As the number of elders with disabilities and chronic illnesses rose in recent decades—and families’ ability to assist them dropped—nursing homes emerged to serve those most needing attention. Since the public sector supported long-term care only for the indigent living in institutions, many elders needing long-term care opted to move to nursing homes, even though they preferred to stay in the community. Today, the public sector is gradually broadening its perspective on long-term care to include support for those with disabilities who want to stay in the community. But for Frank Caro, strengthening community-based support with the help of public subsidies has been a central interest since 1970.
Since his retirement in 2008, Caro has continued his active research on long-term care and productive aging. One of his projects examines the circumstances under which elders make decisions to cope with declining mobility, whether these include modifying their homes, relocating, or using assistive devices. His findings will provide information that can lead to better informed planning and decision-making by elders and their adult children.
Another project examines the range of activities elders often engage in—jobs, self-employment, volunteer service, recreation, civic or political involvement, and so on—to study their collective and cumulative impact on elders’ well-being. Recognized as one of the first researchers to devote serious attention to productive aging, Caro is gratified that more people are now working in this arena with its strong policy implications. His own research raises issues of institutional ageism, such as human resource policies that effectively push older people out of the workforce. During hard economic times such a corporate policy generally has a much greater negative impact on older employees. As this segment of the population continues to grow, so will the impact of policies driven by institutional ageism.
Caro, who earned his PhD in sociology from the University of Minnesota with a minor in psychology, explains that he, like other gerontologists of his generation, “came into it during the course of our lives. It’s not something we were specifically trained for.” He learned a bit about gerontology as a graduate student, but he was interested in issues associated with his generation’s then-youthful stage of life. It was his fascination with the policy implications of applied research that led to his being invited to join a project to evaluate home- and community-based elder services as alternatives to long-term nursing home care.
Through this, he developed a deeper interest in the issues centering on elders’ loss of independence as they age. This placed him at the forefront of the study of long-term care options based in the home and the community, options now widely recognized as a crucial element in elders’ quality of life as well as social and economic policy. Today, more home- and community-based alternatives exist, as do more residential options. Yet Caro reminds us that challenges remain—and new ones arise—as the population worldwide continues to age and the long-term care sector grows in size and complexity.
In accepting the position of associate director of the Levinson Gerontological Policy Institute at Brandeis University in the early 1970s, Caro solidified gerontology as his lifelong career. Since then, he says, “I’ve kind of aged into the topic.” UMass Boston recruited him in 1988 to be research director of the Gerontology Institute; two years later he began developing the university’s doctoral program in gerontology. UMass Boston, the second in the world to offer this program, has now graduated more PhDs in gerontology than any other university in the world.
In 1996 Caro became director of the doctoral program and the Gerontology Institute. Throughout his career, and in his varied roles, he chaired scores of dissertation committees and coached graduate students from all over the world as they worked on their dissertations. Among his last group of students was Kim Sauder Stoeckel, graduating this May, who came into the program with experience working in a retirement community. Her dissertation topic, “The Role of Home Environments in Residential Adjustment Decision Making in Later Life,” fit compatibly with Caro’s own research interests, enabling close collaboration with her mentor. She is currently a post-doctoral fellow at the Israel Gerontological Data Center at Hebrew University, Jerusalem, Israel.
Eilon Caspi ’10, also in Caro’s last group of students, came to UMass Boston from Israel with a very specific topic in mind: long-term care for elders suffering from dementia who also exhibit agitative behavior. He did his dissertation research in an assisted living facility, specializing in such care using qualitative methodology, “an approach I haven’t used extensively in my own work, but which I appreciate,” says Caro. Thus, he gave Caspi the leeway he needed in working with that methodology, and in the process learned much about an aspect of long-term care with which he wasn’t familiar.
Caspi, currently teaching a UMass Boston course on the psychology of older adults with memory loss, is effusive as he describes what he gained in the six-year research relationship he enjoyed with Caro. “Coming from a different country, I had to make a lot of adjustments—and Frank was an anchor,” he says. He describes a quality “almost spiritual in his centeredness and attentiveness in connecting with a mentee,” an attribute he tries to emulate in relationships with his own students. Caspi also recalls that, in six years, he never once heard Caro use the word “no,” but instead would say, “Well, let’s think about it.” The effect was to open up his thinking, consider new layers of information, and make him more receptive to other ideas.
Among other graduates of the PhD program since 2009, one is a research fellow, three hold university faculty positions, and two hold research/analyst positions for healthcare companies. For his part, Caro maintains a strong connection to UMass Boston as the editor of the Journal of Aging and Social Policy, a well respected professional journal supported by the university. He is also piloting a unique Internet-based survey instrument with a RAND Corporation online panel of people 50 years and older. The survey uses an interactive approach with video vignettes to determine how respondents would make a decision to undergo hip replacement surgery.
In his limited spare time, Caro is involved with an initiative in his home town, the Brookline Community Aging Network (pictured below). This advocacy group works with town administrators and the Council on Aging to address quality of life issues for elders in the community. He views this activity as a practical way to apply the themes he has emphasized in his scholarly work. The group has developed a web site with, among other resources, a locator map for public restrooms and a listing of residential buildings with elevators as alternatives to homes with only stairs.
Caro’s interest in gerontology shows no signs of flagging. The discipline remains, for him, “intellectually intriguing” as he stays abreast of local, national, and global policy issues that arise from what is now an unprecedented rate of population aging. Today, he concludes, “is a great time to be a gerontologist.”