Gender and Money in Later Life: How Older Women Face Greater Economic Insecurity than Men

Most older women spent their working lives behind the economic curve. They were typically paid less than men when at work and more likely to provide family care that reduced employment opportunities.

Their economic situation doesn’t improve in later life. Lower Social Security and pension benefits, the result of working and earning less over decades, and the fact that women are more likely to live longer than men just extend that gender disadvantage into older age and often make it worse.

A new report by the Gerontology Institute at the University of Massachusetts Boston uses the Elder Index™to demonstrate the depth and scope of economic disadvantage experienced by older women living alone across the United States. It is documented in every state in the nation and only increases with age.

“Life-long patterns of inequality in work experiences and wealth accumulation are behind a substantial gender disparity in retirement economic security,” said Jan Mutchler, the report’s lead author and a professor of gerontology at UMass Boston. “The consequences of that disparity affect so many older women who routinely face hard choices about basic expenses they simply can’t afford.” Continue reading

Q&A with Jo Owens, author of A Funny Kind of Paradise

Jo Owens became a nursing home aide in Canada out of a need for money, and came away with her calling. And from that experience, the pain and the human glory, came her debut novel A Funny Kind of Paradise, set in a Canadian nursing home.

The Vancouver Sun wrote “Owens…captures the skill and tenderness of caring for someone at the end of life in direct and unvarnished prose…Each [care aide] …is richly drawn and complex… [and the novel] serves to illuminate a vital profession that has been rarely documented in fiction.”

“Her writing is richly informed by her 20 years working as a care aide in Victoria, British Columbia,” said interviewer Len Fishman, head of the University of Massachusetts Gerontology Institute. And their conversation continues from there. Thanks to Taryn T. Hojlo for the interview transcription.

Author Jo Owens

LF: Let’s start by asking why you became a care aide and what’s kept you in that profession for 20 years?

JO: Actually, desperation drove me there. Much like Molly [a character in the book], an aide suggested that I take this job and that I would be good at it, and I absolutely needed money. That got me over the initial stages when it was terrifying to be doing something so new. What keeps me at it is that I have a calling for this work. I definitely ended up in the right place.

LF: The book’s narrator is Francesca, or Franny. She’s in her late sixties, and a stroke has left her unable to move, walk, talk, or eat, but Franny’s cognition is completely intact. Tell us more about her, and let’s start with you reading a passage.

JO: [reads from A Funny Kind of Paradise – youtube link]

“Franny says, ‘The stroke has left me emotionally labile, and the feelings I’ve struggled so hard to contain (or at least disguise in shrouds of anger) are naked for all the world to see. I literally lack the muscular strength to suppress them.

But here is the gift. I don’t care. I don’t care! My right hand is useless, I can’t speak and more people have seen my bare ass in the last year than if I was a streaker at the opera, because I need my diaper changed, for God’s sake. Do you think I care if you see me cry?’”

LF: Tell us a little more about her.

JO: Francesca was a strong, independent woman who ended up raising her two children on her own. She’s a home-based small business accountant, and she kind of came at life as though…if you attacked it with hammer, you’re going to get the job done. That’s not necessarily the best way to parent children, so like everyone else, she has her own baggage and things to think about. Originally, she was the kind of person who would say to herself, as you often hear people say, “If that happens to me, I would rather die.”

LF: She recalls a time when she accompanied her son’s class to a nursing home around Christmas time. When they leave, she tells him, “I’d rather be dead than have to live in a place like that.” Later she thinks, “I changed my mind when I came here.” What changed?

JO: First of all, I think that the will to live is extremely strong. We think that we can’t tolerate this, but it’s amazing what humans can get used to and even learn to embrace. Partly, that’s what’s going on, but also Franny was fortunate to end up in a good facility where she has loving care and she’s still engaged in life. She enjoys watching the care aides that work around her and gossip freely in front her because Franny can’t repeat what she’s hearing. She thinks about her children and she’s still engaged with her son who comes to see her. There’s enough in her life to make her life meaningful. This is my experience at work. When suffering becomes acute, residents do say they’d rather die. And we do hear that. But generally speaking, I find that people want to live. And they continue to want to live. Much longer than we’d think.

LF: Franny’s got issues – fear and anger are her “left and right crutches” as she puts it – and she’s really trying to work through them. Have you seen residents that you’ve cared for grow emotionally as she does?

JO: Absolutely. Absolutely I have seen people change and grow. We do. Our situations force us to. It was the famous psychologist, Karen Horney, who said, “Life itself remains a very good therapist.” Things happen. We’re forced to change, and life doesn’t stop because you’re forced into care. You’re still going to be changing. For Franny personally, I used my imagination obviously to create what’s happening to her, but as she thinks about what is meaningful in life, thinks about what she can change and what she can’t change – particularly with regard to her son, her missing daughter, and how she behaved in the past – as new residents come into her life, she is adjusting her thinking and she’s moving along in her mind, as people do. And yes, I’ve seen that in care.

LF: So, as you’ve mentioned, Franny’s brain is sharp and because she can’t talk the aides are actually more willing to speak their minds in front of her, even confide in her. What were you hoping we’d learn, through her, about the inner workings of a nursing home?

JO: One of the reasons I set this novel in a five-bed ward is because I wanted to be able to show Franny listening to people talking all the time…I wanted people to see how human your aides are…Every one of your [aides] comes with their own set of baggage. And I wanted to show some of the things that the care givers are trying to balance, some of the things that they have on their plate. The struggle that is part of life, trying to triage six to eight – or in worse scenarios, 12 to 14 – residents. Who eats what, who do you go to first? How can you give everyone good care, not just the ones that can speak up and demand it, but also the ones that are immobile and deserve just as much of your love and attention? I wanted to do that in a way that wasn’t completely preachy, and boring and I really hope that I achieved that goal because what happens in [nursing homes], in that private little world, is frequently not seen, and I wanted to show it.

LF: In Franny’s world, licensed nurses, whether it’s LPNs or RNs, are distant figures and doctors are almost entirely absent; it’s all about the aides. Is this what it looks like on the inside?

JO: I’m sure I showed quite a bit of bias there because I am a care aide, so I think it’s all about me [laughs]. But, in terms of the bulk of time caring, aides are the faces that the residents are going to see the most. I see my people every day, whereas the doctor might see you every two weeks if you have a problem, less if you don’t. The LPNs are going to see you every day also to give you your pills and if you have a dressing change, you’ll see them a little bit more. The RN, as I mentioned to you before, at my facility the RN has one hundred people. They’re going to deal with problems. So, it may be very difficult to even know their name. The care aide is the person that they see. I did an interview with a person in Toronto whose father was in care. He told me that the care aides became his father’s family. Even though I only know a small portion of my resident, the part that they are now – the whole iceberg of their previous life is unknown to me except for a little bio that might be done by a social worker or a family member – I have this tiny little part of this person, right? But they’re still mine. I have them every day. I know how they want their socks pulled up – do you want a little space at the end, or do you want them nice and snug? Do you want your tea spun like this or like that? They’re mine.

LF: I want to ask you about families of nursing home residents, especially those that visit frequently. What qualities do staff most appreciate?

JO: The first thing that’s coming to my mind, Len, is forgiveness. Maybe I’m only speaking for myself, but I want to be forgiven for my imperfections. I’m going to do the very best that I can, and sometimes it’s going to feel like it’s not enough because sometimes it’s not enough – I just run out of time. I forgot to bring your husband down for his visit, which is now going to be downstairs in the village square, or I’m not able to brush your family member’s teeth, their hair isn’t…Yeah, I want to be forgiven for the fact that I can’t do a perfect job. Maybe other care aides would speak differently.

LF: Two aides in your book are talking about the difficult daughter of one of their residents. The mother is pretty difficult, too. And one aide sums up her philosophy as follows, “If we only looked after the people who deserved kindness, it’d be a skinny job.” This is a telling commentary on the challenge of being a good caregiver, so tell us about it.

JO: This reminds me of a fridge magnet I once saw that said, “The staff are human and will react unpredictably when abused,” as opposed to being a robot. Every healthcare worker has a right to be treated like a human being. We have little signs in our elevator saying that if you don’t treat the staff with respect, you will be required to leave. But the people that I’m working with are emotionally labile and sometimes they have difficulty controlling any number of their emotions, whether it’s anger or frustration or – sometimes they yell at us, sometimes they hit us.

LF: In recognizing the time that we’re living in, in the U.S., residents account for about 40 percent of COVID deaths nationally. In Canada, the percentage is even higher. It seems to me that this hasn’t caused as much of an outcry as one might expect. What do you think?

JO: So, this is a question I was asked in the NPR interview and so I gave it a lot of thought, Len, because I had difficulty answering it. And here’s the reason I had difficulty: I do not want to contribute to our phobia of death. There is a time when it is good to die. At the same time, how we treat the more vulnerable members of our population during a pandemic is a measure of our integrity as a society. It’s really important not to get the idea that any group in our society, whether it’s their age, their ethnic background, their financial worth, their sexual orientation, that that group is in any way disposable, because that’s the kind of thinking that Hitler had. It is not acceptable.

LF: What do you want people to know about your job?

JO: Well, I was hoping that with my book I would be able to increase empathy for the people that live and work in care. But what would I want them to know? We’re here and we’re alive and just as important as anybody else – really that’s the only message.

Dean David Cash announces retirement of Institute Director Len Fishman

I write to announce that Len Fishman, after serving seven years as director of the Gerontology Institute at the McCormack Graduate School of Policy and Global Studies, will be retiring on August 31.

Gerontology Institute Director Len Fishman

A nationally recognized leader in health care and aging, Len’s priorities as director were guided by two goals. First, increasing the institute’s relevance, reputation and influence through its research and policy work. Second, boosting external funding.

He achieved both. Thanks to the Institute’s enterprising faculty and fellows, external funding from grants nearly tripled during Fishman’s tenure, and private donations soared. Financial support for students increased two and a half times, opening doors for future scholars and policymakers.

Fishman also helped the Institute become even more prominent in its signature areas of research on older people, including economic insecurity, race- and ethnicity-related health disparities, healthy aging, and age-friendly communities, while striving to bring that work to the attention of policymakers and the general public through robust communication.

The Gerontology Institute also deepened its expertise in long-term services and supports (LTSS) under Fishman by adding a fourth center — the LeadingAge LTSS Center @UMass Boston. This three-way partnership among Community Catalyst, LeadingAge and UMass Boston unites researchers and policy analysts in academic and applied settings, an innovative collaboration illustrative of Len’s knack for building strategic alliances whose whole is greater than the sum of their parts.

Fishman and Gerontology Department Chair Jeff Burr treated their respective units as a united enterprise, resulting in increased productivity of faculty and more opportunities for students to conduct research, be mentored, and earn money for their education. Fishman and Burr led the recent effort to establish the Frank Caro Scholarship for Social Justice in Aging. Named after one of the UMass Boston Gerontology program’s founders, the fund has raised approximately $370,000 thus far. The funds will be used to recruit and support doctoral students from under-served communities.

“The last seven years have been the best years for gerontology at UMass Boston and a lot, a lot, a lot of the credit goes to Len,” Burr said.

Len came to UMass Boston after serving for 12 years as CEO of Hebrew SeniorLife, New England’s largest nonprofit provider of senior housing and health care. Prior to joining HSL, Len was president and CEO of LeadingAge, in Washington, D.C., which represents 6,000 non-profit senior housing and health care providers in the U.S. and Canada, serving over two million older people. Before that, he served in the cabinet of Governor Christine Todd Whitman as commissioner of the New Jersey Department of Health and Senior Services, where he led the governor’s initiative to unite programs serving older people into one cabinet-level department. He previously practiced law as a health-care lawyer in New Jersey and Pennsylvania.

“We are on the cusp of the greatest demographic transformation in history,” said Fishman. “The human lifespan has increased by more than a third, and very soon, one in five Americans will be 65 or older. Yet we are nowhere near ready to meet the challenges or take advantage of the opportunities presented by these changes. Our gerontology program is a beacon of learning and hope.”

“I will, of course, remain involved in the field of aging. As our chancellor, Marcelo Suarez-Orozco recently observed, population aging is one of the three greatest challenges facing humanity. My generation (me included) has not covered itself in glory in dealing with the other two: climate change and racialized inequity. My retirement will allow me to spend more time on both. It’s been an honor to work with the Gerontology program’s talented faculty, fellows, staff and students, and a privilege to work at the nation’s third most diverse university during this most recent racial reckoning. The demographics of UMass Boston’s students are a preview of what our nation is becoming – they are my greatest source of hope for the future.”

Elder Index at Work: Helping Boston’s Age-Friendly Plan Take Aim at Economic Insecurity

This article is one in a series of stories about how people across the country are using the Elder Index to understand the true cost of living for older adults and its economic implications. If you know someone who would like to receive information about these stories, send us a note at gerontologyinstitute@umb.edu.

Go to any city across America and you will find older adults struggling to make ends meet. Go to Boston and you will see some of the most serious elder economic insecurity problems in the nation.

This is not news at Boston’s Age Strong Commission, which first launched an ambitious age-friendly plan in 2017. The commission is now developing a Step 2 blueprint with a focus on the problem of economic security among older residents. A critical tool for that job: The Elder Index. Continue reading

New Report Ranks Elder Economic Insecurity in 100 Largest U.S. Metro Areas

Jan MutchlerOlder adults in every one of America’s large metropolitan areas face serious challenges affording their local cost of living. But the scale of economic insecurity varies dramatically, depending on what city those older adults call home.

A new report by University of Massachusetts Boston professor Jan Mutchler and graduate assistant Yang Li uses the Elder Index™ to analyze the cost of a no-frills elder budget in each of the nation’s 384 metropolitan statistical areas (MSAs), where 83 percent of older Americans live. They also tracked income levels of older adults in the 100 largest metro areas to determine what percentage of elders in those cities had insufficient income to afford their local cost of living without help.

They found a wide range of elder economic insecurity levels among both older individuals and couples living in the larger metro areas. More than 67 percent of older individuals in the Texas metro area covering McAllen, Edinburg and Mission did not have enough income to meet local expenses on their own, the highest rate among the 100 largest MSAs. Continue reading

Transforming the Future of Aging

Bei Wu works toward improving health status through research and policy

If the world of academic gerontology had a rock star, it would be Bei Wu, MS ‘97, PhD ’00.

Recognized for her extensive research and pursued by top tier universities, Wu has become an international leader in the field since graduating from the University of Massachusetts Boston’s Department of Gerontology. Add the years in policy work before earning her doctorate and Wu chuckles that, having spent more than half of her life in the field of gerontology, she herself is now experiencing the aging process.

“I’ve become my own study subject,” Wu says.

Today, Wu is the Director of Global Health and Aging Research at the Rory Meyers College of Nursing, and Director for Research at the Hartford Institute for Geriatric Nursing at New York University (NYU) and the inaugural co-director of NYU’s Aging Incubator, a university-wide aging initiative.

Given her considerable success in gerontology, it’s fitting she credits her grandmother — with whom she was extremely close — for nudging her into the field. Born in Shanghai, Wu’s parents left her and her brother in their grandparents’ care when the two were young. After college, Wu accepted a research position with the Shanghai Commission on Aging only after prompting by her grandmother.

“At the time, very few people thought aging would be a challenging issue in the future,” Wu says.

But writing policy briefs and launching studies on intergenerational support with the United Nations Population Fund convinced Wu to pursue graduate studies. With no options available in China, she chose UMass Boston.

“UMass Boston has had a significant impact on my career,” Wu says. “The gerontology program has a critical mass of excellent faculty.” Continue reading

Elder Index at Work: A Texas Area Agency on Aging Tracks the True Cost of Rural Living for Older Adults

multigeneration portraitThis is the first in a series of stories about how people across the country are using the Elder Index to understand the true cost of living for older adults and its economic implications. If you know someone who would like to receive information about these stories, send us a note at gerontologyinstitute@umb.edu.

By Taryn Hojlo

The Alamo Area Agency on Aging has a lot of ground to cover.

The agency serves a dozen rural Texas counties surrounding San Antonio. About a half-million people live in those counties, a combined territory larger than the states of Connecticut, Rhode Island and Delaware put together.

Trina Cortez was beginning to work on a draft of the Alamo AAA’s upcoming bi-annual area report and she wanted to track correlations between the level of elder expenses and service referrals for members. To do that, she needed a source that could accurately calculate the true cost living for older adults in individual counties.

The agency had struggled to make assessments like that in their previous plans. Then, Cortez discovered the Elder Index. Continue reading

The Age-Friendly Movement: How it Grew and What Plans for an Older Future Could Achieve

The age-friendly movement is being embraced in small towns, cities and even states across the country. All of them see populations growing older and recognize that they must adapt. They are assessing needs and creating plans so their communities will be great places for residents of all ages to live in the future. The Gerontology Institute Blog invited three of the leading age-friendly voices in Massachusetts to discuss the movement — what it has achieved and where it is going.

Michael Festa is the Massachusetts state director of AARP, the leader in developing age-friendly community networks across the country.  Nora Moreno Cargie is president of the Tufts Health Plan Foundation, a leading supporter of work in healthy living with an emphasis on older adults. Jan Mutchler is director of the Center for Social and Demographic Research on Aging at the University of Massachusetts Boston. Her center works directly with communities across the state to assess age-friendly needs and develop action plans to address them. The following is an edited version of their conversation.

Q: Mike, AARP recently designated Massachusetts the nation’s second age-friendly state. How did that happen and what does it mean?

Michael Festa: It means Massachusetts is in a place where all departments of state government – not just public health and human services, but in all aspects – are committing to a process in which an age-friendly lens is applied. But the application also asks what you are doing already that is reflective of that commitment. There are a lot of things going on in communities with the age-friendly initiative. You already have a coordination of professional associations like planning councils and other groups. AARP asks, is this state in a place where we can acknowledge it is age-friendly or in the process of achieving all it is aspiring to do? The reality of what is happening in Massachusetts made it quite easy for AARP to say yes.

Nora Moreno Cargie: I would add just to that the Governor’s Council to Address Aging in Massachusetts. There’s this statewide body, to Gov. Baker’s credit. We talk to ourselves about ourselves — here you have three people who are involved in age-friendly stuff. What the governor recognized is that we had to talk to people in transportation and housing and those other areas, so that they could also become aware of what was necessary to achieve this age-friendly work.

Q: Local age-friendly planning is taking place all over the state. How did it become so popular on the municipal level?

Jan Mutchler: This whole initiative took off because there was an interest in doing something innovative, but there hadn’t been a name for it or models for it. It’s been so successful here because there were early adopters and the publicity about this being an initiative that had a name and a framework attached to it. People are excited and moving ahead because it’s been where they wanted to go all along. Communities approach all of this with very different capacities. We’re seeing a huge range needs for guidance and support. Continue reading

Crucial Support for Senior Affordable Housing at Risk in Tax Reform Legislation

Len FishmanBy Len Fishman

Low-income elder Americans face a housing crisis today. We don’t have nearly enough decent, affordable housing for them, and our country’s aging population is adding waves of new seniors to the waiting lists every day.

States and the federal government generally do not build new affordable housing directly. Instead, they maintain a market-based system that allows private firms and nonprofits (many of them faith-based) to partner with government to build and preserve housing for low-income elders and the working poor.

For decades, this public-private partnership has been the main engine driving new construction and preservation of subsidized senior housing. With the passage of tax legislation in both houses, Congress now faces a stark choice.

The House tax bill would eliminate private activity bonds and accompanying tax credits—one of the last forms of government support making private investment in affordable housing for seniors possible. The Senate bill would leave the bonds and tax credits largely intact. It’s essential that a final bill preserves these critical tools to help us address the dire housing problem facing many of our most vulnerable citizens. Continue reading

How Weaker Affordable Care Act Would Squeeze Hospital Finances

This article originally appeared on STAT on Oct. 11, 2017

By Joel S. Weissman, Marc A. Cohen and Amanda Reich

While the Trump administration and the Republican-led Congress failed to repeal and replace the Affordable Care Act, a number of ACA-weakening strategies put forward by the administration are already underway. These include inadequate enforcement of the individual mandate, imposition of work requirements on Medicaid recipients, and failure to promote enrollment through advertising and outreach. An unintended consequence of these strategies is likely to be an increase in the amount of uncompensated care provided by America’s hospitals.

Continue reading