INCLUDING CONNECTIONS TO THE COURSE TEXT OF:
                                                    "The Last Days of Ptolemy Gray"

Social Support

According to Ajrouch, Hillcoat-Nalletamby, and Phillips (2010), social support is “The exchange of different types of resources channeled through supportive relationship”(p. 199). The authors differentiate between social networking and social support in that the latter is a function of relationships and the result of social capital networking. It encompasses various aspects of support, including but not limited to emotional, social, informational, and instrumental resources (Ajrouch, et al., 2010). The type, amount, and accessibility of support depends greatly upon the availability and the cultural environment. One of the most challenging aspects of providing ample supports is the funding. More research is needed, as few longitudinal studies have taken place, as is with many areas of gerontology (Ajrouch, et al., 2010).

     Connecting the course text of “The Last Days of Ptolemy Grey”, Ptolemy certainly had no social support after the death of his caregiver Reggie passed away, and even then he was lacking so many supports that could have enhanced his life. Social support is not an embellishment to life, but a necessity, and once Robyn was a part of Ptolemy’s life, he was able to expand this, especially when he allowed himself a friendship with Ms. Wring (Mosley, 2010).

Independence

Independence is: “A sense or state of physical, psychological and spiritual autonomy, self-identity, self-respect, control and degree of functional capacity” (Ajrouch, et al., 2010, p. 131). I have personally seen great progress in the past four decades in regard to promoting autonomy and independence among younger people, but the development in this area addressing older adults is much slower in the making. Surely, due to the huge reduction in older adults living with family, they are more on their own, but also the prevalence of residing in nursing homes with compromised care only confirms the grave need to recognize older adults’ individual needs and desires. The increase in assisted living facilities proves hopeful progress, but with the baby boomer population now aging and with many in need of care, there should be great promotion of businesses in assisted living. One idea is if the government were to either subsidize or give tax reductions for those investing in the older adult population by investing in assisted living and nursing homes. Of course, aging in place in a person’s own home is the ideal living situation.

     Ptolemy was fortunate to be able to stay in his own home, although his living conditions were not acceptable until Robyn came into his life. She gave him a new lease on his life by helping him in many ways, especially by bringing him to the doctor for the medicine that helped his cognition, which in turn improved all of his functioning other than the physical realm. Even if the medicine promoted an earlier death, he was able to think in a linear fashion, and make huge decisions based on his memories of the past and his current assessments of many areas of his life and those around him (Mosley, 2010).

Housing

While addressing independence, aging in place is key, and housing accommodations should be given priority when assessing the needs of older adults. Thorough assessments for all aspects of biopsychosocial status should be considered to properly meet the needs of older adults, always keeping in mind the least restrictive environment to allow for maximum life fulfillment. One great dilemma is cost. Surely, a facility will declare a guarantee of housing for an older adult (I experienced this with my father), but also at the cost of depleting that person’s life savings. As the text states, many older adults are “income poor but equity rich” (Ajrouch, et al., 2010, p. 127). The cost for housing should be regulated by the government, and considered to include caps. Along with the financial aspects, conditions are also an increasingly great concern. Older adults live in rentals in need of repair and are unable to carry out the tasks for which to maintain suitable living conditions, and if the landlords fail to do so, their quality of life is compromised (Ajrouch, et al., 2010).

     The housing that Ptolemy inhabited for many decades was almost uninhabitable until Robyn helped him. He was able to survive, and became accustomed to his awful environment, but received almost a new lease on life when it was transformed to be more livable. Robyn reflected the epitome of respect toward Ptolemy, never discounting his decisions to keep certain objects and very sensitive to his state of mind as he was living in a realm of sentiment more than he was in the present (Mosley, 2010).

Filial Responsibility

Filial Responsibility: “The expectation that adult children will provide assistance to older parents in times of need, giving priority to their parents’ needs over their own” (Ajrouch, et al., 2010, p. 101). Surely sacrifice is expected when people take on the responsibility of raising children, but the expectations of taking care of older parents is not always seen as so. “Exchange theory highlights the act of reciprocity in human interaction” (Ajrouch, et al., 2010, p. 102), yet family caregivers of older adults need to be educated on this, understanding all that it involves. Unfortunately, outlooks have changed over the past few generations, as cohort socialization suggests (Ajrouch, et al., 2010). With social changes in careers and family dynamics, such as single-parent households, latch-key children, and the economy as the cost-of-living has increased in ratio to income, more adults are not as accessible to stay at home to care for their older parents. Of course, filial responsibility also depends upon moral and spiritual values, as well as cultural, but overall in the United States there has been an enormous decrease in the adult children obligations to care for their older parents (Ajrouch, et al., 2010). Social workers should work to advocate for older adults in that family support is key to successful aging, even if they are not living with adult children, that family visit them often.

     While Ptolemy had few living relatives that he knew of, he was very limited in connections with them, especially not having acknowledged his own children with no contact whatsoever. This gave no ability for a reciprocal relationship of caregiving, but nonetheless, Ptolemy eventually made sure that he provided for them financially after his death. Reggie was encouraged to care for Ptolemy by his mother, and Robyn was given the same directive, but Robyn had a genuine caring that was easily detected as honest and of integrity by Ptolemy. It was a wonderful way for Ptolemy to live his last days (Mosley, 2010).

Frailty

As adults age, frailty is an issue that encompasses vulnerability within the whole person, emotionally, psychologically, and physically, as well as social independence, of any one or combinations of the various aspects of a person (Ajrouch, et al., 2010). Social workers can greatly assist in reducing this problem, because interventions can make the difference in slowing down the decrease in abilities (Ajrouch, et al., 2010). This issue has been addressed at length by the medical field, with many indicators giving ratings of severity, but “frailty is multidimensional” and includes many aspects of an older person’s life (Ajrouch, et al., 2010, p. 107). Human rights have played a part in accommodating older adults, as accessibility laws have been implemented, but not to the extent necessary, as obviously the majority of retail establishments do not fully accommodate disabilities. Ajrouch, et al. (2010) suggest that a “multidisciplinary team involving [medical] specialists, social workers and therapists” should assess and treat adults who are frail, and devise plans for all professionals to implement as interventions, hopefully not only addressing all of the older adult’s needs but to also slow the process of further frailty (Ajrouch, et al., 2010, p. 109).

     Ptolemy had various physical ailments, yet did not complain, as he accepted them to be a part of aging and his way of life. He was fortunate to be 91 years old and still walking, and found ways to accommodate and adapt to his surroundings, such as using his little multi-colored portable stool. Even at an old age, Ptolemy displayed great strength emotionally, and cognitively with the use of his wisdom derived from his past. The honest interactions from Robyn did not demean him whatsoever, but as she gave him the benefit of the doubt of his abilities, her expectations were high in that she did not discount his multi-faceted thoughts whether it be physical, sexual, or any other area. (Mosley, 2010).

Ajrouch, K., Hillcoat-Nalletamby, S., Phillips, J. (2010). Key concepts in social 
     gerontology. (1st ed.). Thousand Oaks, CA: Sage Publications, Ltd.

Mosley, W. (2010). The last days of Ptolemy Grey. (1st ed.). New York, NY: 
     Riverhead Books.

(Please note that I have two blogs for Week 6; see below for the blog on Ptolemy Grey)

I had heard about how people were using Skype to see psychiatrists on the internet rather than in person in an office, but I never researched the issue before. I found an article about counseling on the internet which tells of some of the pros and cons. 

Eye on Ethics
Navigating the New Age of Electronic Counseling
By Frederic G. Reamer, PhD
Social Work Today
July/August 2006

It can be found at this address: http://www.socialworktoday.com/news/eoe_0706.shtml

Several cautions and guidelines are listed after this excerpt from the web page.
(Some of the main concerns were about privacy laws and rights.)

 “The NASW Code of Ethics does not prohibit online and other forms of electronic counseling. However, the code does highlight a series of ethical considerations related to confidentiality, informed consent, professional competence, and client records (see standards 1.03[e], 1.04[b,c], 1.07[l,m], 4.01[b])”.

      If a client has extreme difficulty coming to an appointment, it is a great option, but I think that meeting in person is more than just seeing a face.  I believe that environment goes beyond the physical space of a room, and that there is a sort of spiritual realm that needs to be considered, considering that emotions are more difficult to detect over a computer screen.  

Reflecting on Walter Mosley’s “The Last Days of Ptolemy Grey”…

DEMENTIA : “A clinical state, characterised by a loss of function in multiple cognitive domains and accompanied by a series of symptoms that accompany diseases or conditions that affect the functioning of the brain” (Ajrouch, Hillcoat-Nalletamby, & Phillips, 2010, pg. 70).

Ptolemy certainly showed signs of memory impairment. He also demonstrated aphasia or the inability to understand words, but only mildly. He may have shown signs of agnosia, or decreased ability in recognizing objects (excluding sounds), but it could have been that he did recognize the objects, but could not think of the name of the objects. Dementia was apparent, as he could not function well alone, with loss of memory nearly every minute of his life (Ajrouch, et. al, 2010).
                                                   ~  ~  ~  ~  ~
ELDER MISTREATMENT/ABUSE: “Actions perpetrated by a trusted other, intended or not, that risk harm to a vulnerable older adult” (Ajrouch, Hillcoat-Nalletamby, & Phillips, 2010, pg. 79).

This was certainly apparent as people took advantage of his memory loss and low functioning. An example from the book is when his nephew cashed his three checks but only gave him the money from one of them, stealing the rest for himself. Also, the drug addict on the street bullied him; she took his money money and demanded he continue to give her money any time she saw him. He was clearly frightened of her.
                                                   ~  ~  ~  ~  ~
LONGEVITY: From the Latin “roots [of] longaevitas reflecting the words longus or long and aevum or age… when [a person] survives longer than the average person” (Ajrouch, Hillcoat-Nalletamby, & Phillips, 2010, pg. 152).

Ptolemy beat the odds of the average life expectancy, which according to the Center for Disease Control is 78.7 years. Having lived past 91 years, he was able to talk, although with memory impairment, and although unsteady he was still able to walk (Retrieved from: http://www.cdc.gov/nchs/fastats/lifexpec.htm).
                                                   ~  ~  ~  ~  ~
BEREAVEMENT: “The situation of individuals who anticipate or experience the loss of someone significant through that person’s death, and the subsequent adjustments made as a result” (Ajrouch, Hillcoat-Nalletamby, & Phillips, 2010, pg. 35).

Ptolemy was in the state of bereavement, yet had not gone through all of the processes that usually take place. He held on to his wife’s belongings in an unhealthy manner by shutting off the bedroom door and placing a tarp over everthing that was connected to her. Not using the bedroom and leaving her things untouched signifies that he had not moved beyond the initial stages.

Ajrouch, K., Hillcoat-Nalletamby, S., Phillips, J. (2010). Key concepts in social 
     gerontology. (1st ed.). Thousand Oaks, CA: Sage Publications, Ltd.

.

The link below is for the:

NASW Standards for Social Work Practice
with Family Caregivers of Older Adults 
(copyright 2010)

http://www.socialworkers.org/practice/standards/NASWFamilyCaregiverStandards.pdf

I posted this link because I did not know it existed until I searched, and it is most definitely an extremely valuable resource for practicing as a social worker for older adults. Although it appears to be 47 pages in length, it is only half of that, as each page is only one column on the page. It answers any basic questions that a social worker may have while working with the elderly, and although brief, they all are connected to the NASW Code of Ethics.

Following is the Table of Contents:

5 Introduction
7 Background
9 Goals of the Standards
10 Definitions
14 Guiding Principles
18 Standardsfor SocialWork Practice
18 Standard 1: Ethics andValues
21 Standard 2:Qualifications
22 Standard 3: Knowledge
25 Standard 4:Cultural and Linguistic Competence
27 Standard 5:Assessment
30 Standard 6: Service Planning,Delivery, and Monitoring
32 Standard 7:Advocacy
33 Standard 8:Collaboration
35 Standard 9: Practice Evaluation and Improvement
37 Standard 10:Documentation
39 Standard 11:Workload
39 Standard 12: Professional Development and Competence
41 References
44 Resources
47 Acknowledgments

Stevie Wonder emits such passion in everything he does; I loved filling my living room with his music. I decided to find the written lyrics to have an accurate understanding of every word. (at first I thought he sang “2000 ladies” - heehee!)

First of all, it always amazes me that when I went to school the history books failed to mention all of the horrible stuff that people have done, especially Americans and the Indians (the readings on this in my Diversity class sickened me, and I learned that they choose to be called ‘Indians’ over ‘Native Americans’).

It certainly is true, that there is no chance of world salvation unless the main focus is PEACE. Unfortunately, the main focus is usually MONEY and POWER. And although my Christian faith recommends people to “turn the other cheek” and “love thy enemies”, we also cannot be trampled on and give up our freedom.

Most people will say that the best way to live is to “do unto others as you would have them do unto you”, but Stevie Wonder goes further with this in saying ME for YOU, YOU for ME. As in any relationship, it will not work if each side gives 50%; all should give 100%.

Overall, it seems that the United States has lost the unity of the people. I have a strong philosophy that this is mainly due to selfishness and greed, as well as ignorance about how values have declined. Our country puts a great deal of emphasis on material things, and some things that formerly were a luxury for most are now seen as a necessity; I blame this on the media, promoting more with each generation, to 'look out for yourself’. 

I can say from experience that the breakdown of the family has become worse with each generation, but I hope that this is now turning around. Of course, the economy is to blame for many of these things, causing depression, addiction, etc., and especially children raising themselves after school, etc. I know that it appears as though I have gone off in a different tangent, but I think that all of these things contribute to the lack of unity among people. 

Let us all hope that we can make a difference in how we help others, conduct ourselves as models by not participating in negativity about situations and people, and educate others in better ways to live.  “When publicly or privately convened, may love, positivity and life’s preservation be the basic theme.”

http://www.michigan.gov/osa/

[Click on the above link to enter the OSA website]


THE  FOLLOWING  IS  DIRECTLY  FROM  THE  WEBSITE:

OSA operates under the authority of the Older Americans Act, which was signed into law in 1965 to meet the diverse needs of the growing numbers of older adults in the United States. 

Vision - To promote independence and enhance the dignity of Michigan's older adults and their families.
Mission - OSA is the focal point of our statewide aging network providing leadership, innovation, advocacy, and supportive services on behalf of Michigan's older adults and caregivers.

Three big ideas from the modules:

• I have never worked in an environment where knowledge sharing was implemented as a regular task, only meetings about specific situations and new requirements. In past employment, I have felt that asking too many questions would make me appear incompetent or as though I had a poor memory for remembering procedure. This leads me to my next point...
• While reading/listening about knowledge sharing, I felt empowered just sitting at my computer! I surely hope to work in an organization that views this as an integral part of working in social work, especially for the benefit of the clients.
• While at my internship, with 12 other interns (on any given day, anywhere from 3 to 8 joining me in an office), at first I felt uneasy when we were chatting with one another, as if we weren't supposed to be talking but only working at the task at hand, even though we didn't have much to do at that time. I soon learned that my supervisor encouraged this, to learn from one another and share our experiences at the agency and our background as well. **On my last day of the internship, a seasoned therapist, whose office was next to ours, enlightened me by exclaiming that the interns were a great group, mainly in how supportive we were of one another, helping each other along the way. Great compliment!**

FOUR EXAMPLES:

• I learned a great deal about information sharing and look forward to implementing them during college and in my professional career. Combining the Chapter 2 reading with the modules on technology, I can say that as an older adult (mid-'50s), I do need to catch-up a bit on the progress in technology with things such as Wiki, Mindmapping, and RSS Aggregation, but I am more than capable of doing so.
  
•  As I will be searching for some work for the summer, I fear that I will be discriminated against (ageism), just as the reading explains how employers have negative attitudes toward older adults. I realize that the way in which I portray myself to others can make a world of difference; if I feel confident, I will appear more confident and capable. I can see implementing this idea in working with older adults in empowering them to advocate for themselves.
• In regard to the modules, I felt a bit disappointed that it was based in and for the UK; for example, when directed to the social services site, I can only believe that our equivalent would be the NASW. (?)
• I found many of the points addressed as valuable, such as: "Knowledge is not seen as power", and "Trust is evident", and Knowledge sharing is valued as collaboration, not competition". 

QUESTION:  If communication  in "knowledge sharing" is compromised by a resistant co-worker, (similar to the two negative people in the modules), what are some approaches to solving this problem? I understand that it depends upon the climate of the organization and the personalities of the co-worker and supervisor(s), but other than understanding the chain of commands (who to report to), I would like ideas on how to address this problem.