Bucket list

Preparing to "kick the bucket"

At this month’s Jewish Community Center of San Francisco’s 2^nd Annual Embracing the Journey End of Life Resource Fair, attendees were presented with a bucket list kit—complete with bucket, pencil, mini-composition book and instructions to answer: What do you want to do before you “kick the bucket”?

I thought been there, done that.  Long before the Hollywood film The Bucket List (2007), I compiled a list of places to visit and pursued them all.  While I enjoyed the anonymity and stimulation from exposure to different cultural experiences during my world travels, however ephemeral, I felt world-weary after I became eligible to join Travelers Century Club.  Like Thomas Jefferson noted, travel makes one “wiser, but less happy.”  So I reduced my carbon footprint by staying home, content to put down roots while returning to my childhood pastime of gardening (being with nature).   

“…chasing bucket-list thrills ignores a deep psychological truth: You don’t need to make yourself happy in old age.  We get happier naturally as we grow older… The increased happiness doesn’t come through doing but simply through being.  It is the natural result of lower expectations and ambition, less emotional volatility, increased gratitude and acceptance and enhanced problem-solving skills.

In fact, the need for a bucket list goes against our deepest instincts as we age. Older brains are less influenced by novelty-seeking and more by conscientiousness; they are less impetuous and more emotionally stable.” 

– Marc E. Agronin, MD, geriatric psychiatrist, It's Time to Rethink the Bucket-List Retirement 

Stan Goldberg, cancer survivor, hospice volunteer and author of Lessons for the Living: Stories of Forgiveness, Gratitude, and Courage at the End of Life, presented, One Day to Live: What Would You Say and Do?

1. focus on journey – makes it easier to accept losses and prepare for death; start with one simple, enjoyable activity
2. ask for forgiveness – makes you more peaceful
3. offer forgiveness – begins healing
4. understand what/when you can’t forgive – work towards understanding
5. let go of what you can’t change
6. offer thanks for kindness shown – change relationship
7. complete unfinished business
8. create legacy – make a difference 

Therapeutic humor expert Allen Klein provided comic relief in his presentation, Seeing Demise Thru Humorous Eyes: How Cartoonists, Comedians and Cinematographers Help Us See Death as Less of a Grave Matter.   My favorites were clips from Woody Allen films like Hannah and Her Sisters (life affirmation after attempted suicide) and Love & Death (dance with death).

End of Life (EOL) Options (ways to "kick the bucket")

Matt Whitaker, Multi-State Implementation Manager at Compassion & Choices, provided an overview of authorized EOL options:

1. refuse treatment
2. discontinue treatment
3. hospice – “gold standard” for last 6 mos. covered by Medicare, but average utilization only 20 days
4. VSED (Voluntarily Stop Eating & Drinking) – death by dehydration
5. palliative sedation – induce coma
6. aid in dying – legal in 5 states, OR (since 1997), WA (2008), MT (2009), CA (2016) and CO (2017)

California’s End of Life Option Act requires self-ingestion of a lethal dose of 100 capsules of Seconal, produced by Valeant Pharmaceutical, at a cost of $4,000; in California, only 80% of private insurers and Medi-Cal cover this cost.  A 1997 federal law prohibits use of federal monies (Medicare, VA) to cover aid in dying costs. 

JFCS Seniors at Home hosted End of Life Option Act: Effects on our Practice panel presentation:

• Linda Blum, GNP, Palliative Care Coordinator at California Pacific Medical Center: shared two cases when patients were not able to exercise EOL Option due to short time frame of patient with untreatable gastrointestinal bleeding who died in hospice at home before he was able to manage 2 requests to doctor, and another patient with ALS who was not able to self-administer aid-in-dying drug; in both cases, it was “care as usual, the old way.”
• Maryellen Collamore, ASW, Oncology Clinical Social Worker at UCSF: talked about her role to provide educational materials on EOL Option and to conduct psychosocial assessment of patient (motivation for inquiry, understanding of diagnosis, social supports, defining quality of life, perception of dying process, exploring belief systems, etc.); patient also must obtain mental health evaluation by psychiatrist; easier to find consulting MD than to find MD who will actually prescribe aid-in-dying drug; patient’s initial inquiry opens door to conversation, and most patients go to hospice.
• Lael Duncan, MD, Medical Director at Coalition for Compassionate Care California: opined that access remains an issue, given the length of the process (patient makes 2 oral requests > 15 days apart, patient attestation 48 hours prior to ingestion) and few participating providers. She described lethal prescriptions—traditional high dose barbiturate (100 capsules of Seconal used in Oregon) dissolved in 4 oz. water; cocktail mixtures (opiates, benzos, cardiac meds); complications can arise if patient has difficulty swallowing, digestive issues, insufficient absorption; time to death depends on underlying disease process and patient’s physiology, but usually deep coma within 10-15 min. after ingestion.
• Redwing Keyssar, RN, Director of Palliative Care at JFCS Seniors at Home: shared two cases of patients who changed their minds about EOL due to different outlook and changed circumstances because pain and symptoms were better managed. 

Lonny Shavelson, MD, started Bay Area End of Life Options in Berkeley, to consult with physicians and patients who are deciding whether to participate in EOL Options Act. He sees writing the lethal prescription to a terminally ill patient as the last resort only after considering alternatives (hospice and palliative care approaches).  

Documenting life

At Rhoda Goldman Plaza, Gloria Hollander Lyon, who survived seven concentration camps during the Holocaust, read excerpts from her memoir, Mommy, What’s that Number on Your Arm? A-6374: failing Dr. Mengele’s inspection and then escaping the gas chamber by jumping off a truck at age 14; later living with a foster family in Sweden after liberation when she noticed she lost her sense of smell – perhaps her body’s defense mechanism to protect herself from the horrific stench of bodies burning in the gas chambers and crematoria; and then returning to visit Auschwitz in 1991 when she finally regained her sense of smell after 47 years. 

Addressing an intergenerational audience that included her son, Lyon said her father told her what is important: do not cry over what is lost if you have freedom for continued life, let it rest and start all over; those who survive are eager to tell the world that it’s worth surviving regardless of loss. 

Lisa Kokin’s Inventory, exhibited at From Generation to Generation: Inherited Memory and Contemporary Art at Contemporary Jewish Museum, is composed of over 1,000 pieces of objects representing the lives of those who endured the Holocaust.  Inventory was created in 1997 after the artist, whose own Jewish family left Europe before Hitler’s rise, visited Buchenwald concentration camp and confronted the piles of objects left behind.

At this month’s meeting of San Francisco Task Force on Hoarding, Carolyn Rodriguez, MD, PhD, Director of Stanford Hoarding Disorders Research Program, talked about her research combining Buried in Treasures (BIT) workshop support group with one-to-one home de-cluttering.  She viewed hoarders as “enthusiastic collectors” and talked about elevating ordinary objects into art by Marcel Duchamp’s Readymades and Andy Warhol’s Time Capsules.  She mentioned artist Song Dong’s Waste Not installation of over 10,000 everyday objects collected by his mother in their Beijing home over five decades that reflects on culture of frugality; in persuading his mother to make art out of her possessions, the artist showed respect while also improving the quality of home life by de-cluttering – more creative than the KonMari method! 

As in Roz Chast’s Can’t We Talk About Something More Pleasant? discussing hoarding and even the inevitable like end of life can be uncomfortable for some.  Yet, the wisdom of Ecclesiastes chapter 3 reminds us: “there is a time for everything … a time to be born and a time to die … all come from dust, and to dust all return.”

With Howard Levy, Executive Director at Legal Assistance to the Elderly (LAE) for 28 years until his retirement today, all discussions are possible! (Though professionally, Howard is probably not as candid as his high school classmate Pepper Schwartz, AARP’s Sex and Relationship Expert and author of the sizzling erotic memoir, Prime: Adventures and Advice on Sex, Love and the Sensual Years.)  At weekly case acceptance meetings deftly facilitated by Howard, all staff and volunteers present contributed to the lively, often passionate, discussions for each client intake after hearing the facts.  Occasionally tired of the faux (steamed, not authentically boiled) bagels brought in by Howard, staff and volunteers turned the weekly meetings into potluck affairs.  Howard and the mostly senior staff at LAE remind me of The Supremely Old, Supremely Sharp, Supreme Court, with their wit and crystallized intelligence, which gets better with age. 

Inspired to create my own art, here’s collage of Howard's greatest hits at LAE’s office and fundraising events!

Shut-ins

In contrast to my mostly homebound senior clients, I’m usually out and about so I’ve often considered taking a 30-day challenge to live like a shut-in so I could experience life like my clients.  As an introvert, I am inspired by shut-in clients who engage in creative arts like writing and publishing poetry, painting and selling artworks online, composing and performing music, etc.     

The Shut-Ins perform at fundraiser for Legal Assistance to the Elderly (LAE).  

LAE staff attorneys – Judy Hitchcock (elder abuse prevention; also Spanish bilingual), Christine Lau (public benefits; also Cantonese bilingual), Tom Drohan (housing; also bass player with The Shut-Ins) – have been with LAE for about 25 years each!  Paralegal Christy Nieves brought age diversity (and Spanish bilingual skills) after Bessie (who joined LAE in 1980 shortly after its founding) retired last year.  

Volunteer receptionist Tom Tallman (sandwiched between friend Richard and LAE Director Howard Levy, in photo above) has been with LAE for more than 25 years! 

Howard presented long-time LAE volunteer paralegal Sandra Fenix (Portuguese bilingual) with Volunteer Award. 

Howard announced his retirement by year-end after 28 years as LAE’s Executive Director.  Howard’s legacy is his role in fostering employee and volunteer retention (aging in workplace!), which seems remarkable for a non-profit serving older adults in San Francisco.  (Staff retention also helped by union membership in National Organization of Legal Services Workers.) 

LAE Board (not bored) member and journalist Tim Redmond noted that 14% of eviction defense cases in San Francisco are represented by LAE, winning each case to promote aging in place!  Woo-hoo! 

Get up and dance to music of The Shut-Ins!

Mental health 

Department of Aging & Adult Services (DAAS) Education Coordinator Rick Appleby introduced presenters at DAAS Community Training on Mental Health in Older Adults.  None of the presenters were psychiatrists, but it was refreshing to hear two geriatricians take a holistic (mind+body) approach rather than focus only on internal medicine diseases of older adults. 

Pei Chen, MD, UCSF Division of Geriatrics, presented on Depression, Suicide and Loneliness.  The risk factors for late on-set depression and loneliness seemed to describe my shut-in clients:

• Female
• Social isolation or low contact with friends or low quality relationships
• Widowed, divorced, separated marital status
• Lower socioeconomic class
• Comorbid medical conditions or worsening physical health

Dr. Chen shared screening tools for depression (PHQ-9), suicidality (P4), and loneliness (De Jong Gierveld 6-item).  Her recommendations: ask about mood/loneliness, be present and encourage interactions, connect with community resources.

While my shut-in clients seem receptive to contacting Friendship Line or friendly visitor programs, they are sometimes reluctant to seek services of mental health professionals due to stigma. 

Anna Chodos, MD, UCSF Division of Geriatrics, presented on Substance Abuse, a cohort issue with higher lifetime prevalence among baby boomers age 60-64. She also noted that 25% of older adults use psycho-active prescription drugs with potential for misuse/abuse:

• Opiates: morphine, oxycodone, methadone; 40-50% older adults in chronic pain
• Benzodiazepine: lorazepam, diazepam, etc.; avoid in older adults as these may cause decreased attention, memory, cognitive function, motor coordination lead to increased risk of falls/car crashes
• Medical marijuana: controversial (risk/benefit not clear); used for neuropathy, glaucoma, pain, anxiety

Screening for substance use disorders include TWEAK for alcohol use, and DAST-10 for other substance use.

Tobacco is the most common substance used by my clients.  As much as I want to support aging in place, there have been days when I’d come home smelling like an ashtray after home visits with clients who smoked like chimneys, and I’d think I’d be better off in a non-smoking institution like a nursing home!

Sonya Maeck, LCSW, Clinical Administrator and Program Director at Jewish Home, discussed her facility’s 12-bed acute geriatric psychiatry hospital that exclusively serves older adults who require short-term treatment (average 18-day stay) for psychiatric conditions like anxiety, depression, suicidal thoughts, etc.  Its staff has specialized training in the unique medical and psychiatric needs of older adults to evaluate physical conditions (e.g., infection) that can be underlying factors in mental disorders; after successful treatment, the goal is for the senior to return home.

Encourage interaction

My work with shut-ins is rewarding with opportunities to make a difference and the mutual appreciation for home visits.  While I wish I had more time with clients, I have a fairly tight schedule of 5 to 6 home visits per day plus travel time.  I often politely redirect clients who use questions to seque into long stories.  (See The Onion video report, “Census Visits Providing Shut-Ins Once-A-Decade Chance For Human Interaction,” featuring 87-year-old Helen DeAngelis who gives tips for trapping a census worker in your home for as long as possible.) 

For example, when I asked one client about her mobility, she replied that she used a cane to ambulate, and then she proceeded to recount her delightful story about getting the carpet in her studio apartment shampooed, which required her to leave home for 6 hours, so she took this opportunity to explore her neighborhood, which included visiting library to get a library card, then went to the movie theatre, etc.  Being out and about improved her disposition.

One way to reduce isolation of shut-ins is to fix broken doorbells, especially those who live in houses with outer gates preceding front doors so visitors need to ring doorbell or telephone: ding-dong-ding, how else can Jehovah’s Witnesses go door-to-door and reach isolated seniors who might welcome free home Bible studies?

Advance care planning 

San Francisco Village and Institute on Aging (IOA) hosted Talk to Me: Conversations that Matter about advance care planning and end-of-life options. IOA’s Patrick Arbore was a no-show due to illness, so SF Village Executive Director Kate Hoepke assumed role as moderator, opening up discussion by asking panelists what are the results of having these conversations?

• Sarah Hooper, Executive Director of the UCSF/UC Hastings Consortium on Law, Science & Health Policy, talked about how the process of documenting one’s legacy (in the form of advance health care directives, power of attorney for finance, wills, etc.) is empowering because law students care to ask and listen to clients about their goals and wishes, which are given the force of law—yet emphasizing the conversations are more important than the forms.

• Eric Widera, Clinician-Educator at UCSF Geriatrics, said “ditto” adding though it’s hard to predict future situations, conversations focus on what are important values—some people are known to appoint their bartender, who is someone they trust, they can have conversation and who is available to serve.

• Stefanie Elkins, California Medical Outreach Manager at Compassion & Choices, discussed California End of Life Option Act, which became effective June 9, 2016, authorizing medical aid in dying.

Because I have shut-in clients who cycle in and out of hospice care, I wonder about California End of Life Option Act applying to terminally ill adults with a “prognosis of six months or less to live” when it is difficult to predict when someone will die. 

Power to the Elderly

Power = Legal assistance

“The most important thing a lawyer can do is become an advocate of powerless citizens. . . Lawyers should represent systems of justice.”

-- Ralph Nader, public interest lawyer (attorney)

This month’s Legal Assistance to the Elderly (LAE) fundraiser was attended mostly by lawyers.  In California, the July bar exam results are released just before Thanksgiving; the pass rate was 69% for first-time takers from ABA-accredited law schools.  But how many of these new admittees will practice elder law in public interest settings or empower older adults to exercise their legal rights to income, employment, health care, housing, etc.?

Ageism takes away power from older adults, who may protest that they’re not heard so they seek “magical attorney letters” on law office letterhead to get attention, or sue oppressors to regain control over their lives – whether it’s potential loss of respect (elder abuse), home (evictions, habitability), standard of living (public benefits), independence (service dogs as reasonable accommodation), etc.  As Gray Panthers founder Maggie Kuhn noted, people go through more psychological changes in the last 20 years of their life than they do in the first 60:  “Older persons experience the traumas of retirement; death of friends, spouse, children; lack of income, health, mobility.”  (Maggie Kuhn on Aging, 1977, p. 98)  

San Francisco Main Library’s exhibit, HEAL! Veterans and Their Service Dogs, is a photographic series about veterans with post-war disabilities and their service dogs for hearing, psychiatric service, mobility and medical alert provided through Operation Freedom Paws. 

According to David Solie, physician assistant and author of How to Say It to Seniors: Closing the Communication Gap with Our Elders (2004), the “secret mission” of older adults is to maintain control over their lives in face of almost daily losses (physical strength, health, peer group, consultative authority, identity, physical space, financial independence) and simultaneously to discover their legacy.  In trying to resolve this conflict (need for control v. reflection to discover legacy), elderly will wander from subject to subject, repeat stories we’ve heard, postpone decisions, go off on tangents, or describe something in endless detail. 

Solie argues that older adults’ communication style is not a problem, but an attempt at problem-solving based on developmental psychology to fulfill needs like self-esteem (associated with autonomy that is threatened by loss of control) and legacy (a larger issue for consideration if one is not consumed by focus on control).  In the elderly, attempts to resolve this developmental crisis propel them backward (v. forward) to reflect on what their lives have meant.  If this crisis is not resolved in favor of generativity (creating legacy), then they experience stagnation. 

Further, Solie theorizes that what appears to be diminished capacity in the majority of older adults is “slowing down” due to awareness of their different developmental mission, which results in refocusing life’s priorities from the goal-oriented productivity of middle-age years to reflective activity.  He explains that an aging brain’s physiology changes to promote an older person’s need for reflection and insight at the end of life: the prefrontal cortex (platform for working memory capacity, processing information) takes longer to process multiple points of information, so the external world may begin to fade, distraction sets in and focus is compromised – but this lag time allows for wisdom to surface.  

LAE Director Howard Levy greets arriving guests at fundraiser.  Donations to LAE always welcome at http://laesf.org/#/donate/

“You teach yourselves the law, but I train your minds.  You come in here with a skull full of mush; and if you survive, you leave thinking like a lawyer.”

-- The Paper Chase’s Law Professor Charles W. Kingsfield, Jr.

While working with the elderly seeking legal assistance in eviction cases based on nuisance claims, I considered Solie’s ideas and wondered if any allegations of hoarding and cluttering might be related to an older tenant’s need for control and legacy: in the face of overwhelming losses, this creates a need to “hang on tight” to a lifetime of collectibles (repository of memories), which may represent one's legacy? Thus, we argue that nuisance was due to client’s mental health impairment and request reasonable accommodation for additional time to clear out stuff to maintain tenancy?  Yet, some clients will not acquiesce to a defense that they find stigmatizing like a mental health disability, and might decide to pay for storage space rather than their tenancy.

 

LAE’s staff attorney/lawyer Tom Drohan plays stand-up bass with Shut-Ins, who play “Hulabilly,” a lively amalgam of hillbilly, hula, folk and country music.  Their CDs include Sing Songs of Pain and Joy and A Very Shut-Ins Xmas.  Tom also plays “Roadhouse Swing” with ChazzCats, and keeps his busy day job as housing lawyer.

“Lawyers know how to apply law to power.” – Ralph Nader

In my visits to the elderly living in SROs, what appears to be hoarding and cluttering is really a lack of adequate physical space.  Though hoarding behavior seems to be more problematic (deferred maintenance, falls, fire, pest infestation, etc.) as people age, hoarding documents is empowering evidence!  For example, in determining a tenant’s lawful rent in San Francisco, the Administrative Law Judge will evaluate each rent increase going back to the commencement of the tenancy or April 1, 1981, whichever is later. This hoarding advantage made a huge difference in the case of an elderly couple who received a three-day notice to pay (back rent) or quit: after reviewing their “hoarded” documents from 20 years of rent increase notices, rent receipts and canceled checks, we identified a pattern of improper rent increases; after computing the lawful rent, it was determined that this couple actually overpaid rent to their landlord! 

Shut-Ins' drummer is LAE’s tech guy.  As landlords seek to take advantage of rising real estate values fueled by the tech boom, low- and moderate-income tenants including nonprofits risk losing their tenancies.  Due to new building ownership, LAE and other nonprofit tenants (including Eviction Defense Collaborative) are being displaced from their office space within Twitter tax break zone (Market and 6^th Streets) next year while tolerating remodeling work this past year.

Legal assistance empowers the elderly by listening and working with them to honor their needs.  In a case involving an elderly client who faced eviction because he did not trust his building's management to perform bed bug control treatment in his rental unit, I was aghast hearing an Adult Protective Services worker suggest a mental assessment for possible conservatorship or 5150 (involuntary psychiatric hold).  Fortunately, empathetic LAE staff intervened to speak on behalf of client (too frail to be present at hearing) who felt manhandled by property management team but could be persuaded to agree to pest control when approached in a more respectful manner and with his input in making arrangements.

  

Preposition use:  to v. for

“It’s hard to avoid the ‘doing for.’ Some people are hungry for attention and are quite ready to be cared for, well on the way to wrinkled babyhood.”

–Maggie Kuhn On Aging (1977, p. 23)

According to Robert Butler’s Why Survive? Being Old in America (1975), there was no public or private legal program for older people until 1968 when a grant from the Office of Economic Opportunity funded Legal Research and Services for the Elderly under sponsorship of the National Council of Senior Citizens.  In 1972, National Senior Citizens Law Center (NSCLC) was formed to be a national resource to protect the rights of low-income older adults in America. 

In California, there are more legal aid agencies serving older adults that are doing “for”:

·         Alameda County’s Legal Assistance for Seniors was founded in 1976 by three women graduates of the Displaced Homemakers Paralegal Program at Mills College (which had Maggie Kuhn as member of the advisory board).

·         Monterey County has Legal Services for Seniors in Salinas and Seaside.

·         Sonoma County has Council on Aging Services for Seniors in Santa Rosa.

·         Yuba-Sutter County has Legal Center for Seniors in Marysville.

In contrast, San Francisco County’s Legal Assistance to the Elderly began serving elders in 1977 as a pro bono program, then hired paid staff shortly after becoming a non-profit corporation in 1979.  In 2003, LAE expanded to serve younger adults with disabilities (though this is not reflected in organization’s name).

Grammar lesson:  “For” is used to indicate on behalf (e.g., do for seniors), while “to” is used to indicate directed action (e.g., do to seniors). 

“Words are the essential tools of the law. In the study of law, language has great importance; cases turn on the meaning that judges ascribe to words, and lawyers must use the right words to effectuate the wishes of their clients. . . .”

http://www.law.du.edu/index.php/law-school-learning-aids/legal-language

At Books, Inc. in San Francisco, Timothy Shriver introduced his new memoir, Fully Alive: Discovering What Matters Most, about finding inspiration (overcome fear of judgment) from his aunt Rosemary Kennedy and people with intellectual disabilities he’s met as Special Olympics Chairman, collaborating with Farrelly brothers in The Ringer film, campaign not to use r-word, and his preference for using “diffabilities” (different abilities) to rethink that there are multiple intelligences.  When asked about Alzheimer's, he mentioned his late father Sargent with Alzheimer's demanded much compassion and his sister Maria's work with The Alzheimer's Project.

  

Elderly v. Seniors

“We are not ‘senior citizens’ or ‘golden agers.’ We are the elders, the experienced ones; we are maturing, growing adults responsible for the survival of our society.  We are better educated, healthier, with more at stake in this society.  We are not wrinkled babies, succumbing to trivial, purposeless waste of our years and our time.  We are a new breed of old people.  There are more of us alive today than at any other time in history.” 
– Maggie Kuhn On Aging (1977, p. 14)

What do we call old people? How do we define an old person?  Should laws treat older adults as a special class “deserving” of special treatment due to ageism that makes them vulnerable to discrimination and disadvantage?          

·         In San Francisco evictions based on owner or relative move-in (under rent control), older adults age 60+ or disabled (SSI eligible) tenants with 10 or more years tenancy, or catastrophically ill tenants with 5 or more years tenancy have protected status and cannot be evicted from a building of two or more units. 

·         In San Francisco evictions based on landlord removing building from rental market (Ellis Act, under rent control), older adults age 62+ with at least one year tenancy are entitled to one-year notice (rather than 120 days notice) and additional relocation payment.  

·         California’s elder abuse law covers anyone age 65+ and “dependent adults.”
                                                       

There are challenges in representing older adults:

·         lack of capacity due to cognitive impairment from dementia, stroke, depression or other condition

·         sudden death (LAE had sad case of elderly couple with more than 5 years but less than 10 years tenancy, when catastrophically ill husband died leaving wife to fight owner move-in eviction without his protected status)

·         frailty so older adult accompanied by relative (spouse, child) who may have conflicting interests (always communicate directly to older adult as client)

  

Get into the Act  

 

In 1961, President John F. Kennedy convened the first White House Conference on Aging.  Four years later, his successor President Lyndon B. Johnson included three bills to assist older adults as part of his Great Society reforms: 

• Older Americans Act (OAA), which established the federal Administration on Aging, to provide comprehensive services for older adults;
• Medicare to provide basic hospital and supplemental medical insurance to older adults and younger persons with disabilities; and
• Medicaid to provide health coverage for low-income persons of all ages and funding expansion of nursing home industry.  

These government safety net programs and Social Security have reduced the elderly poverty rate from 35% in 1960 to 9% in 2012.  There is broad public support for entitlements like Social Security and Medicare.  Yet means-tested programs like public housing, Medicaid (Medi-Cal), SSI or SNAP (CalFresh) are stigmatizing (like mental health disease) to the Greatest Generation (born 1901-1924) and Silent Generation (born 1925-1945) cohorts who are reluctant to apply for welfare though they qualify. 

OAA’s Title III programs (nutrition, community services) are not means-tested and are not permitted to charge for their services (though voluntary donations are encouraged), but expected to target services to individuals with the greatest economic or social needs (low-income minorities) and yet Congress has never appropriated sufficient funds to make them universal in practice.  In fact, OAA expired in 2011, and we’re waiting for Congress to restart the reauthorization process next year. 

Aging America: We Can Do Better

Though most OAA programs are age-segregated, they end up benefiting all ages; for example, providing adult day care, meals and transportation frees mobile younger adults from providing direct care or support to their aging parents.  However, developing a coordinated long-term care system remains a public policy challenge due to partisan politics and the existing fragmentation of programs and services with different entitlements and eligibility requirements.

Organizing around common concerns for social justice (Gray Panthers’ motto is “Age and Youth in Action”) is the legacy of Maggie Kuhn, a proponent of generational interdependence (v. independence), cooperation (v. competition), intergenerational involvement (v. age segregation), public interest (v. self interest)—for more Power to the People including Elderly!

Legacies

“ . . .the day of death is better than the day of birth . . .  The heart of the wise is in the house of mourning, but the heart of the stupid is in the house of rejoicing."

-- Ecclesiastes 7:1, 4

Perhaps it’s my introverted nature, but I prefer memorial services than other occasions for reflection and inspiration.  This year I attended two services that stand out:  my 94-year-old landlord, who knew me for more than half my life; and a 61-year-old tenant advocate, who never met me. 

First, my landlord: a retired County District Attorney—a fact that he never volunteered to me (but I learned from his daughter) because he was so endearingly unassuming (one obituary described him as “homespun”). As a clueless and unemployed twentysomething recent graduate when I became his tenant, my landlord provided gentle encouragement as I searched for gainful employment that would enable me to pay rent J.  

When my landlord got out of his pickup truck with toolbox, he passed as a handyman, a real do-it-yourself landlord who repaired my windows and often accompanied electricians and plumbers doing work in his multi-unit apartment building.  Even after he retired from landlording, delegating duties to a property management firm, he continued to check on the building, which I saw as an opportunity to check on him – how was he and his wife doing in their retirement community in Sacramento?  Since I knew them with their children and grandchildren, it seemed unusual to live in an age-segregated community.

After my landlord died, I attended a celebration of his life at the retirement community.  As the only tenant present, I could say he was the model landlord, embodying the fruitages of the spirit (“love, joy, peace, patience, kindness, goodness, faith, mildness, self-control” from Galatians 5:22-23) along with being fair and responsive – the same qualities consistently mentioned by his family, friends, neighbors, and colleagues.   I was inspired learning about my landlord’s legacy in representing justice in his legal career. . .and doing so with civility, which made a comeback with this year's California bar admittees who took a new oath:  “As an officer of the court, I will strive to conduct myself at all times with dignity, courtesy, and integrity.”  

Second, the tenant advocate: Ted Gullicksen, director of San Francisco Tenants Union since 1988 until his sudden death in October.  Though I never met Ted in person, I admired his advocacy work from afar so his memorial was an opportunity to learn more about his life and legacy from his associates.  

 

Just outside Mission High School auditorium was a wall papered with a collage of photos, posters and news clippings of Ted's work to fight displacement and protect rent control; a table held the tools of his trade—bolt-cutters (to get into locked abandoned buildings to occupy in his Homes Not Jails campaign), bullhorn (to shout his messages), chocolate espresso beans (for sustenance) and SFTU Tenants Rights Handbook (given to members and updated annually that often included legislation that he helped draft) among other items.

Prayer flags created by attendees and strung outside auditorium.  Ted liked donuts so one flag had a picture of a donut with message, "I donut want a San Francisco without Ted." Ted spoke out against landlords making unilateral changes to leases, like one who evicted an elderly couple who had goldfish in their unit.

 

Upon entering the auditorium, we received a 12-page booklet filled with photos and remembrances about Ted’s lifelong commitment to social justice.  Inside the auditorium, Brass Liberation Orchestra welcomed attendees: Housing is a human right! 

 

Artist Hugo Kobayashi wears his portrait of Ted and dog Falcor, who was adopted by

 

Sara Shortt of Housing Rights Committee. 

Sheriff Ross Mirkarimi in dark suit standing in back row.  Sheriff’s Office took a break from carrying out usual Wednesday evictions on Xmas Eve and New Year’s Eve this year.