Freedom

Since George Michael's death at age 53 this past week (truly his “Last Christmas”), I’ve been listening to this bootleg cassette tape of his addictive pop music when he was part of the duo Wham!  I remembered Wham! made history as the first Western pop group to perform in China in 1985, which was captured in their “Freedom” video, as well as their “Foreign Skies” documentary.  Those images made me nostalgic for pre-1989 China, where I did my study abroad at Peking and Fudan universities: the lack of bourgeois vanity in make-up free faces and utilitarian Mao suits; moving qi via martial arts and bicycling; all ages occupying public places, etc.  Interestingly, I was the only Chinese participant in a mostly Jewish group (also Maoist/Marxist sympathizers) led by intellectual property expert Peter Jaszi of The American University, when I bought this copyright infringement tape (Made in China)! Growing up during the harshness of Reaganomics and the rise of homelessness, China’s socialist safety net was appealing ... if only it could exist with political freedom! 

Make It Big (just like 1980s Wham! George Michael J) hair and skirt (useful for squat toilets) … at the end of my China study abroad, I visited my mum's elderly aunt and uncle in Hong Kong. 

Since the outcome of last month’s election, many clients have reported anxiety, depression and stress (—but no memory loss!) over the future of disability rights and safety net programs (Social Security, Medicare, Medicaid, etc.) under Republican control of the Presidency and both houses of Congress.  I cheerfully remind clients of our San Francisco bubble: Proposition I aka Dignity Fund passed, which means increased funding for home and community based services for seniors and people with disabilities!

I thought about the wisdom of 67-year-old Carolyn Davidson, who took a part-time job at a senior center following her retirement 5 years ago after decades as a social worker supporting older adults.  When her skin cancer diagnosis and treatment last year prevented her from working, her financial resources were strained: 

“Retirement has left her on a fixed monthly income of $1,088 from Social Security, which suits her just fine. She also receives $194 in food stamps and gets help from a local food pantry operated by Catholic Charities Brooklyn and Queens, one of the eight organizations supported by The New York Times Neediest Cases Fund…

Because Ms. Davidson’s income disqualified her from receiving traditional Medicaid, she had to enroll in a reduced Medicaid plan for higher earners and has had to use her own money to pay off portions of medical bills. After paying her $663 monthly rent and more in utilities, she has only $389 remaining each month to pay for everything else and any unexpected costs.

In April, she received a hospital bill for $239. She could not afford it. The debt halted her Medicaid benefits.”

--A ‘Do It’ Kind of Woman Waits for the Strength to Get Back to Being Herself, The New York Times (December 20, 2016) 

Fortunately, as an experienced geriatric social worker, Ms. Davidson was able to secure relief from a charitable organization, allowing her Medicaid plan to resume.  She also avoided bankruptcy, though she experienced the top 3 reasons why people go bankrupt: unexpected medical expenses, reduction of income and job loss.  As Ms. Davidson told The New York Times, “There are so many things that seniors don’t know they are eligible for, it’s ridiculous.” 

As late Bob Marley, paraphrasing Matthew 16:26, sang in Zion’s Train: “Don't gain the world and lose your soul, Wisdom is better than silver and gold” (mural from Haight Central Market)

Retirement in old age is associated with freedom to live at home and to do what one wants, especially if one has deferred gratification from years in the workplace.   But at any age, lack of income limits this freedom of choice … or one needs to be very resourceful to access opportunities.

Freedom to age in place

In mostly capitalist U.S.A., income and health (or ability to carry out activities of daily living) often determine where and how one can age in place.  

With my work focused on home visits to homebound seniors, in a non-profit that limits training during work hours since focus is on production quantity, my world gets smaller like my clients... so I continually make efforts to attend training/networking events outside of work hours to learn tips and resources available to my clients and future self (as aspiring older adult).  One advantage of these meetings held in evenings/weekends is the availability of food and refreshments! 

SFSU Gerontology Class of 2014 had mini-reunion on-campus (1/3 of class pictured above with popular Professor Brian De Vries) at this month’s Gerontology Celebration honoring classmate Raenika Butler, who was inspired by the work of late African-American gerontologist George W. Davis, and works as Executive Assistant to his partner, Cathy Davis, Executive Director at Bayview-Hunters Point Multipurpose Senior Services (BHPMSS).  In June 2016, they helped realize Dr. Davis’ vision of an “Aging Campus” with the grand opening of Dr. George W. Davis Senior Center and Residence, including 121 units of low-income senior housing.  Over 4,000 applications were submitted; seniors age 62+, with income of $35,700 or less per year, pay rent at 30% of their income.  Mary Schleeter and Diane Houlton, classmates who founded Aging Plan-It, commuted from Sacramento to join us!

At Rhoda Goldman Plaza, assisted living for high-end clients (studios start at $6,027 per month), SFSU alum and elder care consultant Kira Reginato talked about her new book, Tips for Helping Your Aging Parents (without losing your mind), such as preparing a grab-and-go bag for hospital visits, assessing home for accessibility and safety, deciding when move from home is necessary (isolation, safety), kinds of senior housing, etc. Kira hosted a weekly radio talk show, Call Kira About Aging! 

Freedom to eat

The growing diet divide between rich and poor has been attributed to food cost, time cost, and heavy marketing of junk/fast food to low-income people.  Convenience food manufacturers have come between eaters and the kitchen, so TV dinners and microwaveable meals replace home cooking.  In “The Symbiotic Relationship Between Oral Health, Nutrition, and Aging,” published in ASA’s Generations Fall 2016 issue, Ronni Chernoff wrote about the role of on-demand meal services in promoting food security, from Meals on Wheels to food delivery apps. 

At Home With Growing Older’s forum on Food on the Table–Aging in Place featured Chief Government Affairs Officer Anne Quaintance of high touch, non-profit (one of the highest ranked charities in the Bay Area, according to Charity Navigator) Meals on Wheels San Francisco (MOWSF), and Marketing Manager Clare O’Brien of high tech, for-profit UberEATS.  

The presentations and ensuing discussions were a real commentary on our growing digital divide (UberEATS users who have smart phones to use app v. some MOWSF clients who don’t even have phones) and income inequality (UberEATS users can afford minimum $4.99 delivery charge v. some MOWSF clients can’t afford suggested contribution of $5 daily for 2 subsidized home-delivered meals).  
While Uber has partnered with healthcare providers to enable Americans (or 70% of Americans age 65+) without smartphones to access ride hailing services, this is not yet an option at UberEATS.  Audience also raised concerns about Uber’s contribution to traffic congestion (no less its controversial driverless cars running red lights) in San Francisco. Last year, Uber partnered with AARP's Life Reimagined to recruit older drivers with safer driving records, yet only 23% of Uber drivers are age 50+.

Anne emphasized that MOW delivers more than a meal (“nourishing the whole person”) – relationships that support a client’s ability to live safely at home.  MOWSF actually knows their 3,600+ clients (who are subject to social work and nutrition assessments): 92% are age 60+ and 75% live below poverty. (For more about food justice, check out blog post about my participation in Oxfam’s Hunger Banquet moderated by Anne.)  In contrast, UberEATS is transaction-based, eat anything you can have restaurant made-to-order, so it doesn’t collect data on users (nice for folks who value their privacy), but relies on third-party research firm to estimate 6% of UberEATS users are age 65+.  

Anne with MOWSF Social Work Supervisor Lara Medvedeva and Department of Aging & Adult Services (DAAS) Nutritionist Linda Lau.  MOWSF provides 85% of the home-delivered meals funded by DAAS!

Freedom to dodge Xmas

During Christmastime, articles galore are published about lonely seniors during this holiday season.  This year, National Association of Area Agencies on Aging (n4a) and AARP partnered on a campaign, "Home for the Holidays," to raise awareness about loneliness among the elderly during the holiday season, combating stigma while providing tips and resources to stay connected and engaged.  Age UK has a similar campaign, “No one should have no one at Christmas,” providing befriending services with volunteers who visit or make calls to seniors feeling lonely.

Given the wonderful diversity of San Francisco’s senior population, some of my homebound clients don’t seem affected by more loneliness during this particular holiday season, especially those who don’t buy into this commercial pagan holiday, but find it particularly alienating like Puritans who banned Xmas in the New World.  And I have other clients with profound forgetfulness such that they always seem oblivious to time and thus have no expectation/pressure of imposed merriment, gluttony, gift exchanges, etc. 

In past years, I would escape the commercial holiday season by flying to a developing country too poor for mass consumerism.  Then starting last year, I volunteered at Kung Pao Kosher Comedy, 3 nights of Jewish stand-up comedy in an American-Chinese restaurant with proceeds benefiting non-profit organizations, such as Legal Assistance to the Elderly (last year) and JFCS Seniors at Home (this year). 

Comedian Lisa Geduldig produced and hosted the 24^th Annual Kung Pao Kosher Comedy.

Lisa and Volunteer Macher Shani Heckman on stage for raffle drawing before full house of all ages and mostly Jewish at Chinese restaurant... almost felt like my China study abroad experience J! All 3 nights, both 7-course banquet dinner & dim sum cocktail shows, completely sold out!  This year’s comedians included aging and grandma jokes by headliner Elayne Boosler, Eddie Sarfaty (writer of video short, Second Guessing Grandma) and Alex Edelman.

Sunie Levin, author of Make New Friends...Live Longer: A Guide for Seniors (2010), said Seniors need chutzpah: "Yes, I can. Why not? What's to lose by trying?" 

25^th Annual Kung Pao Kosher Comedy scheduled Dec. 23-25, 2017!

To my homebound clients unable to attend Kung Pao Kosher Comedy, I recommend ordering take-out from Chinese restaurants that offer free delivery—cut out the middle guy (UberEATS) and tip the restaurant driver, instead! Then, sing-along to Darlene Love’s “Christmastime for the Jews” (named one of the greatest rock & roll Christmas songs by Rolling Stone).  Other suggestions: Wham! playlist and Woody Allen DVDs from SFPL Books by Mail.  

Bucket list

Preparing to "kick the bucket"

At this month’s Jewish Community Center of San Francisco’s 2^nd Annual Embracing the Journey End of Life Resource Fair, attendees were presented with a bucket list kit—complete with bucket, pencil, mini-composition book and instructions to answer: What do you want to do before you “kick the bucket”?

I thought been there, done that.  Long before the Hollywood film The Bucket List (2007), I compiled a list of places to visit and pursued them all.  While I enjoyed the anonymity and stimulation from exposure to different cultural experiences during my world travels, however ephemeral, I felt world-weary after I became eligible to join Travelers Century Club.  Like Thomas Jefferson noted, travel makes one “wiser, but less happy.”  So I reduced my carbon footprint by staying home, content to put down roots while returning to my childhood pastime of gardening (being with nature).   

“…chasing bucket-list thrills ignores a deep psychological truth: You don’t need to make yourself happy in old age.  We get happier naturally as we grow older… The increased happiness doesn’t come through doing but simply through being.  It is the natural result of lower expectations and ambition, less emotional volatility, increased gratitude and acceptance and enhanced problem-solving skills.

In fact, the need for a bucket list goes against our deepest instincts as we age. Older brains are less influenced by novelty-seeking and more by conscientiousness; they are less impetuous and more emotionally stable.” 

– Marc E. Agronin, MD, geriatric psychiatrist, It's Time to Rethink the Bucket-List Retirement 

Stan Goldberg, cancer survivor, hospice volunteer and author of Lessons for the Living: Stories of Forgiveness, Gratitude, and Courage at the End of Life, presented, One Day to Live: What Would You Say and Do?

1. focus on journey – makes it easier to accept losses and prepare for death; start with one simple, enjoyable activity
2. ask for forgiveness – makes you more peaceful
3. offer forgiveness – begins healing
4. understand what/when you can’t forgive – work towards understanding
5. let go of what you can’t change
6. offer thanks for kindness shown – change relationship
7. complete unfinished business
8. create legacy – make a difference 

Therapeutic humor expert Allen Klein provided comic relief in his presentation, Seeing Demise Thru Humorous Eyes: How Cartoonists, Comedians and Cinematographers Help Us See Death as Less of a Grave Matter.   My favorites were clips from Woody Allen films like Hannah and Her Sisters (life affirmation after attempted suicide) and Love & Death (dance with death).

End of Life (EOL) Options (ways to "kick the bucket")

Matt Whitaker, Multi-State Implementation Manager at Compassion & Choices, provided an overview of authorized EOL options:

1. refuse treatment
2. discontinue treatment
3. hospice – “gold standard” for last 6 mos. covered by Medicare, but average utilization only 20 days
4. VSED (Voluntarily Stop Eating & Drinking) – death by dehydration
5. palliative sedation – induce coma
6. aid in dying – legal in 5 states, OR (since 1997), WA (2008), MT (2009), CA (2016) and CO (2017)

California’s End of Life Option Act requires self-ingestion of a lethal dose of 100 capsules of Seconal, produced by Valeant Pharmaceutical, at a cost of $4,000; in California, only 80% of private insurers and Medi-Cal cover this cost.  A 1997 federal law prohibits use of federal monies (Medicare, VA) to cover aid in dying costs. 

JFCS Seniors at Home hosted End of Life Option Act: Effects on our Practice panel presentation:

• Linda Blum, GNP, Palliative Care Coordinator at California Pacific Medical Center: shared two cases when patients were not able to exercise EOL Option due to short time frame of patient with untreatable gastrointestinal bleeding who died in hospice at home before he was able to manage 2 requests to doctor, and another patient with ALS who was not able to self-administer aid-in-dying drug; in both cases, it was “care as usual, the old way.”
• Maryellen Collamore, ASW, Oncology Clinical Social Worker at UCSF: talked about her role to provide educational materials on EOL Option and to conduct psychosocial assessment of patient (motivation for inquiry, understanding of diagnosis, social supports, defining quality of life, perception of dying process, exploring belief systems, etc.); patient also must obtain mental health evaluation by psychiatrist; easier to find consulting MD than to find MD who will actually prescribe aid-in-dying drug; patient’s initial inquiry opens door to conversation, and most patients go to hospice.
• Lael Duncan, MD, Medical Director at Coalition for Compassionate Care California: opined that access remains an issue, given the length of the process (patient makes 2 oral requests > 15 days apart, patient attestation 48 hours prior to ingestion) and few participating providers. She described lethal prescriptions—traditional high dose barbiturate (100 capsules of Seconal used in Oregon) dissolved in 4 oz. water; cocktail mixtures (opiates, benzos, cardiac meds); complications can arise if patient has difficulty swallowing, digestive issues, insufficient absorption; time to death depends on underlying disease process and patient’s physiology, but usually deep coma within 10-15 min. after ingestion.
• Redwing Keyssar, RN, Director of Palliative Care at JFCS Seniors at Home: shared two cases of patients who changed their minds about EOL due to different outlook and changed circumstances because pain and symptoms were better managed. 

Lonny Shavelson, MD, started Bay Area End of Life Options in Berkeley, to consult with physicians and patients who are deciding whether to participate in EOL Options Act. He sees writing the lethal prescription to a terminally ill patient as the last resort only after considering alternatives (hospice and palliative care approaches).  

Documenting life

At Rhoda Goldman Plaza, Gloria Hollander Lyon, who survived seven concentration camps during the Holocaust, read excerpts from her memoir, Mommy, What’s that Number on Your Arm? A-6374: failing Dr. Mengele’s inspection and then escaping the gas chamber by jumping off a truck at age 14; later living with a foster family in Sweden after liberation when she noticed she lost her sense of smell – perhaps her body’s defense mechanism to protect herself from the horrific stench of bodies burning in the gas chambers and crematoria; and then returning to visit Auschwitz in 1991 when she finally regained her sense of smell after 47 years. 

Addressing an intergenerational audience that included her son, Lyon said her father told her what is important: do not cry over what is lost if you have freedom for continued life, let it rest and start all over; those who survive are eager to tell the world that it’s worth surviving regardless of loss. 

Lisa Kokin’s Inventory, exhibited at From Generation to Generation: Inherited Memory and Contemporary Art at Contemporary Jewish Museum, is composed of over 1,000 pieces of objects representing the lives of those who endured the Holocaust.  Inventory was created in 1997 after the artist, whose own Jewish family left Europe before Hitler’s rise, visited Buchenwald concentration camp and confronted the piles of objects left behind.

At this month’s meeting of San Francisco Task Force on Hoarding, Carolyn Rodriguez, MD, PhD, Director of Stanford Hoarding Disorders Research Program, talked about her research combining Buried in Treasures (BIT) workshop support group with one-to-one home de-cluttering.  She viewed hoarders as “enthusiastic collectors” and talked about elevating ordinary objects into art by Marcel Duchamp’s Readymades and Andy Warhol’s Time Capsules.  She mentioned artist Song Dong’s Waste Not installation of over 10,000 everyday objects collected by his mother in their Beijing home over five decades that reflects on culture of frugality; in persuading his mother to make art out of her possessions, the artist showed respect while also improving the quality of home life by de-cluttering – more creative than the KonMari method! 

As in Roz Chast’s Can’t We Talk About Something More Pleasant? discussing hoarding and even the inevitable like end of life can be uncomfortable for some.  Yet, the wisdom of Ecclesiastes chapter 3 reminds us: “there is a time for everything … a time to be born and a time to die … all come from dust, and to dust all return.”

With Howard Levy, Executive Director at Legal Assistance to the Elderly (LAE) for 28 years until his retirement today, all discussions are possible! (Though professionally, Howard is probably not as candid as his high school classmate Pepper Schwartz, AARP’s Sex and Relationship Expert and author of the sizzling erotic memoir, Prime: Adventures and Advice on Sex, Love and the Sensual Years.)  At weekly case acceptance meetings deftly facilitated by Howard, all staff and volunteers present contributed to the lively, often passionate, discussions for each client intake after hearing the facts.  Occasionally tired of the faux (steamed, not authentically boiled) bagels brought in by Howard, staff and volunteers turned the weekly meetings into potluck affairs.  Howard and the mostly senior staff at LAE remind me of The Supremely Old, Supremely Sharp, Supreme Court, with their wit and crystallized intelligence, which gets better with age. 

Inspired to create my own art, here’s collage of Howard's greatest hits at LAE’s office and fundraising events!

Aging = living

San Francisco State University (SFSU)’s Gerontology Program has moved from the School of Social Work to the School of Public Affairs & Civic Engagement (PACE), which includes Criminal Justice Studies, Environmental Studies, Public Administration, and Urban Studies & Planning.  Earlier this month, I volunteered to participate in a focus group for PACE alumni, and I was the sole gerontology alum who showed up to explain, “What is gerontology?” Since gerontology is interdisciplinary, it could probably fit in anywhere in the College of Health & Social Sciences.  In fact, I tend to see the world through a gerontologist’s lens such that everything is related to aging; after all, aging=living!

Films 

Last month’s 6^th Annual Legacy Film Festival on Aging at New People Cinema (which should have been renamed Old People Cinema J) featured diverse themes centered around The Art of Living (including The Presence Project), Who Cares? (A Letter From Fred), Deep Learning (The Family Dog), Generations; Memory; Life, Death and Love; and Gotta Dance! (Hip Hop-eration; check out TEDx talk by this dance troupe’s manager Billie Jordan). 

Legacy Film Festival Director Sheila Malkind, with Board Member Arlene Reiff, announced that Bradford (England), the world’s first UNESCO City of Film, will host its inaugural 3-day Golden Years Film Festival – Celebrate Life through Film, October 3-5, 2016, a free event featuring films from Sheila’s Legacy Film Series! 

Panel discussion with Snow Day: Life, Death, and Skiing documentary filmmakers and director Erica Milsom’s parents, and Wayne filmmaker Mario Galaretta, MD.  During Q&A, it was interesting to learn about Dr. Galaretta’s career change from neuroscience researcher to filmmaker! (So awesome to have filmmakers who are trained physicians, like Voices documentary filmmaker Gary Tsai, MD, because there is greater authenticity in their work featuring people experiencing disability/disease/death.)

For the past year, I have joined my friend Jane at free Hollywood movie screenings hosted by AARP’s Movies for Grownups, which have included Hello My Name Is Doris, Miles Ahead, My Big Fat Greek Wedding 2, Florence Foster Jenkins, and The Hollars.  As I prefer documentaries for greater authenticity, these Hollywood films featuring older adults seem to target audiences who want to escape reality.

Time 

Whenever my employer stresses doing more assessments and data entry (like bringing out my iPad to type during home visits with clients, which can be more challenging to maintain eye contact—done more easily when using pen to paper), I feel like a factory worker in a widget production line.  But then my clients appreciatively remind me that I actually spend more time with them than the average 15 minutes that doctors spend with patients.  Administrative work can take more time than being present for clients/patients.  This is a scary thought since the complexity of my clients’ lives (especially clients with dual diagnoses) demand more time.  For example, shorter doctor visits increase the likelihood that patients leave with a prescription for medication, rather than for more sustainable behavioral change — like eating more healthy and exercising.  In my work, I help fill the gaps by referring clients to health promotion resources like tips for home safety, fall prevention, smoking cessation, etc.  And I am always eager to learn to be a more effective advocate for my clients.

Food & Addiction

I was mesmerized by many presenters who were as engaging as the topic of UCSF’s conference, Food & Addiction: Environment, Policy & Individual Factors.  Fortunately, the busy doctors gave more than 15 minutes of their time J. None of the presenting doctors were geriatricians, but what they had to say applies throughout one’s life course and most of my clients continue to see their internists. 

Elissa Epel, PhD, noted for her research on the role of chronic stress on cellular aging and incorporating behavioral science into UCSF medical school curriculum, introduced renowned addiction medicine expert Mark S. Gold, MD.  

In his presentation, Food Addiction: How did we get here and where are we going? Dr. Gold, a self-described “itinerant food addict,” took a life review perspective of his academic pursuits based on food, “I like French fries, pizza and frozen custard” – attending Yale School of Medicine in New Haven for Pepe Pizzeria, and Washington University in St. Louis for Ted Drewe’s frozen custard! Dr. Gold’s 30+ years of addiction research has demonstrated similarities in the effects of drugs (tobacco, cocaine, opiates) and certain foods (fast food, sugar) on the brain and behavior.  Based on successful treatment of addictions to drugs, Dr. Gold is researching treatments for food addictions and hyperphagia.  

Drs. Dean Schillinger and Robert Lustig, sample paleo-friendly, gluten-free muffins from Muffin Revolution.  

Laura Schmidt, PhD, chaired session on Preventing Food Addiction in Vulnerable Populations, with George W. Albee’s prevention is better (than treatment) quote on screen: “No epidemic has ever been resolved by paying attention to the treatment of the affected individual.”  Schmidt’s view is that addictive substances, like sugar, should be regulated through taxation and limits on marketing and access. 

Dr. Schillinger, founder of UCSF Center for Vulnerable Populations, talked about his work with Youth Speaks through The Bigger Picture to combat the rising epidemic of type 2 diabetes (formerly known as adult-onset diabetes, but increasing in younger people). He showed spoken word video, Death Recipe, by San Francisco resident Erica McMath-Sheppard at age 16:

We eat like we still slaves
Cause back in the days we got what whites didn’t want
And now we got something called freedom of eat
But granny still chooses salt covered pigs feet
And mama still chooses KFC
And I still choose whatever is given to me …

(I thought about the 64-year-old grandmother who filed $20 million suit against KFC for false advertising because she paid $20 expecting bucket overflowing with chicken to feed the whole family, but only got ½ bucket; and KFC “helping” to fight breast cancer with pink buckets.) 

Nancy Adler, PhD, founder of UCSF’s Center for Health and Community, and Robert Lustig, MD, UCSF Professor of Pediatrics and President of the Institute for Responsible Nutrition, with power point summary of his What’s the real addiction? presentation on screen: “The only items in 'junk' food that are addictive are sugar and caffeine; but they are really food additives.”

[In Sugar: The Bitter Truth (2009), Dr. Lustig talked about turning around 40 years of mainstream nutrition belief that blamed fat v. sugar for dis-ease.  He declared sugar is toxic like alcohol and tobacco, urging us to reduce sugar consumption for public health.]

Last month, UCSF researchers Stanton Glantz, Cristin Kearns and Schmidt published an article in JAMA Internal Medicine about the sugar industry paying Harvard scientists to blame fat and cholesterol as dietary causes of coronary heart disease, while downplaying evidence that sugar consumption was a risk factor, about 50 years ago. This resulted in misleading a generation of baby boomers who counted calories (though all calories aren’t equal, according to Dr. Lustig), gave up eating saturated fats like butter (in favor of trans fat margarine or low-fat) and cholesterol-rich egg yolks (in favor of whites only).  Just as there should be more geriatric training among doctors, reliable and accurate nutrition science training is needed to promote healthy aging!

Communication 

At Jewish Home, CPMC psychologist Jeremy Bornstein presented Effective Healthcare Communication with Difficult Patients and Families.  Key points:

• “Difficult” is subjective assessment when one’s perceived skill is not up to challenge
• “Difficult” is manageable by acknowledging level of challenge and looking for ways to increase skill
• Get behind “difficult” behavior (e.g., aggressive, depressed, anxious) and address emotional needs with support, education and mental health resources
• Develop rapport to understand underlying values, beliefs, goals and expectations

He reminded us of the Talmudic quote, “We don't see things as they are, we see them as we are.”

Eating for Health 

UCSF rheumatologist Cristina Lanata, MD, presented Update in Lupus Research at Lupus of Northern California’s Fall Conference.  Almost 2 million Americans suffer from lupus—more prevalent than AIDS, cerebral palsy, multiple sclerosis, sickle-cell anemia and cystic fibrosis combined.  Lupus mostly affects women, and is more common among women of African-American descent. (However, late-onset lupus after age 55 is more common among Caucasians.)  While 40% of lupus is transmitted genetically, the actual expression of genes is based on epigenetics or life-course exposures to external and internal stimuli. Exposures to smoking, asbestos and nail polish were associated with higher risk for lupus. Having a diagnosis of lupus is an opportunity for self-care. 

After Jessica Goldman Foung was diagnosed with lupus-related kidney failure 12 years ago, her doctors prescribed a low-sodium diet.  As she let go of sodium, she began focusing on all the healthier alternatives (replacing high sodium processed foods) and taking control – motivating her to learn cooking, inspiring her to share her adventures in her Sodium Girl blog, and rebranding low-sodium in her new book, Low-So Good: A Guide to Real Food, Big Flavor, and Less Sodium with 70 Amazing Recipes (May 2016).  Her zest for healthy living was apparent in her schedule of back-to-back health events: she had attended National Kidney Foundation’s Annual San Francisco Authors Luncheon prior to speaking at Lupus Conference!

At World Veg Festival, Shanta Nimbark Sacharoff introduced her new book, Other Avenues Are Possible: Legacy of the People’s Food System of the San Francisco Bay Area (September 2016). Shanta, an original member of Other Avenues Grocery, a worker-owned food co-op started in 1974, documented the rise of the “Food for People, Not Profit” movement that challenged agribusiness and supermarkets, and promoted healthy foods to local communities.  Long live SLOW (Seasonal, Local, Organic, Whole) food movement!

Speaking before an intergenerational audience at University of San Francisco, Filipino Food Movement Board Chairman PJ Quesada said that Filipinos need to get over tyranny of "authentic" food like "no one cooks better than grandma," particularly since Filipino cuisine is “fusion” with influences from Spanish and Chinese.

SFSU History Professor Dawn Mabalon noted difference between fusion and whitewashing food, criticizing Bon Appetit’s “Ode to Halo Halo” made with gummi bears and popcorn.  This was a very timely topic as I have been working with a client, first generation Filipino-American who may outlive her retirement savings if she continues paying $250 per month for her daily dish of authentically prepared Filipino food (which supplements her 2 home-delivered Western meals)--so we are exploring options like persuading her IHSS worker to cook authentic Filipino meals since my client can no longer cook for herself.

  

Pork tocino buns & arroz caldo from F.O.B. Kitchen Chef Janice Dulce

Senior Prom 

The Village Project’s A Senior Moment: Senior Prom for the 50+ featured entertainment by West Coast Blues Society and awards presentation by Bayview Senior Services Executive Director Cathy Davis. 

Senior Prom honorees with Supervisor London Breed, who said she preferred oldies but goodies music over her generation’s music with “swear words”! 

Aging Commission President Edna James got into the picture! 

Healthy plate of mostly plant foods.