Get together

Love is but a song we sing
And fear's the way we die
You can make the mountains ring
Or make the angels cry …
C'mon people now
Smile on your brother
Ev'rybody get together
Try to love one another right now
Some will come and some will go
And we shall surely pass
When the one that left us here
Returns for us at last
We are but a moment's sunlight
Fading in the grass …

--“Get together”(1964) by Chet Powers

The inaugural Getting There Together (GTT): A Celebration of All Ages and Abilities event took place during Sunday Streets Tenderloin in the Civic Center.  Presented by CASE (Coalition of Agencies Serving the Elderly) in partnership with Livable City/Sunday Streets, SF Department of Aging and Adult Services (DAAS), Age and Disability Friendly SF, and Dignity Fund Coalition, there was something for everyone under the sun!

Cathy Davis, Executive Director of Bayview Senior Services, stood ready with staff to serve barbecue.

Seniors and people with disabilities took the main stage outside the steps of SF Main Library to share their talents in five hours of programming, with line-up including Wake-up Call by Sounds from the Ground Drumming Group.

Marie Jobling, Executive Director of Community Living Campaign (CLC), came out of her Dignity Dog costume to join David Knego, Executive Director of Curry Senior Center and Board President of CLC, at SF Dignity Fund Coalition table with invitations to Be Part of the Plan: The California Master Plan for Aging.  Interactive Resource Fair was one-stop shop organized to showcase housing, transportation and street safety, financial planning, health, fitness, and caregiver resources so all San Franciscans can thrive.

At SFSU’s Sixty Plus event, 67-year-old Mark Leno, former SF Supervisor (1998-2002), State Assemblyman (2002-2008) and Senator (2008-2016), and SFSU Gerontology Program's 2017 Long-Term Care Advocate awardee, spoke about The Joy, Opportunities and Frustrations of the Legislative Process.  He said being a legislator appealed to him because he is “a salesperson of ideas” and a good fundraiser.  After serving as SF Supervisor, he found the “severity of partisanship” the most surprising as a legislator in Sacramento where he was challenged to find common ground working with Republicans for the first time.  During Q&A, he made clear that he had no plans to run for Mayor again. 

Toni Newman of St. James Infirmary and Hediana Utarti of Asian Women’s Shelter presented on rights of sex workers and survivors of domestic violence and human trafficking of all races and genders, at this month’s National Association of Social Workers-SF Unit meeting.  Hediana talked about human trafficking and labor exploitation of Filipino immigrants in their 60s forced to provide 24/7 caregiving to older adults in their 80s in San Mateo County care homes. 

The Care Agenda: Expanding Long-Term Supports and Services (LTSS) for All town hall meeting featured a panel discussion + working lunch session at SF Main Library.  By 2030, more than 9 million Californians will be over the age of 65.  This unprecedented growth in the older adult population is contributing to a rising demand for LTSS, and paying for these services is bankrupting middle-class older adults and their families throughout the state.  (See Eduardo Porter's "Why aren't more women working? They're caring for parents," in The New York Times, Aug. 29, 2019.)  Time to get together for a solution!

Jessica Lehman, Executive Director of Senior and Disability Action (SDA), welcomed the audience, clarified the definition of “long-term supports and services” in reference to accessing long-term care (LTC) needed to live at home, and then introduced presenters who shared their challenges when seeking (spending down retirement assets to pay for care, ultimately becoming very poor to access care through Medicaid) and providing LTC (poor working conditions and low wages for workers).

Next Jessica asked the audience:

·       Who here wants to be completely dependent on other people? (no one)

·       Who here believes that any of us can be completely independent? (no one)

·       How many of us believe in the concept that we all depend on each another, and we should be proud of that, and we all can and should be interdependent?

Following this last question, Jessica noted, “you raised your hands before I finished (asking the question)! It’s an interdependent system that we will create.”  Woo-hoo!

Kathy Kelly, Executive Director of Family Caregiver Alliance, described how the current system forces people to spend down assets for Medi-Cal that pays for LTSS, no stable access to LTSS but reliance on 80% unpaid family caregivers, and those who work part-time do not accrue Social Security benefits needed to retire but go into poverty and debt.

The panel of politicians (all expected to hit age 60+ by 2030!) included State Senator Scott Wiener (supports social insurance model for LTSS), and Assemblymembers Phil Ting (supports universal healthcare system) and David Chiu (acknowledged “Silver Tsunami” and “look forward to figuring out, if not my elderly mother would have my head”).

Hearty food kept momentum for advocacy and community building!

During working lunch, we were asked to “talk to someone you don’t know to build a movement.”  I was introduced to Art, who wore Troublemakers Union T-shirt, and we shared our connection to the movement (both family caregivers).  With another person I didn’t know, we discussed what made us feel hopeful (Ting and Wiener “got it” with their proposed solutions for universal healthcare and new social insurance program covering LTC) and one way we would get involved.

California Aging & Disability Alliance (CADA) facilitated afternoon discussion of ways to take action to expand LTSS for all in a program that is universal (regardless of income), affordable and accessible, sustainable (revenue mechanism that is stable and solvent), offers flexible benefits (range of LTSS such as durable medical equipment, home care, home modifications, etc.), and is supportive of the direct care workforce (including fair working conditions).  We completed surveys indicating our interests:

·       Sign name to petition asking Governor Newsom for support

·       Contact State Assemblymember or Senator in support

·       Share story of LTSS with media or policymakers

·       Join a visit to legislator in 2020

·       Tell family and friends

The Dignity Fund Coalition and SF Long-Term Care Coordinating Council (LTCCC) hosted Be Part of the Plan: The California Master Plan for Aging and What it Means for You, at Hyatt Embarcadero on the same day as Global Climate Change Strike.  This public policy event opened with Tabling Resource Fair and then panel discussion.

Lolita Kintanar of Felton Institute promotes civil engagement through Senior Corps programs, Foster Grandparents (intergenerational) and Senior Companions (mutual aid).

Jessica Lehman, SDA Director, and Maria Guillen, CLC Connector (retired DAAS Program Analyst).

CLC Executive Director Marie Jobling, co-authored with SF DAAS Executive Director Shireen McSpadden, a thoughtful op-ed piece in SF Examiner, “San Francisco has much to say about the state’s master plan on aging,” recommending 1) improve integration across systems (currently spread across 20 agencies and administrative units) to make access easier, 2) whole-person approach that considers social determinants of health, 3) incorporate flexibility to accommodate diversity and unique needs of local communities, and 4) factor in continued growth of aging and disability populations so we have enough resources to go around as we uphold values of inclusion and justice so all are empowered to participate and contribute to our society. 

African-American Aging Partnership Chair Edna James and Meals on Wheels social worker Lois Heaton-Camacho get together for mini-SFSU gerontology alumnae reunion.  California Collaborative for Long-Term Services & Supports’ Creating a California Master Plan for Aging was stuffed in yellow tote bags from MyCareMyChoice (Making Medicare + Medi-Cal Work for You) on seats.

Fiona Hinze, Systems Change Coordinator/Community Organizer at Independent Living Resource Center SF, and Anne Quaintance, Chief Government Affairs Officer at Meals on Wheels SF, welcomed attendees and provided background on host organizations, The Dignity Fund Coalition and SF LTCCC.

Janet Spears, CEO of the Metta Fund and SF Aging & Adult Services Commissioner, provided opening remarks about demographics (1 in 3 San Franciscans will be age 60+ by 2030, more likely to live alone and susceptible to social isolation, facing higher housing costs), systems fragmented and under-resourced, why we need Master Plan, “aging and ageism is a social justice and human rights issue.” Next she read a statement shown on screen by California Governor Gavin Newsom: his hope “to build environments for health(y) aging.”

Via video, SF Mayor London Breed expressed her hope for SF to continue leading the way for California, in housing (funding more senior housing), transportation (Muni easier to access), health and wellness, and jobs (first-ever job fair for older adults and people with disabilities last month).

Bruce Chernof, MD, President & CEO of The SCAN Foundation (which helped lead #StandWithSeniors campaign for Master Plan on Aging last year), moderated discussion with panelists and questions from audience (including from livestream):

·       Norman Yee, President, SF Board of Supervisors: disclosed his age 70, plan for 300 units of senior housing on Laguna Honda campus, pilot $5 million SOS (Senior Operating Subsidy) making housing affordable to seniors at 15% Area Median Income

·       Scott Wiener, California State Senator: repeated proposal for social insurance model for LTSS at federal, if not state level

·       Jeannee Parker Martin, President & CEO, LeadingAge California (also on Master Plan on Aging Stakeholder Advisory Committee): aging is personal, depending where you live to get services, focus on person-centered and addressing disparities

·       Shireen McSpadden, Executive Director, SF DAAS: advocated for local flexibility (e.g., SF unique with its Dignity Fund), integrate Aging & Disability (vote yes on Prop B!), ton of money to execute, Reframe Aging (messaging campaign to launch October 14)

·       Sandra Lee Fewer, SF Board of Supervisors: mentioned she would like “sh-tload of money” for Master Plan, then started choking (censoring herself?) while moderator commented about her language for “mature audiences only”

·       David Chiu, California State Assemblymember: repeated “Silver Tsunami” speech from The Care Agenda 

As I exited the Ballroom, a reporter from Berkeley asked to interview me and I referred him to Anne Hinton, former DAAS Executive Director (2005-2015).

1% (9,784) of San Franciscans are homeless, and most are concentrated in the Tenderloin neighborhood, where sidewalk encampments are common.

SFSU Gerontology Program hosted its 2^nd SF State Silver Lining Lecture & SF DAAS Community Training, Addressing Aging and Homelessness in San Francisco.  Mayor London Breed was featured speaker and recipient of 2019 Distinguished LTC Advocate Award.  She was raised by her grandmother in public housing, and later faced challenges getting support when her grandmother developed Alzheimer's Disease.  Since becoming Mayor over a year ago, Breed has focused on helping the City’s homeless population: opening up over 400 new shelter beds, co-authoring Proposition A for $600 million affordable housing bond, introducing legislation to implement housing conservatorship (SB 1045 authored by Scott Wiener, last year’s LTC Advocate awardee), expanding mental health stabilization beds (thus SF Department of Public Health decided to evict residents at SF General Hospital’s Adult Rehabilitation Facility to convert long-term beds into temporary shelter beds), continuing support of Healthy Streets Operations Center (though at times City's response to homeless encampments and "behaviors that impact quality of life" has resulted in constant shuffling of people living on the streets and sweeping their life-saving medications, walkers and other belongings), etc. 

Group photo: SFSU Gerontology Advisory Council President Tom Berry, SFSU College of Health & Social Sciences Dean Alvin Alvarez, SF Mayor London Breed, SFSU President Lynn Mahoney, and SFSU Gerontology Professor Darlene Yee-Melichar.

Mayor Breed stood between Felton Senior Division Director Cathy Spensley and LTC Ombudsman Benson Nadell.

Professor Yee-Melichar introduced training agenda.

UCSF's Margot Kushel, MD presented Aging among Homeless Populations: Causes, Consequences, Solutions (mostly repeated presentation from UCSF Grand Rounds in July).  Nearly half of SF’s homeless population is age 50+, and living on the streets takes a toll on health, so a huge percentage are at high risk of needing nursing home care.  Dr. Kushel acknowledged that while mental health and substance use disorders are common, underlying causes of homelessness are structural.  She proposed solutions to match the problem: deeply affordable housing and prevention (eviction protection, Adult Protective Services’ Home Safe Program). 

Edna James, former Aging Commission President and retired nurse, in deep discussion with Dr. Kushel.

Presenter for Lived Experience of Aging and Homelessness was no-show. Curry Collaboration panel discussion with Curry Senior Center (CSC) team: Executive Director David Knego (also SFSU MSW alum), Geriatrician Alicia Oberschelp, MD, and Clinical Services Director Ann Tuszynski.  

·       David:  Founded in 1972, CSC was originally a primary care clinic that later added social programs to serve older adults in their two buildings in Tenderloin.  As a Federally Qualified Health Center (FQHC) since 1994, CSC receives enhanced reimbursement for offering integrated wraparound services. 

·       Dr. O:  Medical staff consists of 3 doctors, 1 nurse practitioner, 5 nurses. Older patients present more medically complex conditions, like dementia, psychosis, paranoia, intoxication, alcohol withdrawal, abscess and infections from congregate settings, ulcers, edema (often no place to elevate leg), environmental challenges (no access to bathroom/hydration/food/place to rest/recline, stolen/lost medications/prosthetics/DME/CPAP machines).

·       Ann:  Case management staff consists of 4 LCSW, 3 SW with ASW, 1 licensed psychologist. Homeless seniors have frequent hospital stays, and unique challenges with medical and behavioral health needs served by clinical team using integrated model.  Because homeless are used to being turned down and placed on wait lists, relationship building and problem-solving are key; they work with homeless from 6 months to a year.  She emphasized the collaborative process with high-risk seniors because workers burn out and “get angry” so case managers talk through problems and get support. Homeless seniors present history of trauma, substance use and mental health disorders, cognitive distortions and emotional dysregulation impeding follow-through, difficulty with delaying gratification so they spend support checks within first two weeks.  Case managers will do intake assessment, schedule appointments structured for 1 hour per week with homeless seniors to talk, get organized and take control of lives. Case managers can get frustrated with challenges presented by homeless who lose documents needed to access services, no mailing address, lack motor/sensory skills to use cell phone, afraid to leave Tenderloin, fail to use services; street survival skills mean being on guard and not translate to living in SRO/apartment community; homeless have their own community, with parallel interactions that do not support daily living.  Ann ended her presentation with Helen Keller quote: “Alone we can do so little, together we can do so much.”  (And I thought, can we get together and identify strengths instead of pathologizing people?)

Final day of 9th Annual Legacy Film Festival on Aging (LFFoA) at New People Cinema coincided with Sunday Streets in Western Addition nearby.  

But it was more comfortable sitting in an air-conditioned theater for screening of Satan and Adam (2018) documentary filled with blues music.  Afterwards, LFFoA Board member Paul Kleyman interviewed Tom Mazzolini, host of KPFA’s Blues By the Bay and founder of SF Blues Fest, focused more on music than the intergenerational, interracial relationship between older black guitarist Sterling “Satan” Magee and younger white harmonica player Adam Gussow. 

LFFoA Executive Director Sheila Malkind introduced the last screening, In a Different Space (2018), an 18-minute Australian film showcasing older adults dancing their life stories, including a 101-year-old tap dancer. 

Closing reception to celebrate 9^th Annual LFFoA!

This cool, interactive outdoor exhibition, Middle Ground, was installed outside of SF Main Library last month.  It invites us to consider reciprocity, in the ways we impact one another, looking to others in deciding what to do: Follow v. lead? Give v. receive? Be kind v. be mean?  Stay silent v. speak? 

Stand by v. step up?

Time in a bottle

When flying from San Francisco to Honolulu, sit on right side of plane for this aerial view passing Diamond Head.  Flygskam! Couldn’t I have set sail on a solar yacht instead, like Greta Thunberg and her father?  This month, 50-year-old Spanish endurance athlete Antonio de la Rosa paddled 2,900 miles from San Francisco to Honolulu.  His self-described journey of “absolute loneliness and self-sufficiency” to raise awareness about protecting the ocean from man-made pollution took over 76 days.

    

In contrast, I didn’t even last 76 days rowing for my college crew team, so I took a full passenger flight for 5 hours, contributing about .59 metric tons of carbon dioxide.  Climate change is real as much of Hawaii (sparing Honolulu) was declared a disaster (eligible for federal funding) after Category 5 Hurricane Lane last year.

This time-consciousness relating to travel reminded me of two favorite songs from the 1970s about time, coincidentally by singers who died in transportation crashes:

“If I could save time in a bottle
The first thing that I'd like to do
Is to save every day till eternity passes away
Just to spend them with you…
But there never seems to be enough time
To do the things you want to do, once you find them”

--Time in a Bottle (1973) by Jim Croce (died in 1973 airplane crash)

Cat’s in the Cradle (1974) sung by Harry Chapin (died in 1981 car crash) and written by his wife Sandy from the point of view of a busy father—when son asks to play, father brushes him off, time passes; father and son grow older, now father asks son to spend time with him; by now, grown-up son very busy so brushes off father who sings wistfully:

“I've long since retired, my son's moved away

I called him up just the other day

I said, "I'd like to see you if you don't mind"

He said, "I'd love to, Dad, if I can find the time

You see my new job's a hassle and the kid's got the flu

But it's sure nice talking to you, Dad

It's been sure nice talking to you"

And as I hung up the phone it occurred to me

He'd grown up just like me

My boy was just like me”

             

Once I landed in Honolulu, I lowered my carbon footprint by taking TheBus, carpooling and walking.  But mostly I was a homebody because I am more conscious of time ticking away…

Growing up in a free-range household, we were not homebodies but often out and about.  Both parents were busy working, my siblings and I (under influence of Tiger Mum) were busy in school and extra-curricular activities (including child labor in family business, fired/rehired many times!), and my grandparents (with dementia) enjoyed wandering.  With my grandparents dead and one storefront business sold, my parents have relatively more “free” time (though still managing other family business) so I make time to be with them during my wikiwiki visits.

Slow healing

While listening to slack key guitarist Makana’s “Deep in an Ancient Hawaiian Forest” (from The Descendants film soundtrack), I looked at forest bathing materials – struck by sign stating “Neuroscience shows that 50-year-olds can have the brains of 25-year-olds if they sit quietly and do nothing for 15 minutes a day.”  Yikes, better avoid that because I don’t want to revert to immature 25-year-old brain! (Researchers have found that short-term memory peaks at age 25, emotional intelligence in our late 40s, and crystallized intelligence in the late 60s or early 70s.)  

Uloha hosted “Under the Banyan Tree” talk on Forest Bathing Hawaii by Phyllis Look, Hawaii’s first and only forest therapy guide (trained in Costa Rica) certified by Association of Nature & Forest Therapy (ANFT).  Her role as guide is to open door by awakening senses for groups to connect to the forest = therapist.  Her point is to slow down.  She presented a power point presentation using anatomy of a tree to explain forest bathing:

·       Roots in Japanese tradition of shinrin-yoku (“forest bathing”), term coined in 1982 by Japan’s Forestry Minister to encourage its mostly urban population susceptible to karoshi (“death by overwork” legacy of competition and economic dominance from post-World War II reconstruction) to de-stress in nature while taking advantage of forests that make up nearly 70% of Japan, in a public health promotion program 

·       Trunk in science with 30 years of evidence-based research showing forest bathing therapy results in physiological (lower cortisol levels, higher natural killer activity, cardiovascular and immune health) and psychological (improved well-being and social harmony) health benefits from breathing phytoncides (wood essential oils) 

·       Crown relationship of reciprocity, so nature connection and culture repair arise together, like caring between Kalo (taro) as the older brother to kanaka (Hawaiians).

Phyllis wrote Chinese pictographs for tree + human = rest.  After working in SF Bay Area theater scene, she returned to Hawaii 20 years ago for “family reasons” and now enjoys an encore career that takes her outdoors as forest therapy guide. 

Phyllis offered us mamaki (Hawaiian nettle) herbal tea, invited us to join her 3-hour, 1-mile forest bathing walk through University of Hawaii at Manoa’s Lyon Arboretum.  Her forest therapy was featured in August/September 2019 issue of Hana Hou, in-flight magazine of Hawaiian Airlines.  She offered me kama’aina (Hawaii resident) discount for forest walk.

Instead, I spent slow time with my parents, including being present for house call visit by Jessica Ackerman, NP with Queen’s Medical Center (QMC) Geriatrics, who spent a whole hour with us! Pop is patient, Mum is primary caregiver, and I am pro bono gerontologist freely offering my assessments 😊.  My parents say different QMC geriatric specialists visit quarterly, but consistently good! Plus, they know to call me (“daughter in California”) if follow-up needed. So grateful for their thoughtful, unrushed care provided to Pop, who had been immobilized due to pain after falling twice in monster home.  With one-time epidural shot for pain, ongoing physical therapy to regain strength, and deprescribing meds, Pop has gotten much better! We are so relieved because he had polio in his youth, and worried he might have post-polio syndrome (experienced by some of my clients).  Now Mum wants her own geriatrician, as her internist as primary care physician gives her only 15 minutes.

Quick building a village

At Ala Moana Hotel, enjoyed breakfast at 15^th Annual Hawaii Floodplain Management Conference hosted by Hawaii State Department of Land and Natural Resources. 

With limited time, I only showed up for Hawaii Homeless Initiative presentation, which fit conference theme Ho’o Laulima (“Many Hands Working Together”)—as well as my return to community work with older adults who are homeless or at-risk of losing their housing.  Hawaii State Homelessness Coordinator Scott Morishige, MSW, described how government and private sector worked together to quickly build Kahauiki Village, which provides long-term, affordable rental housing ($725 for 1 bedroom, $900 for 2 bedroom) for homeless families with children (no mention about kupuna).  The Village’s plantation-style community was brainchild of local businessman Duane Kurisu, who had organized fundraising for survivors of 2011 earthquake and tsunami in Japan; this “Aloha for Japan” returned to Hawaii in the form of pre-manufactured units, previously used to house them.

Government’s contribution came in the form of State land transferred to the City via executive order and leased to Duane’s aio Foundation for 10-year term at $1 per year, and Governor’s emergency homeless proclamation (Hawaii has highest per capita rate of homelessness) to suspend regulations facilitating quickly build of infrastructure (utilities, sewer, electricity, water).

  

Relatively isolated with water on 3 sides and highway, near industrial Sand Island Access Road, this almost self-sufficient Village (on-site preschool, daycare, laundry, and market) apparently did not have to contend with protesting NIMBY neighbors. Scott emphasized that Village tenants are screened and selected by Institute of Human Services (social services agency) – targeting people who are “clean, no substance use, motivated to get out of homelessness” and able to take advantage of nearby employment opportunities like laundry business operated by Hawaii’s former First Lady.  Replication of plantation village for modern-day laundry service workers…no wonder kupuna excluded?! 

Project Manager Lance Takehara presented Case Study: Kahauiki Village, which was built up on a floodplain, avoiding low-lying areas.  Transplanting modular units involved adjustments like short doorway and installing whole fans.  Project began in Fall 2015, and tenancy began in 2018.

Hope there's a good evacuation plan in event of flooding disaster!

This quick build project reminded me of The Union’s 5-storey, 110-unit apartment development in West Oakland, after 10 days fitting together pre-assembled modular units for relatively affordable housing (but not designed for homeless families and their plantation labor). 

History

Hawaiian history has been about its many struggles over land use, and tourism/military/commercial development usually won over affordable housing and traditional uses like agriculture, threatening Hawaii’s food sovereignty.  While riding The Bus, bittersweet to see this patch of watercress farm (since 1928) near Pearlridge Mall and along Kam Highway with passing vehicles spewing exhaust pollution.  Also viewed nearby construction of Honolulu (snail) Rail Transit, very slow work in progress.  

At Honolulu Design Center, attended screening of Reel Wahine of Hawaii, an intergenerational project of young graduates of Hawaii Women in Filmmaking (Executive Director Vera Zambonelli, in photo above) making documentaries of veteran women filmmakers, including

·       Victoria Keith, schoolteacher-turned-filmmaker of Hawaiian culture documentaries focused on local land struggles, from the 1976-1997 

·       Heather Haunani Giugni, co-founded first woman-owned video production company and filmmaker of stories about native Hawaiians 

·       Ciara Leina`ala Lacy, “directher” of Out of State (2018) documentary about the rehabilitative role of cultural practices among Native Hawaiians in Arizona prison 

·       Anne Misawa, director of State of Aloha (2009) documentary about Hawaii's history, motivating paths toward statehood and its legacy 

McCully-Moiliili Library commemorated its 50^th anniversary with a screening of Under the Blood Red Sun and talk with 75-year-old Graham Salisbury, haole author of 1994 novel that inspired film, and Tim Savage, director of 2014 film.  The novel focused on racial tensions following the 1941 Japanese attack on Pearl Harbor, as seen through the eyes of a Japanese boy living on Oahu with his immigrant grandfather and parents; the film was local production with mostly local cast.  Graham is a descendant of Thurston Twigg-Smith, Honolulu Advertiser publisher who wrote Hawaiian Sovereignty: Do The Facts Matter? (1998) and Lorrin A. Thurston, leader of Annexation Club instrumental in overthrow of Hawaiian Kingdom that replaced Queen Liliuokalani with Republic of Hawaii. (Pictured above is librarian in long-sleeved turtleneck, appropriate given air-conditioning blasting inside library, while it was sweltering hot outside, typical summer weather in Honolulu.)

Admission or Statehood Day is a holiday (3^rd Friday in August) in Hawaii that is not celebrated with fanfare.  Hawaii State Library hosted The Promise of Statehood: Looking Back, Moving Forward, with exhibit commemorating the 60^th anniversary of Hawaii’s statehood and a “Try Think” community discussion on “What do we dream for the future generation of Hawaii” with panelists: Anne Misawa (one of Reel Wahine of Hawaii); John Rosa, UH History Professor; John Waihee, former Hawaii governor and leader in 1978 Constitution Convention and formation of Office of Hawaiian Affairs; and Dean Itsuji Saranillio, author of Unsustainable Empire: Alternative Histories of Hawaii Statehood (2018) and critic of ongoing U.S. occupation (including Thirty Meter Telescope on Mauna Kea) and Asian settler colonialism in Hawaii. 

Waihee, age 13 when Hawaii became a state (only kupuna on panel), said he viewed statehood as civil rights victory against racism during territorial era, and supported ability to elect its own Governor.  Native Hawaiian Waihee represented his self-interest as he was elected 4^th Governor of Hawaii (1986-1994) during a period marked by tourist industry boom and increased foreign investment, mostly from Japan. To this day, many Native Hawaiians (Kanaka Maoli), whose ancestors were dispossessed of their lands, regard Hawaii statehood as continuing illegal occupation and motivated by capitalist greed of haole and Asian settlers. 

Statehood enabled Hawaii residents to vote for current Governor David Ige, best known for his delay in communicating correction about false ballistic missile alert because he forgot password to his Twitter account! 

At Made in Hawaii Festival in Blaisdell Center, surprised to see stand-up comic Frank de Lima doing “sit-down” comedy until he explained he had hip replacement surgery.  Now age 70, he remains the one comedian who can do gentle ethnic humor due to his own inter-ethnic background, descended from indigenous (Hawaiian), colonial settlers (Irish, English, Spanish, Scottish), and plantation immigrants (Portuguese, Chinese). 

To folks outside Hawaii, ethnic humor might seem politically incorrect—and some are downright sarcastic and demeaning.  But Frank might be an exception and his impersonations—especially of his multi-ethnic neighbors—might suggest empathy, as he views his contribution to peace:

“Hawaii's ethnic humor developed in the plantation days when people had humility, which they needed because if they weren't humble, the pride everybody has could have turned into arrogance and hatred and violence. Instead it turned into humor. And there was a lesson that went out through the years. Most people can handle Hawaii's humor, not everybody. But during the plantation days, most people could find humor in the different ethnic behaviors, and that's why there was peace.”—Frank de Lima, Acid Logic 

Frank’s “sit-down” comedy extended beyond ethnic humor. To tune of Jackson 5’s Rockin’ Robin, Frank sang these clever lyrics:

“Donald Trump

I sit in the White House all day long

watching TV and getting the news all wrong

with the news reporters

I grab my phone and I tweet tweet tweet

Tweeting Donald, tweeting Donald”

Derek Kurisu (older brother of Duane who inspired Kahauiki Village) introduced Chef Sam Choy, who used to say “never trust a skinny cook.”  Surprised to see his weight loss, but trust that 76-year-old Sam still knows how to cook… he made Hawaiian Poi Beef Stew using local ingredients like breadfruit (ulu), Hilo sweet potato, poi.

“Aging in Place”

Back at Ala Moana Hotel, 13^th Annual Aging in Place event was a mix of workshops (few informative, mostly marketing) and providers exhibiting their products and services (lots of assisted living facilities, though they really should not count for “Aging in Place”).  Visited Kupuna Pono, program of non-profit The Mediation Center of the Pacific, designed to help “families talk and support their kupuna” including advance care directive family conferences.  It was formerly named Neighborhood Justice Center, where I did an undergraduate internship!

Eileen Phillips, RN, discussed Understanding Your Home Care Choices.  (Reassuring familiar face as I took her Fall Prevention class years ago!)  She didn’t talk about me and family members (unpaid caregivers), but how to choose among 150 home care agencies in Hawaii that charge at hourly rates starting at companion level of $24 (minimum 3 hours per day).  

Afterwards, I walked couple of blocks over for tour of The Plaza Assisted Living at Waikiki.  It had the vibe of a cruise ship, but windows did not open for access to nature like breeze from trade winds, air from outdoors—just stuck with air-conditioning indoors, 24/7 year-round—like TheBus, hospital, and other controlled environments; no balconies, though there was patio on 3^rd floor facing Kalakaua Avenue traffic. 

I don’t like how air-conditioning has taken over; rather welcome humidity which is like natural skin moisturizer. Very sad to see wooden jalousie windows closed shut in older buildings and window mounted air-conditioners blocking out access to fresh air and natural sunlight.

Though made in Hawaii, I never felt like I belonged – I used to say I felt like an outsider.  Now I think it’s more accurate to say I didn’t feel at home in Hawaii because its land and culture has been hijacked by U.S. military, tourism, horrendous traffic, and air-conditioning!

   

In politically correct SF, there’s often an acknowledgement of being on indigenous land; unless one is indigenous, everyone else is an outsider.

Wonder what “aging in place” means for Kanaka Maoli? Hawaiian nationalist Haunani-Kay Trask gave advice about going away for college, leaving Hawaii because it’s too small, to find your voice because one always has to be too careful about what to say/what not to say in Hawaii, like definitely “no make waves” though surrounded by water?! “Get out of the colony” or drown.  How does one feel at home without free expression?

The end

“You better know that in the end
It's better to say too much
Than to never to say what you need to say again…”

--John Mayer, “Say (What You Need to Say)” from The Bucket List (2007) 

Lori Protzman, RN, Advance Care Planning Coordinator at QMC, presented all-day Ain’t the Way to Die: Advance Care Planning Workshop.  She reminded us that 5% of patients “create” 50% of health care costs, including 1/3 during last month of life; nearly 20% of deaths occur in ICU or immediately after discharge (“treated to death”).  Objective: help patients and families “say what they need to say” and let them know they were heard. 

What’s a good death from perspectives of Family, Patient and Health Care. Goals of care: concentrate on improving quality of life; help live meaningfully in time you have; ensure you receive kind of treatment you want; comfort and dignity will be our top priority. 

Lori recommended watching film, The Farewell, based on Taiwanese director Lulu Wang’s own experience with her dying grandmother, and her family wanting to hide terminal diagnosis from her and planning fake wedding as excuse for family reunion. 

I like palli care doc + cartoonist Nathan Gray’s Dying Words Aren’t What I Imagined. 

Back in SF Bay Area

At this month’s SF Bay Area Network for End-of-Life Care meeting, Lonny Shavelson, MD, presented on Medical Aid in Dying: Ethically Challenging Cases (and a pharmacology update!).  Based in Berkeley, he is a former emergency room physician, author of A Chosen Death: The Dying Confront Assisted Suicide (1995), and founder of Bay Area End of Life Options for patients at the end of their lives who are considering various options, including medical aid-in-dying (MAID) under California’s End of Life Option Act (2016).  He said writing a lethal prescription for terminally ill patients is “last resort,” with purpose for “dignified death” (never use “death with dignity”) after considering hospice and palliative care options.  He also consults with physicians and plans train-the-trainer as he intends closing date for his practice.  Always at his patients’ bedside, he highlighted challenges:

·       Secobarbital (induces sleep into coma so brain stem no longer drives respiration) cost increased to $3,500, then “disappeared from market”; DDMP2 (valium + morphine suppress respiration for cardiac arrest) takes longer for effect.  Taking more than 4 hours to die after ingesting lethal meds is “problematic,” less than 2 hours possible after “playing with meds.”  Brain damage can result from incomplete AID.

·       30% of terminally ill patients eligible for MAID died during 15-day waiting period; most oncologists decline to participate, and refer to primary care physician, who has no training, so refer to hospice which provides consulting MD, but only attending MD can start 15-day waiting period.  In July 2019, Oregon amended its law to make it ok to administer drug during waiting period if death is imminent.

·       If terminally ill patient loses ability to swallow (oral self-ingest), self-administering meds or ingestion can take place using GI tract, feeding tube or rectal catheter, with patient pushing syringe.

Meeting Co-Chair Nate Hinerman introduced psychiatrist and bioethicist Stanley Terman, MD, PhD, of Caring Advocates.  Dr. Terman is proponent of VSED (Voluntarily Stopping Eating and Drinking) as alternative to MAID. 

Scribd hosted How to Live Life and Face Death with UCSF palliative care physician BJ Miller & Shoshana Berger, co-authors of A Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death, discussing what really matters, how to prepare for the inevitability of death, and make the most of life before that time comes. 

Researchers are getting closer to developing a blood test that predicts when a person will die.  Last month, California Department of Health issued report finding that 88% of people who use California’s EOL Option are white. 

In Oakland, attended Racial Equity, Homelessness, and Homeless Systems of Care, hosted by Bay Area Regional Health Inequities Initiative (BARHII coalition of public health departments) and Homebase.  BARHII Executive Director Melissa Jones discussed roots of crises from structural racism: homelessness is result of failed housing policing and systems v. individual/behavioral issue for intervention.

According to Point-in-Time counts, SF Bay Area has the 3^rd largest population of people experiencing homelessness (28,200) in the U.S., behind NYC (76,500) and Los Angeles (55,200).  Bay Area also shelters a smaller proportion of its homeless (33%) than any metro area in U.S. besides Los Angeles (25%), making crisis highly visible. 

Bay Area’s homeless population is disproportionately comprised of single, male minorities age 25+.  Meeting focus on race so no breakdown for older adult age range provided.  African Americans, Native Americans and Latinx are overrepresented among homeless.  Bay Area Asians were reported to have 0.1x homeless rate relative to general population, so I asked whether this was due to Asians living in multi-generational households like 6 people crammed in single-room occupancy unit with bunk beds? Who knows?! Group activities involved using Government Alliance on Race & Equity toolkits. 

Lunch included soda + chips below “health happens here with prevention” poster!

At SF Village, Palo Alto University Professor Lisa Brown presented on Climate Change and Healthy Aging, discussing impacts of rising temperatures, flooding and changing wind patterns; how to stay safe and make a difference with Elders Climate Action and next month’s Global Climate Strike with 1000 Grandmothers.

Finally, another reminder about breathing from geropsychologist Janet Meiselman, PsyD, who presented talk on Brain Health, Mindfulness, Mood & Memory.  And remember what we learned from forest bathing presentation: “50-year-olds can have the brains of 25-year-olds if they sit quietly and do nothing for 15 minutes a day.”