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Self in community

As COVID-19 transitions from pandemic to endemic, so much talk about returning to normal or “new normal.” What does this mean for self in community?

“New Normal”

Last year, Pew Research surveyed experts who believed COVID-19 pandemic’s impact on new normal life would be

·       worse in terms of greater inequality (tech privilege), rising authoritarianism and rampant misinformation,

·       better in a “tele-everything” world where workplaces, health care and social activity improve (remote processes). 

Others speculate another Roaring 20s of decadence and frivolity, like after trauma of 1918 Flu Pandemic/WWI, which might suggest greater prosperity to wealthy whites, while “others” (farmers, immigrants, labor unions, etc.), are left behind? Will “post-traumatic growth” (feeling more appreciative, spiritual and resilient) continue? 

When California’s indoor mask mandate expired on Feb. 15, CA Public Health tweeted: “A mask is no longer required for vaccinated individuals but is still strongly recommended to protect you and others from #COVID-19.” 

Almost overnight, gains from two years into the pandemic—like mask mandates (though barely enforced, given SF Mayor’s disdain for fun police micromanaging mask wearing) and remote work intended to protect the common good—are being cast aside…until the next coronavirus variant/COVID surge and communal call to do our mindful part to flatten the curve?

Hope “new normal” is better than normal, like individual risk decision-making in larger context of shared responsibility for collective well-being, especially looking out for most vulnerable (immunocompromised, older adults, unvaccinated under age 5, etc.)? Like during early months of pandemic, with focus on greater community care such as mutual aid beyond charity. And, wow, SF government taking responsibility for housing and welfare of its unhoused older adults… even if motivated to mitigate social unrest and pacify population (inspired by Piven & Cloward’s Regulating the Poor?) by prioritizing seniors as more “deserving poor” with their projected shorter remaining life expectancies to fund housing and supports. (In contrast, SF Mayor’s defunding police plan proved unsustainable, short-lived from February 2021 until December 2021.) 

Consider more silver linings during pandemic, like re-examining what is “normal” workplace and reducing carbon footprint while working remotely from home; promoting fresh air ventilation and nature’s restorative effects (e.g., Slow Streets and car-free JFK Drive in Golden Gate Park to encourage people of all ages to get out of vehicles in more equal footing and face-to-face engagement in the Great Outdoors); getting “woke” to confront inequities and foster greater DEI (Diversity, Equity, Inclusion) and belonging, especially advocacy with marginalized communities like unhoused people (estimated 50% of unhoused in SF are age 50+), older adults and direct care staff in long-term care (LTC) facilities at disproportionate risk for severe COVID-19 and deaths.

“a community is also built on trust and trust is the expectation that you're going to do what you ought to do. That we have the same set of values and that we understand what the right thing to do, that we have a set of norms… in America, our trust levels have just, just declined, precipitously…

the crucial skill in the center of any healthy community is the ability to see each other well, make them feel seen and understood…You have to ask questions to really know someone.” –David Brooks, “Being Seen, Social Trust and Building Relationships” (Dec. 10, 2021) 

When WHO declared COVID-19 pandemic on March 2020, I thought of the potential of emerging from the collective experience of this pandemic from individualistic self-care to generous community care as a matter of survival. Instead, the outcome of USA’s personal responsibility approach is reaching 1 million deaths from COVID-19.

Since the onset of COVID-19 pandemic, California’s population of 39 million declined by almost 300,000 due to increase in pandemic-related deaths and residents moving to other states (at its highest level since mid-1990s), declines in birth rates and international migration (at its lowest level in at least 40 years). According to CDC, USA had more than 1 million “excess deaths” since the pandemic began, with majority of deaths caused by coronavirus directly, and remaining deaths attributed to disruptions caused by pandemic (e.g., canceled health screenings and treatments, drug overdoses). Who’s ready to return to normal after the trauma of these premature/excess deaths?

The inhumane lockdowns and casualties of people segregated/isolated in LTC facilities during COVID-19 pandemic  has given impetus for expansion of home and community-based services (HCBS) so more people can access community living integration as an alternative to institutionalization. Yet, declining population, particularly in California, means workforce challenges in HCBS supports like caregivers and community case managers.

Caregivers

Age-Friendly Insights Poll: Direct Care Workers Are Underpaid, Lack Support and Oversight (Feb. 9, 2022) 

According to Profile of the California Medicare Population (Feb. 2022): 

·       In 2021, 1 in 6 Californians had Medicare

·       More than 1 in 5 California Medicare beneficiaries are dually eligible for Medi-Cal

·       Nationwide, 2 out of 3 Medicare beneficiaries living in the community have difficulty with an activity of daily living (ADL) or use an assistive device; of those, half use caregiver assistance and/or have 2 or more ADL limitations

California Direct Care Workforce Current Investments (Feb. 1, 2022) 

NPR reported “The pandemic pummeled long-term care – it may not recover quickly, experts warn” (Feb. 22, 2022). Assisted living facilities experienced 50% staff turnover, despite wage increases. Biden Administration has proposed nursing home reform initiatives to establish minimum nursing home staffing requirement and create “Pathways to Good-paying Jobs with the Free and Fair Choice to Join a Union.” 

Caregiver assistance remains critical for older adults who wish to remain in their homes and communities. (See “Pandemic-Fueled Shortages of Home Health Workers Strand Patients Without Necessary Care,” Kaiser Health News, Feb. 3, 2022.) This month California Department of Aging hosted Direct Care Workforce Current Investments webinar focused on Master Plan for Aging (MPA) Goal 4: Caregiving that Works! To reach target 1 million high quality caregiving jobs, strategy is to maximize existing staff, systems, structures and build new career pathways; fund $150 million for training and stipends to recruit, retain and promote staff; improve web-based training in multiple languages; build capacity, expand HCBS infrastructure, deliver on vision for more options. 

Community case managers

California MPA doesn’t address community case management workforce, other than indirect reference to programs that provide case management, e.g., CalAIM’s Enhanced Care Management and Community Supports (Initiative 36 under Goal 2: Health Reimagined), and expansion of older homelessness assistance and prevention programs (Initiative 118 under Goal 5: Affordable Aging), such as HomeSafe and Housing and Disability Advocacy Program.

“California’s unhoused population is aging and increasingly composed of older adults: Roughly 45% of unhoused Californians in adult-only households who came in contact with the homelessness response system in the 2020-21 fiscal year were aged 50 and older. Financial and medical emergencies later in life can push those who were already struggling to make ends meet into homelessness. Challenges in accessing support and social safety net programs for older adults in crisis and inadequate benefit amounts are also a driving factor.  Older adults are more likely to have underlying health conditions and disabilities that may be exacerbated by the additional stressors of being unhoused…unhoused adults develop similar rates of geriatric conditions as housed adults who are 20 years older. The distinctive circumstances older adults face will require more assistive services to obtain and maintain housing. Due to this, these Californians have significant implications for current homeless intervention practices as specific service needs should be integrated with other service systems and funding sources.”—Monica Davalos and Sara Kimberlin, “Who is Experiencing Homelessness in California? Tailored Housing Interventions are Needed for California’s Diverse Unhoused Population,” California Budget & Policy Center (Feb. 2022) 

The existing safety net system (staffed with neoliberal social workers) pathologizes poverty, by diagnosing people based on a deficit framework, “othering” them as permanent cases of dependency and placing them in “supportive” housing that employ case managers who are supposed to connect them to “supports” to provide stability (public benefits, in-home care, food, healthcare, transportation, etc.).

When this doesn’t happen, SF attorney Martha Bridegam (self-described “advocate for very poor people”) observed that “disabled supportive-housing tenants are neglected and allowed to fail” so she has handled some of her clients’ case management to prevent their eviction because their assigned case managers didn’t. Attorneys can be more effective advocates than case managers without legal training to properly inform clients of their rights/legal processes, especially under Americans with Disabilities Act.

More anecdotes about safety net case managers: Margaret Stawowy worked with a nonprofit social worker for more than a year to access safety net programs for her mother with dementia and living in low-income senior housing, and did not succeed until a social worker in private practice helped her apply successfully. Veteran Del Seymour became his own case manager to get himself housed. 

“…the path from homelessness to housing can take as long as two years, and that’s for someone lucky enough to make it onto the waitlist.

San Francisco’s struggle with housing its unhoused population is notorious across the nation…

The City’s software to track vacant units is error-prone, unit maintenance problems take a long time to resolve, case managers quit and it can be impossible for people who have been living on the street to meet document requirements. (The homelessness department said that the city is currently working on the software and documentation issues, and has put a raise for case managers into its budget request for next year.)

…a shortage of case managers, who are the crucial link between vacant units and the hundreds of people approved for housing. There is frequent turnover in the high-stress positions, and nonprofits struggle to fill new job openings.

Stroud said she has been assigned six case managers in two years. To figure out who is assigned to her, she regularly checks a piece of paper taped to a wall in her hotel, which lists the name of the case manager assigned to each floor. She describes calling her case manager repeatedly to set up an appointment and not getting through.”—Nuala Bishari, “In San Francisco, Hundreds of Homes for Unhoused People Sit Vacant,” ProPublica (Feb 28, 2022) 

CalMatters reported on “a severe worker shortage in the California homeless services field threatens the state's ability to massively expand services. Many homeless service workers – who make low wages for high-stress jobs – are burned out.” Last year’s SEIU survey found that nonprofit workers, on average, made 45% less than City workers with equivalent positions. In SF, low starting wages (e.g., $21-$35 hourly) are paid to homeless service workers in nonprofit agencies that outbid each other for contracts with the City, while the City pays its own homeless service workers more competitive wages (e.g., SF Department of Public Health/SF Department of Homelessness & Supportive Housing 2920 medical social worker/2930 behavioral health clinician positions pay start at $46.225 hourly rate). As a result, the City was able to quickly hire 100 workers to respond to the Tenderloin state of emergency, plus plan to hire 100 more workers at the end the 90-day emergency declared by SF Mayor in December. (This month staff at nonprofit agencies, contracted by SF Department of Disability and Aging Services, received $500 as hazard pay for working the past year during pandemic.)

Will proposed pay raise for case managers address high staff turnover? Maybe, but will pay raise improve employee engagement/morale so staff genuinely show up for older clients? (See Lincoln Mitchell's “Opinion: S.F. Police Chief Bill Scott’s complaints of low morale are code for something else - ‘Asserting that police will not do their job if morale is low is a form of blackmail’’, SF Examiner, Feb. 28, 2022.) 

Seems easier to throw money (higher pay) at “problem” than address root causes like toxic work culture/autocratic supervisor and trickle-down effect on staff and clients? 

“Being supported, valued, and heard were all things that frontline staff reportedly did not feel in the study…What’s really upsetting about this is that these three feelings are what human services work to achieve with their clients. Often this issue stemmed from the staff’s perceptions of management - they felt that management did not support, respect, or appreciate the work the staff did. Frontline staff often said that they were never recognized for the work they did with clients or the extra hours they always put in.”—"What’s Happening to Human Services? Why Employee Attrition is Off the Charts,” ANCOR (Oct. 18, 2016). 

“As employees return to the office and are confronted once again on a daily basis with annoying personalities and the grievances of office-life, they may also decide the money just isn’t worth it. Gallup research found that 50% of employees leave their jobs "to get away from their manager to improve their overall life at some point in their career."—Nicole Goodkind, “Some companies can’t get employees to stay even when they throw millions at them. Here’s why,” Fortune (Feb. 11, 2022) 

Use of self to help build community

SCW © 2020 https://www.syracuseculturalworkers.com/products/poster-how-to-build-community-during-a-pandemic

In social work practice, the use of self is a therapeutic tool that enables the social worker/case manager to integrate aspects of personality, belief system, relational skills, and personal experience to engage clients in the helping relationship. The idea of professional self-care is to heal oneself to be in a position to heal others. And healing takes place in the context of supportive relationships, like community building to create a sense of belonging. Aspire to be person-centered social work community builders like Marie-Louise Ansak, who co-founded On Lok’s Program of All-Inclusive Care (PACE) in SF, and Yvonne van Amerongen, who co-founded Hogeweyk village to care for people with severe dementia. Ideally, use of self in collaboration with like-minded folks who challenge the status quo to improve quality of life for people who want to age in community!

Social Work Practice 101: social work/case management doesn’t happen until trusting connection/relationship develops between worker and client, and this takes time; when there is high turnover, trust deteriorates. Case managers/human services workers were quitting long before the Great Resignation prompted “rethinking what work means to them, how they are valued, and how they spend their time” so they do not work just to pay bills but work needs to accommodate their life? Challenging enough at non-profit agencies where case managers are expected to use own mobile phones and vehicles for client work, while trying to maintain boundaries between work and personal life—and reimbursement process adds to paperwork.

https://www.dukeupress.edu/the-revolution-will-not-be-funded

Awkward experiences with the non-profit industrial complex (NPIC), as I reflect on my non-profit work serving older adults as similar to muckraker Barbara Ehrenreich taking low-wage jobs (to investigate impact of welfare reform on working poor, as reported in her 2001 book, Nickel and Dimed: On (Not) Getting By in America). After I accepted case manager position that was non-exempt under Fair Labor Standards Act, agency changed my position to exempt and explained this elitism was the only way the position could be paid above union scale. Higher pay without overtime and union benefits?! What happens to worker solidarity?! Another nonprofit agency required staff to work alternate days between windowless basement office and home, understandably for physical distancing during pandemic, but without providing agency computers for this remote work so staff use their personal home computers for agency business—raising HIPAA privacy issues?!

Time to “tell it like it is” with call for independent audit of case management system in NPIC.

Great Resignation/Rethink/Discontent

According to authors/executive coaches Russ Hill and Jared Jones, “The Great Resignation is being fueled by a workforce that will no longer tolerate a bad boss, a toxic culture, a company without purpose, or a lack of development.”

The Great Resignation has been called the Great Rethink of self in relation to workplace culture—a desire for workplace spirituality that integrates employee well-being/quality of life, a sense of “real purpose and meaning in their work beyond paychecks and task performance,” and a sense of interconnectedness/community. 

“The pandemic changed the way people work and how they view work. Many are reflecting on what a quality job feels like, and nearly half are willing to quit to find one. Reversing the tide in an organization requires managers who care, who engage, and who give workers a sense of purpose, inspiration and motivation to perform. Such managers give people reason to stay.

In other words, reversing the Great Resignation requires fixing the Great Discontent -- and managers are the key.”—Vipula Gandhi & Jennifer Robison, “The 'Great Resignation' Is Really the 'Great Discontent',” Gallup (July 22, 2021) 

Yet workplace spirituality can be lacking in social work environments, especially given the disconnect between social workers who believe clients’ spirituality can improve mental health yet these same social workers aren’t even discussing spirituality with clients. If social workers can’t address spirituality with clients, can they address spirituality in their workplace? Integrating spirituality often leads to improved holistic health because it reduces self-centeredness while it creates a sense of belonging to a larger community when one contributes value to the greater common good, potentially reducing feeling of other-ness.

According to MIT researchers, “toxic corporate culture” (i.e., failure to promote DEI; workers feeling disrespected; and unethical behavior) is driving the Great Resignation, and ten times more important than compensation. BBC reported toxic work culture also exists in remote work: “Most toxic work cultures originate with poor management, whose bad habits can be contagious.” 

No surprise. While researching effective ways to integrate gerontology into MSW curriculum to promote preparedness to work with older adults, related inquiry why people don’t want to work in places that serve older adults? It’s the toxic culture, which includes ageism. Great Resignation is like #MeToo movement against toxic work culture.

Return to community that values aging

During pandemic, people who returned to multigenerational living gained benefits of age diversity: opportunity to experience value of generational caregiving and perhaps to become a “better” person by living interdependence and searching for commonalities before differences. 

“Spending more time with elderly loved ones may also emerge as something people cherish post-COVID, and the reality of not knowing what we have until we lose it could very well translate into more time spent with family and friends.

The people who moved out of the cities could find a new lifestyle and prefer the sound of nature in their backyard over the honking of heavy traffic. The adults who moved in with their parents due to the virus may feel closer to them than ever before and see them through an entirely different lens of appreciation. Without the obstacles of the pandemic and quarantine, people may not have discovered such personal changes.”—Jared Glasser, “We All Quit—Sorry for the Inconvenience,” HR Daily Advisor (Aug. 4, 2021) 

Gerontologist Tracey Gendron wrote about halcyon days when people were more holistic, living and working on the family farm that brought all ages together and older people were valued.

“After the Industrial Revolution, … places where we were working and living became separate. That was truly a turning point when it comes to attitudes about aging. You started to see the families change in shape and form. So that was one factor in the workplace. We started to value more productivity. And you started to see some sentiments that older workers were doing things the old way and that they couldn't keep up with the new way of doing things.

At the same time, we also started to socially construct childhood to more of how it looks today. Instead of having children work on the farms as they used to do as active contributors, childhood became this protected period of time for children to develop and be nurtured and grow. Caring for children became something that was expected, that came with great rewards and great challenges. But a byproduct was that we started to see caring for elders as something different, more of a burden. We started to institutionalize, to create these nursing facilities that would house older people.”—Tracey Gendron, Ph.D., director of Virginia Center on Aging and author of Ageism Unmasked:Exploring Age Bias and How to End It (2022). 

Self-help books by men of AARP age

In From Strength to Strength: Finding Success, Happiness and Deep Purpose in the Second Half of Life (2022), social scientist Arthur C. Brooks (age 57) shared research on human happiness: 

·       Happiness tends to decline throughout young adulthood and middle age, bottoming out at about age 50, and then heads back up again into one’s mid-60s. Then, older people split like two roads diverged in a wood: one group getting much happier (“happy-well” enjoyed good physical/mental health and high life satisfaction), and other group getting much unhappier (“sad-sick” who were below average in physical/mental health and life satisfaction).

·       Arthur noted at least seven self-care cumulative advantages are under our control to plan for later life happy-wellness: no smoking, avoid “problem” drinking, “healthy” body weight, physical movement, emotional resilience (practice coping via spiritual practice, therapy), “lifelong, purposive learning,” and cultivate “stable, long-term” relationships.

·       Arthur’s model speaks to Anglo-American ideal of rugged individualism, almost like opportunity to achieve “successful aging” through one’s own efforts.

“Aging in place is the dream plan for a lot of us, but for our families it can be more of a nightmare. I will make the appropriate arrangements for my care, and not just hope it all works out.”—Steven Petrow, “I Won’t Burden My Family with Taking Care of Me,” Stupid Things I Won’t Do When I Get Old: A highly judgmental , unapologetically honest accounting of all the things our elders are doing wrong (2021)  

After his 50^th birthday, civilist Steven began compiling a list of “things I won’t do when I get old,” mostly based on the experiences of his parents (who used profanity, which is used in his book). For example, Steven writes how his parents’ insistence on “aging in place” became a burden on him and his two siblings who took turns being on-call for their parents while providing money management, hiring/firing health aides… After his parents died, and after his 60^th birthday, with no partner and no kids, elder orphan/solo ager Steven decided to think about “an aging plan for just me.” He seemed to limit this plan to asking friends about “senior living” and toured continuing care and cohousing communities (caution: read “They took a chance on collaborative living. They lost everything,” NY Times, Feb. 13, 2022) before mailing his deposit for the former (though he didn’t complete tour to skilled nursing facility). Steven makes this decision, though transitioning to higher level of senior living might make it more difficult to avoid “things I won’t do when I get old” like:

·       “I Won’t Limit Myself to Friends My Own Age” (p. 36): senior living is age-segregated for residents.

·       “I Won’t Be Ordering the Early Bird Special” (p. 172): facilities schedule mealtimes while sun is still out, which can be beneficial for eating patterns in sync with our natural circadian rhythm.   

·       “I Won’t Turn My House into a Sweat Lodge” (p. 177): facilities are required to maintain temperature range of 71- 81 F, often at high end in practice.              

In “I Won’t Postpone for Tomorrow What Matters to Me Today” (p. 216), Steven used DeathClock.com to find out his personal day of death – age 73, which was within range provided by his oncologist, and then at age 56 he decided to quit his job as salaried editor to write. Yet, Steven may outlive this prediction (and possibly live out more years in senior living). When I entered data for my parents (who are happily aging in place!) on DeathClock.com, the message was “I am sorry, but your time has expired. Have a nice day!”  

Wonder if I should introduce myself as gerontologist to engage Steven to consider “aging in place” options? Wonder if Steven’s response due to internalized ageism (passive recipient deferring to industry “expert” v. older person as expert of own life) or lack of imagination to mobilize for change (ask what you hope/want, if you know what you hope/want)?  

This morbid idea of checking oneself into a LTC facility to avoid becoming a burden or “nightmare” for family caregivers reminded me of The Manor, last Halloween’s horror film featuring protagonist (played by septuagenarian Barbara Hershey) who moves into a nursing home after suffering a stroke on her 70^th birthday…and resident nightmare begins with evil gaslighting! When asked, "What do you think it is about nursing homes and assisted living facilities that make them a perfect setting for a horror story?" The Manor's writer/director responded:

"You have vulnerable people whose abilities are starting to decline, whose own minds they sometimes have trouble trusting. And they’re stuck in a place where communication is difficult, where even people who mean well have trouble hearing and understanding and figuring out how to help. And where, for your own good, you’re locked inside... So your world gets smaller and smaller and very often if your symptoms manifest as [fear], you will be locked in the very place that you’re scared of.

The experience of not knowing how to communicate must be incredibly isolating…So there’s a lot of elements that thematically were very rich. And also in a horror movie we always try to justify: Why can’t she call for help? Why is her cellphone not working? Why is she not running away from this place? And all of this is kind of answered by, Well, she’s in a nursing home, there are rules [in place that limit outside contact]."-- Jenny Desborough interview with Axelle Carolyn, “'The Manor': Amazon Horror Movie's 'Provocative' Ending Explained By Cast and Director,” LA Times (Oct. 15, 2021) 

Recent headlines about family caregiving costs sound horror-scary:  

“People Over 80 Are Still Taking Care of Their Parents and Partners” even when parents live in a continuing care community (Wall Street Journal, Feb. 9, 2022)

“Caring for Older Relatives Is So Expensive That Even AARP’s Expert Filed for Bankruptcy: Unexpected costs can accumulate over time and overwhelm even most experienced of nation’s 53 million family caregivers” (Wall Street Journal, Feb. 20, 2022)   

“What caring for an aging parent could cost you” (NerdWallet, Feb. 20, 2022)   

Imagine: how a LTC “facility” can transform into a “community?” Make the culture change you want to see in LTC!  

   

“When I talk with people who are getting into the field, I always recommend that they choose their employer very, very carefully…Look for the innovators, the learning organizations that are pushing back against the status quo. The ones with healthy cultures that promote the potential and value of the people who live and work in their communities. Culture is everything and healthy cultures lead to personal and organizational success.”—Jill Vitale-Aussem, “Disrupting the Status Quo of Senior Living,” Mindshift (Aug. 20, 2019) 

In need of Pep talk, I turned to reading Disrupting the Status Quo of Senior Living: A Mindshift (2019) by Jill Vitale-Aussem, who shared her 20+ years of senior living employment (plus admitting herself as a resident to experience what it’s like, similar to being a refugee after a hurricane, trading freedom/self-determination for protection/care) and how she came to reframe her facility to “community.” Introduced to Dr. Bill Thomas’ Eden Alternative and after confronting her internalized ageism, Jill led her facility to culture change shift from traditional senior living framework of segregation (ageism, ableism), paternalism (regressing into dependency, focusing on self), institutional mindsets (diagnosing/medicating/mind-numbing people who exhibit “normal” human response/”acting out” to loss of power/purpose) to an “inclusive culture of possibilities and purpose, where people continue to grow and flourish” (p. 6). Rather than view residents as mere recipients of services, encourage community organizing by empowering residents to organize on their behalf – like disability movement’s mantra, “nothing about us, without us!”  

Jill discussed four components of building community in senior living:

1.   Fulfillment of needs: might be sole focus of traditional senior living to provide basic needs and functional assistance with activities of daily living for residents

2.   Membership & belonging: intentional creation of “us” community (reciprocal relationships) including everyone who works (staff) and lives (residents), e.g., purposely inviting to sit at mealtimes people with different cognitive and physical abilities to foster culture of acceptance and inclusion

3.   Influence: put real power into people, be transparent about problem and own things together as community of citizens, ask for participation and accountability in problem resolution; e.g., stop “doing for” customer service and empower citizen residents to start pet committee – “when we promote (bi-directional) influence and encourage experience and knowledge to play out in community decision-making, we achieve better outcomes” (p. 78).

4.   Shared emotional connection: encourage real relationships where community members experience meaningful interactions and emotional risk with each other. Here, Jill ditched the disempowering “escape” from real life/everything done for guest hospitality model and Disney “happiest place on earth” model (role-play using customer service scripts, full of joy and cheer) in favor of Real World like normalizing death by embracing community-driven rituals and opportunity to mourn.  

Jill saw the light in keeping it real, so one/we can be our self/selves in community: “When we sanitize life and try to hide everything that might feel uncomfortable, we devalue the people who live and work in our organization and create unhealthy environments. When we are open and embrace the bad and the good in life, we build community as people come together to work through the hard times” (p. 83).  

Wise words like those spoken a century ago by the kind and old Skin Horse, who explained “Real” is “a thing that happens to you. When a child loves you for a long, long time, not just to play with, but REALLY loves you, then you become Real.”  

'Sometimes,' said the Skin Horse, for he was always truthful. 'When you are Real you don't mind being hurt.'

'Does it happen all at once, like being wound up,' he asked, 'or bit by bit?'

'It doesn't happen all at once,' said the Skin Horse. 'You become. It takes a long time. That's why it doesn't happen often to people who break easily, or have sharp edges, or who have to be carefully kept. Generally, by the time you are Real, most of your hair has been loved off, and your eyes drop out and you get loose in the joints and very shabby. But these things don't matter at all, because once you are Real you can't be ugly, except to people who don't understand.”
― Margery Williams, The Velveteen Rabbit (1922)

Love the sense of community and shopping locally at farmers markets, even ones overrun by tourists at SF Ferry Plaza Farmers Market, which hosted SF General Hospital Foundation’s Hearts in SF. 

Michele Bell’s Chinatown Live heart sculpture has fortune cookies with solidarity mantras like “Respect your Elders,” “Look out for each other,” “Help your community,” etc. 

Todd Berman, known for his City of Awesome collage works on SF Muni buses, painted colorful Four Hills, Four Towers, Flowing Fog, Native Flowers.  

Civility

As COVID-19 pandemic reaches its 2nd anniversary and COVID-19 death toll approaches 900,000 in USA, wish for more civility:

“…the original definition of civility, from the Latin and from the French. Civility: citizens willing to give of themselves for the greater good. For the good of the city.”—Steven Petrow, Three Ways to Practice Civility, Ted Salon (Jan. 2019)  

“If you’ve noticed, much of the emphasis of media conversations on COVID are individualistic: wear a mask, get vaccinated to protect *yourself,* go back to work even w/ symptoms bc *you’re* “fine” (even if you’re not). And while some of these recommendations are good- like getting a vaccine + wearing masks where appropriate, the motivations for them shouldn’t just be selfish. It should also be bc we actually give a damn about other people - our disabled neighbors, our coworkers who haven’t said (and shouldn’t feel obligated to say) they’re immunocompromised, etc….
And if there’s one lesson I think we as a country are repeating until we learn, it’s that community and collective good is our best shot through our greatest challenges …Individualism is inadequate for planetary forces like climate change or global pandemics, no less societal ones like healthcare, economic inequity and racism. But WE, as a collective, can confront them. In a world of MEs, let’s build team WE. 💙”—Alexandria Ocasio-Cortez (Jan. 16, 2022) 

Biden administration made at-home COVID-19 test kits more readily available (free order online)—so more COVID-19 cases underreported to SF Department of Public Health (SF DPH). Given City’s 82% vaccination rate, SF DPH is paying more attention to COVID-19 hospitalizations that represent more serious cases.

Also, Biden administration is making available free N95 masks for pick-up at pharmacies nationwide. SF DPH is reinstating mask mandate exception in public indoor settings where there is 100% vaccination, effective Feb. 1…until the next COVID variant surge?! I plan to keep my mask on, as I continue to work with clients who are immunocompromised.

We must keep a distance

A safe space between us

Days of my poor hygiene are gone

Stay far, whoever you are

If in public, a mask should go on

Before, I’d laugh at this chore

Now let’s all play our part

So my mask will go on – stay on…

Yes, I’ll care about you

I don’t need to know you

To ensure I don’t pass it on

Bizarre – how selfish they are!

It won’t hurt when you’re out to wear one

(And no, your rights aren’t gone)

Once more, it’s far from a chore

Show you care in your heart

Time to start putting a mask on

Not fear – just common sense here

How could helping each other be wrong?

(An act so small – put it on!)

We’ll stay the virus this way

Keep us safe with a mask

When in public, put your mask on!

--Shirley Serban, “My Mask Will Go On – COVID-19 Titanic Parody Song of Celine Dion’s My Heart Will Go On” (July 13, 2020) 

Due to COVID omicron surge, pause on client home visits continued this month, so my work has been virtual and paperless (pleasing my inner treehugger). Amazing how much work is now conducted over the phone, and some clients have gotten comfortable with telehealth.

Recently conducted assessment by phone of prospective client, who incessantly used profanity like George “7 Dirty Words” Carlin while laughing. I have yet to obtain medical records, but wondered if the use of profanity might suggest dementia? 

Civility has declined, especially in relative anonymity of physical distancing, while we have evolved to “trust” larger groups of strangers; was this prospective client using profanity to build trust? 

“People laugh (sometimes nervously) when a norm is violated… Next time you come across somebody new but are not quite sure whether to trust them, try telling a joke…a shared sense of humor indicates shared norms. Shared norms form a solid foundation for trust…use of profanity also can build trust. The use of profanity is a deliberate breaking of a taboo…By deliberately breaking the taboo, the profaner places themselves in a state of vulnerability, thus initiating an act of trust. A positive response to the expression of profanity reciprocates that act of trust.”—Benjamin Ho, “The History of Trust,” Why Trust Matters: An Economist’s Guide to the Ties that Bind Us (2021)

IMHO, there are better ways to build trust than use of jokes and profanity. Blame 45^th President of USA for taking swearing mainstream in public as news media began publishing his profane rants (noise pollution!), and his supporters viewed him as more “authentic.” As Rolling Stone reported, presidential profanity is ol’ news. As examples provided do not appear to advance trust, why not just stick to “expletive deleted” as done in Nixon’s Watergate tapes?

This month filled with events to practice civility = give of ourselves for the greater good, in the form of civic engagement in gerontology. And #ThankU Frontline! 

Happy Anniversary, Master Plan for Aging!

California Department of Aging (CDA) hosted virtual celebration for the 1^st anniversary of the Master Plan for Aging (MPA): lots of back patting for what was accomplished during COVID-19 pandemic environment, silo-busting and “whole-government” approach to aging.

Kim McCoy Wade, Senior Advisor on Aging, Disability and Alzheimer’s for the Office of Governor Gavin Newsom (new role created by MPA), declared “We all go further when we go together” (but maintain physical distance)! 

WHAT GIVES ME HOPE IS WHEN I THINK ABOUT THE PEOPLE OF CALIFORNIA. AND WHAT IS GOING TO START TO HAPPEN THIS YEAR AS PLANS HAVE LED TO POLICY, HAVE LED TO DOLLARS. IF YOU THINK FOR A MOMENT,

-        WE'RE GOING TO SEE ALZHEIMER'S DAY CENTERS OPEN AGAIN IN CALIFORNIA SO PEOPLE WITH DEMENTIA CAN GET CRITICAL DAY ACTIVITY AND CAREGIVERS CAN GET SUPPORT.

-        WE'RE GOING TO SEE HOME-DELIVERED MEALS AND HOME MODIFICATIONS PAID FOR BY HEALTH PLANS SO PEOPLE CAN KEEP LIVING IN THEIR HOMES.

-        WE'RE GOING TO SEE NEW RESIDENTIAL FACILITIES PURCHASED SO PEOPLE CAN HAVE HOUSING AND SERVICES. THIS IS GOING TO HAPPEN IN COMMUNITIES WHERE YOU LIVE AND WORK. 

-        GOING TO HAVE SENIOR CENTERS REOPEN.

-        WE'RE GOING TO HAVE VOLUNTEERS WALK INTO SCHOOLS AND TUTOR CHILDREN SO WE CAN BE TOGETHER AGAIN SAFELY -- AFTER COVID -- BUILDING BACK BETTER WITH INTERGENERATIONAL CONNECTIONS.

Lourdes Castro-Ramirez, California Secretary of Business, Consumer Services, and Housing Agency, spoke of the sense of stability and belonging in intergenerational households based on her lived experience. She grew up in a two-bedroom house with her immigrant parents, nine siblings, aunt and uncle with their children; plus two other families lived in a “tiny house in the back, along with the converted garage.”

JUST AS THIS MASTER PLAN WAS DONE IN A COLLABORATIVE WAY AND ALSO WITH SIGNIFICANT ENGAGEMENT FROM STAKEHOLDERS, OUR AGENCY WILL CONTINUE TO ENSURE WORK IS ROOTED IN REAL LIFE STORIES AND EXPERIENCES. AND ALSO, UNDERSTANDING WHO WE'RE SERVING…ELDERS AND OUR AGING POPULATION.

CDA Director Susan DeMarois invited us to check out MPA First Annual Progress Report (2022). 

Christina Mills, Executive Director of California Foundation for Independent Living Centers (CFILC), talked about joint advocacy across aging & disability to MPA because aging is all of us, and disability is a natural part of life for those born into disability, or age into disability. She talked about getting people, like Justice in Aging Executive Director Kevin Prindiville, to embrace and call out disability:

MASTER PLAN FOR AGING IS WHERE WE STARTED AND A STEP IN THE RIGHT DIRECTION...GOING TO THE MASTER PLAN FOR AGING TABLE FOR MONTHS AND HEARING COLLEAGUES UNABLE TO SAY DISABILITY HAS DEFINITELY CHANGED. ALMOST EVERY SINGLE TIME I'M IN A MEETING WITH KEVIN -- I HOPE IT HAPPENS WHEN I'M NOT WITH KEVIN TOO -- HE IS SAYING PEOPLE WHO ARE AGING AND DISABLED PEOPLE FOR THE FIRST TIME…HERE IS THE THING: DISABILITY IS IN EVERY COMMUNITY. AND YOU CAN JOIN THE COMMUNITY AT ANY GIVEN TIME.

Ed Roberts Day

Youth Organizing! Disabled & Proud hosted celebration of Ed Roberts Day with launch of YO! Ed Roberts Oral History Project.

"We make such fundamental errors in taking care of people all the time. Think about your own life…if you had people taking care of you, making all your decisions, what is there to life, really? In almost all of social programs we set up take care of us or put us away in institutions to be cared for. And I think once I began to discover that, how important it is to help yourself and to move on from that and to go beyond what people thought my limits were…

What’s a life living in an institution or nursing home someplace?... Yet, we spend billions and billions of dollars on these… what we have to do is break that money loose from very strong special interests and move it into the community and deal with quality of life  issues. We do not want to be segregated in the traditional sense." –Ed Roberts (1939-1995), “Father of Independent Living Movement,” 60 Minutes (1989) 

Harry Reasoner on why Ed’s “story worth telling” on 60 Minutes: Ed contracted polio at age 14 in 1953 (two years before Jonas Salk’s unpatented vaccine ended polio epidemic), paralyzed from the neck down and required an iron lung to breathe; with his mother Zona’s fearless advocacy, Ed insisted on attending schools in-person while fighting for accommodations through his political science PhD at UC Berkeley, as Director of California Department of Vocational Rehabilitation, co-founder of Center for Independent Living (CIL) and World Institute on Disability (WID). 

Joan Leon, self-described as 83-year-old person with invisible disability, CIL Board member and WID co-founder, is helping to make a film about Ed Roberts’ mother Zona, who is 101 years old.  

Tatum Tricarico (disability pride flag in her background) and Evan Milburn led Oral History Project on Ed Roberts Day last year, collectively spending 40-50 hours in interviews over the past year.

YO! Oral History Project paired 20 youth with 20 older people who knew Ed Roberts. One lesson for youths facing peer pressure: how Ed changed his fear of being different into power, realizing he was a “star” to control social situations. Check out Ed Roberts Oral History Project playlist. 

80 over 80 SF

UCSF geriatrician Dr. Anna Chodos provided update on her 80 over 80 SF project to amplify stories of older adults age 80+ and to end ageism. My question: Were 80over80 SF subjects asked whether they prefer to be called “older” or “senior” among language choices from Reframing Aging SF? Answer: No.

Geriatricians like Dr. Chodos speak out against ageism in healthcare. Yet few social workers call out ageism, which I suspect is due to so few social workers have gerontology competencies that they’re not even aware that they’re ageist/patronizing and working for organizations that perpetuate ageism. Justice, not charity! 

Chat box included Ashton Applewhite’s observation that organizations that serve older adults are often the most ageist of all. Sadly true, IMHO, and perhaps an example of the intersection of ageism + classism: age-segregated spaces providing “supervision” (social control, often subsidized by government) like senior centers and pre-school/K-12 structures that allow capitalism to function so working stiff are not “burdened” with caring for their aging parents and minor children at home. My views have been informed by my work with older adults across the wealth spectrum: high net worth clients afford to age at home with privately hired staff to cater to their needs, so no need to go to age-segregated senior center, adult day health or social center, assisted living, nursing home (see “How the poor get stranded in Bay Area nursing homes”) or other institutional settings.

80over80 SF project began before COVID-19 pandemic, and later included questions about living through this pandemic. (Just 18 months ago, 80over80 SF had 30 profiles.) Look forward to hearing if subjects share their experiences of ageism (as in Irish Examiner’s “Ageing in the Pandemic” articles). Also would be interesting to see reaction of Zeke Emanuel, who said at age 62: “There are not that many people who continue to be active and engaged and actually creative past 75. It's a very small number.” 80 is not a very small number?!

Dr. Chodos plans to complete this 80over80 SF project by May 2022, coinciding with Older Americans Month – publish everything on website, partner with a radio station, make a book for participants, hold events. To date, 69 participants (43 women; 4 LGBTQ; 8 African American, 4 Latinx, 16 Asian), looking for recommendations to profile as 11 more to go (looking for Filipino, greater diversity).

In addition to usual demographics (socially constructed race/ethnicity and SOGI), it would be good to profile folks age 80+ in different living environments. Because SF land has been too precious for prisons, would miss profiles of octogenarian prisoners (like murderers Charles Manson and Phil Spector, fraudster Bernie Madoff) to hear voices of remorse or unrepentant evil?! Age 80 cut-off also might result in marginalizing low-income and unhoused people who have shorter life expectancies. 

Cool to see my recommendations (Legacy Film Fest Director Sheila Malkind and SF Chinatown activist Dorothy Quock) appearing as talking heads in 80over80 SF video clip. Sadly, I nominated several SF beatniks (including one in a nursing home) who died few months later, and don’t know if they were profiled before their untimely deaths.

MLK, Jr. Day/Speaking Truth to Power

MLK, Jr. Day reminded me that we need poor people’s movement! Due to omicron surge, I stayed put watching documentaries for MLK, Jr. holiday curated by The World House Project at Stanford. 

“As an old man who has seen all the corners in this corrupt old world, who wants to change this corrupt old world, I have decided to start with myself… I know as a fact that the courage of this man (MLK, Jr.) has made a better man of me… You are truly a new man in an old world.” – Sidney Poitier (1927-2022), as 40-year “old man” delivering keynote at 1967 Southern Christian Leadership Conference  

In Speaking Truth to Power (2021) documentary of 75-year-old Rep. Barbara Lee, she opens up her personal life and how it shaped policy (“people closest to pain should be closest to power, driving policy”) – describing how she roamed streets to stay away from her batterer and slept in “flea bag hotels” as a domestic violence victim; how she benefited from HUD program that enabled people on public assistance to purchase her own home for $19,475 near Mills College in Oakland, where brought her two sons to classes when she didn’t have child care.

Encouraged by Rep. Lynn Woolsey "the first former welfare mother to serve in Congress" and Progressive Caucus Co-Chair, Barbara went public about being a welfare mother.

Barbara said at Mills, she nearly flunked her only government course due to an assignment to work in 1972 presidential primary campaign when none of the white male candidates (McGovern, Humphrey, Muskie) spoke to her as a young African-American mother on welfare with two kids. When Barbara invited Shirley "Unbought & Unbossed" Chisholm to Mills campus, the first African-American woman elected to Congress announced her historic presidential campaign! Barbara registered to vote for the first time, helped organize the Northern California campaign and passed course with "A" grade, then served as delegate at Democratic National Convention. As Barbara launched her public service career, Shirley became her mentor: "Because of Shirley Chisholm, I am" (wearing her pearls)!   

Back last August as USA withdrew from Afghanistan, I tuned into World Affairs program, Barbara Lee Speaks for Me, about what it was like for her to stand alone in opposition to President George W. Bush 20 years ago when she was the lone dissenting vote on the authorization of war in Afghanistan in 2001. Right to dissent is central to democracy! 

Age 60+ “best years”

“Your best years will be after you’re 60.”—Robert Reich (former U.S. Secretary of Labor, UC Berkeley Professor of Public Policy and The Common Good host), Answer This, Politico

Happy new year brings benevolent ageism! Thanks to AB 695, the eligibility age threshold for Adult Protective Services (APS) was lowered from age 65+ to age 60+ beginning Jan. 1, 2022. 

Ahead of Chinese Lunar New Year, SF Police Department reported 567% increase in reported hate crimes against Asian Americans and Pacific Islanders from 2020 (9 victims) to 2021 (60 victims)! Likely this represents underreporting for cultural/language access reasons. News reports did not disclose age range of victims, but SF Mayor London Breed referred to “seniors in the AAPI community being attacked.”

“When I was growing up in some of the most challenging circumstances in San Francisco it would have broken my heart to have my grandmother be attacked in the way that we see so many of our seniors in the AAPI community being attacked. But that did not happen because as a community, we protected each other.”—London Breed, “Hate crimes against AAPI community jumped more than sixfold, police say,” SF Chronicle (Jan. 25, 2022) 

Advocates helped preserve Cantonese language classes at City College of SF, led by Trustee Alan Wong whose parents are Cantonese-speaking immigrants from Hong Kong: “We need to rescue the Cantonese program to stop Asian hate and make sure the Chinese community has access to bilingual services. We need to have firefighters, police officers and social workers that are bilingual…Language should not be a barrier for victims of crime and immigrants reporting an incident and needing care.” 

Ashby Village hosted 61-year-old Bill McKibben in Engaging Elders in Climate Action. Environmentalist Bill, who co-founded 350.org with his Middlebury College students in 2008, recently founded non-partisan Third Act for “experienced Americans” age 60+ to clean up their legacy in climate change. Desmond Tutu (1931-2021, who had eco-friendly aquamation) regarded climate change as human rights issue like apartheid in 1980s, and used divestment as tool for change. Bill’s Third Act argues that Boomers and Silent Gen, who hold 70% of nation’s wealth, can use their collective power for fossil fuel divestment from biggest banks (Chase, Citi, WF, and BofA) funding climate destruction; sign Banking on our Future pledge!