Self Care Work and Retirement

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Self CareWork and Retirement

• OT 665

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Self Care

• Daily activities comprising duties ands chores
  ranging from personal care to personal business.
• They are fundamental to living in the social
  world enable basic survival and well-being
• Referred to as ADLs.

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Self Care Personal Care
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Self Care Personal Business
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Self Maintenance Activities

• Require 10-15 of average persons waking day
• People need home health services if they
• Need/receive help with at least 1/7 ADLs
• Need/receive help with at least 1/4 IADLs
• Stay in bed most of the time
• Need help with urinary/bowel device.

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Self Care

• Important for
• Social relationships
• Self Identity
• Psychological well-being

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Functional Limitation

• Predicted by
• Cerebrovascular Disease
• Arthritis
• Coronary Artery Disease

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Impairments Limiting Self Care

• Problems in
• Vision (shopping, paying bills, traveling by car)
• Hearing (quality of life and ADLs)
• Taste/smell (nutrition, food intake)
• Cognition (safety, ADL, use of time, IADLs)

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Self Care Assessment

• Most research focuses on this for NH placement
  rather than meaningfulness
• Underlying issues may be causing loss in function
  rather than problems with task performance
• Suggest using a
• Top-down approach
• Look at Task and role performance
• Possible reasons for person not being able to do
  tasks
• Rather than components

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Assessment

• Visual/Perceptual
• The Rivermead Perceptual Assessment Battery
  (RPAB)
• Auditory Deficits
• minimize excess noise move closer to the person
  improve lighting, maximize glare (if a lip
  reader)
• Sensorimotor
• The Assessment of Motor and Process Skills (AMPS)
• Cognition
• Bristol Activities of Daily Living Scale
• IADLS
• Kohlman Evaluation of Living Skills (KELS)
  Tappens Refined ADL (RADL) Assessment of Living
  Skills and Resources (ALSAR)
• Safety- Functional Assessment of Safety Tool
  (FAST)
• Environmental Factors
• Overlap with self care see environment chapters
  from 606

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ADL limitations

• Age group with highest percentage of ADL
  limitations
• Eating 75-84 (46.5)
• Dressing 75-84 (79.3)
• Toileting 85 (67.5)
• Getting in/out of bed/chair 85 (85.1)
• Getting around inside 85 (88.1)
• Bathing 65 (97.4)
• Any ADL limitation 85 (98.9)
• No ADL limitation 65-74 (8.6)

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Modifications

• Environmental
• House
• Ramps, widened doors, no throw rugs, long pile
  carpet, leg extenders to beds and chairs,
  rearrange furniture for safe easy access, removal
  of exterior bathroom/bedroom door, add shower
  curtain for privacy
• Bathroom
• Raised toilet seats, grab bars, glass shower
  doors replaced with shower curtains, adequate
  lighting lower cabinets/remove cabinet doors
• Kitchen
• Lowered kitchen counters, use microwave for meal
  prep, lighting and contrast
• Consider aesthetics of person

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Assistive Technology

• Be economical when recommending devices
• Consistently store devices in same location
• Is the device replaceable and how much will it
  cost
• May not use device because it isnt what they
  really need (cant afford what they really need).
• Older adults may be hesitant to order devices
  because they are unsure of their helpfulness.
• 23 of older adults use assistive devices

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Devices

• Low Vision
• Strategies - large print, magnifying glass,
  memorizing location of items, contrast, non glare
  lighting-
• Devices corrective lenses, telephones clocks
  with large numbers, large print cookbooks and
  other reading, games computers with large
  screens, print sound electronic reading
  machines, closed-circuit television.

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Devices

• Hearing
• Hearing Aid
• Phone amplifiers, timers with light indicators,
  doorbell/phone lights when rings, closed
  captioned TV.

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Devices

• Cognition
• Signs
• Labels
• Calendar
• Electronic calendars
• Memory notebooks
• Pillboxes with alarms to remind to take meds
• Cabinet locks
• Emergency response systems

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Devices

• Physical Limitations
• Plate guard, scoop dish (CVA)
• Non-skid mats (CVA)
• Built up utensils (arthritis)
• Long handles, long straw, universal cuff, swivel
  utensils, mobile arms supports
• Hook and loop fasteners, button hook, shoe horns,
  elastic laces, sock aids, zipper pulls
• Electric razor, electric toothbrush
• Extended handle mops, dust pan broom
• Front loading washing machine and dryer
• Wheeled utility cart transport groceries, food etc

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Task Modification

• Substituting one activity for another
• Compensation doing task a new way (reacher)
• Alteration new more efficient ways (sitting
  rather than standing)

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Work and Retirement

• Work paid employment
• Retirement the process of terminating paid
  employment

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People in the workforce in 1950 and 1993
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People are working less Retiring sooner
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Average Percentage in the labor force 1993 by
Race and Gender
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Employment Status of Older Americans, 1995 -
Percentage
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Wellness and Prevention

• Preventative wellness
• Holistic
• Physical fitness
• Nutrition
• Weight control
• Stress management
• Hypertension control
• Smoking cessation

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Wellness and Retirees

• Retirees often overlooked in health promotion
  efforts of organizations.
• Belief that elders are too old to benefit/change
  behaviors
• Actually, wellness programs for elders are a way
  to manage escalating health care costs
• Suggested approach to include prevention,
  health maintenance and rehabilitation of
  functional abilities.

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Current Wellness Approaches

• Appraisals of health risk (medical screenings)
• Written information (Newsletters)
• Classes, seminars and programs (senior aerobics)

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Considerations for Developing Wellness Programs

• Goals, needs, desires, health level of
  participants
• Social, psychological, physical needs
• Safety, motivation, and confidence
• Intensity level of exercise (if included)
• Ethical issues
• who is ultimately responsible for the persons
  health organization or individual?

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Older worker performance

• Equal studies support a decline, an increase and
  stability in older workers work performance
• Experience may counteract aging issues
• motivation, ability, personality are other
  factors that influence work performance

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Training older workers

• Obsolescence vs maintaining competence
• Keeping current with changes in technology is
  important
• Need to be continuously updating skills
• Individual Characteristics related to
  obsolescence include
• Age (been out of school for a long time updating
  skills is vital)
• Motivation and ability (both critical for
  maintaining competence)
• External factors (organization may either foster
  or discourage updating behaviors)

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Training Older Workers

• Barriers
• situational (lack of info, lack of money),
• dispositional (self-perception),
• institutional (policies and procedures)
• Person factors
• motivation
• may feel inadequate, fearful, low self esteem due
  to lack of education
• Structured
• relevant to the job
• based on job analysis
• small steps, bit by bit
• offering positive feedback to older trainees

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Training Older Workers

• Active participation
• Familiarity
• Organized
• Slower in pace for presentation of materials
• Learning strategies offered

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Adult Learners

• Self directed
• Rich in experience
• Choice of learning depends of developmental stage
• Problem centered
• Internally motivated

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Retirement experience

• Positive or negative? Depends on
• Voluntary versus non voluntary
• Health status (healthier have more positive
  retirement)
• Income (loss of income very stressful)
• Attitudes (positive attitude leads to positive
  retirement)
• Preparation for retirement 9planning for major
  life changes)

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Retirement Preparation Programs

• Formal
• few of them offered by
• employer, non profit organizations, consulting
  firm, retirement specialist
• Pre-retirement sessions
• single session to group sessions
• financial planning, health issues, leisure,
  housing, interpersonal relationships, use of
  time, adjustment to role changes.
• These help short term , more long term outcomes
  need to be done.

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Alternatives to Retirement

• More than half retirees would like part time work
  rather than complete retirement
• Scheduling issues, unavailability of work in
  expertise area

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Options Other Than Retirement

• Job sharing
• job splitting
• work sharing
• phased retirement
• job transfer
• reemployment
• flextime
• variable days.

• Two or more part time workers share hours,
  responsibilities, and benefits of one job.
• A single jobs tasks are divided between 2
  employees
• One group reduces its hours to enable employment
  of another group.
• Gradual reduction of hours or extended non-work
  periods of several months at a time.
• Transfer to a job with fewer responsibilities
• Rehiring of retirees on a temporary basis
• Full-time work with flexible working hours
• A variation on flextime in which work days vary.

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Unemployed Older Workers

• Unemployment rate low for those over 60
• Many may choose to retire rather than look for
  another job
• 7 weeks longer to find a job than a younger
  person
• Being a black male, male with health problems, or
  having a less formal education makes it more
  difficult
• Very discouraging.

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Displaced Workers

• Older workers less likely to be displaced, more
  likely to be recalled to work
• Unless unable to keep up with technological
  changes
• Federal employment and training programs
  available for people 14 yrs and up
• The Senior Community Service Employment Program
  under Title V Older Americans Act elders can
  continue to work if they would like to.
• (see http//www.aarp.org/scsep/)
• Climate is currently more favorable for older
  workers.

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The Senior Community Service Employment Program

• National Statistics
• For the 2000-2001 grant year, SCSEP was funded at
  440 million to support 61,762 job slots
  nationwide. SCSEP sponsors provided job training,
  counseling and support services for 123,626
  enrollees aged 55 and over, owing to enrollees
  who transitioned from the program into full- or
  part-time jobs and other program attrition.
• SCSEP sponsors exceeded DOL's goal of placing
  12,352 enrollees (or 20) in unsubsidized
  employment. The program found part- or full-time
  unsubsidized jobs for 22,851 older Americans (or
  37) nationwide. SCSEP enrollees during the grant
  year ending June 30, 2002 had the following
  characteristics (overall)
• 30 male
• 70 female
• 27 with less than a high school diploma
• 12 veterans
• 13 disabled
• 51 white
• 49 minorities
• 78 age 60 and older
• (From http//www.aarp.org/scsep-what/Articles/a20
  03-02-26-nationalstats.html)

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SCSEP National Statistics Employment With the
Program June, 2002
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Questions and Answers

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