Pause

According to San Francisco Department of Public Health (SF DPH) COVID-19 data tracker based on 249,599 test results reported: 6,575 positive cases and 59 deaths (39 male=66%; 33 age 81+, 11 age 71-80, 10 age 61-70, 91.5% of deaths age 60+; 26 Asian=44%, 14 Latinx, 12 White, 6 Black; 1 homeless).  This month SF reported its first COVID-19 death in age 51-60 group; still no COVID-19 deaths in age groups <18 and 31-40.

After July 4^th weekend, SF DPH Director Grant Colfax, MD, returned to press conferences, calmly sharing what keeps him up at night: SF’s reproductive rate rising above 1 (meaning each person infected with COVID-19 is infecting more than one other person, contributing to spread that could overwhelm our health care system).  As a result of rising COVID-19 hospitalizations, SF was placed on state watch list, requiring further pause on reopening.  Dr. Colfax reported that the average age of COVID-19 patient at SF General Hospital has been 41 years, debunking the belief that only older people are most at risk. 

Yesterday, Dr. Colfax noted rapid increases in SF’s COVID-19 cases: took 38 days to go from 2,000 to 3,000 COVID-19 cases, half as long to go from 3,000 to 4,000, and just 10 days this month from 5,000 to 6,000! Based on current estimates, he projected more than 750 COVID-19 hospitalizations by October and more than 600 COVID-19 deaths in 2020; worst case scenario projected 2,400 hospitalizations and 1,800 deaths!

Epidemiologists estimate that every death from COVID-19 will leave approximately nine bereaved in U.S.  If data does not persuade people to follow public health orders (distancing, masking), then perhaps sharing more personal stories of losing family and friends to COVID-19 might be more compelling.

In just six weeks, COVID-19 hospitalizations rose from 26 to 109, with one-quarter in intensive care units (ICU); acute care and ICU beds have grown 15% each week this month.  As a result of this COVID-19 surge, SF officials announced plan for temporary overflow hospital in the Presidio for non-COVID-19 patients in case hospital beds need to be cleared for COVID-19 patients. 

“Get back to normal”?

https://twitter.com/Bob_Wachter/status/1289030021554688000

This pause might continue through the next year, according to yesterday’s UCSF Medicine Grand Rounds COVID-19 update on Testing, Treatments, and Vaccines. Can we use this pause to do better than “get back to normal”?

In Gerontological Society of America’s webinar, Aging Native American, Rural, and Homeless Populations: Engagement and Advocacy During the COVID-19 Pandemic, Curry Senior Center Director David Knego, MSW (SFSU), talked about serving homeless older adults in Tenderloin, SF’s skid row. 

Lack of coordination partly explains why it took a minimum of 2 years to house a homeless senior in 2018!

Last year, SF Department of Homelessness and Supportive Housing launched Coordinated Entry system to improve response to homelessness. During this pandemic, SF made progress in housing homeless older people (age 65+) who receive priority under Project Roomkey. Notably, settlement from UC Hastings School of Law’s suit against SF resulted in rapidly moving over 400 people living in tents crowding sidewalks in Tenderloin to hotels leased by the City with wraparound services for duration of emergency.  Can this be a New Normal, making temporary relief into permanent supportive housing? 

Before COVID-19, “normal” rent for 1-bedroom in SF was $3,500 per month. Since COVID-19 pandemic, SF rents have dropped because younger people are leaving the high cost of living, as more people lose jobs or work from home, and many attractions (restaurants, theater, libraries, community events, etc.) have closed.  This has eased the housing shortage for people who remain and wish to age in place.

Mask wearing

When President Trump said wearing a mask made him look like Lone Ranger (eye mask with peep holes?), wonder if he covered his nose and mouth? UCSF’s Bob Wachter, MD, suggested having “sports and media influencers” instead of politicians to persuade people to act safely.  Very sad comment on who people trust?! University of San Francisco data research scientist Jeremy Howard launched #masks4all movement “for people and Governments to follow the overwhelming scientific evidence that shows we need to wear homemade masks in public to slow COVID-19.”  If not homemade, one can buy a mask (preferably tightly woven, 100% cotton, layered, snug fit; not uncomfortable N95 mask). 

On July 22, SF DPH updated its order expanding mandatory mask wearing to age 10+.  Dr. Colfax reiterated enforcement focus on businesses/institutions, while leaving individuals to voluntary compliance based on his belief that “best way to change the social norm” is messaging by “trusted community members” to provide information and support, including facial coverings.  How will this “benefit of the doubt” approach address violators who don’t care about community while they insist mask wearing infringes on their civil liberties?  SF needs to consistently enforce its own health orders to protect health and ensure safety during this pandemic!

CDC Director Robert Redfield said, “If all of us would put on a face covering now for the next 4-6 weeks, we could drive this epidemic to the ground.”  SF entrepreneur Marc Benioff said 3 weeks of mask wearing "would not have anymore coronavirus", and invited young innovators, ages 15 to 24, to submit ideas for “culturally cool” masks in $1 million Next Gen Mask Challenge. Why limit challenge to Gen Z only? Need to engage all ages who are not wearing masks!

#FindSomethingNew!

#FindSomethingNew does not refer to ongoing research about novel coronavirus/COVID-19 and the latest policies/health orders. (Huge relief to learn coronavirus is not easily transmitted from touching surfaces, so no longer fear snail mail and ok to bring reusable bags for shopping again!) Instead, it’s the name of White House’s American Workforce Policy Advisory Board (AWPAB) campaign launched this month to urge Americans who are underemployed/unemployed (especially with federal pandemic unemployment benefits ending) to #FindSomethingNew! AWPAB co-chairs are 38-year-old Ivanka Trump, advisor to (and daughter of) U.S. President, and 82-year-old Wilbur Ross, Secretary of U.S. Department of Commerce.

Ivanka tweeted, "There has never been a more critical time for Americans of all ages and backgrounds to be aware of the multiple pathways to career success and gain the vocational training and skills they need to fill jobs in a changing economy." Example: Wilbur Ross told NPR that his decision to drop out of a college English course that required writing 1,000 words a day because he ran out of things to write about after 2 weeks, "probably saved me from a life of poverty." You go, Wilbur! If you can’t think to FindSomethingNew—like look at a picture worth 1,000 words—to write about, and value liberal arts education to expand your horizons, then go to trade/vocational school… After graduating with Harvard MBA, he spent 55 years in banking and became a billionaire.  Then he launched encore career at age 79, oldest first-time Cabinet appointee in U.S. history! 

  

During this pandemic, bored homebodies #FindSomethingNew:

Got tired of baking bread

So I went out to build a garden bed…

The first time now I know

The difference between parsley and cilantro

Now I’m growing all these veggies and herbs

And I’m watching birds with binoculars

Bored in the USA…

--Penn Holderness, “Bored in the USA” (COVID-19 parody of Bruce Springsteen’s “Born in the USA”) 

#FindSomethingNew supports a neoliberal agenda to crank out worker bees, so it misses inspiring stories of entrepreneurship like 93-year-old Ray Boutwell, Navy cook who worked in food service throughout his life, started boozy cupcake business and became instant media darling. 

Stop faking “normal”

According to ProPublica, 56% of Americans age 50+ are forced to leave “stable” jobs before they want to retire, often suffering irreversible financial harm.   

Joined Elder Action Network’s Elder Activists for Social Justice Curious Listening Initiative featuring Elizabeth White, author of 55, Underemployed, and Faking Normal: Your Guide to a Better Life (2019).  Now at age 66, she reflected on her experience over a decade ago during the Great Recession while in her mid-50s: broke, piecing together gigs while trying to keep up appearances like everyone else – after her career of privilege and Harvard MBA. She learned she was not alone: 40% of people near retirement may face poverty, not due to financial struggles throughout their lives, but middle-class facing downward mobility for the first time, hearing that she was “overqualified” which she interpreted as code for ageism.  Instead of being stuck in feeling shame, she got practical like starting a resilience circle to find solutions for living a “richly textured life on a modest income” and adjusting to her new reality, including downsizing. 

Elizabeth’s message—stop faking “normal” and tell the truth—was reinforced in another talk scheduled afterwards, Noetic Approaches to Aging, with Elizabeth joining a panel about conscious aging, or “getting closer to being the person we’d like to be.”  Take-aways: People can speak only from their own experience.  When she shares her own vulnerabilities, it allows others to share their own truth with less or no shame.  If you don’t talk about the problem, you can’t solve it! 

Marc Blesoff, retired criminal defense attorney turned mediator, talked about gerotranscendence: bypass the monkey mind, not rely on rational mind, better acquaint with intuition and what’s really important.

New Ageism?

This year 2020 has been compared to 1968 in a “shattered America” with racial, political and economic divisions expressed in civil unrest.  Add ageism, a term coined in 1968 by geriatric psychiatrist Robert Butler, who witnessed generational clashes as a delegate to the 1968 Democratic National Convention.  During this COVID-19 pandemic, social media seem to make divisions sharper with #BoomerRemover and frustration over restrictions to “protect older people.”

“Whatever care we extend to the aged we consider a gift, or an act of charity, and not something we owe them because they exist… The elderly are no more or less human than they were in their 20s. They aren’t a contagion to be sequestered, or a burden to reluctantly tolerate. Whatever system we build from the ruins of the moment, it ought to be as inclusive as the experience of old age itself.”—Sarah Jones, “No One Should Be Surprised That America Abandoned the Elderly to Die,” New York magazine (July 9, 2020) 

Ken Stern, Chair of the Longevity Project, moderated A New Ageism? Fallout from the Pandemic panel discussion on “how society has been responding to the most vulnerable population during the coronavirus pandemic and what that means going forward.”  In this age of being woke to racial equity, the program poster featured a black man, yet the panelists appeared to be from the same tribe: Louise Aronson, UCSF geriatrician; Richard Eisenberg, Next Avenue managing editor (who published program highlights); and Paul Irving, chairman of the Milken Institute Center for the Future of Aging.  My question in Zoom Q&A was ignored: “If you could add a BIPOC (Black, Indigenous, Person of Color) to diversify this panel, who would you choose?”

Moderator acknowledged my Zoom chat comment in favor of Dr. Aronson’s remark: “We’re all aging …Being old in and of itself should not elicit respect any more than being young should. I think behavior should.  If you have more needs, you’ve reached a stage of dependence, which we all begin in, and most of us end in, and most us experience intermittently in between. You need some compassion,..best way to address is to increase our humanism, not say respect or reverence, but see people as humans.”  Yes, this why SF has Dignity Fund! The dignity v. respect difference: Dignity refers to inherent worth as humans apart from actions (e.g., Biblical command to “honor” parents); Respect refers to admiration for someone, earned because of their qualities or achievements.

Gerontological Society of America (GSA) released Understanding Ageism and COVID-19 infographic to dispel myths, such as suggesting:

·       “only older people should worry about getting COVID-19”

·       “age is the primary risk factor for COVID-19”

·       “only older people are dealing with loneliness and isolation because of social and community lives disrupted by COVID-19”

·       “isolation is particularly difficult for older people because they cannot use technology to communicate with family and friends.” 

The Onion satirically reported, “Teen Who Died From Coronavirus Probably Had Undiagnosed Old Age”!  Notably, during this pandemic, my email account has been filled with invites to virtual meetings focused on loneliness/isolation and technology solutions relating to older people.

Isolation & Technology

Motion Picture & Television Fund (MPTF), a non-profit that provides a safety net of health and social services for entertainment industry members in Southern California, hosted 3-hour Social Isolation Summit. The opening panel discussion on Confronting Loneliness in a Turbulent World presented common sense from SCAN CEO Sahin Jain, MD, influenced by his Harvard Public Policy Professor Robert Putnam, author of Bowling Alone: The Collapse and Revival of American Community (2000) and Better Together: Restoring the American Community (2003): everyone has power to solve problem of isolation and loneliness, without spending $; he called for a national conversation for a social contract that prioritizes community and connection; relying on technology is the wrong direction as we have an opportunity to get to a higher plane by thinking collectively, looking out for one another, visiting/making phone calls to family/friends/neighbors, and caring for one another the way we used to. Yes, we need Mister Rogers’ Neighborhood! 

Nora Super of Milken Institute Center for the Future of Aging moderated all-female BIPOC panel discussion on Identifying and Filling Loneliness Gaps Across California through government and non-profit initiatives: maintain connections using continuum of technology, old tech telephone (conference call, phone tree) in diverse languages, listen to older people to design more user-friendly online technology rather than expect them to adapt, importance of agency in older people as “venerable” v. vulnerable, intergenerational supports, yada yada. 

Zoom chat was relevant with contributions by people working directly with clients (not mere administrators overseeing others’ work), and not so relevant by marketing folks trying to sell services (which I mostly ignored):

·       CyberSeniors to bridge digital and generational divides

·       Making “right” connection counts (Jon Schaeffer, Dementia Activity Club in Los Angeles): just calling/being friendly face/offering general activities is not what seniors truly need; instead, virtual visit/phone call has to target and honor their developmental tasks of maintaining control and working through their legacy; every activity should give them the opportunity to share their life stories, or they will leave this earth unfulfilled; and we need to hear their stories for our journey. Yes, power to older people! 

·       Promote independence and build resilience (Lualhati Anderson): older adults have lived through much more challenging times and continue to build resilience; important to assess skills level and needs before offering buffet of services available; sometimes offering too many services can create dependency

·       Peer mentoring (Clayton): The Impact of Peer Mentoring on Loneliness, Depression, and Social Engagement in Long-Term Care (outcomes of peer mentoring show 30% drop in depression scores); tips for peer mentoring; The Need for a Social Revolution in Residential Care (being passive recipient of care fosters loneliness and depression, peer support and social productivity help create valued social identities)

·       Age-friendly public health system (Jane Carmody): work with community-based organizations—e.g., AARP’s Experience Corps, Villages, community health workers—to provide older adults with opportunities for social interaction and development of new friendships    

·       Resilience & connection (Len Muroff): resilience is about becoming, not overcoming; vulnerability and fracture from trauma can lead you toward connecting to something greater than yourself, connecting to others and to the divine; refer to Sherri Mandell’s 7 steps of resilience (Chaos, Community, Choice, Creativity, Commemoration, Consecration, and Celebration) 

·       Unlonely Project (Jeremy Nobel, MD, Foundation for Art and Healing): sharing stories about ourselves through creative expression to improve well-being and connection, Unlonely Film Fest (free streaming); StuckatHome (together) community 

At this month’s SF Tech Council Meeting on Isolation, Loneliness, and Technology, UCSF geriatrician Ashwin Kotwal presented his research based on 150 SF community-based older adult study participants (age 60 to 96):

·       over half reported worsened loneliness due to restrictions related to COVID-19

·       over a third were socially isolated, driven by lower use of video communication (4/5 not using regularly, 1/4 not using internet at all for socializing)

·       “incredible ability” to adopt new technologies

·       not all older adults have access to technologies for social connection and many feel discomfort with available technologies

·       recommended including older adults with classes, volunteers, other methods to facilitate training, age-friendly design

Maureen Feldman, Director of Social Isolation Impact Project at MPTF, talked about Daily Call Sheet, a social call program that pairs trained volunteers of all ages with retired MPTF members for telephone chats several times a week, and has seen a 41% increase in new volunteers since COVID-19 pandemic.

My clients have complained that their discomfort with video technology has to do with computer vision syndrome and blue light that disrupts their sleep. SFSU Health Professor Erik Peper, PhD, author of TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics (Aug. 2020), recommends taking momentary breaks from screens to relax our eye muscles by looking at a far distance and in different directions—preferably objects green in color; palming; and blinking many times. 

I find that looking at myself displayed on a screen is like staring into a mirror for periods much longer than necessary, so I often have my video off during Zoom, and move around while listening. Before and during this pandemic, telephone calls are more comfortable for movement, eye rest, and usually better sound quality.  Advocacy groups like Gray Panthers and Senior & Disability Action have been awesome in offering meetings via Zoom or telephone.

Technology ideas to make real: Echo Silver (“Alexa for the greatest generation”) and Blacklexa (modify to be “better ally” to old people, start video at 1:30).

As an introverted old soul, I reframe social isolation as an opportunity for solitude rather than loneliness.  Solitude or alone time is refreshing to cut out noisy distractions, and enjoy quiet thinking, reading, and writing… seriously, no problem writing 1,000 words a day!

“Loneliness is failed solitude, when the absence of company is enforced and unwelcome…the impact of the pandemic has been to place a new premium on solitude. Households that were spacious enough when most of their occupants were away in offices or schools during the day now seem unbearably crowded. Prohibitions on walks out of doors are all the more frustrating…Human beings are social animals. But they need breaks from each other’s company.”—David Vincent, “The Pandemic Has Raised Fears About Loneliness. History Suggests We Should Worry About the Opposite, Too,” Time (July 8, 2020) 

Geriatric neuropsychiatrist Dilip V. Jeste, Director of Stein Institute for Research on Aging at UC San Diego, presented his related idea of wisdom as an antidote to loneliness—during two webinars this month (Loneliness: COVID-19 Toll on Elderly and Loneliness in Seniors: Wisdom as an Antidote).  According to Dr. Jeste, increasing globalization and advances in technology causing modern behavioral pandemics of loneliness, opioid abuse, and suicides point to need for societal wisdom:

·       Self-reflection: ability to look inward at one’s own behavior and change

·       Compassion: kindness to oneself and others

·       Emotional regulation: ability to control our emotions and remain calm despite ups and downs of life situations; face reality and still be more contented

·       Accept diversity: humility (Serenity Prayer)

·       Spirituality: purpose in life (“Those who have a ‘why’ to live, can bear with almost any ‘how’.”—Viktor E. Frankl, Man’s Search for Meaning) 

Long-term care (LTC) facilities

In U.S. LTC facilities, over 62,000 residents and workers have died from COVID-19, representing more than 40% of nation’s COVID-19 deaths.  In Canada, 81% of COVID-19 deaths have been linked to LTC facilities. Hong Kong reported its first COVID-19 death in nursing home. 

Popular culture (satire or not) reinforces stigma of LTC facilities as modern-day poorhouses (congregate settings benefit from economies of scale) for elderly who have been abandoned by families: SF Mime Troupe presented Tales of Resistance online with 2-minute commercial for The Palms nursing home (10 minutes after start time).   The Onion headline read, “Family Left Elderly Grandmother To Die In Nursing Home But Not Like This” and reported her “inevitable death at the assisted-living facility” (confusing nursing home with assisted living). 

In fact, families have been advocating to visit their loved ones in LTC facilities since March when paternalistic policies required LTC residents to isolate in rooms and restricted in-person visits. Family members are finding workarounds, such as wife who took job as dishwasher to see her husband residing in facility (originally misstated as nursing home, then corrected to memory care center); or daughter who moved into assisted living facility where her nonagenarian parents resided during COVID-19 outbreak until both parents contracted COVID-19 and died in hospital, while she quarantined after contracting COVID-19 herself. 

During my stints in LTC facilities, isolation in a unit might last up to a month during seasonal flu outbreaks.  With COVID-19, isolation and loneliness (failed solitude) have exacerbated and there seems to be no end in sight…so long as there is community spread, no vaccine, lack of rapid testing, shortages of PPE, etc.

While California DPH and Department of Social Services finally (on June 26) issued respective visitation guidelines (outdoor visits allowed, unless prohibited by local public health order) for nursing homes and assisted living, SF DPH maintains more restrictive visitation in nursing homes and assisted living, unless “necessary” (“urgent health, legal or other issues that cannot wait until later”).

DPH’s imposition of obnoxious (however well-meaning) policies have caused harm and suffering to LTC residents separated from their loved ones. What happened to harm reduction for residents of LTC facilities? Rather than base decisions solely on the biomedical model (prevent bodily deaths from COVID-19), how about a more holistic model or collaboration with interdisciplinary (bio-psycho-social-spiritual) approaches like gerontology, as well as consultation with stakeholders like older people about their wants/needs? To borrow from the disability civil rights movement: Nothing about us, without us! 

Moving into LTC facilities should not mean losing agency for residents.  While no one wants to overwhelm hospitals with severely ill COVID-19 patients, why not allow visits with precautionary measures (distancing, masking) in place outdoors, and especially if both LTC residents and visitors have executed advance health care directives and POLST forms declining life-prolonging treatment like feeding tubes and/or ventilators? (Check out UCSF webinar, Preparing for Potential COVID-19 Infection: What are Odds and What are Options?) 

Can we have a New Normal that supports frail older people to retain Dignity with greater agency to evaluate their own risk tolerance in decision-making?

National Center on Elder Abuse and the National Consumer Voice for Quality LTC released checklists:

·       Should I Take My Loved One Home during COVID-19 Crisis? First, ask if resident wants to leave? Is your home equipped? Who will provide care; if you bring outside help, who will pay? How will you protect from COVID-19? Will loved one be able to return to LTC facility (find out if you can hold bed)? What led to decision to place loved one in LTC facility in first place, what has changed? 

·       Keeping Family Together during COVID-19 

Older age and frailty risk for COVID-19 severity

According to U.S Centers for Disease Control and Prevention, risk for severe illness from COVID-19 increases with age, with older adults at highest risk. UK researchers stressed frailty as a risk factor for COVID-19 death, as much as old age or having an underlying health condition. 

In American Thoracic Society’s Promoting Recovery in Critically Ill Older Adults with COVID-19: Bench to Bedside webinar, Canadian immunologist Dawn Bowdish, PhD, presented on how features of aging immune system contribute to risk and hamper recovery of COVID-19:

·       Age, chronic health conditions, frailty are independent!

·       Frailty (increased vulnerability from decline in reserve and function, less resilience to stress) is better predictor of outcome to infectious disease/hospitalization than chronological age; this might explain COVID-19 survival of centenarians who are not frail.

·       Frail individuals may present different diseases, more likely to report abdominal symptoms, fatigue, shortness of breath

·       Infections in older people are chronic (not acute), enhance age-related inflammation; COVID-19 increases risk of stroke, cardiac damage, decreased lung function, increased frailty/disability

COVID-19 does not follow U-shaped curve in infectious disease like pneumonia and flu, where susceptibility high among very young (immunologically naïve) and severity high among very old (immune senescence, co-morbidities), with mid-life ages protected; instead, middle-age also susceptible to COVID-19.  Older adults with COVID-19 less likely to present fever and respiratory symptoms.

What older people need to recover from COVID-19: dedicated interdisciplinary geriatrics team; careful monitoring for emerging health issues; tailored physiotherapy – rehab focus on building muscle, weight training gives reserve and helps mitigate chronic inflammation.

She added that COVID-19 outbreaks in LTC facilities are not inevitable; instead, need to create “rings of steel” to keep out infection, minimize exposures because dose influences immune response, and facilities have problematic air circulation.

UCSF geriatrician/pulmonologist Leah Witt and pulmonologist/hospitalist Lekshmi Santhosh discussed promoting recovery in critically ill older adults from COVID-19, based on 4 Ms of age-friendly care: what Matters (advance care plan), Medication (avoid errors after discharge), Mentation (cognitive change, effects of delirium), Mobility (functional impairment), within holistic and multidisciplinary integration (pulmonary, geriatrics, psychiatry, integrative med, cardiology and neurology). 

Storytelling

“Many cultures revere old people because of their storytelling ability like the old lady from Titanic.” –Michael’s Tutorial on Avoiding Ageism, The Office US (satire, 2015) 

During webinars about older people, saw and heard talking heads discuss ageism as happening to “other” rather than personal lived experience; excluded were voices of older people impacted by oppressive policies requiring cocooning.  In fact, there are stories by older people—though few from LTC residents—during this pandemic.  Storytelling can be powerfully moving for advocacy, but these personal narratives amount to “swamp,” until they can be curated to present major themes and connect to policy proposals, then presented in 2-minute sound bites during public hearings. 

“Suddenly, you started thinking, oh, my God, yes, I'm actually older than I think; I'm actually older than I feel. Suddenly, people have all kind of gathered round you, pointed a finger and said, you're old; you need minding. And you think to yourself, ah, sweet Jesus, no, how could this have happened overnight?” –68-year-old Jimmy Hoban, Lemon Drizzle Cakes And Radio Show: How 1 Irish County Helps Elderly During Pandemic, NPR All Things Considered (July 23, 2020) 

Are these paternalistic policies, sheltering older people from risk of coronavirus transmission, actually helping them feel more vulnerable by doing things for them when they are capable? Such policies are not helpful, but dis-empowering people.

At British Gerontological Society’s virtual conference, UK-based Boomer researcher Naomi Woodspring interviewed Meredith Minkler, Professor Emerita at UC Berkeley School of Public Health, from her home where she is “point & click activist.”  It was refreshing to hear Meredith speak as gerontologist + older person, how COVID-19 pandemic has magnified devaluation of older people. When Meredith began her gerontology career 40 years ago, her focus was critical gerontology/political economy; now as an older gerontologist, she has embraced the humanities to better focus on moral and ethical issues, and what it feels to be an older person who’s less visible and at future risk of having her rights slip away, particularly her risk for dementia that has affected 3 generations in both sides of her family. 

Joined Reimagine’s Fireside Chat with Dave Isay, founder of StoryCorps, and Ira Byock, MD, founder of Institute for Human Caring’s Coronavirus Chronicles, exploring how stories build human connection during a global health crisis.

Planned to rest my eyes while listening to stories, but this was “show and tell” audio-visual program…so kept eyes on screen and caught “aloha” message in Zoom chat box from gerontologist Hope Levy, who recently completed 14-day quarantine in Hawaii!

California-based Ira (standing) and New York-based Dave (sitting) appeared to be from same tribe, with matching blue oxford shirts and eyeglasses.  In response to COVID-19 pandemic, Dave launched StoryCorps Connect allowing interviews to “collect wisdom of humanity” (Great Questions include 16 relating to COVID-19 pandemic) via video conference technology; he shared a sweet video exchange between his mother Jane (whose grandmother died in 1918 flu pandemic) and his 11-year-old son Tobey who survived COVID-19.  StoryCorps collaborated with LeadingAge to create a toolkit for organizations serving older adults and participant packet for older adult and families.  Ira’s website also offers questions and opportunity to share stories online.

Last month, Changing the Narrative Colorado launched On the Same pAGE series of intergenerational conversations (on social connection, future of work, technology, health equity, arts and culture, ageism) and provided a facilitator toolkit (questions on COVID-19 and isolation, stereotyping, language, intergenerational relationships, etc.).

At virtual Tucson Festival of Books, Stu Mellan facilitated conversation with Louise Aronson (SF) and Judy Heumann (Washington, DC) about their respective books on aging and disability, Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life (2019) and Being Heumann: An Unrepentant Memoir of a Disability Rights Activist (2020).  Louise, who disclosed her visual disability (but not age) and writing her book as a process to come to terms with her “inner ageism,” discussed the intersection of ageism and ableism. Judy, who disclosed being born in 1947 (now age 72), having polio at 18 months and using a wheelchair for most of her life, focused more on changing systems for inclusion of people with disabilities like herself fighting to attend public school and obtain license to teach (when education system considered her a “fire hazard”), demanding civil rights legislation (504, ADA), never giving up when someone says no, understanding that it may take decades before getting to yes. 

Woo-hoo, way to go, yes to human rights! I’ve already read Elderhood, now I must read Being Heumann! What struck me was Judy owning her disability, but what does it mean to own aging (process) as “old”—which seems to lack clear definition (chronological age, function, life stage, etc.)? For example, some people didn’t even realize they were “old” until the invention of policies intended to protect them from COVID-19, starting at various ages when they fall under “vulnerable” category: 60 (SF), 65 (California), 70 (Ireland), etc.

At another virtual book talk, Chinese Historical Society of America’s college interns Anna (Stanford computer science major) and Chris (Berkeley math major) interviewed 78-year-old author Maeley Tom (SFSU social work major).  After serving as the first woman and ethnic minority at the highest level of California legislature— Chief Administrative Officer of California State Assembly under Speaker Willie Brown, Jr., and later appointed Chief of Staff to State Senate President David Roberti—Maeley retired and self-published her memoir, I’m Not Who You Think I Am: An Asian American Woman's Political Journey (2020).  Born to parents who were traveling Cantonese opera performers (similar to Bruce Lee’s Chinese-Jewish parents), she grew up in foster home with French Basque family, learned to be self-reliant at an early age and graduated from college at age 16.  Maeley shared her toughest life lesson was learning that some people wanted her to fail when she always wanted to be liked, so she met challenges by doing “what people say you cannot do,” stressed doing homework, and developed reputation for her people and communication skills to get things done. However, she had no desire to run for political office out of fear of "losing face" if she lost, and now she feels “too old.”  Say that to leading Presidential candidates, Biden (77) and Trump (74)!

Advocacy & Celebration

Today's California Alliance for Retired Americans (CARA) Celebration included Call to Action by CARA Legislative Director Hene Kelly to protect and expand safety net programs.  Hene dated classmate Bernie Sanders while they were at University of Chicago in the 1960s, and endorsed him for U.S. President! 

U.S. Postal Service - 245 years (July 1): Congress should support the $25 billion included in the HEROES Act to protect the USPS, which seniors rely on to deliver their life-saving medications.

LaborFest screening and discussion of Gone Postal documentary with filmmaker Jay Galione, whose father was a postal clerk for 30 years enduring toxic work culture related to privatization pressures, and employer retaliation.

Older Americans Act – 55 years (July 14) 

Americans with Disabilities Act (ADA) – 30 years (July 26) 

Monthlong celebrations included:

·       George and Barbara Bush Foundation’s The ADA at 30: “Let the Shameful Wall of Exclusion Come Down,” taken from President Bush’s remarks as he signed the ADA

·       Disability Rights California's Celebration of 30th Anniversary of ADA discussion with pioneers like Judith Heumann and Dr. Fred Schroeder, DRC advocates Yolanda Vargas, Rosy Tellez, and Eric Harris 

·       Disability Action Coalition’s ADA for Next Generation 

·       Senior & Disability Action hosted Crip Camp: A Disability Revolution (2020) watch party with audio description and discussion about power of community and diverse abilities for civic engagement.  

Medicare and Medicaid – 55 years (July 30)

Medicare: Congress Should Enact Lower Drug Costs Now Act (HR 3) requiring government to negotiate lower drug prices for Medicare and provide discount rate to all payers; cap yearly out-of-pocket spending in Medicare to $2,000 and limit drug price increases in Medicare Part B and D to the rate of inflation; savings would be reinvested into Medicare to expand benefits for vision, hearing, and dental.  Also, SUPPORT Medicare for All Act (HR 1384) creating Improved Medicare for All system where everyone gets the care they need, where they need at prices they can afford, choice of providers and a comprehensive benefit plan.

All of me, health care for you and me
Co-pay free, with a choice of providers
Eyes and teeth – Don't want to lose them!
Local clinics – I want to use them!

Say goodbye to costs that soar sky-high
Middlemen – we'll do better without them
Long-term support, you won't get sold short
With Medicare for you and me!

All of me, health care for you and me
Guaranteed from pre-birth to departure
Change your job, and you won't lose it
Unemployed? You can still use it

Dignity, no fear of bankruptcy
When in need, everybody's covered
Let's win the fight, good treatment is our right
With health care for you and me!

--All of Me (Health Care for All) by Hali Hammer

Medicaid: Congress Should Increase the Federal Medicaid Assistance Program (FMAP) to help provide for uninsured individuals during this pandemic, and adopt 10% increase in FMAP for Home and Community-Based Care included in the House’s HEROES Act to keep seniors in their homes and out of nursing homes.

Social Security – 85 years (August 14)

Congress Should SUPPORT Strengthening Social Security Act (HR 2654) to improve the solvency of the trust fund by SCRAPPING the CAP; improve the annual COLA – basing it on the CPI-E; improve benefits for widows and widowers.  Also, support Social Security Fairness Act (HR 141) which would repeal the Government Pension Offset/Windfall Elimination Provision that denies certain public employees their earned benefits.

Congress Should OPPOSE Cutting the Payroll Tax, which funds Social Security program, to avoid jeopardizing the trust fund and benefits of current and future retirees.  Also, OPPOSE any Efforts to Enact the TRUST Act (S. 2733 and HR 4907) that creates closed-door commissions to cut Social Security and Medicare; provides no beneficiary protections from benefit cuts, nor does it mandate plan adequacy given the growing number of Americans who rely on these programs. 

National Academy of Social Insurance (NASI) hosted 4-hour Intergenerational Dialogue: Why Social Insurance? Inspired by Why Social Insurance? (1999) essay by E.J. Dionne, op-ed columnist for The Washington Post, a discussion of how the nation's social contract might evolve in light of both COVID-19 pandemic and increased calls for social justice.  With conviction of AOC, NASI intern Alexandra Allen spoke out about how social insurance enables systemic inequality because it relies on wealth of incoming payroll tax, whereas most wealth comes from stock capital and intergenerational transfers; because Social Security benefits are insufficient, she proposed funding Social Security via progressive payroll and capital gains tax, as well as expanding Medicare to all by investing away from military and to the community!

Age-friendly developments/”New Normal” ideas

·       Protecting community members in SF: Right to Recover Fund, would provide two weeks-worth of wage replacement up to $1,285 for up to 1,500 SF residents who test positive for COVID-19; another program offers smaller one-time payment to assist with groceries and other supportive services. 

·       Charles Sabatino, director of American Bar Association Commission on Law and Aging, proposed to defund nursing homes in favor of Dr. Bill Thomas’ Green House Model (smaller “households” with private room/bath, flattened hierarchy, cross-trained staff) to replace problematic institutional nursing home model of warehousing frail older people into hospital-like buildings with high staff turnover

·       Terry Fulmer of Hartford Foundation proposed rethinking LTC, calling for hospitals to return to inpatient acute care for patients who require intensive rehab (instead of discharging to skilled nursing facilities for short-term rehab), enhanced community based supports for people who need help with activities of daily living and can remain at home, and nursing homes as true LTC facilities for people who truly can no liver live at home  

·       Framework for Aging-Friendly Services and Supports in the Age of COVID-19 on strengthening person-centered services and supports for older adults, via in-home acute and primary medical care, expansion of video telehealth and social interaction, and implementation of volunteer/paid intergenerational service. 

·       Justice in Aging’s What Older Adults Need from Congress 

·       Media and public learn about MOCA, or cognitive test taken by President Trump, though increasing concern about test utility when much of content shared in media

More gerontology conferences go online:

·       Association for Anthropology, Gerontology and the Life Course’s Aging & Social Justice Slow Conference (June 27-Aug. 31) 

·       Aging & Social Change: 10^th Interdisciplinary Conference/New Ageism in Times of Pandemic: Tensions between Active Aging & Risk-Group Definitions (Sept. 24-25) 

·       Grantmakers in Aging (Oct. 14-16) 

·       Gerontological Society of America Turning 75: Why Age Matters (Nov. 4-6)