Senior moment

When I tell people that I’m studying gerontology, some people will look puzzled, “What are you studying?”  After I explain that gerontology is the study of aging, they continue to look puzzled, “Why?”

Gerontology program representatives recruit students with dazzling statistics about career opportunities to prepare us for the Silver Tsunami:  since the baby boomers began turning age 65 last year, 10,000 people will turn 65 every day for the next 20 years.  By 2030, almost 20% of the U.S. population will be age 65+ (http://www.agingresearch.org/content/article/detail/826,
http://www.careersinaging.com/careersinaging/why.html & http://www.un.org/en/development/desa/news/nocat-uncategorized/un-urges-countries-to-address-needs-of-ageing-population.html). 

My reasons for studying gerontology are more personal:  growing up the youngest in a multi-generational household, I’ve always valued the “been there, done that” wisdom of elders and enjoy their company.  Our lives are enriched when everyone can “age in community” rather than be sent away to institutions (nursing homes) where they become invisible.

I think my defining senior moment (“aha, I want to work with seniors”) came to me just a little over a year ago after I attended this inspiring rally with senior advocates to urgently save Adult Day Health Care (ADHC). 

  ADHC rally:  “We won’t go to a nursing home!”

Thanks to “fiscal conservative” Mayor Jerry Brown, a 71-year old senior, Adult Day Health Care (ADHC) will lose its funding as a Medi-Cal benefit, effective December 1, 2011.  Statewide, this funding loss would impact 310 ADHC centers that serve about 37,000 fixed-income seniors and adults with disabilities (AWD), who would be forced into costly institutional care (nursing home) or staying at home alone until their health deteriorates into emergency room visits or hospitalizations.  San Francisco, which has the highest proportion of seniors and AWD in the state, would see the closure of ten ADHC centers affecting thousands of current and future patients without personal choice to safely continue living in their homes (“aging in place”).

Rally to stop elimination of ADHC

On Thursday (October 20, 2011), I attended a noon rally at City Hall to Save ADHC.  It was a well-organized event, almost theatrical, that started on time, provided seats and refreshments for elders and AWD, featured the requisite sound bites by local politicians (including four mayoral candidates), followed by powerful personal narratives from ADHC participants and caregivers, and covered by TV stations.  Like members of a studio audience, we applauded louder when signaled by peppy conductors positioned at each side of the stage.

Politicians speak first

Department of Aging and Adult Services (DAAS) Executive Director Anne Hinton introduced Mayor Ed Lee, who spoke about ADHC serving our most vulnerable population—elders and AWD—and how taking away ADHC would also burden working families who rely on ADHC so they can go to their jobs to support their elders.  Then he announced plans for consideration at next week’s Board of Supervisors meeting to release funds (undisclosed amount, but later revealed in press release to be $3.4 million) from a reserve to cover ADHC effective December 1.

Afterwards, Supervisor Eric Mar stepped up to declare this memorable sound bite:  “We are an aging City! We are a City that ages friendly!”  Next came Supervisors John Avalos and David Chiu, both mayoral candidates.  Then Bayview ADHC Director Cathy Davis led a rousing chant, “We won’t go to a nursing home!”  We heard from an aide to Supervisor Jane Kim (no-show due to illness) followed by Senator Leland Yee, who reminded us that he previously worked at On Lok and was the only Democrat who voted not to cut ADHC funding. 

ADHC women & caregivers

Then finally we got to hear from the real stakeholders:  ADHC participants and their caregivers – all women (who tend to outlive men)!  Caregivers did double duty as translators for three elderly immigrants from Philippines, Ukraine and China.  Each spoke about how ADHC helped transform their lives by offering health care, meeting place for socialization, exercise therapy, social services, etc. after experiencing depression, isolation, multiple chronic health problems from the loss of a spouse and accidents that limited their ability to perform ADLs (activities of daily living).  

The highlight was listening to a woman, standing beside her silent mother who was holding Avalos for Mayor campaign lit.  This daughter described each morning’s routine at home when she prepares to send her mother to “school” (what her mother calls Bayview ADHC) so she can go to work.  From the time her mother wakes up until the 9 am bus arrives to pick her up, the mother continually asks, “What am I supposed to do today?” though the daughter repeatedly responds, “You’re going to school today.”  The daughter told us, “You see, my mom has Alzheimer’s disease.  Can you imagine a day with my mom at home by herself or at a nursing home?”  She said that her mother could do all the things she didn’t know how to do, and she remembered all the times her mother stood strong for her, so now she was going to stand strong for her mother.  At this point, I got all choked up at this model of Confucian filial piety and wanted to excuse myself from the masses so I could bawl out in private, but then . . .

ADHC anthem

Hene Kelly, who represents 900,000 seniors from California Alliance of Retired Americans (CARA), told us that other cities won’t pick up ADHC, but San Francisco is different because we care about all; Governor single-handedly cut ADHC and can reverse it; instead, he proposed a “transition plan” but nothing to date, and December 1 is coming soon.  Then, Hene broke out into the following song, which we sang back to her line by line in People’s Mic fashion:

Everywhere we go
People want to know
Who we are
So we tell them
We are the seniors
Mighty seniors, mighty seniors
Fighting for health care

Fighting for respect

Watch out, we’re going to win health care
Adult Day Health Care is a right

Get out of our way

Give it back to us!

Jaywalking & wheeling to Governor’s office

About 25 of us (including a Bay Citizen reporter and photographer—separate positions, while I assumed both roles for this coverage!) followed James Chionsini of Planning for Elders, who led a march to the Governor’s office to present a 3” stack of signed petitions.  As we made our way from City Hall to Governor Brown’s office, many held up eye-catching STOP signs that served a dual purpose to declare our message and STOP traffic when the red light suddenly came on while we were still crossing McAllister Street!

“STOP ADHC Elimination”

“STOP Dissing Grandma”

“STOP This is not how we treat our elders”

Winning signs

State Building Security wouldn’t allow us to bring in signs so we left them planted outside.  While waiting in line to go through security check, I judged the signs as contestants and decided on the following winners:

Most effective message to support cause:

“Honk to save ADHC”

“NO ADHC means taking Independence & Dignity away from our frail, Elderly and Disabled”

Most informative signs:

“Gov. Brown: Adult Day Health Makes $ense . . . “

“Average Daily Cost Assisted Living $153 Nursing Home $308-435 Emergency Room Visit $1200+++ ADULT DAY HEALTH $79/day YOU DO THE MATH”

15 minutes of fame: Occupy Governor’s Office!

James explained that we didn’t have an appointment so we weren’t all that surprised when the receptionist behind a glass window told us that the Governor was not in San Francisco to receive us and the signed petitions.  Hene made a cell phone call using speaker phone to the Governor’s Office in Sacramento, listened to a recording of menu options before reaching a constituent affairs representative named “John.”  The Governor was not available to come to the phone so Hene said she would send a letter with the petitions; “John” said the Governor’s office would respond in 90 days; some shouted, “We need a response in a week!”   Hene said we would follow-up in one week with “John.”

Then we politely exited and vans were waiting outside to escort the senior and AWD activists.  Not quite the Power of 504 demonstration (when AWD occupied the old San Francisco federal building for 26 days in 1977 until the fed agreed to implement regs to enforce the 1973 Rehab Act), but I walked away with a “Power to the People” feeling. 

Postscript:  Prior to December 1, 2011, the State reached a settlement with advocates to allow ADHC centers to provide services until the launch date of the new Community-Based Adult Services (CBAS) program (http://www.californiahealthline.org/articles/2011/11/18/state-reaches-settlement-to-establish-new-version-of-adhc.aspx, http://www.californiahealthline.org/capitol-desk/2012/10/program-launches-for-seniors-disabled.aspx)

October is Disability Awareness Month

Since diversity makes life richer, we should promote inclusiveness and universal design to create environments for people of all abilities.  Last year, I wrote the following paper for my Ableism class that challenges assumptions about “disabilities”—like aging is not about degeneration but strength based on endurance and wisdom from living an examined life.

 Through Deaf Eyes

“I'd pretend I was one of those deaf-mutes. That way I wouldn't have to have any ---- stupid useless conversations with anybody. If anybody wanted to tell me something, they'd have to write it on a piece of paper and shove it over to me. They'd get bored as hell doing that after a while, and then I'd be through with having conversations for the rest of my life. Everybody'd think I was just a poor deaf-mute bastard and they'd leave me alone.”

Holden Caulfield from The Catcher in the Rye, by J.D. Salinger

What I learned about myself and responses to issues presented

I began watching the documentary, Through Deaf Eyes, without sound so I could experience what it’s like being a deaf person and rely on reading subtitles like watching a silent film.  But when Beethoven’s Nightmare (deaf rock band) appeared within the first five minutes, I was curious to hear sound.  I clicked the mute icon to turn the speaker on and got hooked on to sound. 

Though I was disappointed in myself because of my utter lack of discipline in maintaining silence like a deaf person, I just felt sound added an extra dimension to the viewing experience.  For example, I like to watch foreign language films by reading subtitles and hearing sound though I might not even understand the spoken language because varying tones provide emotional context.  I also love music, which I would really miss if I lost my hearing.  At the same time, I love American Sign Language (ASL) as an expressive language when I studied it several years ago, but found the dramatizing to be a lot of work mentally and physically.

While I like the ability to turn sound on and off, I can identify with deaf persons based on the shared experience of being “different,” not fitting in within a larger majority.  I think this feeling of not really belonging to the majority, but mostly observing them as an outsider, has made me more introspective so I’m more sensitive and respectful of differences.  Thus, I learned that I still feel righteous indignation anytime the film covered insensitivity or ignorance by the hearing majority’s treatment of deaf persons—e.g., Alexander Graham Bell’s promotion of eugenics and oralism; U.S. Civil Service policy to no longer allow deaf to work for the government; attempts to cure deaf by airplane loops or revival; National Association of Deaf’s discrimination against deaf blacks until 1965, etc.

During the 1988 Deaf President Now protest, I found it outrageous when the fire alarms went off and Gallaudet University Board Chair Jane Spilman asked deaf students, “How can you understand me with all this noise?”  Seeing Spilman, who wasn’t deaf and didn’t know ASL, made me wonder if she was the one with the disability because she was dependent on an interpreter among the deaf who knew ASL.

In the film, one woman mentions about wanting to be “normal” while growing up, but now as a mature adult, she likes being different.  Another talks about being pliable like a marshmallow – being afraid to show her true self, confused about wanting to speak or sign, but just wanting to connect with people.  Yet another acknowledges the “met deaf wow” experience of finally meeting with other deaf persons who share a common experience and feeling like “you’re home.”  From watching this film, I learned that I could relate to these universal struggles about being different and wanting to be accepted and understood on my own terms.

I was struck by how some deaf persons insisted that they’re “really normal,” while others celebrated being deaf as intrinsic to their identity and happiness so they would not wish to change (e.g., actress Marlee Maitlan, who said she’s used to being deaf).  If I lost my hearing, I would feel regret and try to live with my limitation, but still aspire to be hearing again because some sounds are so beautiful that they really enhance the quality of life.  But as one mother put it, her deaf son has no experience of hearing so he doesn’t miss it.  Instead, many deaf persons focus on what they can do – just like my deaf uncle, who seemed to compensate for his hearing loss with amazing talents in painting and carpentry.

How watching the film changed my understanding about deafness

Before watching this film, my understanding about deafness was mainly through personal relationships with hearing impaired elders and family members who gradually lost their hearing so they view their hearing loss as a disability.  For example, my uncle lost his hearing as a teenager over 40 years ago, and recently had a cochlear implant at age 60; being able to hear again has ended some of his isolation because he now has the ability to be engaged in spoken conversations, or not.  My uncle’s favorite mug says, “I’m not deaf. I’m ignoring you.”  One advantage of being deaf is not hearing so you can shut out unpleasant noises (including hurtful things spoken by inconsiderate people)—like Holden Caulfield playing deaf-mute.  In the film, we see Beethoven’s Nightmare musicians playing music loud enough so they can feel the vibration but they don’t have to worry about hearing loss because they’re already deaf!

Because I work with elders who are progressively losing their senses (hearing, seeing, smelling, tasting, touching), I’m influenced by their perspectives that they’re no longer at the prime of their lives and some work very hard to prevent further “losses” and/or to reverse declining organ functions. Thus, I found refreshing Rory Osbrink’s perspective that being deaf is “normal”—not a physical handicap:  granted accommodations are made to survive in a society dominated by hearing people; but if we (hearing people) were to come into a room full of deaf people, then we would need the accommodation, too.   Why do we expect deaf persons to lip-read, when most hearing persons can’t lip-read themselves? If we expect deaf persons to lip-read, can they likewise expect everyone else to meet them where they’re at and communicate in sign language?  We live in an unfair world where majority rules and thus defines “normal” – but the silver tsunami (aging baby boomers) may change this!

           

There’s diversity among the deaf:  some favor oralism and adopt cochlear implants as a way to better assimilate into a hearing world, while others view sign language as part of their special culture.  Several deaf persons spoke about the hard work involved in lip-reading:  arranging circumstances so the speaker looks directly at you, with light and no background noise.  One deaf woman who got worn out lip-reading finally decided she would turn off her voice so others would stop assuming that she didn’t need an interpreter because speaking is a two-way communication.

Steps to create a more inclusive future

Based on the Action Continuum to confronting oppression, I will take the following steps to create a more inclusive future:

1. Recognize oppressive actions and prepare to take action to stop it:  It’s important to respect people’s right to self-determination, so we should ask how a deaf person prefers to communicate, and then we should accommodate individual choices—rather than expect that everyone conform to the majority.  Taking this full-day Ableism class has raised my consciousness to view disabilities from a difference/minority experience rather than a medical model or characteristic of a person—I’m more conscious of saying, and correcting others to say, “persons with disabilities” (PWD) instead of “disabled persons.”
2. Educate self about oppression and support the target group:  The medical model often means prescribing medication/diet/physical therapy to the PWD instead of changing the environment to provide access/accommodation to the PWD.  I look up to heroes like Gallaudet and Clerc (deaf himself) who had a great deal of empathy so they could see that signing was a natural and practical language for deaf persons.  When I don’t share a spoken language, I resort to charades.  I plan to learn more about other disabilities so I can be more sensitive to special needs.
3. Educate others by question and dialogue to share why I object to a comment or action.  I will share Disability Etiquette Tips; for example, don’t bother shouting at someone who doesn’t share the same language—try communicating with facial expressions, gestures or body language instead, or get an interpreter.
4. Support by backing up others who speak out, form allies, join coalition, etc.:  I support deaf persons to lead deaf organizations (like Gallaudet University) because we need role models from similar backgrounds (inspiring people so they can be empowered to do anything in this world!) who personally understand deaf experiences. 
5. Initiate and prevent:  I will challenge persons like Alexander Graham Bell, however well-meaning they may appear, who attempted to ban signing in favor of oralism in the belief that this would integrate deaf persons within the wider hearing society that defines “normal” standards.

Technology (email, twitter, texting, etc.) has helped to bridge the gap between the deaf EYEth and hearing EARth.  I support free choice and accept people for who they are, especially if it’s something they can’t change like being deaf.  (More important is one’s character!)

I am just beginning to work as an advocate on elder issues which include disability access.  This year the first of the baby boomers turn 65 (“silver tsunami”) and their sheer numbers are sure to influence how we view and accommodate PWD related to aging.  Instead of focusing on “losses” as limitations, we’ll focus on making accommodations and appreciating what PWD can still do!       

Note:  Presbycusis ("old man's hearing") is the most common form of hearing loss with aging.  It is characterized by a decrease in perception of higher frequency tones and a decrease in speech discrimination.  It's hard to determine how much of the hearing loss is due to aging, exposure to environmental noise or chronic age-related conditions (hypertension, diabetes).  (http://www.nidcd.nih.gov/health/hearing/Pages/presbycusis.aspx)

References:

Action Continuum to Confronting Oppression: http://www.stepupprogram.org/docs/handouts/STEPUP_Action_Continuum.pdf

Arizona Bridge to Independent Living covers etiquette tips relating to persons using wheelchairs and persons with speech difficulties, cognitive/language impairments, hearing and vision losses, and multiple chemical sensitivities:  http://www.abil.org/disability-etiquette-tips

Community Resources for Independence covers etiquette tips relating to persons with mobility, cognitive, psychiatric, visual, hearing and speech impairments:  http://www.crinet.org/education/Independent%20Living/Etiquette

Through Deaf Eyes: http://www.pbs.org/weta/throughdeafeyes/

Aging + disability: common ground? yes, we can!

In my Aging Processes class, I underwent several “aging simulation” exercises intended to experience first-hand the effects of age-related sensory losses (vision, hearing, taste + smell, touch) on activities of daily living (ADL). 

As a result, I learned to value my strengths in remaining senses (e.g., touch and smell to compensate for vision and hearing losses), go slow and pay more attention to navigating my environment, give up some independence and allow others to help me get around safely, appreciate Impressionism and the sound of silence, get motivated to learn Braille, be patient and adapt to taking a longer time to perform activities.  (See fact sheet on Physical Changes of Aging, with suggestions on managing these changes, at http://edis.ifas.ufl.edu/he019.)

These exercises also further reinforced my advocacy efforts for universal design to make our environments accessible to people of all abilities.  As we go through life, it seems a majority of us will experience sensory impairments, either temporarily or permanently, so we’re all in this together to improve the quality of life for everyone.

On April 16, 2012, the U.S. Department of Health and Human Services created a new organization, Administration for Community Living (ACL), which consolidates three agencies for aging and disability services:  Administration on Aging (AoA), the Administration on Intellectual and Developmental Disabilities, and the Office on Disability.  The intent is to improve community supports for older Americans and people with disabilities to enjoy “the fullest inclusion in the life of our nation.”  (http://www.hhs.gov/news/press/2012pres/04/20120416a.html) 

Golden Gate Park's Project Insight Garden is open to people of all abilities!(http://sfrecpark.org/Rec-ProjectInsightProgram.aspx)

Living long + healthy

Does growing older mean living with chronic disease and accompanying disability?  What’s the reality of aging as opposed to social stereotype? 

The average 75-year-old American suffers from three chronic conditions and takes five prescription medications.  (http://www.silverbook.org/fact/21)  Yet, chronic diseases are mostly due to environmental and behavioral factors, rather than genetics or age, and are preventable.   (http://www.cdc.gov/chronicdisease/resources/publications/AAG/chronic.htm & http://www.californiahealthline.org/capitol-desk/2012/3/state-poll-numbers-support-prevention.aspx)

At the 5^th Annual On Lok Conference on Sustainable Long-Term Care Cultivating Healthy Aging, keynote speaker Dan Buettner said that 20% of how long we live is dictated by genes, and the remaining 80% by lifestyle and environment.

Buettner’s research findings are published in his book, Blue Zones, where he identifies the Power of 9 habits shared by populations who live long, healthy lives with low rates of chronic disease.  It’s noteworthy that the common denominator is living close to nature:

1.      move naturally (versus exercise)

2.      “right” outlook: having purpose in life, daily rituals to de-stress

3.      eat wisely: plant-based, eat until 80% full (Confucius recommended 70%), moderate consumption of wine with food/friends (though Adventists abstain from alcohol)

4.      connect: loved ones first (intergenerational families), belong to faith-based community, right tribe to reinforce healthy behaviors

The conference ended with panelists discussing uses of technology to provide social networks, videogames and cell phone texting for medication reminders.  As a nature lover and reluctant blogger, I’m skeptical about making technology into a “healthy” habit.

I always thought a gardening habit—which provides natural movement, a reason to get up in the morning, daily meditation with nature to de-stress, fresh produce to eat, a form of recreation with family/friends, etc.—kept my grandfather alive through 9 decades.  Gardening happens in the natural, not virtual, world.

Blue Zones:  http://www.bluezones.com/live-longer/power-9/

2012 On Lok Conference presentations: http://www.onlok.org/Events/AnnualConference.aspx

"I'm glad I am 101"

“I've lived a long time, a very long time, 101 years, and I'm still here.  I'm done with the doubts and struggles and insecurities of youth. I'm finished with loss and guilt and regret. I'm very old, and nothing is expected of me. Now, provided good health continues, I can do what I want. . . I can even do nothing -- what a luxury that is! I have new priorities and a new appreciation of time. I enjoy my family more than ever, and also a sunny day and a comfortable bed. I keep up my interest in books and theater and people, and when I'm tired, I rest.... I had many problems and disasters in my life; fortunately at my age, I don't remember what they were. I'm glad I am 101.”--“Test of Time,” by Bel Kaufman, Vogue, August 2012 (The Age Issue), p. 82

"The paradox of aging is that realizing you don't have all the time left in the world doesn't make you sad and miserable; it makes you live in the moment and be appreciative of the day.  That's the secret to happiness.” --Laura Carstensen, Director of Stanford Center on Longevity
(http://health.usnews.com/health-news/articles/2012/08/30/getting-better-with-age-why-seniors-are-more-satisfied)

Words of wisdom from world's oldest living person

Besse Cooper, the world’s oldest living person who turned age 116 on Sunday, shared some secrets to her longevity:  "I mind my own business, and I don't eat junk food.” 
Her son Sidney observed, "The older she has gotten the more wittier she has gotten." 

(http://www.guinnessworldrecords.com/news/2012/8/happy-birthday-besse-cooper-worlds-oldest-living-person-turns-116-44470/)

Sensible advice like Michael Pollan's commandment in Food Rules:

“Don’t eat anything your great-grandmother wouldn’t recognize as food."

How long do you want to live?

The New York Times recently published an essay, “How long do you want to live?” by David Ewing Duncan, author of When I'm 164: The New Science of Radical Life Extension, and What Happens If It Succeeds (http://www.davidewingduncan.com/whenim164/). At bioscience gatherings, Duncan surveyed audiences to respond to that question, given the following choices:

A. 80 years, the current average life span in the West;

B. 120 years, close to the maximum anyone has lived;

C. 150 years, which would require a biotech breakthrough; and

D. Forever

According to Duncan, the majority opted for 80 years, while few wanted to live forever.  Many respondents explained that they “didn’t want to be old and infirm any longer than they had to be,” even if medicine could postpone this inevitability.  However, few viewed the extension of healthy lives as an opportunity to “accomplish more in life and to try new things.”  

Imagine the possibilities from a genius like Albert Einstein if he lived beyond his 76 years.  Duncan noted that if Einstein were alive today, he would be 133 years old, but "That’s assuming that he would want to live that long. As he lay dying of an abdominal aortic aneurysm in 1955, he refused surgery, saying: 'It is tasteless to prolong life artificially. I have done my share, it is time to go. I will do it elegantly.'"

(http://www.nytimes.com/2012/08/26/sunday-review/how-long-do-you-want-to-live.html)