Shades of gray

No to Ageism, Yes to Aging

This Chair Rocks: A Manifesto Against Ageism author Ashton Applewhite rocks, ever since I read her April 2015 post about starting a campaign for Letting Our Hair Go Gray, and coloring her naturally brown hair a shade of gray.  During this experiment, she concluded “gray hair + confidence is an empowering and liberating combo.  I hope to see more people rocking the look ...”  

"Love means never having to say you’re sorry" about gray hair … At age 75 (in 2014), actress and style icon Ali MacGraw finally embraced gray hair (to match her natural eyebrows!), after being surrounded by “grown-up women” in her hometown of Santa Fe—away from the superficiality of la-la land.  Glamour magazine reported celebrities of all ages who also rocked the granny hair vogue. Esquire featured “The Men Who Rock Silver Hair Right." According to San Francisco Chronicle, it’s never too young to go gray.  The New York Times noted, “For Millennial Men, Gray Hair is Welcome” in the tradition of artist Andy Warhol who dyed his hair gray in his early 20s.

Instead of being trendy, I prefer low-maintenance so I just let nature take its course with my graying head of hair (plus wrinkles).  Going gray is a natural process, starting at age 30 for men and age 35 for women, though years later for Asians and African-Americans.  However, I don’t know about going out in public with lady whiskers, sported by a few of my shut-in clients, and high-maintenance removal techniques ... I suppose it depends on whether lady whiskers draw unwanted attention or allow one to pass as a man with privileges? 

Ashton showed up with mostly brown hair for her presentation, This Chair Rocks: An Evening with Activist Author Ashton Applewhite, at Institute on Aging (IOA).  She stated her age 64, because ageism is reinforced by hiding one’s age.  However, I prefer to be person-first and age-less, like comedian Jerry Seinfeld’s remark about his former teenage girlfriend “is a person, not an age." 

Ashton was preaching to the choir of primarily older adults, mostly women, reminding us that all aging is successful until we’re dead; the sum of our experiences make us rich; losses are real, so we need friends of all ages and social connections, etc.  Her call to action was to start a consciousness-raising group, inviting us to check out her how-to booklet, “Who me, ageist?” 

Fortunately, aging anxiety drops with maturity as priorities change with age so older women focus more on function than appearance of their bodies.   

“I’ve spent an awful lot of time worrying about looking old, and I’m ready to give it a rest. … I want the world to recognize the beauty of time on a woman’s face, and if the world never will, I want, at least, to make peace with it in my own life. I want to be like one of those confident older women…wrinkles, gray hair, and all. …

Lately I’ve been thinking more about how to avoid the things I’m actually scared of about getting old: becoming set in my ways, stuck in my thinking or narrow in my influences. I want to keep my mind-set open, my life full of voices that are vibrant and diverse. That takes a lot of work too, but I’m confident it will have a greater return on investment than all the creams in the world. That was always the case, it just took me getting older to recognize it.” --Stella Bugbee, “Can Age-Shaming Be the Next Fat-Shaming?”, New York magazine(January 30, 2017)

According to Global GfK study (October 2016), the top 5 physical concerns around aging are:

• eyesight getting poorer
• not being as mentally alert /memory loss
• lacking energy
• having trouble taking care of themselves physically
• losing mobility / being unable to walk or drive

But there are key differences by country: Russia is the only country surveyed where “losing your teeth” is a top 5 concern, while China is the only country where “having digestive problems” is a top 5 concern.  South Korea included “gaining weight” (as did USA) and “getting wrinkles or sagging skin” (as did Japan) as top 5 concerns. According to a study published in The Lancet (February 21, 2017), women of South Korea are projected to have the highest life expectancy of 90.8 years.

Timeless fashion 

Kimono: Shades of IOA fashion show featured IOA staff modeling the work of 18 On Lok Lifeways participants who hand painted garments created as part of their care plans. 

Model shows kimono print of dragon in front, clock in back symbolizing late bloomer.  Expressive art therapist Tandrika Mayweather discussed value and benefits of the project: strengthening hand and eye coordination, gross and fine motor skills, use of imagery and symbolism (right brain) until language regained (left brain goes offline in trauma), and restoration as time slips away while in the zone of creative expression. 

Understanding Alzheimer’s disease

Alzheimer’s Foundation of America (AFA) celebrated its 15th year with AFA Educating America Tour: Concepts in Care Educational Conference, at Bentley Reserve. Loren Alving, MD, Director at UCSF Fresno Alzheimer & Memory Center, presented Unraveling Alzheimer’s Disease (AD): 6^th leading cause of death in U.S., and 1/3 cases of AD might be attributable to 7 potentially modifiable risk factors: diabetes, midlife hypertension, midlife obesity, physical inactivity, smoking, depression and low educational level (or life experiences). Yikes, this seems to describe many of my homebound clients!

AFA President Charles Fuschillo shared the stage with Dillon Campbell, son of musician Glen Campbell, who was commended for going public with diagnosis of AD to create more awareness and understanding towards a cure.  Dillon mentioned that his father treated AD with CBD from marijuana while living in Malibu, now “checked out” but physically strong in assisted living facility in Nashville. 

Dillon performed “Letter from a Son,” a song he wrote after learning his father had AD. 

Moira O’Neill, Director of Interpretation and Senior Researcher at FrameWorks Institute, discussed challenges in framing (how to communicate about) aging and how to advance understanding: 

• fatalistic (incurable) à ingenuity (serious problem, but resourceful in providing solution)
• paternalistic (objects of care, charity response) à justice (collective responsibility, systemic change)
• private trouble (individual choice, family responsibility) à support structures (everyone safe inside)

AFA conference also included The Hardest Crossword exercise, caregiver panel, free memory screenings, Quilt to Remember displays and resource tables.  Conference ended with The Beatles song, “In My Life,” which made me think about Life Story Work to enhance person-centered care for people with dementia. 

Lifelong advocacy

“Refreshments served” was more like a complete dinner at Rhoda Goldman Plaza, host site for this month’s At Home With Growing Older (AHWGO) forum, Advocate! 

Candiece Milford, Managing Director of Marketing at Rhoda Goldman Plaza, continues to host learning and networking events for residents and the public.  She mentioned that residents range from age 65 to 102, and many made Rhoda Goldman Plaza their home due to issues relating to stairs and taking out the trash.  AHWGO founder Susi Stadler announced her organization attaining nonprofit status. 

Speaker Barbara Kate Repa shared her 30 years of lifelong advocacy starting as a Nolo Press author of books on estate planning and end-of-life, member of Bay Area Funeral Society, and then volunteer with San Francisco Long-Term Care (LTC) Ombudsman (advocating for residents in LTC facilities; see this month’s CNN nursing home sex abuse investigative report) and IOA Friendship Line (10-minute phone calls).  She mentioned reverse ageism when older callers might question the credibility of younger volunteers, who are often students.  After all, book learning is no substitute for real world experiences to impart perspective, wisdom and perhaps peer support.  

Sheila Malkind mentioned her advocacy work with Legacy Film Festival on Aging (showcasing more honest representations of the aging experience) and Older Women’s League.  

AHWGO Board member Cathy Spensley’s advocacy work includes Aging and Disability Friendly SF and geriatric mental health at Felton Institute.  Cathy recommended signing up for Marie Jobling's monthly Community Living Campaign e-newsletter packed with aging and disability advocacy opportunities!

Seated behind Cathy is Odile Lavault, Jewish Home recreational therapist and advocate of Naomi Feil’s Validation Method.  

“Gray hair is a crown of beauty when it is found in the way of righteousness.”--Proverbs 16:31

Live simply

“Live simply, so others may simply live.” – Mahatma Gandhi

“For we have brought nothing into the world, and neither can we carry anything out.  So having sustenance and covering, we will be content with these things.“—1 Timothy 6:7-8

“Really having not enough is horrible: persistent hunger and cold make you unwell and stressed. Having just enough, plus a little more, is absolutely lovely. Having even more than that, just because it’s the cultural norm, starts to make you unwell and stressed all over again …”—Annie Raser-Rowland, co-author of The Art of Frugal Hedonism: A Guide to Spending Less while Enjoying Everything More (Finding Pleasure in the Free Things in Life) 

Seniors on fixed income live simply, out of necessity or practicality. My clients who live in Single-Room Occupancy (SRO) housing simply lack physical space to accumulate lots of material stuff! Some tell me they wish to maintain their SRO tenancy (though their limited mobility and lack of building elevator makes them homebound) because their community of neighbors is their social safety net. To live simply, it helps to be content with what one has, and to be resourceful by embracing permaculture: whole-systems approach to sustainable living based on ethics (earth care, people care and fair share) and principles (observe and interact to design solutions that suit our particular situation, integrate rather than segregate so relationships develop and support each other, creatively use and respond to change, etc.).  

Housing

Pictured above, left to right: Steven Wallace, Margot Kushel, Cathy Davis, Cristina Flores, Wendy Max (moderator and Director of UCSF Institute for Health & Aging)

UCSF Institute for Health & Aging and the Dorothy P. Rice Center for Health Economics hosted a stimulating discussion on Economic Security and Housing Among Older Adults:

• Keynote speaker Steven Wallace, Professor at UCLA Fielding School of Public Health, provided a wealth of data showing shortcomings of Federal Poverty Level (FPL) (failure to keep up with costs like housing and healthcare, The Hidden Poor: Over Three-Quarters of a Million Older Californians Overlooked by Official Poverty Line), and need for Elder Economic Security Standard (EESS) Index to adjust for local (county) costs of living and actual costs of basic necessities (food, housing, transportation, healthcare); Affordable Housing: A Key Lever to Community Health for Older Americans. Example: 2017 FPL of $1,005 per month is not enough to cover HUD fair market rent of $2,411 per month for 1-bedroom in San Francisco! He discussed innovations like Santa Monica’s rental assistance (compare San Francisco's rental subsidy program cuts), improving SSI/Social Security (avoid chained-CPI), and linking housing assistance to health care funding.  
• Cristina Flores, Assistant Professor at UCSF Department of Social and Behavioral Sciences, talked about how long-term care (LTC), when one can no longer remain at home, threatens economic security due to its cost outpacing inflation since 2013.
• Cathy Davis, Executive Director of Bayview Hunters Point Multipurpose Senior Services, talked about barriers to access affordable senior housing, based on her experience with George W. Davis Senior Residence, which opened June 2016: waiting list (pre-application process), lack of computer knowledge (SF Housing Authority required online applications), misunderstanding (offers v. information), lack of advocacy, language and cultural barriers, varying income guidelines, missing window of opportunity to apply (October 2015), complexity and bureaucracy. 

• Margot Kushel, UCSF Professor of Medicine, talked about homeless older adults age 50+ who often have geriatric conditions usually found in people who are 20 to 30 years older, and hard to have home care when they don't have a home.  Based on her research of homeless seniors in Oakland, 44% were never homeless until their 50s, and 80% were African-American. Their homelessness was not only due to mental illness or substance abuse; instead, they had low-wage, non-union employment, severe rent burden, job loss, poor access to healthcare, spouse/parent died, etc.–stressors that give rise to hypertension, and 1/3 had problems with executive function so they would be challenged following housing application procedures. Dr. Kushel advocated Housing First adapted for seniors; since 60% of homeless seniors are engaged with family members, address barriers to allow the latter to house former; and more Medicaid LTC spending on home and community-based services. (Dr. Kushel's work to date is featured in "Why Grandpa is Homeless,"published in January/February 2017 issue of Pacific Standard magazine.)

After retiring from federal service, including serving as Director of National Center for Health Statistics, Dorothy Rice joined the faculty at UCSF Institute for Health & Aging.  Professor Emerita Rice, now 94 years old, resides in a senior community.

In my work with homebound seniors, mostly low-income and marginalized in Tenderloin and South of Market Area, some clients have experienced abrupt termination or denial of support services that impact their ability to continue living safely in housing. Several (now former) clients became homeless from evictions due to nonpayment of rent after they were dropped by their representative payees (due to staff layoffs) and were not able to pay rent on their own.  For my frail clients who are dual eligible beneficiaries and could benefit from coordinated care, I referred to On Lok Lifeways Program of All-Inclusive Care for Elderly (PACE) only to learn that they do not qualify because they are not considered “able to live safely in the community” due to their dual diagnoses.

  

Home care

Many of my homebound clients receive home care assistance to remain safely in their homes through In-Home Supportive Services (IHSS), which is covered by Medicaid.  Jill Nielsen, Deputy Director of Programs at San Francisco Department of Aging and Adult Services (DAAS), provided the following statistics at IHSS in San Francisco Symposium:

• 22,000 IHSS consumers
• 19,000 IHSS providers
• 1,320 consumers in contract mode (Homebridge)

Symposium featured following panel of agency directors:

• Megan Elliott of DAAS IHSS oversees 200 employees who receive 400+ referrals per month; IHSS social workers, who have caseload of 350+ each, see consumers at initial application and annually thereafter to determine services and hours needed (detailed in “notices of action”); 90% of consumers use family and friends as independent provider (IP mode); use IHSS Public Authority registry to find provider; less than 5% use Homebridge homecare agency; few use combination IP + Homebridge; Independent Provider Assistance Center (IPAC) enrolls providers and processes their timesheets
• Kelly Dearman of SF IHSS Public Authority provides registry of 250 screened IPs, offers health and dental benefits
• Mark Burns of Homebridge (formerly called Consortium) has about 60 program staff to train/place 400+ home care providers for 1,350 consumers who must be referred by DAAS social worker. 

They discussed the “crisis” of provider retention. IHSS might curtail referrals to Homebridge, by starting waitlist.  Each month, Homebridge recruits 100 providers, "lucky” if 60 show up for training, 20-25 complete 2.5 weeks of paid training, 20 providers from prior trainings are terminated (more than 50% fired for no-show or abandonment), so there is usually net gain of 2-5 providers. Homebridge's home care workers are paid $13/hour minimum wage (v. private agencies pay $19/hour), so Burns advocates a career ladder to attract and retain more workers.  (Burns’ talk about job abandonment reminded me of “A Separation,” an Iranian film portraying the demands of caring work: a caregiver who places her own health at risk and temporarily abandons her job caring for a man with Alzheimer’s to visit a hospital.)

Home design

Rhoda Goldman Plaza hosted this month’s Case Management Society of America (CMSA) dinner meeting. 

Architect Susanne Stadler and Social Worker Donna Schempp presented Aging at Home 360: An Interdisciplinary Approach to Aging in One’s Home.  They showed a 5-minute video, “A Day in the Life,” featuring 4 older adults talking about the role of their home (affordable senior housing, co-op, private home, and Section 8 housing). Susi said who we are depends on our environment, which should support and adapt to our needs and abilities. We should ask: Can my home grow with me? Can I continue to grow in my home?

We need a home base to stay connected and engaged with community, yet the majority of homes do not support all ages and abilities.  As a result, one can become a prisoner at home.  Enter Stadler & Associates offering the power of design with social services to re-imagine aging at home beyond the basics of safety: food, fitness and social connections keep one going and engaged.  

Their collaborative approach has 4 elements:

• Architectural design: spaces are functional & beautiful
• Tools/technology: interactions are healthy, intuitive & delightful
• Health/human connection: promote optimal health, function & support
• Mental health/emotional perspectives: develop understanding, coping strategies & support

 Some of their findings:

• Most significant barrier to change is one’s emotional attachment to the way one has lived for a long time
• A participatory process through conversations is key in overcoming emotional barriers (“telling one’s story”)
• One of the biggest barriers to simplifying life is getting rid of books and personal papers
• It is hard to make changes on your own – one needs partnership of family/friends/neighbors

Their Aging at Home 360 assessment costs $2,000, which they are working to make more accessible by creating a DIY workbook for a workshop. 

Audience included movers and shakers of aging in place advocacy: SFPL health librarian Janet Tom, Aging Commission President Edna James, Community Technology Network Kami Griffiths (who recently launched Tech Allies to bring tech training to homebound seniors), Meals on Wheels social workers Amy and Lois, DAAS Nutritionist Linda Lau, and Sutter Health social worker Vladimir.

Caring for someone with dementia

UCSF Memory and Aging Center presented Caregiving & Dementia workshop at Armstrong Place Senior Housing.  Serggio Lanata, MD, presented on “Dementia 101: Learn the Basics and Understand the Disease.”  After describing the clinical syndromes (typical, posterior, logopenic, frontal) associated with Alzheimer’s disease and urging cognitive assessment, he advised preventive measures like keeping physically and mentally active, adding “the worst thing to do is to stay home and watch TV.”
Yikes, most of my homebound clients are doing this “worst thing”—except during my home visits when I ask them to at least turn down TV volume (as well as to refrain from smoking and drinking alcohol)! And many affordable senior housing and centers have activity calendars that promote a culture of TV watching, along with greed (bingo, casino trips). 

Sarah Dulaney, RN, Nurse Coordinator for Care Ecosystem study, presented tips on “How to be a Caregiver” of someone with dementia: 

• Structure and daily routine to help person preserve the ability to do things—providing more time, support and supervision as person loses ability to organize, plan and initiate activities
• Simplify the environment by removing clutter, organizing objects by task, using visual cues (label objects, color contrast)
• Though Reisberg’s theory of retrogenesis suggests that the cognitive level of a person with Alzheimer’s disease develops in reverse order of how the brain develops from birth, don’t treat the adult with dementia as a child 
• Keep instructions simple and respectful (offer simple choices, break task down to simpler steps, be patient and give time to be successful, etc.)
• Use DICE (Describe context, Investigate, Create plan, Evaluate)  approach to respond to challenging behaviors
• Go with the flow or try to enter the reality of the person with dementia
• Self-care!

Listening to your favorite music is better than watching TV! Music therapist Ruth MacGregor re-enacted the response of her elderly client, with dementia, listening to The Platters’ song, “Remember When”: changing flat affect to engagement, tapping feet, lifting hand to shake rattle, opening up position, etc.  She explained selecting favorite music from era of a client’s teen years to 30s seems to have the most impact. 

End of Life 

UC Berkeley Extension hosted End of Life Option Act:  Clinical and Legal Implications with the legal overview presented by Sara Hooper of UCSF/UC Hastings Consortium on Law, Science & Health Policy, and the clinical perspective by Lael Duncan of Coalition for Compassionate Care of California. Under the Act, aid-in-dying is not “suicide” but underlying disease is listed as cause of death.  Presenters said it’s hard to predict how many California residents will avail themselves of the Act due to our demographics and culture that are very different from other aid-in-dying states (that are mostly white).

This month KALW 91.7FM Host JoAnn Mar launched her 4-part The End of Life Radio Project covering Advance Care Planning, Palliative Care, Advance Directives, and Physician-Assisted Dying.  Five years ago (before I entered the gerontology field), I executed an Advance Directive choosing no life support treatment (preferring to keep things simple, to live/die naturally). Since then, I’ve learned from my senior clients, many who return home after hospital discharge and adapt to their changed quality of life because they’re tethered to an oxygen tank, exhausted from dialysis 3x a week, recovering from major surgery, etc.  Clients say they are grateful for what they have, another chance to savor the gift of life … so you just never know until life happens to you, and I may be reconsidering a few life support options. 

Keep it simple thoughts

53-year-old pop artist Cary Leibowitz got his own solo exhibit at Contemporary Jewish Museum.  His works also will be on view at Muni bus shelters—similar to last year’s poster art from Susan O’Malley’s Advice from My 80-Year-Old Self. 

“if U try reaLLy hard and stiLL faiL U deseRve aLL tHE sympathy U can get”  

“U CAN’T B Dead aLL the TimE”

“it’s not humility or humbleness it’s regret”

“HEY! I’M NOT DEPRESSED ANYMORE"

"IT’S A BEAUTIFUL DAY AND YOU’RE HERE HOORAY!"
These umbrellas cheered me up during this rainy January.

Freedom

Since George Michael's death at age 53 this past week (truly his “Last Christmas”), I’ve been listening to this bootleg cassette tape of his addictive pop music when he was part of the duo Wham!  I remembered Wham! made history as the first Western pop group to perform in China in 1985, which was captured in their “Freedom” video, as well as their “Foreign Skies” documentary.  Those images made me nostalgic for pre-1989 China, where I did my study abroad at Peking and Fudan universities: the lack of bourgeois vanity in make-up free faces and utilitarian Mao suits; moving qi via martial arts and bicycling; all ages occupying public places, etc.  Interestingly, I was the only Chinese participant in a mostly Jewish group (also Maoist/Marxist sympathizers) led by intellectual property expert Peter Jaszi of The American University, when I bought this copyright infringement tape (Made in China)! Growing up during the harshness of Reaganomics and the rise of homelessness, China’s socialist safety net was appealing ... if only it could exist with political freedom! 

Make It Big (just like 1980s Wham! George Michael J) hair and skirt (useful for squat toilets) … at the end of my China study abroad, I visited my mum's elderly aunt and uncle in Hong Kong. 

Since the outcome of last month’s election, many clients have reported anxiety, depression and stress (—but no memory loss!) over the future of disability rights and safety net programs (Social Security, Medicare, Medicaid, etc.) under Republican control of the Presidency and both houses of Congress.  I cheerfully remind clients of our San Francisco bubble: Proposition I aka Dignity Fund passed, which means increased funding for home and community based services for seniors and people with disabilities!

I thought about the wisdom of 67-year-old Carolyn Davidson, who took a part-time job at a senior center following her retirement 5 years ago after decades as a social worker supporting older adults.  When her skin cancer diagnosis and treatment last year prevented her from working, her financial resources were strained: 

“Retirement has left her on a fixed monthly income of $1,088 from Social Security, which suits her just fine. She also receives $194 in food stamps and gets help from a local food pantry operated by Catholic Charities Brooklyn and Queens, one of the eight organizations supported by The New York Times Neediest Cases Fund…

Because Ms. Davidson’s income disqualified her from receiving traditional Medicaid, she had to enroll in a reduced Medicaid plan for higher earners and has had to use her own money to pay off portions of medical bills. After paying her $663 monthly rent and more in utilities, she has only $389 remaining each month to pay for everything else and any unexpected costs.

In April, she received a hospital bill for $239. She could not afford it. The debt halted her Medicaid benefits.”

--A ‘Do It’ Kind of Woman Waits for the Strength to Get Back to Being Herself, The New York Times (December 20, 2016) 

Fortunately, as an experienced geriatric social worker, Ms. Davidson was able to secure relief from a charitable organization, allowing her Medicaid plan to resume.  She also avoided bankruptcy, though she experienced the top 3 reasons why people go bankrupt: unexpected medical expenses, reduction of income and job loss.  As Ms. Davidson told The New York Times, “There are so many things that seniors don’t know they are eligible for, it’s ridiculous.” 

As late Bob Marley, paraphrasing Matthew 16:26, sang in Zion’s Train: “Don't gain the world and lose your soul, Wisdom is better than silver and gold” (mural from Haight Central Market)

Retirement in old age is associated with freedom to live at home and to do what one wants, especially if one has deferred gratification from years in the workplace.   But at any age, lack of income limits this freedom of choice … or one needs to be very resourceful to access opportunities.

Freedom to age in place

In mostly capitalist U.S.A., income and health (or ability to carry out activities of daily living) often determine where and how one can age in place.  

With my work focused on home visits to homebound seniors, in a non-profit that limits training during work hours since focus is on production quantity, my world gets smaller like my clients... so I continually make efforts to attend training/networking events outside of work hours to learn tips and resources available to my clients and future self (as aspiring older adult).  One advantage of these meetings held in evenings/weekends is the availability of food and refreshments! 

SFSU Gerontology Class of 2014 had mini-reunion on-campus (1/3 of class pictured above with popular Professor Brian De Vries) at this month’s Gerontology Celebration honoring classmate Raenika Butler, who was inspired by the work of late African-American gerontologist George W. Davis, and works as Executive Assistant to his partner, Cathy Davis, Executive Director at Bayview-Hunters Point Multipurpose Senior Services (BHPMSS).  In June 2016, they helped realize Dr. Davis’ vision of an “Aging Campus” with the grand opening of Dr. George W. Davis Senior Center and Residence, including 121 units of low-income senior housing.  Over 4,000 applications were submitted; seniors age 62+, with income of $35,700 or less per year, pay rent at 30% of their income.  Mary Schleeter and Diane Houlton, classmates who founded Aging Plan-It, commuted from Sacramento to join us!

At Rhoda Goldman Plaza, assisted living for high-end clients (studios start at $6,027 per month), SFSU alum and elder care consultant Kira Reginato talked about her new book, Tips for Helping Your Aging Parents (without losing your mind), such as preparing a grab-and-go bag for hospital visits, assessing home for accessibility and safety, deciding when move from home is necessary (isolation, safety), kinds of senior housing, etc. Kira hosted a weekly radio talk show, Call Kira About Aging! 

Freedom to eat

The growing diet divide between rich and poor has been attributed to food cost, time cost, and heavy marketing of junk/fast food to low-income people.  Convenience food manufacturers have come between eaters and the kitchen, so TV dinners and microwaveable meals replace home cooking.  In “The Symbiotic Relationship Between Oral Health, Nutrition, and Aging,” published in ASA’s Generations Fall 2016 issue, Ronni Chernoff wrote about the role of on-demand meal services in promoting food security, from Meals on Wheels to food delivery apps. 

At Home With Growing Older’s forum on Food on the Table–Aging in Place featured Chief Government Affairs Officer Anne Quaintance of high touch, non-profit (one of the highest ranked charities in the Bay Area, according to Charity Navigator) Meals on Wheels San Francisco (MOWSF), and Marketing Manager Clare O’Brien of high tech, for-profit UberEATS.  

The presentations and ensuing discussions were a real commentary on our growing digital divide (UberEATS users who have smart phones to use app v. some MOWSF clients who don’t even have phones) and income inequality (UberEATS users can afford minimum $4.99 delivery charge v. some MOWSF clients can’t afford suggested contribution of $5 daily for 2 subsidized home-delivered meals).  
While Uber has partnered with healthcare providers to enable Americans (or 70% of Americans age 65+) without smartphones to access ride hailing services, this is not yet an option at UberEATS.  Audience also raised concerns about Uber’s contribution to traffic congestion (no less its controversial driverless cars running red lights) in San Francisco. Last year, Uber partnered with AARP's Life Reimagined to recruit older drivers with safer driving records, yet only 23% of Uber drivers are age 50+.

Anne emphasized that MOW delivers more than a meal (“nourishing the whole person”) – relationships that support a client’s ability to live safely at home.  MOWSF actually knows their 3,600+ clients (who are subject to social work and nutrition assessments): 92% are age 60+ and 75% live below poverty. (For more about food justice, check out blog post about my participation in Oxfam’s Hunger Banquet moderated by Anne.)  In contrast, UberEATS is transaction-based, eat anything you can have restaurant made-to-order, so it doesn’t collect data on users (nice for folks who value their privacy), but relies on third-party research firm to estimate 6% of UberEATS users are age 65+.  

Anne with MOWSF Social Work Supervisor Lara Medvedeva and Department of Aging & Adult Services (DAAS) Nutritionist Linda Lau.  MOWSF provides 85% of the home-delivered meals funded by DAAS!

Freedom to dodge Xmas

During Christmastime, articles galore are published about lonely seniors during this holiday season.  This year, National Association of Area Agencies on Aging (n4a) and AARP partnered on a campaign, "Home for the Holidays," to raise awareness about loneliness among the elderly during the holiday season, combating stigma while providing tips and resources to stay connected and engaged.  Age UK has a similar campaign, “No one should have no one at Christmas,” providing befriending services with volunteers who visit or make calls to seniors feeling lonely.

Given the wonderful diversity of San Francisco’s senior population, some of my homebound clients don’t seem affected by more loneliness during this particular holiday season, especially those who don’t buy into this commercial pagan holiday, but find it particularly alienating like Puritans who banned Xmas in the New World.  And I have other clients with profound forgetfulness such that they always seem oblivious to time and thus have no expectation/pressure of imposed merriment, gluttony, gift exchanges, etc. 

In past years, I would escape the commercial holiday season by flying to a developing country too poor for mass consumerism.  Then starting last year, I volunteered at Kung Pao Kosher Comedy, 3 nights of Jewish stand-up comedy in an American-Chinese restaurant with proceeds benefiting non-profit organizations, such as Legal Assistance to the Elderly (last year) and JFCS Seniors at Home (this year). 

Comedian Lisa Geduldig produced and hosted the 24^th Annual Kung Pao Kosher Comedy.

Lisa and Volunteer Macher Shani Heckman on stage for raffle drawing before full house of all ages and mostly Jewish at Chinese restaurant... almost felt like my China study abroad experience J! All 3 nights, both 7-course banquet dinner & dim sum cocktail shows, completely sold out!  This year’s comedians included aging and grandma jokes by headliner Elayne Boosler, Eddie Sarfaty (writer of video short, Second Guessing Grandma) and Alex Edelman.

Sunie Levin, author of Make New Friends...Live Longer: A Guide for Seniors (2010), said Seniors need chutzpah: "Yes, I can. Why not? What's to lose by trying?" 

25^th Annual Kung Pao Kosher Comedy scheduled Dec. 23-25, 2017!

To my homebound clients unable to attend Kung Pao Kosher Comedy, I recommend ordering take-out from Chinese restaurants that offer free delivery—cut out the middle guy (UberEATS) and tip the restaurant driver, instead! Then, sing-along to Darlene Love’s “Christmastime for the Jews” (named one of the greatest rock & roll Christmas songs by Rolling Stone).  Other suggestions: Wham! playlist and Woody Allen DVDs from SFPL Books by Mail.