Building a caring community

Theme of this month’s Senior & Disability Action (SDA) General Meeting was 2015 Election: The Fight for Affordable Housing with panelists discussing Propositions A ($310 million bond for affordable housing), D (Mission Rock Development to include 40% affordable housing), F (regulate and enforce short-term rentals), I (Mission District market rate development pause and neighborhood stabilization plan to prioritize affordable housing) and K (securing public lands for new affordable housing).  SDA recommended YES! YES! YES! YES! and YES!  

Affordable housing remains a hot issue in San Francisco, where seniors and persons with disabilities continue to be targeted for eviction from their long-term tenancies.  This has become common when older, long-term landlords--often content receiving monthly rental income stream from stable, hassle-free tenants--transfer property to new landlords who view housing as a commodity to make quick profits and ignore community.  

News headlines like "City Sues San Francisco Landlord Accused of Bullying Elderly and Disabled Tenants” and “S.F. landlord evicting seniors who helped her ailing aunt” are disturbing.  

One would expect better behavior from landlord Annlia Paganini-Hill, a UC Irvine investigator of The 90+ Study to determine factors associated with longevity--"Because little is known about people who achieve this milestone, the remarkable increase in the number of the oldest-old presents a public health challenge to promote the quality as well as the quantity of life."  After Paganini-Hill inherited San Francisco property from her aunt, she evicted the tenants (including SDA housing organizer Theresa Flandrich), seniors who had cared for her ailing aunt when she was in her 90s.  Paganini-Hill's eviction actions did not contribute to quality/quantity of life, with one 78-year-old tenant who died while fighting her Ellis Act eviction.  Maintaining a sense of caring and community appears to be a public health challenge. 

At the same SDA meeting, Joyce and David invited all to join celebration of Social Security Act’s 80th Anniversary at visibility events in San Francisco. 

On August 14, members of California Alliance for Retired Americans (CARA) held up Happy 80^th Birthday Social Security: Protect, Improve and Pass It On banner and passed out information flyers to passersby on Market Street.  One CARA member asked, “Do you want to be stuck caring for your parents?” I don’t like being “stuck” but like to keep moving and sure, I want to be caring for my parents! 

Social welfare entitlement programs, like Social Security and Medicare, have shifted income and health care support from filial obligation to societal responsibility.  Yet, aside from Medicaid for low-income persons, long-term care remains a family responsibility. 

Growing up in a multi-generational household, generational interdependence and caring for all family members was reciprocal.  For example, my grandparents cared for me and my siblings when we were very young (while we provided priceless entertainment :-)) and my parents worked outside of the home (earning money for our basic needs and wants); then as my grandparents developed dementia issues later in life, my siblings and I looked after them (while my grandparents provided amusement) and we took turns working for our parents who ran several businesses.  Caring was an expression of filial piety and love, so we never viewed caring as a burden or sacrifice. 

Oddly, bullying is rampant in “caring” professions like health care, education and public service/government, according to a 2013 Workplace Bullying Institute (WBI) study.  At last month’s LaborFest, Workplace Bullying Labor Educational Conference: What It Is and How to Stop It! featured Derek Kerr, MD, vindicated whistleblower who received a $750,000 settlement and plaque recognizing his 20+ years of distinguished service, including founding the hospice care unit at Laguna Honda Hospital (subject of Geriatric Nursing study, “A model long-term care hospice unit: care, community, and compassion”).  Dr. Kerr and Dr. Maria Rivero, who were both terminated in retaliation for exposing wrongdoing by Laguna Honda administrators, write a Watchdog column in the monthly Westside Observer, while the corrupt bullies remain at Laguna Honda.  (Ten years ago, Dr. Rivero had questioned whether San Francisco's Director of Public Health was changing Laguna Honda's commitment to elderly patients after noticing a sharp increase in younger patients who were taking up beds needed by the elderly.) 

Dr. Kerr talked about growing recognition of workplace bullying as psychological violence.  WBI defines bullying as repeated, malicious, health harming mistreatment that interferes with work performance—different than incivility and discourtesy.  One-third of workers experience bullying at some point in their career; 60% inflicted by supervisors, 30% by peers, 10% by subordinates.  Since workplace bullying results in symptoms of PTSD and major depression, Dr. Kerr said it is extremely debilitating, an occupational health hazard.

Carrie Clark and Michelle Smith talked about their work with California Healthy Workplace Advocates to “Raise Public Awareness and Compel our State to Correct and Prevent Abusive Work Environment Through Legislation”  based on Healthy Workplace Bill drafted by Suffolk Law Professor David Yamada. 

Elderly bullying can be a form of emotional/psychological/mental abuse, which is a non-mandated report in California.  A 90+ year-old woman told me she was bullied by her senior son, who repeatedly taunted her about moving out of the home which she transferred to him, yet the APS worker said she could not make the son “be nice” to her. 

National Long-Term Care Ombudsman Resource Center (NORC) hosted an excellent webinar last month on Identifying, Preventing, and Responding to Bullying in Long-Term Care Facilities presented by Robin Bonifas, PhD, MSW of Arizona State University’s School of Social Work.  Bullying is defined as intentional, repetitive, aggressive behavior involving an imbalance of power or strength; among older adults, relational aggression is a common form of bullying intended to damage peer relationships and social connections.  Dr. Bonifas noted that because engaging in bullying requires a level of cognitive and social skills, senior environments with higher functioning residents or participants tend to have more problems with bullying.  Bullies seek to control others, have difficulty tolerating individual differences and lack empathy; among older adults, older bullies may be seeking control at a time in their life when they may feel powerless over losing independence, so they act out by dominating others.

Dr. Bonifas also distinguished bullying from behaviors related to dementia and mental illness like verbal or physical aggression linked to decreased impulse control or frustration with inability to express needs.  

Dr. Bonifas recommended a three-tiered intervention model to prevent and minimize bullying behavior: 

1) organization’s goal is to create caring communities requiring a culture of respect (zero tolerance for bullying), accountability for behaviors, willingness to stand up for what is right (bully has to be confronted often and clearly, even called out publicly since no one self-identifies as bully), civility training (pay attention, listen, be inclusive, don’t gossip, show respect, be agreeable, apologize, give constructive criticism, and take responsibility);

2) intervention for bullies (consistently set limits on bullying behavior; offer appropriate outlet to vent frustrations; identify alternative methods for bullies to feel in control, learn positive communication skills like making “I" statements, develop empathy by modeling, help expand social network, and address feeling of loss); and

3) intervention for victim/target (assertiveness training to stand up for one’s rights, use direct communication strategies, manage feelings of anger, and setting boundaries).

“The world is a dangerous place, not because of those who do evil,

but because of those who look on and do nothing.”

—Albert Einstein

At last month’s NAMI convention in San Francisco, neuroscientist Jill Bolte Taylor, PhD , author of My Stroke of Insight: A Brain Scientist’s Personal Journey (2006), presented an insightful talk about Our Beautiful Brain. When Dr. Taylor suffered a stroke almost 20 years ago, she lost function on the left hemisphere of her brain and her mental processes shifted to her right hemisphere.  In this shift from the doing-consciousness of her left brain to the being-consciousness of her right brain, she experienced Nirvana—a sense of being fluid, at one with the universe and in the flow, tuned in to energy dynamics and body language, feeling deep inner peace and calm. 

Dr. Taylor said the brain’s judgmental left hemisphere would rather be right than happy, whereas its open-minded right side would rather be happy than right. 

• We care about “Me” (not we)
• Focus on personal gain (not community)
• Care about profits (not people)
• Strive for authority (not equality)
• Seek differences (not similarities)
• Competitive (not compassionate)
• Judgmental (not forgiving)

According to Dr. Taylor, our left brain dominant society is eroding our self value when we are rewarded for what we do, rather than who we are.  We are in pain, which results in a mental health crisis: pain is masked in various forms of addiction to substances like drugs and alcohol. 

Dr. Taylor explained that information received into our brain is organized by the limbic (emotional) system and then sent for cognitive thinking, thus we are FEELING creatures who THINK.  Our limbic system cells never mature, which is probably why people can react like a two-year-old when emotional “buttons” are triggered.  Yet it takes only 90 seconds for our body to rid itself of the rush of adrenalin caused by an explosion of anger.  If people stay angry longer than 90 seconds, it's because they have chosen to have a thought in their brain that makes them angry—so every time they think that thought, they run the same circuitry in their brain that keeps them angry. 

Response-ability: Dr. Taylor said if we use our limbic system in the proper way (and we own the power to choose how we perceive and respond to experience), it will dissolve barriers between us and the world, allowing us to see ourselves as a member of the human family, showing compassion to one another in one big caring community!