Academic journal article Health and Social Work

Denial of Death and Taxes: America at Middle Age

Academic journal article Health and Social Work

Denial of Death and Taxes: America at Middle Age

Article excerpt

American society is aging. This increasingly familiar refrain describes the slow population shift toward more older members resulting from lower birthrates and increased longevity. The proportion of people over age 65, only 4 percent in 1900, was 12.7 percent in 1994 and is expected to increase to 17 percent by 2020. Yet even as the baby boomers see daily the creeping signs of their own middle age, American society and many of its institutions deny the implications of this profound societal change.

Given the health and social needs of an aging population, there is growing concern that professional schools are not training future practitioners adequately. The field of gerontology is beginning to affect social work, but the social work profession, not unlike other professions and American society in general, is having difficulty institutionalizing an agenda for aging.


A couple of recent gatherings in Washington, DC, illustrate just how strongly social work has established itself in gerontological policy circles. The most notable was the Fourth White House Conference on Aging held from May 2 to May 5, 1995. This underreported representative gathering of 2,260 older Americans and their advocates debated and adopted 50 resolutions to help the government chart the course of aging policy over the next decade. Social workers were prominent among the delegates, and the 15-member policy committee included familiar colleagues and friends: Fernando Torres-Gil, Commissioner of the Administration on Aging; Rose Dobrof of the Brookdale Center at Hunter College; Secretary Donna Shalala of the U.S. Department of Health and Human Services; Monsignor Charles Fahey of the Fordham University Third Age Center; Senator Barbara Mikulski (D-MD); and Dan Thursz, former dean of the University of Maryland and president emeritus of the National Council on Aging.

As expected, the top priorities of the White House Conference included the preservation of social security, the Older Americans Act, and the Medicaid and Medicare programs. Other priorities included a call for increased federal involvement in training health care workers at all levels and increased federal, state, and regional funding for education in geriatric mental health. The conferees urged integration of gerontology and geriatrics in the curricula of all health care specialty programs and strengthening the role of the Department of Veterans Affairs, the National Institute on Aging, and the graduate medical education program. In addition, they requested that by the year 2000 at least 1 percent of federal funds spent on health care for elderly people be set aside for research on the mechanisms of aging, diseases of older people, long-term-care systems and services, and special populations ("White House Conference," 1995).

Another meeting, the Geriatrics Initiative Forum, was organized by the Geriatrics Initiative Branch of the Bureau of Health Professions and held in late April. The bureau's chief, Bernice Parlak (a social worker), gathered 120 leaders of geriatrics education to review the need for health professions development in the next decade. Besides the Task Force on Social Work, which included JoAnn Damron-Rodriguez, Rose Dobrof, Barbara Berkman, and Lois Harry, social workers were significant contributors to the working groups on managed care, case management, ethnogeriatrics, long-term care, and interdisciplinary education.

Ever since President Clinton appointed his Task Force on Health Care Reform in 1993, analysts have predicted new roles for social workers in a reformed and more responsive community-based health care system (Day, 1993). Social workers have felt confident that despite the hospital downsizing and cost containment pressures since then, new social work roles would emerge throughout the community. The Geriatrics Initiative Forum agreed that the projected numbers of older people will lead to an increasing demand for health and social services and that projections of the need for geriatric social workers have consistently and significantly exceeded supply (Greene, Barusch, & Connelly, 1990; Tobin, 1973). …

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