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"We've put more effort into helping folks reach old age than into helping them enjoy it."

—Frank A. Clark


By the end of this chapter, readers will be able to:

  1. Explain the ways in which public policy affects the experience of growing older.

  2. Discuss important federal, state, and local policies that relate to aspects of aging.

  3. Compare U.S. policies with policy initiatives in other countries.

  4. Discuss, compare, and contrast models of advocacy.

  5. Describe strategies for influencing policy.

  6. Describe strategies for advocating for patients.

  7. Discuss the role of occupational and physical therapy in advocacy.

Clinical Vignette

Mary Consuello is a physical therapist working for a home health agency in a midsized western U.S. city. Her agency serves largely inner-city clients, many of whom live almost exclusively on their social security benefits. These clients tend to live in small, older apartment buildings that are not well maintained. Many do not have cars, and public transportation is not well developed. There are issues of crime and safety in these neighborhoods, limiting their access to opportunities for exercise.

  1. Are the issues described here relevant to Ms. Consuello's activities as a physical therapist? In what ways might she have responsibility for addressing them?

  2. How might Ms. Consuello take action to help her clients?

This chapter describes existing U.S. policies that relate to older adults and briefly compares them to those of other countries. It then discusses the way in which public policy emerges and focuses on how new and existing policies can be influenced. Because advocacy can also focus on individual clients, an overview of strategies for advocating for individuals is discussed. Finally, the role of occupational therapist (OT) and physical therapist (PT) in advocacy is considered.

It should come as no surprise that our lives are strongly influenced by laws and regulations that govern such things as infrastructure, food and drug safety, zoning and other housing-related issues, environmental safety, social services, health care, health insurance, retirement income, and many other aspects of daily life. All of these issues affect all of us, whether we are attending to them or not. And they are most evident when focused on matters related to those who are most vulnerable—children, the disabled, individuals who are socioeconomically disadvantaged, and older adults.

Many individuals and organizations are active in working to ensure that these laws and regulations are fair, reasonable, and appropriately enforced. There are also many who are active in protecting the rights of individuals. Increasingly, therapists and their professional associations recognize that providing effective service to clients must necessarily involve a role in advocacy.

Public Policy and Aging

Public policy can be defined as actions taken by government (or others who play a role in policy, like school officials or city council members) to address problems presented to ...

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