Dignity + R-E-S-P-E-C-T

“Dignity is our inherent value and worth as human beings; everyone is born with it. Respect, on the other hand, is earned through one’s actions…

This shared desire for dignity transcends all of our differences, putting our common human identity above all else...The glue that holds all of our relationships together is the mutual recognition of the desire to be seen, heard, listened to, and treated fairly; to be recognized, understood, and to feel safe in the world.”

--Donna Hicks Ph.D., founder of Declare Dignity and author of Dignity: Its Essential Role in Resolving Conflict

Because of my current work focused on home visits to mostly homebound seniors, I miss a lot of community meetings during working hours, and thus sometimes feel as isolated and invisible like my clients.  Outside of working hours, I make efforts to stay connected with advocates from Community Living Campaign, Gray Panthers, Older Women’s League (OWL) and Senior & Disability Action (SDA).  And I share information with clients to empower them to make themselves heard because “all lives matter,” including homebound older adults!  

Though it might be challenging for clients to show up at City Hall for the July 19 rally before the Board of Supervisors’ vote on The Dignity Fund to place it on the November 2016 ballot, perhaps clients can send representatives to speak on their behalf about removing barriers that keep them as shut-ins, like funding for:

·         escort services (beyond medical appointments, like affordable outings for people with dementia)

·         elevator repairs in SROs

·         stair lifts in buildings without elevators

·         power wheelchairs/scooters for seniors tethered to oxygen tanks

·         neighborhood and pedestrian safety 

·         taxis willing to serve residents in Bayview-Hunters Point (aka “the San Francisco America pretends does not exist” according to James Baldwin in his 1963 Take this Hammer documentary)

·         treatments for urinary incontinence, etc.

Legal Assistance to the Elderly = Power to the Elderly! 

The Dignity Fund includes provision for protecting the rights of seniors to remain living in their homes: legal services focused on eviction/homelessness prevention.  For example, a court ruling in April allowed 99-year-old Iris Canada to remain in her San Francisco home if she pays over $100K in legal fees to her landlord or else agrees to a condo conversion; two months later, her landlord is attempting to evict her again though she needs more time—and likely legal counsel—to understand condo conversion documents. 

 

Marilyn French-Speller, at her retirement party from Meals On Wheels of San Francisco (MOWSF; see Marilyn in video at 2:15), gets R-E-S-P-E-C-T and honorable mention for at least three reasons: 1) her influence in inspiring me to pursue MA in Gerontology from SFSU, as she did, 2) her example of having a sustainable career spanning 30+ years working in non-profits while residing in San Francisco, and 3) her decision to leave San Francisco (one of the most expensive cities) to be closer to her family in St. Louis (more affordable) as she embarks on her next stage in life, got me thinking about where I want to be “aging in place.” (Would I want to retire in Honolulu, which is more expensive than San Francisco, just to be closer to family?) 

Studying gerontology

When I met Marilyn five years ago during a stint at MOWSF’s Social Work Department, while I was an intern at Department of Aging and Adult Services, I was deciding whether to pursue graduate studies in gerontology or public health.  Marilyn’s passionate advocacy, manner of treating everyone with dignity and infectious laugh just won me over.  I didn’t consider social work because gerontology was already part of the School of Social Work at SFSU, and I was more intentional about studying aging.

At API Social Work Council’s Panel: Preparing You for a Career in Social Work, it was refreshing to see that the only male panelist represented gerontology! Chris Lum, MSW medical outpatient social worker with the Veterans Administration (VA), didn’t intend to work with older adults but now works mostly with veterans age 50+.  His experience included work in a homeless shelter and community mental health when he applied twice with the VA until he got hired. 

Social work representation was absent among the five awardees (which included one male!) of this year’s PG&E Legacy Employee Resource Group (ERG) Scholarship, intended to award students who “support Senior communities.”  At its “Reaching for Tomorrow” Awards Ceremony, I was the only recipient to attend in-person to give another big shout out to PG&E Legacy ERG for extending its scholarship eligibility to persons pursuing continuing education (not just degreed programs), and not limiting applicants to long-term care administration (as is the case with nearly all scholarships offered at SFSU Gerontology Program; last fall, I was surprised to learn that my donation check intended for SFSU Professor Brian de Vries’ retirement gift actually went to Frank P. Broz Long-Term Care Administration Program Fund at SFSU.) 

“Surviving” in non-profit work/pay

When people learn that I work at a non-profit agency serving seniors, they often remark, “wow, you must have a lot of dedication,” and then remind me, “non-profits don’t pay anything like comparable positions in government” and ask, “how do you manage to survive, especially living in San Francisco?” Oh, hand to mouth, one day at a time . . . like my mostly homebound clients on limited income, thanks for your concern.

But for the grace of my landlord who allows me to continue living in my rent-controlled apartment, I am managing financially to work at a non-profit and reside in San Francisco (the most expensive rental market in the nation where the median monthly rent for a one-bedroom is $3,590; and landlords have been reported to raise rents more than fourfold in units not subject to rent control).  During my stint in affordable senior housing, female residents who were retired social workers expressed the irony of how they found themselves income-qualified to live in the same housing as their clients who had mental illnesses, substance abuse and/or were formerly homeless--with all the drama of adapting to community living.  Would I have a similar fate (and loss of professional boundaries)?

All women panelists from the non-profit sector at this month’s OWL meeting focused on Women & Money offered some survival strategies:

• Lori Nairne, RN at Kaiser Permanente, talked about the feminization of poverty and campaign of Global Women’s Strike for recognition and payment for all caregiving work by investing in caring, not killing (military). 
• Lea Salem, Director of Finance at Northern California Community Loan Fund, spoke on investing conscientiously in socially responsible loans that support non-profits and social enterprises.
• Rebecca Paul, attorney at Jewish Family and Children’s Services, discussed fiduciary services (power of attorney for finances, conservatorship, trustee, administrator of estate, representative payee).

I contemplated my first foray into non-profit employment was probably many years ago at a bank's personal trust department administering probate, conservatorship and other fiduciary accounts for high net worth individuals. As a result of the bank's real estate loan losses, the bank was unprofitable and laid-off one-third of the department. A few months after I was laid-off (and already employed elsewhere), I was invited to return to my old position due to deaths that generated more probate work.  I decided then that it was too morbid to have a career profiting off people dying. 

Where to age in place

As we age, we grow more different from one another so there’s a diversity of opinion as to where we wish to age in place, so long as there is R-E-S-P-E-C-T for elders and their differences.  

Architect Susanne Stadler of At Home With Growing Older hosted Redefining Mobility to Ensure Social Inclusion at IDEO’s San Francisco office.  In her introduction to the salon’s theme, she noted that allowing people to “age in place” only works if they can continue to participate in public life.  She challenged us to brainstorm what qualities of public spaces invite all? 

IDEO’s own Gretchen Addi moderated the interdisciplinary and intergenerational panel of designers/planners and expert users to explore: What does it take for an older adult with mobility, vision, hearing or cognitive impairments to participate in life outside the home?

• Richard Weiner, transportation designer at Nelson Nygaard, shared strategies for improving senior mobility: work with transit agencies to educate ineligible applicants; work with DMVs when people lose licenses to educate about range of options; develop win-win cost sharing arrangements; identify subset of seniors who are not benefiting from ADA—lobby for customized services.
• Dan Gillette, research specialist/product designer at CITRIS, UC Berkeley, talked about co-design and transforming car-centric culture in favor of navigating a human path through community connections (neighborhood, condo) and transportation (shuttle bus stops, BART elevator signage, trip planning apps).
• Jarmin Yeh, a doctoral sociology student at UCSF, talked about redefining mobility to ensure social inclusion instead of mainstreaming.
• Dr. June Fisher and Barbara Beskind, UCSF professor and IDEO designer respectively who are both expert users, talked about their positive experiences riding CalTrain because of the courteous conductors.

Barbara Beskind’s suggestion, at last year’s Aging and Technology conference, for an app to translate language to facilitate communication with non-native English language caregivers is now reality with the launch of Ladon, a platform to crowdsource interpreters to promote language access.

Ladon was designed by Anh-Thu Ho, a UC Berkeley student who provided Vietnamese interpretation services through Volunteer Health Interpreters Organization (VHIO), for residents at my Oakland senior housing site, which was like Tower of Babel.  It was awesome to have VHIO provide simultaneous interpretations to facilitate language access for community building among residents who were monolingual in six languages other than English, while contributing to an intergenerational experience!  

Pedestrian safety

Essential to aging/living in place is avoiding premature death.  WalkScore ranked San Francisco as the 2nd most walkable city because most errands can be accomplished by foot; however, pedestrians can risk their lives sharing public space with vehicles.  Though San Francisco adopted Vision Zero in 2014, with the ambitious goal to eliminate all traffic deaths by 2024, pedestrian deaths have not declined.  

Lurilla Harris with ubiquitous eyeglasses and cap, dressed in yellow sweater, while seated in back center of table during SDA Leadership Training more than three years ago 

86-year-old Lurilla Harris would have been amused by earlier reports of her untimely death describing her as a woman in her 50s, but not by the circumstances of her death by a Paratransit driver who drove over her body after dropping her off late to this month’s SDA meeting.  I miss her tremendously as we often showed up at the same gatherings where our minds could be stimulated, and she would greet me, “We can’t go on meeting like this—people will gossip about us!”  I believe Lurilla’s death was preventable. 

Took an afternoon of personal leave from work to attend Safe Streets for Seniors and People with Disabilities Town Hall Meeting with a focus on pedestrian safety, at George W. Davis Senior Center in Bayview, where I have at least one homebound client residing in the new senior housing that opened this month.  In my work visiting homebound seniors in the predominantly residential southeastern part of the City (Bayview-Hunters Point, Excelsior, Ingleside, Portola and Visitacion Valley), I am required to drive a vehicle and assumed the lack of pedestrians was due to the lack of commercial corridors and public transit options (perhaps related to area’s reputation for crime and poverty?)… but perhaps residents are staying home to avoid vehicle traffic for safety reasons?  At the end of home visits, my clients often repeat, "God bless you! God bless you!" Yes, I drive safely...

SDA’s Pi Ra (who facilitated Transit Justice advocacy training two years ago in the pedestrian and commercial-rich Mission District) and Lighthouse for the Blind’s Beth Berenson hosted this meeting with Bayview seniors, who presented pedestrian safety concerns and recommendations.  Their concerns included:

• Vehicles encroaching into crosswalk on red traffic light
• Vehicles not yielding to pedestrians when making a left or right turn
• Not enough pedestrian crossing time
• Vehicle speed
• Vehicles running red/yellow light
• Poor maintenance of streets and sidewalks
• Street refuge islands too narrow

SF Municipal Transportation Agency Board member Cristina Rubke and Transportation Planner Anh Nguyen were present to hear recommendations of Bayview seniors:

• For enforcement: greater presence of SF Police Department’s Traffic Company; more periodic enforcement of all modes of travel; pedestrian crosswalk stings
• For engineering: corner bulb outs; widen refuge islands; lengthen crossing times by lengthening traffic cycle; installing advance pedestrian crossing; better maintenance of sidewalk & street facilities
• For education: traffic & pedestrian lights; better distribution of videos 

Recommendations favored co-existence rather than banning vehicles (like Golden Gate Park’s car-free Sundays—similar to Sunday Streets, or Twin Peaks Boulevard pilot program banning vehicles so pedestrians and cyclists can enjoy panoramic views).

Cultural humility

MOWSF Social Work Director Robin Meese-Cruz introduced Rochelle Towers, who presented LGBT Cultural Humility Training, and Openhouse Program Director Michelle Alcedo.  Rochelle talked about the unique conditions of LGBT seniors: more likely to be childless, single, living alone; higher rates of poverty, suicide ideation and PTSD due to a legacy of past discrimination.  The idea of cultural humility is to avoid making assumptions that may perpetuate stereotypes and discrimination, in favor of an ongoing process of engaging (by asking, actively listening to) people who experts of their own lives.  She shared the following best practices to create an inclusive, respectful and safe environment for LGBT seniors:

• explicit nondiscrimination policy in intake materials that includes sexual orientation & gender identity; LGBT-friendly language, images, resources, programming, staff & leadership
• allow individuals to identify themselves across the spectrum (e.g., transgender, in addition to binary male or female) & ask how they wish to be addressed in their chosen language
• maintain privacy & confidentiality

Cultural diversity

In honor of the 110th Anniversary of Japantown in San Francisco's Western Addition, Kokoro Assisted Living for Seniors hosted an Open House.

Kokoro Executive Director Kirk Miyake gave tour of studio that rents for $2,178-$5,959 per month, depending on level of care needed to assist with activities of daily living; monthly fee includes resident services (Japanese & Western meals, care staff, housekeeping, recreational activities, etc.). Studio resembled SRO unit with private bath, mini-refrigerator and microwave. 

Inside former synagogue’s Ohabai Shalome Temple is dining room with sushi bar and performance by koto player Tamie Koyooenga.  Kokoro offers a Japanese cultural setting to its 61 residents, which include five Chinese, one White and the remainder are Japanese.

Eat a rainbow of colors! Sushi prepared by Kokoro Chef Taka Nagamine.

Older Americans Month: Blaze a Trail

“Older Americans have unique knowledge and a breadth of insights that are tremendous assets to our country -- and our seniors are eager to impart the wisdom learned from their experiences….Aging affects us all, and I am dedicated to empowering more of today's seniors and future seniors.”

– Barack Obama, Presidential Proclamation of Older Americans Month (OAM) 2016 

This year’s OAM theme: “Blaze a Trail emphasizes the ways older adults are reinventing themselves through new work and new passions, engaging their communities, and blazing a trail of positive impact on the lives of people of all ages.”  The OAM website included tip sheets for Civic Engagement, Reinvention, Securing Your Finances, and Wellness.

Civic Engagement:  Getting Involved

Leaders from California Alliance of Retired Americans (CARA) and Community Living Campaign (CLC) volunteer their unique experiences to make a difference in the community by presenting a 2-hour Empowered Elder Workshop at this month’s Older Women’s League (OWL) meeting.

 

Hene Kelly, retired public school teacher and former CPR instructor whose nephew is an EMT, presented on Vial of Life: a kit to store medication information for access by emergency personnel.  

Sandra Mack, another retired teacher, presented 4 key lessons on Hospital Stay: 1) use personal support network, including patient advocate and someone who can care for your responsibilities like pets, 2) money – know insurance coverage, 3) arrange for visitors and/or bring pictures of family/friends – humanize yourself to receive better treatment from hospital staff, and 4) engage with discharge planner – exercise your right to a safe discharge, including appeal an early discharge by calling 1–877–588-1123 if necessary.  To get full benefits of Medicare after hospitalization, make sure to ask each day if you’re inpatient (formally admitted to hospital) versus outpatient (observation status).   

Gray Panthers advocate Michael Lyon presented on Advance Health Care Directives for durable power of attorney and health care.  He reminded us that these forms can be amended when our definition of an “acceptable quality of life” changes with medical expectations and situations. 

Hene is one of the Inspiring Women for Democratic County Central Committee!  

Legacy Film Festival on Aging Director Sheila Malkind with Pia.  Sheila’s 6^th annual Festival on September 16-18, 2016 is an opportunity to further civic engagement with each film screening followed by Q&A forum to discuss aging issues.

Reinvention:  Follow Your Passion, Use Your Skills

AARP “Real Possibilities” hosted a 3-hour LifeReimagined Checkup: a personal guidance system to help people navigate life transitions and pursue new opportunities in work, well-being and relationships. 

• Ice breaker question: If you had an opportunity to travel to a different time and place, when and where would it be?  My answer: Back to the time of Adam and Eve in the Garden of Eden J!
• Purposeful Life = Gifts (what you’re good at) + Passions (what you love) + Impacts (who you want to benefit) + Values (what motivates you) + Possibilities (what you want to be, feel & have)

The following 6 practices of Life Reimagined made me think appreciatively of my ERISA recruiter Jeff, who was always checking up on me to stay relevant (and not to be shy about changing jobs to gain advantages like expanding KSA and access to professional networks):

1. Reflect:  present situation is opportunityà take inventory of where you are, people you care about, your work & purpose
2. Connect:  don’t have to go it aloneà engage people to mentor, support & listen to you
3. Explore:  approach future with openness & curiosityà discover & bring new possibilities into your life
4. Choose:  commit to making a changeàweigh options & decide on your new direction
5. Repack:  accept necessary tradeoffsàdecide what you need to reach your goal, what you can do without
6. Act:  you can do ità take 1^st step & adapt as you go

As an island girl inspired to be a do-gooder from weekly Bible study and seeking opportunities to leave the rock, I thought becoming a traveling missionary would be my life’s purpose.  However, as a child of Chinese immigrants, I could choose from 5 acceptable career fields: medicine, engineering, finance, law and academia.  Been there, done that! Now I suppose it’s surprising that I chose an encore career in social services since I am more an introverted ideas (ITNJ personality) than extroverted touchy-feely, social butterfly type of person.  But organizations need employees who reflect the diversity of their clients, including those near the end-of-life (i.e., older adults) – always an opportunity for more introversion/introspection and appreciation. 

Throughout my life, my passion for reading, mostly nonfiction, has been constant and so engrossing that I sometimes forget about eating (another lifelong passion).  

As a bookworm, I had a blast indulging at Oakland Book Festival, a celebration of what makes us human – our ability for reflection, storytelling, sharing ideas! This year’s theme was Labor, and I was able to meet many talented and inspiring writers!

Mary Roach on her latest book, Grunt: The Curious Science of Humans at War, about how science is trying to make soldiers immune to panic, exhaustion and trauma.  If I am to make a living pursuing my passion for books, including exploring topics that pique my curiosity, I will need to be more disciplined to find time …

My passion for social justice led to me attend “Justice for the Young” panel: Elaine Brown talked about the Black Panthers starting their own Liberation School because they were against desegregation, which they perceived as inferior mis-education at the time because teachers had no relationship based on life experience shared with black students.  I continue to have mixed feelings about segregation based on race, gender, age, etc. to counter –isms, especially since I loved to sing-along to USA for Africa’s “We Are the World” during my formative years:

(Tina Turner) We are all a part of God's great big family …

(Michael Jackson) We are the world, we are the children

We are the ones who make a brighter day

So let’s start giving …

(Cyndi Lauper) Let us realize that a change can only come

(Kim Carnes) When we stand together as one …

“The Uncanniness of Altruism” panel gave me more food for thought about my own career choices, including my latest desire to advocate for older adults’ right to live independently in their homes for as long as safely possible.  San Francisco Magazine editor Gary Kamiya moderated this thought-provoking discussion based on Larissa MacFarquhar’s  Strangers Drowning: Impossible Idealism, Drastic Choices, and the Overpowering Urge to Help (2015).  I identified with social worker Julia Wise, one subject of extreme altruism profiled in this book.  Julia’s utilitarian dilemma:  is the greater good served by taking a higher-paying (corporate) job to make monetary contributions, or taking a lower-paying (non-profit) job to make direct labor contributions, for worthy causes?  While working in the corporate sector, I attempted to do both—maximizing tax-deductible contributions by making donations to non-governmental organizations (e.g., Foundation for Sustainable Development and Global Service Corps) to personally volunteer overseas using paid time-off from work.

“Undervalued, Invisible: Domestic & Emotional Labor” featured panel of Bay Area women:  Katie Quan, UC Berkeley labor specialist; Ruth Rosen, author of The World Split Open: How the Modern Women’s Movement Changed America (2006); Arlie Hochschild, author of The Second Shift: Working Families and the Revolution at Home (2012); and moderator Deidre English, former editor of Mother Jones magazine.  This discussion focused on childcare (last month, San Francisco passed Paid Parental Leave for Bonding with New Child Ordinance), rather than eldercare, which needs more attention like San Francisco Supervisor Eric Mar’s Support at Home to subsidize home care for seniors and persons with disabilities (PWD) who do not qualify for IHSS yet do not have enough income to pay for private home care.  Eric also introduced Dignity Fund, a proposal to amend the City Charter to authorize setting aside 2% of future property taxes to stabilize funding services for seniors and PWD.

At AgeSong’s University campus, passionate Julia Wolfson presented From the Inside Out: Changing the Culture of Care about the shift from the medical model (fix problem patient) to an empowerment model (learn what’s important to the person). She said using the power of love-based curiosity, we find out what makes one come alive from inside out, even from someone who does not use words to communicate.

Securing Your Finances: Plan Wisely, Watch Closely

At Chinatown Night Out, I drew more Blaze a Trail inspiration from 41 Ross Alley’s 3650 exhibit featuring Mr. Zhao, who immigrated 10 years ago from China at age 66 with his American Dream to “make a decent living” in San Francisco, which necessitated hard work including his steadfast determination to acquire English fluency. 

Instead of learning the phonetic English alphabet, Mr. Zhao denoted the pronunciations of English words with Chinese characters in his hometown dialect—transcribing over 2,000 words on cardboards plastered on the walls and ceilings of his Chinatown SRO.  He studied ESL at City College, earned his driver’s license, found work in a white-owned store, became a U.S. citizen within 5 years, collected recyclables, etc.  Then, 3650 days after his immigration, mission accomplished: Mr. Zhao earned enough to enable a “return home in silken robes” to visit his 90-year-old mother in China. 

                                   

Wellness:  Be Wise, Be Well

OAM tip sheet for Blaze a Trail to Wellness reminds us:  “Activity is important, but nutrition is equally vital.”  Krab cake in dill sauce with herbed rice and country veggies, courtesy of Meals on Wheels of San Francisco! 

Normalization

In No Pity: People with Disabilities Forging a New Civil Rights Movement (1993), Joseph P. Shapiro noted that deinstitutionalization and the community living movement in the 1960s was driven by the rise of the concept of normalization.  This sociological (as opposed to medical) approach to disability has application to all who wish to age in place by normalizing aging and dying:  ask the elderly what matters in the end. Nothing about us without us!

“The normalization principle means making available to all people with disabilities patterns of life and conditions of everyday living which are as close as possible to the regular circumstances and ways of life or society.”

– Bengt Nirje on Normalization, which laid the groundwork for social inclusion and self-determination for people with disabilities

“Normalization demands …an entire spectrum of community living arrangements to serve all ages and age appropriate behavior levels, to address progress, integration and independence appropriate to a person's age and competencies.” – William G. Bronston, MD, on Concepts and Theory of Normalization 

Normalization means giving people with disabilities (including older adults) the same opportunities in life that others have.  The person is not the one being forced to be normal, but the environment is changed to give this person a chance to experience what is considered "normal." 

Senior & Disability Action staff presented Disability & Ableism Training, including skit on how to communicate and interact effectively with people with disabilities.

Nourishing the whole person

Normally eating can be a pleasurable activity, but can be challenging to those with dental problems (missing teeth, adjusting to dentures) or medical conditions (dry mouth, fatigue).  In my work with seniors, I routinely assess for nutritional risk asking, “Do you have tooth or mouth problems that make it hard for you to eat or chew?” When a client responds in the affirmative, my follow-up question is, “Would you like to change to a mechanical soft diet?”  Initially clients resist saying that they “don’t want any pureed baby food.”  Then I explain a mechanical soft diet includes a spectrum of different textures and consistencies (soft, liquid, blended, chopped, ground or minced) so it’s easier to chew and swallow.  The following are sample foods prepared by Meals On Wheels of San Francisco—so you see, these meals are age-appropriate for senior clients! 

Mechanical soft pork loin in sesame with peas & curried lentils: looks similar to kitfo (Ethiopian minced meat) or moo-shu (Chinese ground pork) moistened with sauce/gravy! 

Salisbury steak in mushroom sauce with broccoli, cauliflower & carrots

Dementia = Being present (tense)

At SFSU Counseling Student Association’s 5^th Annual Counseling Symposium, Nader Shabahangi and Sally Gelardin of AgeSong presented on 17 Things I Would Want, If I Get Forgetful (adapted from Rachel Wonderlin’s 16 Things I Would Want, If I Get Dementia).  Nader’s introduction raised the issue of labeling that separates humanity; for example, “disabilities” suggests being outside of the mainstream, rather than different functional abilities giving rise to possibilities.  Another example is “dementia” meaning “out of one’s mind” (from Latin), and this could suggest emptying the mind as in Zen enlightenment.  

Instead of the scientific view of dementia with its emphasis on cure, Nader talked about adopting an attitudinal shift towards a humanistic view of forgetfulness with an emphasis on care.  He noted that forgetfulness has a purpose to “let the mind go” of memories causing pain or embarrassment, to slowly work one’s way through death.  “If we view elders as our teachers, then forgetfulness as our teachers” that push us to learn wisdom and qualities like being present. 

  

Contemporary Jewish Museum’s Access Program hosted The Power of Art and Music: In the Lives of Those Living with Alzheimer’s seminar exploring research on creativity and the brain, and how arts and cultural experiences can enrich the lives of people living with Alzheimer’s or dementia.  The panelists included:

• Zachary Miller, MD Assistant Professor of Neurology, UCSF Memory and Aging Center – Neuroscience of Visual Art: lefty doc noted greater number of left handers in mental asylums & artistic behavior among mentally ill
• Lola  Fraknoi, founder of Ruth’s Table and Art Time Programs for a Creative Life  - Prompting to Make Art kit to release creativity in persons with moderate dementia
• Andrea Korsunsky, Coordinator for Center for Dementia Care, Seniors at Home, a program of Jewish Family and Children’s Services (JFCS) - Communication Strategies: use nonverbal body language to listen & be present, avoid word “remember”, ask for help & support in community
• Rachel Main, Family Support Coordinator, Ray Dolby Brain Health Center, Alzheimer’s Association – Why is Music and Art Important in Daily Life for People with Dementia? Engage both sides of brain to reduce 4 A’s (agitation, anxiety, apathy, aggression) & replace antipsychotics, focus on strengths that remain. 

Lola's examples of Prompting to Make Art: 1st slide (top left) shows beginning sketch of open image as visual cue for persons with Alzheimer’s to “think outside the box” and continue the drawing. 

Other resources:

·         TimeSlips 

·         Alzheimer’s Poetry Project 

·         NCCA Creative Caregiving 

Care giving/taking

At Ed Roberts Campus, UC Davis Alzheimer’s Disease Center and Alzheimer’s Association presented the 8th Annual African-American Caregiving and Wellness Forum: Focusing on Brain Health and Disease Management, which included a discussion moderated by Miranda Wilson of Smooth Jazz 98.1 FM:

·         Rita Hargrave, MD, geriatric psychiatrist at Veterans Administration

·         Yaisa Andrews-Zilling, PhD, who also presented on Recent Developments in Alzheimer’s Research: prevent and reduce risk by paying attention to heart health, exercise (African-Americans at highest risk of ethnic groups due to higher rates of cardiovascular disease, obesity & diabetes), brain stimulation/education/novelty, nutrition, social and emotional well-being

·         LoWanda Moore, MSW, who also presented on Taking Care of the Caregiver, demonstrated relaxation techniques like deep breathing and guided imagery

Elena Portacolone, PhD, of UCSF Institute for Health & Aging, is recruiting older adults age 65+ who are living alone with either Alzheimer’s disease or mild cognitive impairment for a research project, supported by National Institute on Aging and Alzheimer’s Association (which offers Dementia Capable Services & Supports, a free program to assist people living alone with dementia in San Mateo).  

Alzheimer’s Association Community Outreach Specialist Debbie Williams quit her job (supported by husband Lenny of Tower of Power) to care for her mother who was diagnosed with Alzheimer’s.  Though anyone with a brain is at risk, she emphasized that African-Americans are typically diagnosed in later stages of disease when they are more cognitively and physically impaired, needing more medical care yet less opportunity for input in long-term care and financial plans.

Treating Sickness & Death = Palliative & Hospice Care

Nearly half of all people with Alzheimer’s and other dementias are in hospice care at the time of their death, yet fewer than half of surveyed nursing homes have some sort of palliative care program.  Palliative Care and Hospice Education and Training Act (PCHETA) would increase palliative care and hospice training for health care professionals, launch a national campaign to inform patients and families about the benefits of palliative care, and enhance research on improving the delivery of palliative care. 

JFCS Seniors At Home launched a new Palliative Care Lecture Series, "Let's Keep Talking About..."  Psychotherapist Sylvia Boorstein and JFCS Director of Palliative Care Program Redwing Keyssar began the community conversation with “Let's Keep Talking About Old Age, Sickness, and Death - Liberating the Hard Questions from the Shadows.”

• Old Age:  Sylvia embraces old age by disclosing that she is 80 years old
• Sickness & Death:  Sylvia said if one gets cancer, one who thinks why me? suffers a lot; but one who thinks why not me? does not suffer so much.  Accept that death happens so don’t struggle with what can’t change.  Redwing expressed her disappointment reading Dr. Paul Kalanithi’s memoir, When Breath Becomes Air (2016), because the doctor dying of cancer only mentioned palliative care at the end, no mention of spiritual care but only medical treatment.

Redwing shared palliative care physician Ira Byock’s The Four Things That Matter Most: A Book About Living (2004) -- “Please forgive me,” “I forgive you,” “Thank you,” and “I love you” – the role of forgiveness as an opportunity to let go. 

At Books Inc., Pamela Skjolsvik read excerpts from her memoir Death Becomes Us (2015) about overcoming social anxiety disorder and fear of mortality.  Her use of humor to normalize death is similar to mortician Caitlin Doughty, author of Smoke Gets in Your Eyes & Other Lessons from the Crematory (2014) and founder of Order of the Good Death.

Aging policies

At Home With Growing Older hosted Brooke Hollister, Assistant Professor of Sociology in the Institute for Health & Aging at the University of California, San Francisco, for a discussion on Communicating Aging Issues At The Policy Level.

Congress finally passed legislation to reauthorize Older Americans Act (OAA), which President Obama signed into law this month—nearly five years after it expired  -- a symbolic act as funding remains flat for OAA programs like Meals On Wheels.  For example, government funding provides only 40% of the operating budget for Meals On Wheels of San Francisco (MOWSF), which fundraises the remainder; this month's MOWSF Star Chefs & Vintners Gala raised $3.3 million or 25% of its annual budget.  In contrast, Medicare expenditures doubled between 2005 and 2015, suggesting that unmet social needs are "medicalized" and delivered in higher-cost settings.

Booksmith hosted panel discussion on Marijuana in the Haight: From the 1967 Grateful Dead Bust to Legalization in 2016 with these movers and shakers: 

• Andy Clark, Assistant District Attorney
• Dennis McNally, The Grateful Dead’s publicist and historian
• Michael Stepanian, who formed the Haight-Ashbury Legal Organization (HALO) to defend the Grateful Dead who were busted for marijuana in 1967
• Marsha Rosenbaum, who made available free copies of Safety First release by Drug Policy Alliance
• Steven Heilig, San Francisco Medical Society and member of Lt. Governor Gavin Newsom’s Blue Ribbon Commission on Marijuana
• David Talbot, founder of Salon and author of Season of the Witch, a cultural history of San Francisco
• David Smith founded Haight Ashbury Free Clinic (HAFC) to care for young drug users and Rock Medicine to provide medical services at Bill Graham concerts.

Is medical marijuana as effective as opiates in treating pain?  Timely topic, especially following 57-year-old artist Prince’s death of possible opioid overdose.  In contrast to the epidemic of deaths from opioid overdose, the death rate from marijuana overdose remains zero.  And legalization of marijuana could generate tax revenue to fund senior services!

The New York Times' article, “U.S. Suicide Rate Surges to a 30-Year High,” (April 22, 2016) reported that from 1999 to 2014, suicide rates in the United States rose among most age groups:

• Men and women from 45 to 64 had a sharp increase
• Though suicide rates for older adults fell over the period of the study, men over 75 still have the highest suicide rate of any age group — 38.8 per 100,000 in 2014, compared with just 4 per 100,000 for their female counterparts.

Does Death With Dignity normalize suicide?

Stefano Bini, MD, UCSF Professor of Clinical Orthopaedics, highlights “Age is not a problem” during his presentation on Total Hip and Knee Replacement as a Treatment for Arthritis and New Developments.

DAAS Benefits & Resources Hub Grand Opening

San Francisco Department of Aging & Adult Services (DAAS) opened its Benefits and Resources Hub as a one-stop shop for the public to access in-person intake services (Adult Protective Services, In-Home Support Services & Home Care, Nutrition, Case Management, Information & Referral to Community Services), benefits (CalFresh, Medi-Cal), and Veterans Services.

Entrance to 2 Gough Street

Signs in English, Chinese, Spanish

Check-in with Greeter (gatekeeper) who asks for name & purpose of visit

Service counter

Waiting area