Nebraska Healthcare Association

September 18, 2018

Gayle Resh MA, CTRS, CDP, CPRP, LNHA

Cultural Perception & Aging

Halfway Between Life, and the Cemetery

Perception of Skilled Living /Nursing Homes

Messages that float above the heads of cartoon and comic characters

Both as speech and Thought

Engage us

Allow us to learn more about the world around us

Poking humor at our own beliefs

Messengers of the funny

The serious–a reflection of our complicated lives

Social commentary for adult readership

Interpretive Guideline CMS tag F679

§483.24 (c)(1)

The facility must provide, based on the comprehensive assessment and care plan and the preferences of each resident, an ongoing program to

support residents in their choice of activities, both facility sponsored group and individual activities and independent activities, designed to

meet the interests of and support the physical, mental and psychosocial well-being of each resident, encouraging both independence and

interaction in the community.

• Prior language in place since 1987

• Cultural perception of large group; everyone participates – regardless of interests

• Care planning problems is NOT necessary-adopted from a medical model, not a Quality of Life Model

• Attendance is not engagement

Psychosocial theories of old age

Continuity Theory of Aging:

Adults generally maintain the same activities, behaviors, relationships as they did in earlier years.

Consistency in activities, personalities, relationships despite changing physical, mental and social status

Disengagement Theory

"aging is an inevitable, mutual withdrawal or disengagement, resulting in decreased interaction between the aging person and others in the social system he belongs to". The theory claims that it is natural and acceptable for older adults to withdraw from society

Relatively recent demographic reality

Before 19th century no age restricted institutions for elder care existed.

Incapacity, impoverishment, family isolation –Alms houseWith Insane, inebriated, homeless; part of a communities' most needy

1800’s – ‘worthy individuals’ of ethnic &/or religious background

“preserved those who once live respectively from becoming residents of Alms House”

For most impoverished –alms house-last refuge• % elderly in institutions – 2% (consistently)

• % of elderly in almshouses == 1880 33%; 1923 67%

Supreme Court Justice Benjamin Cardozo, for the majority

Supporting Social Security Act 1935

“the hope behind this statute is to save men and women

from the rigors of the poorhouse as well as the haunting

fear that such a lot awaits them when the journey's end is

near”

Centers for Medicare & Medicaid ServicesCMS

On July 30, 1965, President Lyndon B. Johnson signed the bill for Medicare and Medicaid. The original Medicare program included Part A (Hospital Insurance) and Part B (Medical Insurance) – Now “Original Medicare.”

Congressional changes to Medicare:

More people have become eligible.

Example, in 1972, Medicare was expanded to cover the disabled, people with end-stage renal disease requiring dialysis or kidney transplant, and people 65 or older that select Medicare coverage.

More benefits, like prescription drug coverage, have been offered.

Initially Medicaid included medical insurance to people receiving cash assistance. Currently:

Low-income families

Pregnant women

People of all ages with disabilities

People who need long-term care

Wide variation; state to state

OBRA

Federal Nursing Home Reform Act (OBRA'87) Law and Legal Definition. Nursing Home Reform Act (OBRA'87) is a federal law that sets some standard of care and establishes certain rights for elderly persons in the U.S. The provisions of the Act are contained in Omnibus Budget Reconciliation Act of 1987 (OBRA'87).

• 1987, President Ronald Reagan signed into law the first major revision of the federal standards for nursing home care since the 1965 creation of both Medicare and Medicaid

Social and Cultural ChangesAttitudes

Idle hands are the devil’s workshop

BUT

All work and no play makes Jack a dull boy

(Or Jill a dull girl)-

§483.15(f)(1) The facility must provide for an ongoing program of activities designed to meet, in accordance with the comprehensive

assessment, the interests and the physical, mental, and psychosocial well-being of each resident.

“They reflect us. It’s the ultimate popular culture of America. They really document what we’ve been interested in for most of the 20th century and beyond. It’s also a reflection of the good and the bad of our society.”

Georgia Higley comic-book curator-Library of Congress

What We Remember

Reminiscence ‘Bump’

As of 2018;

• Year of birth + 17 = area of greatest recall

• Area of Greatest recall = moments never forgotten and relevant information for individual

• Strong Historical memories

• Formative engagement can and does occur later

• Transformative

• Transitional

• Over decades – changes in toys, music, resources

Birth year + 17=Relevant Decade(s)Historic Events• 1930’s: 20th & 21st amendment, WWII begins, Roosevelt’s

New Deal/3R’s (Relief, Recovery, Reform)

• 1940’s: Pearl Harbor, Roosevelt dies, 400 mine workers on strike

• 1950’s: Rosa Parks, 1st attempt by US to launch a satellite into space fails/explodes, Alaska & Hawaii admitted to US

• 1960’s: First 50 star flag, Martin Luther King assassinated, Medicare begins, Neil Armstrong on the moon.

• 1970’s: Lower voting age to 16, Watergate, Viking 1 Space Probe on Mars

• 1980’s: Mt. St. Helen’s Volcano, highest unemployment rate since 1940, Exxon Valdez oil spill, stock market crashes

• 1990’s: World Trade Center bombed, OJ Simpson trial, Oklahoma tornados, NATO alliance expands

• 2000’s: Hillary Clinton in Senate, NASA space shuttle Columbia explodes, Swine Flue deemed global, Barack Obama elected US 44th President

Song & Artists• 1930’s: God Bless America (Kate Smith), Lady Luck (Dick

Robertson), Here Comes the Sun (Charles King)

• 1940’s: White Christmas (Bing Crosby), You Are My Sunshine (Jimmie Davis), This Land is Your Land (Woody Guthrie)

• 1950’s: Hound Dog (Elvis Presley), Great Balls of Fire (Jerry Lee Lewis), I Walk the Line (Johnny Cash), La Bamba (Ritchie Valens)

• 1960’s: The Twist (Chubby Checker), Sugar, Sugar (The Archie's), Honky Tonk Women (The Rolling Stones)

• 1970’s: ABC (Jackson 5), Knock Three Times (Tony Orlando & Dawn), Bennie & the Jets (Elton John)

• 1980’s: Physical (Olivia Newton-John), Eye of the Tiger (Survivor), Billie Jean (Michael Jackson)

• 1990’s: Wannabe (Spice Girls), Ice Ice Baby (Vanilla Ice), UCan’t Touch This (MC Hammer)

• 2000’s: Bye Bye Bye (NSYNC), Single Ladies (Beyoncé), I gotta Feeling (Black Eyed Peas)

Birth year + 17=Relevant Decade(s)Vehicles: Makes & Models• 1930’s: Ford Model B, V-8 engine, Cadillacs ($1,343.00)

• 1940’s: Cadillacs get hydraulic brakes, Dodge sealed headlights, First Station Wagon produced

• 1950’s: Ford seatbelts, Studebaker new Bullet nose introduced, push-button handles on exterior doors

• 1960’s: Mini Cooper, Futuristic “Batmobile”, power steering/brakes, Portable Car Radios

• 1970’s: Buick Rivera “Boat Tail”, Cadillac Seville “Best Caddy for 26 Years”, Chevrolet Pickup ($2,229.00)

• 1980’s: Jeep CJ 4 wheel drive, Ford Mustang, Pontiac Firebird

• 1990’s: Ford Escort, Honda Civic, Ford Focus, Mercedes-Benz C-Class

• 2000’s: Ford Explorer, Jeep Grand Cherokee

Technology/Inventions• 1930’s: Scotch Tape, ball point pen, strobe light, Motion

Picture Production Code, Stereo records

• 1940’s: first atomic bomb, Elmer's glue, aerosol cans, synthetic rubber tires

• 1950’s: Credit card, first color TV, super glue, pacemaker

• 1960’s: Typewriter, Etch A Sketch, ATM, artificial heart, zip codes

• 1970’s: Email, Home VCR, Post-It Notes, Push through Top on Pop

• 1980’s: First version of Windows, cell phone, internet, Sony Walkman, Nintendo, disposable camera

• 1990’s: World Wide Web, digital answering machine, the smart pill

• 2000’s: iPod, GPS, Amazon Kindle, Wii, X-Box, USB Flash Drive

Birth year + 17=Relevant Decade(s)

Sports• 1930’s: Masters Golf Tournament held for first time in Georgia,

Summer Olympics in Berlin, Babe Ruth points to stands & retires from Major League Baseball, Boxing #1 most popular

• 1940’s: Jackie Robinson breaks Major League Baseball race barrier, Women played baseball in dresses

• 1950’s: First triple jump and figure skating, football games televised for first time

• 1960’s: US figure skating team killed in plane crash, Mickey Mantle hits 500th home run, sports at home

• 1970’s: Marshall Football Plane Crash, Magic Johnson vs. Larry Bird NCAA Basketball Championship Game, Munich Massacre

• 1980’s: Michael Jordan’s playoff Buzzer, Doug Flutie’s Hail Mary, USA upsets Russia in winter Olympics

• 1990’s: Magic Johnson’s retirement after HIV-positive, Tyson bites Evander Holyfield, Michael Jordon won NBA Finals with Bulls

• 2000’s: Michael Phelps wins 8th Gold Metal for US swimming Olympics, Boston Red Sox win World Series, Shaq & Kobe 3-peat

Fashion• 1930’s: high waist, fitted hips, high neck line, wide shoulders,

“rough” fabrics (cotton & less expensive)

• 1940’s: thick wool or tweed suits, muted colors, Hawaiian shirts, wedges, bikinis, colored & chunky jewelry

• 1950’s: pencil skirts, peplum tops, hourglass figure, “Ivy League” (peppy), shoes shined, pipe smoking

• 1960’s: Jackie Kennedy Look, tight pants & flare bottoms, long collars, silk ties, mini skirts/dresses, big bows, clean

• 1970’s: mood rings, leisure suits, bell-bottoms, long hair, platform shoes, crossover trends, chest hair, jumpsuits

• 1980’s: feathered hair, glitter, crimped hair, friendship jewelry, exercise gear, spandex, legwarmers, parachute pants, puff paint

• 1990’s: “Casual chick look”, denim button down shirts, neon colors, oversized sweatshirts, flared trousers, bleached hair, wind breakers, sketchers, striped sweaters, flannel, combat boots, man tanks

• 2000’s: “Mash ups decade”, Daisy Dukes, Distressed jeans, flip flops, ponchos, knee-high boots, UGG boots, skinny jeans, side swiped bangs, letterman jackets

Birth year + 17=Relevant Decade(s)

Food & Drinks• 1930’s: DUST BOWL – soup kitchens, penny restaurants, wonder

bread sliced, Bisquick

• 1940’s: Cake Mix, Frozen French fries, Corndogs, M&M’s

• 1950’s: Deviled Eggs, Baked Alaska, Tuna Noodle Casserole, Meatloaf, McDonalds

• 1960’s: canned Coca-Cola, Easy Bake Oven, Kellogg’s pop tarts, SpaghettiOs

• 1970’s: Swanson frozen dinners, pineapple chicken, cheese balls/logs, carrot cake

• 1980’s: bread bowls, ranch flavored everything, Reese's pieces, whatchamacallit, sundried tomatoes

• 1990’s: pop rocks, bubble tape, push pops, ring pops, dippin dots, gushers, Capri suns

• 2000’s: bacon, mini cupcakes, fruit smoothies, sliders, cake pops

Family Life & Education• 1930’s: Fireside Chats, Monopoly, Birthrates declined

• 1940’s: Scramble, School is a priority, relaxed discipline, respect

• 1950’s: ate out more, dropping out of school, little spare money, divorce uncommon

• 1960’s: “Middle Class Style of Life”, Single at Heart, teenagers more innocent

• 1970’s: 72% of women unemployed, more than 25% single parent homes, employment is no longer gender based, education is not top priority

• 1980’s: higher divorce rate, centered around TV, videogames, music, teaching was viewed as a weakness, more subject centered curriculum

• 1990’s: traditional American family making a comeback, SMART board introduced, white boards, Baby Boomers start making families

• 2000’s: Delay marriage, anxiety, depression, anger in children, emphasis on fame, money, image, group affiliation, money on technology

Birth year + 17=Relevant Decade(s)

Media: Books, Movies, TV, Radio• 1930’s: Life Magazine, The Wizard of Oz, Gone With the Wind

• 1940’s: Propaganda, Fireside Chats, prohibited bad news

• 1950’s: rock & roll, The Catcher in the Rye, Elvis Presley, Marilyn Monroe youth icon, Gunsmoke, I Love Lucy

• 1960’s: radio shows, computer games, Cosmopolitan, Bogue, Presidential debates televised

• 1970’s: Wheel of Fortune, MASH, Woodstock, The Brady Bunch

• 1980’s: Dirty Dancing, Family Feud, Golden Girls, Miami Vice, My Two Dads

• 1990’s: The Simpsons, Pretty Women, Forest Gump, That’s 70’s Show

• 2000’s: Apple iTunes, The Dark Knight, The Office

Leisure & Recreation• 1930’s: Gambling, Movie theaters (Shirley Temple), make up

games, play with neighbors, dancing swing and jazz

• 1940’s: toy guns (Support war), Captain America comics, dinner with friends, riding bikes, increase of art for propagandas, sporting events

• 1950’s: Jump rope, hula hoop, checkers, marbles, chess, cards, family road trips, street hockey, Mr. Potato head, play-doh, Barbie

• 1960’s: race tracks, troll dolls, sporting events, fishing, skateboards

• 1970’s: Walt Disney World, Art, pet rocks, nerf ball, Star Wars toys, Legos, “mommy toys”, action figures, modern dancing (Disco, Jitterbug)

• 1980’s: videogames, play tents, UNO, Care Bears, Rubik's Cube, Pictionary, Packman, Transformers, Snakes & Ladders

• 1990’s: Water guns, Bop It, Moon Shoes, American Girl Dolls, Easy-Bake Oven, Furby, Beanie Babies, Yo-Yo, Hot Wheels

• 2000’s: X-Box, Nintendo, Rock Band, Wii, Harry Potter games, Social Media (Facebook, MySpace), Call of Duty

Movies related to each decade

• To see information, styles, traditions, and the ways of prior times, these movies best show these transitional times, but not completely true to times.

• 1930’s: Seabiscuit

• 1940’s: A League of Their Own

• 1950’s: La Bamba

• 1960’s: Bobby

• 1970’s: Now and Then

• 1980’s: The Breakfast Club

• 1990’s: Pay It Forward

• 2000’s: Extremely Loud and Incredibly Close

• ELDER PERCEPTION/SOCIETY BARRIER: THE INTERN (movie)

Cultural AwarenessFoundation of communication and it involves the

ability of standing back from ourselves and becoming aware of our

values, beliefs and perceptions

• FunctionalFunctional -

• Sense of freedom and choice

• Options and alternatives

• Meaningful experiences require selection and development of skills sufficiently diverse for enjoyment in current setting, adaptable to future

Criteria• Choice by individual

• Within functional ability

• Feasible

• Respect for cultural and ethnic preferences

- Compatible with overall life situation

• Opportunity for continued development

and involvement at later stages

• Consideration of place of residence, socioeconomic status, educational level, religion

Variety is the spice of life

BUT

Don’t change horses in mid-stream

Culture & Spirituality

Autonomy & Control

• Implied Freedom of Choice – including to fail

• Ultimately responsible for own success or achievement of goals

• Shared responsibility for involvement and behavior

“It isn’t in the conventional way so it is perceived as being wrong”

References• Encyclopedia of Recreation and Leisure in America COPYRIGHT 2004 The Gale Group, Inc

• Sue Myllykangas, Ph.D., CTRS Professor Undergraduate Curriculum Coordinator: Parks and Recreation & Gerontology -Reminisce Bump

• Katilynn Pieper, CTRS – Reminisce Bump Data

• Dr. Norma Stumbo PhD, CTRS Therapeutic Recreation Program Design: Principles and Procedures

• Comics –Baby Blues, Bizarro, Family Circle, Frank & Ernest, Garfield, Pearls Before Swine, Pickles, Real Life Adventures, Sally Forth, Zits

• A Continuity Theory of Normal Aging – George Maddox 1989

• Continuity & Adaptation in Aging: Creating Positive experiences Robert Atchley 1999

• Foundation Aiding The Elderly : The History of Nursing Homes www.4fate.org

• https://www.cms.gov/About-CMS/Agency-information/History/

• https://medium.com/@librarycongress/the-american-way-how-comic-books-reflect-our-culture-47620e71f599

• http://lilyandthetwins.com/recreation-therapy-worksheets/

• Regulations and Standards for Homes for Aged or Infirm –Nebraska Department of Health 1973

• Old Age and the Search for Security: An American Social History: Carole Haber & Brian Gratton 1994

• Active Photos: Alan (Al) Mytty: Associate Director -Navigant Healthcare

• Creative Forcasting, Inc April, May 2018

gresh@vhsmail.com; gayleresh@hotmail.com

402.327.6340