, and older LGB people will continue to be excluded from policy and service provision as long as they are not included in consultations on service needs and equality.

Thoughts on the ‘Heat Wave’

 

Photo from The Guardian

When I got back to the UK from Spain and the temperatures were in the mid to high twenties, I started hearing the phrase “heat wave” on the news, and I laughed. “This is a heat wave?” I thought. Similar to how the British seemed ill-prepared for winter weather and shut down at a mere inch of snow, it seemed like people were overreacting. Last summer in Iowa, the temperatures were above 30 degrees celsius most of the summer, and we were in a drought. That was a bit extreme even for the Midwest, known for experiencing extreme highs and lows winter and summer, and that was what I’d call a heat wave. But the current weather is more like a typical summer where I’m from, so I was baffled. At first. Then, I came home to our flat which doesn’t make it below 28 degrees celsius (about 82 fahrenheit for my US readers) even at night, because it’s built to keep in the heat. Our windows are all on one side, so we don’t have any form of circulation going, and we’ve yet to manage to find a fan anywhere. My place of employment doesn’t have a single window that opens on the main floor, so we prop the door open, turn the fans on high, and sweat it out. Slowly I’m beginning to understand why this is a heat wave for the UK, and why it actually is dangerous–because no one is prepared for it. In my hometown it would be rare to find a flat or home without air conditioning of some kind. My flat in college didn’t have central air,  but we had an air conditioner/fan in the window in the living room, which was better than nothing. We have hotter weather, but we’re more prepared for it. When it gets really hot, schools and churches open up as cooling centers for people who don’t have air conditioning, to lower the risk of heat-related deaths and dehydration.Without such options available here, people have to get by on their own, and this is especially troubling for older people.

The effects of climate change on older adults is a growing area of research and policy focus, and this heat wave is an example of why it needs to be. Recent data estimates suggest that nearly 700 people in the UK have died as a result of the heat wave, and older people are among those at the highest risk of heat-related death. This is because as our bodies age, the body’s ability to adapt to change and extreme circumstances declines. The body has to work harder than it did when it was younger to keep warm or cool off, and cannot do these things as efficiently. On top of that, many medical conditions can increase risk of dehydration or be exacerbated by the heat, and older people who are living alone may not realize that they are suffering from heat stroke or dehydration or may attribute the symptoms to other causes. Age UK has released a guide to “Staying Cool in a Heat Wave” and many charities supporting older people have been encouraging people to check in on older neighbors, friends, and family during the heat wave to ensure that they are taking care of themselves. Obviously I’m not a climatologist, and I don’t think one hot summer means the climate of the UK has been changed forever. But if climate change does lead to warmer weather on a more regular basis, there are a lot of things that housing policy and public services will have to consider to address this issue, for people of all ages.

Back in the UK!

I came back to the UK from Spain on Sunday to find the weather nearly as warm as what I’d left behind! Awesome :) Though somehow I managed to go on holiday to somewhere with the weather at 40+ degrees and come back with a cold, which is not so awesome. However, my holiday was great. The flat we rented was literally right around the corner from the beach, and we spent plenty of time taking advantage of that! I also got to practice my Spanish and eat loads of fresh seafood, and did plenty of leisure reading, which makes a nice change from dissertation-related reading. It’s good to be home though. On the train ride back from the Birmingham airport, I didn’t start to feel like I was really back until we got into Wales and started seeing signs in Welsh and English. I’m so used to that now! I am really pleased to have gotten a few days away and also to have made it to another country. As you may know I haven’t done any traveling outside of the UK since I arrived here in August. I guess that’s not quite typical for an international student. Most Americans come to the UK to study and travel as much as they can around Europe because it’s so much easier and cheaper! But between uni and having a part-time job, I haven’t really had the time to travel, and I also don’t want to spend too much money on traveling because the money I’m earning now will go towards paying back my student loans. Since I am hoping to stay in the UK long-term, I don’t feel there’s as much pressure to do everything I want to do and go everywhere in the year that I’m here for my program. I definitely want to see more of Spain, the big cities like Barcelona and Madrid with lots of unique culture and history, but for this holiday I really just needed to relax, so it was perfect. I hope everyone is enjoying the sun! I have plans to go to the beach later this week, taking advantage of the heat while we can!

This is just a quick update on what’s going on for me lately for those who read regularly! Today is the first day that’s truly felt like summer to me, based on what I’m used to summer being at home! It’s a gorgeous 77 degrees Fahrenheit out and all I want to do is go to the beach! As luck would have it, I’m leaving early Wednesday morning for a few days in Spain, so there will be lots of beach time to be had there. I think I mentioned in my last post that I’d received ethical approval for my research study, so last week I began the process of recruiting participants and that seems to be on the right track! I’m looking forward to my holiday and ignoring my studies for a while though, and then when I get back I should really be able to begin doing my interviews and collecting data. I hope those of you in the Wales with me are taking full advantage of this beautiful weather; I will report back on my return from Spain!

Job shadowing

Hello there! I am a bit late getting this post up because I’ve just come back from a lovely, relaxing weekend with a friend at her parents’ house in England. We had gorgeous weather and spent lots of time in the garden, and we also went to this gorgeous village called Lacock. The whole village is protected by the National Trust due to the fact that there are lots of wonderfully-preserved historic buildings there from various time periods; if it weren’t for the cars parked around I wouldn’t have even remembered I was in the 21st century! It was great to relax and recharge so that I can work really hard for the next ten days before I go away on a mini-holiday to Alicante, Spain. Friday was my last of three days spent job shadowing with the Teifi, Tywi & Taf Community Resource Team. This is an organization run by the local authority that is responsible for the provision of health and social care in Carmarthenshire. They receive referrals from the community, which can come from individuals seeking assistance for themselves, hospitals, care homes, etc. They can provide NHS-funded long-term care in the home for individuals who are eligible for a continuing care package due to the presence of complex and ongoing healthcare needs, and they also provide short-term services towards rehabilitating people adjusting to being back in their home after a hospital stay, or to individuals who may be in need of long-term care from a private provider in the transition period. I found out about the team through one of my classmates, who works on the Ammanford team, and through her was put in contact with the 3Ts team and able to arrange the opportunity to spend a few days with them to see how the whole thing works. I wish I could spend more time there but with my dissertation coming up soon I need all the free time I have to devote towards that! However even in such a short amount of time I felt it was extremely beneficial to have a behind-the-scenes look at how some of the health and social care services work in Wales. It was a chance to ask all sorts of questions and get a glimpse at multidisciplinary working and the coordination between the private and public sectors.

My first day there I shadowed the third sector broker, Emma. She is in a very new role and is responsible for managing communication and coordinating services between the voluntary sector and the CRT. She takes referrals from the CRT from clients whose needs may be able to be met by organizations in the voluntary sector, and is also responsible for keeping track of all the third-sector organizations in the area, from groups as well-know as Age Cymru or Tenovus to things as small as village church groups and luncheon clubs. Right now there is a big push towards making healthcare providers more aware of the availability of voluntary services and the assistance they can provide, so one of the things that I did with Emma was attend a GP conference where she gave a presentation to local GPs about her role and answered questions about referring patients to third-sector services. Her job is a great mix of strategic planning and one-to-one service provision, because she als o does home visits to get to know clients and assess whether their needs can be met by third sector groups in order to make referrals. This day of the job shadowing was particularly interesting to me because many of the topics I’ve written essays on (end-of-life care; service provision for carers) have led me to reading about the role of voluntary organizations in care provision and support, which is much greater than I initially thought.

On my second day I shadowed some members of the Reablement Team on their home care visits. Though I’m familiar with what long-term care and rehabilitative care provision generally entails due to my experience in a nursing home, this was interesting to me because although Medicare and Medicaid will sometimes cover home care, the U.S. doesn’t have government-run or funded home care teams (at least not to my knowledge), so I was able to learn a bit more about eligibility criteria of who receives NHS home care and how the transition to private services would work.

On Friday I shadowed one of the CRT social workers. We spent most of the morning at a residential home meeting with a woman and other members of her team regarding an upcoming transition in her living circumstances. It was really good to unexpectedly get a chance to go into a residential care facility in Wales and compare it to what I’m familiar with from the United States, and also observing the decision-making process and coordination of different professionals as well as the family’s input and the woman’s input to try and make a decision was quite interesting. Overall I feel like I learned a lot just from being able to go into a professional environment in health and social care and observe the different levels of coordination between areas, as well as the barriers and challenges encountered and how they differ within a different healthcare system than what I’m used to. I know three days isn’t much, but I also will take advantage of any opportunity I have to gain experience and insights into the health and social care system over here, as any and all opportunities could help when it comes to hopefully working over here in the future!