May 2017
LTC NEWSLETTER
EXTENDED CARE LINK
Cheri Benander, MSN, RN, CHC, NHCE-C
Health Services Consultant, HealthTechS3
OVERCOMING AGEISM
According to Merriam Webster Dictionary (2017), ageism is defined as a prejudice or discrimination against a particular age-group and especially the elderly. When one thinks of prejudice or discrimination they tend to immediately focus on acts based upon sexism or racism.
But prejudice and discrimination against the elderly is extremely common and occurs frequently, especially in long-term care facilities.
“When age is the defining feature, our personality, beliefs,
and individuality are replaced with stereotypes of incompetence, debilitation, and dependency. Which leads to one
of the most damaging of the discriminating behaviors of
ageism—we start treating older adults like children.“1
In a 2001 survey of 84 people age 60 or older, Erdman Palmore, PhD, from Duke University, found that almost 80 percent had experienced ageism. Respondents had experienced other people assuming, that because of their age,
they had memory or physical impairments. The most frequent response in the survey, 58 percent of respondents, reported that the most frequent
type of ageism they had experienced was being told a joke that makes fun of older people.
Many of us have been guilty of some form of ageism and probably weren't aware of our actions or its negative effects. Psychologist, Becca Levy, PhD. indicates that “age stereotypes
are often internalized at a young age... even by the age of four, children are familiar with
age stereotypes, which are reinforced over their lifetimes.”2
In the healthcare setting, ageism presents itself quite frequently. While some may feel it nurturing to refer to elder patients or residents as “honey” or “sweetie”, the receiver of these terms
often feel they have been disrespected. Another example of ageism is talking to a friend or
family member about a resident as if the resident were not in the room, similar to a caregiver
talking to a parent caring for a child.3 Ageism can also be found within families, an example
would be grandchildren who assume that their grandparents don’t understand what is going
in their world and therefore converse with them superficially. An assumption that older adults
couldn't possibly understand the latest technology, much less be able to use it. 4
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FIGHTING AGEISM
In a longitudinal study of 660 people age 50 years and older, performed by Levy, she found
that those with more positive self-perceptions of aging lived 7.5 years longer than those with
negative self-perceptions.5 Ageism can lead to depression, impaired recovery from illnesses,
and increased stress.6
Additional studies have show that there are
several benefits, to both older adults and children who are engaged in intergenerational
programs. For the older adult they experience
enhanced socialization, increased emotional
support, improvements in health, and are stimulated to learn.7 While children demonstrate
an improvement in academic performance,
enhanced social skills, increased stability, and
a decrease in negative behaviors.8
Long-Term care facilities provide a unique opportunity to foster intergenerational learning by
connecting elders with children and breaking down stereotypes. Providence Mount St. Vincent in Seattle, Washington has implemented an Intergenerational Learning Center. In December 2016, the administrator indicated that they had six classes and 125 children ranging
from 6 months to 5 years of age. These classes provide “...opportunities for the residents and
children to be together in a variety of activities such as art, music, exercise, and storytelling.”9 Similar programs have opened in long-term care facilities across the county.
Two associations, Pioneer Network and The
Eden Alternative, have also taken on the
culture change movement and support intergenerational programs. The Pioneer Network was created to foster a change in culture to promote person-centered care and
a respect for the elders and their choices.10
The Eden Alternative’s philosophy is about
continuing to grow regardless of age and
working towards changing a culture that
views aging as a period of decline.11
Community programs also exist to encourage intergenerational activities. In 2012, Generations United and the MetLife Foundation recognized five communities for their intergenerational programs. Although several community programs exist, these five communities located in Texas, California, Iowa, Ohio, and Virginia were recognized for their successes in creating intergenerational programs.12
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The Centers for Medicare and Medicaid Services (CMS) also identified the need to address
ageism. In a memo to State Survey Agency Directors in 2009 (S&C-09-31), CMS provided Interpretive Guidance for the revision of several tags in Appendix PP. One of those revisions
was to the interpretive guidelines at F-Tag 241, §483.15 (a) Dignity. This guidance reinforces
the requirement that employees should speak respectfully, and address the resident by his
or her name, avoiding the use of labels.13 Attached to the memo was an article written by
Karen Schoeneman, who at the time was the Acting Deputy Director in the Division of Nursing Homes of CMS. She wrote the article as a representative of the Pioneer Network and not
that of CMS. Ms. Schoeneman wrote that during her 30 years in long-term care, she has
come to realize that “...much of the language we use is in need of replacement because it
unintentionally demeans people, contributing to a hierarchical sense of “us and them” or a
dehumanizing institutional culture instead of a nurturing community with respect for its members.”14 In her article, Ms. Schoeneman indicated that the idea behind person-centered language is to acknowledge and respect people as individuals.
A table listing several wording changes in the long-term care environment is included in the
document. For example, discontinuing the use of the words like grandma, mommy, kid,
sweetie, honey, girls, and old timer with the residents name. She also suggests that people
discontinue labeling residents by their needs, i.e. wanderers and feeders, to people who like
to walk and people who need assistance with dining.
CONCLUSION
Ageism, although most likely unintended can be
hurtful and have detrimental effects on the elderly.
In recent years, intergenerational programs have
been developed in communities and long-term
care facilities. These programs have helped to
break stereotypes, improve the quality of life for
our elders and enhance the personal and social
development of children.
INTERGENERATIONAL PROGRAM RESOURCES

Generations United — http://www.gu.org/

Alive Inside — https://www.aliveinside.org/

The Eden Alternative — http://www.edenalt.org/

the Pioneer Network — https://www.pioneernetwork.net/

Centers for Medicare & Medicaid Services — Center for Medicaid and State Operations/
Survey and Certification Group — Ref: S&C-09-314 https://www.cms.gov/Medicare/
Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/downloads/
SCletter09_31.pdf
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1 Reslock,
D. (2016). The cruelty of calling older adults ‘sweetie’ or ‘honey’ Available from http://
www.huffingtonpost.com/entry/the-cruelty-of-calling-older-adults-sweetie-orhoney_us_5812261fe4b064e1b4b0d444
2 Dittmann, M. (2003, May). Fighting ageism. Monitor on Psychology (34)5, p. 50
3 Ibid #1
4 Orenstein, B.W. (2015). 7 ways to overcome ageism. Available from http://
www.everydayhealth.com/longevity/emotional-wellness/fighting-age-discrimination.aspx
5 Ibid #2
6 Seegert. Liz. (2016). How ageism can negatively affect the health of older adults. Available from
http://healthjournalism.org/blog/2016/06/how-ageism-can-negatively-affect-the-health-of-olderadults/
7 Generations United. (2007) Fact Sheet-The benefits of intergenerational programs. Available from
http://www.gu.org/LinkClick.aspx?fileticket=71wHEwUd0KA%3D&tabid=157&
8 Idem
9 Boyd. C. (2016, December). An intergenerational model of care for long-term care facilities. Annals
of Long-Term Care: Clinical Care and Aging. 2016;24(11):17-19
10 Pioneer Network: About us. Available from https://www.pioneernetwork.net/about-us/overview/
11 Eden Alternative: About. Available from http://www.edenalt.org/about-the-eden-alternative/
12 MetLIfe and Generations United. (2012), America’s Best Intergenerational Communities. Available
from http://www.aarp.org/content/dam/aarp/livable-communities/learn/civic/americas-bestintergenerational-communities-aarp.pdf
13 Centers for Medicare & Medicaid Services: Center for Medicaid and State Operations/Survey and
Certification Group. (2009, 10, April). Ref: S&C-09-31, p. 8
14 Centers for Medicare & Medicaid Services: Center for Medicaid and State Operations/Survey and
Certification Group. (2009, 10, April). Ref: S&C-09-31, p. 47
HealthTechS3’s LTC Consulting Services are intended to be educational in nature and are not
intended to identify potential compliance violations. The LTC Consulting Services may include
advice and recommendations, but the ultimate responsibility for decisions regarding Client’s
compliance program and related processes, policies and procedures, including without
limitation, the decision to further investigate, consult original source materials or notify qualified
healthcare regulatory counsel for specific guidance remains with Client as the owner and
operator of its business.
For more information, please contact Cheri Benander:
Cell: 615-636-9042
Main: 615-309-6053
Fax: 615-370-2859
[email protected]
5110 Maryland Way, Suite 200 | Brentwood, TN 37027
www.healthtechs3.com
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and hospital management firm based in Brentwood, Tennessee with clients across the United States. We are
dedicated to the goal of improving performance, achieving compliance, reducing costs, and ultimately
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LTC Newsletter | Long Term Care | May 2017 | Page 4