Sunday, October 28, 2012

Senior moment

When I tell people that I’m studying gerontology, some people will look puzzled, “What are you studying?”  After I explain that gerontology is the study of aging, they continue to look puzzled, “Why?”

Gerontology program representatives recruit students with dazzling statistics about career opportunities to prepare us for the Silver Tsunami:  since the baby boomers began turning age 65 last year, 10,000 people will turn 65 every day for the next 20 years.  By 2030, almost 20% of the U.S. population will be age 65+ (http://www.agingresearch.org/content/article/detail/826,
http://www.careersinaging.com/careersinaging/why.html & http://www.un.org/en/development/desa/news/nocat-uncategorized/un-urges-countries-to-address-needs-of-ageing-population.html). 

My reasons for studying gerontology are more personal:  growing up the youngest in a multi-generational household, I’ve always valued the “been there, done that” wisdom of elders and enjoy their company.  Our lives are enriched when everyone can “age in community” rather than be sent away to institutions (nursing homes) where they become invisible.

I think my defining senior moment (“aha, I want to work with seniors”) came to me just a little over a year ago after I attended this inspiring rally with senior advocates to urgently save Adult Day Health Care (ADHC). 
  ADHC rally:  “We won’t go to a nursing home!”

Thanks to “fiscal conservative” Mayor Jerry Brown, a 71-year old senior, Adult Day Health Care (ADHC) will lose its funding as a Medi-Cal benefit, effective December 1, 2011.  Statewide, this funding loss would impact 310 ADHC centers that serve about 37,000 fixed-income seniors and adults with disabilities (AWD), who would be forced into costly institutional care (nursing home) or staying at home alone until their health deteriorates into emergency room visits or hospitalizations.  San Francisco, which has the highest proportion of seniors and AWD in the state, would see the closure of ten ADHC centers affecting thousands of current and future patients without personal choice to safely continue living in their homes (“aging in place”).

Rally to stop elimination of ADHC

On Thursday (October 20, 2011), I attended a noon rally at City Hall to Save ADHC.  It was a well-organized event, almost theatrical, that started on time, provided seats and refreshments for elders and AWD, featured the requisite sound bites by local politicians (including four mayoral candidates), followed by powerful personal narratives from ADHC participants and caregivers, and covered by TV stations.  Like members of a studio audience, we applauded louder when signaled by peppy conductors positioned at each side of the stage.

Politicians speak first
Department of Aging and Adult Services (DAAS) Executive Director Anne Hinton introduced Mayor Ed Lee, who spoke about ADHC serving our most vulnerable population—elders and AWD—and how taking away ADHC would also burden working families who rely on ADHC so they can go to their jobs to support their elders.  Then he announced plans for consideration at next week’s Board of Supervisors meeting to release funds (undisclosed amount, but later revealed in press release to be $3.4 million) from a reserve to cover ADHC effective December 1.

Afterwards, Supervisor Eric Mar stepped up to declare this memorable sound bite:  “We are an aging City! We are a City that ages friendly!”  Next came Supervisors John Avalos and David Chiu, both mayoral candidates.  Then Bayview ADHC Director Cathy Davis led a rousing chant, “We won’t go to a nursing home!”  We heard from an aide to Supervisor Jane Kim (no-show due to illness) followed by Senator Leland Yee, who reminded us that he previously worked at On Lok and was the only Democrat who voted not to cut ADHC funding. 

ADHC women & caregivers

Then finally we got to hear from the real stakeholders:  ADHC participants and their caregivers – all women (who tend to outlive men)!  Caregivers did double duty as translators for three elderly immigrants from Philippines, Ukraine and China.  Each spoke about how ADHC helped transform their lives by offering health care, meeting place for socialization, exercise therapy, social services, etc. after experiencing depression, isolation, multiple chronic health problems from the loss of a spouse and accidents that limited their ability to perform ADLs (activities of daily living).  
The highlight was listening to a woman, standing beside her silent mother who was holding Avalos for Mayor campaign lit.  This daughter described each morning’s routine at home when she prepares to send her mother to “school” (what her mother calls Bayview ADHC) so she can go to work.  From the time her mother wakes up until the 9 am bus arrives to pick her up, the mother continually asks, “What am I supposed to do today?” though the daughter repeatedly responds, “You’re going to school today.”  The daughter told us, “You see, my mom has Alzheimer’s disease.  Can you imagine a day with my mom at home by herself or at a nursing home?”  She said that her mother could do all the things she didn’t know how to do, and she remembered all the times her mother stood strong for her, so now she was going to stand strong for her mother.  At this point, I got all choked up at this model of Confucian filial piety and wanted to excuse myself from the masses so I could bawl out in private, but then . . .

ADHC anthem

Hene Kelly, who represents 900,000 seniors from California Alliance of Retired Americans (CARA), told us that other cities won’t pick up ADHC, but San Francisco is different because we care about all; Governor single-handedly cut ADHC and can reverse it; instead, he proposed a “transition plan” but nothing to date, and December 1 is coming soon.  Then, Hene broke out into the following song, which we sang back to her line by line in People’s Mic fashion:

Everywhere we go
People want to know
Who we are
So we tell them
We are the seniors
Mighty seniors, mighty seniors
Fighting for health care
Fighting for respect
Watch out, we’re going to win health care
Adult Day Health Care is a right
Get out of our way
Give it back to us!

Jaywalking & wheeling to Governor’s office
About 25 of us (including a Bay Citizen reporter and photographer—separate positions, while I assumed both roles for this coverage!) followed James Chionsini of Planning for Elders, who led a march to the Governor’s office to present a 3” stack of signed petitions.  As we made our way from City Hall to Governor Brown’s office, many held up eye-catching STOP signs that served a dual purpose to declare our message and STOP traffic when the red light suddenly came on while we were still crossing McAllister Street!
“STOP ADHC Elimination”
“STOP Dissing Grandma”
“STOP This is not how we treat our elders”

Winning signs
State Building Security wouldn’t allow us to bring in signs so we left them planted outside.  While waiting in line to go through security check, I judged the signs as contestants and decided on the following winners:

Most effective message to support cause:
“Honk to save ADHC”
“NO ADHC means taking Independence & Dignity away from our frail, Elderly and Disabled”

Most informative signs:
“Gov. Brown: Adult Day Health Makes $ense . . . “
“Average Daily Cost Assisted Living $153 Nursing Home $308-435 Emergency Room Visit $1200+++ ADULT DAY HEALTH $79/day YOU DO THE MATH”

15 minutes of fame: Occupy Governor’s Office!
James explained that we didn’t have an appointment so we weren’t all that surprised when the receptionist behind a glass window told us that the Governor was not in San Francisco to receive us and the signed petitions.  Hene made a cell phone call using speaker phone to the Governor’s Office in Sacramento, listened to a recording of menu options before reaching a constituent affairs representative named “John.”  The Governor was not available to come to the phone so Hene said she would send a letter with the petitions; “John” said the Governor’s office would respond in 90 days; some shouted, “We need a response in a week!”   Hene said we would follow-up in one week with “John.”

Then we politely exited and vans were waiting outside to escort the senior and AWD activists.  Not quite the Power of 504 demonstration (when AWD occupied the old San Francisco federal building for 26 days in 1977 until the fed agreed to implement regs to enforce the 1973 Rehab Act), but I walked away with a “Power to the People” feeling. 

Postscript:  Prior to December 1, 2011, the State reached a settlement with advocates to allow ADHC centers to provide services until the launch date of the new Community-Based Adult Services (CBAS) program (http://www.californiahealthline.org/articles/2011/11/18/state-reaches-settlement-to-establish-new-version-of-adhc.aspx, http://www.californiahealthline.org/capitol-desk/2012/10/program-launches-for-seniors-disabled.aspx)

1 comment:

  1. “Might as well have them walk the plank” — Cuts may force many seniors into nursing homes
    BY BARBARA FEDER OSTROV
    MAY 19, 2020
    Gov. Gavin Newsom's proposed cuts to meet the new coronavirus economy include two California day programs aimed at keeping poor and medically fragile seniors in their homes, and out of institutions.
    …Multipurpose Senior Services Program, or MSSP…serves more than 11,000 people…who are older, medically fragile and at real risk of being institutionalized in a skilled nursing facility. Every month, a social worker visits …to assess her needs, making sure she has enough food, arranging transportation for doctor visits, installing grab bars in her bathroom to prevent falls, even providing an emergency kit.
    Grim pandemic-fueled cuts to California’s state budget could shutter…program as early as July — along with another adult day health program that supporters say also has helped keep thousands of low-income seniors out of expensive nursing homes.
    Gov. Gavin Newsom’s revised budget, which must be approved by state lawmakers, eliminates that program and another one called Community-Based Adult Services, in which seniors go to adult day health programs for medical care, physical therapy, meals and socialization. These programs, paid for by Medi-Cal, California’s Medicaid program, are considered by the federal government to be optional. In contrast, Medi-Cal must pay for nursing home care for those who qualify for it; those benefits can’t be cut to trim the state budget.
    Together, the two senior health programs serve nearly 46,000 of California’s poorest and most medically frail seniors in their homes or at one of 260 adult day health centers around the state.
    Eliminating them could save the state about $410 million over the next two budget years — but health advocates say that could force thousands of seniors into skilled nursing facilities in the middle of a pandemic.
    The novel coronavirus has raced through nursing homes with devastating speed. More than 4,800 California skilled nursing facility residents have contracted COVID-19, and nearly 850 have died as of May 19, according to California Department of Public Health data.
    …blindsided by the proposed budget cuts from a governor who last year called for a new state “master plan for aging” by this October…MSSP program costs no more than $5,000 per client per year, compared to the roughly $40,600 per year that Medi-Cal would pay for a typical patient to live in a skilled nursing facility, though costs can be significantly higher.
    …California, like other states, has long experimented with state-subsidized programs that offer social services and health care coordination to keep seniors independent and living in their communities, rather than institutions. The senior health programs now slated for elimination also faced the ax more than a decade ago amid budget cuts during the Great Recession. But consumer advocates filed a federal class action lawsuit against California to restore them and won in 2011, with some changes to the programs.
    …Advocates for the programs say keeping seniors out of nursing homes is better for their well-being and more cost-effective than institutionalizing them.
    But California’s adult day health program also has drawn scrutiny from federal officials. A Health and Human Services Inspector General’s report released in September found that the state needed to more closely monitor the adult day program sites. The report noted that 23 of 24 sites where it conducted unannounced inspections had violations including improper storage of patient medicines, poor record keeping, and even in a few cases rodent and bug droppings. California officials, in response to the audit, agreed with the findings and said they had stepped up inspections and training for program staff…
    https://calmatters.org/aging/2020/05/seniors-budget-cuts-california-coronavirus-day-care-programs/

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