Age of Isolation: Understanding Stakeholder Relations
Assignment #2: Mapping Stakeholder Relations
Carnegie Mellon, Transition Design Seminar 2023
Team Holarchy : Jasmin Palermo, Gabriela Arias, Gladys Mercier, Misari Patel, Saurin Nanavati
Nowadays, more people are aging in place and generally living longer, however, due to various reasons such as divorce, death of a spouse, geographic separation from family members, or health concerns they are socially isolated. In our first installment of “The Age of Isolation”, we explored issues surrounding social isolation (SI), which provided us a starting point to better understand the context of this wicked problem. We learned that SI is defined as having objectively few social relationships and infrequent social contact. We also learned that SI differs from loneliness, a subjective feeling of a lack of connection to other people and a desire for more satisfying relationships. While the two terms differ in meaning, the Global Initiative on Loneliness and Connection (GILC) highlights that they can occur at the same time. We were especially intrigued by the evidence revealing that loneliness severely affects health — putting older adults at risk for high blood pressure, heart disease, obesity, a weakened immune system, anxiety, depression, cognitive decline, Alzheimer’s disease, and even death. Notably, leading researcherJulianne Holt-Lundstad found that loneliness can increase risk of mortality by 50% — higher than the effects of air pollution, obesity, and excessive alcohol use. According to a study by Stanford University, Harvard University, and AARP (Adamy, 2018), Medicare spends $6.7 billion each year on hospitalization and nursing facilities for seniors who lack close kin. This means that the senior demographic (over 65 years old) is severely impacted and has a significant impact on the Pittsburgh region from an economic standpoint.
The relationship between isolation and well being has a very cyclic nature. Seniors who are socially isolated may not have access to the help and companionship they need to manage the challenges of aging. Social isolation may lead to loneliness, which then has a negative impact on one’s physical and mental health, which then leads to increased social isolation.
To better understand how older adults can navigate this vicious circle of social isolation, loneliness, and the associated social, health and financial related issues, we are now exploring key stakeholders. In this installment of the “Age of Isolation” we dig deeper into the context to better understand relations of conflict and power imbalances among three key stakeholder groups:
1) Senior citizens
2) Family of senior citizens
3) Care Facility Managers
Process
There are a number of approaches to stakeholder mapping, however the goals are the same: Identify and prioritize key stakeholders based on assessing the influence of, importance of, and level of impact on the target population.
We used a semi-structured approach that involved group discussion, desk research, and sharing of findings through Miro. This approach allowed us to first consider stakeholder groups associated with the issues identified around social isolation of the seniors in Pittsburgh.
Identifying and assessing specific stakeholders helped to classify them with respect to other stakeholders that are also orbiting the issues around the isolation of senior citizens (see Article 1).
Once key stakeholders were identified, we prioritized them based on power relations among stakeholder groups. We began with seniors and their families as the starting point. Agreeing on the third stakeholder was mainly based on the importance of healthcare for aging populations, especially considering the above mentioned linkage between social isolation, loneliness and related social, health and financial ramifications.
Once we prioritized the key stakeholders we began researching the beliefs, assumptions and cultural norms for each group. Through our Transition Seminar we learned that:
“Although some traditional problems-solving approaches consider user preferences and motivations, they seldom consider the ways in which individual and collective stakeholder beliefs, assumptions and cultural norms have contributed to the problem. Factors such as social practices and behaviors which are sometimes considered, are always underpinned or arise out of beliefs, assumptions and cultural norms, and these must be considered when framing the problem and formulating interventions. Identifying each stakeholder group’s attitudes, beliefs and assumptions about the problem will require a wide variety of research methodologies that will vary in place, situation and culture-specific ways”.
Summary of Findings
To better understand each stakeholder group’s attitudes, beliefs and assumptions we investigated the “Fears and Concerns” and “Hopes of Desires” for each group. This process provided first-person statements from these stakeholders which made the problem multi-dimensional. For example, the potential “bad guys” (e.g. care facilities profiting from privatization of senior care) do not seem like such villains now. The people that work in these facilities have legitimate concerns about providing quality care for residents while still covering their costs of operations.
In an ideal setting, we would have engaged stakeholders through focus groups. The potential for dialog across and among the prioritized stakeholder groups could benefit everyone. Talking about shared fears and hopes could dial down the emotional load of dealing with this problem and might encourage those involved to move into a cooperative stance for solving the problem together.
Senior citizens
An interesting thing we are beginning to notice about wicked problems is that the ones that are most impacted are the same people with the least amount of leverage and power in the system — in this case its senior citizens. When doing research about first-hand experiences of isolated seniors in Pittsburgh, their concerns ranged from the general stigma of their age group to specific elements of Pittsburgh culture.
A universal fear that senior citizens express is the fear that their needs and conditions will burden their family or loved ones. Family support (emotional, physical, and financial) is crucial to the health of the senior citizens who are isolated. However, this dependency can be uncomfortable for both parties, as the senior citizens find themselves feeling guilty and lacking personal freedom, and families may gain resentment as their list of responsibilities grows longer. Many seniors feel so averse to being beholden to others that they don’t accept assistance from anyone out of worry over the mental and financial debt it may cause. Simply put, senior citizens don’t want to feel like a burden.
One of the main issues with growing old is that your body ages, and in that process, you are more susceptible to pain and injuries. Senior citizens fear falling and injuring themselves, not only because of the physical pain and recovery involved, but also because of the expenses attached to it. Especially for elderly people who don’t support themselves financially, getting the proper care for an injury may be out of the picture. This fear throws people deeper into isolation, as they are less likely to try new things in environments they are unfamiliar with.
Financial stress also plays a big role in everyday decisions, and considering how many senior citizens are on fixed incomes in Pittsburgh, it is an important consideration. One account of an isolated senior citizen in Pittsburgh who could barely afford to buy food reached the point where her phone line was about to get cut off, and that is what forced her to ask for help, restore connections, and pull herself out of her isolation. She was able to overcome her fear of burdening others, but unfortunately, many people in her position may have thought the reduced phone cost was a better option.
Another major factor contributing to the isolation of the senior citizens in Pittsburgh is transportation. Without a vehicle to go places, they find themselves stuck at home. Public transportation is another source of fear, as bus drivers can be impatient, especially towards those with canes or wheelchairs. The college culture in Pittsburgh also plays a role in how seniors experience isolation, as apartment buildings that were once filled with older adults are now being filled with college students.
All in all, the main fear of senior citizens in Pittsburgh is dying alone. In other cultures death is embraced, but here it is a taboo subject, and it looms over the mind of elderly people, especially when they find themselves being shut out, or shutting themselves out of society.
The main hopes of senior citizens according to our resources revolve around elderly perception and community. They want to play a more active and revered role in society, one where they are valued for their wisdom. Especially in Pittsburgh where there is strong discourse around innovation, which tends to exclude senior citizens, they hope that young people will see the value and gain interest in innovating ways for society to become more elderly-friendly because, after all, everyone grows old someday. A sense of community is also what isolated senior citizens in Pittsburgh hope for because within these groups they can find respect and share their experiences with others. Many find these communities through churches, community outreach organizations, and senior centers, which improve their well-being and help them become more integrated with others around them and society at large. Just like all of us, senior citizens crave empathy and deep connections that can fulfill their desire to be needed, loved, and cared for.
Family of Senior Citizens
The families have perhaps the most important role to play regarding the isolation of senior citizens. Family members have power/authority to make important decisions for their aging relatives . Having this ‘power’ over (Miller, n.d., p.3; Pettit, 2014, p.43) your loved one can be very tricky to handle because it also involves a great sense of responsibility. Families have to balance their responsibilities with taking care of aging relatives, which is more often easier said than done.
In most cases, taking care of an elderly person can be tricky and sometimes harder than taking care of a child because seniors are used to being independent and as they age, they start losing that independence. This can be exacerbated through physical and mental decline which cause safety and health problems. This may lead families to send seniors to assisted care facilities in which they may feel even more isolated because they are being restricted from trying new things or from doing things they used to do before.
Some other problems may arise from seniors losing their independence. For example, they might prefer staying at home where they feel more comfortable, but that might not be possible because their family members can’t stay at home taking care of them, or they can’t afford to hire someone to help them. Even though some family members may be able to stay at home and provide care, they might have the appropriate infrastructure and/or skillset.
In some cases, not all family members can help take care of their elders and the responsibility lies on only on specific family members. What happens when they can’t afford it anymore? What happens when their lives get in the way, who is going to take care of them? Family members are usually very busy with their own lives, they have a job or kids that don’t leave them enough time to take care of someone else. This shows that even if they wanted to take care of their aging loved ones, they might not be able to.
Moreover, there are underlying concerns on what would be ideal for some seniors. Are care facilities better than hiring a nurse? Often, families don’t know what to do with their loved ones because there are many fears involved with letting someone else take care of them. What if they get mistreated? What if they don’t fit in?
Overall, family members have a lot of decision power over their loved ones as well as great responsibility. Some family members might not care about their seniors and cast them to the side. Others might have the best intentions at heart and try to help them, but due to external reasons they might not be able to.
Care Facility Managers
Most senior citizens in Pittsburgh have a strong connection to this area, and many have lived in the same house for over 50 years. Considering those emotional ties, the fear of leaving their home to go to a care center is very reasonable. The idea of a care facility is scary because it feels clinical and loveless, whereas senior citizens are comfortable in their homes where they have cultivated memories and have set routines. The reality is that most senior citizens need care at some point, and home care is not always available, so the fear is that their only option is to go to an expensive care facility away from their loved ones. According to Genworth’s Cost of Care Survey 2020, seniors in Pittsburgh can expect to pay an average of $3,250 per month for assisted living.
Due to the many public and private efforts, and the evolving body of rules and regulations that led to better health and housing options for senior citizens, today’s care facilities and long-term assisted living centers provide much improved living conditions than were seen in the past. Some of the innovations that led to the standard of care we see today include the emergence of a home health care industry, the creation of federal pension programs such as The Social Security Act of 1935, and advances in medical technology (Hoyt, 2022). However, the emotional issues that loom over the decisions surrounding long-term care still persist for elders and their families.
Today, the assisted living industry is experiencing an historic staffing crisis that is expected to worsen. From workers who are front-line caregivers to the back office IT, staff are afraid of getting Covid. Due to pandemic, residential care facilities lost 400,000 employees between February 2020 and March 2022 (BLS, 2022).
Assisted living facility operators are concerned that without sufficient levels of staff they may have to close down (Regan, 2021). Hiring the right personnel for senior care facilities has always been difficult, but pandemic conditions exacerbate this problem. The problem is not just in hiring enough medical care staff. Seniors and healthcare facilities are targets for cyber crimes. Care facility managers need to hire qualified information technology staff but now have to compete with high-tech companies who can pay more and provide posh work environments (Rogers, n.d.).
Care facility operators realize the potential for this situation to worsen due to the oncoming “Silver Tsunami” as evidenced by this statement from Distinctive Living — “By 2030, the entire baby boomer generation (born between 1946 to 1964) will be over 65. The demographic includes more than 73 million people, with many potential residents for senior living homes.” (Rogers, n.d.).
Demand for memory care is also increasing — this requires specialized caregiver skills and planning for these special needs on the part of the facility’s physical operations team. While the situation seems dire, according to a recent survey by the National Investment Center for Seniors Housing & Care (NIC), some managers of senior living facilities are optimistic about the return to pre-pandemic levels of occupancy (Bonvissuto, 2023). That condition could generate much needed revenue for operators to hire the staff needed to provide quality care the operators intend to provide.
Our initial thinking about the care facility managers puts them in the stakeholder group that has a lot of power, keeps the problem stuck, or even stands to benefit from the problem persisting. However, the genuine concern expressed by individuals working in this industry, and their knowledge of the challenges they face today and in the future, indicate they may not be coming from solely a profit-focused mindset. It might be more the case that the organizations responsible for aggressive privatization of senior care facilities are the ones who stand to gain from continued or worsening of the issue (Keystone Research Center, 1998).
Conclusion
We noticed a common thread that actually aligned all three stakeholders. It is easy to imagine that one of the greatest fears for seniors (and perhaps all of us) is being injured in isolation and subsequently dying alone. This fear also happens to be shared by family members and the managers of care facilities. Understanding the power dynamics between these three stakeholder groups allowed us to better understand the complexity of decision making that happens at the personal, family and care facility levels. Having these multiple perspectives help to improve our understanding of what it means to grow older in the Age of Isolation.
REFERENCES
Adamy, J. & Overberg, P. (2018 December 11). The Loneliest Generation: Americans, More Than Ever, Are Aging Alone. The Wall Street Journal. https://www.wsj.com/articles/the-loneliest-generation-americans-more-than-ever-are-aging-alone-11544541134
Bonvissuto, K. (2023 January 20). Senior living operators express optimism over occupancy, staffing: NIC. McKnights Senior Living. https://www.mcknightsseniorliving.com/home/news/senior-living-operators-express-optimism-over-occupancy-staf fing-nic/
Bureau of Labor Statistics. (2022 March). BLS 2022 Jobs Report. Bureau of Labor Statistics. https://www.ahcancal.org/News-and-Communications/Fact-Sheets/FactSheets/BLS-MARCH2022-JOBS-REPORT.pdf
Hoyt, J. (2022 July 11). 200+ Years of Senior Living History. SeniorLiving.org. https://www.seniorliving.org/history/
Keystone Research Center. (1998 May 1). Nursing Home Privatization: What is the Human Cost? In The Public Interest. https://inthepublicinterest.org/nursing-home-privatization-what-is-the-human-cost/
Miller, V. (n.d.). Power Matrix Introduction. Powernet.org. https://www.powercube.net/wp-content/uploads/2009/12/Power_Matrix_intro.pdf
Pettit, J. (2014). Power Analysis: A Practical Guide. Swedish International Development Cooperation Agency, Stockholm.
Regan, T. (2021 September 22). 77% of Assisted Living Providers Say Staffing Crisis Getting Worse. Senior Housing News. https://seniorhousingnews.com/2021/09/22/77-of-assisted-living-providers-say-staffing-crisis-getting-worse/
Rogers, L. (n.d.) 10 Challenges Facing Assisted Living Facilities. Distinctive Living. https://distinctive-liv.com/10-challenges-facing-assisted-living-facilities/
