“One more song about movin' along the highway/ Can't say much of
anything that's new” reminded me
that coronavirus infects people regardless of age, health status,
race/ethnicity, or income/wealth. Yet it
has a disproportionate impact of severity on older people and certain groups
due to structural ageism/ableism and other -isms that drive social determinants
of health—housing, income/wealth, employment, education (including English
language/digital fluency), immigration, access to health systems—and make it challenging
for people to protect themselves. I protect myself, and you.
“The people who get the
most severely sick from COVID-19 will sometimes be unpredictable, but in many
cases, they will not. They will be the same people who get sick from most every
other cause. Cytokines like IL-6 can be elevated by a single night of bad sleep. Over the course of a lifetime,
the effects of daily and hourly stressors accumulate. Ultimately, people who
are unable to take time off of work when sick—or who don’t have a comfortable
and quiet home, or who lack access to good food and clean air—are likely to
bear the burden of severe disease.”—James Hamblin, MD, “Why some people get sicker than others: COVID-19 is proving to be a disease of the immune system. This could, in theory, be controlled,” The Atlantic, Apr. 21, 2020
According to
the American Geriatrics Society, more than 30% of COVID-19 cases in the U.S. involve
older people (age 65+), who also account for 45% of hospitalizations, 53% of
intensive care unit (ICU) admissions, and 80% of deaths. To what extent are
these outcomes related to ageism in overlooking unique COVID-19 symptoms presented
by older adults who are not provided option of safely testing at home, and provider
bias in how older lives are valued when faced with scarce resources?
May you
live until 120+! While
older people have higher risk of mortality after coronavirus infection, there
has been good news coverage of the resilience of centenarians (most identified
as residing in care facilities, previously invisible to the public) who survived COVID-19:
·
107-year-old
Cornelia Ras, Netherlands nursing home resident, takes no medicines, loves sitting
in her balcony on sunny days and has good workout routine (“still walks well
and gets down on her knees every night to thank the Lord”)
·
106-year-old
Connie Titchen, Brit credited being “physically active and very independent”
·
104-year-old
Vera Mueller, Minnesota assisted living resident, credited “faith and family”
·
104-year-old Bill Lapschies, Oregon Veterans Home
resident, said “sit out here and you can get rid of anything”
·
103-year-old
Ada Zanusso, Italy “old people’s home” resident with no chronic illness, credited
“courage and strength, faith”
Aw, nothing
like the lived experience of centenarians to inform one’s perspective on the
current COVID-19 pandemic:
"Over 107 years
I've faced other problems. Living is a problem. You do what you need to do to
handle the problem that's in front of you at this moment. And this moment it's
a virus that unfortunately we don't understand too much about … together, we’re
207, the
years we can look forward to, whatever they be, whether they be many or few,
and even if they're just days, to look forward to them. And then hope for
another one."—107-year-old Joe Newman in conversation with his
100-year-old fiancé Anita Sampson, both residents in senior community in Sarasota,
Florida, “For centenarian survivor of 1918 flu pandemic, coronavirus is just another'problem',” NPR Hunker Down Diaries, Apr. 15, 2020
“Our lives, our dreams, our productivity don’t end when we turn 65, an
age that society decided was ‘old enough.’ Senior citizens can be productive
and contribute to the world, bringing to it their added dimension of age and
experience. I think no limit should be set on when a person’s life is no longer
valuable.
I’m 90 and I’m waiting for the quarantine to end. As long as I’m still
creative and surrounded by the love of family and friends, as long as I still
enjoy life, nobody has the right to write me off.” –Varda Yoran, “Just because I’m 90 doesn’t mean I’m ready to die – or disposable,” HuffPost, Apr.
29, 2020
Last month, the U.S. Department of Health and Human Services’ Office of
Civil Rights issued guidance saying that states, hospitals and doctors cannot
put older people/people with disabilities at the back of the line for care. Alarmingly, but not surprisingly, California Governor Newsom’s Administration advised
hospitals to prioritize care for young people, and people with the greatest
likelihood of surviving with treatment over those with serious chronic
conditions that limit their life expectancy, during COVID-19 outbreak, and then
retracted in response to protests. #NoBodyIsDisposable.
“While we’re sheltering in place, it will save the human
race
The economy might stink, while our stocks have gone extinct”
—Abby Goldfarb, Corona virus (Grease Lightning)
The evolving COVID-19
pandemic seemed to bring confusion each day: face mask recommendation, reusable
shopping bag ban, “unusual” symptoms, possible “cures,” politicians
backtracking and not really doing much to strengthen the safety net to address people’s
real fears about survival (some taking on risks of public-facing “essential
work” to pay bills) and desires to “reopen the economy” and get back to “making
a living.” Some called for herd immunity, which
would be most devastating to older people/vulnerable groups and overwhelm
hospitals, instead of waiting for scientists to develop a vaccine. 81-year-old Mayor Carolyn Goodman callously offered to reopen Las Vegas
as a “control group” to measure effects of lifting restrictions. Calls
that “we are all in this together” were matched with deepening political
polarization and intensified economic and social inequities resulting from
flawed policies.
“From a
distance,
Trump’s still an
idiot, motivated by pure greed
We need someone
smart, Someone science-based
Let Tony Fauci
lead
Now you’re
watching us from a distance…
From a distance
that’s where we’ve got to stay
If we want to
make it through…”
From a (social) distance song parody by
Emma’s Revolution (Apr. 7, 2020)
So far away
from reopening as SF issued extension of “shelter-in-place” order (32 pages!)
from May 3 to May 31. Just need to add
digit “1” on old SF DPH’s stay home longer poster. Extension allows opening of outdoor businesses
like plant nurseries, but
why not reopen SF Botanical Garden for staycation? As a good citizen, I stay
tuned to SF COVID-19 updates on Monday, Wednesday and Friday—listening to City
officials report progress on activities/plead for public cooperation to slow
the spread of transmission (shelter-in-place, distancing, face covering, disinfecting
environment), testing, contact tracing, and treatment (dedicated hospital beds,
ventilators).
After CDC recommended cloth face masks (not medical N95 masks in short supply) for the public, SF DPH issued order requiring public age
12+ to wear face coverings except if one has “trouble breathing or is
unconscious, incapacitated, or otherwise unable to remove the Face Covering
without assistance.” Or what many Chinese were already doing because who knows if one is
infected and asymptomatic? Yet, cloth face masks may not be a safe option for some black and Latinx
people due to racial profiling associating handkerchief/bandana face coverings
with violent gangs. I was disappointed to see people continue to smoke in public, perhaps trying to fit under “trouble breathing” exception
to wearing face covering?
“The global
lockdowns and forced hibernations should not just be seen as measures of
imposed isolation. The Pandemic State has done much to kill off that delicate
creature of solitude, the routine of tranquil space essential to life.
Privacy…vanishes in spaces crowded and crammed, even with your intimates.
In the context
of health and a raging pandemic,…using a disease to affect vulnerability,
thereby keeping a tormented partner or relation in that space. The range of
human manipulations in that regard are legend and endless…
The impediments
for sufferers to access services has also seen social workers and activists
turn to more virtual and online methods of communication, a point that can only
ever be half-satisfying at best…”--Binoy Kampmark, Hell
is other people: Pandemic lifestyles and domestic violence, Counterpunch,
Apr. 17, 2020
Reports of
domestic violence have increased since stay at home orders, with victims stuck
in proximity to perpetrators, restricting access to counseling, shelter and
other community resources. But South Africa reported a decline in domestic violence, thanks to its lockdown that
included banning alcohol and tobacco sales (though latter recently lifted).
In SF, people
experiencing domestic violence now can silently text 911 for help, and the Census is online for the
first time. For people in the digital divide such as many older adults who lack internet access or digital
literacy skills, Census 2020 can be completed by phone and
mailed questionnaire.
Advocates
took action to urge CMS to expand telehealth to include Medicare reimbursement
for psychotherapy provided via audio-only devices (e.g. landlines),
particularly for Medicare beneficiaries experiencing adverse effects of
distancing who may not have access to audio-visual technology yet need to
connect with mental health providers like clinical social workers. Today, CMS announced pay parity for audio-only telehealth visits for psychotherapy, retroactive to March 1, 2020.
“No,
Papa. It is not because the CDC asked me to stay.
I want to stay. I need to help flatten the curve,
It is the greatest curve we’ve had to smush, Papa.
But I am not alone
We are together for seder on the Zoom…”
--Marnina Schon, Far from the home I Zoom
parody of Fiddler on the Roof’s Far from the home I love (Apr. 13, 2020)
SF DPH
released its COVID-19 data tracker online reporting demographic data (gender,
age group, race/ethnicity, zip code). Of
18,815 test results to date, 1,499 positive cases (60% men) and 25 deaths (96% age
60+; 13 Asian, 6 White, 3 Black). While
this transparency is welcome, SF DPH will not disclose SRO hotels with COVID-19
cases as privacy concerns seem to outweigh protecting other residents. (The City
also failed to follow through on providing hotel rooms for quarantine; instead,
it provided a COVID+ SRO resident age 80+ with a commode as alternative to
using shared bathroom, and expected this monolingual Chinese resident to
communicate in English via email to SF DPH staff!)
Instead,
non-profit organizations have made disclosures, alerting the media to report 24
COVID-19 cases in 52-unit Casa Quezada SRO hotel in Mission District, and
demanding that DPH begin widespread testing on all people living in SROs, people living
on the streets and in shelters (93 COVID-19 cases at Multi-Service Center South), people with underlying health conditions, formerly homeless
people and all essential service workers --notably, this list did not specify any
age groups, but rightly focuses on context.
Stay home,
save lives does not
apply at congregate settings. At least
40% of COVID-19 deaths in California came from “eldercare homes.” Outbreaks continued at nursing homes (67 COVID-19 cases, 4 dead at for-profit,
CMS rated 4-star Central Gardens Convalescent Hospital in SF), where
understaffing and lack of PPE contribute to inability to control infectious
outbreaks. At
for-profit, CMS rated 2-star Magnolia Rehabilitation and Nursing Center in
Riverside, 84 residents were evacuated after staff failed to show up (for
reasons not disclosed, though 34 residents and 5 staff were infected with
coronavirus, so prudent to quarantine if exposed).
For each COVID-19 outbreak in a nursing home, I wish
reporters would identify ownership type; based on CMS Nursing Home Compare lookups,
troubled nursing homes are for-profit
with wide-ranging ratings. This calls
for a re-evaluation of for-profit nursing home industry that make up 70% of
nursing homes. Yet, nursing home operators had the gall to
ask Governor Newsom for near-complete immunity from administrative, criminal,
and civil liability during COVID-19 pandemic.
Last month’s draconian
lockdown of nursing homes didn’t prevent transmission from asymptomatic staff,
and the situation became so dire that Los Angeles County Public Health Director,
Barbara Ferrer, PhD (Social Welfare), advised families to consider pulling residents from nursing homes over coronavirus if families are able to
provide care at home now that so many people are working from home; Michael
Wasserman, MD and California Association of Long-Term Care (LTC) Medicine
President, estimated that 10%-20% of nursing home residents could be cared for
by their families at home. Even before last month’s stay at home order and nursing
home lockdown, concerned physicians advised, “If you have
parents/grandparents in a nursing home, you should consider moving them home
for now.”
Since the early 1990s,
self-described nursing home abolitionist and geriatrician Dr. Bill Thomas has
advocated for the Eden
Alternative to transform the hospital-like environments of nursing homes to be
more home-like “human habitats.” Perhaps
staff could live in facilities like self-isolating families? Maybe board and care homes that SF recently funded to prevent closures?
Kokua Council
held its inaugural Zoom meeting
for an update with Hawaii LTC Ombudsman John McDermott, who wanted to focus on LTC
beds in the community—assisted living, adult residential care home (ARCH),
Community Care Foster Family Homes (CCFFH)—because Hawaii has 8,397 of them, in
contrast to 4,492 nursing home beds that get more media attention. He shared that staff from Community Ties of
America (CTA) continue
annual inspections of CCFFH, but now CTA staff will no longer
remove shoes before entering a home! CTA justified this change in practice to
protect both staff per OSHA and people in CCFFH, a business like a nursing home
where staff do not remove shoes before entering (and disposable shoe coverings
like PPE are in short supply). CCFFH
objected to this cultural insensitivity. Could CTA staff wipe down heels
of shoes or bring a change of clean footwear for use exclusively inside home (as
in Chinese custom to switch to indoor footwear)?
In the past,
I associated National Healthcare Decisions Day (NHDD) with the day after April 15 tax
filings due date. Because of the
three-month extension on tax filings this year, almost forgot about NHDD though
it carries greater importance during this risky age of coronavirus. UCSF launched Be Prepared: Take Control campaign to help people make plans in
the event of illness. The goal of the
campaign is to inspire people to take three actionable steps: 1) make a
hospital go bag, 2) choose a medical decision maker, and document in
Advance Health Care Directive (AHCD), and 3) talk to your families about
your health care wishes.
SF has
flattened the curve for now at least, but the focus on COVID-19 means people
are delaying care or other health concerns that could lead to complications, as telehealth care
is limited, with emergency rooms reporting
drop in heart attacks and strokes.
Nature (while
physical distancing from people) is essential to counter computer fatigue, more
so since I’ve been working remotely from home connected to my computer all day
– even phone calls are made via my computer.
I joined Senior Outreach Society (SOS), brainchild of 70-year-old SF
Board of Supervisors President Norman Yee, to make wellness check-in calls to senior
voters in SF District 7 via CallHub, enduring annoying music played between calls.
Unsurprisingly,
SF residents responded to “shelter in place” order by heading to enjoy the great
outdoors, as infamously reported by CNN. After initially defending SF
residents as complying, SF Mayor then threatened to close public parks if people continued to defy public health orders for
distancing. Instead of overbroad
policies to close parks, gardens and beaches, other protective measures like enforcing
physical distancing through timed entry and capacity limits (as done at Trader Joe's) would enable balancing
the benefits and risks of nature healing and coronavirus infection.
Not
only do we face the challenge of finding out who are asymptomatic (aka “Achilles
heel” of public health interventions to control COVID-19), but doctors say old people with
COVID-19 show “unusual symptoms” like changes in usual status,
delirium, falls, fatigue, lethargy, low blood pressure, painful swallowing,
fainting, diarrhea, nausea, vomiting, abdominal pain and the loss of smell and
taste. Few were included in
CDC’s updated list of COVID-19 symptoms, which now include chills, repeated shaking with chills,
muscle pain, headache, sore throat, and loss of taste or smell—in addition to
the original three listed symptoms of fever, dry cough and shortness of breath. Journal of American Geriatrics Society
reported that older people, especially if frail with multiple chronic
conditions, may not have fever, cough, chest discomfort, or sputum production, but
may present with delirium, elevated respiratory rate or heart rate.
When will SF
adopt FDA-approved saliva testing to expand testing capacity to include
asymptomatic carriers? The saliva test process of spitting in
vial at home, then sending for lab processing appears much safer and accessible
than having older people leave homes to test sites, furthering their risk and
dwindling limited supply of nasal swabs and PPE for health care workers.
Hong Kong was
an early adopter of saliva testing and behavioral interventions, described
in a study published in The Lancet this month, such as face covering (even by
protestors and HK Chief Executive Carrie Lam during public speeches!), physical
distancing, isolating people who tested positive, and quarantining close
contacts identified through contact tracing.
Much of this protocol had been followed during 2003 SARS epidemic, a
memory seared in the minds of Hong Kongers. As a result, restaurant dining
remained open because these measures were enforced to reduce transmission. During
UCSF COVID-19 Town Hall meeting last week, UCSF Asian Health Institute Director
Diana Lau opined that many Americans view interventions taken in Hong Kong as
infringing on individual civil liberties, and UCSF infectious disease
specialist Dr. Peter Chin-Hong favored saliva test but speculated
Americans have a cultural bias against spitting.
I also wonder whether Hong Kong’s Confucian culture that reveres old age, family, collectivism, adaptability, long-term orientation and restraint can be credited for its impressive stats: HK has population of 7.5 million, 4 COVID-19 deaths versus SF population of 883K and 22 COVID-19 deaths, overall U.S. is worse…perhaps matching the hurtful rhetoric of vocal Americans who view deaths among older people as acceptable collateral damage so others can get on with life and restart the economy?
I also wonder whether Hong Kong’s Confucian culture that reveres old age, family, collectivism, adaptability, long-term orientation and restraint can be credited for its impressive stats: HK has population of 7.5 million, 4 COVID-19 deaths versus SF population of 883K and 22 COVID-19 deaths, overall U.S. is worse…perhaps matching the hurtful rhetoric of vocal Americans who view deaths among older people as acceptable collateral damage so others can get on with life and restart the economy?
Joined Caring Across Generations for an afternoon of #CareForAll consciousness
raising and, what Bobbie Sackman of NYCaring Majority called, organizing to
build a “feminist caring economy.” Host Alicia Garza of National Domestic Workers Alliance (NDWA) reminded us that care is a collective
responsibility that requires a collective solution, a caring majority to build
a culture of care across communities and generations. Participants called for paid family leave, universal
health care, livable wages, hazard pay, immigrants’ access to supports…NDWA
Executive Director Ai-jen Poo called for universal family care.
According to
the NYTimes, 1 in 3 jobs held by women (mostly nonwhite) have been
designated as “essential”—mostly underpaid, undervalued—labor that takes care
of people most in need and “holds everything together.” In this COVID-19 pandemic, essential workers are mostly women, including 78% of social workers, 77% of health care, and 53%
of critical retail. Notably, women make up nearly 90% of nurses and nursing
assistants working the frontlines doing essential work requiring in-person
interaction, and 73% of health care workers who have been infected.
We Can Do Better: How Our Broken Long-Term Care System Undermines Care calls for equitable investment in
direct care workforce to meet consumers’ needs – a failing of our system more
pronounced during COVID-19 pandemic.
This is not
the opening of The Brady Bunch, but lunch bunch with Lynn Mahoney, a
social historian specializing in women’s rights and whiteness who made history last
year when she became first female President of SFSU (120 years after its
founding)! Due to COVID-19 distancing measures,
her March 18 investiture ceremony as 14th SFSU President was
canceled. However, I was one of 50
selected for free delivered lunch (SF recently capped third-party delivery app fees
at 15%) and Zoom meeting with Boomer President
Mahoney this week. I’m old school in my
preference for in-person meetings, and the only student who didn’t bring my own
computer to class (though I used SFSU computer provided in research classes), so
surprised to hear students complain about transition to zoom instruction. I have managed computer screen fatigue by turning
off my video and listening to zoom classes as if they were podcasts, freeing up
my eyes and allowing me to move around, occasionally contributing to chat box and
unmuting to add my two cents.
As expected,
students asked about getting refunds because campus closure prevented use of library
book loaning, wellness center, student org funds, etc. (Prior to lunch date,
class action already filed against California State University system.) SFSU President shared that she was always so
busy working her way (starting at Jewish bakery!) through school that she never
participated in campus clubs, and then she replied no refunds because tuition
collected doesn't even cover actual cost.
With shelter-in-place orders, she declared now is the best time to
remain in school even if it’s online. (She
did not entertain like NYU
Tisch School of the Arts Dean Allyson Green who said no refund to performing
arts students, and then turned to dancing to “Losing my religion”, which she
explained help her “get going again, even in the darkest moments.”)
I may be in
school as long as it takes me to complete my culminating experience, which I
had to start over again because I could no longer conduct field interviews at
nursing homes as planned in my original research. Since this COVID-19 pandemic, I have been
conducting research for my new project, Creating Age-Friendly Social Work
Education, based on World Health Organization's Actively Ageing framework
incorporating strengths-based, person-centered and life course perspectives.
To get out of my SF bubble, I
continued my free online learning spree – sometimes by myself and other times
converging with shut-ins from all over the world!
Gerontological Society of America (GSA) made Ageism First Aid online course freely accessible through July 1, 2020! (Usual cost for
members $20, non-members $30.) This
course’s objective is to disrupt common negative misconceptions/myths about
aging by replacing them with facts that should be common knowledge—much needed
during this age of coronavirus! Some
age-friendly affirmations:
· On our
aging process: Throughout our lives, when our interests and activities change,
some of our abilities may be lost. As adults, most losses in abilities happen
when our interests and activities change.
Use it or lose it!
·
Mental and emotional development can continue our
entire life: Older people also develop the ability to manage conflicting emotions
better, and thus more likely to continue on with daily life in situations that
would have disrupted their life when they were younger. Been there, done that!
·
At any age, our minds make connections to our
stored memories: An older mind holds more stored memories, and thus may require
more time to make connections between the stored memories and the new
information. In most cases, having more experience and knowledge makes up for
the extra time it may take for older people to process new information.
·
Hearing loss is not a normal part of the aging
process: Hearing
loss is not common among older people in non-industrialized countries or
traditional indigenous communities. In the
United States, many older people have hearing loss from damage that
happened to their ears when they were much younger, before simple hearing
protection was available to everyone. The unnaturally loud sounds of our
industrialized modern society from blasting music, gunfire, machinery, hair
dryers, etc. caused the initial damage that progresses slowly.
·
Words matter:
To avoid the negative impressions associated with the word old (“useless,
inferior, out of date” or “being put/given/thrown away”), simply add
an “er” and use the word older. For most of our
lives, getting older is positive—as we look forward to becoming more independent.
·
Based on research about how people age 50+ in the
United States feel about aging labels, nouns person and people are
preferred over the nouns adult or adults. The most positive labels to use
are older people, older persons, mature adults, or number-plus
labels such as 50+ adults.
·
“Helping” Behaviors: Helping an older person or a
person with a disability without invitation can stigmatize people and be insulting
(suggesting that you do not believe they can do the task on their own, despite
your good intentions). Instead of helping without an invitation, state “let me
know if I can be of assistance” or “let me know if I can lend a hand” before
they start on the task. Avoid using words “help” and “need” in your statements.
This approach lets the client know you are available without suggesting they
are not able to do the task on their own and are less likely to be offensive.
What about reclaiming the power of old, while
still embracing older? I thought
about Cat Stevens’ Father & Son lyrics, “Look at me, I am old,
but I’m happy,” which David Scott @ the Kiffness turned into “Look at me, my beer is cold, and I’m happy.” (All
the funnier because they’re in lockdown with alcohol sales ban under South
African President Cyril Ramaphosa of elbow greeting and mask wearing fame.)
In this month’s Reframing the Response to COVID-19: Applying Reframed Language to Counteract Ageism, FrameWorks Institute VP for Research
Interpretation Moira O’Neil objected to “vulnerability” frame because it
creates distance: us (sacrificing to protect) v. them (othering/stigmatizing
vulnerable older people). Her tips for framing a society that supports
older people:
· Balance
urgency and efficiency, by bringing solution and explaining: “Because older
people are disproportionately impacted by the disease, states are planning
community actions to reduce exposures to the virus.”
·
Careful about positioning groups, by focusing on interconnection/shared
responsibility as source of strength and universalism: “This virus is
highly contagious and people could be spreading it without realizing. When we all stay home today, we see fewer new
cases tomorrow. By keeping our physical distance, we slow the spread. This protects people in our communities who
are most at risk and the availability of the lifesaving health care we all
depend on.”
· Explanation=power,
by showing how actions can address problem: “Under stressful conditions,
health care providers are likely to make snap decisions about people solely
based on their age that will determine the quality of care they receive. We need to make sure our standards of care do
not discriminate on the basis of age.”
Finally, some age-friendly
developments during COVID-19 pandemic:
·
Car-free
“slow streets” for distancing on narrow or crowded sidewalks in parts of
Chinatown, Tenderloin, Twin Peaks and Golden Gate Park’s JFK Drive -- especially great for users of
wheelchairs and walkers!
·
SF MTA Essential Trip Card subsidizes 2-3
roundtrips by taxi per month for age 65+ and people with disabilities who pay
20% of the cost of a regular taxi ride fare for essential trips to grocery or
medical visit (but what was SF MTA thinking when it
increased Muni fares, effective July?! Objection!)
·
California Governor’s initiatives to support older Californians via
Restaurants Deliver Home Meals for Seniors (who are not eligible for other
nutrition programs); Social Bridging Project (phone check-in); and Friendship
Line California (1-888-670-1360)
·
Being resourceful
like Shirley Serban’s “Cut My Hair That Way” (parody of Backstreet Boys’ I Want It
That Way)
Due to
COVID-19 pandemic, National Association of Social Workers will hold its June
14-17 “virtual” instead of meeting in Washington, DC. American Sociological Association (Aug. 8-11 in SF) cancelled, and Hawaii Pacific Gerontological Society
(Sep. 9-10 in Honolulu) postponed. #share aloha
