Growing Older in World Cities: New York, London, Paris, and Tokyo

7. Lifestyle Patterns, Social Networks, and Use of Formal Services in New York: The Impact of Ethnicity, Class, and Culture on Older People

126 7. Lifestyle Patterns, Social Networks, and Use of Formal Services in NewYork:The Impact of Ethnicity, Class, and Culture on Older People Marjorie H. Cantor A major objective of supportive services for older persons is the maintenance of a positive quality of life. Although this goal is rarely defined as such, factors that contribute to a positive quality of life for an older person include economic security, adequate health care, suitable housing and environmental conditions (including personal and household safety and adequate transportation), and meaningful roles and relationships. An additional and crucial component as people get older and face the potential of increased frailty is the nature and extent of the social care they receive. What is meant here by social care? The term is often used synonymously with social services, but the concept is much broader and encompasses both informal and formal care, which exist side by side. Although purely medical and health-care services may be involved, usually the assistance is of a social nature, addressing three major kinds of needs: first, opportunities for socialization and self-actualization , such as those provided at senior centers; second, assistance with everyday tasks of daily living, usually provided by the informal system augmented by the formal system; and third, help with more personal care, necessitated by illness or disability.1 This last type of assistance is sometimes the provenance of family but increasingly involves formal home-health services. The goal of social care is to augment individual competency rather than increase dependency. How does the system work? Perhaps it can best be illustrated through a system model as shown in Figure 7.1. The social support system is made up of a series of concentric circles, each containing a different type of support element, ranging from informal at the center to formal at the periphery. The older person is at the core of this model, interacting with each of these circles at varying times according to particular needs. Although each of these elements usually operates independently, at times they interact, illustrating the concept of a broad-based social support system. In the outermost circle, farthest from the older person, are the political entities, such as federal, state, and local legislatures responsible for determining social policy and entitlements. Somewhat closer, in the next circle, are the governmental and voluntary agencies that execute these economic and social policies. These bodies provide the services mandated under laws such as the Social Security Act and the Older Americans Act, or those dictated by community need. Organizations in the two outer rings are clearly the formal part of the support system. Lifestyle Patterns, Social Networks, and Use of Formal Services in NewYork 127 Still closer, between formal organizations and kin and significant others, are the nonservice and quasi-formal organizations. Often called mediating structures, such groups can serve as a link between the older person and the broader community and may provide direct help at times of emergency need. Included in this circle are religious organizations; ethnic, cultural or social groups; and neighborhood and block associations; as well as individuals who help older people informally, such as storekeepers, mail carriers, building personnel, and even bartenders. Finally, closest to the older person and most directly involved in day-to-day life are the individuals who comprise the two innermost circles, the informal system of family, friends, and neighbors. These significant others interact most frequently with older people, are turned to first when instrumental and emotional support are needed, and comprise the broad base of the social support system both in the United States and around the world. By placing the older person at the center and informal care as the closest of the circles, it is clear that changes in the status of older persons and in the availability of informal care have a crucial effect on the other elements of the social care system. Figure 7.1.The Social Care System of Older Persons: A Model Source: Cantor, Marjorie. 1977. “Neighbors and Friends: An Overlooked Resource in the Informal Support System.” Paper presented at the Thirtieth Annual Meeting, Gerontological Society, San Francisco. 128 Growing Older inWorld Cities Part II: NewYork Although older people may receive help from family, community, or tertiary groups, they also often provide considerable help to other generations in the kinship system, as well as to friends and neighbors, demonstrating the reciprocity of informal social care.And increasingly, older persons...