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Caring for the Aging, Elaine Blake
Elaine is an Assistant Professor of Nursing at Belmont University School of Nursing in Nashville, TN. She is responsible for teaching the Leadership and Management course and overseeing of clinical placement for the leadership and management students. In addition, Elaine serves as the Collaboration Coordinator for the Belmont University / LifeTrust America Joint Development Project which focused on assisted living facilities.

Prior to joining Belmont University School of Nursing, Elaine was the Program Director for the Senior Life Center at Tennessee Christian Medical Center (TCMC). While at TCMC, Elaine specialized in the care of senior adults with depression, late-life psychosis and behavior problems associated with dementia.

Elaine is an experienced consultant whose clients include the Centennial Medical Center in Nashville, TN, Vanderbilt University Medical Center and the Rochelle Center. During her work with the Rochelle Center, Elaine assisted in the development of the Adapted Work Program which was sponsored by a grant from the Robert Wood Johnson Foundation. This program provided strategic planning to explore older adult programs and assisted in the development of a hospital-based care coordination program for senior adults.

Elaine received her Bachelor of Science in Nursing from Goshen College School of Nursing and a Master's of Science in Nursing from Northwestern University.

Due to Elaine's schedule questions may not be answered until late in the day. Thank you.

Question 1 - Elaine, Thanks for hosting this Forum. It is critical for us to focus on the imminent collision of two social phenomena: the burgeoning senior population and the decreasing numbers of health care providers, particularly CNA's and RN's. I also note with concern, but understand, the increased interest in collective bargaining among professionals.

Some very sobering HRSA data show an enormous gap between the volume of future patient needs for nursing care and the capacity to meet those needs. From a a public health standpoint I'm concerned that the nursing industry may not be capable of independently "morphing" itself into an effective response to this population's future needs, but I am very open to hearing I'm off base about that and there are great plans underway. What do you (and others) think will be happening in the future regarding this issue? Will nursing adequately reinvent itself? If the answer is "maybe" what are the current obstacles that must be overcome? If the answer is "doubtful," what types of very practical activities (construction of new roles, legislation, etc.) must happen now to protect patients in the future?

FYI: I have had a 28 year history in the hospice movement as nurse practitioner and CEO, and am a national standards, outcomes and policy advocate in end of life care.

Thank you!
True Ryndes, ANP, MPH
President and CEO
National Hospice Work Group
Vice President for Mission and Policy
San Diego Hospice
by TRyndes on February 21, 2000

Answer 1 - Thank you, True, for your thoughtful question. You highlight a very real concern of mind also. In short, I don't see a widespread, concerted plan for assuring enough nurse providers and the drop in enrollments in nursing schools is real. There are some bright spots though. One example is the Hartford Foundation in the Division of Nursing at New York University ( by Elaine Blake on February 22, 2000

Answer 1 - Continue - Their mission is to make dissemination of geriatric education/knowledge easy; one product they offer is a notebook of ready to teach topics they have determined as essential geriatric content that can be customized through the curriculum of any nursing program. They also assist young researchers to develop significant research, identify best practice models and work to increase public awareness of geriatric nursing accomplishments. Another problem with meeting the needs of the future is that nurses (and other health provider group also) seem almost to avoid geriatrics as a specialty. It is my belief that this is largely because we are uncomfortable, even fearful, of our own aging and have few encounters with elders who are doing well. Have you ever noticed how the well elderly seem to vanish in our society? Will that change as the baby boomers age? I don't know. I don't want to sound hopeless about the future though. Need and wants have always shaped our options. It may well be that baby boomers will be willing to pay for more services out-of-pocket and will demand reimbursement for more chronic care services. Increased reimbursement may well increase awareness, interest and shape services. Ideally, experienced nurses with gerontological experience would become part of for-profit and not-for-profit groups creating new businesses and services. It will require them to have a new language and an appreciation of the economic pressures of our capitalistic society but these nurses might learn to operate with one foot in each camp and contribute to new solutions. I see other provider groups as critically important also - occupational therapy, physical therapy, and social services, and others are all necessary to provide for the complex needs of an aging society. Thanks again for your question. Elaine by Elaine Blake on February 22, 2000
Question 2 - Hello Elaine, Not being very familiar with Assisted Living Facilities, what are the unique needs of the residents and what makes these facilities different from other long term care facilities? by yvette on February 21, 2000

Answer 2 - Assisted living is the newest option in the continuum of care for those between nursing home and independent living. It's not healthcare, many models have no healthcare providers at all, but a "home-like" atmosphere where incidental help like meals, housekeeping, packaged meds delivered on schedule, some social activities, and even some personal care are provided. Charges are on a sliding scale based on hours of service needed. As a social model rather than the medical model of nursing home, it has become quite popular for those on the edge of frailty. A recent study of about 1200 residents in one southeastern assisted living network showed the average age of their residents to be about 84 yrs. Of course the vast majority are women. The challenge and the opportunity is to support their frailties and sustain their remaining abilities. We're just begining to learn how to do this. Timely question. Thanks. Elaine by Elaine Blake on February 22, 2000
Question 3 - With the adage "Necessity being the Mother of Invention"; many of the perceived economic problems of the past have been solved with technology. An example would be the economists of the 1920's projecting based on population growth we would all starve before 1960; but technology steps in; giving us more food per acre and mass transportation and storage solutions that saved us from eminent doom.

Do you feel that the aging crisis, too, will be attacked with technology? If so, what kind of technology and how effective will this be? by BenDover on February 22, 2000

Answer 3 - Interesting you should ask this question because someone just handed me an article about a robot, actually a "nursebot" called Flo that can stay with an older person and reminds her when to take her medicine, opens the bottle lids, checks vital signs, follows the person around so she won't get lost, communicates with health care professionals through two-way screens via Internet and even interacts with the person "as a human would". That last part is a little hard to believe! I have read that Sweden is way ahead of the US in keeping older adults in the community because of their innovative architecture. Some futurists envision virtual long term communities where there is a central command station which monitors and communicates with older people in their own homes (maybe with Nursebot, Flo). Yes, I think technology will be of considerable assistance. There are a couple of cautions: techology is usually expensive and the needs of the elderly are extraordinarily complex and diverse. Techology will always need to be coordinated by knowledgable caring individuals. Thanks for the question. Elaine by Elaine Blake on February 22, 2000
Question 4 - Elaine, What social and ethical issues must this country face and change in order to better care for our growing elderly population? by tammy on February 25, 2000

Answer 4 - Tammy, I'll respond to your question about social and ethical issues with the top three that come to mind. I think there are many more we will need to face. An obvious healthcare issue is who will get what kind of care in face of the necessity to contain costs. Will certain high dollar treatments be unavailable once one reaches a certain age? Or is it income and type of insurance that determines this? I think there will be some hard decisions to be made on these issues and we don't even have a real forum for discussion yet.

A second issues relates to who will care for the personal and healthcare needs of the large numbers of old and very old people in the future. More and more healthcare - everything but very acute stages of illness - are taken care of in the community these days. Even if we do a better job with home health care, someone has to coordinate it. Families already provide 85% of care of the elderly, perhaps more. Will they continue to do more and more in a dispersed society with so many working women? Alzheimer's disease increases dramatically in incidence (some studies show it to be as high as 45%) in the over 85 population though the rate of progression of symptoms seems to be slower. Some gerontologists say this will be the real crisis of an aging society. Our healthcare system does not, maybe could not, cover the real care needed for this group. by Elaine Blake on February 25, 2000

Answer 4 - Another very important issue that must be grappled with is creating real choice about how we die. I don't mean assisted suicide so much as choices about where and with what care a person can die. And who really makes the decision. This is not easy.

Balancing the needs of a society that will fundamentally change as the percentage of older people increases in the next 25 years, a group with a huge diversity of needs and expectations, will have impact on every one of us in ways we do not even imagine at present. Creativity and compassion will certainly be needed. elaine by Elaine Blake on February 25, 2000
Question 5 - Hi there! I have two questions, one more personal than the other. Less personal first: how well do you think the Internet and computers in general have been serving the aging population? I.e., is there more the computer/Internet community can do to assist elderly folks benefiting from use of the technology?
More personal question: How do nursing staff handle a person with multi-infarct dementia? Is it better to allow the person to wander the ward, or should there be more intervention? How does the nursing staff help explain this condition to a family? Recent experiences have made me wonder. Thanks so much!! by Ingolfsson on February 25, 2000

Answer 5 - Hi A.M.: Your question about the internet is a good one. I have not approached searching the internet from the perspective of an older person either to look for content of interest or for user-friendly sites so cannot speak to issues about the internet itself. I know thatopportunities for learning to use computers and to access the internet are essential if it is to be used and the teaching and support approaches must be tailored to older learners who are generally not familiar or very comfortable with technology in general. At our local Senior Center they do offer courses and some computers for their members to use and I understand these courses are always full. Last spring I talked with representatives of a young company, Senior Explorer
(, who is creating a produce for use by seniors that provides a user friendly Internet access design that is being marketed to senior centers and retirement communities. by Elaine Blake on February 25, 2000

Answer 5 - (Continue) They offer a touch-screen so users don't have to learn traditional mouse and keyboard skills and a listing of web-sites by categories interesting to seniors so that the older user can navigate easily and quickly without complicated searches. This is intended for sites where groups would use the system, however, each user who signed on would have an individual e-mail address. And, of course, the company provides support to the contracting organization and to individual users. Seemed elegantly simple to me in preview. My observation is that for those who get engaged in internet use, it's a window to the world that's very exciting. For those who feel put off by technology or fear invasion of privacy, a comment I heard with some frequency, it's likely to remain a mystery. Potentially, the ability to communicate via e-mail with others at a distance or who are quite disabled can re-connect older people with families and friends and even offer brand new communities. I hear such wonderful stories fairly often. I'll post a separate answer to your second question. Thanks for your inquiry. Elaine by Elaine Blake on February 25, 2000

Answer 5 - Caring for people with multi-infarct dementia. Not easy to summarize; many books have been written on the care of Alzheimer's dementia and all those care approaches work for multi-infarct dementia also. The person with multi-infarct dementia may have a different cause but their experience of the world is very similar. Of course you need to look at the stage of the illness and gear interventions accordingly. Providing activity and structure is absolutely key to integrating individuals who are forgetful into an environment. A number of studies recently have shown how behaviors problems drop when people are engaged and guided. Perhaps the best help I can offer is to suggest just two books that outline simple approaches that I have appreciated. There are many other good ones these days. One is The Best Friends Approach to Alzheimer's Care by Bell and Troxel, Health Professions Press and another is Theurapeutic Caregiving by Bridges, BJB Publishing. Helping families to understand what the person may be experiencing and they are not intentionally forgetting is most helpful. Dementia, no matter what the cause, is very painful to families. Good luck. Elaine by Elaine Blake on February 25, 2000

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