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

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

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

The Nature of Diversity 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

The Value of Cohort Analysis 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

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

It is more than sheer size 1010 It is more than sheer size Each generation is shaped by context – the historical and social experiences

The GI Generation (Born 1901 – 1924) 1111 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)

GI Generation Formative Experiences 1212 GI Generation Formative Experiences Experienced Depression and World War II GI Bill – Housing and Education Expected and Valued Government Role

GI Generation Formative Experiences 1313 GI Generation Formative Experiences First Aging Generation First generation to benefit from Medicare, Medicaid, Social Security and Aging Network

GI Generation Values Respect Authority (and seek respect) 1414 GI Generation Values Respect Authority (and seek respect) Follow Orders, “Regular Guy”, Team Player Altruistic “Can Do” Rigid Sex Role Definitions

The Silent Generation (Born 1925-1942) Formative Experiences 1515 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

The Silent Generation Values 1616 The Silent Generation Values “Fitting in” – The Organization Man Emerging Concern with Inner Self Transitional – Cultural and Gender Roles

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.

The Traditionalists Implications for Medical Care and End-of-Life 1818 The Traditionalists Implications 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

The Traditionalists Implications 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

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

The Traditionalists Implications 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

The Traditionalists Implications 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

The Traditionalists Implications 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

The Traditionalists Workplace 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

The Traditionalists Attitudes toward Recreation and Leisure 2525 The Traditionalists Attitudes 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.

The Baby Boom (Born 1943-1960) Formative Experiences 2626 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.)

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

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

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

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?

Boomer Values 3131 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

Boomer Sense of Justice 3232 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

3333 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”.

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.

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

Baby Boom Generation Implications for Medical Care and End-of-Life 3636 Baby Boom Generation Implications 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

3737 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?

Baby Boom Generation Implications 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

Baby Boom Generation Implications 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!

Baby Boomers Implications 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

Baby Boomers Institutional Care 4141 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

Boomers will demand 4242 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

Boomer Concerns for Parents 4343 Boomer Concerns for Parents Reshaped Adult Care Market Emphasizing continuum of care Assisted Living Amenities for well older persons such as spas and gyms

Baby Boomers Implications for Funeral Service 4444 Baby Boomers Implications 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.

The Baby Boom Recreation and Leisure 4545 The Baby Boom Recreation 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

The Baby Boom Recreation and Leisure 4646 The Baby Boom Recreation 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)

Baby Boomers Workplace 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

Aging Boomers Retirement 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

Generation X (1961 –1981) Formative Experiences 4949 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.

Generation X Values 5050 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

Generation X Implications for Medical Care and End-of-Life With the oldest members approaching 50, just beginning to struggle with an awareness of mortality Value speed, efficiency and a consultative style in medical providers More open to non-traditional forms of care Often seek information from the Internet including costs Beginning to be parental caregivers More critical of medical care than Baby Boomers or Generation Y – perhaps reflecting they are relatively new to negotiating the system

Generation X Implications for Counseling Open to counseling, responsive to coaching, they embrace an expansive and enhancing view of counseling Often both genders have tried to cultivate support systems based on friendship bonds “urban tribes” Depression, anxiety, and eating disorders are the major psychological issues that this generation experiences Substance abuse (outside of smoking) is not major – entered the workforce when drug-testing is common

Generation X Implications for the Workplace Entrepreneurship valued as is a more equalitarian and horizontal work environment Prefer flexible options – including flextime, working remotely as an option Expect voice to be heard, opinions solicited, and disputes conciliated Want to balance life and work

Generation X Implications for Health Care Seeking a sense of balance has created generational shifts in medicine Generation MD’s are more likely to be female, technologically savvy, want stability, and balance “I am not bothered by older doctors saying ‘we worked harder.’ Instead I pity them for justifying their misery.”

Generation X Recreation and Leisure Emphasis on balance offers opening to leisure Often leisure is focused on self-development, inner growth, nurturing relationships, and keeping fit Because of economic challenges, cost is a factor in the activities chosen

5656 Generation Y “The Millennial Generation” (1982 - 2000) Formative Experiences Born in a time where there is a deep interest in youth – education, health, etc. Late Boomer parents seeking not to repeat mistakes – civic virtues emphasized Tolerant generation (Diversity emphasized) Technologically advanced Pragmatic and non-ideological Most “medicated”generation – now relatively high rates of underage alcohol, illegal drug use and trading of prescription medications

Generation Y Formative Experiences 5757 Generation Y Formative Experiences The first internet generation Digital natives – rather than digital immigrants Accentuated differences between “the know” and “know nots” Strong technological connections to parents – texting etc. Emerging adulthood – a lengthened period of dependency The “virtual” community – where things are not always what they seem!

Generation Y A “wanted” generation as abortion is legal and parenthood valued as a choice A “nurtured” generation – social promotion, self- esteem valued, trophies for participation Scholars feel that their high and perhaps unrealistic expectations may be dashed as they enter a highly competitive world in adulthood

Generation Y Values Accept diversity including more accepting of LBGT Self expression valued more than self control Adapt easily to change and technology Respect must be earned – not based on age, authority, or title

Generation Y Implications for Medical Care and End-of-Life Little experience for most with anything but routine medical care Most have yet top experience serious illness or the deaths of parents Any experiences with death likely to traumatic Questionable as to whether media has desensitized persons to death (Kastenbaum)

Generation Y Implications for Counselors In a generation used to transparency on the web, confidentiality will have to be carefully explained Expect that you, as counselor, will be googled Develop a policy, in the consent form, on social networking sites – “to friend or not to friend” Multitasking is common in this generation – consent forms may need to address use of cell phones, texting (both in general and in session) etc.

Generation Y Implications for the Workplace 6262 Generation Y Implications for the Workplace Natives too to the information age Very open and sharing Not hierarchical – so will often skip chain of command Will often, for example, share salary information with friends to assess their own salaries Expect quick and positive feedback Will avoid or leave positions that limit access to the Internet

Generation Y (Millennials) Workplace Attitudes 6363 Generation Y (Millennials) Workplace Attitudes Want to be treated as special Often remain close to parents – may even bring them to interviews Need structure and desire feedback May be dependent Team and collaboration oriented rather than competitive Desire long-term careers with few risks and with benefits Likely to remain loyal to supportive companies Howe, 2010

Generation Z (2001- ?) 6464 New generation emerging Most technologically connected – many have TV’s, DVD’s in rooms, cell phones likely as they age Will likely be technologically connected, multi-taskers Heavily influenced by Disney images – Hanna Montana, The Suite Life etc. Possible the “New Silent Generation”

6565 Generation Z Cyber community and cyber interaction

Generations at Work A Summation 6666 Generations at Work A Summation Silent Generation – Value loyalty and discipline, respect authority and hierarchy Boomers entered work force at a competitive time – self-motivated, often hard workers Generation X – entrepreneurship valued, prefer a more flexible and horizontal structure. Strong sense that disputes should be conciliated Generation Y – First digital natives, individualistic, value autonomy, horizontal structures. Little loyalty or expectation of life- long employment. Often loyalty is more based on personal relationships

Generational Differences Career Goals 6767 Generational Differences Career Goals Silent Generation – Build a legacy Boomers – Build a stellar career (Competitive) Generation X –Build a portable career – showing many areas of competence and achievement

Generational Differences Retirement 6868 Generational Differences Retirement Silent Generation – Retirement as a reward Boomers – Retirement as an opportunity for retooling, possible second career

Generational Differences Changing Jobs 6969 Generational Differences Changing Jobs Silent Generation – Shows disloyalty Boomers – Puts you behind in your career Generation X & Y – A necessary move to keep current and advancing (the moving shark analogy)

Some Programs Can Transcend Cohorts 7070 Some Programs Can Transcend Cohorts Life Review and Reminiscence Programs Intergenerational Programs Even here, themes and activities must be cohort-sensitive

The Value of Reminiscence 7171 The Value of Reminiscence Enhances mood Establishes time and role parity Bolsters self-esteem Establishes a continuity of identity As therapeutic tool Part of later life development Creates and bolsters community

7272 Danger of Life Review Can resurface earlier losses and traumas

Life Review Differences with Reminiscence 7373 Life Review Differences with Reminiscence Reminiscence focuses on positive memories and experiences Personal history – including positive and negative experiences Careful observation by therapist Attribution of meaning

Life Review May Not be Useful with Highly Narcissistic Troubled Life 7474 Life Review May Not be Useful with Highly Narcissistic Troubled Life Alienated Relationships Persons Unable or Unwilling to Reflect

Life Review Problematic Populations Drawing life’s lessons What lessons would I like to pass on to others?

Techniques for Life Review and Reminiscence 7676 Techniques for Life Review and Reminiscence Photographs and memorabilia Music and film Creative expressions Genealogies and genograms Reunions Pilgrimages

Use all senses Sound Sight Touch and texture Taste Smell and aromas 7777 Use all senses Sound Sight Touch and texture Taste Smell and aromas

7878 Ethical Wills: A Tool for Legacies, Remembrances and Inter-Generational Dialog “Legal wills bequeath valuables, ethical wills bequeath values.” (Baines, 2002)

Age Lines A Life Review Technique 7979 Age Lines A Life Review Technique Chart significant points in one’s life Identify the challenges faced along the way Discuss strategies used to overcome these challenges

Intergenerational Programs 8080 Intergenerational Programs Can involve older persons assisting younger, younger assisting older, or mutually beneficial programs – perhaps joint service to the community Intergenerational programs can offer new stimulations, friendships, experiences, decrease isolation and loneliness, and raise self-esteem

Re-Packaging Programs 8181 Re-Packaging Programs Other programs may still be used but will have to repackaged to meet generational interests The value of Bingo – hand/eye coordination, stimulation etc. Selling wellness Offering choices

Everything Old Is New Again 8282 Everything Old Is New Again Truth of Cohort Analysis – We constantly reinvent systems of care and modify counseling approaches with each new generation