For example, Massachusetts and California have made recent improvements by upgrading care quality and professionalizing care; by contrast, despite Florida's large population of seniors and the beginning of a coalition of patients, families, and workers on behalf of better care, the state administration remains inflexible in their funding approach (Fitzgerald 30).
Nursing homes and other long-term-care facilities are unique among low-wage labor markets in that government, in effect, sets wages and career paths by setting reimbursement rates. Government also regulates the conditions of care and subsidizes training programs for nursing assistants and other paraprofessionals. Unlike other low-wage sectors, a broad-based, middle-class constituency for better wages and benefits potentially exists in the form of family members of nursing home residents. Therefore, there is a potential solution that benefits all the stakeholders by providing higher reimbursements together with tighter regulation and deliberate professionalization of the direct-care workforce; unfortunately, while some states have made some progress along these lines, resources remain scarce and many initiative have never got off the ground:
Though bits and pieces of this strategy are emerging in a few states, it is being blocked nationally by warped budgetary priorities and a failure of political imagination" (Fitzgerald 30). Unfortunately, the problem is likely to get worse before it gets better: "Hospitals are increasingly discharging patients before they can care for themselves at home. The over-65 population will double between 2000 and 2030, while the traditional paraprofessional caregiver population, women aged 25 to 54, will decline by 7%" (Fitzgerald 31). In addition, the demand for nursing care is increasing dramatically, but the current labor market is providing better options than the low-paying, stressful job of nurse's aide, resulting in an enormous shortage of qualified personnel in the nation's nursing homes. In this regard, Hovey points out that, "Improving quality of care in nursing homes often means adding more staff, better qualified (hence more expensive) staff, or both. Doing so increases costs" (43). While there may be no magic bullet for these problems, there are some low-cost or free alternatives that can be used to improve the quality of care and life for nursing home and retirement community residents through the provision of educational opportunities which are discussed further below.
C. Effectiveness of Educational Activities on Wellness. Rowe and Kahn (1998) describe three characteristics of the successful aging process: 1) low probability of disease and disease-related disability, 2) high cognitive and physical functioning, and 3) active engagement with life. Rowe and Kahn (1987) first described successful aging solely in reference to the avoidance of disease and disability; however, based on the results of the MacArthur Study of Successful Aging (a $10 million, 10-year effort, by dozens of scientists) which they headed, based on an appreciation of the positive aspects of aging, the model was subsequently expanded. Thereafter, successful aging was regarded as embracing two additional components: 1) maintenance of high physical and cognitive functional capacity, and 2) active engagement in life. In sum, the avoidance of disability involves increased, rather than decreased, attention to preventive health care and health promotion in the later years, in part to "compress" morbidity; as a result, illness and disability comprise a much smaller portion of the last years of life (Rowe & Kahn 1998).
Maintaining physical and mental function also involves an accent on both prevention and health promotion; this aspect of the successful-aging framework presupposes that:
a) Fears of loss of function are often greatly exaggerated;
b) Much functional loss can indeed be prevented; and,
Many functional losses can be regained (Fadem & Minkler 2002:229).
Finally, the third aspect of successful aging, the continuing active engagement with life, was advanced as a direct response to the earlier and largely discredited "disengagement theory" described by Cumming and Henry (1961). The disengagement theory conceptualized late life as a time of mutual withdrawal and letting go, during which individuals gradually relinquished roles and responsibilities while society prepared to replace its older members. In contrast to disengagement theory, the third component of Rowe and Kahn's (1998) conceptualization of successful aging requires the maintenance of "close relationships with others, and remaining involved in activities that are meaningful and purposeful, are important for well-being throughout the life course" (46).
Education is a highly valued commodity in the United States, and this value has traditionally extended to the elderly as well (Acher 1990). Providing educational opportunities for senior citizens is congruent with generally accepted and socially approved needs: "They [educational opportunities] are an inherent part of a lifestyle society encourages. Moreover, satisfaction of such needs is a good that society itself desires. Society as a whole benefits when any of its members is educated or provided with medical care. And if certain members of society are educated or provided with medical care at private expense, government need not bear those costs" (142). Indeed, studies have shown time and again that the more active and engaged with life elderly people remain, the longer they live and the more mental faculties they retain in the process.
Seniors have also been shown to be capable of continuing to learn and be creative well throughout their lives. Past studies have thoroughly documented age-related variations in the quantity (or productivity) of creative work. According to Adams-Price, "Productivity can be measured by counting the number of works that an individual produces during a certain span of time, such as a decade. In general, productivity increases rapidly with age to a peak, often around age 40" (1998:23). Thereafter, productivity decreases slowly through the rest of the individual's life span, frequently continuing to decline until productivity is a mere half of its former peak rate; in fact, this general association between productivity and age has been found in both artistic and scientific fields, and across different cultures (Simonton 1990). The precise location of the peak and the rate of change in productivity both relate to the field of endeavor involved; for example, in some fields (such as pure mathematics), the productivity peak is reached fairly early (e.g., age 30 years) and productivity rapidly declines with age to one quarter of the peak performance level. By contrast, in fields of endeavor such as history and philosophy, there is a much later age peak for productivity (e.g., age 50) with small decreases being experienced beyond the peak (Adams-Price 23). This author emphasizes that it is important to point out that productivity of creative work declines asymptotically; certainly, there are countless instances of creative work by people in their eighties and older. In addition, there are large individual differences in the productivity changes with age. For example, McLeish (1976) identified a number of "Ulysseans" who continued to demonstrate high productivity levels throughout their old age.
Opportunities for learning need not be confined to formal settings. For example, elderly volunteers who provide services in hospitals have found that not only do they help others, but, also their own health is improved in the process; in these situations, Ebersole and Hess note that elderly volunteers "act as foster grandparents, tutor ill children, and write letters for or visit with ailing elders. Johns Hopkins Hospital has had such a volunteer program for 60 years and finds the services of elders invaluable" (727). These authors also report that senior citizens can provide a valuable service as paid or unpaid workers in nursing homes. In this regard, Ebersole and Hess suggest that legislation that would train and pay older people who may wish to work in nursing homes would be desirable. "Older volunteers have been used extensively in nursing homes without pay," they say. "One concern is the tendency for older adults to become depressed when constantly exposed to the limitations of their age peers" (727). To help overcome this constraint, the authors recommend that a consistent coordinating individual be assigned; this component is essential to the success of such programs and may produce a more rewarding experience for both the elder provider and the recipient of such services (Ebersole & Hess 727).
Enlisting the assistance of higher educational institutions to provide instructional services for elderly residents may be problematic, though, based on past efforts. In his attempts to develop an outreach program that would help keep seniors engaged and active, for instance, Marc Freedman (1999) reports that his experiences attempting to secure senior training for his initiative, the "Experience Corps," were initially less than productive: "Most [colleges] had been burned before by volunteer programs in which individuals showed up sporadically, requiring more work than they were worth. The last thing these educational institutions needed -- we were warned -- was a bunch of older people who required baby-sitting when the schools were already understaffed and overwhelmed" (emphasis added) (Freedman & Harris 1999:193). The Experience Corps did manage to receive the training they needed, and the results were impressive. "Indeed, the inner-city public schools we were working in -- like so many similar institutions around the country -- were so desperate for responsible human beings to help that…