Topic 1: Introduction to Social Work with Older Adults
Lesson 1 Discussion (250 words).
Please create a discussion post
Do you have any experience in Social Work and/or working with older adults? If yes, please share some of your experience (s).
What do you hope to learn from this course?
Topic 2: Culture & Meaning/Culture as a Social Construct
Lesson 1 Discussion-2 (250 words).
After reviewing the readings/video, please consider the following in your discussion post.
What are your current perceptions of older adults?
What do you think needs to change regarding society’s view of older adults/aging?
What needs to change about how older adults are cared for in the US?
What are some of the myths about older adults that surprised you?
Please complete the following Implicit Association Test (IAT). You will click on “Take a Test” and then choose the “Age -IAT test.” https://implicit.harvard.edu/implicit/takeatest.html
Please submit one-page to include the following information.
• What were your thoughts on taking this test?
• What did you learn about any potential bias you may have relating to age?
• Please share any other thoughts.
Approximately one page and include high-quality writing. Please include a title page and double-check all spelling and grammar prior to submitting. Also, please make sure to cite all relevant information and include references as appropriate.
Topic 2- Aging and Wellness
Lesson 2 Discussion-1 (250 words).
Please view the Ted Talk below:
Buetter, D. (2009, September). How to live to be 100. . TED Conferences. https://www.ted.com/talks/dan_buettner_how_to_live_to_be_100/transcript?language=en
After reviewing the above Ted Talk: How to Live to be 100, please consider the following in your discussion post:
What is your perspective on individuals living past 100 years?
If you had the opportunity to meet a Centenarian, what are 5 questions you would ask to better understand this generation?
Did you notice any similarities or differences between the Centenarians from the “Living to 100 Years of Age” video from the 1980s and the Ted Talk above?
How can loneliness and social isolation impact older adults as they age?
Lesson 2 Readings and Videos Resources
Thames Tv. (2021 Feb 15). Living to 100 years of age. . YouTube: https://www.youtube.com/watch?v=aJ_RVsf90xg
LESSON 2 ASSIGNMENT
Please conduct a 45 minute to 1-hour interview with an older adult (65 or older). You can choose a family member, friend, neighbor, co-worker, etc. Use the following topics as a guide for your interview.
• Information about their childhood and family.
• Any particular ages the person noticed that they were getting older?
• What are 1-2 historical or societal events the person has lived through and how did that impact them?
• What have been some of the biggest changes you have seen in life/society as you have aged?
• What have been the best ages/times of your life so far?
• Do you have any particular goals/hopes for the future?
• How are young people today different from when you were their age?
• What advice/words of wisdom would you give young people to help them prepare for their old age?
• Have you ever experienced any negative attitudes or discrimination because of your age?
• Other topics you feel are relevant.
For this assignment, please submit in 2–3-page using the following outline:
• Summarize your interview.
– How did you feel during the interview?
– What did you learn about this person’s life and their experience with aging?
– Did anything surprise you about the interview or interviewee?
– How did this interview impact your view of older adults?
Approximately 2-3 pages and include high-quality writing. Please include a title page and double-check all spelling and grammar prior to submitting. Also, please make sure to cite all relevant information and include references as appropriate.
Jean Galiana &
William A. Haseltine
Solutions to the Most
Challenges of Aging
Jean Galiana • William A. Haseltine
Solutions to the Most Pressing Global
Challenges of Aging
ISBN 978-981-13-2163-4 ISBN 978-981-13-2164-1 (eBook)
Library of Congress Control Number: 2018962361
© The Editor(s) (if applicable) and The Author(s) 2019. This book is an open access publication.
Open Access This book is licensed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adapta-
tion, distribution and reproduction in any medium or format, as long as you give appropriate credit to
the original author(s) and the source, provide a link to the Creative Commons licence and indicate if
changes were made.
The images or other third party material in this book are included in the book’s Creative Commons
licence, unless indicated otherwise in a credit line to the material. If material is not included in the book’s
Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the
permitted use, you will need to obtain permission directly from the copyright holder.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or
the editors give a warranty, express or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional affiliations.
Cover illustration: Halfpoint
This Palgrave Macmillan imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721,
Los Angeles, CA, USA
William A. Haseltine
ACCESS Health International
New York, NY, USA
This book is a product of ACCESS Health International (www.accessh.
org). ACCESS Health is a think tank, advisory group, and implementa-
tion partner dedicated to assuring that everyone, no matter where they
live and no matter what their age, has access to high-quality affordable
healthcare. ACCESS Health works in low-, middle-, and high-income
countries. In high-income countries, our focus is on care of older adults
and those with dementia. This book identifies and analyzes policies and
practices in the United States that serve as models of excellence in elder
care and optimal aging. We chose the title Aging Well because we believe
that well-being should be the number one focus of all aging care, sup-
ports, and interventions. A companion book Aging with Dignity exam-
ines similar topics in Sweden and several Northern European countries.
Our method was to identify organizations in the United States that
exemplify the best in elder care and optimal aging. We then interviewed
the leaders and champions of those organizations and programs. The full
text of the interviews is available on the ACCESS Health website or at
this link: www.accessh.org/agingwell. Here, we analyze our findings and
present them in the broader context of elder and dementia care and social
inclusion. Our focus areas include long-term care financing, person-
centered care, coordinated primary care, home-based palliative and pri-
mary care, support for those living with dementia and their caregivers,
acute and emergency care in the home and community, the combination
of health and social care that addresses the social determinants of health,
and housing, social inclusion, purpose, and lifelong learning.
From these interviews we abstract eight key lessons for achieving high-
quality affordable elder care and effective systems that support social
inclusion and purposeful aging. Those lessons are:
• The availability of affordable long-term care insurance is essential to
improve access and sustain the costs of caring for older adults.
• Person-centered care is a lynchpin of high-quality care and well-being
for older adults.
• Support and palliative care in the home and community setting is
essential for making care accessible to older adults that honors their
care and late-life priorities.
• Coordinated primary healthcare improves elder care quality and acces-
sibility and lowers healthcare costs.
• It is imperative that we build systems of support and inclusion for
those with dementia and their caregivers.
• Delivery of acute and hospital-level care in the home and community
is essential to lower healthcare costs and improve access, health out-
comes, and well-being for older adults.
• Social inclusion and the opportunity to live a purposeful life are essen-
tial to the happiness and well-being of older adults.
• Combining health and social care with upstream interventions to treat
the biopsychosocial and environmental needs is the way forward to
sustainable systems of care that improve function, well-being, and
The book identifies and details global aging challenges and, chapter by
chapter, offers innovative and impactful solutions to those challenges that
our interviewees have designed. It is our genuine hope that providers and
government entities around the globe that are seeking methods to improve
their elder care and social support systems will find ideas, inspiration, and
possibly collaborative opportunities to enhance the well-being of older adults.
Los Angeles, CA Jean Galiana
New York, NY William A. Haseltine
We thank all those who contributed their time and thought to help us
understand the issues facing older adults and what can be done to ensure
that all have access to high-quality affordable care and the opportunity to
live productive and active lives.
Claude Thau patiently described the rocky history of the long-term
care insurance industry and why many still do not have long-term care
We learned the true meaning of patient-centered care culture from
Christopher Perna, the former CEO and President of the Eden Alternative.
Rebecca Priest from St. John’s explained how to build an operational
culture around person-centered philosophies.
The leadership of Beatitudes Campus brought the person-centered
concept to a new light with their Comfort Matters™ palliative care for
those living with dementia.
Dr. Allen Power made us think about the possibility of not segregating
those who have dementia from the rest of the community.
They all convinced us that person-centered communication and care is
almost always a better option than the use of antipsychotic medications
to meet the needs of someone living with dementia.
Dr. Allan Teel of Full Circle America, Dr. Diane E. Meier of the Center
to Advance Palliative Care, and Dr. Kristofer Smith of Northwell Health
inspired us with their dedication to enabling aging in place and where
patients receive the right care in the right setting and live with dignity
throughout their life.
Kristofer and Allan have been making house calls for all of their careers
because they know that it improves access to care, costs less, and signifi-
cantly contributes to the well-being of their patients.
Allan connects his patients to local supports and services so that his
patients stay engaged and connected to their neighborhoods.
Diane remains vigilant in her pursuit to make palliative care available
in all care settings.
Drs. Michael Barr and Erin Giovannetti of the National Committee
for Quality Assurance gave us a compelling case for the patient-centered
medical home to improve coordinated efficient primary care.
The Director of the James J. Peters VA Medical Center, Dr. Erik
Langhoff, uses technology to improve access to high-quality care for
Dr. Mark Prather and Kevin Riddleberger with DispatchHealth and
Dr. Kristofer Smith with Northwell Health are proof positive that deliv-
ering acute medical care in the home and community improves access
and quality at a fraction of the cost.
Dr. Bruce Leff with Johns Hopkins School of Medicine showed us that
providing hospital-level care in the home to patients who qualify can
reduce care costs and produce higher-quality health outcomes.
Timothy Peck, Garrett Gleeson, and XiaoSong Mu with Call9 are con-
tributing to the well-being of patients living in skilled nursing by provid-
ing technology-enabled emergency care and palliative care around the
Dr. Mary Mittelman with the NYU Caregiver Intervention has proven
the value of supporting the informal caregiver for someone living with
Jed Levine and Elizabeth Santiago tirelessly support those in the early
stages of dementia and their caregivers with their vigorous programs at
Davina Porock impressed upon us the importance of the built envi-
ronment of the hospital for those living with dementia.
Karen Love and Jackie and Lon Pinkowitz remind us of the vital
importance of fighting the stigma of dementia with thoughtful
community conversations. They also noted the importance of involving
those with dementia in policy and program design.
Brian LeBlanc shared his journey of living for dementia and his stories
about his impactful advocacy efforts.
June Simmons with the Partners in Care Foundation impressed upon
us the need to combine social care and healthcare and address social
determinants of health through evidence-based prevention programs.
Sarah Szanton with CAPABLE proved that it is possible to improve
function in frail older adults by providing home modifications with nurs-
ing and occupational care to support the goals and priorities of
Joani Blank invited us into her home at the Swan’s Market cohousing
community in Oakland, California. We spent a half-day seeing how
cohousing promotes community inclusion and multigenerational
Rebecca Priest with St. John’s and the management of Beatitudes
Campus regaled us with stories of resident-run activities that facilitate
productive living and generativity.
Anne Doyle surprised us with the amount of lifelong learning and
intergenerational connections taking place at Lasell Village, a retirement
community on the campus of a college.
Mia Oberlink formerly with the Center for Home Care Policy and
Research impressed the importance of involving older adults in the design
of all initiatives that serve them. Ruth Finkelstein formerly with the
Robert N. Butler Columbia Aging Center and the International Longevity
Centre USA is committed to ensuring that employers who retain and
attract older employees are honored so others will follow suit. Ruth and
Dorian Block are combating the stigma of aging by telling the stories of
older adults who exceeded life expectancy in New York City and are liv-
ing vibrant productive lives.
Lindsay Goldman with Age-Friendly NYC expressed the need for
public and private partnerships to make environments accessible to those
of all ages and abilities. She explained that older adults must be consid-
ered in all areas of city planning and policy making.
Emi Kiyota showed us how multigenerational community hubs con-
tribute to resilience after natural disasters and serve as places of produc-
tive engagement and social inclusion.
Dr. Paul Tang, formerly with the Director of the David Druker Center
for Health Systems Innovation, uses social connections as a form of
health prevention by connecting patients to a timebank where they
exchange tasks and teaching of hobbies and new skills.
Our research was supported by the William A. Haseltine Charitable
ACCESS Health International is an independent, nonprofit think tank
that works for the provision of high-quality, affordable care for all, includ-
ing the chronically ill. Our method is to identify, analyze, and document
best practices in helping people and to consult with public and private
providers to help implement new and better cost-effective ways to offer
care. We also encourage entrepreneurs to create new businesses to serve
the needs of this rapidly expanding population. Our goal is to inspire and
guide healthcare professionals and legislative leaders in all countries to
improve care for their own people.
About ACCESS Health International
1 Demographics 1
2 Healthcare in the United States 7
3 Long-Term Care Financing 19
4 Person-Centered Long-Term Care 29
5 Home-Based Palliative Care and Aging in Place and
6 Coordinated Primary Care 79
7 Emergency Medicine and Hospital Care in the Home and
8 Support for Those Living with Dementia and Their
9 Merging Health and Social Services 139
10 Purpose and Social Inclusion 159
11 Eight Lessons for Social Inclusion and High-Quality
Sustainable Elder Care 203
William A. Haseltine, PhD He is the Chair and President of ACCESS Health
International. He was a professor at Harvard Medical School and Harvard
School of Public Health from 1976 to 1993, where he was founder and the chair
of two academic research departments, the Division of Biochemical Pharmacology
and the Division of Human Retrovirology. He is well known for his pioneering
work on cancer, HIV/AIDS, and genomics. He has authored more than 200
manuscripts in peer-reviewed journals and is the author of several books, includ-
ing Aging with Dignity: Innovation and Challenge in Sweden and Affordable
Excellence: The Singapore Healthcare Story.
Jean Galiana, MASM, RCFE In her role at ACCESS Health International,
Jean Galiana successfully promoted key messages about elder care and optimal
aging to engage policy makers, healthcare providers, the general public, and
stakeholders. She managed qualitative research projects to discover, document,
and advocate for best practices in aging in the United States. Currently Jean works
in communications and survey research for Vital Research in Los Angeles,
CA. She obtained her undergraduate degree in business from Lehman College
and holds a master’s degree in aging services management from the University of
Southern California Leonard Davis School of Gerontology.
About the Authors
Fig. 1.1 Rectangularization of the global aging pyramid from 1970 to
Fig. 1.2 Global distribution of population 65 and over in 2015 and
2050. Source: U.S. Census Bureau, 2013, 2014a, 2014b;
International Data Base, U.S. population estimates, and U.S.
population projections 3
Fig. 1.3 Potential support ratios by region, 2015, 2030, and 2050.
Source: UN Department of Economic and Social Affairs 4
Fig. 3.1 Growth in demand for LTSS. Source: Bipartisan Policy Center 20
Fig. 4.1 Green House at Penfield 36
Fig. 4.2 Penfield Green House Great Room 36
Fig. 4.3 Mr. H’s binder 40
Fig. 4.4 St. John’s to traditional skilled nursing regional comparison 42
Fig. 5.1 Palliative care gap 70
Fig. 8.1 CaringKind entrance welcome 121
Fig. 8.2 MedicAlert® bracelet and necklace 128
Fig. 9.1 Results of HomeMeds PLUS Pilot Program. Source: Partners
in Care Foundation 147
Fig. 10.1 AdvantAge Initiative. Age-friendly Measures 176
List of Figures
1© The Author(s) 2019
J. Galiana, W. A. Haseltine,