Generations A Hidden Source of Diversity

1. GenerationsA Hidden Source of Diversity Kenneth J. Doka, PhD Professor of Gerontology, The College of New Rochelle Senior Consultant, The Hospice Foundation of America

2. Objectives • Describe the characteristics of varied generations • Formative Experiences • Core Values • Explore the implications of generational differences • Medical Care and End-of-Life • Counseling Issues and Concerns • Workplace Differences

3. Caution! • Generational differences are only one source of diversity • Others include: • Ethnicity and Culture • Gender • Social Class • Spirituality/Humanism • Geographical

4. The Nature of Diversity • Remember Sue & Sue’s Asian Proverb – Every person is • Like no other person • Like some other persons • Like all other persons

5. The Value of Cohort Analysis Understanding Generations

6. Generations • Each generation is unique – shaped by social, historical and demographic (size, composition) forces • (Strauss and Howe)

7. Implication Systems of care need to be reassessed and reinvented as each new cohort ages Note such reimagining involves intergenerational considerations – i.e. Baby Boomers managing care of GI Generation Parents

8. Generations • Generations are both interactive and reactive • Each generation not only interacts with others (despite the fact that industrial societies are more age-segmented) but reacts the experiences shaped by preceding generations

9. Cohort analysis begins with the size and composition (gender, ethnicity etc.) of a generation

10. It is more than sheer size Each generation is shaped by context – the historical and social experiences

11. The GI Generation(Born 1901 – 1924) • Childhood – a time of prosperity • Decline in child labor • Increase in education • Development of mass adolescent organizations (Boy and Girl Scouts)

12. GI GenerationFormative Experiences • Experienced Depression and World War II • GI Bill – Housing and Education • Expected and Valued Government Role

13. GI GenerationFormative Experiences • First Aging Generation • First generation to benefit from Medicare, Medicaid, Social Security and Aging Network

14. GI GenerationValues • Respect Authority (and seek respect) • Follow Orders, “Regular Guy”, Team Player • Altruistic • “Can Do” • Rigid Sex Role Definitions

15. The Silent Generation(Born 1925-1942)Formative Experiences • Sandwiched between GI Generation and Boom – a “Transitional Generation” • Many fought in career, those on the cusp may have served in Vietnam • First American Generation the declined in numbers • Generally Experienced Prosperity and Security • Divorce still rare in their childhood • Civil Rights Generation

16. The Silent GenerationValues • “Fitting in” – The Organization Man • Emerging Concern with Inner Self • Transitional – Cultural and Gender Roles

17. The Traditional Generations • Often the GI Generation and the Silent Generation are now grouped together as they now share common experiences of later life, GI Generation rapidly dying off, and many formative experiences were not radically different – intact homes, utilized savings accounts, etc.

18. The TraditionalistsImplications for Medical Care and End-of-Life • As a group, often accept the fact that life is unfair – hence accepting of fate • Grow up at a time when medical treatments were limited – children died from polio, whooping cough, heart attacks were fatal – hence some may be fatalistic and view medications and hospitals with suspicion • Yet generally adherent – will seek doctors advice for anything health related; rarely will question physicians

19. The TraditionalistsImplications for Medical Care and End-of-Life • African-Americans in these generations experienced harsh discrimination and prejudice – themes that may emerge in life review • Because of the Tuskegee experiments may be distrustful of medical professionals • That distrust as well as spiritual values may leads to a reluctance to consider palliative care • Many persons may have a pride of survivorship

20. Langston Hughes’ Mother to Son • Well son, I’ll tell you • Life for me ain’t been no crystal stair. • It’s had tacks in it, • and splinters, • And boards torn up • And places with no carpet on the floor • Bare. • But all the time • I’se been a-climbin’ on, • And reachin’ landin’s • And sometimes goin’ in the dark • Where there ain’t been no light. • So boy, don’t you turn back. • Don’t you set down on the steps • “Cause you find it kinda hard. • Don't you fall now – • For I’se still goin, honey, • I’se still climbin • And life for me ain’t been no crystal stair

21. The TraditionalistsImplications for Medical Care and End-of-Life • Often end-of-life preparation meant wills and other estate planning • Now accepting need for healthcare proxies and advance directives – yet ethnic differences exist • With increasing dependence they may have conflicts with baby boom caregivers on “downsizing” as they eschew the wastefulness as their boomer children attempt to toss out “clutter” • May seriously struggle with difficult decisions regarding savings and assets v. eligibility for governmental programs

22. The TraditionalistsImplications for Counselors • Tend to be quiet about emotions and feelings • Generally resistant to therapy as defined as for persons who were “crazy” • Even resistant to EAP’s since they first experienced such programs as dealing with occupational alcoholism • Though first generation to embrace widow/widower and other grief support groups

23. The TraditionalistsImplications for Counselors • Often rising rates of alcoholism – these generations tended to exhibit more drinking and alcohol use may increase with retirement • Yet a rising rate of suicide as this group ages – probably a result of untreated depression, alcoholism, status changes, and cascading issues arising from aging and loss

24. The TraditionalistsWorkplace Implications • Value honesty, loyalty, and hard work – one thing at a time • Detail oriented • Communication more formal • Works well with hierarchy and rules – has a sense of organizational history • Historically the last generation where males primarily worked and women stayed home or had part-time or traditionally female careers • Likely in the leadership of the organization

25. The TraditionalistsAttitudes toward Recreation and Leisure • Often a challenge to redefine themselves distinct from occupational roles • A paradoxical perspective • Recreational and leisure a reward for productivity • Yet a reversion to unproductive periods of life albeit deserved • In recreational therapy there is value of explaining rationale behind activity • Younger traditionalists may see leisure more productively – elderhostel, “grand” travel etc.

26. The Baby Boom(Born 1943-1960)Formative Experiences • Sheer Size – Now 73 Million • Shaped by Watergate, Vietnam • A Generation of Worsening Trends (Divorce, Delinquency, etc.)

27. The Baby Boom and Diversity • The Baby Boom is a diverse generation both ethnically and spiritually • Ethnic diversity and the 1965 Immigration Act • Spiritual Diversity – the growth of non-Western Religions

28. The Baby Boom and Diversity • The Baby Boom generation experienced the sexual revolution and was active in gay rights movements • This was the first generation to experience gay marriage and same sex partnerships

29. Boomers Have Changed Every Institution They Have Encountered • Schools and Colleges • The Military • Music and Media • Politics • The Workplace • Society

30. Boomer Legacy • Agitated for Civil and Individual Rights • Including strong inter-gender support for Women’s Rights • Created a strong and sustained Environmental Movement • Aging Rights -- The next crusade?

31. Boomer Values • Individualistic • Eclectic Spirituality • Resource Aware • Choice, Creativity and Control • Distrustful of Authority – including government • Trust persons not positions • Sense of Entitlement • Aging Adverse • Strong Emphasis on Health and Wellness

32. Boomer Sense of Justice • Boomer’s have a finely tuned sense of “injustice” that can alienate them from businesses that they perceive as greedy or unfair • Example – Stewart Shops and the pricing of The NY Times

33. Baby Boomers • A 2009 study by Martin, Freedman, Schoeni, and Andreski about Boomers approaching 60 did not find major improvements in health over the past generation despite public health successes and generational emphases • This may reflect greater improvements in diagnosis, subjective expectations of Boomers on how they doing, and other factors such as obesity • The authors note that final conclusions could not be made but “it is perplexing boomers are not doing better”.

34. Aging Boomers • On Jan. 1, 2011, the first Boomers turned 65 years old • Everyday thereafter 10,000 more will cross that threshold • By 2030 when all Boomers are over 65, 18% of the US population will be 65 or older.

35. Aging Boomers • Boomers generally consider old age begins at 72 • Most feel near a decade younger than their actual age • Implications for marketing and programming

36. Baby Boom GenerationImplications for Medical Care and End-of-Life • Boomers will expect to be actively involved in determining their medical care • Boomers are heavy consumers of alternative medicines including chiropractors, acupuncture, herbal and natural treatments, vitamins

37. Boomer Drug Use • Boomers had a high rate of experimentation with recreational drugs • A certain percentage have continued drug use as they age • Health consequences of life-long use are still unclear, and likely vary dependent on the drug of choice • Policy issues?

38. Baby Boom GenerationImplications for Medical Care and End-of-Life • Boomers value “death with dignity”, as well as effective pain management – they were in the forefront of the hospice movement so that portends well for hospice use • On the other hand, control and options might make hospice more attractive if it offers concurrent care • Katz and Wright (2011) recount a case where a woman opted out of hospice since it did not offer life-extending treatment nor nutritional support – patient wanted to survive till daughter’s wedding

39. Baby Boom GenerationImplications for Medical Care and End-of-Life • Boomer focus of control may lead to some interesting ethical dilemmas • Some boomers have stated in advance directives that if they do not know enough to eat – do not feed them!

40. Baby BoomersImplications for Counselors • As a generation, grew up with guidance counselors so not adverse to therapy (mediated by other variables) • Embraced self-help movements – especially as self-help turned from prohibitory to enhancing

41. Baby Boomers Institutional Care • Boomers value privacy, dignity, and autonomy • Private rooms will be in demand • Cost analysis indicates that such use of space is viable even at Medicare rates in about 7.5 years (Calkins & Cassella, 2007) • In addition, remember the opportunity costs – double rooms are more likely to stay empty

42. Boomers will demand • Individuality (Matching Environments) • Freedom to choose • Continuity in life styles • Personal belongings • Privacy – including private rooms • Contact with grandchildren (children-friendly facilities) • Internet and technology • Safety

43. Boomer Concerns for Parents • Reshaped Adult Care Market • Emphasizing continuum of care • Assisted Living • Amenities for well older persons such as spas and gyms

44. Baby BoomersImplications for Funeral Service • Boomers will demand greater options – choice including products, services • Boomers will wish options for creative rituals • Internet savvy – video streaming, Internet Memorials and Sign in’s • Diversity – language cards etc.

45. The Baby BoomRecreation and Leisure • The generation that refused to grow! • Boomers value recreation, activity, and leisure • See it as essential to good physical and mental health • Embrace the premises of recreational and activity therapy (relation of leisure to life satisfaction) • Caveat – Sensitive to activities considered demeaning or attitudes perceived as disrespectful

46. The Baby BoomRecreation and Leisure • First generation with widespread technological literacy (first generation to fully experience computers as routine in the workplace – yet still digital immigrants • Gender roles not as rigid • Boomers have a strong outdoor emphasis • Aquatic programs are valued – especially for fitness (rather than play)

47. Baby BoomersWorkplace Implications • The retirement of the Baby Boom Generation will create job shortages in many fields as 73 million boomers will need to be replaced by 49 million in the next generation • Skewing the dependency ratio

48. Aging BoomersRetirement and Work • 70% of Boomers say they plan to work beyond retirement age. • While there are financial reasons for this, Boomers also cite the need for mental and social stimulation, and physical activity • Many Boomers, especially professionals define themselves by their careers • Yet about half do retire at 65 – for reasons of health, age discrimination or a declining economy

49. Generation X (1961 –1981)Formative Experiences • Strauss & Howe call them “The Thirteenth Generation” • Raised in a time of terrorism, environmental disasters, disease (AIDS) • See Boomers childhood as carefree – more aware of consequences • Boomer parents – friendship valued, high divorce rate • Higher percentage of latch key children • Economically “a depression of the young” as houses seem hard to afford, etc.

50. Generation XValues • Technologically advanced and aware • Independence and self-reliant • Entrepreneurs • Savvy consumers and distrustful of work organization’s commitment • Non-ideological • Music and dress as a divider • Decline in college graduation (especially for males) compared to Boomers • Reactive – trying still to see what they believe and where they fit in