Strength in Age: Harnessing the Power of Networks at GSA

Care partners

“When you give something, you’re in much greater control.  But when you receive something, you’re so vulnerable.” – Fred Rogers to Jeanne Marie Laskas, “The Mister Rogers No One Saw,” The New York Times (Nov. 21, 2019)

At this month’s Gerontological Society of America’s Annual Scientific Meeting, the term “care partner” seemed to be used more often, replacing caregiver.  While a caregiver is one who gives care to a recipient who needs assistance, a care partner describes both parties in a caring partnership with shared goals, opportunities to both give (control) and receive (vulnerability).  Care partner also reflects more dynamic roles in person-centered and partnership-centered models of care. 

“Person-centered care involves engaging with people as equal partners in promoting and maintaining their health and assessing their experiences throughout the health system, including communication, trust, respect, and preferences.” –Primary Health Care Performance Initiative 

Partnership-centered care goes beyond person-centered care by promoting a culture of collegiality:

“(Partnership-centred care) approach promotes collaboration between all those involved in an older person’s care. It recognises the values of interdependence and reciprocity, and aims to maximise the wellbeing and dignity of all by creating a positive environment that draws on the best evidence-based practice available.”—Caring for Older People: A Partnership Model, Centre for Innovation and Education in Aged Care (CIEAC), Deakin University 

Caregiver Action Network (CAN), a non-profit organization advocating for more than 90 million Americans who care for loved ones of all ages, selected the annual theme for National Family Caregivers Month, #BeCareCurious: about your loved one’s goals, treatment options, research, the care plan, and insurance coverage.

Language matters because words have meanings that shape culture, attitudes and behavior.  Yet reframing care takes time as there was no rebranding of National Family Caregivers Month to Family Care Partners Month?

As a follow-up to September’s Care Agenda: Expanding CA’s Long-Term Services and Supports (LTSS) for All Town Hall meeting, California Aging and Disability Alliance is circulating a petition for a new social insurance program to help Californians afford LTSS needed to live and age with dignity in our communities. 

According to this month's AARP report, Valuing the Invaluable, the availability of family “caregivers” is unlikely to keep pace with future demand: in 2026, baby boomers begin to turn age 80—when people are most at risk of needing long-term care (LTC); yet the U.S. population aged 45-64, “peak caregiving” years, will increase by only 1% between 2010 and 2030, while the age 80+ population likely to need LTC will increase by a staggering 79%!  

House Ways and Means Committee held a hearing, Caring for Aging Americans, that included powerful testimony from a family “caregiver” faced with raising $84,000 to pay for her mother’s home healthcare, or dropping out of her last year at Yale medical school to provide this care.  Proposed solutions included universal LTC, increased reimbursement rates for nursing homes, stronger enforcement to prevent elder abuse, expanding access to hospice care, addressing LTC access in rural areas, developing workforce, paid family leave, etc.

At Institute on Aging (IOA), Jenny Yen, PsyD, Director of Training for Integrated Behavioral Health, presented on De-escalation Techniques and Strategies.  In her work consulting IOA staff in addressing challenging client behaviors due to dementia and psychiatric issues, she emphasized the need to view and understand people and their behaviors with compassion (=reduce suffering), increase empathy and strengthen relationships.  We all experience suffering (e.g., loneliness, fear, anxiety, stress, unmet need, being misunderstood, underappreciated, etc.) and want to be respected, so approach the person with suffering with a view to help, not punish. 

This training made me reflect on my work in the Tenderloin serving marginalized and diverse older adults, observing conflicts arising from control issues relating to personal space (lack thereof in densely populated congregate places like senior centers and SROs), mental illness (loss of control in anxiety/trauma, confusion in psychosis, trust and safety violations in personality disorders, not knowing how to express complex feelings in grief and loss), cognitive disorders (impulsive, forgetful expressions), and impact of cumulative disadvantages (poverty, discrimination).  Her tips included:

·       Compassionate listening: ask what is their suffering, what is trigger? Be present, give complete attention (no multi-tasking), convey you are following discussion, avoid problem-solving (unless they ask?), be open-minded and curious (no judgment), listen for suffering and triggers (work to remove triggers, create sense of safety), reflect/validate (e.g., “Sounds like you’re going through a tough time.  Tell me more.  What helps you when you are stressed?”)

·       Redirect attention: ask/use “we” language to change topic/activity/environment (be ally, “let’s do together”); offer choices to regain control & opportunity to grow/learn (integrate person’s strengths)

At JCCSF’s 5^th Annual Embracing the Journey End of Life Resource Fair, Dr. Shelly Garone presented two talks on Palliative Care: 

·       The Art of Taking Care of Our Dying Loved Ones – Finding Peace Within Knowledge: where would you prefer to die (90% of Californians want to die at home, only 25% actually do); how would you choose to die (“sudden death” in sleep for 10-15% Americans, cancer 20-25%, organ system failure 20-25%, dementia/frailty 40%); physical & emotional aspects of dying (disengagement from prior joys-life smaller, loss of appetite, onset of skinniness, increasing sleep; delirium, chorea, pain, air hunger/shortness of breath, own un-ease & un-readiness); timing (out of doctor’s control, loved one choose moment most protective, ears last to turn off so say everything want to say)

·       Taking Care of Caregivers – Finding Hope Despite Grief: keep notebook (jot to-do tasks, clinical notes); delegate; get informed; don’t lose your health; take breaks (nobody likes to be watched while they sleep, some too private to die with others present); our bodies die, this doesn’t mean that life is worthless.

SF Supervisor Hillary Ronen delivered keynote at Redefining Crazy: It’s the System, not the People conference hosted by Mental Health Association of San Francisco.  She introduced her proposal for universal Mental Health SF, which emphasizes voluntary engagement and addresses current gaps in “coordinated, managed care fashion”:

·       24/7 service centers (similar to Behavioral Health Access)

·       office of coordinated care (real-time inventory of beds, high quality data, regular/intensive/critical levels of case management with standardized supervision)

·       crisis intervention street team (similar to Mobile Crisis)

·       expansion of services (more beds, cooperative homes)

·       office of private insurance accountability to advocate for access to anyone insured

·       use $400 million budget for behavioral health more wisely, plus additional $100 million funding via taxes.

She explained her proposal evolved from trying to address the homeless crisis, especially after homeless from Super Bowl City near Embarcadero Plaza were cleared to the Mission in 2016, so she fought for a Navigation Center that reduced the number of tents from 260 to 30 in her district.  She declared the major causes of homelessness were economic inequality and displacement, compounded for people with mental illness and substance use disorders; 38% of people discharged from Psychiatric Emergency Services were not connected with follow-up services, due to lack of communication among agencies operating in silos or lack of high quality data regarding availability of beds; and her rejection of SB 1045 housing conservatorship, which targets homeless people with dual diagnosis, whose presence on the streets of San Francisco have increased visibility.  (A week after her keynote, Mental Health SF was revised to limit its scope in a compromise with SF Mayor.)  

Susie DuBois, MFT, presented on the development of a drop-in support group for Family & Friends of People with Hoarding & Collecting Behaviors.  Five years ago, SF Department of Aging & Adult Services provided funding to start support group, which evolved from 6 weeks in 2015 to 14 weeks.  There is a two-hour orientation session for new members; each two-hour session includes 1^st hour didactic on topic in lecture/discussion, 2^nd hour open group sharing & support.  About 5 to 14 participants attend, ranging from age 19 to 75.  The model curriculum includes: 

·       Family and Personal Vulnerabilities: genetic predisposition, executive function deficits; trauma, scarcity, loss; learned about possessions, acquiring, anti-organizing; lack of skill how to discard, maintain; mental health issues

·       Relationship Issues: communication; high conflict/passivity/avoid conflicts (couple); co-dependence/control; lack of connection; power imbalance; blame & responsibility; standoff

·       In-Home Issues: turf wars; loss of control; conflict; clutter-blindness; mutual avoidance/standoff

·       Community and Social Issues: shame & embarrassment; isolation; lack social norms; difficult find support; neighbor & landlord conflict; involving social services; secret keeping

·       Accommodations: OCD scale/symptom severity

Lunch & Learn Q&A with Esme Weijun Wang, author of The New York Times bestselling essay collection, The Collected Schizophrenias (2019).  She discussed the mental health stigma of “schizophrenia terrifies” due to psychosis that results in later discharge from hospitals.  In contrast, people with anxiety, depression or eating disorders are reframed (almost mainstreamed) as having “attention to details” and “empathic concern.”  Schizophrenia is commonly diagnosed during young adulthood, and colleges find it difficult to deal with mental health issues.  As a Yale student struggling with mental illness, she was hospitalized against her will.  She talked about the loss of dignity in involuntary hospital stays, which resembled prisons; her need to access outdoors and fresh air.  Her self-care/wellness plan includes medications, therapy, journaling, dressing well to restore dignity, support system, and "wonderful dog."

Human rights advocate Kirsten Irgens-Moller left SFSU’s MSW program over 30 years ago to co-found Global Exchange and serve as its Executive Director, then returned to complete her MSW degree in 2015, with a field placement that turned into employment at Ombudsman Services of San Mateo County (OSSMC)! OSSMC advocates for the rights of 10,000 residents in LTC facilities in San Mateo, accomplishing 5,000 unannounced visits in the past year.  When Kirsten interviews field ombudsman candidates, she asks “why do you like old people?”  The responses often relate to experiences with a grandparent and love of stories/wisdom.

Senior & Disability Action’s Housing Collaborative celebrated victory of Proposition A, which funds $600 million for affordable housing bond, including $150 million for senior housing! SDA members called 2,500 senior voters to support Proposition A, which passed with 71% of votes.  Gen Fujioka, Policy Director at Chinatown Community Development Corporation (CCDC), which houses 2,379 seniors age 65+, representing 53% of its low-income residents, talked about Senior Operating Subsidy (SOS), need to increase senior housing (currently representing only 12% of housing pipeline) and for public oversight of Mayor’s Office of Housing. 

Jen Low, legislative aide to Board of Supervisors President Norman Yee, talked about plan to construct a 200-unit affordable continuum of care campus at Laguna Honda: senior independent housing, assisted living, and an intergenerational early childcare education center with adult day health center.  She also spoke of need for data to organize for transparency and accountability, such as a comprehensive needs assessment, income levels, wait list for BMR housing, etc.

#endageismsf

This month San Francisco Department of Aging & Adult Services launched its End Ageism campaign to reframe how we talk about aging and older adults, with a website EndAgeism.com.  The campaign website features five older San Franciscans’ eyes with crow’s feet juxtaposed on (younger) smooth faces, identified by traits that “never gets old”: Passion, Leadership, Creativity, Courage, and Intelligence.  It invites us, “We all have strengths that stay with us throughout our lives.  Click here to see the stories behind the eyes.”  When I clicked on the faces, the men’s jaws changed shape from square to pointed! What gives? Did they get facelift dentistry? After this brief distraction, I read their stories describing what they do (volunteer) but missing their thoughts.

In contrast, Ashby Village’s 2017 Reframing Aging photo exhibit https://www.ashbyvillagegallery.org/, displayed photographs of its members at younger age with current age and their own quoted thoughts plus bio.  Its website says of its featured 12 members: “None of them spend much time looking back—they’re looking ahead with enthusiasm, curiosity, and optimism.”  For example, 93-year-old Jeanne Bamberger (described as having "energy and intellectual engagement of someone half her age") mused: “I used to say, when I wake up in the morning, I have to decide who I am. These days, it’s more like I have to decide if I am!”

Storyteller Chimamanda Ngozi Adichie warned against the danger of a single story: “show a people as one thing, as only one thing, over and over again, and that is what they become.”  But is Reframing Aging coddling old age (as in “The Coddling of the American Mind”) by filtering out the perceived negative (frailty, vulnerability) in favor of the “the more positive story” dumbing down the diversity of older adult experiences?

“Our senior years are evidently a time to celebrate ourselves and the wonderful things to come: travelling, volunteering, canoodling, acquiring new skills, and so on. No one, it seems, wants to disparage old age. …we get such cheerful tidings …meant to reassure us that getting old just means that we have to work harder at staying young…

At the moment, we seem to be compensating for past transgressions: far from devaluing old age, we assign it value it may not possess. Yes, we should live as long as possible, barring illness and infirmity, but, when it comes to the depredations of age, let’s not lose candor along with muscle tone. The goal, you could say, is to live long enough to think: I’ve lived long enough.

…The years may broaden experience and tint perspective, but is wisdom or contentment certain to follow?

A contented old age probably depends on what we were like before we became old. Vain, self-centered people will likely find aging less tolerable than those who seek meaning in life by helping others. And those fortunate enough to have lived a full and productive life may exit without undue regret. 

…just about every book on the subject advocates a “positive” attitude toward aging in order to maintain a sense of satisfaction and to achieve a measure of wisdom. And yet it seems to me that a person can be both wise and unhappy, wise and regretful, and even wise and dubious about the wisdom of growing old.”

—Arthur Krystal, “Why we can’t tell the truth about aging,” The New Yorker, Oct. 28, 2019 

Last year, I expressed concern about Reframing Aging's campaign strategy to “avoid discussing or showing older people as ‘vulnerable’” and place greater emphasis on the “more positive story of aging, too.”  Can we reframe vulnerable as a strength? After all, being vulnerable makes us more human, and can teach us to develop Humility along with Appreciation, Endurance, Generosity, Humor, Integrity, Justice, Kindness, Patience, Respect—desirable traits at any age.  Instead of just focusing on "strengths that stay with us," let’s pay attention to our potential for developing these traits as we grow older and help end ageism.

“we see canes and other assistive devices of older age in the same way we see the tricycles and training wheels of youth: as tools that support our independence and freedom to move about rather than as visible representations of loss…

How can I prepare to live my best life as I age? Rethinking my perception of canes and walkers and even wheelchairs is a start. First, the personal reframing: Now, when I see someone using an assistive device, I think, “Go you. You are out and about and active in the world.” Second, the professional: I am committed to keeping the pendulum from swinging so far toward images of older adults who are free of obvious physical disabilities that we unintentionally “otherize” frail older people by taking them out of the picture… we also need to continue reflecting on all the realities of what it means to age…and representing the diversity of older people in the images we choose…so we do not unintentionally create a future where we cannot see the most vulnerable and the most frail because we have cropped them out of the frame”—Nancy E. Lundebjerg, “When it comes to images, let's not crop frail older adults out of the frame,” Journal of the American Geriatrics Society, Sep. 4, 2019 

“OK boomer”

"The phrase is a culmination of annoyance and frustration at a generation young people perceive to be worsening issues like climate change, political polarization and economic hardship …The rise of the phrase “OK boomer” mirrors the growing anger among young people at the older generation’s passivity for the issues facing the world, not only today, but for the issues that young people say will be left to them to figure out once they become adults."—Kalhan Rosenblatt, “Teens use 'OK boomer' to fire back at older generations' criticisms,” NBC News, Oct. 29, 2019 

What is our future with septuagenarian boomers like Senator Elizabeth Warren (age 70) and incumbent President “The Donald” Trump (age 73) as leading candidates for President in 2020?  Shall we skip the boomers in favor of Traditionalist (“Lucky Few”) candidates like Senator Bernie Sanders (age 78) and former VP Joe Biden (age 76)? 

Because older adults are known to vote at high rates, they are an important voter demographic to candidates.  Yet, senior interests are not monolithic, especially as our aging society is becoming more diverse—racially/ethnically with increasing income inequality, and living longer with disabilities.  In San Francisco, older adults (age 60+) make up 23% of the City’s population: 43% identify as Asian/Pacific Islander, 40% White, 10% Latino, and 6% Black. 14% of San Francisco older adults live below the federal poverty level, and nearly 30% live alone.   

This month, Senior & Disability Action (SDA) hosted a Local Election Candidates Forum, inviting candidates for District 5 and District Attorney.  As usual, politicians said anything to get elected, pandering to what they thought older voters wanted to hear.

Democratic Socialist tenant lawyer Dean Preston and Democrat incumbent Vallie Brown are frontrunner candidates for District 5 (covering Haight-Ashbury, Hayes Valley, Fillmore/Western Addition, Japantown, etc.), which has an older adult (age 60+) population of 15,309 representing 18.2% of the district.  Vallie tarnished her reputation when news broke that she did an owner move-in eviction against long-term, low-income African American tenants 25 years ago, and lied about a tenant’s failure to pay rent until her 69-year-old former tenant came forward with rent receipts.  

When SDA asked non-partisan candidates for District Attorney (DA) about their priorities, it seemed disingenuous to hear each candidate declare elder abuse.  Deputy DA Nancy Tung and interim DA Suzy Loftus are career prosecutors with tough on crime platforms.  Deputy Attorney General Leif Dautch talked about “transformative justice”; his website mentions confronting hate crimes “particularly against our Latino, Muslim, Jewish, and LGBTQ communities”—but what about Blacks? Chinese seniors? 

Public defender Chesa Boudin, whose 75-year-old father remains incarcerated for a 1981 armored car robbery that murdered two policemen and a security guard, spoke passionately about criminal justice reform like addressing the underlying causes of crime by “replacing jail with mental health care.” Afterwards, I decided to visit his campaign website: Chesa Boudin for SF District Attorney video reminded me of Alexandria Ocasio-Cortez's The Courage to Change video as he dresses up for work, steps out to take public transit … talks about equity and inclusion, but shows only one old person with white beard?  Why are images of old people absent from his campaign website? 

Intersectionality

What is the impact of ageism on cultural identities such as sex/gender and race/ethnicity, or intersectionality with patriarchy and white privilege? Are female racial/ethnic minorities in old age further marginalized and rendered invisible by dominant society?

At Tenderloin Museum, Magic Theatre presented a special matinee performance of The Chinese Lady, a witty play about the first Chinese female brought to the U.S. in 1834, by American merchants who put her “otherness” on display to market imported Chinese goods.  For the price of 25 cents for adults and 10 cents for children, curious visitors could gawk at 14-year-old Afong Moy, whose life became a performance as she was a representative of the Chinese Lady: “1^st lady of the Orient in America,” highlighting her exotic and foreign features, dressed in Chinese costume, her tiny bound feet walking around a room filled with Chinese furniture, using chopsticks to eat Chinese vegetables and shrimp from a rice bowl, pouring and drinking tea in a ritualistic way, etc.  How much of her performance was really her, or what was expected? 

Afong was aided by her skeptical man-servant interpreter Atung, whom she called “irrelevant.”  In her own yearning to be relevant, optimistic Afong reframed her role as “ambassador” to share Chinese culture and promote world peace, embarking on a tour of the eastern U.S. and met President Andrew Jackson, etc.  After two years of experience, her price went up to 50 cents for adults and 25 cents for children.  At age 17, Afong presaged that she would be “more and more old … inevitable that people will stop looking at me.”  At age 29, Afong had a new employer P.T. Barnum, part of a larger show, crowds were lighter as Chinese were more common in the U.S. in 1849. 

At age 44, Afong was “replaced, betrayed, discarded”—retired from the entertainment business—made “irrelevant.”  Years roll on, as Afong recited acts against Chinese, such as Chinese Exclusion in 1882, its renewal in 1892, made permanent in 1902, etc.  
In 2019, 199-year-old Afong tells the audience that indulging in the past is “all that is left of me”—as she shares her life review to make herself relevant to the present.  She walks in a circle, where she began with endless possibilities, hope, empathy—asking the audience to really look at each other for what’s true and real, to see long enough to be understood.

Post-show discussion with Will Dao, who played both self-effacing Atung (less known about his character than Afong Moy) and arrogant President Andrew Jackson (best known as face on $20 bill and for his racist 1830 Indian Removal Act to open lands for slave plantations). 

Attendee (seated in front row) claimed her late husband was descendant from Afong Moy’s family in China.  

Will Dao (Atung) with Rinabeth Apostol (Afong Moy), who gets kudos for memorizing Lloyd Suh’s script in The Chinese Lady's 90-minute performance—explaining her story from age 14 to 199, aging in place (appearing age-less, almost like The Age of Adaline) on stage!

At SF Main Library, Arthur Dong introduced his new book, Hollywood Chinese: The Chinese in American Feature Films, 12 years after his Hollywood Chinese documentary.  Back of his book features portrait of Anna May Wong (1905-1961), first Chinese-American Hollywood star, one year prior to her death at age 56 from heart attack and before filming Flower Drum Song musical.  Due to anti-miscegenation laws and lack of Asian leading men at the time, she mostly played exotic roles, losing role of The Good Earth’s Chinese peasant O-Lan, which went to Jewish actress Luise Rainer who won 1937 Best Actress Oscar for her portrayal of the subservient wife to farmer Wang, played by Jewish actor Paul Muni. 

Journalist Ben Fong-Torres, subject of his own upcoming documentary Like a Rolling Stone, interviewed Arthur Dong.

Intergenerational connections

EndAgeism suggests actions (presumably directed at relatively non-older people?) like: 

·       “Spend time with older people: …Reach out to older colleagues and neighbors. Call older friends and relatives.” 

·       “Avoid ageist comments and jokes”… Ashton Applewhite, former equal opportunity offender of Truly Tasteless Jokes book series (circa 1980s) and featured in 2018 documentary, Tasteless, has given up on ageist jokes.  Now that she is an older adult, she self-published This Chair Rocks: A Manifesto Against Ageism (2016) and EndAgeism site has link to her “Let’s end ageism” (2017) talk. 

·       “Promote intergenerational experiences: Create and participate in opportunities to get to know people of different ages—one of the best ways to learn about strengths and to learn about the diversity among older adults.”

SDA hosted film screening and discussion of “Maggie Growls” about founder Maggie Kuhn of Gray Panthers (formerly called Consultation of Older and Younger Adults for Social Change) and featuring Ralph Nader (my hero). 

SafeHouse Executive Director Toni Eby (MSW classmate) with Glenda Hope greeting guests at opening celebration of SafeHouse’s Hope Center, named after SafeHouse founder Glenda Hope (now Cayuga Connector with Community Living Campaign).  Based in the Tenderloin, Hope Center intends to be a healing space that provides supportive services to homeless women.

[In contrast, Safehouse is the name of the program developed by Tenderloin Senior Outreach Project (TSOP) nearly 40 years ago, when elderly residents of SRO hotels in Tenderloin’s “grey ghetto” recruited local businesses and agencies to serve as safehouses, or places of refuge where they could go in time of police or medical emergency.]  

Valorie Villela and Marie Jobling, respective directors of On Lok’s 30^th Street Senior Center and Community Living Campaign, both partners in #endageismsf. 

SDA Board President Betty Traynor with Hope Center Program Manager Ali Chiu (former SDA Consumer Rights Director).

SafeHouse Operations Manager Stacy Thompson provided tour, stopping to admire quilt on wall: “Trust the process … life is a process.”

Tenderloin "improve with age" banner.

Intergenerational support for Mental Health SF rally at steps of City Hall.

Get together

Love is but a song we sing
And fear's the way we die
You can make the mountains ring
Or make the angels cry …
C'mon people now
Smile on your brother
Ev'rybody get together
Try to love one another right now
Some will come and some will go
And we shall surely pass
When the one that left us here
Returns for us at last
We are but a moment's sunlight
Fading in the grass …

--“Get together”(1964) by Chet Powers

The inaugural Getting There Together (GTT): A Celebration of All Ages and Abilities event took place during Sunday Streets Tenderloin in the Civic Center.  Presented by CASE (Coalition of Agencies Serving the Elderly) in partnership with Livable City/Sunday Streets, SF Department of Aging and Adult Services (DAAS), Age and Disability Friendly SF, and Dignity Fund Coalition, there was something for everyone under the sun!

Cathy Davis, Executive Director of Bayview Senior Services, stood ready with staff to serve barbecue.

Seniors and people with disabilities took the main stage outside the steps of SF Main Library to share their talents in five hours of programming, with line-up including Wake-up Call by Sounds from the Ground Drumming Group.

Marie Jobling, Executive Director of Community Living Campaign (CLC), came out of her Dignity Dog costume to join David Knego, Executive Director of Curry Senior Center and Board President of CLC, at SF Dignity Fund Coalition table with invitations to Be Part of the Plan: The California Master Plan for Aging.  Interactive Resource Fair was one-stop shop organized to showcase housing, transportation and street safety, financial planning, health, fitness, and caregiver resources so all San Franciscans can thrive.

At SFSU’s Sixty Plus event, 67-year-old Mark Leno, former SF Supervisor (1998-2002), State Assemblyman (2002-2008) and Senator (2008-2016), and SFSU Gerontology Program's 2017 Long-Term Care Advocate awardee, spoke about The Joy, Opportunities and Frustrations of the Legislative Process.  He said being a legislator appealed to him because he is “a salesperson of ideas” and a good fundraiser.  After serving as SF Supervisor, he found the “severity of partisanship” the most surprising as a legislator in Sacramento where he was challenged to find common ground working with Republicans for the first time.  During Q&A, he made clear that he had no plans to run for Mayor again. 

Toni Newman of St. James Infirmary and Hediana Utarti of Asian Women’s Shelter presented on rights of sex workers and survivors of domestic violence and human trafficking of all races and genders, at this month’s National Association of Social Workers-SF Unit meeting.  Hediana talked about human trafficking and labor exploitation of Filipino immigrants in their 60s forced to provide 24/7 caregiving to older adults in their 80s in San Mateo County care homes. 

The Care Agenda: Expanding Long-Term Supports and Services (LTSS) for All town hall meeting featured a panel discussion + working lunch session at SF Main Library.  By 2030, more than 9 million Californians will be over the age of 65.  This unprecedented growth in the older adult population is contributing to a rising demand for LTSS, and paying for these services is bankrupting middle-class older adults and their families throughout the state.  (See Eduardo Porter's "Why aren't more women working? They're caring for parents," in The New York Times, Aug. 29, 2019.)  Time to get together for a solution!

Jessica Lehman, Executive Director of Senior and Disability Action (SDA), welcomed the audience, clarified the definition of “long-term supports and services” in reference to accessing long-term care (LTC) needed to live at home, and then introduced presenters who shared their challenges when seeking (spending down retirement assets to pay for care, ultimately becoming very poor to access care through Medicaid) and providing LTC (poor working conditions and low wages for workers).

Next Jessica asked the audience:

·       Who here wants to be completely dependent on other people? (no one)

·       Who here believes that any of us can be completely independent? (no one)

·       How many of us believe in the concept that we all depend on each another, and we should be proud of that, and we all can and should be interdependent?

Following this last question, Jessica noted, “you raised your hands before I finished (asking the question)! It’s an interdependent system that we will create.”  Woo-hoo!

Kathy Kelly, Executive Director of Family Caregiver Alliance, described how the current system forces people to spend down assets for Medi-Cal that pays for LTSS, no stable access to LTSS but reliance on 80% unpaid family caregivers, and those who work part-time do not accrue Social Security benefits needed to retire but go into poverty and debt.

The panel of politicians (all expected to hit age 60+ by 2030!) included State Senator Scott Wiener (supports social insurance model for LTSS), and Assemblymembers Phil Ting (supports universal healthcare system) and David Chiu (acknowledged “Silver Tsunami” and “look forward to figuring out, if not my elderly mother would have my head”).

Hearty food kept momentum for advocacy and community building!

During working lunch, we were asked to “talk to someone you don’t know to build a movement.”  I was introduced to Art, who wore Troublemakers Union T-shirt, and we shared our connection to the movement (both family caregivers).  With another person I didn’t know, we discussed what made us feel hopeful (Ting and Wiener “got it” with their proposed solutions for universal healthcare and new social insurance program covering LTC) and one way we would get involved.

California Aging & Disability Alliance (CADA) facilitated afternoon discussion of ways to take action to expand LTSS for all in a program that is universal (regardless of income), affordable and accessible, sustainable (revenue mechanism that is stable and solvent), offers flexible benefits (range of LTSS such as durable medical equipment, home care, home modifications, etc.), and is supportive of the direct care workforce (including fair working conditions).  We completed surveys indicating our interests:

·       Sign name to petition asking Governor Newsom for support

·       Contact State Assemblymember or Senator in support

·       Share story of LTSS with media or policymakers

·       Join a visit to legislator in 2020

·       Tell family and friends

The Dignity Fund Coalition and SF Long-Term Care Coordinating Council (LTCCC) hosted Be Part of the Plan: The California Master Plan for Aging and What it Means for You, at Hyatt Embarcadero on the same day as Global Climate Change Strike.  This public policy event opened with Tabling Resource Fair and then panel discussion.

Lolita Kintanar of Felton Institute promotes civil engagement through Senior Corps programs, Foster Grandparents (intergenerational) and Senior Companions (mutual aid).

Jessica Lehman, SDA Director, and Maria Guillen, CLC Connector (retired DAAS Program Analyst).

CLC Executive Director Marie Jobling, co-authored with SF DAAS Executive Director Shireen McSpadden, a thoughtful op-ed piece in SF Examiner, “San Francisco has much to say about the state’s master plan on aging,” recommending 1) improve integration across systems (currently spread across 20 agencies and administrative units) to make access easier, 2) whole-person approach that considers social determinants of health, 3) incorporate flexibility to accommodate diversity and unique needs of local communities, and 4) factor in continued growth of aging and disability populations so we have enough resources to go around as we uphold values of inclusion and justice so all are empowered to participate and contribute to our society. 

African-American Aging Partnership Chair Edna James and Meals on Wheels social worker Lois Heaton-Camacho get together for mini-SFSU gerontology alumnae reunion.  California Collaborative for Long-Term Services & Supports’ Creating a California Master Plan for Aging was stuffed in yellow tote bags from MyCareMyChoice (Making Medicare + Medi-Cal Work for You) on seats.

Fiona Hinze, Systems Change Coordinator/Community Organizer at Independent Living Resource Center SF, and Anne Quaintance, Chief Government Affairs Officer at Meals on Wheels SF, welcomed attendees and provided background on host organizations, The Dignity Fund Coalition and SF LTCCC.

Janet Spears, CEO of the Metta Fund and SF Aging & Adult Services Commissioner, provided opening remarks about demographics (1 in 3 San Franciscans will be age 60+ by 2030, more likely to live alone and susceptible to social isolation, facing higher housing costs), systems fragmented and under-resourced, why we need Master Plan, “aging and ageism is a social justice and human rights issue.” Next she read a statement shown on screen by California Governor Gavin Newsom: his hope “to build environments for health(y) aging.”

Via video, SF Mayor London Breed expressed her hope for SF to continue leading the way for California, in housing (funding more senior housing), transportation (Muni easier to access), health and wellness, and jobs (first-ever job fair for older adults and people with disabilities last month).

Bruce Chernof, MD, President & CEO of The SCAN Foundation (which helped lead #StandWithSeniors campaign for Master Plan on Aging last year), moderated discussion with panelists and questions from audience (including from livestream):

·       Norman Yee, President, SF Board of Supervisors: disclosed his age 70, plan for 300 units of senior housing on Laguna Honda campus, pilot $5 million SOS (Senior Operating Subsidy) making housing affordable to seniors at 15% Area Median Income

·       Scott Wiener, California State Senator: repeated proposal for social insurance model for LTSS at federal, if not state level

·       Jeannee Parker Martin, President & CEO, LeadingAge California (also on Master Plan on Aging Stakeholder Advisory Committee): aging is personal, depending where you live to get services, focus on person-centered and addressing disparities

·       Shireen McSpadden, Executive Director, SF DAAS: advocated for local flexibility (e.g., SF unique with its Dignity Fund), integrate Aging & Disability (vote yes on Prop B!), ton of money to execute, Reframe Aging (messaging campaign to launch October 14)

·       Sandra Lee Fewer, SF Board of Supervisors: mentioned she would like “sh-tload of money” for Master Plan, then started choking (censoring herself?) while moderator commented about her language for “mature audiences only”

·       David Chiu, California State Assemblymember: repeated “Silver Tsunami” speech from The Care Agenda 

As I exited the Ballroom, a reporter from Berkeley asked to interview me and I referred him to Anne Hinton, former DAAS Executive Director (2005-2015).

1% (9,784) of San Franciscans are homeless, and most are concentrated in the Tenderloin neighborhood, where sidewalk encampments are common.

SFSU Gerontology Program hosted its 2^nd SF State Silver Lining Lecture & SF DAAS Community Training, Addressing Aging and Homelessness in San Francisco.  Mayor London Breed was featured speaker and recipient of 2019 Distinguished LTC Advocate Award.  She was raised by her grandmother in public housing, and later faced challenges getting support when her grandmother developed Alzheimer's Disease.  Since becoming Mayor over a year ago, Breed has focused on helping the City’s homeless population: opening up over 400 new shelter beds, co-authoring Proposition A for $600 million affordable housing bond, introducing legislation to implement housing conservatorship (SB 1045 authored by Scott Wiener, last year’s LTC Advocate awardee), expanding mental health stabilization beds (thus SF Department of Public Health decided to evict residents at SF General Hospital’s Adult Rehabilitation Facility to convert long-term beds into temporary shelter beds), continuing support of Healthy Streets Operations Center (though at times City's response to homeless encampments and "behaviors that impact quality of life" has resulted in constant shuffling of people living on the streets and sweeping their life-saving medications, walkers and other belongings), etc. 

Group photo: SFSU Gerontology Advisory Council President Tom Berry, SFSU College of Health & Social Sciences Dean Alvin Alvarez, SF Mayor London Breed, SFSU President Lynn Mahoney, and SFSU Gerontology Professor Darlene Yee-Melichar.

Mayor Breed stood between Felton Senior Division Director Cathy Spensley and LTC Ombudsman Benson Nadell.

Professor Yee-Melichar introduced training agenda.

UCSF's Margot Kushel, MD presented Aging among Homeless Populations: Causes, Consequences, Solutions (mostly repeated presentation from UCSF Grand Rounds in July).  Nearly half of SF’s homeless population is age 50+, and living on the streets takes a toll on health, so a huge percentage are at high risk of needing nursing home care.  Dr. Kushel acknowledged that while mental health and substance use disorders are common, underlying causes of homelessness are structural.  She proposed solutions to match the problem: deeply affordable housing and prevention (eviction protection, Adult Protective Services’ Home Safe Program). 

Edna James, former Aging Commission President and retired nurse, in deep discussion with Dr. Kushel.

Presenter for Lived Experience of Aging and Homelessness was no-show. Curry Collaboration panel discussion with Curry Senior Center (CSC) team: Executive Director David Knego (also SFSU MSW alum), Geriatrician Alicia Oberschelp, MD, and Clinical Services Director Ann Tuszynski.  

·       David:  Founded in 1972, CSC was originally a primary care clinic that later added social programs to serve older adults in their two buildings in Tenderloin.  As a Federally Qualified Health Center (FQHC) since 1994, CSC receives enhanced reimbursement for offering integrated wraparound services. 

·       Dr. O:  Medical staff consists of 3 doctors, 1 nurse practitioner, 5 nurses. Older patients present more medically complex conditions, like dementia, psychosis, paranoia, intoxication, alcohol withdrawal, abscess and infections from congregate settings, ulcers, edema (often no place to elevate leg), environmental challenges (no access to bathroom/hydration/food/place to rest/recline, stolen/lost medications/prosthetics/DME/CPAP machines).

·       Ann:  Case management staff consists of 4 LCSW, 3 SW with ASW, 1 licensed psychologist. Homeless seniors have frequent hospital stays, and unique challenges with medical and behavioral health needs served by clinical team using integrated model.  Because homeless are used to being turned down and placed on wait lists, relationship building and problem-solving are key; they work with homeless from 6 months to a year.  She emphasized the collaborative process with high-risk seniors because workers burn out and “get angry” so case managers talk through problems and get support. Homeless seniors present history of trauma, substance use and mental health disorders, cognitive distortions and emotional dysregulation impeding follow-through, difficulty with delaying gratification so they spend support checks within first two weeks.  Case managers will do intake assessment, schedule appointments structured for 1 hour per week with homeless seniors to talk, get organized and take control of lives. Case managers can get frustrated with challenges presented by homeless who lose documents needed to access services, no mailing address, lack motor/sensory skills to use cell phone, afraid to leave Tenderloin, fail to use services; street survival skills mean being on guard and not translate to living in SRO/apartment community; homeless have their own community, with parallel interactions that do not support daily living.  Ann ended her presentation with Helen Keller quote: “Alone we can do so little, together we can do so much.”  (And I thought, can we get together and identify strengths instead of pathologizing people?)

Final day of 9th Annual Legacy Film Festival on Aging (LFFoA) at New People Cinema coincided with Sunday Streets in Western Addition nearby.  

But it was more comfortable sitting in an air-conditioned theater for screening of Satan and Adam (2018) documentary filled with blues music.  Afterwards, LFFoA Board member Paul Kleyman interviewed Tom Mazzolini, host of KPFA’s Blues By the Bay and founder of SF Blues Fest, focused more on music than the intergenerational, interracial relationship between older black guitarist Sterling “Satan” Magee and younger white harmonica player Adam Gussow. 

LFFoA Executive Director Sheila Malkind introduced the last screening, In a Different Space (2018), an 18-minute Australian film showcasing older adults dancing their life stories, including a 101-year-old tap dancer. 

Closing reception to celebrate 9^th Annual LFFoA!

This cool, interactive outdoor exhibition, Middle Ground, was installed outside of SF Main Library last month.  It invites us to consider reciprocity, in the ways we impact one another, looking to others in deciding what to do: Follow v. lead? Give v. receive? Be kind v. be mean?  Stay silent v. speak? 

Stand by v. step up?