"Shouldn’t we be
moving from the concept of self-care to a broader, more inclusive notion of
collective care?...
While looking after
yourself is great, self-care is still an idea rooted in a neoliberal tradition
of looking out for ourselves, rather than seeing ourselves, our health and our
fates as inextricably linked to our fellow human beings.
Wouldn’t it be
great if this decade we took the self out of self-care and
strived instead for communal care?
Self-care is
saying “I need to look after me”, while collective self-care is saying “we need
to look after each other”…
Communal care
can include things like being a better neighbour, making yourself available for
people who may need support, communities supporting each other emotionally and
practically during crises such as the bushfires, to larger, more macro reforms
and structural changes in society, such as advocating for universal health
care, …”—Brigid Delaney, “We need to move on from self-care to something that cannot be captured by capitalism,” The Guardian, Jan. 30, 2020
Self-care is so passé
from last decade of 2010s, something Millennials may have absorbed from Boomer
parents who came of age during the narcissistic Me Decade of the 1970s? Millennials and Boomers continue to be divided, with the former calling the 2019 novel
coronavirus disease (COVID-19) “boomer remover” (referring to higher mortality
among older adults infected with coronavirus), and accusing each other of
ignoring public health guidance.
Seems this neoliberal
pursuit of self-interest motivated governments in framing their response to the
rapidly evolving COVID-19 pandemic as a binary choice between saving vulnerable
human lives and “saving the economy”? U.S. Senators were quick to engage in
insider trading, selling off holdings in retail stores and airlines, buying up Personal
Protective Equipment (PPE) and telework software companies.
"There's a
choice we're making,
We're saving our own lives,
It's true we'll make a better day, just you and me”
We're saving our own lives,
It's true we'll make a better day, just you and me”
--Michael
Jackson & Lionel Richie, “We Are the World” (1985)
Political
correctness (fear of racism charges) was blamed for Italy government’s slow
response to COVID-19. Notably, left-wing
Florence Mayor Dario Nardella began “Hug a Chinese” campaign on Twitter last
month, calling for “unity in this common battle,” and a video was posted
showing a street demonstration by Chinese (“I’m not a virus. I’m human.
Eradicate the prejudice.”) man wearing a face mask that is removed by a hugger!
Public health emergency => collective
care
In
response to the global COVID-19 threat first identified in Wuhan (China), San
Francisco Mayor London Breed encouraged supporting Chinatown business after she
declared a state of emergency on February 25 to mobilize resources (federal and
state reimbursement $) toward containment of any outbreak, and its proactive
Department of Public Health (DPH) had been monitoring people returning from
travel in China. Last month, experts were more concerned about flu outbreak while
monitoring COVID-19 situation (and
local news was preoccupied with ethics and bribery scandals involving SF Mayor
and her ex-boyfriend who resigned as Public Works Director after his FBI arrest). In late February, 79-year-old House Speaker
Nancy Pelosi did her “Come to Chinatown” trek, and I continued medical social work outreach
inside crowded single-room occupancy (SRO) hotels in Chinatown, in contrast to
the nearly empty streets outside due to fears of “Chinese virus” or “kung flu,” stigmatizing Chinese
or Asians, who seem to all look alike to the clueless. (WHO does not name diseases after animals and
places; Spanish flu did not originate in Spain, a neutral country that made news
of 1918 influenza epidemic public.)
While CDC has not recommended masks for the general public, many Chinese wear face masks out of communal concern, reducing stigma. Particularly in East Asia, face masks are worn for protection against virus outbreaks, air pollution, cold weather—and seen as part of people’s collective responsibility--dating back to 1911 when Cambridge-educated Dr. Lien-Teh Wu of the Chinese Imperial Court designed a breakthrough “anti-plague” mask, used worldwide and forerunner of N-95 mask. Pharos Global Health Advisors recommended wearing masks to help prevent face touching (potentially blocking coronavirus from entering mucous membranes in nose, throat, and eyes to cause infection).
Though
testing has been limited due to supply shortages, California Governor Newsom declared a state of emergency
on March 4 after a 75-year-old Californian man died from COVID-19 on Grand
Princess cruise ship. However, other
local and state governments were “business as usual” and much slower to
respond. 73-year-old President Trump and
Fox News treated situation like Pandumbic.
On
March 5, I was out and about, joining Senior & Disability Action’s SRO
Workgroup at a crowded City Hall demonstration for #30RightNow Rent Relief for
SRO Tenants. SF Mayor London Breed was
unavailable, so her Chief of Staff Sean Elsbernd met with us.
Last
summer, SRO tenant Jordan Davis went on a 21-day hunger strike that succeeded
in the City budgeting $1 million to Economic Hardship Fund for Masterlease
Tenants, a one-year pilot program to get City-leased SRO hotel rents down to
30% of tenants’ income. However, there
has been no implementation to date. Sean
committed to have a plan in two weeks…but SRO tenants like Jordan, who pay more
than half their income towards rent, are still waiting for rent relief. (Four days later, SF Mayor announced that City
would spend $5 million for “roving cleaning teams” to better protect seniors
living in SRO hotels and shelters from coronavirus.)
While
visiting supervisors’ offices, Supervisor Aaron Peskin’s Chief of Staff Sunny
Angulo said Supervisor was unavailable because he was on the phone negotiating
to keep Princess Cruise luxury ship’s 3,000 passengers and crew—some infected
with coronavirus—from docking in San Francisco.
Protecting vulnerable
After
attending this crowded gathering with Senior & Disability Action, DPH announced
two SF residents (including man in his 90s, with underlying health conditions)
tested positive for COVID-19 and issued “aggressive recommendations” for
“social distancing” meant to “disrupt normal social behavior” to reduce
community spread of coronavirus: “vulnerable
populations” (age 60+ and people with heart/lung/kidney disease, diabetes, and
weakened immune systems) should “stay home as much as possible,” and general
public should “cut back on the time you spend with groups.” Oops!
As
it turns out, we are all vulnerable because COVID-19 is equal opportunity: it
does not discriminate by age, race or income/wealth. Anecdotal evidence suggested that racial
minorities and people with less wealth do not have equal access to COVID-19
testing. California law requires equal access to healthcare services, but COVID-19 made healthcare rationing
inevitable as elective surgeries were suspended. And people who do visit hospitals for medical
emergencies risk exposure to coronavirus.
Doctors
from Bergamo—considered epicenter of Italy’s COVID-19 epidemic—recommended adoption
of community-centered care, reserving hospitalization for severe cases (versus
patient-centered care in U.S.), strict containment measures and inclusion of
social scientists addressing pandemic, which is a public health and humanitarian
crisis, to prevent rationing in overwhelmed hospitals with shortages (PPE, ICU
beds, ventilators, etc.):
"The situation here is dismal as
we operate well below our normal standard of care. Wait times for an intensive
care bed are hours long. Older patients are not being resuscitated and die
alone without appropriate palliative care, while the family is notified over
the phone, often by a well-intentioned, exhausted, and emotionally depleted
physician with no prior contact."—Physicians in Papa Giovanni XXIII
Hospital in Bergamo, “Dire warning from Italian doctors: How U.S. can avoid COVID-19 disaster,” quoted from New England Journal of Medicine in SFGate,
Mar. 25, 2020
SF Bay Area health departments have been reluctant to release data on race and location of COVID-19 cases, fearing this could heighten discrimination against certain communities where there might be clusters (two or more cases that appear to be connected). The first cases in the Bay Area were among ethnic Chinese residents returning from trips to China. According to WHO and CDC, coronavirus is believed to be spread during close contact and by respiratory droplets produced when people cough, sneeze or exhale, so it was troubling when media reported spitting incidents here in streets of SF, including racially motivated spitting on a Chinese-American woman.
Thus
far, SF has prioritized protecting the “most vulnerable” from coronavirus: older adults and
people with underlying health conditions, people living in congregate settings
(nursing home/assisted living facilities, cruise ships, SROs, shelters, prisons)
and people experiencing homelessness (but SF police continue sweeps, forcing unhoused to “move along”
instead of supporting their ability to “shelter in place”). Risk factors like underlying health conditions and living in congregate
settings are influenced by social determinants including income, education,
access to wholesome food, occupational safety. COVID-19 pandemic has exposed
our broken systems perpetrating health inequities, with disproportionate
impacts on old people.
Nursing
homes, with their high concentration of the elderly and chronically ill, have
been ground zero for coronavirus clusters. Life Care, a for-profit nursing home in
Kirkland, Washington, became the nation’s epicenter of the COVID-19 pandemic. Despite a 5-star rating at CMS Nursing Home Compare, it reportedly held a Mardi Gras “germ fest” party leading to an outbreak
that has killed at least 37 residents and visitors to date. Since then, old people have been in the news daily in connection with
COVID-19.
Ageism?
After COVID-19
outbreak at Life Care, responses to protect old people in nursing homes was
quick with lockdowns, and soon Governor Newsom calling for seniors age 65+ and
people with underlying medical conditions to stay home for their protection—almost
like an “othering” (stigmatizing?) old people as frail and vulnerable to disease—upending
#endageismsf campaign
efforts to downplay “vulnerable” feature of older people?
Shortly
after Governor’s directive and after one SFSU employee was diagnosed with
COVID-19, SFSU President ordered that all SFSU employees meeting the Governor’s
criteria “must stay off campus.” Whoa, many SFSU faculty appear 65+! Fortunately, SFSU President had foresight to suspend
face-to-face classes and transition to remote instruction effective March 16.
The Supreme Court postponed hearing cases to protect the health of justices, many
of whom are most at-risk for COVID-19 given their older age and underlying
health conditions. Six of the nine
justices are 65 or older, with the oldest Justice Ruth Bader Ginsburg at age 87
and survivor of multiple cancers.
Yet, not all
seniors stayed home waiting for grocery deliveries, as we saw infectious
disease experts old enough and experienced (crystallized intelligence!) with
HIV/AIDS pandemic to provide their calm voices of reason: 79-year-old Dr. Anthony Fauci, Director of
National Institute of Allergy and Infectious Diseases (NIAID); 68-year-old Dr. Robert
Redfield, Director of CDC; and 63-year-old Dr. Deborah Birx,
White House Coronavirus Task Force Coordinator.
While politicians spin
their narratives of hope, I prefer to fast forward listening to the calm
delivery of data-driven public health experts like Drs. Fauci, Mark Ghaly
(California Health & Human Agency Secretary and pediatrician) and Grant
Colfax (SF DPH Director and AIDS expert).
One exception was waking up to hear long-winded Governor Gavin Newsom scolding (social distance shaming) young people (presumably under 25 with
not yet fully developed brains to behave responsibly):
“Assume that you are potentially
contagious and act accordingly, socially distance yourself from others. Just use common sense. Be a good neighbor, be a good citizen. Those young people still out there on the
beaches thinking this is a party, time to grow up, time to wake up. Time to recognize it’s not just about the old
folks. It’s about your impact on their lives.
Don’t be selfish. Recognize you
have a responsibility to meet this moment as well.”—California Governor Gavin
Newsom, Mar. 21, 2020 (video at 13:30)
When
Kaiser Health News journalist Judith Graham asked, “Should everyone over 60 take the same coronavirus precautions?” geriatricians responded this depends
on individual’s state of health; for example, St. Louis geriatrician John Morley considers
increased risk if person is FRAIL (Fatigue;
Resistance problems – Cannot walk up a flight of stairs; Aerobic
problems – Cannot walk a block; Illnesses – Greater than 5; Loss
of 5% or more of weight in six months). UCSF geriatrician Carla Perissinotto
replied, “I don’t think it’s as simple as ‘Don’t go out’ for all older adults.
Social contact is still really important.
If you’re healthy and over 60, with prudence, hand hygiene and being
aware of your surroundings, you should still be able to go about some
activities,” while maintaining a safe distance.
Hardy 102-year-old Italia Gordona, survivor of Spanish Flu, recovered
from COVID-19 after her 20-day hospital stay in Italy.
Tent
encampments on Taylor Street sidewalk in bustling Tenderloin provide shelter to
some of 8,000 unhoused people in SF.
Unhoused survive on streets, challenged with access to enable proper
hygiene and physical distancing. Being outdoors in Tenderloin = exposure to
lots of smoking. Scottish microbiologist
claimed coronavirus transmitted via blowing out e-cig vapor = being spat on face, but UCSF docs disputed
this unless the e-cig user coughs when exhaling – ahem, highly likely smokers
cough to clear polluted airways!
Mobile
Health meets people where they are outside Glide in Tenderloin, helping to
reduce unnecessary movements. Glide closed over one weekend for deep cleaning after
suspected COVID-19 outbreak.
Patient
Safety Awareness Week
“Flatten the curve” efforts include hygiene and safety measures to avoid overwhelming hospitals and forcing healthcare rationing. This year’s Patient Safety Awareness Week was observed on March 8-14, with UCSF nurses demonstrating over understaffing and lack of PPE: "When Nurses Aren't Safe, Patients Aren't Safe" rally.
Bad enough that
there’s a global shortage of PPE, but what about higher wages/hazard pay and benefits
for frontline workers who sacrifice their own health and safety? CDC
found patient safety at LifeCare was compromised by nursing home staff who
worked while sick and without PPE, helping to spread coronavirus in a controlled
environment. The reality is some essential workers in the healthcare sector cannot
afford to stay home if sick, especially if they do not have paid sick leave.
Last
week, SF DPH’s 780-bed Laguna Honda Hospital & Rehab Center was placed in
lockdown due to COVID-19 outbreak, yet another patient safety scandal after
last year’s elder abuse. The American Bar Association warned that isolation, quarantine and lock
downs may increase risk factors for elder abuse, neglect and exploitation.
On
March 13, CMS seemed to increase risk for isolation and elder abuse when it ordered
nursing homes to restrict in-person visitors—including LTC ombudspeople!—and cancel
communal dining and group activities. After this, ombudspeople continued their resident advocacy work by
turning to telephone and other technology, limiting their ability to
investigate complaints.
After
Patient Safety Week, California DPH appeared to add more risk to nursing home
population by notifying nursing homes to prepare to accept and care for
patients with coronavirus! Los Angeles County DPH went further, telling nursing home administrators
that they cannot refuse to take COVID-positive patients! California Department of Social Services officials told adult and
senior-living facility inspectors not to wear gloves or masks during site
visits because supplies were low and donning the equipment might unnecessarily
“scare” residents!
Housing = healthcare = privilege?
With
SF’s “shelter in place” order, suddenly COVID-19 appeared not to be just about
old people but all of us. As routines
were disrupted, longstanding inequities in our dysfunctional systems were
exposed in this public health crisis that has forced government action to
flatten the curve. Quarantining people
who have been disadvantaged by ageism, ableism, racism and poverty does not
merely save lives of disenfranchised people, but prevents hospitals from being
overwhelmed by catastrophic surges in emergency care (and hospitals are
prohibited from denying emergency care, thanks to Emergency Medical Treatment & Labor Act of 1986).
“Shelter
in place” is a privilege. In this
pandemic, suddenly government was forced to respond: Where do unhoused people
“shelter in place”? What if “shelter in place” is not safe for households that
experience domestic violence, exacerbated by isolation from school closures and
financial stressors from being furloughed as “non-essential worker” who is
unable to work from home? What supports are available for people who have
mental/substance use disorders that make it challenging for them to follow
“shelter in place” orders and practice good hygiene? How does one maintain
physical distancing of at least 6 feet in SROs, shelters and prisons?
What
do multigenerational households make of advice from UCSF pediatrician Dr. Lisa Dana: “The best way you can keep your grandparents alive is to Facetime with
them or give them a call. Do not visit them. That visit could be a death
sentence.”
California
Governor and SF officials began leasing vacant hotels with plans to house vulnerable
people. SF Mayor stated intention to
prioritize moving seniors and people with disabilities in SROs into hotels with
private bath and delivered meals.
However, SF Human Services Director’s plan to move homeless people (half
of SF homeless are age 50+) into shelters was clearly at odds with SF Health Officer
Dr. Tomas Aragon, who recommended moving homeless people into private rooms
from a disease prevention perspective.
Meanings
SF
DPH posters provided clearer communication than City officials and other media
on interventions:
·
“Shelter in place” (used in SF order makes me think of alternative to evacuation during a disaster) v. stay at home (CA order used clearer language)
·
What
age is a senior? Age 60+ (SF) v. Age 65+(CA)
·
Social
v. physical distancing - latter more accurately captured intention to maintain
6 feet distance
With
schools closed and a statewide stay-at-home order in place except for essential
workers, SF libraries have been repurposed as emergency care centers for
children K to 8th grade to support first responders, healthcare
workers and “essential” City employees. But what about workers who care for elderly
parents at risk?
This stay-at-home directive
was nothing new for people permanently shut-in due to certain disabilities. But now homebound clients fearful of coronavirus
transmission refused assistance from home health aides—as potentially unwitting
asymptomatic vectors—coming into their homes. According
to CDC, nearly half of U.S. coronavirus patients in intensive care are under 65, but death rates still higher for older adults.
Finally,
during March 23 COVID-19 update, SF Mayor announced first virtual press conference to
demonstrate by example social distancing—just one speaker at a time on stage, with ASL
interpreter maintaining at least 6 feet distance. (CDC guidance advises 6 feet distance from other people, which is double the 3 feet distance recommended by WHO.)
Dr. Colfax provided
this memorable line: “Let us stay apart as we stand together.”
“No one reached out to me and said, as
a senior citizen, are you willing to take a chance for your survival in
exchange for keeping the America that all America loves for your children and
grandchildren? And if that’s the exchange, I’m all in.” –Texas Lt. Governor Dan
Patrick, 69-year-old Boomer with heart disease, “Dan Patrick says he is willing to risk his own life to allow economy to resume,” SFGate, Mar. 24, 2020
One
has to wonder about the impact of ageism, relegating the role of older adults
to stay home for their protection, and searching for deeper purpose in life like
Dying4WallStreet because the "cure can't be worse than the disease"? Essential workers are exceptions to
stay-at-home order, and people of all ages need a reason to get up in the
morning. Like the 4,500 retired nurses and doctors who signed on to rejoin National Health Service (NHS) in the UK
within 48 hours in response to “Your NHS Needs You” to fight COVID-19, over
25,000 healthcare professionals (including retirees within the last five years
who could reinstate their licenses) applied to California Health Corps less
than 24 hours after Governor Newsom’s announcement for COVID-19 emergency
medical staffing roles.
Practicing wellness
I have learned from my shut-in clients how to be a great
indoors person, and have practiced being an intentional shut-in, turning to my favorite solitary/wellness
activities of reflective daydreaming, reading, walking, cooking, listening to
music, and sometimes my own choreography.
Boomer tunes inspire
coronavirus musical parodies
79-year-old Neil
Diamond, who retired from touring two years ago due to Parkinson’s, made us
feel better with his fire-side singing “Sweet Caroline” (1969) into Coronavirus PSA: “Hands / Washing hands / Reaching out / Don’t touch me / I won’t touch you…”
Old people were included
in lyrics of coronavirus musical parodies.
·
Boomer Frank de Lima, who brought us Stayin’ Alive (the Hawaii Missile Threat),
shared his latest hit song Corona, Corona (sing to tune of Corrine, Corrina):
“Stay calm, don’t panic, gotta keep real cool/ Just take precautions,
especially our tutus.”
·
MyLifeSuckers sang
Self-quarantine (Diamond’s Sweet Caroline): “Tell my parents to be
good, don’t go outside/ Self-quarantine I won’t infect the neighborhood/
Self-quarantine this is for the greater good/ Self-quarantine to save our
humanhood.”
·
Maria
Wojciechowski sang Self-quarantine (ABBA’s Dancing Queen, 1976): “…don’t be that guy who’s like, ‘I
don’t care, I am 25’/ Time to face the music, everything’s not fine/ This is
the circumstance from New York to San Fran/ It’s time to self-quarantine, or we
will be worse than Italy…/Don’t take the chance, grandpa could die/ If you
don’t stay the hell inside/ Flu-uu, it’s not the flu, it’s COVID-19.”
·
Zac
Kessel sang I miss American life (McLean’s American Pie, 1971): “…And as the cases climb it gives us
fright/ Will all our parents be alright?/ We’ve just begun to fight the fight/
We must all stay inside/ We were singing bye bye, I miss American life… On
social media they were hoping/ And the seniors we admire most/ The ones who
will not read this post/ Protect them all from coast to coast/ These days we
all must hide …”
·
Luke
Murgatroyd sang I think we’re alone now (Tommy James & Shondells, 1967): “Not easy to hideaway for 20 nights/
But it means I won’t be deadly to the old folks that I meet and so that’s why/
I’m being alone now…”
·
Kiffness sang Yesterday (Beatles, 1965): “I can’t even see my mom
for 20 days / now I’m stuck at home with bills to pay...”
Boomers and Gen X are good at staying home, according to Holderness Family’s 1980s Guide to Quarantine (Boredom): phone, video games, hair, TV, music mix tape, dance.
Boomer/Gen X cellist Jan Vogler and Gen Z pianist Tiffany Poon hosted 24-hour
Music Never Sleeps NYC online concert with performers of all ages, which kept me up all night! Just
as musicians can perform without live audiences, so can “spectator sports”?!
Governor
Newsom announced statewide initiative, “Stay Home. Save Lives. Check In,” to
urge Californians “to help combat
social isolation and food insecurity among Californians who are over the age of
65– a community that is uniquely vulnerable to COVID-19.” 72-year-old Larry
David urged everyone to stay home in his PSA: “You’re hurting
old people like me. Well, not me... I’ll never see you.”
Start planning for the future: getting
old
“Never allow a crisis go to waste. Start planning for the future.”—Rahm Emanuel,
former Chief of Staff to President Obama (2009-10), “Rahm Emanuel reprises 'never let a crisis go to waste' catchphrase amid coronavirus pandemic,” Washington
Examiner, Mar. 24, 2020
After SF announced
extension of “shelter in place” at least through May 1, I wondered about any
lasting impact from this heightened awareness of our shared
vulnerabilities—live long enough and we will find ourselves old in all its rich
diversity of experiences. Living in this
state of emergency has forced rethinking priorities and underlying values: what
is truly “essential” to quality of life, that we are all interdependent, and
need to look out for one another through collective action to improve community
care, strengthen our safety net and bring about systems change. Some age-friendly developments:
·
Private
sector accommodating seniors for early morning shopping hours and free delivery of prescriptions
·
Expansion
of telehealth (phone, videoconference) to Medicare patients (previously limited
to only rural areas)
·
SF
government plan to house homeless, prioritizing most vulnerable seniors and
people with disabilities, into vacant hotels with private bath and wrap-around
services –how about next step for permanent supportive housing?
·
SF
government’s re-opening shuttered hospital, safety-net Seton Medical
Center, which served mostly older and low-income patients
·
Federal
government’s coronavirus stimulus check, almost like universal basic income?
This year’s Social
Work Month theme is Generations Strong! My planned groundbreaking research, Social Work
Interventions to Ease Nursing Home Relocation Stress, came to a halt with
the suspension of visits to nursing homes this month. Given uncertainty over this pandemic’s
duration, I began another research project to infuse aging content in MSW core
curricula. This is much needed when
considering that only 4% of social workers have completed specialized
geriatrics training even though 75% of social workers work with older adults,
according to Eldercare Workforce Alliance. Hope my effort will bring MSW training close to the “weeks” of geriatrics
training provided at medical schools.
“Medical schools devote months to
teaching students about child physiology and disease, and years to adults, but
just weeks to elders; geriatrics doesn’t even appear on the menu of required training. The
National Institutes of Health mandated the inclusion of women and people of
color in medical research in 1986, but it didn’t issue a similar mandate for
elders until 33 years later, in 2019….
Even though older people are far
more likely to die from it, until 2018, the California Department of Public
Health counted flu deaths only for children and adults under 65… The problem is
that when the impact of disease in a population is unknown, there’s little
incentive to develop treatments tailored to that group’s needs. When the
affected population is elders, the problem is especially bad: As we’ve already
seen with the current crisis, many people say that elders are dying
anyway and
tend to blame old age itself for their deaths—not a flawed system…
Everyone can help create a less
ageist culture and improve individual institutions. Aging experts like myself
are (for now, digitally) collaborating to devise elder-specific protocols for
managing COVID-19…”
--UCSF geriatrician Louise Aronson, “Ageism Is making the pandemic worse: The disregard for the elderly that’s woven into American culture is hurting everyone,” The Atlantic, Mar. 28, 2020
Woo-hoo! Coronavirus Aid, Relief, and Economic Security Act (CARES
Act) included reauthorization of the federal geriatrics workforce
programs, the Geriatrics Workforce Enhancement Program (GWEP) and the
Geriatrics Academic Career Award (GACA) at $40.7 million for five years!
COVID-19
pandemic led to cancellation of several annual gerontology/geriatrics
conferences: American Association for Geriatric Psychiatry (March 13-16 in San Antonio), American Society on Aging’s Aging in
America (March 24-27 in Atlanta), Oregon State University’s Gerontology
Conference (April 1-2 in Corvallis), Berkeley Retirement Center’s Engage with Age (April
21), and American Geriatrics Society (May 6-9
in Long Beach). With time saved from
traveling, I am homeschooling (inspired by Dr. Colfax, whose parents wrote Homeschooling
for Excellence), working remotely, enduring Zoom meetings, and keeping up
with old people in daily news.
SF struggles to help COVID-positive tenants living in group settings
ReplyDeleteJOE FITZGERALD RODRIGUEZ
Apr. 18, 2020
Besides San Francisco’s homeless population, single-room-occupancy hotel dwellers are among the highest risk to catch and spread COVID-19: Dozens of tenants living in single rooms in SROs often share kitchens and bathrooms, making healthy isolation nearly impossible.
Nonprofits running SROs are experiencing what they call frustrating miscommunications with the San Francisco Department of Public Health that may put those hotel-dwellers at risk.
…City officials want the Department of Public Health to notify them of buildings containing COVID-19 positive patients, so that quarantine measures can be enacted, but public health officials have refused, citing medical privacy laws.
…Department of Public Health has in some instances ordered SRO residents to shelter-in-place at home, despite The City’s stated practice of moving COVID-19 positive SRO residents into roughly 2,000 hotel rooms that have been obtained specifically for SRO residents and homeless people to be quarantined.
The lack of communication may also hamper contract-tracing, as public health officials have reached out to desk clerks instead of SRO property managers, in what officials called a demonstration of inexperience with SRO operations.
Interviews reveal at least one case of mistaken identity in an attempt to quarantine family members of a COVID-19 positive patient, and a lack of Cantonese-language speakers has hampered doctors’ ability to timely help SRO-living COVID-19 positive patients and their family.
Sheltering-in-place is nearly impossible in an SRO, where shared surfaces — like bathrooms, faucets and kitchen tables — mix the lives and fates of as many as 200 households in a single building.
There are roughly 500 SRO hotels in San Francisco, encompassing roughly 20,000 living units, some of which are home to families of three or more.
City leaders fear that without proper protocols, SRO’s may just be a powder keg. So far there have been relatively few COVID-19 positive cases in San Francisco, respective to the rest of the United States. But SRO residents remain particularly at risk.
That’s the fear of Mrs. Chen, a self-chosen pseudonym for one Nob Hill SRO tenant…
Mrs. Chen, her husband, and two sons, aged 16 and 10, live in the same SRO as her in-laws, just downstairs. The chance that they, and her mother-in-law, were exposed to COVID-19 was strong. They were terrified…
Five days after Mrs. Chen’s father-in-law tested positive for COVID-19, the mother-in-law also tested positive...When the family, with the help of a translator, told the Department of Public Health that the mother-in-law lives in an SRO, with shared bathrooms and a shared kitchen, and could not possibly quarantine without effecting others, the solution officials gave them was a portable toilet.
“Someone has to pour it out for her,” Mrs. Chen told me. But, “her own children are afraid to help her … She is in her 80s and she is pouring out her own toilet at night.” Mrs. Chen said her mother-in-law should be quarantined in a city-provided hotel, with available city staff.
The private SRO property manager informed the building of the positive COVID-19 cases, Mrs. Chen said. “We heard some people have requested my father-in-law and mother-in-law move away,” she said. “But they can’t afford to.”
To add insult to injury, they asked to send documents by email. The mother-in-law, in her 80s, does not have an email address. The family also did not have access to email, Chinatown CDC staff told the Department of Public Health in an email.
At around the same time, Mrs. Chen’s family had not yet been quarantined. Public health officials mistook Mrs. Chen’s family for her brother-in-law’s family, who was already in contact with the Department of Public Health…
https://www.sfexaminer.com/news-columnists/sf-struggles-to-help-covid-positive-tenants-living-in-group-settings/
NYTimes California Today: Inside the Bay Area’s Geriatric Homeless Shelter
ReplyDeleteApril 23, 2020
By Jesse Bedayn and Brett Simpson
OAKLAND — …There are some 28,000 homeless residents in this region. Thousands are senior citizens. Out of that population, just 11 homeless seniors…found themselves quarantined inside St. Mary’s Center in downtown Oakland. They were watched and worried over by a vigilant, exhausted staff of mostly volunteers who worked around the clock in masks and gloves serving meals, delivering medicine, changing sheets, cleaning toilets, sanitizing surfaces and doing their utmost to make sure no one from the infected world beyond the center’s steel gates set foot inside.
…As the executive director of St. Mary’s, Ms. Cornu was all too aware of how the novel coronavirus is ravaging places where the elderly live in close quarters. Only weeks ago, men in hazmat suits were carrying bodies out of a nursing home in nearby Hayward, where scores of residents were infected.
She was no less fearful of what will happen if the virus begins to hopscotch through the Bay Area’s vast shadow world of homeless encampments. How long, she wondered, could shelters like St. Mary’s stay virus free? The question hit especially hard when officials disclosed that 96 residents in a homeless shelter in San Francisco had tested positive for Covid-19. In New York, at least 23 shelter residents have died from the outbreak.
“None of our procedures anticipated this scale of a global pandemic,” Ms. Cornu said.
The full weight and meaning of this realization first coalesced within Ms. Cornu in mid-March when the order came for the entire Bay Area to shelter in place. At the time, she had 30 homeless seniors in her care at St. Mary’s. They slept in cots a few feet from one another, and there wasn’t near enough space to enforce proper social distancing.
So Ms. Cornu and her staff scrambled to move guests out of St. Mary’s and into every nearby single-room apartment they could find. They sought to reunify others with relatives. Although they could arrange spots for only 19 people, their efforts created enough room to position cots at a safe distance for the remaining 11. Ms. Cornu also had much of her staff work from home, leaving only a skeleton crew of people like Janny Castillo, who found herself choking back tears when they discussed how to protect those who remained. Once homeless herself, Ms. Castillo was terrified of carrying the disease into St. Mary’s...
Researchers estimate homeless seniors will be up to three times as likely to die if infected by Covid-19. This is because homeless seniors have higher rates of chronic illnesses, and their bodies seem to age faster on the street. (Many develop frailties commonly seen in people 20 years older.) “It’s a crisis upon a crisis upon a crisis,” said Margot Kushel, director of the Center for Vulnerable Populations at the University of California, San Francisco.
Gov. Gavin Newsom has responded by securing 15,000 hotel rooms around the state for the homeless, with preference given to the elderly, those with symptoms and those who test positive. But according to the latest state figures, most of the rooms remain unused, …
Not far from St. Mary’s is St. Vincent de Paul of Alameda County, an 80-bed shelter for the general population…
But for the small staff of St. Mary’s, the stress of protecting and caring for 11 people week after week was becoming unbearable and unsustainable. They began searching for “transitional housing’’ where they could place their remaining clients…They began exploring how they could support their clients by delivering meals and medicine to their temporary homes.
“Like other shelter providers, as we learned of the challenges faced by hospitals and nursing homes in managing exposure to Covid-19, we determined that we were not equipped to continue providing a healthy environment and needed to move shelter residents to individual rooms,” Ms. Cornu wrote in an email.
By April 7, the Bay Area’s last refuge for homeless seniors sat empty, one more victim of Covid-19.
California restaurants to get public money for healthy meals
ReplyDeleteAdam Beam, Associated Press
Friday, April 24, 2020
SACRAMENTO, Calif. (AP) — California restaurants will get taxpayer money to feed millions of seniors during the coronavirius pandemic, but only if they can offer meals with fresh fruit, vegetables and no sugary drinks.
Gov. Gavin Newsom said Friday the requirements reflect California’s values, though lawmakers have repeatedly failed to impose special taxes and require warning labels for sugary drinks in the past.
“We want to ... have a diversity of options and make sure what we are sending to our seniors is low sodium and not high-fructose drinks or sugary drinks and the like,” Newsom said.
California has been under a mandatory stay-at-home order since March 19, forcing schools and nonessential businesses to close. Restaurants have been one of the hardest-hit industries in the state, with more than 1 million workers either laid off or furloughed, according to a survey by the National Restaurant Association.
Local governments will choose which restaurants will make the food and get the money. But restaurants have to meet nutrition guidelines. Meals can’t have too much sodium and lunch and dinner must have at least one piece of fresh fruit or vegetable.
Jot Condie, president and chief executive officer of the California Restaurant Association, said he believes restaurants can adapt to the requirements.
“We are aware that it’s a sensitive subpopulation that has special dietary needs and I think that it may not be for every restaurant,” he said, adding that: “We have fielded a crush of phone calls from restaurants eager to participate.”
Newsom said the federal government will cover 75% of the cost while the state and local governments will pay for the rest.
To be eligible, seniors must either live alone or live with one other person who is also eligible. They can’t earn more than $74,940 per year (or $101,460 for a household of two) and they must have documented exposure to the coronavirus. Anyone already getting money from other federal food programs would be ineligible.
California has about 5.7 million people 65 and older, of which about 1.2 million live alone. A qualifying senior will get up to $66 per day for three meals at local restaurants that meet certain criteria.
“We will provide an unlimited number of meals," Newsom said.
While taxpayers will pay for the food, local sales taxes will still apply. That could be a boon to local governments, which have suffered as sales tax collections have dried up with few people out spending. The League of California Cities says local governments will lose an estimated $6.7 billion over the next two years because of the coronavirus…
California has more than about 40,000 confirmed virus cases and more than 1,500 deaths, according to data compiled by Johns Hopkins University. The number of infections is likely much higher because many have not been tested, and studies suggest people can be infected without feeling sick.
Newsom has said hospitalizations and patients in intensive care units are key statistics for deciding when to loosen stay-at-home orders. Both numbers have been essentially flat for much of the week.
For most people, the virus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia and death.
That's why Newsom said the stay-at-home orders will likely last longer for people 65 and older.
“Our seniors will continue to be a focus of our energies,” Newsom said.
https://www.sfgate.com/news/article/California-restaurants-to-get-public-money-for-15225556.php
Immigrants working in health care bring a culture of caring
ReplyDeleteJAYA PADMANABHAN
Apr. 22, 2020
In early December last year, my mother fell and sustained multiple injuries to her pelvis. In due course, she recovered from the injury, but the experience exacted a steep toll. From a fully functioning 86-year-old, she became a dependent 87-year-old. Her physical compass had to re-orient and she had to relearn simple everyday activities she had given no thought to earlier.
During her recovery and rehabilitation, she was at a nursing home in the bay area, where I was rather astonished to discover that over 80 percent of the staff were immigrants…
According to research from New American Economy (NAE), immigrants make up 16.4 percent of all health care workers nationally, and in metros like San Francisco, New York, Los Angeles and Miami that number more than doubles. In these four metros alone, there are close to a million immigrant health care workers.
In The City, 60 percent of all health aides, 40 percent of nurses, and 30 percent of physicians and surgeons are immigrants. “During an ongoing health crisis, such as COVID-19, the ability to communicate with each patient is crucial — especially in large urban areas with diverse populations. We find that immigrant health care workers are especially well-suited to this challenge. We find that the majority of them are bilingual, speaking both English and at least one more language,” the NAE analysis elaborated.
Many immigrants come from cultures where families take care of their old and sick. As the noted writer and surgeon Atul Gawande describes in his book “Being Mortal,” grandparents in India are typically cared for in multi-generational homes. “There was no need to save up for a spot in a nursing home or arrange for meals-on-wheels. It was understood that parents would just keep living in their home assisted by one or more of the children they raised.” Living in such homes and being exposed to the vulnerabilities of the sick and elderly builds capacity for patience and tolerance. Out of this experience emerges the ability to react appropriately to the fears and anxieties of patients.
That’s why it’s no surprise to discover that 29,000 Dreamers — Deferred Action for Childhood Arrivals program recipients — work as health care aides and nurses nationwide.
…According to NAE analysis, in 2018, there was an average of “12.3 open health care jobs per unemployed health care worker” and for specialized jobs, including physicians, surgeons and registered nurses, that ratio was even higher, “with 27 open health care practitioner jobs for each unemployed health care practitioner.”
In San Francisco, the shortfall is even more acute, with 15 open health care jobs for every unemployed health care worker, and 28 open health care practitioner jobs for every unemployed health care practitioner. That means that for every specialist or physician in San Francisco, there’s a choice of 28 job opportunities, which means that 27 of them will go unfilled.
In light of these health care job vacancies, President Trump’s announcement to halt immigration to the country to shore up the economy and protect American jobs in the wake of the COVID-19 pandemic doesn’t appear to have the support of data.
“Foreign nationals are critical to the U.S. economy, especially the health care industry,” said Richard Burke, CEO of Envoy Global, a global workforce management firm. He added that “immigrants represent 24% of direct-care workers, including the nurses and assistants who have been on the frontlines of the COVID-19 pandemic.”…
https://www.sfexaminer.com/news-columnists/immigrants-working-in-health-care-bring-a-culture-of-caring/
After covid-19, aging in America may never be the same
ReplyDeleteBy Michele L. Norris
April 24, 2020
…The spiraling death toll in the nation’s patchwork of nursing home facilities has revealed just how broken the system already was — understaffed, unevenly regulated and economically challenged. And it has underscored the urgency of reexamining and improving the prevailing model of senior care.
More than 10,000 residents and staff have died from covid-19 infections in long-term care facilities across the United States, according to an analysis of state data by the Kaiser Family Foundation. The actual death toll among nursing home residents is certainly higher because not all states release data. We will soon get a clearer picture with new federal rules that require weekly disclosure of coronavirus cases and a commitment to alert patients and families within 12 hours if a resident in a facility has tested positive.
As it is, these numbers are already staggering. Nursing home deaths account for more than 50 percent of all covid-19 deaths in six states: Colorado, Delaware, Massachusetts, Oregon, Pennsylvania and Utah. They represent one-fifth of deaths from the virus nationwide.
…More than half a million residents live in nursing homes rated “average” or “below average” by the federal government, about one-third of the overall population. The Post found that 40 percent of the more than 650 nursing homes that have reported cases of the coronavirus had been cited more than once for violating federal infection-control standards — procedures such as washing hands and wearing protective equipment.
…Trump administration began reducing fines last year and called for relaxing rules that required all nursing homes to keep infection specialists on staff on at least a part-time basis.
…labor standards and demographic trends were on a dangerous collision course…600,000 nursing assistants forms the backbone of the assisted-living model, earning a median annual income of $22,200. Nine out of 10 are women, half have no formal education beyond high school, and 1 in 5 were born outside the United States.
Because of the physical nature of nursing assistants’ work — repeated turning, lifting and transporting of patients — their likelihood of injury is three times greater than that for the general population. Not surprisingly, staffing shortages and rapid turnover are endemic.
…the elderly population in America is set to double over the next 20 years, from 48 million to 88 million by 2050….governments are unprepared for that deluge. Families and seniors often lack adequate savings to pay for institutional care.
And nursing homes around the country were stretched thin before the wave of coronavirus tragedies, arguing that Medicaid and Medicare reimbursement rates did not keep up with their mounting costs…
One alternative is supporting in-home care for seniors to age in place, undergirded by technology that can virtually detect falls, provide companionship through robotics, monitor... The pandemic should prompt us to explore these alternatives, or options for generational living where grandparents reside with younger generations, contributing to the mortgage and pitching in with child care.
But not everyone can afford or manage such arrangements. The pandemic should prompt us to reexamine the model of for-profit long-term care facilities that account for 70 percent of nursing homes and tend to have lower ratings and higher tallies of infraction.
… only one-third of the 15,000 nursing homes in the United States have easy access to covid-19 tests…staff show up for work every day knowing that they are walking straight toward danger.
…There will most certainly be a national commission to examine the U.S. response to this pandemic. It should include a robust investigation of nursing home deaths — and the underlying structure that left so many vulnerable.
…living in the petri dishes of potential infection that are nursing homes right now… https://www.washingtonpost.com/opinions/2020/04/24/nursing-homes-deserve-our-prayers-serious-reforms/
As coronavirus shut down support systems, the struggles of dementia patients and caregivers only get worse | Opinion
ReplyDeleteApril 29, 2020
Sara Manning Peskin, Allison K. Hoffman, and Jason Karlawish, For The Inquirer
…Now more than ever, caregivers and persons living with dementia are struggling. The social distancing necessitated by the COVID-19 pandemic has shattered the country’s already-precarious system for community-based long-term care.
Nearly 5,000 adult day centers are closed. For the 286,000 people who had been attending the centers, there’s no more art therapy, sensory rooms, or expertly trained staff. Many in-home aides have been let go. All of a sudden, millions of family caregivers are on their own.
Our experience suggests this is already causing a surge in mental health problems, what clinicians call “behavioral and psychological symptoms of dementia.” Families call it for what it is: agitation, aggression, sometimes violence.
…memory center means being connected to a network of physicians, psychologists, and social workers trained in dementia…
Yet, even in normal times, most people with dementia don’t have access to a memory center, an adult day center, or other supportive infrastructure. Half of primary-care doctors feel unprepared to care for persons living with dementia, and most report there aren’t enough dementia specialists to see their patients. Adult day centers cost an average of $75 per day and aren’t widely available. The median cost for a home health aide is $23 per hour. For spouses with dwindling financial reserves, or adult children struggling to care for their own young families, paying for dementia care was impossible before the pandemic.
Now, even those who could afford the right supports aren’t getting them. We’ve unwillingly entered into an awful social experiment, testing what happens when there are little to no community resources for people living with dementia. The results are disturbing.
Caregivers stuck at home are asking us for medications to help with their loved one’s aggressive behavior. Usually, we can avoid these prescriptions, and instead recommend going outside, socializing, and engaging in structured activities. But in these unusual times, we’ve had to do the best we can to make life manageable. We obey the dictum of geriatric prescribing, to start with a low dose and increase it slowly, knowing all along that we’re trying to heal a broken arm with an aspirin.
We expect, from April 2020 forward, there will be a spike in prescriptions for antipsychotics, antidepressants, and antianxiety medications -- all “last-in-line” treatments to quell the behavioral symptoms of dementia. We believe that in the months to follow, a bump in diagnoses of falls, some with hip fractures, as well as strokes and sudden death arrests — all complications of these drugs — might be seen. We may notice a spike in admissions to nursing homes this summer, precipitated by the agitation we are seeing today.
When the country goes back to work, we’ll be left with bitter proof of the value of dementia care. We’ll understand why adult day centers and funding for caregiving in the home are critical for the health and security of people with dementia and their families. Our peer nations have social insurance to pay for this care, but the United States pays for it only once families have impoverished themselves. The costs to families who are left on their own to care for loved ones with illness or disability are immense, measured in hours of uncompensated care and in harm to their own jobs and well-being.
The lack of any coordinated long-term care policy has forever been untenable. The coronavirus pandemic has only made the consequences even clearer; with soaring unemployment, even fewer caregivers will be able to afford the supports that should be universal…
https://www.inquirer.com/opinion/commentary/coronavirus-covid-pandemic-dementia-caregiving-adult-day-centers-20200429.html
The pandemic has amplified ageism. ‘It’s open season for discrimination’ against older adults
ReplyDeleteBy LAURA NEWBERRY
MAY 1, 2020
On the good days, Bonnie Reed believes that, for the first time in a long time, just about everyone is united in a common cause: to protect society’s most vulnerable citizens against the coronavirus.
On the bad days, …message about how little some people care about the well-being of older adults, who make up roughly 80% of those who die from COVID-19 complications…
As the debate rages over when or how to resume public life, older adults like Reed have increasingly borne witness to behavior and rhetoric that implies that their lives are not as valuable as reviving the economy.
…Ageism has been quietly pervasive in American culture for decades, according to those who work with and study the health of seniors. But they fear that this particular form of discrimination has become magnified during the pandemic as those who have lost income and stability look for someone to blame.
The stigma [against elders] is growing,” said Dilip Jeste, a geriatric psychiatrist at the UC San Diego Center for Healthy Aging. “Anytime you mention the virus and risk, immediately people think of older adults. They think of the people more likely to be hospitalized, to take up beds in the ICU.”
This rejection of prolonged sacrifices made by all for the sake of the old has been voiced from the highest ranks of government.
…a subtler disdain for older people has been a running thread in American culture. They are well aware of the prevailing belief that beauty and productivity — the primary measures of worth in the U.S. — are the domains of the young.
Gregory Kuhl, a 69-year-old … felt similarly disregarded when he learned that most coronavirus testing in Los Angeles occurs at drive-up mobile sites. “Where do seniors who no longer drive go to get tested?” he wondered.
“Somebody somewhere needs to be thinking about the consequences [of the shutdown] for older people,” Kuhl said in an interview.
In these unprecedented times, unfavorable perceptions of older adults can be a matter of life and death, according to advocates for seniors and people with disabilities.
California Gov. Gavin Newsom was roundly criticized last week after his administration advised hospitals to prioritize younger people with greater life expectancy for care during the coronavirus outbreak. Those guidelines were swiftly retracted…
When doctors are forced to make gut-wrenching decisions around who will receive scarce medical resources such as ventilators, two factors are typically considered: the likelihood that a person’s life will be saved, and the estimated years of life left, said David Magnus, director of the Stanford Center for Biomedical Ethics.
…The bioethicist noted that in an “era of plenty,” healthcare systems often spend large amounts of money keeping people alive for weeks or months; a quarter of Medicare spending occurs in the last year of life.
…Jeste insists that this way of thinking is short-sighted. Assigning a value to seniors based on their economic output ignores the many other ways people contribute to society, he said. They travel and volunteer. They are mentors with decades of hard-earned wisdom. They take care of grandchildren and older family members.
…Scott Kaiser, an L.A. geriatrician, stressed the interdependence of all age groups.
…Kuhl offered his own suggestion for combating ageism: reminding young people that they, too will grow old — if they’re lucky.
“If you don’t think older people have value, what you’re really saying is that you’re not going to have value,” he said. “Is that what you really want?”
https://www.latimes.com/california/story/2020-05-01/coronavirus-pandemic-has-amplified-ageism
Policy Brief: The impact of COVID-19 on older persons (May 2020)
ReplyDeleteThe COVID-19 pandemic is causing untold fear and suffering for older people across the world. As of 26 April, the virus itself has already taken the lives of some 193,710 people, and fatality rates for those over 80 years of age is five times the global average. As the virus spreads rapidly to developing countries, likely overwhelming health and social protection systems, the mortality rate for older persons could climb even higher.
Less visible but no less worrisome are the broader effects: health care denied for conditions unrelated to COVID-19; neglect and abuse in institutions and care facilities; an increase in poverty and unemployment; the dramatic impact on well-being and mental health; and the trauma of stigma and discrimination.
Efforts to protect older persons should not overlook the many variations within this category, their incredible resilience and positivity, and the multiple roles they have in society, including as caregivers, volunteers and community leaders. We must see the full diversity of people within the older persons category. Women, for instance, are over-represented among both older persons and among the paid and unpaid care workers who look after them. We must also recognize the important contribution of older persons to the crisis response, including as health workers and caregivers. Each of us – States, businesses, international organizations, companies, communities, friends and family – need to step up our effort to support older persons. We must do everything possible to preserve their rights and dignity at all times…
1. Ensure that difficult health-care decisions affecting older people are guided by a commitment to dignity and the right to health.
2. Strengthen social inclusion and solidarity during physical distancing.
3. Fully integrate a focus on older persons into the socio-economic and humanitarian response to COVID-19.
4. Expand participation by older persons, share good practices and harness knowledge and data.
https://unsdg.un.org/resources/policy-brief-impact-covid-19-older-persons
Critics Call $1,000-a-Day State Offer a ‘Bounty’ to House COVID-Positive Residents
ReplyDeleteBy Jaxon Van Derbeken
May 7, 2020
Teresa Palmer’s mother, Berenice, turns 103 next month.
While Berenice is COVID-19 free, Teresa, a geriatrician, had worried about the risk when she heard the San Francisco Campus for Jewish Living where Berenice lives was planning on a COVID-only wing.
While she’s now satisfied the wing of the nursing home is taking precautions like installing a protective ventilation system, she is worried about the state’s plan to encourage assisted living homes to take in COVID-positive residents.
“I don’t think it’s safe,” she said, stressing that assisted living facilities are often converted homes and are not required to have either medical staff or protective equipment.
Still, the state Department of Social Services is now offering small care homes, those with six or fewer beds, $1,000 per day for every COVID-positive resident they take in. At that same time, the notice stresses the state is waiving many of its regulations.
Critics say the offer amounts to a dangerous “bounty.”
“It’s Russian roulette,” said Jody Spiegel, an attorney and advocate for residents in assisted living homes. She says the state should be providing more protection for residents during the outbreak – not weakening oversight to encourage facilities to take on a challenge they are ill-equipped to handle.
“We are giving facilities an incentive – a tremendous financial incentive – to accept these residents at the same time we relax the regulations that protect the health and safety of these residents,’’ she said. “So it’s a recipe for disaster.”
Michael Wasserman, president of the California Association of Long-Term Care Medicine agreed, saying the state’s incentive plan “makes no sense.”
Right now, he said, even skilled nursing homes are struggling to control COVID outbreaks. He questioned why the state could believe that assisted living homes – with little or no medical care – could be prepared to take a crush of residents.
“If I have a loved one in an assisted living facility,” Wasserman said, “this guidance scares the daylights out of me – this can only lead to bringing the virus in to assisted living facilities and group homes, where it may not already exist. and that is just so wrong.”
The state stresses in its notice to the 7,500 homes across the state that units with staff and infected residents have to be in separate facilities from the rest of residents. The $1,000 a day offer is restricted to the more than 5,000 homes that house six or fewer residents. The notice indicates the state wants the other facilities to negotiate a price.
The social services agency, however, did not respond to questions about the notice that went out May 1, including how it will ensure that small homes will be able to implement that restriction.
The latest data, released by the state Wednesday, shows more than 200 people have died due to outbreaks in assisted living facilities across the state that have sickened some 1,500 residents.
https://www.nbcbayarea.com/investigations/critics-call-1000-a-day-state-offer-to-care-homes-a-bounty-to-house-covid-19-patients/2285862/
Striking report compares coronavirus response in San Francisco, New York City
ReplyDeleteBy Eric Ting, SFGATE
Saturday, May 16, 2020
A new, and very long report from investigative journalism website ProPublica compares the early response to the coronavirus pandemic in San Francisco to the early response in New York City,…
SAN FRANCISCO WAS MAKING PREPARATIONS FOR AN OUTBREAK AS EARLY AS JANUARY
Breed told ProPublica that over the course of January and February, she grew increasingly worried about the possibility of an outbreak in her city after receiving daily briefings from city director of public health, Dr. Grant Colfax. He informed officials of what was going on in Wuhan and highlighted the fact that San Francisco had one of the highest Chinese American populations in the country. President Donald Trump did not suspend travel to and from China until Jan. 31.
As early as Jan. 27, Breed launched an Emergency Operations Center that paired physicians with emergency responders to identify and respond to the city’s needs for protective personal equipment and possible makeshift hospitals.
"Just imagine people showing up to the hospital, like if my grandmother, who is not alive today, but let’s say if she were and I took her to San Francisco General because she had the virus and she couldn’t hardly breathe," Breed told ProPublica. "And she was turned away because they didn’t have a bed for her."
IN EARLY MARCH, BREED WRESTLED WITH "ARBITRARY" GUIDELINES WHILE DE BLASIO CLASHED WITH HIS CITY'S HEALTH DEPARTMENT
Breed declared a state of emergency in her city on Feb. 25, even though San Francisco did not have any confirmed cases until March 5. ProPublica reported that she did so at the urging of Colfax, since both saw a growing swell of cases reported in nearby Santa Clara County.
On March 6, Breed issued an order that recommended people ages 60 and older stay home as much as possible, …
WHEN SAN FRANCISCO BECAME THE FIRST MAJOR CITY TO SHELTER-IN-PLACE, CUOMO REPORTEDLY DISMISSED IT
Colfax, Breed and other San Francisco officials coordinated with health officials across the Bay Area to issue the nation's first shelter-in-place order on March 17, with Santa Clara County public health officer Dr. Sara Cody reportedly serving as the driving force behind the order. ProPublica reported that Breed sent the text of the order to de Blasio immediately afterwards, thinking it could help.
When de Blasio reportedly passed the order on to Cuomo, he was said to have reacted to the idea "with derision." ProPublica reported that Cuomo said that "shelter-in-place" sounded "like it was a response to a nuclear apocalypse."
…The ProPublica article also highlights New York's policy of forcing nursing homes to take in COVID-19 patients that are deemed "medically stable" to ease the burden on hospitals. This policy has been widely linked to increasing spread of the virus in nursing homes, and New York finally reversed this policy last week. ProPublica does not mention the fact that California has an identical policy in place that has yet to be lifted. About 40 percent of the death toll in California can be attributed to nursing homes.
SAN FRANCISCO NOW GETS TO MOVE FASTER THAN NEW YORK CITY ON REOPENING
New York City is 10 times larger than San Francisco, but has seen 555 times the number of deaths. At least 20,000 people have died in New York City to this point, but that figure is widely expected to be an undercount. San Francisco has seen a total of 36 COVID-19 deaths.
On Wednesday, San Francisco became one of the first Bay Area counties to break off from the six-county regional order and join the rest of the state in Stage 2 of California Governor Gavin Newsom's reopening plan on Monday…
https://www.sfgate.com/news/editorspicks/article/San-Francisco-New-York-coronavirus-compare-Breed-15274888.php
‘Age is a sloppy proxy’: Older adults push back on idea that staying safe from coronavirus means staying isolated
ReplyDeleteRyan Kost
May 19, 2020
…broad category of “older adults” — a category the Centers for Disease Control has said includes anybody 65 years and older. This group, health officials say, is at a higher risk of severe illness should they contract COVID-19. The CDC has an entire webpage for aging and older adults dedicated to tips on safer living.
But it’s not as simple as a single number. As the Bay Area moves to reopen, experts and older adults say age shouldn’t be the only consideration when deciding who leaves home or returns to work. The broad range of “65 years and older” doesn’t differentiate between those who are healthy and fully self-sufficient and the very vulnerable — those with pre-existing conditions and those who live or work in group housing situations. Moreover, it exacerbates existing tensions between generations: OK Boomer vs. Avocado Toaster.
“Age is a sloppy proxy,” said Louise Aronson, a professor of medicine at UCSF and author of “Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life.”
…None of this means age doesn’t factor when it comes to risk. Those who are 65 years and older account for 80% of coronavirus-related deaths in the United States. That’s not just a matter of hypertension — though the chances of having a comorbidity increase with age.
“Aging itself affects virtually every organ system in our body,” said Laura Carstensen, the founding director of Stanford University’s Center on Longevity. “We don’t regulate temperature as well as we get older. Our lungs don’t function quite as well as we get older. They’re considered ‘normal changes’ with age. . . . But normal, by definition, means it happens to virtually all people.”
... “If you look at the curve anywhere, the risk is not equally distributed,” Aronson said. “The death rate starts going up in the 50s. It goes up more in the 60s. It gets pretty bad in the 70s. It looks god-awful after 80. So we’re sort of lumping them. But more importantly than that is we’re stripping them of their agency.”
…Touch and simple human considerations tend to get lost in numbers and curves. As the threat stretches on, people must weigh relative risk. What is a hug worth? Or a walk in the park?
Ever since the novel coronavirus began to spread widely in the United States, there’s been a lot of talk about grandma and grandpa. On March 17, the same day seven Bay Area counties initiated stay-at-home orders, the hashtag #DontKillGrandma began to trend. “We need you to do this, if not for yourself, then for your abuela. Do it for your granddaddy. Do it for your big momma. Do it for your pop pop,” said Surgeon General Jerome Adams. He was speaking, directly, to Latino and black families, but the point was still the same. Younger people needed to think about older people.
…Judy Lynch,…a retired nurse and longtime advocate for the aging who now knows what it means to age, doesn’t much like the word “grandma.” … “It diminishes who we are. We’re so much more. ... We are still pursuing our own interests.”
…Telling everybody 65 and older to stay at home for the next year or two or three — to make themselves small, quiet and nearly invisible — doesn’t make sense, Carstensen said. “We need all hands on deck.”
…As for a long-lasting stay-at-home directive: “It’s not going to work,” said Anni Chung, president and CEO of Self-Help for the Elderly. “Just the last eight weeks has been problematic for them.” She’s heard members cry. “Why am I living? What’s the point?”
Particularly for the very old, isolation can impact physical and mental health. It can also affect cognitive abilities. Senior centers are more than physical spaces; the community they provide is a lifeline.
…So it’s a matter of risk assessment; not a strict number…
https://www.sfchronicle.com/bayarea/article/Age-is-a-sloppy-proxy-Older-adults-push-15278933.php
Older Adults May Be Left Out of Some Covid-19 Trials
ReplyDeleteThe coronavirus disproportionately affects seniors, but they may not be included in important clinical trials for vaccines and treatments.
By Paula Span
June 19, 2020
Picture the day…when university researchers or a pharmaceutical company announces a breakthrough against the virus that causes Covid-19.
Maybe it’s a successful vaccine or an effective treatment, a discovery that brings hope and relief — especially to the older adults most vulnerable to the disease, eager to return to their pre-pandemic lives.
Imagine, however, that the researchers neglected to enroll many people in their 70s or 80s in the clinical trials that established the effectiveness of this treatment. As a result, it’s unclear how much the treatment will benefit older people, what risks it might pose, or if the dose that works for younger people is the best one for an older population.
Could that really happen? Certainly there is a long history of older people being excluded from clinical trials, even when the diseases in question disproportionately affected this group. They have been underrepresented, for instance, in studies of heart disease, cancer, diabetes and osteoporosis.
…Now, Dr. Sharon K. Inouye, a geriatrician at Harvard Medical School and Hebrew SeniorLife, is sounding an alarm. She points out that in the race to find drugs and vaccines to fight the pandemic — in which 80 percent of American deaths have occurred in people over age 65 — a substantial proportion of studies may be excluding older subjects, purposely or inadvertently.
…She and her team have reviewed 241 interventional Covid-19 studies undertaken in the United States and listed on clinicaltrials.gov, a site maintained by a division of the National Institutes of Health.
…Overall, when Dr. Inouye compiled preliminary results, which have not yet been published, she found that about one-quarter of interventional trials in the United States could exclude or underrepresent older adults.
“To have them be this gravely impacted and not include them is immoral,” said Dr. Louise Aronson, the author of the best-selling book “Elderhood” and a geriatrician at the University of California, San Francisco…
In response to similar concerns, the N.I.H. began last year to require the studies it funds to include “individuals across the life span,” unless investigators provide an “acceptable justification” for exclusion. If they cannot, N.I.H. won’t award the grants.
…But most clinical trials are privately funded and need not follow N.I.H. policy.
…Still, the rush to learn more about the deadly coronavirus could exacerbate the problem, because including older people can make research slower, more complicated and more expensive.
In clinical trials, “you want to control as many factors as possible,” Dr. Aronson said. Most older adults have other illnesses and take multiple medications, so-called confounding variables that make it difficult to distinguish the effects of the drug or vaccine being studied.
Older people also suffer more side effects. “Nearly all drugs are less toxic when given to younger, healthier people,” Dr. Sloan said in an email. Focusing on them produces fewer adverse effects that must be reported, “and thereby improves chances for F.D.A. approval.”
Physical disabilities, which make it harder for seniors to reach study sites, or hearing and vision impairments requiring large-print forms or audio amplification, can further decrease participation…
“The same things that put you at higher risk for Covid make it harder to study you,” Dr. Aronson said.
But that shouldn’t prevent researchers from incorporating the population most at risk from the coronavirus. “If that’s the real-world scenario, you’ve got to deal with it,” said Susan Peschin, the president of the nonprofit Alliance for Aging Research…
https://www.nytimes.com/2020/06/19/health/vaccine-trials-elderly.html
The pandemic has people reexamining their lives. Some don’t like what they’re seeing
ReplyDeleteBy Beth Teitell
July 5, 2020
…With COVID-19 cases mounting and the fear of death hovering, therapist Sam Nabil captured the question lurking barely beneath the surface:
“If I die now, have I lived the life I wanted to?”
For many, the answer is no. Spouses are being left, retirements pushed up, friends dropped. People are moving to rural spots and strengthening their faith, and those fortunate enough to have a choice are saying “no” to commuting.
The changes can be as easy to see as Alice Beltran’s decision to spend more time around dogs. She recently left a position in human resources at Tufts University to go full time with her dog day care company, North Shore Dog.
Watching friends lose their grandparents, and being unable to visit her 89-year-old father, made her focus on the brevity of life.
“You think you’re going to have forever, but you don’t,” she said. “If in three months I have to go back to human resources, fine. I get calls [offering work] every day.”
The shifts can also be as subtle as a new mindset. That’s what the pandemic has triggered for a 61-year-old Wakefield woman whose husband lives in a nursing home. “Before COVID, I was often sad and lonely and feeling left out of life,” she said, asking her name not be used.
But now — especially since her husband contracted and recovered from COVID-19 — she focuses on what she has: a home, a yard, a dog, phone calls with her children and spouse.
“I’m actually happy for the peacefulness of living simply and without the feeling of missing out on life, as I had before the pandemic,” she said.
Nabil, the therapist, says “death anxiety” has people questioning career choices and the quality of relationships…
Lovern Moseley, a psychologist at Boston Medical Center, is regularly hearing a similar question. “Am I truly happy if this is it?” her clients ask. “If we get back out again, is this what I want to be doing?”
Laura Carstensen, a professor of psychology at Stanford University, sees two phenomena at work.
“When people are reminded of the fragility of life, they see more clearly what’s important and what’s not,” she said.
These shifting priorities are typically seen among older people, but in the six months following 9/11, younger people also felt the nearness of death, she said. That’s happening now, too.
“With COVID-19, the suddenness with which our world changed is allowing us to look at the culture surrounding us, the social norms, and this lets us see things we would normally never notice,” she said.
Or that we do notice — like traffic — but accept as inevitable.
“I think we’re going to see a lot of change post-pandemic,” she said. “It will be an accelerator.”
The pandemic has made Renee Ruggiero of Wakefield aware of time that she’s missed with her family in exchange for a corporate career and a good salary.
“I can’t say that looking back it was worth it,” she said. “How many times did I tell my kids I couldn’t help them with this or that because I had to work, or because I was exhausted?”
She lost her job during the pandemic, and she prefers her new self. “I’m able to take care of my elderly father-in-law and enjoy it rather than think of it as a burden,” she said. “COVID has blessed me with the ability to take stock of my life.”
On the North Shore, a married couple have also taken stock of their lives and drawn a different conclusion. They have been hanging out with the wrong people — friends who were nice to their faces, but, they now realize, are selfish.
The friends refuse to wear masks or support Black Lives Matter, stances that rule out any further relationship, said the couple, who asked to remain anonymous.
“I”m going to have to find new people that I feel safe with,” said one of the spouses. “This has peeled back the layers.”
https://www.bostonglobe.com/2020/07/05/nation/if-i-die-now-have-i-lived-life-i-wanted/
As the pandemic surges, old people alarm their adult kids by playing bridge and getting haircuts
ReplyDeleteBy Tara Bahrampour
July 10, 2020
…The effects of covid-19 are most devastating for older people, with a 30 percent death rate among people over 85 in the United States who develop it. Many in that age group are sheltering in place and skipping social events in an effort to avoid the virus that causes the disease, and younger family members have often stayed away…
But others have taken a more relaxed attitude, engaging in behavior that fills their middle-aged children with terror, for both their parents’ health and their own.
Various factors are contributing to this generational divide. Older people in the United States are statistically more likely than younger generations to listen to conservative media and to politicians who have played down the of the virus, and some may have followed their lead. Others may be well aware of the risks but have weighed them against the mental and physical benefits of maintaining exercise and social routines.
Whatever the reasons, the dynamic can leave middle-aged people, many of whom may already be worried about their adult children going to protests or beach gatherings, feeling that they must also parent their parents.
…Even when older people do understand the risks, it may not terrify them as much, said Laura Carstensen, director of the Stanford Center on Longevity. “Older people in general experience less stress in everyday life,” she said, adding that surveys show that older people are doing just as well now as in pre-coronavirus times.
“They absolutely see themselves at risk, [but] there is lots of evidence that as people come to the end of their life, they come to live in the present and they stop worrying about the what-ifs,” she said.
Bill Thomas, a geriatrician and founder of ChangingAging.org, agreed…
“As we get older, we are more likely to lose the illusion of immortality compared to younger people…Older people are more likely to be living with the awareness that they are in fact mortal and they have a limited amount of time left. Many older people are more conscious of weighing the risk-benefit based on the knowledge that they’re not going to be around much longer. So you make some different calculations than younger people.”
People in their 50s and 60s tend to still be invested in maximizing their life span, Thomas said. “The 80-plus, they’re the real lions of the human race. They’ve seen more, done more, and a lot of times may be more realistic about their end-of-life prospects.”
JoAnn Schaffer, 89, of Shaker Heights, Ohio…“I have a different perspective…I’m old, and if I die, I die. If it’s going to kill someone, let it happen to the older people. I’ve lived my life.”
…Thomas cautioned against young people trying to change older parents’ activities: “It’s a really ageist presumption on the part of these 60-year-old children that they get to tell their parents what to do…Part of being an adult or a grown-up is you have the right to do stupid things . . . but that person has to accept the consequences — young people aren’t going to want to be around you.”
…In some cases, adult children have come to a kind of peace with their parents’ relative lack of concern.
Dana Faulkner of Chevy Chase, Md., realizes that, thanks to the pandemic, she may not see her mother again. Her mother, whom Faulkner describes as “an outdoors person,” is 92 and in an assisted-living …
If this was going to be her mother’s last summer on earth, maybe the most important thing to her was to get out and breathe the fresh air.
“I would say her impulse to be outside and to enjoy the world while she has it is instinctive rather than analytical…There isn’t a big fear factor going on — she seems to be pretty calm about the whole thing…”
https://www.washingtonpost.com/local/social-issues/as-the-pandemic-surges-old-people-alarm-their-kids-by-playing-bridge-and-getting-haircuts/2020/07/10/e10aa6e8-bd7b-11ea-bdaf-a129f921026f_story.html
US economy will not recover until the elderly feel safe
ReplyDeleteBY DR. DAVID BLUMENTHAL, OPINION CONTRIBUTOR — 07/10/20
Policymakers trying to boost the economy during a pandemic need to face a fundamental truth: the U.S. economy will not recover until the most vulnerable among us — the elderly — feel safe.
According to the Federal Reserve, Americans over 70 control 28 percent of the nation’s household wealth. Americans over 65 account for 20 percent of consumer expenditures, according to data from the Bureau of Labor Statistics. They spend that money on health care, travel, dining, and a vast array of other goods and services.
But according to the most recent CDC data, the death rate without an underlying condition among individuals 70-79 who test positive for the SARS COV-2 stands at 16.7 percent, rising to 28.7 percent among those over 80. For people with common problems like diabetes, hypertension, or cancer, the rates almost double. Even if the numbers continue to decline, as they have been, it will be a while before they reach less appalling levels.
…policymakers should realize that much normal consumer spending may stay frozen in the accounts of older Americans, as they make the rational calculation that staying inside is critical to their health and safety. It makes total sense for vulnerable people to remain in lockdown until their chance of getting the virus drops to near zero.
Of course, a highly effective vaccine — say equivalent to those for measles or smallpox — will make us all safe and release the economy for much more rapid recovery. But despite optimistic predictions, there is no guarantee that we’ll have such a vaccine any time soon. And policymakers should also be aware that vaccines have differing efficacy for different demographic groups, so it is vital for our economic futures to find immunizations that are highly effective for the most vulnerable age groups. A vaccine that is 60 percent effective, such as many annual influenza shots, will not do the trick. Does it make sense for a 75-year-old to go out on the town if they’re 60 percent protected against illnesses with a mortality rate as high as one third? Lots of older adults will not like those odds.
What can we do to make it safer for older people while we wait for an effective vaccine? Every state that wants to revive its economy should implement aggressive so-called non-pharmaceutical interventions — wearing masks, careful social distancing, frequent hand washing, widespread testing, contact tracing and isolation of the symptomatic and asymptomatic individuals who test positive for the virus. Many other countries have done this and are reaping the rewards through an economic revival. Even in the U.S., several northeastern states seem in striking distance.
It is true that the mortality rates cited here are for proven COVID cases. Many are asymptomatic or undiagnosed, so the actual chance of dying for an infected elderly person is likely much lower than these CDC numbers. But that overall mortality rate is currently unknown in the United States, and won’t be fully understood until we have much more widespread testing of large representative samples of the population. Until we have those data — another reason for a massive, all-out, national campaign of testing — the only guidance high-risk groups will have is startling mortality rates among the diagnosed.
In many states that have opened up prematurely in the hopes of reviving the economy, leaders are dealing with angry, resistant populations who want their jobs back now and resent being told to wear masks or restrict their activities…They may be writing the death warrants for their own prosperity as they shed masks and break loose. The key to unlocking a healthy economy may be hiding at home, where their parents and grandparents are still locked in place. When it comes to COVID, only when the weakest are safe will the strong thrive.
https://thehill.com/opinion/healthcare/506784-us-economy-will-not-recover-until-the-elderly-feel-safe
How SF’s Laguna Honda averted coronavirus disaster
ReplyDeleteState, feds stepped in with training, protocols and action plan for largest nursing home in California
Sarah Ravani | July 27, 2020
…Now, four months into the pandemic, not one Laguna Honda resident or worker has died of COVID-19…Of the 721 people living there, 19 have become infected. And of more than 1,800 employees, 50 have tested positive.
…With help from the state and federal governments, San Francisco city leaders were able to create a response around the virus that prevented tragedy: creating COVID wards to keep people separate, training in proper infection controls for workers and enlisting a contact-tracing team to track how far the virus may have spread from person to person. Laguna Honda achieved what it did despite the fact that for several months, it couldn’t meet federal testing recommendations due to nationwide shortages.
…San Francisco Mayor London Breed, who requested state and federal help… “My grandmother was a resident at Laguna Honda for years before she passed away, so I know how important a place it is…”
Nursing homes and assisted-living facilities remain the main drivers of California’s COVID-19 fatalities, accounting for 46% of all deaths…these elderly residents typically have health problems that make them more susceptible to the coronavirus and more likely to die from it, their vulnerability means they need a lot of extra protection from caretakers.
…On March 27, Breed and Public Health Director Grant Colfax sent a formal request to the state and the Centers for Disease Control and Prevention in Atlanta, asking for help at Laguna Honda.
The next day, the state sent two infection control experts who stayed for a week. A day later, six nurses and epidemiologists arrived from the CDC.
…staff members…complained about being short-handed and lacking equipment…no one was listening.
But now the CDC team was there — to listen and help — for three weeks. Six workers had already tested positive. And by March 26, so had a resident.
With no isolation unit for infected residents, the CDC team helped the nursing home create a COVID unit around each sick patient’s room. That allowed up to 15 infected patients to be kept safely apart from other residents.
…social distancing rules and quarantine requirements were not always enforced before state and federal help arrived.
The nursing home began making a practice of transferring residents with the virus to the COVID unit for 28 days — two weeks longer than the usual quarantine time recommended by the CDC.
…The CDC’s health team also taught nursing home workers — health aides and nurses — how to use personal protective equipment properly: sanitizing their hands before putting on gowns and wearing only gowns that fit…when to wear a surgical mask and when it was necessary to upgrade to a more protective respirator mask.…how to remove the protective gear to avoid contaminating hands, face and clothes.
Laguna Honda administrators now know that people going in and out of nursing homes, most often staff, are the main sources of coronavirus transmission.
Since March, every time employees enter the nursing home, they have had to sanitize their hands and take a new face mask. Someone checks their temperature and asks about symptoms that could signal COVID-19. Workers who pass receive a sticker to wear signaling their clearance.
Although the CDC team recommended that administrators test all 721 residents and 1,750 employees every two weeks, it wasn’t until May that the administrators had enough tests to achieve that…
The staff at Laguna Honda also learned to do contact tracing from the CDC.
…Managers sent exposed workers home to quarantine for at least 14 days. They have sent more than 35 employees home so far, or about 20 workers per patient.
…Because of sick workers, staffing shortages have become a challenge…So employees work overtime…
https://www.sfchronicle.com/bayarea/article/A-deadly-coronavirus-outbreak-seemed-inevitable-15433148.php