Quality of life

According to Chinese Medicine’s Five Element (WuXing) system, the autumn/fall/harvest season is associated with metal (element) and old age (life stage).  As an introverted old soul, I identify with the metal element and embrace old age with its potential for gerotranscendence:

“These typically include a redefinition of the Self and of relationships to others and a new understanding of fundamental existential questions. The individual becomes, for example, less self occupied and at the same time more selective in the choice of social and other activities. There is an increased feeling of affinity with past generations and a decreased interest in superfluous social interaction. The individual might also experience a decreased interest in material things and a greater need for solitary "meditation". Positive solitude becomes more important. There is also often a feeling of cosmic communion with the spirit of the universe, and a redefinition of time, space, life and death.” --Lars Tornstam, author of Gerotranscendence: A Developmental Theory of Positive Aging

I crave private moments to experience nature in solitude.  It’s about knowing how to be with “aliveness and newness moment by moment,” according to ancient Taoists, if we can experience energetic balance (qi flow) as we become one in harmony with our natural environment, and privacy gives one the freedom to be.

In this era of online social networking, I can seem like a Luddite because I

I don’t participate in friending, tweeting, LinkedIn, etc.  I value privacy, freedom of being off-the-grid and maintaining my small circle of confidants.  These cherished values inform my support for aging in place since an institutional alternative would diminish privacy and freedom that I believe to be so essential to quality of life. 

Social butterflies don’t have deep friendship connections (Butterflies & Blooms exhibit at Conservatory of Flowers), but social introverts do J.

Maslow’s theory of motivation suggested that our most basic needs must be met before attaining self-actualization (gerotranscendence). 

Physiological: gimme shelter & food

Senior & Disability Action (SDA) Housing Organizer and POOR Magazine co-editor Tony Robles and Housing Rights Committee of SF Tenant Rights Advocate Jennifer Willis at last month’s SDA meeting focused on Public Housing.  Jennifer said that SF Housing Authority is in the process of purging its Section 8 waiting list of 30,000 persons (some have been on this list for 10 years!) through the end of November, so it’s important to respond with current address: if letter is returned to sender, then person is removed from wait list.  Housing Authority wait list has been closed for years, and expectation is to purge 10,000 from current list and then re-order based on preferences such as disability or no permanent address.

The median age of America’s rapidly aging homeless population is 53.  Homelessness and the stressful conditions of living on the streets can take a heavy toll on health, and life expectancy on the streets is about age 64. 

At times, it seems like legislation tackles the problem of homelessness as a quality of life issue that jeopardizes public safety and aesthetics for NIMBY residents.  Homeless advocates view the effect of San Francisco "quality of life" ordinances that make it illegal for persons to sleep in public parks (which are now closed from midnight to 5 am) and in oversized vehicles parked overnight in certain neighborhoods as criminalizing homelessness and poverty. 

Why pick on vulnerable people who are already suffering (sleeping in vehicles are the last refuge from ending up on the streets), and why can’t we be just like Mister Rogers’ Neighborhood where neighbors peacefully work out their differences with compassion?  If we view homelessness as a symptom of poverty and the larger problem of wealth concentration (99% of Americans subject to the wealthiest 1%, who control more than 40% of the nation's wealth), then perhaps we can look to rich countries, like Sweden and Japan, that distribute their income the most equally have the longest life expectancy and the highest quality of life.

California Alliance for Retired Americans supports AB 5, Homeless Person’s Bill of Rights and Fairness Act.  According to the Bill’s author Assemblymember Tom Ammiano, “This bill is really about basic justice.  People who are homeless not only have to struggle with life on the street, [but] the indignity of being treated like criminals because they have nowhere to eat, sit or sleep except in public.”

San Francisco has the highest median rent in the nation.  The economic recovery, fueled by the latest tech boom (thanks to tax breaks and other corporate welfare incentives), has raised concerns that new, young workers willing to pay more for housing are displacing long-time, older residents on fixed incomes who are losing their homes because they can’t afford rent increases and Ellis Act evictions.  More LGBT elders are homeless on the streets of San Francisco.

Inclusionary housing isn’t just about affordability but universal design access for all ages.  This month the Long-Term Care Coordinating Council endorsed the Mayor’s Disability Council Resolution #2013-01 Recommending Guiding Principles for the Construction, Maintenance and Financing of Permanently Affordable and Accessible Housing for People with Disabilities and Seniors.

On Election Day (November 5), Tenderloin Neighborhood Development Corporation hosted Home Matters for Health symposium as part of a campaign to raise national awareness about the connections between home and health:  the impact of stable affordable homes on health, the value of supportive housing with health services provided at home, and the cost effectiveness of health care that prevents homelessness.

Mayor Ed Lee talked about San Francisco Department of Public Health’s Direct Access to Housing that provides on-site supportive services to low-income residents who were homeless or at-risk; last year’s creation of the $1.5 billion Housing Trust Fund for affordable housing to low- and middle-income residents over the next 30 years; tripling the funding to Human Services Agency to provide homeless prevention and eviction defense services; “re-envisioning” public housing by working with HUD on repairs (including elevators) to expand on SF HOPE model of community development; the opening of Veterans Commons with on-site supportive services for senior veterans; and emergency services with strong housing connections by expanding Project Homeless Connect to Every Day Connect. 

According to Dr. Joshua Bamberger (only male on panel, pictured above), San Francisco Department of Public Health’s Medical Director for Housing and Urban Health, living in “more beautiful” housing is associated with better health outcomes and even lower mortality rates--“self-efficacy and beauty make the difference.”  After the symposium, I asked Dr. Bamberger for his definition of “beauty” – did he mean housing that includes therapeutic landscapes, perhaps feng shui design? In response, he sent photos, which are posted online, but the interior spaces are not visible so I couldn’t see the inner beauty.

One in four San Franciscans is food insecure, or lacks access to healthy food, according to the San Francisco Food Security Task Force, which presented its 2013 Assessment of Food Security in San Francisco report to the Board of Supervisors this month.  The report notes that low-income households with seniors, children or a single parent are especially vulnerable, yet the report covers for 2010 and 2013 feature photos of young children only.

This month SNAP (Supplemental Nutrition Assistance Program, formerly known as food stamps and now branded as CalFresh in California) benefits were cut by 5% due to expiration of stimulus funding.  I volunteer at Project Open Hand, which prepares nutritious “meals with love” to 18 senior congregate meal sites in San Francisco, so I wanted to participate in its SNAP Challenge from November 21 to 28, by spending no more than $4.56 per day on food, which is the average amount received by 4.1 million SNAP beneficiaries in California.  

This SNAP Challenge week coincided with my attendance at the Gerontological Society of America (GSA) annual meeting in New Orleans, where I couldn’t resist all the receptions and then the Oak Street Po-Boy Festival, where I enjoyed this amazing sweet potato, kale and pesto po-boy from Slow Food NOLA that cost me $5—exceeding the average daily SNAP food budget.

For my Aging & Social Policy class assignment to propose a budget-neutral policy, I presented my poster on Improving CalFresh for Seniors by addressing food security and nutrition.  While my classmates didn’t object to my plan for targeted outreach and marketing to enroll more seniors eligible for CalFresh, I nearly got chewed out for suggesting a waiver from USDA’s Food and Nutrition Service (which administers SNAP) to apply WIC-like standards to promote nutrient-dense foods v. empty calories for low-income seniors, who have special nutritional needs like the WIC population (low-income pregnant/nursing mothers, infants and young children).  Of course, it didn’t help that I criticized SNAP rules that allow purchase of “junk food” items (e.g., soda, candy, chips, etc.) that my own classmates were eating in the classroom during my two-minute presentation.  Yet, proper nutrition is especially critical for senior health promotion and disease prevention, as malnutrition in seniors leads to chronic conditions (heart disease, diabetes), slower healing rates, increased hospital stays, premature nursing home placement, etc. that impair both quality and quantity of life.

Safety (net):  Social Security & Medicare

National Committee to Preserve Social Security & Medicare Foundation (Board Chair Carroll Estes, pictured above, provided introductory remarks) and Openhouse (Executive Director Seth Kilbourn seated in middle) hosted Know Your Rights and Claim Your Money: Social Security and the LGBTCommunity at the San Francisco LGBT Center.  This forum focused on the aftermath of the U.S. Supreme Court’s rulings in June, which cleared the way for federal benefits for same-sex married couples (finding Defense Of Marriage Act’s Section 3 unconstitutional) and for same-sex marriages to resume in California (rejecting Yes on Proposition 8 appeal).  The panel urged same-sex married spouses to file an application for Social Security spousal benefits now since eligibility date is triggered by the filing date of application. Because Social Security law looks to the state of residence in determining whether a same-sex couple is married, it’s not clear what happens to same-sex spouses who move to a non-marriage equality state. 

At JCCSF’s The Art of Financial Well-Being, Carroll Estes discussed how the proposed “chained” CPI (Consumer Price Index) for making COLA (cost-of-living adjustments) to Social Security benefits will hurt seniors by reducing benefits based on lower estimates of inflation.  The current COLA already undercounts the higher inflation experienced by seniors who spend a higher percentage of their spending to health care costs.  Instead, Estes supports a more accurate inflation measurement for the elderly, the CPI-E that was developed in 1982 to reflect the different spending patterns of consumers age 62+, with a greater weight on health expenditures that continue to rise faster than other expenses. 

Kenneth Gardner of the Centers for Medicare and Medicaid Services presented Medicare 101.  Medicare focuses on acute care (doctor visits, drugs, brief hospital stays) and short-term services for conditions that are expected to improve – not chronic conditions, so Medicare does not cover long-term (custodial) care.  Instead, Medicaid is the dominant source of payment for long-term care, followed by out-of-pocket payments by individuals.  The odds are 1:2 whether one will need LTC; in 2012, the national average cost of one year in a private nursing home was $90,520.  

SFSU Health Education Chair Mary Beth Love moderated New Era of Healthcare Panel, noting that the Affordable Care Act (ACA) endorses a public health or ecological model: 

• California Pan-Ethnic Health Network Executive Director Ellen Wu hailed ACA’s policy to improve quality and access to health insurance coverage, with an expansion of the insurance marketplace (e.g., Covered California) and some states expanded Medicaid eligibility.  ACA improvements to Medicare coverage include expansion of preventive services such as free annual “wellness” visits.
• City College of SF Community Health Worker (CHW) Program Coordinator Alma Avila discussed integrating CHWs, housing and employment services in community.
• SFSU Holistic Health Institute Director Adam Burke (also a licensed acupuncturist) discussed the role of low-tech Complementary and Alternative Medicine in health promotion and wellness, recognizing that consistent killers are lifestyle factors (exercise, nutrition, smoking, alcohol, stress) that can be managed with self-care. 

Health care v. insurance: “Medicare for all ages” is the motto for a single-payer system, while Obama’s attempt at universal health care via ACA appears to be a form of corporate welfare because it subsidizes the private health insurance industry by mandating that individual Americans buy its product.  Under ACA, pediatric dental and vision care services are mandated as “essential health benefits”—is this ageism? Aren’t dental and vision care (also not covered by Medicare) essential for all ages?

Social:  community building

One-third of older Americans live alone, mostly out of personal preference; women over age 60 who live alone report more happiness than married women the same age.  Moreover, older adults who live alone are more likely than their married counterparts to spend time with friends and neighbors.  LGBT Aging Task Force found that 58% of gay seniors in San Francisco live alone, but they often are reluctant to use public services for the aging because they don’t feel welcome due to their sexual orientation so informal support (family, friends, neighbors) is important.

 

Community Living Campaign presented its 4-week Connections for Healthy Aging workshop series focused on challenging myths about aging and normalcy, fostering inclusiveness through People First Language, building social networks of care to survive a hospital stay/discharge; documenting health care decisions (vial of life kits, advance health care directive) to make your wishes known to others, etc.

Esteem

Education and advocacy can empower persons against ageism and ableism.

“My moral opposition to prenatal testing and selective abortion flows from the conviction that life with disability is worthwhile and the belief that a just society must appreciate and nurture the lives of all people, whatever the endowments they receive in the natural lottery.” –Adrienne Asch, 67-year-old bioethicist, died this month 

Future Past: Disability, Eugenics and Brave New Worlds symposium was an opportunity to examine the debate favoring the value and contributions of all persons versus discrediting those “not worth living” in a utopian effort to “improve” human breeding via eugenics (like Nazi genocide, euthanasia, sterilization, prenatal selection, etc.).

 

In her welcoming remarks, Cathy Kudlick, Director of SFSU’s Paul K. Longmore Institute on Disability, rejected the notion that disability can or even should be erased; rather, disability remains despite scientific breakthroughs, which allow persons with disabilities to live longer.  By accepting disability and valuing disabled persons as worth preserving, Kudlick said we approach disability as a “generative force for productive conversations” and consider the fundamental questions to advance social justice: “What does it mean to be human? How do we respond ethically to difference? Who gets to decide? What do the answers reveal?”  

WHAT? Eugenics and Disability: Past and Present panel featured

Alexandra Minna Stern, SFSU alumna and author of Eugenic Nation: Faults and Frontiers of Better Breeding in America; Marcy Darnovsky, Center for Genetics and Society; Glenn Sinclair, Living Archives on Eugenics in Western Canada and sterilization survivor; and Nicola Fairbrother, Neighborhood Bridges. 

Eugenics is based on the medical model that attempts to diagnose, manage, control and prevent differences from “normality” by reducing persons who don’t "fit in" to labels (like defective, imbecile, mentally retarded, etc.) and then segregating them, with disparate impact on minorities and poor.  Instead of this misguided science dependent on value judgments, a social model that offers improved access to disability-friendly resources promotes inclusion. 

After listening to each panel, participants at each table engaged in small-group discussions based on materials introduced by Milton Reynolds of Facing History and Ourselves, and then voluntarily reported back to everyone in the conference room. 

 

SO WHAT? The Consequences of Misremembering Eugenics

Rosemarie Garland-Thomson, Emory University, stated “the presence or absence of a disability does not predict quality of life.”

Troy Duster, UC Berkeley Chancellor’s Professor of Sociology, considered the conditions under which society determines “what kind of people you don’t want”—disruptive socio-economic transformations that categorize people as “makers” or “takers” in the struggle for resources—create fertile soil for eugenics.

Rob Wilson, University of Alberta , talked about his institution’s complicity in the sterilization program yet has never apologized.

Marsha Saxton (moderator), World Institute on Disability, mentioned the challenge in funding research for drug treatments that could improve quality of life (like one based on a drug for Alzheimer’s to help “normalize” learning and memory in persons with Down syndrome) that compete against prenatal testing (to prevent Down births). 

NOW WHAT? Looking Ahead to Brave New Worlds

Patricia Berne, co-founder and director of Sins Invalid, showed video clips of her performance art project that celebrates artists with disabilities and other marginalized groups within a social justice context.

Milton Reynolds, Facing History and Ourselves Senior Program Associate, highlighted the role of education, such as California’s Fair, Accurate, Inclusive, Respectful (FAIR) Education Act that requires teaching LGBT, disability and other traditionally underrepresented cultural groups, in transitional justice processes that include institutional reform, cultural response, judicial response, reconciliation, restitution and reparations, and truth commissions.

Gregor Wohlbring, University of Calgary Professor of Disability Studies, who joined the conference via skype, noted that both negative (sterilization of those deemed “unfit to breed,” selective abortion after genetic testing reveals “undesirable” traits) and positive (somatic and germline therapy, human enhancement beyond norm) eugenics are based on ableism (disability discrimination/oppression).

Kate Wiley, SFSU alumna and Lick-Wilmerding High School teacher, talked about her students creating an online petition asking the State of California to include California’s history of eugenics in its public high school curriculum. 

In closing remarks, Emily Smith Beitiks, Assistant Director of SFSU’s Paul K. Longmore Institute on Disability, expressed her hope that in the future we will not need to hold a conference to make the argument that certain people have the right to exist. 

Joanna Fraguli of the Mayor’s Office on Disability (MOD) was one of the presenters at SDA's 4-week Disability Survival School.  In addition to SDA staff presenting on the history of disability rights movement, community organizing, health care and housing, we were introduced to representatives from Independent Resource Living Center for assistive technology and fair housing, SF Municipal Transportation Authority, Department of Rehabilitation for employment, Health Insurance and Counseling Advocacy Program (HICAP) for Medicare counseling, and AIDS Legal Referral Panel for reasonable accommodations.

San Francisco is the place to be happy, healthy and fit!