The month of May celebrates Older Americans, Asian Pacific American Heritage, Jewish American Heritage, and Mental Health Awareness.
Though not
yet an older American (age 60+ for Older Americans Act programs), I work with
this population and listening to their perspectives (descriptive and
prescriptive) help me plan for my future.
Take for example, geriatrician Dr. Muriel Gillick’s reflections on
turning age 70:
“At age 70, I find that I for the most part accept myself as I am,…focus
on what I derive satisfaction from doing, not from what I feel I ought to do.
That means spending time with my husband,…my 95-year-old mother and with my
three sons…It involves trying to make sense of the world, which I often try to
do by reading broadly about health and medicine, incorporating what I learn
from the realms of history, politics, science, sociology, and other disciplines
to shed light on current problems. While I will engage in activities that I
find meaningful, I will avoid activities that are stressful or create conflict.
That has meant giving up seeing patients, which used to make me feel useful and
even important, but which increasingly became burdensome as medicine became
bureaucratic, patients became litigious, and disease remained as intractable as
ever. I also want to devote more time to arguably purely selfish activities
such as exploring the worlds of novels and of nature.”--Muriel Gillick, MD, “Tiptoeing Towards the End Zone,” Life in the End Zone
(May 21, 2021)
Dr. Gillick
sounds like an introvert, focused on handful of close family relationships,
reading and nature. Yet sad she gave up
seeing patients for reasons unrelated to actual interaction, but due to
bureaucracy of system.
Hope I don’t get to that point when I feel like I have to give up seeing clients, who continue to engage me with their life stories. While good to feel useful (especially if I’m collecting paycheck!), I don’t care to feel “important” which sounds rather egotistical, in my humble opinion. I already work within a bureaucratic system that attempts to integrate behavioral health with primary care in a predominant medical model that views old age as pathology. As a result, this pathological approach focuses on client deficits, fitting client experiences into DSM-5 diagnosis for treatment and billing. As I “perform” day-to-day clinical social work, I keep a strengths-based, person-in-environment perspective and look for macro advocacy opportunities, avoiding “toxic boomerang.”
Strength
in advocacy
At virtual California Senior Legislature's Senior Rally Day: Advancing the California Master Plan for Aging (MPA)! Justice in Aging Executive Director Kevin Prindiville served as Master of Ceremonies introducing California Department of Aging (CDA) Director Kim McCoy Wade, who talked about importance of diversity, equity and inclusion strategy because “aging is the report card on discrimination you experienced throughout your life” as its cumulative effects show up in life expectancy, life savings, home equity, etc.
Best news from Adam Willoughby, Assistant Director, Legislation and Public Affairs, CDA, who presented on “highly optimistic budget”: Despite COVID-related job losses, California tax receipts are outpacing projections, and there appears to be sufficient funding to accomplish MPA initiatives/goals!
Senior Rally Day’s afternoon session focused on Knowing Our History: Exploring the Past and Future Directions of Disability and Aging in California, with Darrick Lam, MSW, President and CEO of ACC Senior Services in Sacramento (and former Aging Services Program Specialist who supervised my gerontology internship at U.S. Administration for Community Living). Darrick talked about aging and disability integration, and advocacy to ensure increased funding for growing older adult population. He noted that as former Executive Director of SF Department of Aging and Adult Services (2002-2005), budget was $100 million; 15 years later, today SF Department of Disability and Aging Services budget is almost $400 million (and nearly half of that growth from past five years since Shireen McSpadden became Executive Director in 2016).
This month’s Senior & Disability Action (SDA) meeting focused on Budget Priorities, with an overview of this process and opportunities for advocacy by Ahmed Waheed of SF Budget Justice Coalition (BJC), who shared links to SF Budget Process, Budget Calendar (Public Comment Day on June 25!), Budget Timeline (get involved during next month’s Department hearings, Public hearing before Board of Supervisors, Final Committee Deliberations and “add-back” night), SF Power Structure (including People Power!), and BJC asks.
As homelessness prevention measure, SDA Board President Betty Traynor asked for:
·
$3
million for tenant-based senior and disability rental subsidies
· $3 million for project-based Senior Operating Subsidy (SOS), five-year/$5 million pilot program created in 2019, set aside units in senior buildings to be “deeply affordable” (Shotwell: 20 units at 15% AMI, 20 units at 25% AMI; Davis: 15 units at 30% AMI)
SDA also
seeks $900,000 for computers, laptops, internet services, and digital training
for seniors and people with disabilities, to expand digital equity.
“Age
is only second to poverty as the strongest determinant for lacking internet
access in the United States.
…pandemic
has been a profound exercise in empathy: for the first time, many of us are
experiencing what it is like to be alone, afraid and isolated.
For
so many, broadband access has been a life raft—a portal to nearly every aspect
of our lives. The pandemic made absolute what was already becoming clear:
access to digital technology and high-speed internet is about access to
everything else—essential health information, education and training, our work
and our jobs, the ability to purchase goods and services, our entertainment
and, perhaps most importantly, our ability to communicate and stay connected to
one another. –Peter Rundlett, “Digital equity: A human right whose time has
come,” Generations Today (May-June 2021)
During this COVID-19
pandemic, Emergency Broadband Benefit (EBB) provides to low-income households $50
monthly discount for internet service + up to $100 discount for one-time
purchase of device.
According to City Controller’s latest budget update, the City has $157.3 million budget surplus, thanks to better than anticipated revenue from property taxes. Fiona Hinze, Co-Chair of SF Dignity Fund, called for restoration of $3 million allocation to SF Dignity Fund.
State of California has a $75.7 billion surplus, thanks to its progressive tax structure (half of California's income-tax revenue comes from its top 1% of earners, and capital gains are taxed at the same level as income). Governor Newsom announced a record $267.8 billion state spending plan—or, in his words, a "historic, unprecedented, generational and transformational budget." His $100 billion pandemic recovery plan, California Comeback, includes $12 billion in direct payments to low- and middle-income Californians, and $12 billion to get unhoused Californians into homes.
At virtual
Lobby Day training, California Alliance for Retired Americans (CARA) Executive
Director Jodi Reid discussed priority bills, including AB 695 HomeSafe
expansion - lower age from 65 to 60 for Adult
Protective Services (APS) and increase funding for HomeSafe intended to support
safety and housing stability of individuals involved in APS (e.g., short-term financial
assistance, legal services, eviction prevention, heavy cleaning, landlord
mediation, etc.).
CARA training included role-play by Hene as Assemblywoman and Fran Smith as constituent presenting talking points.
Building connections
To kick-off Asian Heritage Month, PBS broadcast Amy Tan: An Unintended Memoir (2021), based on Where the Past Begins: A Writer’s Memoir (2017), connecting generational trauma and writing as therapy from Amy’s muse Daisy, her Chinese immigrant mother who survived hardships, suffered depression/suicidal ideation and died of complications from Alzheimer’s disease.
AARP hosted screening of Chinatown Rising (2019) documentary made by 85-year-old Rev. Harry Chuck and son Josh, based on former's collection of film strips as SFSU student during Asian American movement, and social activism as Cameron House Executive Director. The film recounts powerful intergenerational community organizing to build Mei Lun Yuen, affordable senior housing in SF Chinatown.
Patrick Arbore, EdD, of IoA’s Friendship Line, and Carla Perissinotto, MD, MHS, of UCSF Geriatrics presented Not Alone: How Older Adults Can Build Connection. Take-aways: first, ask about loneliness and isolation; talking helps destigmatize (share own experience of vulnerability); directly address social isolation and loneliness by connecting clients with programs that enhance social connections and support; don’t forget indirect interventions (e.g., aids for hearing loss).
“It
is not OK to expect clinicians to have the same amount of time in a clinical
visit with an older adults as they do with a younger adult and produce quality
results.
It
is not OK to completely isolate adults without their consent and be fine with
the ensuing death from isolation.
It is not OK to continue to expect older adults to adapt to technologies and built environments that are created without them in mind.” --UCSF Geriatrician Carla Perissinotto, “Why Our Healthcare System is Failing Older Adults,” Generations Now (Apr. 2021)
In The New Yorker’s “What Robots Can—and Can’t—Do for the Old and Lonely” (May 24, 2021), Katie Engelhart explored New York State’s distribution of social robots to older adults as a loneliness intervention—begun as a pilot program in 2018, and then expanded last year when pandemic necessitated lockdowns. Robots were found “good for a person who doesn’t have anybody else” and “better than nothing.”
In report to SF Long-Term Care (LTC) Coordinating Council, "How Do We Respond to That Level of Need?" Mental Health of Skilled Nursing Facility Residents in San Francisco (May 2021) noted role of caregiving staff (CNA, LVN, RN) in supporting resident mental health, and only mentioned social work in context of social work students who volunteered with telephonic outreach to residents.
Social
work: oblivious to ageism?
This year’s
CalSWEC (Social Work Education Center) Integrated Behavioral Health Symposium, The
Intersection of Integrated Behavioral Health and Antiracism: Leveraging a
Person-Centered Care Model to Eliminate Health Disparities, focused on anti-racism and “nonelderly.”
Eboni Winford, PhD, MPH, Director of Research and Health Equity, Cherokee Health Systems from Knoxville, TN, illustrated health disparities by race/ethnicity based on “nonelderly” data: share of nonelderly adults who did not receive care/delayed care in past year, and percent of nonelderly population without a usual source of care when sick other than the emergency room.
This marginalization
of “elderly” seems typical of social work education. Medicare beneficiaries age 65+ also face barriers to
care related to disability and transportation.
Eboni Winford recommended that “one must be in a position of power when addressing microaggression/racism with a member of the majority group.” Hope this includes generous definition of “position of power” to elevate marginalized people.
Last month,
Centers for Disease Control (CDC) got “woke” launching a new initiative to
address racism in health care, noting the role race plays in social
determinants of health. Yet, no similar initiative to address ageism in health care, though search for “ageism”
on CDC site brought up some articles about ageism and poorer health outcomes,
like Mary C. White’s blog post “Celebrate Your Age, It’s Good for Your Health” (July
28, 2020).
Mental
Health Awareness Month
U.S.
Administration for Community Living and Substance Abuse and Mental Health Services
Administration co-sponsored 4th annual Older Adult Mental
Health Awareness Day Symposium (available on-demand).
This month’s American Association for Geriatric Psychiatry (AAGP) webinar, Innovations in Substance Use Disorders Treatment in Older Adults, focused on review of literature on opioid and alcohol use. Nearly 1 million older adults live with substance use disorders (SUD) in 2018, possible increase during pandemic; 10% report binge drinking. Yet, older adults with SUD remain underserved: less likely to be screened, identified, and referred for treatment. Studies show that compared to younger adults, older adults are at least as likely, if not more likely, to benefit from treatment and sustain a meaningful recovery.
Risk factors
for development of SUD in older adults: unmarried/divorced/widowed;
bereavement; chronic pain/illness/disability; loneliness/social isolation;
caregiver strain; depression; change in living situation/career; lack of
spiritual practice/community. Older
adults are at greatest risk for prescription drug misuse!
SUD treatment is important issue in SF: With COVID-19 somewhat under control
among growing numbers of vaccinated, SF Weekly called fentanyl
(synthetic opioid) “San Francisco’s biggest public health crisis” (May 6,
2021). In 2020, SF's 713 drug overdose deaths outnumber recorded 258 COVID-19 deaths. SF
Department of Public Health (DPH) has taken controversial harm reduction approach (California Governor/former
SF Mayor Newsom is said to be open to safe injection sites), which has been criticized for
enabling use, and critics advocate for other approaches like abstinence rehab
and reducing drug supply via law enforcement.
When talking about substance use with older adults, language matters: Instead of Alcoholics (which is stigmatizing) Anonymous, reframe as “Person who uses alcohol, Anonymous”?
DSM-5
symptoms may present differently in older adults, who may be impaired using
same amount taken when younger; may not realize use is problematic, especially
with long-term use; role impairment is less pertinent, especially if retired
and living alone; withdrawal syndrome can occur with more subtle symptoms such
as confusion.
Alcohol Use Disorder (AUD) is most prevalent SUD in later life. Recommended screening tool: 10-item SMAST-G.
Age-Friendly
University (AFU)
Joined Gerontological Society of America (GSA) Age-Inclusive Workgroup for Campus Conversations: Advancing Age Inclusivity in Higher Education. University of Maryland, Baltimore County Sociology Professor John Schumacher presented, Making the Case for Age Friendly UMBC, starting with family photos of Nana born 1907 when life expectancy only 47 years and nephew born 2019 when life expectancy increased to 79 years. More people living to old age, so join Age-Friendly Movement: Cities (WHO), Health Care Systems (IHI), Businesses, Universities (Dublin, Ireland).
Washington University Social Policy Professor Nancy Morrow-Howell said AFU success looks like age diversity! She talked about WashU for Life support group for older students, who are not “specimens in classroom” and inviting younger students to OLLI events.
In chat, Grand
Valley State University Gerontology Professor Phyllis Kimboko shared
information about her campus’ annual Art and Science of Aging conference that
is open to the public. This year’s virtual conference website page includes recording of Promoting Age-Friendly Grand Rapids through Intergenerational Relationships.
Mills College Book Art community came together for virtual celebration of Kathleen Walkup on the occasion of her retirement after 43 years as Professor and Director of Book Art Program at Mills. Kathy shared her reflections on the 90+year history of the program, including successful fight to save renowned Book Art program after threat of closure in 2015 and receiving Institutional Award from American Printing History Association in January 2021.
Got COVID-19 vaccination at City College of SF (CCSF)-Ocean Campus parking lot. Across street stood St. Francis of the Guns, by pacifist sculptor Benny Bufano (1890-1970), who used melted gun metal from voluntary gun turn-in program after 1968 shootings of Bobby Kennedy and MLK, Jr. Something to ponder today, as U.S. has had 225 mass shootings and more than 17,000 people in U.S. have died from gun-related violence in 2021 as of May 28.
Took quick selfie during 15-minute observation after getting my 2nd dose of Moderna vaccine from UCSF nurse, who issued my CDC COVID-19 Vaccination Record Card and #VaccinateSF button in multiple languages. Very efficient operation at CCSF, with hygiene theater and double-masking. This COVID-19 vaccine distribution is model of universal healthcare, funded by tax dollars!
“Missing SF” poster on Muni bus stop pole at CCSF. Hope to “find SF” with reopening!
Day after this 2nd dose, woke up with headache but so tired that I slept it off. Two weeks later, considered “fully vaccinated,” which allowed me to mask off outdoors! By month-end, SF DPH Director Dr. Grant Colfax allowed us to “eat cake” to celebrate 1 million COVID-19 vaccine doses in SF!
Age-Friendly Tenderloin?
Muni bus stop with Mister Rogers’ “Won’t you be my neighbor?” reminds me to be like Good Samaritan (carry Narcan!) as I leave my neighborhood for bus ride to work in Tenderloin. With gradual reopening as more people are vaccinated, crowds are returning to bus and streets.
it
is a serious thing
just
to be alive
on this fresh morning
in the broken world.
--"Invitation”
by Mary Oliver
Tenderloin is home to two senior centers: Curry Senior Center (“Aging with Health, Hope, & Dignity”), and SF Senior Center-Downtown (“Living Well, Aging Well”). (The latter sometimes referred to as near more upscale Union Square or Lower Nob Hill.)
With its high concentration of single-room occupancy hotels, Tenderloin has among the cheapest rents in SF, providing low-cost housing for many seniors on fixed income.
Navigating Tenderloin is like an obstacle course – every single street in Tenderloin is a part of the City’s High Injury Network, so speed limits have lowered from 25 to 20 miles per hour--and there is plan for Safe Passage Park, one block away from Curry Senior Center (which hires St. Anthony's Client Safety Services as ambassadors to ensure "respect" for sidewalk space). Sidewalks throughout 31 blocks of Tenderloin are littered with food packaging, poop, needles (courtesy of SF DPH’s syringe access program), etc.— so pedestrians using canes, walkers and wheelchairs use extra caution.
More than 40% of SF drug overdose deaths occurred in Tenderloin, particularly among older Black men living alone in residential hotels. SF City Attorney filed lawsuits against 28 alleged drug dealers—all but one commuted from outside SF—seeking to ban them from entering Tenderloin, an open-air drug market, based on public nuisance. However, SF Superior Court rejected this proposed injunction as overbroad and infringing on defendants’ constitutional rights.
On my way to work in morning, I pass by Homeless Outreach Team (HOT) which rouses people in tents occupying former parking spaces that serve as extensions of sidewalks during pandemic to reduce crowding in Tenderloin.
“OPEN” sign
reminds us to open our minds and hearts. “Misunderstanding” by Marisol,
13-year-old Tenderloin resident implores: “Why can’t we just listen to each
other?…Maybe if we just listen and love, we’d be okay. Who knows?”
“I AM” by Helen, 13-year-old Tenderloin resident is a force of nature: “I am a colorful rainbow because of the different emotions I feel every day. I am the sea. My waves can be quiet but at times very strong. Am the purple sky at dawn.”
In Tenderloin, strength in community support = social capital.
“You can accomplish anything” reminds me of Helen Reddy singing: “Oh yes, I am wise/ But it's wisdom born of pain/ Yes, I've paid the price/ But look how much I gained/ If I have to, I can do anything/ I am strong (strong)/ I am invincible (invincible)/ I am woman!”
“Stronger together (more love)” reminds me of Ecclesiastes 4:9-12: “Two are better than one…For if one of them falls, the other can help his partner up. But what will happen to the one who falls with no one to help him up?...if two lie down together, they will stay warm, but how can just one keep warm? And someone may overpower one alone, but two together can take a stand against him. And a threefold cord cannot quickly be torn apart.”
Soon after
street cleaning, crumpled paper bag already littered extended sidewalk.
SF Department of Public Works (DPW) worker hoses down sidewalk, careful to keep dry nearby tent and occupant.
Artist Crystal Vieula decorated this solar-powered Bigbelly trash compactor into beautiful “You are loved” affirmation, as part of Tenderloin Community Benefit District’s program to clean up Tenderloin’s sidewalks which already share space with encampments by unhoused. Former SF DPW Director (before he was ousted on fraud charges by Feds) opposed expansion of smart Bigbelly trash cans in favor of awarding $5+ million contract to relative of his partner-in-fraud. Latest DPW selection of rummage-resistant, hard-to-vandalize trash can designs are huge eyesore.
Newer trash cans take away a source of income for people who have lost their jobs during the pandemic and turned to collecting recyclable cans and bottles. This is what 61-year-old Yao Pan Ma was doing when he was savagely attacked in New York City last month, unknown whether this was anti-Asian hate crime.
This month SF
Police arrested 54-year-old suspect in Tenderloin, in connection with stabbing two Asian women, age 85 and 63, at Downtown bus
stop.
Tenderloin-based Glide’s Center for Social Justice hosted Healing Through Culture and Unity, intergenerational discussion with AA (Asian American) pioneers Sandy Ouye Mori (dietitian and co-founder of Kimochi Senior Center) and Anni Chung (President and CEO of Self-Help for the Elderly) and NHPI (Native Hawaiian Pacific Islander) students like Tupou Motulalo Latukefu (influential in getting UC Berkeley to recognize AA and NHPI separately on campus). (Honolulu Councilwoman wants further disaggregation separating NH from PI).
In response to reports of
AAPI hate crimes:
· Self-Help for the Elderly offers free escort services to AAPI seniors in SF
· President Biden signed COVID-19 Hate Crimes Act, introduced by AA women lawmakers, though some AA groups opposed the legislation as too pro-law enforcement
· Grant Avenue Follies recorded "Gai Mou Sou Rap" (Chicken Feather Duster Rap): “Knowledge doesn’t generate automatically from your little pea brain/ The elders are your teachers, Your elders are your guides/ When you mess with them, you’re committing suicide…”
Strong presence of “community ambassadors” in Urban Alchemy uniforms are part of SF Mayor’s Mid-Market Vibrancy and Safety Plan. They focus on “protecting” business storefronts, discouraging loitering and encampments, moving unhoused to vacant spaces (many more since businesses shuttered during pandemic). (In related defunding police measure, SF DPH announced replacing “some” of its sheriffs with “more” trained mental health professionals at SF General Hospital.)
“Any city that doesn’t have a Tenderloin isn’t a city at all.” –Herb Caen
During lunch break, I leave Tenderloin for nearby Civic Center, strolling by vibrant Pattern Recognition (2020 mural by Jenifer K. Wofford) outside Asian Art Museum (AAM), and seeing Jade Snow Wong panel with vase silhouettes of her ceramics in museum’s “treasure wall” cabinet. AAM’s virtual Celebrating AAPI Heritage Month included Jade Snow Wong playlist: Shaping Her Own Story; and Art and Science of Jade Snow Wong’s Work (Ceramics: Carving Her Own Niche; Enamels: Color and Form).
So thrilled to be inside SF Main Library, after 14-month closure, though only 1st floor open for “browse and bounce” service and continued hygiene theater...look forward to full reopening expected on June 15th!
Not Tenderloin/Civic Center, which lacks sidewalk benches as tents already compete for sidewalk space. Instead, seatings beneath tree are from my age-friendly neighborhood.
