Analytical Insights from Gerontology Masters Courses

Susan Salach-Cutler

Developing research skills

Research is the singular area in which I had very little experience. Having worked in the
geriatric health care field in social service, marketing and education I did not have positions that
necessitated the development of research skills. That being said, throughout the coursework I
have gained a greater appreciation for how labor intensive research is and have discovered best
practices for utilizing research to support my writing both academically and professionally.
Although research and practice are distinct from one another, they are not inseparable.
I recognize the value of ethical issues in research practices. Ethical research practices
require the ability to produce naturally occurring situations as opposed to deliberate negligence is
in the area of research. Researchers need to pro-actively evaluate the consequences of the
research practice utilized by the team not only to the participants but also to the community that
could be touched by the results. Evaluating the consequences improves the researchers ability
to be intentional in utilizing the most suitable method. Another area of evaluation is the values
conveyed by my actions throughout the project. Applied gerontological ethics should have
critical attention on the key themes of self-determination, dignity and respect for the participants
involved in the project.
Ethical sensibilities as a gerontologist
Throughout my 20 years of working in the geriatric health care, two primary ethical
questions in my work with caregivers have emerged. First, at what point does family transition
from concerned bystander to active participant in decisions? Along those same lines, can loved
ones be perceptive in how they view autonomy and that there is a point that occurs amid the

pursuit of autonomy by an older adult that allows for simultaneously yielding to the need for
assistance?
Autonomy for any person of advanced age should always be the objective. Engaging the
idea that individuals have the autonomy to choose and create how they acclimate to naturally
occurring changes is important. In addition, I think there is a need for differentiating between
autonomy and self-determination. I would argue that a person could have autonomy without the
larger scope of self-determination by structuring the situation in a way that allows the person to
make decisions by means of pre-selected choices. Along those same lines pro-active measures
such as the construction of advanced directives, living in conjunction with discussions with those
who would be in charge of those future decisions would assist in the creation of (for lack of a
better term) pro-active autonomy/self-determination prior to a potential cognitive decline.
Perceptions and my career
I have spent a good part of my career endeavoring to educate and empower both the
elderly and their family caregivers on the significance of becoming invested in evaluating and
creating a pro-active plan for their future. The question posed by Holstein, Parks & Waymack
(2011), how shall we care for an aging parent while also caring for immediate family and
ourselves? is a question I am perpetually addressing with the family caregivers. Having been a
family caregiver I understand the challenges, concerns and chaos that accompany family
members trying to make important decisions for those they care for, many times in emotionally
charged time-sensitive conditions.
Code of ethics
Understandably, when a field of work directly affects humans it is vital for professionals
to have a code of ethic in which to reference throughout their career. I also believe that most

professionals drawn to the field of gerontology do so because of some personal experience with
an elder. This can both inspire them to a high level of ethical evaluation, as well as create bias
based on a singular or small set of experiences.
Key policy issues
Aging policy is a problem driven approach to highly sensitive issues affecting the elderly.
One of the most notable example of aging policy would be that of Social Security Act of 1935.
This was the centerpiece of President Franklin Delano Roosevelts New Deal in response to
the Great Depression. This act was the catalyst for legitimizing age 65 as a customary age
predictor for people to leave the workforce. Money to fund this program is taken from current
workers as a separate payroll tax line and functions as a pay-as-you-go system. In other
words, taxes taken from the paychecks of current workers are paying for the Social Security
benefits of current retirees at a rate of about 43% of that retirees salary before retirement. The
Social Security Reform Act of 1983, in an attempt to ensure the reliability of the program,
acknowledged the approaching challenges of funding the program and raised the benefit age
from 65 to 67.
The passage of Medicare in 1965 was also a milestone in aging policy. The
establishment of this program was in response to the issue of people over 65 finding it virtually
impossible to obtain private health insurance coverage due to their age or previous medical
conditions. Medicare is a universal health care program aiding those over the age of 65 in
receiving access to health care. This program has contributed to the health and longevity of older
Americans.
The concept of wealth distribution and redistribution has been debated on many levels.
However, many Americans do not currently include a program such as Social Security in that

debate. Social Security is a program that was designed to re-distribute money; it takes money
from those who are working, and gives it to those who have retired. I, just like most Americans,
am concerned for those who live in poverty. However, I am also concerned that many
Americans fail to understand that government subsidized programs are underwritten by money
acquired from earned income of American workers.
There has always been a correlation between the left-wing special interest groups and
welfare-state growth. The theory is that social democratic parties will prevail, form
governments, and enact expansive programs (Hudson, 2010). For me, the larger issue is paying
for promises made decades ago that have now become an expectation of millions of current and
future older adults. The expectation of programs by social democrats have produced generations
dependent on income and health care funded by a government with poor money management
skills that obtains funding for programs via younger working people. This is not to say that I am
against programs that assist the elderly, I think that people need to understand that they are not
funded by some unknown source or money printed just for that program. The government, a nonrevenue generating entity, funds social programs via the working class.
Social Security, often viewed as a program for the old, is the nations most important life
insurance program for the young and also the pension vehicle most equipped in todays volatile
economy to provide retirement and disability protections for young and middle-aged people
(Cornman, Kingson & Butts, 2009). Social security originated as a safety net for the poor. The
Great Depression was clearly a catalyst for the Social Security Act of 1935, and some of its
provisionsnotably the means-tested programswere intended to offer immediate relief to
families (www.ssa.gov). This program was never meant to be a retirement plan for those who
can provide for their retirement. The choice comes down to a painful situation for many people

now or an impossible situation for most later. To deny Social Securitys lack of long-term
tenability is unwise, especially for career politicians who will at some point have to acknowledge
the disintegration of the program.
Of similar concern, Medicare payments for unnecessary tests and procedures, often
directed by doctors trying to cover themselves from potential lawsuits, are contributing to the
financial challenges of continuing to support policies enacted as aging benefits. The future of
Medicare is certain to be a matter of political concern in the decade ahead (Marmor, Martin, &
Oberlander, 2003).
Advances in industrialization and technology inside of the last century, as well as
changing perspectives on life course trajectory (i.e.: postponement of marriage and child rearing
and women as full-time workforce), have changed the way we construct the context in which we
age. Changes to the welfare state have had, and will continue to have one of the most profound
impacts the framework of aging policy. Changes in the delivery of health and social services
experience peaks and valleys based on economic growth or decline, public policy, as well as
political agenda need to be taken into account. According to Barr (2001), the welfare state is
mainly a collective piggy bank designed to insure against social risks and therefore, it is not a
vehicle for equality. Regrettably, risk will always play a role in scenarios involving programs
created and funded largely by government entities. The vulnerability lies in maintaining the
funding especially during economic downturns taking into account the increase in participants
and decrease in supporters whether voluntary or involuntary. One must also consider
constructing programs that involve interdisciplinary perspective and are able to manage and
maintain service provision in spite of economic variations. Another challenge arises from the

fact that the majority of programs, such as Social Security, bolstered as a short term fix did not
take into account future needs.
Reflection - Responsibilities in the field of Gerontology
I believe it is our responsibility as professionals in the field of Gerontology to inform the
conversations in the areas of bio-medical and aging policy as well. Having worked in hospice
care, as well as assisting in the end-of-life decisions of two family members, I fully understand
the ethical struggles associated with end-of-life issues. Terminal illness deprives one of control
over certain outcomes. However, having the autonomy to make thoroughly reasoned assessment
of consequences of the termination of ones own life, whether in the moments proceeding an
end-of-life decision or evaluated pro-actively by means of advanced directives is fundamental.
The challenge most often faced by those who have reasoned through the possibilities and have
made the decisions not to extend their life through artificial means or different treatment options
is most often by medical professionals. Some barriers and challenges relate to physicians and
other health care professionals, such as their difficulty accepting death and their lack of
education in end-of-life care. Other barriers and challenges are the result of patient/family
misinformation and aspects of services such as hospice care (Friedman, Harwood & Shields,
2002).

I agree with Holstein et al., (2011) that we see stick-figure depictions of ethical

dilemmas in medicine that have little to do with the actual lives and experiences of individuals.
Throughout my career, I have found that many well-meaning medical professionals often create
barriers for terminally ill patients who have chosen hospice as opposed to other treatment
options.
Another example is in the arena of aging policy. The majority of politicians that I have
met construct policy within a framework of crisis. Policy constructed within this framework is

reactionary in nature. In my opinion there needs to be more pro-active policy discussion

involving the future potential outcomes of reactionary policymaking. If we as Gerontologist do
not involve ourselves in changing the construction of future policy then I think we are doing a
disservice to our fellow Americans. There is a definite need for those who study aging at the
political table. Throughout my career, I have advised several local politicians regarding policies
affecting the elderly and found that many are not as informed on aging issues as one would
expect.
Growth and gaps in my development
I agree with Beattie (1970) that practicing gerontologist must view his role as that of
providing leadership for the development of adaptative responses among the many social
institutions, agencies, and organizations of society to the facts and realities of aging. I feel it is
our duty as gerontologists to inform the discussion.
For this reason I chose the following artifacts to provide insight into my aptitude
throughout the curriculum.
a) Adult development discussion stereotypes and aging myths
b) Ethics -Ethic Issues Surrounding Institutionalized Older Adults
c) Sociology of Aging Life History
d) Research Research proposal creating a purpose filled life
As gerontologists, we have an obligation to adapt the areas in which we perform research
into practical application. Creating application within a multi-disciplinary framework with other
gerontologists as well as professionals from other disciplines in order to generate a more
cohesive way to bring the disciplines together. Studying and working in the field of gerontology
creates a unique opportunity for those of us who have chosen this direction for our career.

References
Holstein, M., Parks, J. & Waymack, M. (2011). Ethics, Aging and Society, The Critical
Turn. New York. Springer Publishing Co.
Hudson, R. B. (Ed.). (2010). The new politics of old age policy. Johns Hopkins
University Press.
Cornman, J., Kingson, E., & Butts, D. (2009). Time for an All-Generations Approach to
Public Policy. Generations, 33(3), 86-88.
Social Security Administration (www.ssa.gov).
Marmor, T., Martin, S., & Oberlander, J. (2003). Medicare and Political Analysis:
Omissions, Understandings, and Misunderstandings. Wash. & Lee L. Rev., 60, 1137.
Barr, N. (2001). The Welfare State as Piggy Bank. Information, Risk, Uncertainty and
the Role of the State. Oxford: Oxford University Press.
Friedman, B. T., Harwood, M. K., & Shields, M. (2002). Barriers and enablers to hospice
referrals: an expert overview. Journal of Palliative Medicine, 5(1), 73-84.
Beattie, W. M. (1970). Concepts, knowledge, and commitment: the education of a
practicing gerontologist. The Gerontologist, 10(4 Part 2), 5-11.