Showing posts with label storytelling. Show all posts
Showing posts with label storytelling. Show all posts

Saturday, October 31, 2020

Rise

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

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

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

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

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

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

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

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

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

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

“You tell me it's the institution

Well, you know you better free your mind instead”

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


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

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

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

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

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

Long-term care (LTC)

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

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

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

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

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


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

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

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

Nowhere to go, and all booked up

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No human being is illegal.”—Elie Wiesel 

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

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

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

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

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

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

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

“Local” privilege

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

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

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

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

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

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

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

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

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

It’s a wonder I can think at all…

Everything looks worse in black and white…”

--Paul Simon, Kodachrome (1973)  

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

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

COVID-19 corner

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

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

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

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

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

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

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

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

Friday, July 31, 2020

Pause

According to San Francisco Department of Public Health (SF DPH) COVID-19 data tracker based on 249,599 test results reported: 6,575 positive cases and 59 deaths (39 male=66%; 33 age 81+, 11 age 71-80, 10 age 61-70, 91.5% of deaths age 60+; 26 Asian=44%, 14 Latinx, 12 White, 6 Black; 1 homeless).  This month SF reported its first COVID-19 death in age 51-60 group; still no COVID-19 deaths in age groups <18 and 31-40.
After July 4th weekend, SF DPH Director Grant Colfax, MD, returned to press conferences, calmly sharing what keeps him up at night: SF’s reproductive rate rising above 1 (meaning each person infected with COVID-19 is infecting more than one other person, contributing to spread that could overwhelm our health care system).  As a result of rising COVID-19 hospitalizations, SF was placed on state watch list, requiring further pause on reopening.  Dr. Colfax reported that the average age of COVID-19 patient at SF General Hospital has been 41 years, debunking the belief that only older people are most at risk. 
Yesterday, Dr. Colfax noted rapid increases in SF’s COVID-19 cases: took 38 days to go from 2,000 to 3,000 COVID-19 cases, half as long to go from 3,000 to 4,000, and just 10 days this month from 5,000 to 6,000! Based on current estimates, he projected more than 750 COVID-19 hospitalizations by October and more than 600 COVID-19 deaths in 2020; worst case scenario projected 2,400 hospitalizations and 1,800 deaths!

Epidemiologists estimate that every death from COVID-19 will leave approximately nine bereaved in U.S.  If data does not persuade people to follow public health orders (distancing, masking), then perhaps sharing more personal stories of losing family and friends to COVID-19 might be more compelling.

In just six weeks, COVID-19 hospitalizations rose from 26 to 109, with one-quarter in intensive care units (ICU); acute care and ICU beds have grown 15% each week this month.  As a result of this COVID-19 surge, SF officials announced plan for temporary overflow hospital in the Presidio for non-COVID-19 patients in case hospital beds need to be cleared for COVID-19 patients. 

“Get back to normal”?
This pause might continue through the next year, according to yesterday’s UCSF Medicine Grand Rounds COVID-19 update on Testing, Treatments, and Vaccines. Can we use this pause to do better than “get back to normal”?

In Gerontological Society of America’s webinar, Aging Native American, Rural, and Homeless Populations: Engagement and Advocacy During the COVID-19 Pandemic, Curry Senior Center Director David Knego, MSW (SFSU), talked about serving homeless older adults in Tenderloin, SF’s skid row. 
Lack of coordination partly explains why it took a minimum of 2 years to house a homeless senior in 2018!
Last year, SF Department of Homelessness and Supportive Housing launched Coordinated Entry system to improve response to homelessness. During this pandemic, SF made progress in housing homeless older people (age 65+) who receive priority under Project Roomkey. Notably, settlement from UC Hastings School of Law’s suit against SF resulted in rapidly moving over 400 people living in tents crowding sidewalks in Tenderloin to hotels leased by the City with wraparound services for duration of emergency.  Can this be a New Normal, making temporary relief into permanent supportive housing? 

Before COVID-19, “normal” rent for 1-bedroom in SF was $3,500 per month. Since COVID-19 pandemic, SF rents have dropped because younger people are leaving the high cost of living, as more people lose jobs or work from home, and many attractions (restaurants, theater, libraries, community events, etc.) have closed.  This has eased the housing shortage for people who remain and wish to age in place.

Mask wearing
When President Trump said wearing a mask made him look like Lone Ranger (eye mask with peep holes?), wonder if he covered his nose and mouth? UCSF’s Bob Wachter, MD, suggested having “sports and media influencers” instead of politicians to persuade people to act safely.  Very sad comment on who people trust?! University of San Francisco data research scientist Jeremy Howard launched #masks4all movement “for people and Governments to follow the overwhelming scientific evidence that shows we need to wear homemade masks in public to slow COVID-19.”  If not homemade, one can buy a mask (preferably tightly woven, 100% cotton, layered, snug fit; not uncomfortable N95 mask). 

On July 22, SF DPH updated its order expanding mandatory mask wearing to age 10+.  Dr. Colfax reiterated enforcement focus on businesses/institutions, while leaving individuals to voluntary compliance based on his belief that “best way to change the social norm” is messaging by “trusted community members” to provide information and support, including facial coverings.  How will this “benefit of the doubt” approach address violators who don’t care about community while they insist mask wearing infringes on their civil liberties?  SF needs to consistently enforce its own health orders to protect health and ensure safety during this pandemic!

CDC Director Robert Redfield said, “If all of us would put on a face covering now for the next 4-6 weeks, we could drive this epidemic to the ground.”  SF entrepreneur Marc Benioff said 3 weeks of mask wearing "would not have anymore coronavirus", and invited young innovators, ages 15 to 24, to submit ideas for “culturally cool” masks in $1 million Next Gen Mask Challenge. Why limit challenge to Gen Z only? Need to engage all ages who are not wearing masks!

#FindSomethingNew!
#FindSomethingNew does not refer to ongoing research about novel coronavirus/COVID-19 and the latest policies/health orders. (Huge relief to learn coronavirus is not easily transmitted from touching surfaces, so no longer fear snail mail and ok to bring reusable bags for shopping again!) Instead, it’s the name of White House’s American Workforce Policy Advisory Board (AWPAB) campaign launched this month to urge Americans who are underemployed/unemployed (especially with federal pandemic unemployment benefits ending) to #FindSomethingNew! AWPAB co-chairs are 38-year-old Ivanka Trump, advisor to (and daughter of) U.S. President, and 82-year-old Wilbur Ross, Secretary of U.S. Department of Commerce.

Ivanka tweeted, "There has never been a more critical time for Americans of all ages and backgrounds to be aware of the multiple pathways to career success and gain the vocational training and skills they need to fill jobs in a changing economy." Example: Wilbur Ross told NPR that his decision to drop out of a college English course that required writing 1,000 words a day because he ran out of things to write about after 2 weeks, "probably saved me from a life of poverty." You go, Wilbur! If you can’t think to FindSomethingNew—like look at a picture worth 1,000 words—to write about, and value liberal arts education to expand your horizons, then go to trade/vocational school… After graduating with Harvard MBA, he spent 55 years in banking and became a billionaire.  Then he launched encore career at age 79, oldest first-time Cabinet appointee in U.S. history! 
  
During this pandemic, bored homebodies #FindSomethingNew:
Got tired of baking bread
So I went out to build a garden bed…
The first time now I know
The difference between parsley and cilantro
Now I’m growing all these veggies and herbs
And I’m watching birds with binoculars
Bored in the USA…
--Penn Holderness, “Bored in the USA” (COVID-19 parody of Bruce Springsteen’s “Born in the USA”) 

#FindSomethingNew supports a neoliberal agenda to crank out worker bees, so it misses inspiring stories of entrepreneurship like 93-year-old Ray Boutwell, Navy cook who worked in food service throughout his life, started boozy cupcake business and became instant media darling. 

Stop faking “normal”
According to ProPublica, 56% of Americans age 50+ are forced to leave “stable” jobs before they want to retire, often suffering irreversible financial harm.   
Joined Elder Action Network’s Elder Activists for Social Justice Curious Listening Initiative featuring Elizabeth White, author of 55, Underemployed, and Faking Normal: Your Guide to a Better Life (2019).  Now at age 66, she reflected on her experience over a decade ago during the Great Recession while in her mid-50s: broke, piecing together gigs while trying to keep up appearances like everyone else – after her career of privilege and Harvard MBA. She learned she was not alone: 40% of people near retirement may face poverty, not due to financial struggles throughout their lives, but middle-class facing downward mobility for the first time, hearing that she was “overqualified” which she interpreted as code for ageism.  Instead of being stuck in feeling shame, she got practical like starting a resilience circle to find solutions for living a “richly textured life on a modest income” and adjusting to her new reality, including downsizing. 

Elizabeth’s message—stop faking “normal” and tell the truth—was reinforced in another talk scheduled afterwards, Noetic Approaches to Aging, with Elizabeth joining a panel about conscious aging, or “getting closer to being the person we’d like to be.”  Take-aways: People can speak only from their own experience.  When she shares her own vulnerabilities, it allows others to share their own truth with less or no shame.  If you don’t talk about the problem, you can’t solve it! 
Marc Blesoff, retired criminal defense attorney turned mediator, talked about gerotranscendence: bypass the monkey mind, not rely on rational mind, better acquaint with intuition and what’s really important.

New Ageism?
This year 2020 has been compared to 1968 in a “shattered America” with racial, political and economic divisions expressed in civil unrest.  Add ageism, a term coined in 1968 by geriatric psychiatrist Robert Butler, who witnessed generational clashes as a delegate to the 1968 Democratic National Convention.  During this COVID-19 pandemic, social media seem to make divisions sharper with #BoomerRemover and frustration over restrictions to “protect older people.”
“Whatever care we extend to the aged we consider a gift, or an act of charity, and not something we owe them because they exist… The elderly are no more or less human than they were in their 20s. They aren’t a contagion to be sequestered, or a burden to reluctantly tolerate. Whatever system we build from the ruins of the moment, it ought to be as inclusive as the experience of old age itself.”—Sarah Jones, “No One Should Be Surprised That America Abandoned the Elderly to Die,” New York magazine (July 9, 2020) 

Ken Stern, Chair of the Longevity Project, moderated A New Ageism? Fallout from the Pandemic panel discussion on “how society has been responding to the most vulnerable population during the coronavirus pandemic and what that means going forward.”  In this age of being woke to racial equity, the program poster featured a black man, yet the panelists appeared to be from the same tribe: Louise Aronson, UCSF geriatrician; Richard Eisenberg, Next Avenue managing editor (who published program highlights); and Paul Irving, chairman of the Milken Institute Center for the Future of Aging.  My question in Zoom Q&A was ignored: “If you could add a BIPOC (Black, Indigenous, Person of Color) to diversify this panel, who would you choose?”

Moderator acknowledged my Zoom chat comment in favor of Dr. Aronson’s remark: “We’re all aging …Being old in and of itself should not elicit respect any more than being young should. I think behavior should.  If you have more needs, you’ve reached a stage of dependence, which we all begin in, and most of us end in, and most us experience intermittently in between. You need some compassion,..best way to address is to increase our humanism, not say respect or reverence, but see people as humans.”  Yes, this why SF has Dignity Fund! The dignity v. respect difference: Dignity refers to inherent worth as humans apart from actions (e.g., Biblical command to “honor” parents); Respect refers to admiration for someone, earned because of their qualities or achievements.

Gerontological Society of America (GSA) released Understanding Ageism and COVID-19 infographic to dispel myths, such as suggesting:
·       “only older people should worry about getting COVID-19”
·       age is the primary risk factor for COVID-19”
·       “only older people are dealing with loneliness and isolation because of social and community lives disrupted by COVID-19”
·       “isolation is particularly difficult for older people because they cannot use technology to communicate with family and friends.” 

The Onion satirically reported, “Teen Who Died From Coronavirus Probably Had Undiagnosed Old Age”!  Notably, during this pandemic, my email account has been filled with invites to virtual meetings focused on loneliness/isolation and technology solutions relating to older people.

Isolation & Technology
Motion Picture & Television Fund (MPTF), a non-profit that provides a safety net of health and social services for entertainment industry members in Southern California, hosted 3-hour Social Isolation Summit. The opening panel discussion on Confronting Loneliness in a Turbulent World presented common sense from SCAN CEO Sahin Jain, MD, influenced by his Harvard Public Policy Professor Robert Putnam, author of Bowling Alone: The Collapse and Revival of American Community (2000) and Better Together: Restoring the American Community (2003): everyone has power to solve problem of isolation and loneliness, without spending $; he called for a national conversation for a social contract that prioritizes community and connection; relying on technology is the wrong direction as we have an opportunity to get to a higher plane by thinking collectively, looking out for one another, visiting/making phone calls to family/friends/neighbors, and caring for one another the way we used to. Yes, we need Mister Rogers’ Neighborhood
Nora Super of Milken Institute Center for the Future of Aging moderated all-female BIPOC panel discussion on Identifying and Filling Loneliness Gaps Across California through government and non-profit initiatives: maintain connections using continuum of technology, old tech telephone (conference call, phone tree) in diverse languages, listen to older people to design more user-friendly online technology rather than expect them to adapt, importance of agency in older people as “venerable” v. vulnerable, intergenerational supports, yada yada. 

Zoom chat was relevant with contributions by people working directly with clients (not mere administrators overseeing others’ work), and not so relevant by marketing folks trying to sell services (which I mostly ignored):
·       CyberSeniors to bridge digital and generational divides
·       Making “right” connection counts (Jon Schaeffer, Dementia Activity Club in Los Angeles): just calling/being friendly face/offering general activities is not what seniors truly need; instead, virtual visit/phone call has to target and honor their developmental tasks of maintaining control and working through their legacy; every activity should give them the opportunity to share their life stories, or they will leave this earth unfulfilled; and we need to hear their stories for our journey. Yes, power to older people
·       Promote independence and build resilience (Lualhati Anderson): older adults have lived through much more challenging times and continue to build resilience; important to assess skills level and needs before offering buffet of services available; sometimes offering too many services can create dependency
·       Peer mentoring (Clayton): The Impact of Peer Mentoring on Loneliness, Depression, and Social Engagement in Long-Term Care (outcomes of peer mentoring show 30% drop in depression scores); tips for peer mentoring; The Need for a Social Revolution in Residential Care (being passive recipient of care fosters loneliness and depression, peer support and social productivity help create valued social identities)
·       Age-friendly public health system (Jane Carmody): work with community-based organizations—e.g., AARP’s Experience Corps, Villages, community health workers—to provide older adults with opportunities for social interaction and development of new friendships    
·       Resilience & connection (Len Muroff): resilience is about becoming, not overcoming; vulnerability and fracture from trauma can lead you toward connecting to something greater than yourself, connecting to others and to the divine; refer to Sherri Mandell’s 7 steps of resilience (Chaos, Community, Choice, Creativity, Commemoration, Consecration, and Celebration) 
·       Unlonely Project (Jeremy Nobel, MD, Foundation for Art and Healing): sharing stories about ourselves through creative expression to improve well-being and connection, Unlonely Film Fest (free streaming); StuckatHome (together) community 

At this month’s SF Tech Council Meeting on Isolation, Loneliness, and Technology, UCSF geriatrician Ashwin Kotwal presented his research based on 150 SF community-based older adult study participants (age 60 to 96):
·       over half reported worsened loneliness due to restrictions related to COVID-19
·       over a third were socially isolated, driven by lower use of video communication (4/5 not using regularly, 1/4 not using internet at all for socializing)
·       “incredible ability” to adopt new technologies
·       not all older adults have access to technologies for social connection and many feel discomfort with available technologies
·       recommended including older adults with classes, volunteers, other methods to facilitate training, age-friendly design
Maureen Feldman, Director of Social Isolation Impact Project at MPTF, talked about Daily Call Sheet, a social call program that pairs trained volunteers of all ages with retired MPTF members for telephone chats several times a week, and has seen a 41% increase in new volunteers since COVID-19 pandemic.

My clients have complained that their discomfort with video technology has to do with computer vision syndrome and blue light that disrupts their sleep. SFSU Health Professor Erik Peper, PhD, author of TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics (Aug. 2020), recommends taking momentary breaks from screens to relax our eye muscles by looking at a far distance and in different directions—preferably objects green in color; palming; and blinking many times. 

I find that looking at myself displayed on a screen is like staring into a mirror for periods much longer than necessary, so I often have my video off during Zoom, and move around while listening. Before and during this pandemic, telephone calls are more comfortable for movement, eye rest, and usually better sound quality.  Advocacy groups like Gray Panthers and Senior & Disability Action have been awesome in offering meetings via Zoom or telephone.

Technology ideas to make real: Echo Silver (“Alexa for the greatest generation”) and Blacklexa (modify to be “better ally” to old people, start video at 1:30).

As an introverted old soul, I reframe social isolation as an opportunity for solitude rather than loneliness.  Solitude or alone time is refreshing to cut out noisy distractions, and enjoy quiet thinking, reading, and writing… seriously, no problem writing 1,000 words a day!
“Loneliness is failed solitude, when the absence of company is enforced and unwelcome…the impact of the pandemic has been to place a new premium on solitude. Households that were spacious enough when most of their occupants were away in offices or schools during the day now seem unbearably crowded. Prohibitions on walks out of doors are all the more frustrating…Human beings are social animals. But they need breaks from each other’s company.”—David Vincent, “The Pandemic Has Raised Fears About Loneliness. History Suggests We Should Worry About the Opposite, Too,” Time (July 8, 2020) 

Geriatric neuropsychiatrist Dilip V. Jeste, Director of Stein Institute for Research on Aging at UC San Diego, presented his related idea of wisdom as an antidote to loneliness—during two webinars this month (Loneliness: COVID-19 Toll on Elderly and Loneliness in Seniors: Wisdom as an Antidote).  According to Dr. Jeste, increasing globalization and advances in technology causing modern behavioral pandemics of loneliness, opioid abuse, and suicides point to need for societal wisdom:
·       Self-reflection: ability to look inward at one’s own behavior and change
·       Compassion: kindness to oneself and others
·       Emotional regulation: ability to control our emotions and remain calm despite ups and downs of life situations; face reality and still be more contented
·       Accept diversity: humility (Serenity Prayer)
·       Spirituality: purpose in life (“Those who have a ‘why’ to live, can bear with almost any ‘how’.”—Viktor E. Frankl, Man’s Search for Meaning

Long-term care (LTC) facilities
In U.S. LTC facilities, over 62,000 residents and workers have died from COVID-19, representing more than 40% of nation’s COVID-19 deaths.  In Canada, 81% of COVID-19 deaths have been linked to LTC facilities. Hong Kong reported its first COVID-19 death in nursing home. 
Popular culture (satire or not) reinforces stigma of LTC facilities as modern-day poorhouses (congregate settings benefit from economies of scale) for elderly who have been abandoned by families: SF Mime Troupe presented Tales of Resistance online with 2-minute commercial for The Palms nursing home (10 minutes after start time).   The Onion headline read, “Family Left Elderly Grandmother To Die In Nursing Home But Not Like This” and reported her “inevitable death at the assisted-living facility” (confusing nursing home with assisted living). 

In fact, families have been advocating to visit their loved ones in LTC facilities since March when paternalistic policies required LTC residents to isolate in rooms and restricted in-person visits. Family members are finding workarounds, such as wife who took job as dishwasher to see her husband residing in facility (originally misstated as nursing home, then corrected to memory care center); or daughter who moved into assisted living facility where her nonagenarian parents resided during COVID-19 outbreak until both parents contracted COVID-19 and died in hospital, while she quarantined after contracting COVID-19 herself. 

During my stints in LTC facilities, isolation in a unit might last up to a month during seasonal flu outbreaks.  With COVID-19, isolation and loneliness (failed solitude) have exacerbated and there seems to be no end in sight…so long as there is community spread, no vaccine, lack of rapid testing, shortages of PPE, etc.
While California DPH and Department of Social Services finally (on June 26) issued respective visitation guidelines (outdoor visits allowed, unless prohibited by local public health order) for nursing homes and assisted living, SF DPH maintains more restrictive visitation in nursing homes and assisted living, unless “necessary” (“urgent health, legal or other issues that cannot wait until later”).

DPH’s imposition of obnoxious (however well-meaning) policies have caused harm and suffering to LTC residents separated from their loved ones. What happened to harm reduction for residents of LTC facilities? Rather than base decisions solely on the biomedical model (prevent bodily deaths from COVID-19), how about a more holistic model or collaboration with interdisciplinary (bio-psycho-social-spiritual) approaches like gerontology, as well as consultation with stakeholders like older people about their wants/needs? To borrow from the disability civil rights movement: Nothing about us, without us! 

Moving into LTC facilities should not mean losing agency for residents.  While no one wants to overwhelm hospitals with severely ill COVID-19 patients, why not allow visits with precautionary measures (distancing, masking) in place outdoors, and especially if both LTC residents and visitors have executed advance health care directives and POLST forms declining life-prolonging treatment like feeding tubes and/or ventilators? (Check out UCSF webinar, Preparing for Potential COVID-19 Infection: What are Odds and What are Options?

Can we have a New Normal that supports frail older people to retain Dignity with greater agency to evaluate their own risk tolerance in decision-making?
National Center on Elder Abuse and the National Consumer Voice for Quality LTC released checklists:
·       Should I Take My Loved One Home during COVID-19 Crisis? First, ask if resident wants to leave? Is your home equipped? Who will provide care; if you bring outside help, who will pay? How will you protect from COVID-19? Will loved one be able to return to LTC facility (find out if you can hold bed)? What led to decision to place loved one in LTC facility in first place, what has changed? 

Older age and frailty risk for COVID-19 severity
According to U.S Centers for Disease Control and Prevention, risk for severe illness from COVID-19 increases with age, with older adults at highest risk. UK researchers stressed frailty as a risk factor for COVID-19 death, as much as old age or having an underlying health condition. 
In American Thoracic Society’s Promoting Recovery in Critically Ill Older Adults with COVID-19: Bench to Bedside webinar, Canadian immunologist Dawn Bowdish, PhD, presented on how features of aging immune system contribute to risk and hamper recovery of COVID-19:
·       Age, chronic health conditions, frailty are independent!
·       Frailty (increased vulnerability from decline in reserve and function, less resilience to stress) is better predictor of outcome to infectious disease/hospitalization than chronological age; this might explain COVID-19 survival of centenarians who are not frail.
·       Frail individuals may present different diseases, more likely to report abdominal symptoms, fatigue, shortness of breath
·       Infections in older people are chronic (not acute), enhance age-related inflammation; COVID-19 increases risk of stroke, cardiac damage, decreased lung function, increased frailty/disability
COVID-19 does not follow U-shaped curve in infectious disease like pneumonia and flu, where susceptibility high among very young (immunologically naïve) and severity high among very old (immune senescence, co-morbidities), with mid-life ages protected; instead, middle-age also susceptible to COVID-19.  Older adults with COVID-19 less likely to present fever and respiratory symptoms.
What older people need to recover from COVID-19: dedicated interdisciplinary geriatrics team; careful monitoring for emerging health issues; tailored physiotherapy – rehab focus on building muscle, weight training gives reserve and helps mitigate chronic inflammation.
She added that COVID-19 outbreaks in LTC facilities are not inevitable; instead, need to create “rings of steel” to keep out infection, minimize exposures because dose influences immune response, and facilities have problematic air circulation.
UCSF geriatrician/pulmonologist Leah Witt and pulmonologist/hospitalist Lekshmi Santhosh discussed promoting recovery in critically ill older adults from COVID-19, based on 4 Ms of age-friendly care: what Matters (advance care plan), Medication (avoid errors after discharge), Mentation (cognitive change, effects of delirium), Mobility (functional impairment), within holistic and multidisciplinary integration (pulmonary, geriatrics, psychiatry, integrative med, cardiology and neurology). 

Storytelling
“Many cultures revere old people because of their storytelling ability like the old lady from Titanic.” –Michael’s Tutorial on Avoiding Ageism, The Office US (satire, 2015) 

During webinars about older people, saw and heard talking heads discuss ageism as happening to “other” rather than personal lived experience; excluded were voices of older people impacted by oppressive policies requiring cocooning.  In fact, there are stories by older people—though few from LTC residents—during this pandemic.  Storytelling can be powerfully moving for advocacy, but these personal narratives amount to “swamp,” until they can be curated to present major themes and connect to policy proposals, then presented in 2-minute sound bites during public hearings. 

“Suddenly, you started thinking, oh, my God, yes, I'm actually older than I think; I'm actually older than I feel. Suddenly, people have all kind of gathered round you, pointed a finger and said, you're old; you need minding. And you think to yourself, ah, sweet Jesus, no, how could this have happened overnight?” –68-year-old Jimmy Hoban, Lemon Drizzle Cakes And Radio Show: How 1 Irish County Helps Elderly During Pandemic, NPR All Things Considered (July 23, 2020) 

Are these paternalistic policies, sheltering older people from risk of coronavirus transmission, actually helping them feel more vulnerable by doing things for them when they are capable? Such policies are not helpful, but dis-empowering people.

At British Gerontological Society’s virtual conference, UK-based Boomer researcher Naomi Woodspring interviewed Meredith Minkler, Professor Emerita at UC Berkeley School of Public Health, from her home where she is “point & click activist.”  It was refreshing to hear Meredith speak as gerontologist + older person, how COVID-19 pandemic has magnified devaluation of older people. When Meredith began her gerontology career 40 years ago, her focus was critical gerontology/political economy; now as an older gerontologist, she has embraced the humanities to better focus on moral and ethical issues, and what it feels to be an older person who’s less visible and at future risk of having her rights slip away, particularly her risk for dementia that has affected 3 generations in both sides of her family. 
Joined Reimagine’s Fireside Chat with Dave Isay, founder of StoryCorps, and Ira Byock, MD, founder of Institute for Human Caring’s Coronavirus Chronicles, exploring how stories build human connection during a global health crisis.
Planned to rest my eyes while listening to stories, but this was “show and tell” audio-visual program…so kept eyes on screen and caught “aloha” message in Zoom chat box from gerontologist Hope Levy, who recently completed 14-day quarantine in Hawaii!

California-based Ira (standing) and New York-based Dave (sitting) appeared to be from same tribe, with matching blue oxford shirts and eyeglasses.  In response to COVID-19 pandemic, Dave launched StoryCorps Connect allowing interviews to “collect wisdom of humanity” (Great Questions include 16 relating to COVID-19 pandemic) via video conference technology; he shared a sweet video exchange between his mother Jane (whose grandmother died in 1918 flu pandemic) and his 11-year-old son Tobey who survived COVID-19.  StoryCorps collaborated with LeadingAge to create a toolkit for organizations serving older adults and participant packet for older adult and families.  Ira’s website also offers questions and opportunity to share stories online.

Last month, Changing the Narrative Colorado launched On the Same pAGE series of intergenerational conversations (on social connection, future of work, technology, health equity, arts and culture, ageism) and provided a facilitator toolkit (questions on COVID-19 and isolation, stereotyping, language, intergenerational relationships, etc.).
At virtual Tucson Festival of Books, Stu Mellan facilitated conversation with Louise Aronson (SF) and Judy Heumann (Washington, DC) about their respective books on aging and disability, Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life (2019) and Being Heumann: An Unrepentant Memoir of a Disability Rights Activist (2020).  Louise, who disclosed her visual disability (but not age) and writing her book as a process to come to terms with her “inner ageism,” discussed the intersection of ageism and ableism. Judy, who disclosed being born in 1947 (now age 72), having polio at 18 months and using a wheelchair for most of her life, focused more on changing systems for inclusion of people with disabilities like herself fighting to attend public school and obtain license to teach (when education system considered her a “fire hazard”), demanding civil rights legislation (504, ADA), never giving up when someone says no, understanding that it may take decades before getting to yes. 

Woo-hoo, way to go, yes to human rights! I’ve already read Elderhood, now I must read Being Heumann! What struck me was Judy owning her disability, but what does it mean to own aging (process) as “old”—which seems to lack clear definition (chronological age, function, life stage, etc.)? For example, some people didn’t even realize they were “old” until the invention of policies intended to protect them from COVID-19, starting at various ages when they fall under “vulnerable” category: 60 (SF), 65 (California), 70 (Ireland), etc.
At another virtual book talk, Chinese Historical Society of America’s college interns Anna (Stanford computer science major) and Chris (Berkeley math major) interviewed 78-year-old author Maeley Tom (SFSU social work major).  After serving as the first woman and ethnic minority at the highest level of California legislature— Chief Administrative Officer of California State Assembly under Speaker Willie Brown, Jr., and later appointed Chief of Staff to State Senate President David Roberti—Maeley retired and self-published her memoir, I’m Not Who You Think I Am: An Asian American Woman's Political Journey (2020).  Born to parents who were traveling Cantonese opera performers (similar to Bruce Lee’s Chinese-Jewish parents), she grew up in foster home with French Basque family, learned to be self-reliant at an early age and graduated from college at age 16.  Maeley shared her toughest life lesson was learning that some people wanted her to fail when she always wanted to be liked, so she met challenges by doing “what people say you cannot do,” stressed doing homework, and developed reputation for her people and communication skills to get things done. However, she had no desire to run for political office out of fear of "losing face" if she lost, and now she feels “too old.”  Say that to leading Presidential candidates, Biden (77) and Trump (74)!

Advocacy & Celebration
Today's California Alliance for Retired Americans (CARA) Celebration included Call to Action by CARA Legislative Director Hene Kelly to protect and expand safety net programs.  Hene dated classmate Bernie Sanders while they were at University of Chicago in the 1960s, and endorsed him for U.S. President! 

U.S. Postal Service - 245 years (July 1): Congress should support the $25 billion included in the HEROES Act to protect the USPS, which seniors rely on to deliver their life-saving medications.
LaborFest screening and discussion of Gone Postal documentary with filmmaker Jay Galione, whose father was a postal clerk for 30 years enduring toxic work culture related to privatization pressures, and employer retaliation.

Older Americans Act – 55 years (July 14) 

Americans with Disabilities Act (ADA) – 30 years (July 26) 
Monthlong celebrations included:
·       George and Barbara Bush Foundation’s The ADA at 30: “Let the Shameful Wall of Exclusion Come Down,” taken from President Bush’s remarks as he signed the ADA
·       Disability Rights California's Celebration of 30th Anniversary of ADA discussion with pioneers like Judith Heumann and Dr. Fred Schroeder, DRC advocates Yolanda Vargas, Rosy Tellez, and Eric Harris 
·       Disability Action Coalition’s ADA for Next Generation 
·       Senior & Disability Action hosted Crip Camp: A Disability Revolution (2020) watch party with audio description and discussion about power of community and diverse abilities for civic engagement.  

Medicare and Medicaid – 55 years (July 30)
Medicare: Congress Should Enact Lower Drug Costs Now Act (HR 3) requiring government to negotiate lower drug prices for Medicare and provide discount rate to all payers; cap yearly out-of-pocket spending in Medicare to $2,000 and limit drug price increases in Medicare Part B and D to the rate of inflation; savings would be reinvested into Medicare to expand benefits for vision, hearing, and dental.  Also, SUPPORT Medicare for All Act (HR 1384) creating Improved Medicare for All system where everyone gets the care they need, where they need at prices they can afford, choice of providers and a comprehensive benefit plan.

All of me, health care for you and me
Co-pay free, with a choice of providers
Eyes and teeth – Don't want to lose them!
Local clinics – I want to use them!
Say goodbye to costs that soar sky-high
Middlemen – we'll do better without them
Long-term support, you won't get sold short
With Medicare for you and me!
All of me, health care for you and me
Guaranteed from pre-birth to departure
Change your job, and you won't lose it
Unemployed? You can still use it
Dignity, no fear of bankruptcy
When in need, everybody's covered
Let's win the fight, good treatment is our right
With health care for you and me!

Medicaid: Congress Should Increase the Federal Medicaid Assistance Program (FMAP) to help provide for uninsured individuals during this pandemic, and adopt 10% increase in FMAP for Home and Community-Based Care included in the House’s HEROES Act to keep seniors in their homes and out of nursing homes.

Social Security – 85 years (August 14)
Congress Should SUPPORT Strengthening Social Security Act (HR 2654) to improve the solvency of the trust fund by SCRAPPING the CAP; improve the annual COLA – basing it on the CPI-E; improve benefits for widows and widowers.  Also, support Social Security Fairness Act (HR 141) which would repeal the Government Pension Offset/Windfall Elimination Provision that denies certain public employees their earned benefits.
Congress Should OPPOSE Cutting the Payroll Tax, which funds Social Security program, to avoid jeopardizing the trust fund and benefits of current and future retirees.  Also, OPPOSE any Efforts to Enact the TRUST Act (S. 2733 and HR 4907) that creates closed-door commissions to cut Social Security and Medicare; provides no beneficiary protections from benefit cuts, nor does it mandate plan adequacy given the growing number of Americans who rely on these programs. 
National Academy of Social Insurance (NASI) hosted 4-hour Intergenerational Dialogue: Why Social Insurance? Inspired by Why Social Insurance? (1999) essay by E.J. Dionne, op-ed columnist for The Washington Post, a discussion of how the nation's social contract might evolve in light of both COVID-19 pandemic and increased calls for social justice.  With conviction of AOC, NASI intern Alexandra Allen spoke out about how social insurance enables systemic inequality because it relies on wealth of incoming payroll tax, whereas most wealth comes from stock capital and intergenerational transfers; because Social Security benefits are insufficient, she proposed funding Social Security via progressive payroll and capital gains tax, as well as expanding Medicare to all by investing away from military and to the community!

Age-friendly developments/”New Normal” ideas
·       Protecting community members in SF: Right to Recover Fund, would provide two weeks-worth of wage replacement up to $1,285 for up to 1,500 SF residents who test positive for COVID-19; another program offers smaller one-time payment to assist with groceries and other supportive services. 
·       Charles Sabatino, director of American Bar Association Commission on Law and Aging, proposed to defund nursing homes in favor of Dr. Bill Thomas’ Green House Model (smaller “households” with private room/bath, flattened hierarchy, cross-trained staff) to replace problematic institutional nursing home model of warehousing frail older people into hospital-like buildings with high staff turnover
·       Terry Fulmer of Hartford Foundation proposed rethinking LTC, calling for hospitals to return to inpatient acute care for patients who require intensive rehab (instead of discharging to skilled nursing facilities for short-term rehab), enhanced community based supports for people who need help with activities of daily living and can remain at home, and nursing homes as true LTC facilities for people who truly can no liver live at home  
·       Framework for Aging-Friendly Services and Supports in the Age of COVID-19 on strengthening person-centered services and supports for older adults, via in-home acute and primary medical care, expansion of video telehealth and social interaction, and implementation of volunteer/paid intergenerational service. 
·       Justice in Aging’s What Older Adults Need from Congress 
·       Media and public learn about MOCA, or cognitive test taken by President Trump, though increasing concern about test utility when much of content shared in media

More gerontology conferences go online:
·       Aging & Social Change: 10th Interdisciplinary Conference/New Ageism in Times of Pandemic: Tensions between Active Aging & Risk-Group Definitions (Sept. 24-25) 
·       Grantmakers in Aging (Oct. 14-16) 
·       Gerontological Society of America Turning 75: Why Age Matters (Nov. 4-6)