Mattering

Purple

 

Rise

Herb Alpert’s Rise (1979 instrumental) has been playing like an earworm ever since I attended this month’s virtual screening of his documentary, thanks to AARP Movies for Grown-Ups. (While I had reservations about joining an organization that sells insurance and opposes single-payer healthcare, decided to invest in “risk-free” aka cancel anytime AARP membership for access to publications and events; no age requirement unless one wants to purchase age-restricted insurance products.)  

“Herb Alpert Is…” feel-good film this year, like his melancholy yet uplifting music! So mesmerizing, check out his Smile and Wonderful World.  With mandatory mask wearing in public due to COVID-19 pandemic, it will be some time before we can hear live wind instruments like trumpet playing so recordings are good for now.

Herb’s now 85 years old, nearly didn’t recognize him with his beard.  Walking past his elementary school in Los Angeles, Herb shared that a teacher couldn’t decide whether to give him an A or B grade for reading, so she brought in another teacher for him to read, and the teacher told him he was a “B reader, at best.”  From that point on, Herb said, he became an introvert.  Fortunately, his school also offered music appreciation, and Herb chose the trumpet, which “spoke” for him.  When neighbors complained about his trumpet playing, his mother encouraged him to play louder (not considerate!).  Despite mean teachers, industry v. inferiority resolved in favor of competence for Herb.

“Herb Alpert Is…” a beautiful life review, with Herb’s resolution of Erikson’s stages of psychosocial development to achieve virtues beyond competence: fidelity, love, care and wisdom.  Like jazz, this documentary is non-linear, improv-like, meandering with moments of Herb’s reflective self-awareness, vulnerability and earnest striving for authenticity: playing trumpet in the Army, where he perceived other trumpeters playing “better” so he determined to find his “own” voice, inspired to capture sounds of Tijuana Brass after attending a bullfight while on vacation (identity v. confusion, though critics today might accuse him of cultural appropriation?); ignoring Sonny Bono’s advice to “get out of the business” (industry v. inferiority revisited); being rich and famous, but miserable in Beverly Hills (he becomes silent in this exploration, so respect his privacy; as an introvert, I view famous=miserable), ending his marriage then getting remarried and moving to Malibu (intimacy v. isolation); getting “stuck” and unable to play until a teacher in NY helps him re-establish playing his trumpet, knowing how to compensate for not speaking much by partnering with spokesperson in business, trusting his intuition in signing some of my favorite singer-songwriters (Carole King, Cat Stevens, Peter Frampton, Sting/The Police, etc.) to A&M Records, which he co-founded so artists would be treated better (generativity v. stagnation).

As an older adult, Herb pays it forward by generously giving to music appreciation/arts education (notably Music Mends Minds intergenerational support group to address cognitive issues in older adults), waking up each purposeful day to “listen to your soul” with creative expression in daily (almost spiritual) practice playing his trumpet or piano, painting and sculpting for a remarkable legacy (integrity v. despair) and sharing his life process (wisdom).  Arts=liberation, much needed in K-12 and beyond!

For at least his first half century, clean-cut Herb appeared almost like Certified Young Person Paul Rudd, and documentary wasn’t too keen presenting chronology other than wife #1 came before wife #2; each wife appeared in videos of his #1 hits: This Guy’s in Love with You (1968, rare use of his vocals! wife #1 appeared quite hilarious in heavy mascara) and Rise (co-written by his nephew Randy, notable for spouting only F-bomb in film). Documentary is just under two hours, and I wanted more time with Herb, who is easy on ears and eyes, and maybe ask what did he think about Rise being used in rape scene in General Hospital soap opera? Herb Alpert is such an endearing blast to the past, as my boomer uncle played his vinyl records; and I liked listening to Rise on the radio (though Andy Gibb was my heartthrob in 1979 during a time when Video Killed the Radio Star). 

Herb defined himself primarily as an introvert and artist, which is so refreshing in these politically correct times that would expect him to identify as son of Eastern European Jewish immigrants.  As a MSW student required to take a diversity course, I was annoyed that an assignment required me to write about privilege and oppression based on identities of age, gender, sexual orientation, class, religion, mental and physical abilities, nationality, race/ethnicity,…but I could not select introversion that has defined my existence in a society that privileges extroversion?! 

As an introvert who values autonomy and solitude, I initially welcomed distancing and working remotely from home during COVID-19 pandemic...until my extroverted neighbors also were stuck at home blasting their music (not Herb Alpert) and interrupting my Zoom meetings.  With bars shutdown during stay home order, it’s like how Prohibition drove imbibing behaviors underground, as neighbors seemed to make their homes into bars with noisy guests carrying 6-packs and filling up recyclables bin with emptied cans/bottles of alcohol.

Pre-pandemic SF was crowded so welcomed news of recent exodus from SF, with whopping 96% year-on-year rise in housing inventory, thanks to remote work...but could this mean leaving behind mostly retired old people and people receiving government subsidies for basic needs (housing, SNAP, Medi-Cal, SSI, etc.) who contribute less tax? Society needs taxes to provide public services for the common good, and make government leaders accountable to resident taxpayers!

Anyway, my own school experience was like Pink Floyd’s Another Brick in the Wall (1979) with thought control and dark sarcasm in the classroom.  Elementary school was my introduction to losing autonomy and forced assimilation into the ways of an institution – something alien to my free-range childhood at home (and I was spared daycare/preschool).  I hated age-segregation (as my tabula rasa peers simply were not as interesting as my parents/grandparents), imposed afternoon naps in kindergarten, authoritarian school bell ringing, rote memorizing, series of holiday celebrations (which shaped my preference for truth-seeking like de-colonizing Thanksgiving), etc.  I also became an introvert and autodidact, preferring the sound of silence found in the library where I could quietly explore my curiosity.  

“You tell me it's the institution

Well, you know you better free your mind instead”

--John Lennon & Paul McCartney, Revolution (1968)

Those formative years shaped my resistance to this day, always seeking home and community-based services (HCBS) options over institutions that impose hierarchical and regimented structures (mass control), squelching self-determination, creativity and uniqueness. Growing up in a tight-knit family and faith community, members took care of each other, so I never gave thought to institutional care.  When I began my career in investment management and personal trust administration serving high net worth clients (“banking very few, very well”), money bought everything needed to support aging in place. 

(As an intense 20-something-year-old, I yearned for a more challenging career than simply throwing money to solve problems, so switched to institutional trust focused on qualified retirement plans to benefit rank-and-file employees.  My encore career as gerontologist has been the most challenging, largely due to confronting ageism at all levels—individual, institutional, structural/systemic—and its harmful impacts on quality of life.) 

No elementary school library would be complete without libertarian socialist Nathan J. Robinson’s charming antifascist children’s book, Don’t Let the Pigeon Question the Rules: A Parody for Tyrannical Youngsters (2014), which promotes the law of conscience and critical thinking of alternatives (why it’s preferable to “befriend” v. “get” a puppy) than unquestioning obedience in servitude to officious authoritarian/totalitarian mortals.  Likewise, consider a return to New Deal economist John Maynard Keynes, who fought authoritarianism with economic policies to live the good life 😊, because the value of human life does not depend on economic productivity.   

“The moral obligation that we all have is to help sustain the life around us, and we hope that others will sustain us too when we are “feeble” and in need.

…In the United States, work is the point of life, rather than life being the point of work. In many European countries, leisure is taken very seriously indeed, and the purpose of working is so that we may have more of it (leisure)… Life is beautiful in and of itself, and I do not need the old folks to produce scholarly papers in order to care about keeping them alive.”—UK-born Nathan J. Robinson, “Animals Are Pointless, And We Should Be Too,” Current Affairs (Jan/Feb 2020) 

Long-term care (LTC)

As an introvert, I tend to approach work like a cultural anthropologist doing non/participant-observation.  I have worked in institutional LTC settings like adult day health care (ADHC), assisted living facility (ALF) and nursing homes (non-profit, public), so I regard them as hierarchical workplaces.  These LTC facilities operated on the assumption that imposing “structure” (routines) on the lives of retired older adults was somehow beneficial—yet more likely to benefit budgets and staff work schedules.  Thus, I also associate LTC facilities with the gnawing disaffection of my oppressive K-12 years that I would not want to repeat (try watching Groundhog Day every day).  Group travel tours are similar (“you’re on tour, not vacation!”) but manageable because they’re short-term.

While ADHC and nursing homes operate under the medical model (qualifying for Medicaid/Medicare funding) and infection control training was part of orientation, ALF are non-medical (private pay) and could benefit from training.  Medical or not, congregate LTC facilities all operate under economies of scale, mass production with little personalization, though some ALF try to market as luxury lodgings with nickel and dime fees for services. 

In my experience, ALF residents seemed to cope with institutional life (and their medical ailments) through alcohol consumption, cannabis (actually knew two residents who got wealthy from cannabis production enterprises!), and considering California’s End of Life Option Act (EOLOA).  Self-education important because California EOLOA contains conscience clause so health care provider has no liability for “refusing to inform a patient regarding his or her rights…and not referring an individual to a physician who participates” (see Deciding with dignity: The terminally ill patient's right to information about California EOLOA and Dale-Jablonowski v. University of California Board of Regents case dismissed). 

None of these coping mechanisms were available to residents at nursing homes that received federal funds because cannabis (Schedule 1 substance) and medical aid in dying remain illegal under federal law; alcohol abuse was non-existent due to interventions from interdisciplinary team concerned over interactions with drugs or fall risk.

At ADHC under Community Based Adult Services before COVID-19 pandemic, participants were required to stay on-site for at least 4 hours each day for reimbursement ($76 from Medi-Cal Managed Care, $90 from Veterans Affairs).  But this attendance requirement was never enforced and even I turned a blind-eye because participants were mostly showing up for specific services: health care (physical therapy exercises, monitoring of vitals, medication management, etc.), social services (as-needed care coordination, case management, counseling, etc.), and hot lunch (depending on menu).  Participants who stayed 4 hours mostly had cognitive impairment and seemed indifferent to activities with blasting music (holiday celebrations, coloring, puzzles, etc. reminiscent of kindergarten), and they did not leave early because ADHC was respite for their family caregivers.  One silver lining of COVID-19 pandemic has been allowing ADHC “without walls,” accelerating flexibility of reimbursement for services delivered in private homes…closer to On Lok’s Program of All-Inclusive Care for the Elderly (PACE) model that combines HCBS.

On Lok changed its tagline from “Experience matters in senior care” to “Where seniors embrace life.”  Though a partner to SF Reframing Aging campaign, On Lok ignored Reframing Aging Style sheet to change the language: “Say older people or older adults” based on research that these terms are perceived as “more capable than seniors.”  More substantively, unveiling this rebranding seemed to reinforce Old Lives Matter, during this COVID-19 pandemic.  Particularly in residential LTC facilities, fixation on older adults at risk has “othered” them as passive, dependent and vulnerable in a medical model that decided they should not be allowed to take certain risks like embracing life via social visits with precautionary measures in place, while allowing psychosocial risk of extended isolation to jeopardize their well-being and “will to live.”  It has been unsettling to learn about former clients/residents "deaths of despair” while being protected from COVID-19 risk. 

Blame Industrial Revolution’s compulsory mass education for age grading, and using age to organize the tripartite division of life course into schooling, work and retirement. I also resisted this age-segregated institutionalized life course, in favor of age-integration by mixing schooling, employment and retirement with all ages—especially older adults with stories to share. Now COVID-19 pandemic has blurred these boundaries with homeschooling, remote work, and leisure at home… with less age-segregation, perhaps another silver lining in this pandemic?

According to Pew Research, multigenerational households are back, mostly out of necessity:  A majority of young adults in the U.S. live with their parents for the first time since the Great Depression. Intergenerational connections can help reduce ageism, and maybe return to family as informal support for LTC?

Nowhere to go, and all booked up

Attended Gerontological Society of America’s Age-Friendly University Special Interest Group Zoom meeting to get ideas as I develop curriculum to integrate aging content in MSW curriculum that engages students and promote more age-inclusiveness. Cool to see a couple of scholars (Rona Karasik, Nancy Kusmaul) who are included in my literature review on importance of student interaction with older adults, based on theories of social learning and intergroup contact to challenge ageism. To adapt to remote learning, contact includes exposure to older adults’ stories in films and books. 

10^th annual Legacy Film Festival on Aging scheduled this month did not take place, so I streamed several films listed in Professor Karasik’s article, Two Thumbs Up: Using Popular Films in Introductory Aging Courses; only a handful appeared deserving of thumbs up; and such a dearth of older women! My eyes really needed a break from the screen, so I turned to finding literature about older adults with emphasis on intergenerational relationships. When did I last read fiction as I have been so occupied listening to non-fiction experiences of clients/older adults and reading gerontology literature?

When asked “what do you want to be when you grow up?” I considered working in a library or publishing (but ultimately decided on careers that involved travel), so going to indulge here with books…

Reunited with Mills alum to join President Elizabeth Hillman (RBG doll on bookcase!), faculty (Elder in Residence Patricia St. Onge and Natalee Kehaulani Bauer, who are Natives) and students for discussion of Tommy Orange’s There There: A Novel (2018), a multigenerational story of Native Americans in Oakland. Native Peoples who relocated from reservations to urbanized ancestral lands found no there there—just a concrete place, like Gertrude Stein returning to her childhood home to find rural Oakland gone.  Older women (Opal cares for three great-nephews, Maxine is guardian) use the power of storytelling as antidotes to generational trauma (self-medicating to hide/forget with substance abuse and violence as legacy of colonial racism and genocide), offering hope/healing through multidimensional stories of resistance and renaissance (Alcatraz Island occupation) in contradiction to stereotypes…source of greater authenticity in searching for heritage and identity than googling “what does it mean to be a real Indian.” And the idea of home as spiritual community is powerful.

Mills College put up for sale works by dead white men: Shakespeare’s First Folio (1623) sold for nearly $10 million, and handwritten score by Mozart (1770s).  Persimmon Tree, a quarterly magazine by women over age 60 and published in association with Mills College, paid tribute to RBG in its latest issue. 

Litquake co-founder Jane Ganahl (also writes about solo aging) hosted discussion with Amy Tan (Boomer) and Kevin Kwan (Gen X), who both wrote books made into films about filial piety in Chinese families, The Joy Luck Club (1989, 1993) and Crazy Rich Asians (2013, 2018).

During her Zoom appearance, Amy moved her head away from screen several times, so got peek at her craftsman house in Sausalito, with views of SF Bay and Angel Island.  After contracting Lyme disease over 20 years ago, Amy and her hubby made plans to build an all-accessible two-bedroom house to age in place, with elevator, roll-in showers, walk-in bathtubs, wide sliding doors, etc. designed to be functional and beautiful using African mahogany and Asian aesthetic. 

Where the Past Begins: The Life and Work of Amy Tan documentary for PBS was in progress by filmmaker James Redford, who died at age 58 from liver cancer this month. 

Rachel Khong moderated Good Things in Small Packages: Writing Short Stories at Litquake.  She wrote short stories, magazine article about her Po-Po (grandmother) who had Alzheimer’s, and then her first novel, Goodbye, Vitamin (2017), about a millennial who returns home to help care for her father, a retired history professor diagnosed with Alzheimer’s. Probably should check out this novel before its film starring Constance Wu of Crazy Rich Asians.

Senior Planet’s Ryan Kawamoto hosted Ruth O. Saxton (ROS) Presents: Stories That Defy Expectations of Old Women.  Ryan introduced ROS as his classmate’s mother and Mills English Professor Emerita, recently retired after 46 years.  This spring she taught her final course with 15 Mills students and 30 Oakland Senior Center participants who were hungry for conversation beyond bingo and ballroom dancing activities.

Her latest, The Book of Old Ladies: Celebrating Women of a Certain Age in Fiction (2020), was a 20+ year project, begun at age 60 and interrupted by traumatic brain injury from a 2004 car accident.  To gather “examples of good aging,” ROS asked for recommendations, googled, hired students to look for stories, reviewed 100 stories before whittling to 31 stories organized in 5 chapters (Romancing the Past, Sex After Sixty, Altered Realities, It’s Never Too Late, and Defying Expectations).  After printing 800 copies, book sales going well so her book is being reprinted. (UK blogger Caroline Lodge maintains Older Women in Fiction Series.) 

ROS resisted “deathbed bookends,” or stories of a fictional older woman at her deathbed pining for unrequited romance of her youth, and challenged other stories of being a wife and mother as incompatible with career, citing her privileged position as white academic at an all-women’s college. (During this pandemic, women working in academia have struggled with demands of work and caregiving, with reduced productivity that could jeopardize their ability to get tenure—further exacerbating the gender gap where women represent 40% of tenured faculty…but perhaps this pattern is less so in an all-women’s college? ROS' daughter Kirsten T. Saxton, Mills '90, is also Mills Professor of English. Mills faculty can enroll children up to age 10 at Mills College Children's School on-campus.  In general, record numbers of women have dropped out of the workforce during pandemic, which has implications for their retirement security.) 

To combat ageism, ROS recommended: don’t let anyone tell you what you can’t do because you’re a certain age; have friends of all ages including your own cohort age; instead of young people limiting conversations with older people to nostalgia (“what was it like when you were little?”) talk about the present as well. 

SFSU Creative Writing Professor Carolina De Robertis (Mills MFA ’07) hosted super engaging chat with her former student, Jose Antonio Vargas (SFSU BA, Political Science, ’04),  about his memoir, Dear America: Notes of an Undocumented Citizen (2018).  Jose’s grandparents made it possible for him to immigrate from Philippines to California, in pursuit of the American Dream.  At age 12, Jose separated from his mother in the Philippines to live with his grandparents in California after his Lolo (grandfather in Tagalog v. Hawaiian word for idiot) paid $4,500 to a smuggler.  However, after Jose came out gay as a teenager, Catholic Lolo rejected him viewing homosexuality as a sin and complicating plan for Jose to marry an American woman to gain citizenship (before gay marriages became legal).  

As Jose turned to school as his “second home,” he benefited from mentors like his high school principal and superintendent who connected him to a network (“underground railroad”) that financed his SFSU education, living expenses, driving lessons and obtaining a driver’s license so he could pursue journalism. Jose explained that if freedom for undocumented persons like himself doesn’t come from government reform, then it must come from the people you trust: “Surround yourself with people who will say yes to you, who will open windows when all those doors are being closed.  Your survival and your strength comes from that.”

Jose decided to become a journalist because if he was not supposed to be in USA because he didn’t have the right kind of papers, he would write his existence into America by publishing his name (byline) on paper! But this risky endeavor concerned Lolo, who expected Jose to work in unassuming low-paying jobs that undocumented people often take.  Instead, Jose shared a Pulitzer Prize with other writers at The Washington Post.

At age 30, Jose came out as undocumented in his “Outlaw” (2011) essay published in The New York Times, followed by Documented: A Film by an Undocumented American (2013).  Jose faced age discrimination, being “too old” for adoption as a teenager and being “measly one year” over age 30 limit to qualify for DREAM (Development, Relief, and Education for Alien Minors) Act. 

“No human being is illegal.”—Elie Wiesel 

Though Jose thought “life did not start until 40,” he started writing his memoir at age 36 because he was tired of lying (not talking about his mom in Philippines, except with his grandparents), “passing” (replacing his native Tagalog with PBS manner of speech), and hiding (affecting his own mental health).  Jose used his handwriting on book cover, re-writing narrative of being undocumented=not citizen.  He also called out hypocrisy: undocumented farmworkers who are essential workers, but not essential humans?

http://sitn.hms.harvard.edu/flash/2020/racial-disparities-in-covid-19/

Public Service Announcement: Black, Indigenous, and People of Color (BIPOC) have been dying disproportionately from COVID-19, including many immigrants making up the majority of essential workers who more likely interface with others and sometimes without adequate protections (like employers who fail to provide PPE to workers who care for sick/frail people).  Support Essential Worker Bill of Rights! 

Jose also directed White People (2015), interviewing white millennials for MTV documentary...would be great to see follow-up on Old White People! Or undocumented older people who are also “lying, passing, hiding” with no place to age? So important to hear oral histories of diverse older people to counter white-washed history. (Happy 51st anniversary, Ethnic Studies!) When I worked in ALF, residents decided to “cancel” Thanksgiving after empathizing with painful history of genocide from watching Great Courses Plus series on Native Peoples of North America.  If more people can act likewise to cancel Thanksgiving gatherings, no worries about spreading coronavirus! 

Carolina also shared The Purpose of Power: How We Come Together When We Fall Apart (Oct. 2020), memoir and activist book by Alicia Schwartz Garza (SFSU MA Ethnic Studies ’17), co-founder of Black Lives Matter movement and organizer with National Domestic Workers Alliance.   

Institute of Noetic Sciences (IONS) hosted Shifting Ageism: How Consciousness Affects Our Experience of Aging. 

According to the history of ageism, older adults as knowledge keepers (storytellers) for the community began to lose their status when the printing press was introduced in 1440.  Yet, living older adults retain value with their oral histories (memories)—particularly if invited to dialogue.  Being genuinely curious enough to listen to older people about their lives and ideas have led to ideas about my own future, what really matters in life, adapting to and surviving challenges, etc.—how to become a more understanding person?

“Local” privilege

Attended Weaving Voices: Looking to Our Past for New Political Visions, which asked, “What kind of leadership do we need to take us out of COVID-19?” This Zoom meeting featured recorded oral histories of political leaders “to revisit the era of economic change from plantations to tourism, and political change with the return of AJAs and rise of the Democratic Party in the 1950s…sparking huge transformation.”  Following statehood, Hawaii Lt. Governors were Native Hawaiian-Chinese: James Kealoha (Republican 1959-1962), William Shaw Richardson (Democrat 1962-1966).

Included in the otherwise all-male lineup of politicians was Helene Hale (1918-2013), who represented Big Island of Hawaii, retiring at age 88 after suffering a stroke. 

Because my parents are aging in place in Hawaii, I pay attention to COVID-related news that might impact them.  I decided to postpone visiting them, especially frightful to learn how COVID passengers allowed to fly and/or die on flight. Hawaii government’s COVID response has been so frighteningly chaotic during its latest surge that U.S. Surgeon General Jerome Adams was dispatched to provide federal support for COVID-19 testing and contact tracing (after purge of incompetent state health and public safety officials placed on paid leave), and then Hawaii police arrested Adams for taking pictures in a public park! 

Anyway, this political visions program based on oral histories of long-dead politicians could have benefited from voices of living kupuna, preferably Native Hawaiian (like University of Hawaii Professor Emeritus Haunani-Kay Trask), “talk story” based on memories of this transition when Hawaii went from Republican (haole, Chinese) to Democrat (Japanese, Filipino) rule, political party identification stratified along race/ethnicity and social class; Hawaii stuck in Democratic Party groupthink (giving meaning to Ezra Klein’s claim that opposite of polarization is suppression, not consensus).  Sounds like Hawaii needs another transformation to get out of COVID!

“If the Republican Party gave us sugar, the Democrats gave us Waikiki.  If the Republican Party gave us racism, the Democrats gave us another form of racism.”—Haunani-Kay Trask, Centennial of the Overthrow (Jan. 17, 1993)

Two non-kupuna, non-Native, non-local panelists (one female, one male so at least there was some gender diversity!) alluded to current leadership challenges like lack of accountability in Democratic Party (“incumbency protection racket”), lack of transparency in Governor’s suspension of Sunshine laws that closed off public meetings/records during pandemic, less economic diversity from working class representatives like earlier politicians who grew up in plantations to be “more responsive to social welfare issues”, etc.

“Today, modern Hawai’i, like its colonial parent the United States, is a settler society. Our Native people and territories have been overrun by non-Natives, including Asians. Calling themselves “local,” the children of Asian settlers greatly outnumber us.  They claim Hawai’i as their own, denying indigenous history, their long collaboration in our continued dispossession, and the benefits therefrom.”—Haunani-Kay Trask, Settlers of Color and ‘Immigrant” Hegemony: “Locals” in Hawai’i (2000) 

What I found noteworthy in program (but not highlighted by panelists, even after my question about plantation "no make waves" culture stifling progress was read during Q&A) was recording of State Senator John Ushijima (1959-1982) discuss how attending college in the mainland gave “locals” a different perspective from the prevailing “plantation mentality” and motivated them to seek change for “mobility.” Note current Hawaii Governor: “local” who never lived outside Hawaii for any substantial time to gain a different perspective, so he maintains status quo, like denying Medicaid to Micronesians and approving retroactive pay raises for unionized state workers despite growing budget deficit during pandemic.

“When I think back on all the crap I learned in high school

It’s a wonder I can think at all…

Everything looks worse in black and white…”

--Paul Simon, Kodachrome (1973)  

These are mere observations as I have no family history connected to plantations in Hawaii, which gave rise to “local” culture like mixed plate and Pidgin English, synthesizing disparate ethnic contributions to reinforce polarization of insider (“locals”) v. outsider (haoles, recent immigrants) and marginalization of Native Hawaiians seeking sovereignty.  Interracial people seem to identify with group based on appearance, like Barack Obama identifies as Black, though he was raised by haole mother and maternal grandparents. 

Generational trauma seems to keep Hawaii as provincial small-town: “Locals” size up people based on “eh, where you wen’ grad (high school),” fluency in Pidgin/Hawaiian Creole English (resistance against Standard English representing haole oppression), ethnicity, and tanned complexion.  Forget racial paradise myth: “locals” (as in Asian settlers, rather than Native) take care of their own tribe in plantation tradition of “divide and control,” rampant patronage, ethnic groups pitted against another (ethnicity-based pay differential, segregated housing), resulting in shabby treatment to Native Hawaiians and most recent immigrants – painfully apparent with Micronesians during this syndemic. Leave it to “locals”/their allies to praise their replication of racial capitalism/plantation village built on a floodplain for formerly homeless families that provide source of cheap labor (exploitation) to benefit nearby laundry business owned by former First Lady.  Is this indicative of leadership that will take “us” out of COVID-19? 

COVID-19 corner

Woo-hoo! Last week, SF became the 1^st Bay Area county and 1^st major city in California to rise to least-restrictive/minimal yellow tier for reopening during this COVID-19 pandemic.  Wonder how much being stuck at home to avoid smoke from wildfires helped?!

According to SF Department of Public Health (DPH) COVID-19 data tracker based on 681,211 test results reported to date: 12,399 positive cases and 148 deaths (64% male; 58% age 81+, 16% age 71-80, 14% age 61-70, or 88% of deaths age 60+; 38% Asian, 25% Latinx, 22% White, 6% Black; 1% homeless).  Total COVID-19 deaths: over 229K in U.S., over 1 million worldwide. 

SF has averaged 5,000 tests per day (exceeding goal of 1,800) and positive coronavirus test rate of 0.89.  Of the 20 most populous U.S. cities, SF has the lowest positivity rate and the lowest COVID-19 death rate. 

Yesterday, SF decided to pause further reopening next week due to uptick in SF’s key health indicators over last two weeks, COVID-19 cases (rise from 3 daily cases per 100,000 residents to 4 per 100,000, or 25% rise, signaling orange=moderate alert) and hospitalizations (rise from 23 to 37 patients, signaling red=high alert).  Data-driven SF DPH Director Grant Colfax reported other rises in COVID-19 cases, statewide and nationwide: 38% in California, 41% in U.S.; and since we don’t yet grasp the magnitude and potential duration of these increases, pause will help mitigate virus, adding “I wouldn’t be me unless I reminded you” to keep wearing masks, physically distance, wash your hands, avoid large groups, etc.    

According to CDC, self-reported engagement in COVID-19 mitigation behaviors (mask wearing, handwashing, physical distancing, crowd and restaurant avoidance, and cancellation of social activities) was highest among age 60+ (Boomers +) and lowest among age 18–29 group during April to June.  Whereas mask wearing increased over time, other reported mitigation behaviors decreased or remained unchanged. 

SF allows "shared spaces" for outdoor dining on sidewalks, so diners are unmasked while drinking booze and talking loudly—spewing respiratory droplets and aerosols further on passersby, practically forcing me to road facing traffic.  Unacceptable during this pandemic, so I called 311 to complain that outdoor dining should be in parklets, and my complaint was referred to SF DPH. Back in April, I emailed suggestion to SF COVID-19 Economic Recovery Task Force to adopt plexiglass partitions on dining tables as done in Hong Kong, which never shutdown dining during pandemic. 

While COVID-19 cases have increased, COVID-19 deaths appear flat mostly due to treatments learned six months after pandemic (that certainly benefited President Trump’s recovery from COVID-19).  In KZYX Coronavirus Update, Dr. Drew Colfax explained that physicians now know aggressive treatments for low oxygen level like use of ventilators may have been counterproductive; keep lungs dry instead of giving fluids that fill up lungs of COVID patients; rotate entire body regularly in prone position to increase oxygen; dexamethasone and remdesivir. This is reassuring news, unless one ends up with long-haul COVID, while we wait for vaccine/herd immunity. 

While adapting to New Normal, I miss hearing Dr. Drew Colfax’s earlier rants about how this COVID-19 pandemic was entirely preventable if there had been stronger national leadership.  This continues to be the case so worth repeating and ranting! It is unconscionable for government to fund corporate welfare, like $21 billion “no strings attached” COVID-19 relief to nursing homes (of which 70% are for-profit), without expectation to invest in resident care and safety of direct care staff.  Need to demand better because accountability and transparency is critical to take us out of COVID, restore public trust, and ensure survival of storytellers!

Dissent

“Fight for the things that you care about, but do it in a way that will lead others to join you.”— Justice Ruth Bader Ginsburg’s advice upon receiving 2015 Radcliffe Medal, and after former Justice David Souter introduced her as “tiger justice”; dissent jabot from RBG’s 2012 Glamour Woman of the Year Award   

My she-ro, Ruth Bader Ginsburg, died on Erev Rosh Hashanah, which makes her Tzadik (person of righteous deeds), according to Jewish tradition.  May her memory be a blessing. 

https://www.washingtonian.com/2020/07/16/rbg-wear-a-mask-signs-adams-morgan/

Like many RBG followers and her neighbors, who posted sidewalk sign “If you won’t wear a mask to protect your friends and family, do it to protect RBG,” I worried that she might get COVID-19.  Earlier this month, reports circulated about 87-year-old RBG officiating a wedding – outdoors, but no masks worn and no distancing for harm reduction—just two weeks after her latest hospitalization for cancer, a co-morbidity that raised her risk for severe COVID-19 if infected. Very disappointed: The bride’s careless tweet, “don’t worry, we tested negative!” sounded like President Trump’s testing only strategy, providing absolutely no reassurance, as false-negatives occur.  RBG’s death was reported as due to “complications from pancreatic cancer.”

I mourn the loss of RBG, who modeled how to fight for causes: Her pragmatic, incremental approach enabled laws to catch up with social movements over time, leading former opposers to join her.  RBG’s monumental Olmstead decision (1999) makes possible my encore career advocating for community living/aging in place, and her fight for gender equality has my eternal gratitude.  RBG brilliantly applied Americans with Disabilities Act (ADA) and Equal Protection Clause for inclusion of people with mental disabilities and both genders, previously denied rights and opportunities due to discrimination. 

I paid tribute to RBG, along with Mister Rogers, when their documentary films were released two years ago.  They are so inimitable that I have not seen actors imitating them in Hollywood films, On the Basis of Sex and A Beautiful Day in the Neighborhood.  However, I plan to listen to Derrick Wang’s Scalia/Ginsburg comic opera via WNED Classical radio on Nov. 7 @ 1 pm EST. 

https://www.nydailynews.com/news/politics/ruth-bader-ginsburg-funny-t-shirt-brooklyn-court-article-1.2151495

You can’t have TRuth without Ruth!

“When you write a dissent, you’re writing for a future court that will see the error into which your colleagues have fallen.”—RBG, “In Her Own Words,” Elle (Oct. 2014) 

I will miss RBG’s reasoned voice of dissent (for liberal minority), especially in these times when shouting and interrupting pass as debate.  RBG’s style was subtle like dropping “respectfully” before “I dissent.”   

Retirement

After RBG’s death, I was appalled at the meanness of people blaming RBG for not retiring 7 years ago during Obama’s 2^nd term so he could nominate a younger replacement to prolong “liberal” legacy. Why the fixation on life expectancy, based on risk factors like age and disease? To address partisan battles, consider judicial term limits instead of pressuring octogenarian justices to retire? 

At the funeral of Justice John Paul Stevens (JPS), who died from a stroke at age 99 last year, RBG shared her exchange with JPS in the last week of his life when they attended a conference in Lisbon: 

         RBG to JPS: My dream is to remain on the Court as long as you did.

         JPS to RBG: Stay longer!

JPS retired at age 90, after serving 35 years in the U.S. Supreme Court, and then went on to author 3 books, including 560-page memoir!

Thankfully for RBG’s retirement dissent, she became Notorious RBG at age 80.  RBG epitomized the Power of Oldness! 

With a lifetime appointment to the U.S. Supreme Court in 1993 (at age 60), why would RBG retire from a meaningful job that she loved after only 20 years? Sure, she had health issues, including 5 bouts of cancer, heart surgery, fractured ribs, etc. but nevertheless, she persisted with “full steam.”  Nothing affected RBG’s brain or ability for legal reasoning.  Grateful for her fierce work ethic and commitment fighting to protect our rights to the very end! Working Longer Solves (Almost) Everything: The Correlation between Employment, Social Engagement and Longevity. 

American Society on Aging (ASA) CEO Peter Kaldes hosted The Four Pillars of the New Retirement: Dramatic Changes for Aging and Aging Services, based on study prepared by Ken Dychtwald of Age Wave (pictured with his Medicare statement, which he said needs to be more user-friendly), and Ken Cella of Edward Jones, finding that people of all ages are reimagining the pillars of retirement: health, family, purpose, and finances. 

This was a more holistic approach than traditional retirement planning, based on 3-legged stool of employer-sponsored retirement plans + personal savings + social security (safety net). Yet, since study was sponsored by financial services company, lots of messaging how people are not financially prepared to retire and need to start saving/retirement planning while younger...and send $$$$ to professional investment managers to collect fees! Same old, same old messaging when I worked in financial services/retirement plans until Great Recession.

No surprise older generations (Silent Gen, Boomers) have remained more emotionally/psychologically resilient than younger generations (Gen Z, Millennials, Gen X) during COVID-19 pandemic.  Ken D mentioned safety net helps mental health. Yes, thank compassionate ageism for facilitating old-age welfare state! 

Almost 70% of Americans who plan to retire in the next 10 years say they have no idea what their healthcare and long-term care (LTC) costs will be in retirement.  This graph might help: expect 10 years in poor health for Americans who live to age 78.5. 

Thought about this chart after learning about two singer-songwriters who died yesterday at age 78.5+:  Helen Reddy of “I am Woman” (1971), my empowerment theme song forever (relate to “wisdom born of pain,” but not so much “I am invincible”), died in MPTF nursing home, no cause of death reported but she had dementia during last 5 years; and Mac Davis of “In the Ghetto” (1969), social justice song about vicious cycle of poverty, died after heart surgery. 

This month, 89-year-old Chuck Feeney, described to be “in poor health” and living with his wife in rented SF apartment, set aside $2 million for their retirement after donating more than $8 billion to various charities (including UCSF Global Brain Health Institute) via Atlantic Philanthropies.  Way to go, Giving while Living, Chuck! 

Family and community are important to living well with purpose.  Research found definition of family broadened, mostly driven by younger generation, to include "families of affinity” (66%) and related by blood/marriage/legal adoption (34%).  Majority (67%) of Americans say pandemic brought family closer together. 72% of retirees say one of their biggest fears is becoming burden on families; 71% of retirees willing to offer financial support to family, even if this could jeopardize their own financial future.  Wonder if this is reciprocal: Would adult offspring be willing to offer financial support to their retired parents, even if this could jeopardize their own financial future?

U.S. Government Accountability Office published Older Women Report Facing a Financially Uncertain Future (Sept. 24, 2020), based on focus groups with older women mostly age 70+.  Highlights: concerns about future of safety net (Social Security, Medicare), costs of health care and housing, lack of personal finance education negatively affected ability to plan for retirement, etc.  

Cost of retirement living highest in Hawaii, New York and California. 

Things to care about (lead others to join): Long-term care

At ASA Public Policy Town Hall, journalist Jay Newton-Small moderated audience poll and panel discussion with Charlene Frizzera, consultant (retired after 30 years at Centers for Medicare and Medicaid); Kathy Greenlee, JD, consultant (and former U.S. Assistant Secretary for Aging, 2009-16); and Kevin Prindiville, JD, Executive Director of Justice in Aging.  ASA Public Policy Committee asked U.S. Presidential candidates about policy initiatives to meet needs of older adults: Trump has not responded yet, Biden’s response posted on ASA advocacy site. 

In LTC reform, 79% of audience supported nursing homes that are “reimagined” as smaller, more home-like settings. Kathy added systemic changes needed for nursing home staff to be paid more; private rooms for residents; Medicaid paying for LTC impact on state budgets; disability community needs more options; more attention to health equity/intersectionality.

Nearly 62% of audience polled preferred to receive information electronically, followed by 26% talking with someone.  Charlene said COVID has been opportunity to force older adults to use digital tech; Kevin viewed information access as equity issue; Kathy added access needs to consider cognitive impairment, non-English, ADA, facilitation for telehealth. 

When it comes to monitoring and/or analyzing legislation, Kathy recommended looking to trusted experts who can do this for a living (yes, subscribe + donate to Justice in Aging!), at federal level sometimes it’s not about legislation but (agency) regulation, focus on budget driving programs so need “people on the ground” locally talking to legislators back home to advance budget items.

Whether candidates for elected office fully understand issues faced by older adults and are offering coherent policy recommendations, 94% of poll think candidates “need improvement.”

After mentioning that her father hid his Alzheimer’s diagnosis for 10 years due to stigma fears, Jay noted how Presidential candidates seemed to weaponize age and mental acuity, and asked is it appropriate to ask whether someone is sharp enough to be President at a certain age? Kevin replied this was inappropriate as ageist and ableist. 

(University of Illinois longevity researcher Jay Olshansky found that 77-year-old Biden and 74-year-old Trump are likely “super-agers,” who maintain their mental and physical functioning and tend to live longer than the average person.) 

Jay read my question (submitted anonymously) on whether candidate with narcissistic personality disorder (NPD) can properly hold public office? Long silence, then finally Kevin responded in politically correct manner, “is there such a candidate? All kinds of people with all different kinds of abilities can represent our country.”  I dissent, submitting that people with NPD lack empathy needed for leadership and NPD might explain failure to model COVID-19 public health orders like mask wearing! 

When Jay asked about cancel culture, Kathy mentioned she turned age 60 (making her eligible for Older Americans Act programs 😊), recognized term political correctness renamed cancel culture can be taken to extreme to shut down people, which she believes is a symptom, not cause, of distrust and lack of conversation.  For example, when she created Administration for Community Living to combine disability with aging, she worked hard to earn trust from disability field, asked “am I saying this correctly?” to learn her way, doing more listening than talking. (According to POLITICO survey, Gen Z and Millennials favor cancel culture more than Gen X and Boomers.) 

Ken Stern of Longevity Project, in collaboration with Stanford Center on Longevity, hosted Longevity and the Pandemic: A Look Back, A Look Ahead, virtual panel discussion with Laura Carstensen, Stanford Center's founding director (pandemic accelerating changes underway like addressing equity); Andrew Scott, London Business School economist/author of self-help book, The 100 Year Life: Living and Working in an Age of Longevity (2016) (pandemic as “viral attack on aging” and reveals which countries equipped to deal with aging society); Jack Rowe, Columbia Professor and Successful Aging co-author (need “complete redesign” of LTC, more intergenerational spaces via tax breaks and incentives, telemedicine paid by Medicare and insurance here to stay per stock market). Perhaps in response to my question about diversifying panel in July, this program included pre-recording from John Eu-Li of National University of Singapore (discussed Singapore’s success with infection control, Seniors Go Digital program). 

Gray Panthers SF convener Art Persyko moderated meeting on Nursing Home Crisis and Struggle for Aging in Place:

·       Marilyn Albert, Registered Nurse (retired) and advocate with Healthy California Now, explained problem out in open with 76,270 COVID-19 deaths in LTC facilities: private equity consolidation of for-profit hospital system invaded nursing home system to the detriment of health care quality. 

·       Pat McGinnis, Executive Director of California Advocates for Nursing Home Reform (CANHR), recommended lawsuits for nursing home deaths, take profit out of nursing homes; prioritize keeping people out of nursing homes by creating more affordable models to stay at home; get more legislators to care about issue than wait until their own family member needs LTC; non-profit Front Porch + Covia senior living communities.

·       Jodi Reid, Executive Director of California Alliance for Retired Americans (CARA), discussed successful fight against state cuts to Home and Community Based Services (HCBS) and advocacy for HCBS Long-Term Services and Supports (LTSS) in Master Plan on Aging (MPA). 

Coronavirus Commission on Safety and Quality in Nursing Homes released its final report, with lone dissent by Justice in Aging Directing Attorney Eric Carlson due to its imbalance: recommendations for federal government, but not enough to make nursing homes responsible for resident safety and quality of life. 

National Academy of Social Insurance (NASI) hosted virtual forum on Strengthening California’s Care Infrastructure: Poverty, Inequality, and Universal Long-Term Care. Kim Alvarenga of the California Domestic Workers Coalition moderated lively discussion with Fernando Torres-Gil, PhD, of UCLA's Center for Policy Research on Aging; California State Senator Richard Pan, MD, MPH (pediatrician); and Christina Mills of California Foundation for Independent Living Centers. 

Christina and Fernando shared their lived experiences that inform their commitment to strengthening formal safety net to fill gap in absence of informal supports.  As chair of both Senate Committee on Health and Budget and Fiscal Review Subcommittee on Health & Human Services, Richard recognized underinvestment in aging and sponsored SB 512 for actuarial study to create LTSS social insurance program, which was folded into Governor’s MPA. He talked about building political will and framing issue: how much will it cost if we don’t do social insurance program for LTSS? This will make people understand this is better choice for tax dollars.

In response to question about Billionaire’s Tax to help finance LTC insurance (similar to state’s Proposition 63 Millionaire’s Tax that funds expanded public mental health services), Richard cautioned about need for stable financing system as being dependent on state income tax is subject to swings like last year’s $20 billion surplus to this year’s $50 billion deficit.

(Likelihood of achieving universal health care not good where there’s too much income inequality.) 

Advancing Action, 2020: A State Scorecard on LTSS for Older Adults, People with Physical Disabilities, and Family Caregivers is based on these performance indicators: Affordability and Access; Choice of Setting and Provider; Quality of Life and Quality of Care; Support for Family Caregivers; Effective Transitions.  Top 10 LTSS states are: Minnesota, Washington, Wisconsin, Oregon, Vermont, Connecticut, Hawaii, Colorado, California, and Massachusetts.  Interesting to note that Florida, which has 2^nd largest population of older adults (after California), took last place at #51! 

Dishing with Debbie Toth, President of Choice in Aging and member of MPA Stakeholder Advisory Committee, featured Louise Aronson, UCSF geriatrician and author of Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life (2019), on discussion of ageism’s impact on health. Dr. Aronson mentioned insufficient medical school training in geriatrics, yet older adults are disproportionately patients; need health care system focus on continuum of care, body function, prevention v. medical system care for organs/disease that incentivizes serious illness in ICU/hospital and fails to view LTC as part of system.

Debbie talked about planning Choice in Aging’s Aging in Place campus: relocation of existing adult day health care and preschool, construction of 81-unit affordable senior housing, addition of case management.  She obtained 14 streams of funding for housing but no funding for services, though LTSS in HCBS cost is less than nursing home.

Brave space: race + age

Attended Critical Race Theory (CRT) as Tool to Dismantle Anti-Blackness in API Community, hosted by Asian Pacific Islander (API) Social Work Council, to get my dues worth as member of National Association of Social Workers (NASW).  In contrast to safe space, prefer brave space community guidelines: confidentiality; embrace discomfort; “I” statements; controversy with civility; own your intentions and your impact.  This Zoom session had mixed race audience with optional (voice by choice) interaction via video or chat: important to have conversations to understand where people are coming from, maybe find common ground, and keep Socratic dialogue going.

When and how should cultural identity (gender, race, age) differences matter? Try to figure out without constitutional law framework (i.e., discrimination based on race is suspect class subject to strict judicial scrutiny, gender is quasi-suspect subject to intermediate scrutiny, age/disability is subject to rational basis).  For example, why wasn’t old age included in diversity and inclusion criteria by Academy of Motion Picture Arts and Sciences, which announced eligibility reforms to best picture category, effective in 2024, addressing women, LGBTQ, underrepresented race/ethnicity, and disability? This could encourage inauthenticity of Hamilton musical, or re-make The Good Earth with real Chinese actors?! Older people “treated” better in documentaries, like RBG, Ralph Nader (An Unreasonable Man), and 7-Up adults (Up series).

Colorblindness reminds me of MLK’s aspirational “I Have a Dream” about not being judged by skin color but by character.  According to CRT, colorblindness can be a problem that perpetuates fallacy of meritocracy, like Asian model minority myth.  Reality is people have faced discrimination based on appearances like race, gender and age, so critical theory is helpful to question power/privilege and oppression in historical and cultural contexts, engage in consciousness-raising to see need for social change (“dismantle structural oppression”), and work toward emancipation of those who are oppressed. 

Oops, here’s where CRT can provoke/upset dominant groups, like President Trump’s Executive Order banning federal agencies from using tax dollars on CRT training, criticized for how it “engenders divisive, anti-American propaganda.”  Instead of coddling minds via cancel culture/censorship of different viewpoints, learning is about hearing other perspectives (beyond white-washed history), questioning for understanding, engaging in thoughtful silence, always reserving the right to dissent if you care; and if there’s thoughtless noise/profanity, best tune out! 

I embrace my discomfort with identity politics that lead to us v. them tribalism.  Colorblindness and age-lessness not enough, because sad reality is people from the same tribe oppress each other, too…since Biblical times, “man has dominated man to his injury” (Ecclesiastes 8:9).  And experiences of privilege and oppression are fluid in the context of time and place.  

Racism and ageism are hurtful.  Gerontologist Erdman Palmore's research on ageism had its roots in his research on racism: while studying at the University of Chicago in the 1950s, Palmore noticed similarity between stereotypes of Blacks and Old people.  

Colorblindness also calls to mind what RBG accomplished for gender equality, based on gender blindness, when (impressively in her first U.S. Supreme Court brief, Reed v. Reed, in 1971!) she successfully argued against different treatment of women based on a supposed pedestal that was often a cage for women, that so-called protections for women were limiting their opportunities.  And systems such as divisive laws permitting gender discrimination also oppressed men, whom she also represented so that they could receive government benefits (tax deduction, survivor benefits) enabling them to be caregivers to parents and children. Instead of bashing all men who represented patriarchy, fair-minded RBG recognized equal partner in her hubby (who was more extroverted with connections to help advance RBG’s legal career to the Supremes) and found common humanity with her ideological opposite buddy Justice Antonin Scalia (“some very good people have some very bad ideas”).

In her first U.S. Supreme Court oral argument in 1973 case, RBG citing powerful quote from abolitionist Sarah Grimké "I ask for no favor for my sex. All I ask of our brethren is that they take their feet off our necks,” triggers image of white police officer kneeling into neck of Black man lying face-down?

What to think about compassionate ageism, which places older people in “deserving” pedestal, based on risks associated with old age, such as poverty, frailty, dependency, discrimination, etc., enabling old age welfare system, mandatory elder abuse reporting, reserving seats for “seniors” near front of bus, etc.? While Social Security Act (1935) facilitated de-institutionalized ("aging in place") solutions for old-age poverty, Medicaid (1965) continued traditional indoor relief (poor house/nursing home) for people with chronic disease/disability conditions.

Compassionate ageism also has “othered” older people as passive and “deserving” of retirement.  Retirement might be anathema for people with a strong work ethic.  Gray Panthers founder Maggie Kuhn protested her forced retirement at age 65, especially the prospect of old age segregation at senior centers passing time with bingo games, sing-a-longs, no-strain-the-brain activities.  Homer Gere, father of actor Richard, delivered “meals and human interaction” as octogenarian volunteer for Meals on Wheels, featured in folksy public service announcement videos. (Now the elder Gere is 97 years old, unknown if he’s still delivering meals.) 

“Pizza delivery man, 89, receives $12K tip after going viral on TikTok” article included comments like “Somebody at that age should not be working that much” because he was working 30 hours a week during pandemic.  Was this compassionate ageism? Reportedly, he started delivering pizza because he couldn’t “afford his bills on Social Security alone.”  Unlike Chuck Feeney, he didn’t have $2 million in retirement savings, and safety net has become more precarious.  Social Security was amended in 1972 to provide for Supplemental Security Income, which is means-tested, so often refused as “lacking dignity”/stigmatized by Silent Gen (born 1928-1945) cohorts with strong work ethic.

Racialization discussion here got dicey, with example of questioning neutrality of laws in guise of benevolence like mandatory child abuse reporting due to concerns that welfare systems contribute to racialization, or respond in ways to reinforce stereotypes of certain minorities as criminals in need of social control.  Is there a similar argument for compassionate ageism’s mandated elder abuse reporting laws intended to protect older adults, who are viewed as a group that is vulnerable to certain age-related diseases that impair functional abilities including decision-making capacity (that is fluid) and potentially placing older people under conservatorship?  

NASW-CA supports Proposition 16 amending California’s Constitution to restore affirmative action based on race/ethnicity and sex, which was repealed in 1996’s Proposition 209.  Anything less of meritocracy is contrary to values of Tiger Mom Amy Chua, who identified “character traits” of superiority complex, insecurity, and impulse control to "rise" in socio-economic mobility among diverse cultural/ethnic groups like Chinese, Jewish, Mormons, Cuban exiles, Nigerian, Lebanese, South Indian, etc. in The Triple Package: How Three Unlikely Traits Explain the Rise and Fall of Cultural Groups in America (2014, co-authored with her Jewish hubby, recently suspended from Yale for his sexual misconduct).  Add social capital, which helped pull “forgotten poor white American” like Hillbilly Elegy's J.D. Vance (mentored by his Yale Law Prof. Chua) out of poverty.

Before Proposition 209, in Regents of UC v. Bakke (1978), U.S. Supreme Court upheld affirmative action by allowing consideration of race, but not racial quotas used by UC Davis Medical School, in admissions decisions…so white applicant Alan Bakke was admitted to UC.  But what really struck me was this: Bakke was denied admissions by at least two other med schools because he was considered “too old”—when he was in his early 30s during early 1970s—which is prohibited under Age Discrimination Act of 1975!  Race gets more attention than age...

Among Spirit of 1848 listserv members, there was lively debate about COVID-19 dashboards reporting on decedents’ underlying conditions and race, which began with a post of Vanderbilt History Professor Arleen Tuchman’s opinion piece, “Stop blaming COVID-19 deaths on diabetes: Once again, health disparities are being blamed on specific and allegedly racial traits while ignoring the role of structural racism.” Discussion got controversial as some members felt identification of race promoted racism, and thus argued unnecessary to report data on race. So déjà vu like initial reluctance to report race data during early days of COVID-19 pandemic due to xenophobia, fear and stigma associating Chinese with COVID-19.  

I prefer disclosure of data that can inform interventions.  Race is not a problem, but racism is a problem! In contrast, older age presents greater vulnerability to COVID-19 due to less functional immune system, plus ageism is a problem!  Yet confusion reigns because race is socially constructed.  Race might be useful in interpreting impact of racism on chronic diseases—as Professor Tuchman points out how racism exacerbates diabetes by raising stress and glucose levels.  Her book, Diabetes: History of Race and Disease (Aug. 2020) opens with chapter, “Judenkrankheit, a Jewish Malady,” finding that diabetes was considered a Jewish disease due to high prevalence and blaming racial stereotypes of neuroticism or gluttony (rather than poverty and stress of Jewish immigrants fleeing pogroms) in late 19th and early 20th centuries.  This was during a time when racial constructs in the U.S. were influenced by immigration policy, so there was debate about the degree of whiteness among Jews after immigration increased among East European Ashkenazi Jews, who many argued should be classified as Oriental (“purebred Asiatics") and thereby denied entry under Chinese Exclusion Act.  According to Professor Tuchman, history of racism and blaming "lifestyle choices" continue with diabetes associated with Native Peoples and African Americans.

Virtual Hawaii

Decided to postpone trip to Hawaii, which has 14-day quarantine for visitors and seemed less safe during this COVID-19 pandemic due to science-defying policies that place people at greater risk of harm, like closing access to free public outdoors spaces but allowing for-profit indoor bars, gyms and strip clubs to remain open? Why, in light of science community’s greater understanding of risks for airborne transmission of coronavirus in closed spaces? I dissent, and stuck to safer virtual visits to Hawaii…

Indulged in more Chinese-Jewish (called Pake-Jew in Hawaii) connection and listening to Silent Gen by joining PBS Hawaii screening + discussion of Harbor from Holocaust documentary about 20,000 European Jews who escaped Holocaust by immigrating to Shanghai, which already had a Jewish community and did not require visas for entry at a time when U.S. and Canada closed its doors to refugees.  Vienna-based Chinese diplomat Ho Feng-Shan issued about 2,000 visas to allow Jews to leave Austria for Shanghai. (Humble Dr. Ho lived in my SF neighborhood until his death, and I studied at Fudan University in Shanghai via American University program with mostly Jewish socialists.) 

PBS Hawaii Director Leslie Wilcox (leaving next year to mainland for family caregiving) hosted discussion with this woman-majority production team: Shanghai-born director Violet Du Feng, producer Darryl Ford Williams, and 86-year-old Shanghailander Doris Fogel.  Doris related living in cramped quarters during violent Japanese occupation, making friends with Chinese who were equally vulnerable (“together, we didn't have much but we took care of each other”) and learning street smarts during her 9 years in China, then left for Illinois after WWII ended.  

Documentary also featured 79-year-old Laurence Tribe, recently retired Harvard Constitutional Law Professor, who was born in Shanghai to Russian Jewish immigrant parents, and then left for SF. Wish he was included in PBS Hawaii discussion as he successfully represented the state before U.S. Supreme Court in Hawaii Housing Authority v. Midkiff (1984), upholding state’s use of eminent domain to force transfer of leased land to fee simple in land redistribution scheme. (Arguably, this landmark case facilitates aging in place because ownership is more secure than leasehold.)  

Got more of my dues worth attending NASW Hawaii’s Webinar Wednesday on Grief, Loss, and End of Life Transition During a Pandemic with Leilani Maxera, MSW, MPH (and Mills sista!), sharing survival guide tips like Go outside (or look outside)!

COVID-19 update

According to SF Department of Public Health (DPH) COVID-19 data tracker based on 506,677 test results reported to date: 11,275 positive cases and 104 deaths (68% male; 52% age 81+, 19% age 71-80, 15% age 61-70, or 86% of deaths age 60+; 39% Asian, 28% Latinx, 17% White, 8% Black; 1% homeless).  Total COVID-19 deaths: 205,859 in U.S., over 1 million worldwide. Yale researchers believe COVID-19 deaths in U.S. could be undercounted by as much as 28%. 

UCSF infectious disease specialist Peter Chin-Hong, MD, who has presented many COVID-19 townhalls (with Diana Lau, RN, interpreting in Cantonese) since COVID-19 pandemic declared in March, moderated (monolingual English) Asian Health Institute (AHI) COVID-19 Roundtable with UCSF faculty representing internal medicine, infectious disease, cardiology, oncology, psychiatry, endocrinology, and women’s health.  Despite COVID-19’s disproportionate impact on older people, geriatrics missing from panel!  Janet Chu, MD, MPH, discussed challenges due to inconsistent reporting of data for Asians, who might be aggregated with Pacific Islanders or “other.” (Filipinos can claim to be Asian, Hispanic/Latinx, or Pacific Islander.)

According to APM Research Lab’s The Color of Coronavirus findings from COVID-19 data as of Sept. 15, 2020: 1 in 1,400 Pacific Islander Americans has died (or 71.5 deaths per 100,000), 1 in 2,470 Asian Americans has died (or 40.4 deaths per 100,000). 

In SF, Asians continue to have highest COVID-19 death rate and low COVID-19 testing rates.  Are Asians as model minority (who took to wearing protective masks early in the pandemic) being perpetuated in failure to include Asians as one of the vulnerable populations at risk of COVID-19 in SF DPH's Health Advisory: Prioritizing Populations with Structural Barriers to Health in COVID-19 Care Response (which lists Black, Latinx, Native/Indigenous, and Pacific Islander)?  

Asian COVID-19 deaths were highest in age groups 65-74 (18%), 55-64 (17%), 75-84 (15%), 45-54 (13%) and 85+ (12%) – statistically different from studies reporting increased risk of COVID-19 at older ages.  Discrepancy might be related to inaccurate reporting of Asians with COVID-19? 

UCSF infectious disease specialist Monica Fung, MD, discussed COVID-19 symptoms while noting 40-45% of infections are asymptomatic.  This upcoming flu season may be confusing as fever, chills, body aches, sore throat, nausea/vomiting/diarrhea are symptoms of both flu and COVID-19; one distinguishing symptom of COVID-19 is sudden loss of smell/taste. 

This chart presents data showing rising hospitalization and death rates with older age groups.

UCSF geriatrician Anna Chodos presented Our Crisis: Geriatrics and the Public Health Response in Nursing Homes and Residential Care Settings during COVID-19: 40% of U.S. COVID-19 deaths are linked to nursing homes. 

Quadruple aim for COVID-19 response for LTC facilities: readily available testing of staff and residents; sufficient and properly used PPE; stellar infection prevention; and emergency preparedness/incident command mode.

RCFEs aka assisted living facilities (ALFs) are non-medical facilities, less regulated than nursing homes with respect to staffing and infection control requirements. They have experienced “significant increase” in COVID-19 cases and deaths, while mostly left on their own to respond.  In SF, memory care unit in ALF reported COVID-19 outbreak affecting 17 residents and 12 staff, with at least one death. 

During my stint in SNF, there was full-time RN infection control specialist and dozen Social Services staff.  SNFs require social services – critical role, though no mandate for licensed clinical social worker (LCSW) – which seems to reinforce their lower status in medical model/nursing home relative to other mostly licensed/certified staff for nursing (RN), physical therapy, nutrition (RD), psychologist, physician assistant, geriatrician, psychiatrist, etc.

SF DPH finally updated health order to allow outdoor visits at LTC facilities, so retired geriatrician Teresa Palmer’s in-person visits with her 102-year-old mother were featured in SF Chronicle and J Weekly! 

Two weeks ago, Laguna Honda sent email seeking volunteers to observe outside visitation.  Wondered if this could be opportunity to resume my thesis research on Nursing Home Social Work Interventions, so called to inquire. Volunteers need to sign-up for 4-hour afternoon shift, which involves volunteer taking COVID-19 nasal swab test, reviewing rules (masks, distancing, no contraband, 1-hour limit), and reporting violations to staff for enforcement; visitation was being rolled out gradually with just one visit per day.  Need to wait for better air quality.

Yes, geriatricians rock! Dr. Chodos co-authored study of first 50 COVID-19 deaths in SF, nearly half from LTC facilities.  Nearly half of COVID-19 decedents in LTC facilities did not present with typical COVID-19 symptoms of fever, cough or shortness of breath.   Instead, COVID-19 facility residents more likely presented with altered mental status like confusion or lethargy, and more likely to have dementia. 

Older adults continue to be excluded from COVID-19 vaccine and cardiovascular clinical trials. 

Dr. Anthony Fauci said that even an effective COVID-19 vaccine won't replace the need for other public health measures, such as wearing a mask, distancing and washing hands. 

Yesterday, SF moved from the state’s red to orange tier, allowing reopening of restaurant dining rooms.

"We have to be on guard, unfortunately. Everyone is yearning to aspire to the life pre-COVID and this isn’t the time for that.  COVID is still simmering in the community. It’s not like the plague is over and we can all hold hands and rejoice…I think if I was older and had co-morbidities, I personally wouldn’t do the riskier things and I’d still be leery of indoor stuff, especially until this orange status has sustained for a longer time,—UCSF infectious disease expert Peter Chin-Hong, MD, “Experts urge caution as San Francisco expands reopening,” SF Gate (Sept. 30, 2020) 

Last month, he called out people’s failure to distance and wear masks at Dolores Park as “reckless” and “as scary as American Horror story, the COVID version.”  Not long after, smoke from wildfires added to plague.

More things to care about (lead others to join): Community care

In addition to dying disproportionately from COVID-19, an estimated additional 1,200 to 3,000 Californians age 65+ died between August 1 and September 10 from wildfire smoke-related health conditions, according to Stanford researchers; most had pre-existing medical conditions.  

Amid this unprecedented wildfire season, California Governor issued executive order to phase out sales of new gas-fueled vehicles by 2035 in effort to combat climate change. 94-year-old Sir David Attenborough hopes to fight climate change in a way that others will follow him on Instagram: “Don’t waste anything!”   

September 10 is World Suicide Prevention Day, so IOA hosted Older Adult Suicidal Ideation During COVID-19: Understanding & Prevention with Patrick Arbore, EdD, who founded Center for Elderly Suicide Prevention’s Friendship Line in 1973.  He discussed how COVID-19 pandemic has increased the risk of suicide for older people, especially those who live alone as physical distancing mandates strain coping strategies when the tendency is to reach out to people in physical spaces and in-person encounters that have that have been restricted during pandemic. The emotional consequences of chronic stress exacerbate feelings of anxiety, fear, depression, loneliness, and social isolation that can lead to thoughts of suicide.

Before the pandemic, suicide rates were increasing (after falling 1979-2000).  According to California DPH, suicide rates peak at multiple stages throughout lifespan: young adults ages 25-29, middle ages 50-64, and highest at age 85+ group; suicide rates are highest among American Indian/Alaskan Native & White populations; firearms (37%) are leading method of suicide death.

Interpersonal theory of suicide explains late-life suicide: as older people are more likely to experience shrinking social networks (decreased belongingness) and dependence on others due to functional decline (increased burdensomeness).  Being socially connected helps individuals maintain a sense of control and access coping resources; opposite effects with social network losses, such as experienced during late life transitions (retirement, widowhood, residential moves, etc.).

Patrick called COVID-19 pandemic “a time of collective sorrow.”  According to California DPH, as of Sept. 6, 2020: out of 13,596 COVID-19 deaths, 82% were people age 60+.  Ambiguous loss associated with COVID-19 deaths (lacking clarity/finality due to unpredictable losses, denial of being present at time of death/burial ritual) make it very hard to move forward.  Patrick quoted Weir (2020), “We’re talking about grieving a living loss—one that keeps going and going.”  He noted that mental health effects of pandemic are profound, so suicide prevention needs urgent consideration.  Patrick mentioned that most intervention and prevention programs are based upon known risk factors for Caucasians due to their higher rate of suicide in the past. 

Patrick offered these communication strategies:

·       Remember grief + loss is uniquely personal experience

·       Listen compassionately to individual’s stories about their suffering

·       Reassure individuals that you will not abandon them

·       Be aware of resources in communities that support lonely people

·       Ask directly about suicidal thoughts; discuss both sides of suicide equation: reasons for wanting to take one’s life, and one’s psychological strengths and life-affirming reasons for not doing so

·       Pay attention to “daily hassles” experienced by older adults

Linda McKay related her 64-year-old husband Eric Swenson’s suicide by shooting himself at Mission Police Station in 2011, and his suicide note explaining his depression and not wanting to be a burden.

Joined virtual meeting of All Together Now: Dr. Vivek Murthy in Conversation with Dr. Anita Friedman, who asked what’s going on during this pandemic with older adult population who are “losing their zest for life” due to isolation? Dr. Murthy, author of Together: The Healing Power of Human Connection in a Sometimes Lonely World (2020), responded: you see a peak of loneliness often after the age of 80, but many people who are in their 60s and 70s experience loneliness at lower levels than people who are adolescents and young adults. 

“It has to be wrong reinforcing as it does that to be older is to be lonely, isolated, dependent, lacking resilience, sick, in poverty, frail, voiceless and disempowered, the list is endless. Increasing profits or donations by turning me into a commodity and then marketing my ageing self or feelings and emotions in ways that I do not recognise, is dehumanizing and offensive…The notion of victimhood within the context of loneliness feeds the ageist myths… appointing a Minister of Loneliness (England) normalizes the continual exploitation of older adults and is simply a political absurdity.”—Mervyn Eastman, “Manufacturing and manipulation of loneliness in later life narrative,” Co-operative Merv Unleashed (Aug. 9, 2020) 

Merv’s dissent reminds us that “chronic loneliness is not confined to our later years, but exists across all generations” and "loneliness is an economic and societal challenge brought about by lack of meaningful human interaction, belonging and purpose.”  

nature + design

COVID-19 pandemic and wildfire smoke (including Sept. 9 when SF sky was dark orange) has reinforced importance of fresh air and sunlight, which are part of nature.  Ideally, our built environment is designed to maximize our connection to nature which is healing.

Joined Northern California Psychiatric Society (NCPS) and Psychiatric Foundation of Northern California (PFNC) for Nature’s Healing Benefits presentation by Ecotherapy Specialist Darlene DeRose, who worked in financial services before returning to JFK University to study Ecotherapy, Consciousness and Transformative Studies.  We can experience physical, mental, social and spiritual health benefits from being exposed to nature 20-30 minutes a day, based on theories of attention restoration and stress recovery.  

Yes, nature sounds—water, wind, birdsong—do not include construction noise (lots of remodeling going on in my neighborhood) and neighbor's barking dog who probably needs to be let loose outdoors (ecotherapy includes animal-assisted therapy if conducted outdoors). 

Yes, nature inspires awe, transcendence, communion with Mother Nature/Creator.

After this Zoom presentation, I was ready for ecotherapy, so inspired to take a walk outside and reconnect with nature…but remained cooped indoors because AirNow quality was very unhealthy purple (“risk of health effects is increased for everyone”).  

As an aging-in-place advocate, I enjoy learning about designing “forever” homes, incorporating universal design.  COVID-19 pandemic has inspired re-design of LTC facilities for better infection control, improved air ventilation and other resilient design features.

“During Florence Nightingale’s time as a nurse in the 19^th century, she recognized the benefit of fresh air and sunlight for patients. It seems that we have come away from that, but are trying to circle back. Aesthetics are quite important including ventilation, views to nature and access to sunlight…Many people say that for architects, the concept of place matters, but I would like to suggest that for everyone, design matters.”—Diana Anderson, MD, MArch, “Remodeling healthcare through architecture,” Doctors Who Create 

Trauma Informed Design: Designing for Dignity, Healing, and Joy! introduced this framework to design built environment to help people experience resiliency. 

Questions to ask: How to tell if a building is trauma-informed?

·       How have people with lived experience had a say in design of this project?

·       How has the specific lived experiences or identities of potential residents informed the design of amenity space (indoor/outdoor), apartments?

·       How does this building assist individuals in building relationships, both with staff and fellow residents?

·       How does this building help residents experience joy? Create space for grounding? Offer dignity? Ensure residents feel and are safe?

Biophilia design features focus on nature in space (daylight, natural elevation, indoor/outdoor balance), natural analogues (elements of nature shapes/materials), and nature of space (viewpoints offer feelings of expansiveness and security, while places of refuge provide protection and comfort; circular spaces, getting outside). 

Environmental gerontologist Esther Greenhouse (who has perfect last name for the work she does) presented Equity by Design series on Creating Enabling & Equitable Housing and Multigenerational Communities, based on AARP International Statement of Built Environment Principles. 

Urban planner Ifeoma Ebo created Safe Places, Active Places! Community Playbook for Transforming Public Spaces in Your Neighborhood (2019) to improve safety and well-being through the built environment, programs and policies that activate ethic of care and compassion; pandemic resilience design makes use of open spaces on ground floor, housing with outdoor spaces.

Other pandemic designs: low-maintenance Freedom House with wraparound porch; World Alzheimer Report 2020’s Design, Dignity, Dementia: dementia-related design and the built environment for and with people living with dementia.   

While air quality was poor, watching The Dark Divide was like virtual forest bathing.  After fresh air returned, took “awe walk” through SF Botanical Garden, communing with plants from around the world!