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?