Aging in America 2017 conference highlights

Welcome mural at Hostelling International in Chicago, which offered $34 per night rate for my student/non-profit worker budget!  For the third time in five years, American Society on Aging (ASA) held its Aging in America (AiA) conference at the Hyatt Regency Chicago ($239 per night).  I volunteered again for a behind-the-scenes experience, working with ASA staff like Patricia Morazan (volunteer coordinator and fundraiser extraordinaire for homeless Petaluma senior after 15 agencies declined to help) and Steve Moore (poster coordinator and popular webinar host).

Hostel advice: forget the maps ...follow your instincts

During my daily mile-long walk from hostel to conference site, I approached Trump International Hotel and Tower (tallest reinforced concrete building in the world) as a reminder of who’s President … and the March 16, 2017 release of his “skinny budget,” which proposed a 17.9% cut in the Department of Health and Human Services (HHS), impacting discretionary programs “that are duplicative or have limited impact on public health and well-being.”  Trump’s budget director Mick Mulvaney defended cuts to the Community Development and Community Services Block Grant programs, which fund Meals on Wheels (MOW) in some communities, suggesting that MOW is ineffective. In response, the media quickly came to the defense of MOW.  Linda Qiu of The New York Times provided this fact check: 

“Meals on Wheels helps 2.4 million people each year, including 500,000 veterans and 226,000 older citizens in the three states Mr. Mulvaney specified. And a body of research shows that it does work.  Evaluation of the home-meal delivery program found that participating helped reduce feelings of loneliness and the risk of falls while improving nutrition and food security, and even decreasing government spending.

‘If you can provide these lower-cost programs and keep seniors out of nursing homes, that in essence will save money,’ said Kali S. Thomas, a professor of health services at Brown University.  Dr. Thomas’s research showed that Medicaid spending could be reduced by $109 million if all states were to increase the population of people who received home-delivered meals by 1 percent.”

SF Examiner featured Riding Along with MOW driver Viena as she delivered meals + safety checks to homebound seniors in San Francisco’s Bayview district! 

Since military spending appears to be Trump’s priority (America First: A Budget Blueprint to Make America Great Again proposed increases in the Departments of Defense, Homeland Security, and Veterans Affairs), The Daily Show proposed militarizing MOW to trick Trump into funding the home-delivered meal program for frail, homebound seniors. 

At this year’s AiA conference, almost every session included reference to MOW...since I work with homebound seniors who rely on MOW, it was very touching to hear such overwhelming support! ASA Board Chair Bob Blancato, also Executive Director at National Association of Nutrition and Aging Services Programs, issued this forceful statement: 

“While details are still emerging, it is hard to see how key programs that provide vital nutrition services to older adults, like the Older Americans Act and the Social Services Block Grant (SSBG), are not reduced. These programs now operate on the edge in terms of funding and any reductions will mean service disruptions and waiting lists for needy older adults. We intend to work individually and collectively with other aging organizations to keep this budget from ever passing.”

When I overheard Douglas (architect) and Ellen (gerontologist) Gallow’s conversation about MOW, I chimed in and learned their Ohio-based Lifespan Design Studio consulted on George W. Davis Senior Residence and Senior Center in San Francisco, one of the educational trip offerings at this summer’s IAGG Congress!

Advocacy

ASA President Bob Stein shared stage with ASA Hall of Fame Awardee Percil Stanford, who was instrumental in founding the Department of Gerontology at San Diego State University.  Stanford, a 2016 Influencer in Aging, advocated for all ages:

“As our society ages, it is strategically smart to fully utilize all human assets regardless of age…Instead of embracing policies that separate ages, allocate more time toward understanding how limited resources can serve multiple age groups. Food, shelter, clothing and health care are essentials for everyone.”

During the general session, ASA Board Chair Bob Blancato told us our meeting was “not a 3,000 person group therapy session,” rather an opportunity for advocacy “to do right” because “silence is complicity.”  As a follow-up to last month’s National Call-In Day to Congress against repeal of the Affordable Care Act (ACA), Bob urged us to call Congress to Vote No on the American Health Care Act, which would cut over $800 billion from Medicaid. #itsNOTokay.

Later on Day 4 (or March 23, the 7^th anniversary of ACA), we learned that Republicans cancelled vote on Trumpcare largely due to support for Medicaid.

ASA and NCOA United: A Stronger Voice for Advocacy was standing room only.  A larger venue would have been more appropriate for the announcement that ASA, which has focused on professional education and publications, joined National Council On Aging (NCOA) to advocate for low-income older adults.  While both organizations remain nonpartisan, there was discussion about the disconnect between aging advocates and seniors who "voted against their interests" by supporting Trump (who appealed to their “nostalgia, fear of danger and anxiety about social change,” according to "Trump's Graying Army" by Molly Ball of The Atlantic, yet scorned as “basket of deplorables” by candidate Hillary Clinton).

On platform: Kevin Prindiville, ASA Director; Bob Blancato, ASA Board Chair and NCOA Director; Carol Zernial, NCOA Board Chair; Howard Bedlin, VP Public Policy and Advocacy at NCOA; Richard Browdie, ASA Director and NCOA Past Chair; Josefina Carbonell, NCOA Director and former Assistant Secretary for Aging in George H.W. Bush Administration (self-described as the “token Republican”); Bill Benson, ASA Director (reminded us that advocacy is centerpiece of Older Americans Act).  When an audience member expressed disagreement with focus on low-income seniors, Howard acknowledged that modest-income white Americans might perceive low-income seniors get more benefits than deserved, e.g., better health insurance, but everyone hurts when our safety net is threatened. Next step is joint webinars to build capacity.

In Beltway Insiders Round-Up: What You Need to Know About Aging Policy Now, Amy Gotwals, Chief of Public Policy and External Affairs at National Association of Area Agencies on Aging (n4a) moderated discussion with panelists Bob Blancato, Howard Bedlin, Jennifer Dexter, and Tony Sarmiento.  They were uniformly opposed to American Health Care Act (aka "the more you need, the less you get") and Trump’s “skinny budget” proposals:

·         HHS programs (18% cut):  Low Income Energy Assistance Program, Community Development & Community Services Block Grants (include funding for MOW)

·         Elimination of Corporation for National and Community Service, which provides funding for RSVP, Senior Companion and Foster Grandparent programs

·         Elimination of Legal Services Corporation, which provides legal assistance to low-income people including seniors

·         Labor program (21% cut): Elimination of Senior Community Service Employment Program (SCSEP), only federal program to employ low-income older adults.  Tony corrected the “alternative facts” about his organization, Senior Service America Inc. (includes SCSEP), based on Evaluation of SCSEP Process and Outcomes Study Final Report (2012), by Social Policy Research Associates and Mathematica Policy Research, Inc. and Charter Oak Group SCSEP Surveys.

SFSU Gerontology Professor Brian de Vries expressed concern over the disdain for facts in reframing to advance agenda, which is so contrary to fact-checking that he requires of students (--like yours truly).  Afterwards, I mentioned to Brian that disdain for facts in this era of Post-Truth Politics seems to have started comically with Stephen Colbert’s truthiness, in which people who “know with their heart” trump people who think with their head (latter perceived as elitist).

Reframing Aging

Coming of Age in Aging America: Documentary and Discussion.  After screening the one-hour documentary Coming of Age in Aging America, Vital Pictures President and film producer Christine Herbes-Sommers moderated a panel discussion addressing the challenges and opportunities of our changing demographic:

• Paul Irving, Chairman of Milken Institute’s Center for the Future of Aging talked about inexpensive things that can be done quickly to promote a more inclusive society, like intergenerational opportunities in senior centers, lifelong learning and addressing ageism to provide opportunities for ongoing work.
• Donna Butts, Executive Director of Generations United, challenged the average older adult watching TV 49 hours per week to “not let this asset sit dormant.”  (My homebound clients, who might be above average in TV watching, were probably the subject of Andy Borowitz’s satire, “ABLE-BODIED SENIOR WHO WATCHES TV ALL DAY RECEIVES FREE GOVERNMENT MEALS,” in The New Yorker, March 19, 2017). 
• Nathaniel Kendall-Taylor, CEO of FrameWorks Institute, talked about reducing ageism by framing solution-oriented messages and invited audience to join his afternoon session, Telling a New Story: Using Research to Reframe Aging. (Though I missed his session, I heard from his colleague Moira O’Neill last month after Frameworks released Frame Brief: Framing Strategies to Advance Aging and Address Ageism as Policy Issues, Finding the Frame: An Empirical Approach to Reframing Aging and Ageism, and Gaining Momentum: A Communications Toolkit.)

The documentary will be broadcast on PBS stations in April and May, and a companion toolkit is in the works. [Check out video clip, Thinking Out Loud: Learning To Be Old and Interdependency, featuring late geriatrician Dennis McCullough, author of My Mother Your Mother: Embracing Slow Medicine (2008).] Christine mentioned that at age 68, with both parents deceased and after 45 years of documentary filmmaking, Coming of Age in Aging America is her last film because she will enroll in MFA in Classical Realist Painting and Drawing!

Poverty & Health Outcomes

Lisa Marsh Ryerson, President of AARP Foundation, which focuses on creating opportunities for low-income older Americans, delivered the opening general session talk, Out of the Shadows: Poverty and Other Social Determinants of Health.  She discussed 5 building blocks to eradicate poverty from a systemic view (v. individual failure):

1.     adopt integrated perspective

2.     strengthen social connections via Connect2Affect because isolation and loneliness is as bad as smoking 15 cigarettes 

3.     active listening to resist assumptions about motivation, wants and needs; instead, listen with intention to guide sustainable solutions

4.     use opportunities to collaborate and connect to services

5.     get out of silos to join others for collective impact

I was seated to right of Justice in Aging’s Kevin Prindiville who was tweeting,

as panelists spoke:

• Candace Baldwin, Director of Strategy, Aging in Community at Capital Impact Partners, a nonprofit Community Development Financial Institution, has partnered with AARP Foundation for Age Strong initiative to invest in projects and organizations that benefit older adults
• Bill Rivera, SVP Litigation at AARP Foundation, mentioned studying social welfare policy in Sweden, which has low poverty rate   
• Fernando Torres-Gil, Director of the Center for Policy Research on Aging, reminded us that as we get older, we are more at risk of falling into poverty/insecurity, so we need to rebuild our social welfare safety net.

This discussion made me think about The New York Times' op-ed piece, “To Fix Health, Help the Poor” (December 9, 2011), by Elizabeth H. Bradley and Lauren A. Taylor: 

“It is Americans’ prerogative to continually vote down the encroachment of government programs on our free-market ideology, but recognizing the health effects of our disdain for comprehensive safety nets may well be the key to unraveling the “spend more, get less” paradox. Before we spend even more money, we should consider allocating it differently.”

They later published The American Health Care Paradox: Why Spending More Is Getting Us Less (2013), critiquing the “medicalization”—or treatment of social determinants of health as medical problems:

“Rather than relying almost solely on medicine to improve health outcomes, we could look at alternative interventions: adequate housing for people who seek shelter in emergency departments, better nutrition for those suffering from diabetes, transportation services for older adults who can no longer drive to their medical appointments safely. In some cases, such interventions might help obviate the need for additional medical care entirely, while in others they might make certain treatments more successful and efficient.” –Elizabeth H. Bradley and Lauren A. Taylor, “American Health Care: Too Much, Too Late?” The New Yorker (November 13, 2013) 

Partnering with Municipalities: Building Sustainable Bridges Between Community and Clinic:  Executive Director Lynnzy McIntosh and Implementation Director Maripat Gallas from Consortium of Older Adult Wellness (COAW) in Lakewood, CO, talked about improved health outcomes in evidence-based disease self-management and fall prevention programs by using referrals from health partners, a peer coach to support participants, $50 incentive for program completion, etc.

Introducing the National Center on Law and Elder Rights (NCLER) was presented by Directing Attorney Jennifer Goldberg (filling in for Faye Gordon, NCLER Project Director who is on maternity leave) and Executive Director Kevin Prindiville of Justice in Aging—Fighting Senior Poverty Through Law.  Starting September 2016, ACL awarded a 5-year contract to Justice in Aging to launch NCLER, a legal support center providing training (basic and advanced webinars twice a month, but no CLE credit), case consultation (email ncler@justiceinaging.org) and technical assistance to aging & disability and legal networks on topics relating to public benefits, consumer rights, housing, advance directives, etc.

Mental Health     

New Strategies for Engaging Older Adults in Behavioral Health Services: Oregon’s Tri-County Region of specialists (Shannon Baggerman and Kim Jackson of Washington County, Stephanie Barnett-Herro of Clackamas County, and Lauren Fontanarosa of Multnomah County) introduced Older Adult Behavioral Health Initiative (OABHI). The OABHI team conducted over 100 stakeholder interviews to identify challenges older adults face when attempting to access behavioral health services (both system and individual levels), service gaps, programs experiencing success, ideas for system integration and partnerships, etc.  In response to findings, the OABHI team developed the following strategies:

• Workforce development: system navigation and clinical training (Portland State University’s training modules to increase knowledge of behavioral health issues of older adults); Behavioral Health Resource Guide for ADRC toolkit and decision flowchart to facilitate appropriate help at right time and level of care; normalize getting help (“some people find it helpful to talk to someone, would you be interested…?”); Wraparound for Older Adults with complex needs (medical, behavioral and aging)
• Community engagement: senior center projects to incorporate talking about mental health, warmline (suicide prevention & loneliness, challenge is sustainable funding); community events (May is Older Americans and Mental Health Month, focus on strength-based resiliency, resource fairs, community night out with police, etc.)
• Program implementation: peer support (similar to Senior Companions, but hiring challenges), PEARLS (Program to Encourage Active Rewarding Lives for Seniors)  for culturally specific providers (8 sessions delivered in-home, one-on-one, focused on problem-solving to reduce depression); Substance Abuse Relapse Prevention for Older Adults: Group Treatment Approach (2005 SAMHSA curriculum,16 group sessions to start in July, using cognitive behavioral therapy and self-management) 
• Cross-system collaboration: suicide prevention (Suicide Prevention Council’s Get Trained To Help, Zero Suicide Initiative), Dementia Task Force (Mobile Crisis Team, Mental Health Response Team, Collaborative Older Adults Solutions Team (COAST))

Mental Health and Aging Policy in the New Administration: Brian Altman, Division of Policy Innovation Director at Substance Abuse and Mental Health Services Administration (SAMHSA) providing an update:

·         increasing trend in opioid misuse among adults age 50+ appears largely driven by adults age 50-64 (baby boom generation more likely to use psychoactive drugs compared to earlier cohorts)

·         about 95% of opioid misusers age 50+ used prescription pain relievers nonmedically without using heroin

·         opioid misuse also more prevalent among Hispanic, living in poverty, fair or poor health, with past year major depressive episode, and past year alcohol use disorder

·         protective factors include: appropriate assessment and care for physical and behavioral health issues; social connectedness; sense of purpose/meaning; resilience around change

He shared the following SAMHSA toolkits:

• Promoting Mental Health and Preventing Suicide: A Toolkit for Senior Living Communities (2011) 
• Promoting Emotional Health and Preventing Suicide: A Toolkit for Senior Centers (2015) 

Trump’s “skinny budget” proposed funding SAMHSA substance abuse treatment activities, with $500 million increase to expand opioid misuse prevention, treatment and recovery services.

Edwin Walker, Acting Assistant Secretary for Aging at U.S. Administration for Community Living (ACL), shared resources from ACL’s Behavioral Health homepage and the following evidence-based programs:

• PEARLS 
• Healthy IDEAS (Identifying Depression, Empowering Activities for Seniors)
• IMPACT (Improving Mood Promoting Access to Collaborative Treatment) 
• Florida BRITE (BRief Intervention and Treatment for Elders) identify non-dependent substance use/prescription medication issues and provide strategies prior to need for more extensive/specialized substance abuse treatment
• HomeMeds medication safety program

ACL and SAMHSA have partnered with NCOA to present Older Americans Behavioral Health Series of issue briefs and webinars.  Another resource is National Coalition on Mental Health and Aging (NCMHA).

Trauma and Resilience: Understanding and Using Trauma-Informed Services with Older Adults featured panelists:

Brian Sims, psychiatrist and Senior Medical Director/Behavioral Health at National Association of State Mental Health Program Directors (NASMHPD), said ACE (Adverse Childhood Experiences) have long-lasting effects on health and well-being (health-risk behaviors as coping mechanisms, chronic disease, early death); holding on to traumas eventually explode, and recommended reading The Body Keeps Score: Brain, Mind and Body in the Healing of Trauma (2014).  He said introducing medication will put out fire, but not cure; trauma-informed care considers following:

• Ask underlying question, “what happened to you?” because experiences shape who you are
• Symptoms = adaptation to traumatic events (abuse, loss, chronic stressors)
• Healing happens in relationships with the power of empathy

Dr. Sims mentioned he was survivor of POT=Post-Obama Trauma 😀.

Laura Gilman, Care Management Team Manager at Jewish Family Services of Greater Kansas City, talked about Trauma Informed Care: Through Lens of Caring for Our Holocaust Survivor Community. She provided examples of triggers, particularly with institutionalization/hospitalization (medical interventions were lethal/experimental; bright lights, small confined spaces, showers; mistrust related to receiving care from unknown person) and PTSD (neurotoxicity results in cognitive/mental health challenges). She noted the impact of dementia on brain function that might worsen a trauma survivor’s response to triggers: increased potential for survivor to be living in trauma period due to short-term memory loss, and reduced ability for language expression of needs and wants. 

Tobi Abramson, Director of Geriatric Mental Health at New York City Department for the Aging, talked about Resilience and Growth After Trauma.  She shared tips to build resiliency, or transform trauma from pathology to growth:

• encourage supportive relationships
• create narratives to boost sense of identity and control
• develop resilience skills to be flexible and take risks
• practice mindfulness techniques like focus on breathing when hurt
• understand there is no answer to “why me?” instead ask “what steps can I take to deal effectively with situation?”
• view setbacks as experience to learn from, not to be defeated

She noted value of rumination to help reframe trauma with different outcome.  For people who cannot use language, she suggested arts (dance, music, painting, etc.) to create engagement and referred to National Center for Creative Aging.

In Embracing a Trauma-Informed Service Approach, Sue Dichter and Megan Mariner of Northern California Presbyterian Homes & Services (NCPHS) shared their experiences of working with residents during building renovation and relocation, which seemed to trigger past trauma or losses as they refused to leave or confronted hoarding problems.  Resident services coordinators devised opportunities to mitigate stress and build community, starting with safe activities like community meals (including monthly cooking classes), resident storytelling (Inviting Wolf In: Thinking About Difficult Stories, by Loren Niemer and Elizabeth Ellis), and bingo games with cleaning supplies as prizes (hint to hoarders).

 

Creative Expression 

Using Music and Technology to Drastically Improve Our Lives as We Age: Ginna Baik, Senior Care Business Strategist at CDW, partnered with  Andy Tubman, MT-BC, co-founder of Musical Health Technologies/Sing-Fit, to deliver a music health technology kit to actively engage participants in music therapy incorporating movement (beyond passively listening to music, like Music & Memory) for a multi-sensory experience in a group setting.  He inspired us to “Let’s exercise those neurons!” to the tune of Bill Withers’ “Lean on Me”:

·         listening to the lyrics (“Sometimes in our lives we all have pain, We all have sorrow But if we are wise, We know that there's always tomorrow…”)

·         clapping side by side (“Lean on me, when you're not strong, And I'll be your friend I'll help you carry on, For it won't be long 'Til I'm gonna need Somebody to lean on…”)

Andy explained how structured singing is a catalyst for biochemical and neurological change: full brain workout, neurochemical release (oxytocin, dopamine, endorphins, serotonin), respiratory benefits (increase lung capacity), immunity fortitude, and socialization.  He also reminded us that former Arizona congresswoman Gabby Giffords, who was shot in the head, credited music therapy to her speech recovery.

Before a general session, Gold Coast Encore Chorale sang the Beatles’ “When I’m 64” with choir members holding up signs with ages higher than 64 in finale!

Group Drumming for Wellness by Rachelle Norman, MT-BC, Founder of Soundscaping Source LLC, provided 10 reasons to learn an instrument as an adult.

General Sessions: Drugs and Pets

Benjamin Rose Institute on Aging President and CEO Richard Browdie moderated Ensuring Access to Affordable Treatments, sponsored by AARP (co-founded by Leonard Davis to sell insurance products) and PhRMA (trade group representing pharmaceutical industry).

• Leigh Purvis, AARP Director of Health Services Research, discussed why older adults are particularly vulnerable to high drug costs (Medicare beneficiaries have high utilization of average 4.5 prescriptions/month; modest incomes or median income less than $25,000; limited financial resources).  
• Lori Reilly, PhRMA EVP for Policy, Research and Membership, explained cost to develop new medicine more than doubled over past decade (on average, it takes more than 10 years and $2.6B to research and develop a new medicine, while just 12% of drug candidates that enter clinical testing are approved for use by patients).  She offered following solutions: modernize drug discovery and development process; promote value-driven healthcare; and ensure patients directly benefit from manufacturer rebates.

General session offered no opportunity for audience Q&A. On stage, there was no mention of AARP’s support of Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which prohibited the federal government from negotiating discounts with drug companies.  Trump favors the idea of Medicare negotiating drug prices to ensure affordability for all Americans.  (See Consumer Reports' "Is There a Cure for High Drug Prices?")

Exhibit hall vendor Journeyworks displayed publications of common substances (ab)used by my clients. 

Better Together: Healthy Aging for Pets and People was moderated by Steve Dale and co-sponsored by dog food company:

• Zara Boland discussed the power of pets in our lives, assisting in the retention of independence and quality of life, providing benefits for better physical health (pet owners have 21% fewer doctor visits, get out and about more), social connection (pet is often catalyst to start conversation, promoting civic engagement and community), and emotional well-being.
• Steven Hannah discussed molecular nutrition to optimize longevity of dogs to address concerns of senior dog owners (less interaction, lower engagement, more loner)
• Gerardo Perez-Camorgo talked about life stages of cats, who are considered geriatric at age 11+
• Matt Kaeberlein’s Dog Aging Project aims to increase healthy life span of pet dogs

While I recognize the value of pets to my homebound clients, there have been times when I felt like calling ASPCA after home visits with dogs and cats confined to small indoor spaces and bouncing off the walls, ready to follow me out the door to escape outside. 

Aging in Community

Housing Older Adults: Advocating for Expanded and Appropriate Options featured the following speakers: 

Stephanie Firestone, Senior Strategic Policy Advisor at AARP Office of International Affairs discussed Diverse Housing Options: housing cost burdens rise with age, especially for renters and owners with mortgages; projected increase in senior homelessness; oldest households drive growth in single-person households through 2035; increase supply of affordable, accessible housing via incentives for builders and more effective utilization of existing housing (Accessory Dwelling Units, like Fonzi’s bachelor pad above the Cunningham’s family home garage in Happy Days TV show; or homesharing like Golden Girls).

Cindy Campbell, Director of International & Philanthropic Innovation, Office of Policy Development & Research, at U.S. Housing & Urban Development (HUD), discussed Supportive Services & Housing:

• Section 202 Supportive Housing for the Elderly: only 1 in 4 eligible low-income elderly households receive this assistance
• Service Coordinators in Multifamily Housing: 2014 study noted that seniors in buildings with supportive services less likely to enter costly nursing homes and hospitals
• Supportive Services Demonstration for Elderly Households in HUD-Assisted  Multifamily Housing: include full-time enhanced service coordinator (duties beyond information and referral) + half-time wellness nurse (to monitor health conditions and encourage self-care), subject to 4-year evaluation to measure Medicare claims to assess impacts
• Veterans Affairs Supportive Housing (VASH) assisted over 110,000 veterans, and reduced veteran homelessness by 36% between 2010 and 2015
• Shared housing in Germany (grant to owner to make home “age-appropriate” + grant to senior to live in shared housing) and Netherlands (college student lives rent-free if provides 30 hours of care to senior at home)

Trump’s skinny budget proposed 13% cut for HUD. (Notably, on his first day as HUD secretary, 65-year-old neurosurgeon Dr. Ben Carson joked that he likes operating on younger people more than an "old geezer" because latter could "die in 5 years or something else.") 

Jayna Lynott, Senior Strategic Policy Advisor at AARP Public Policy Institute, presented on Age-Friendly Housing Policies, showing winner of last month’s Future of Housing: ReDefine Home Design challenge  and sharing several AARP studies:

• What is Livable? Community Preferences of Older Adults (2014): home modifications is priority for homeowners and people with disabilities; affordability is priority for renters
• Preserving Affordability and Access in Livable Communities: Subsidized Housing Opportunities near Transit and the 50+ Population (2009): affordable housing in transit-oriented developments benefit older residents if they are walkable, accessible, compact, safe, with plentiful resources and healthy air
• Increasing Home Access: Designing for Visitability (2008): inclusion of a zero-step entrance, wide doorways, and at least a half bath on the main floor of the home.
   

Kathy Sykes, Senior Advisor for Aging and Public Health at U.S. Environmental Protection Agency (EPA) presented on Housing and Environmental Health:

• National Healthy Housing Standard developed evidence-based tool connecting housing conditions and public health
• Air pollution ratings at Airnow.gov to find Air Quality Index;  American Lung Association State of the Air 
• HUD Smoke-Free Public Housing, effective February 3, 2017, with 18-month implementation period
• Jack London Gateway Senior Housing Health Impact Assessment (HIA)  to mitigate negative health impacts
• Climate change (risk of heat waves affect old, socially isolated, take meds, mental health conditions, city dwellers, lack air conditioning)
• Partnerships for Sustainable Communities 
• New Partners for Smart Growth 

 Trump’s skinny budget proposed 31% cut for EPA.

  

Receptions

2016 Rosalinde Gilbert Innovations in Alzheimer’s Disease Caregiving Legacy Awards 

AARP hosted reception for Next Avenue’s 2016 Influencers in Aging 

 Not forgotten

AiA17’s weeklong conference in Chicago, with attendees from all 50 states and other countries, was an awesome opportunity to get beyond the San Francisco bubble.  At AiA17, particularly in light of Trump’s proposed “skinny budget,” there seemed to be greater emphasis on protecting the safety net for the most vulnerable seniors living in poverty. It was good to hear from other attendees expressing concern about the forgotten, anxious middle-class who are losing ground yet who are “trying to get along without public relief” and perhaps not income-eligible for subsidized housing, SSI, Medicaid, IHSS, SNAP, and other safety net programs.  Trump appealed to “The forgotten man and woman will never be forgotten again”—his supporters were mostly white, native-born working class.

Yet, as The Washington Post columnist Ruth Marcus observed in her March 17, 2017 opinion piece, “Trump wants the forgotten men and women to stay forgotten”: 

“The Republican health-care plan that Trump endorsed and the budget he just submitted cater more to the interests of the billionaires Trump chose for his Cabinet than to the lower-income, rural and older voters who formed the backbone of his electoral support. …

The new system would hurt the oldest consumers. Insurers would be free to charge those between 50 and 64 five times as much as younger enrollees; under Obamacare, that differential is limited to three times as much.” 

Rising income polarization has gutted the middle-class.  Growing income inequality seems related to growing political polarization, with like-minded people clustering themselves and rarely engaging with people of different political persuasions.

At AiA17, San Francisco presenters included Brian de Vries (LGBT Aging), Carroll Estes (Social Security), Anne Hinton (SF Tech Council), Kate Hoepke (Village Movement), Brooke Hollister (Dementia), Susan Poor (Village Movement), and Cathy Spensley (Age-Friendly Communities).  While they do awesome work, I decided to skip their sessions to learn what is happening outside of our San Francisco bubble.  I also attended the most sessions on Mental Health and Aging, which is the focus of my studies and client home visits.

Fortunately, ASA posted power point presentations on its website for conference registrants so I could access some missed sessions.  Since March is National Nutrition Month, there were several sessions on Food Insecurity and Malnutrition; some resources:

• Implementing Food Security Screening and Referral for Older Adults in Primary Care. AARP Foundation, November 2016 
• IMPAQ Food Security Screening Resources 
• Defeat Malnutrition Today
• NCOA Community Malnutrition Hub 
• Hunger in older adults: Challenges and opportunities for the aging services network. Meals on Wheels America, February  2017 
• Senior Hunger Facts. Feeding America. 
• What we know and can do about malnutrition: Profiles of an aging society. Gerontological Society of America, 2015. 

Save the date: next year’s ASA conference in San Francisco on March 26-29, 2018!

Chicago: Year of Public Art 

At Chicago Cultural Center