Age and Ability Inclusion Toolkit for Senior Living

Ageism is the stereotyping and discrimination against individuals or groups on the basis of their age. Ageism against older people is based on an underlying belief that being younger is superior. It is also rooted in a failure to acknowledge that we are all aging, from the moment we are born, and that aging is a natural process to be embraced rather than avoided. Ageism can take many forms, including prejudicial attitudes, discriminatory practices, or institutional policies and practices that perpetuate stereotypical beliefs about people who are older. Ageism can affect people receiving care and services, the staff who provide care and services, and family members.

Ableism is the stereotyping and discrimination against individuals or groups on the basis of their physical and/or cognitive ability. Ableism is based on an underlying belief that typical physical and cognitive abilities are superior. It is also rooted in a failure to acknowledge that everyone’s abilities vary from situation to situation and that abilities vary time and as the result of injury or disease.

Age and ability inclusion is a way of organizing social worlds and physical spaces in which people of all ages and physical and cognitive abilities feel valued as unique individuals deserving of recognition, respect, and equal access to opportunities and resources. Age and ability inclusion applies to people receiving care and services, the staff who provide care and services, and family members.

The core principles of age and ability inclusion are:

• Proactively counteracting ageism and ableism inside the organization
• Proactively counteracting ageism and ableism outside the organization
• Taking an adaptive and transformational approach that changes people’s priorities, beliefs, habits, and loyalties

Cultural competence embodies a set of attitudes and behaviors within an organization that enable individuals to understand, communicate with, and effectively interact with people across cultures. Being culturally competent means:

Ableism can take many forms, including prejudicial attitudes, discriminatory practices, or institutional policies and practices that perpetuate stereotypical beliefs about people who live with physical and/or cognitive disabilities. Ableism can affect people receiving care and services, the staff who provide care and services, and family members. Being culturally competent means:

• valuing diversity
• being aware of one’s own world view
• gaining knowledge of different cultural practices and world views
• developing skills for communication and interaction across cultures
• developing adaptations to service delivery that reflect an understanding of cultural
  diversity.

Examples of cultural competence include:

• Using inclusive language on paperwork and when connecting with residents/tenants and family members (i.e. spouse/partner instead of husband/wife; woman/man/transgender/non-binary)
• Considering culture when ordering food and building menus
• Acknowledging and celebrating a variety of different religious and ethnic holidays
• Considering and acknowledging a history of racial and gender bias in healthcare, particularly when supporting healthcare decision making and end-of-life planning

Elderhood is the stage of life beyond adulthood, more commonly referred to as “older adulthood.” The point at which one transitions from adulthood into elderhood may vary depending on cultural values and personal outlook. Elderhood is not associated with the attainment of a specific age. Characteristics of elderhood include an interest in one’s inner lifeworld as a way of making sense and deriving meaning from experiences and the ability to draw upon this practical life wisdom in support of self and others. Growth in elderhood can be psychological, social, and spiritual and occurs alongside physical changes that ultimately lead to death. For example, elderhood is a time when individuals often say that they feel more satisfied with their lives and when they recognize the value of being over doing.

Implicit bias refers to the attitudes and stereotypes we associate with other people that exist without our conscious knowledge. Implicit biases may be positive or negative but the key thing is that they are activated involuntarily and without our awareness or intentional control. Implicit biases may result in individuals having feelings and attitudes about other people based on their age, race, race, ethnicity, physical or cognitive ability, or appearance. A common implicit bias about older people is that they are “doddering but dear,” meaning that they are typically incompetent but sweet natured.

Interdependence is the mutual give and take in human relationships that allows us to cooperate, share resources, and provide mutual aid to one another. It is based on the recognition that we all have opportunities to give and to receive and that embracing these opportunities creates a sense of solidarity between individuals. Bonds of interdependence exist between residents/tenants, staff, and family members of a senior living community, each of whom make contributions to and draw support from this relationship.

Intersectional identities refers to the interconnected and overlapping nature of social categorizations of human beings, including for example race, class, gender, age, and ability. For example, a person’s life experience and identity is shaped not only by age or life stage, but also by their race, class, gender, and physical and cognitive ability. Also see intersectionality.

Intersectionality is the complex, cumulative way in which the effects of multiple forms of discrimination (such as racism, sexism, and classism) combine, overlap, or intersect especially in the experiences of marginalized individuals or groups. For example, at the population group level women earn less than men and African Americans earn less than Whites, with African American women earning less than both White men and White women resulting in greater risks of poverty in old age for African American women.

Equality is the state of being equal in terms of our status, rights, and opportunities. It means sameness and assumes, incorrectly, that we all have had equal treatment, access, and opportunity.

An individual may need to experience or receive something different (not equal) in order to maintain fairness, access, and opportunity. For example, an elder using a wheelchair needs differential access to a movie theater (in the form of ramps and wheelchair accessible spaces) in order to enjoy a film compared to someone who does not use a wheelchair.

Inclusion is the practice of an organization or a social system welcoming people of diverse identities with the purpose of not merely tolerating them but expecting them to contribute meaningfully in a positive, mutually beneficial way. Inclusive organizational processes and practices are ones that strive to bring diverse people together to make decisions in a collaborative, mutual, and equitable way, including people receiving care and services, the staff who provide care and services, and family members.

Equity is the principle that all people should receive fair treatment, access, and opportunity. Achieving true equity means that person-directed care is care that encourages individuals to express their choices and practice control over their everyday lives in ways that are meaningful to them. For person-directed care to be a reality, rather than an aspiration, it is critical to collect information about each elder’s life story and how they want to live today. This information must be incorporated into care plans that are specific to each individual and that reflect each individual’s values, preferences, and choices for living a purposeful, self-directed life. It is critical to recognize that person-directed care is made real by supporting the many, small decisions that make up one’s journey through a day and night, including choices about self-care, eating, socializing, being active, being reflective, and sleeping, as well as larger goals that support a sense of identity, meaning and purpose like community service, volunteerism, and individual pursuits.

Reciprocity describes the mutual giving and receiving of practical and emotional support that strengthens social bonds within a relationship. When people are increasingly dependent on staff and family for support, they can feel a sense of powerlessness that makes it difficult for them to reciprocate for the care they receive. Nevertheless, the desire to reciprocate can often remain strong. This desire to reciprocate can lead elders to create a sense of pleasantness in relationships by deferring to the wishes of staff and family rather than expressing their true choices. Therefore it is important to identify ways in which elders can positively express reciprocity in relationships, such as seeking and then acting on their opinions, advice, and life wisdom in all decisions about them.

Relational autonomy refers to the fact that we can control or direct our own lives (our autonomy) only to the extent that is possible within the boundaries of our relationships with other important individuals in our lives. Key to the notion of relational autonomy is the concept of interdependence, rather than independence, meaning that people rely on each other for mutual aid and support. For example, the choices of a person who relies on assistance from a spouse/partner or other family members to age in place at home will impact their spouse/partner and/or family members. Thus, this person’s autonomy is said to be relational, in that there is a mutual impact of their choices on others and the choices of others (for example to either support aging in place at home or not to support it) on them.