I Am Ready

by Elena Portacolone 

After some bargain, Luke gives in. He agrees to talk with me in his hotel room in the Tenderloin. In the lobby he told me: “My room is not ready”. “My room is never ready either”, was my reply. Luke is a 76-year old immigrant from the Caribbean with a taste for clothes and fragrances. My oversize corduroy pants and deformed Puma trainers are shabby compared to his grey suit, ironed white shirt, and silk tie. A tiny elevator leads us to the third floor. We walk along a carpeted l-shaped corridor until Luke unlocks his door. >

Imagine fitting all your belongings in a single room. Even though Luke moved into a room bigger than the previous one, space is compressed. I use the only chair and he sits on the mattress of his unmade single bed. He sits so high that his polished black leather shoes hover in the air. My head is at the same height of his stomach. The rest of the room is filled by a fan blowing warm air in my back, a TV surmounted by a DVD player, books on the floor, DVDs and CDs amassed over the iron board, plastic bags with clothes, the tower of a small fridge topped by a microwave topped by an electric grill, a rice cooker sitting on the floor beside. 

“I am trying to get a better place” Luke says right off the bat. “I’m ready. I don’t want to be stuck in this situation for the remainder of my life”. He recently applied for an apartment in a public housing development. The application assembled by his physician with the help of two social workers was recently rejected as “it was not strong enough”.

An apartment would allow Luke a life that he thinks he deserves:

At the end of the day, when I come home, and I open my door, I want to be able to come to my living room. And then go into my kitchen, and start to prepare dinner for myself. And after dinner is ready, I want to be able to bring it to a dining table and sit down and have a wonderful dinner. And also, I invite some of my friends from time to time to come, and be able to partake a nice dinner with them. You know? I want to be able to give myself a better quality of living.

Luke’s eyes are not only set on him. Moving into an apartment would be a victory dense of meanings also for other San Franciscans. His life purpose is “to help people who are less fortunate in life. And also to show them that there is still hope and they can make it if they try. But they’ve got to try extremely hard because nothing is going to be easy”. That is the rationale behind his elegance. His look and his clothes manifest his inner dignity.

Every day when I leave I go through that door. I get up, brush my teeth, shave.  And go out there looking clean and respectable. I am able to iron my clothes. See, I got my iron, right there. I got my necessary things to take care of myself. I got cologne, all of that. So I am representing myself. I am representing myself.

Lay Down

My sense of directions abandons me when I look for Samuel’s home number. After a few turns in his street, I surrender.   I park my Honda and find my way on a sunny and windy early afternoon. As soon as Samuel unlocks the door to his one-bedroom apartment, he asks me where I parked. He then invites me to park exactly in front of his building as he already told me over the phone. Without a word, I turn on my heels, walk back to my car, and park it right beneath his living room. As soon as I turn off the ignition key, he gives me the thumbs up from the rectangular windowpane.

Back in the living room, I make myself comfortable on the couch, the back of my head against the window facing the street, my green car, and a young tree. Samuel sits on a wheelchair right in front of my eyes. He switches off the TV on the side. He is an 88-yearold veteran with a deep and infectious laugh and an unrelentless faith in God. Formerly married, he has been living alone for 40 years. In his hands, almost anything becomes either a sign of God’s will at work or a source of banter. For example the supreme cleanliness and tidiness of his apartment is a sure sign that he does not need to marry anymore since his outstanding home care worker takes care of him much better than any wife.


I ask him why he needs a wheelchair. The story of his falls and a major surgery reveals that when he fell, his next-door neighbor rung one of his daughters because she noticed that at night the light in the living room was on but nobody picked up the phone. His neighbor has always an eye on him. In his words:

“How you doing?” She calls me. And then, in the night, “Close your windows; close your shades.” She’d tell me that all the time.

Curious, I ask why he needs to close the shades. He replies:

Guys drive-by and shoot. I see guys, some of these guys, up here drinking, and using that dope. And they don’t care; they’re shooting at one another. They don’t have to be shooting at you. […] They don’t care who they’re shooting, they just be shooting. And some of them don’t know how to shoot.

Formerly married, he has been living alone for 40 years. In his hands, almost anything becomes either a sign of God’s will at work or a source of banter. For example the supreme cleanliness and tidiness of his apartment is a sure sign that he does not need to marry anymore since his outstanding home care worker takes care of him much better than any wife. I ask him why he needs a wheelchair. The story of his falls and a major surgery reveals that when he fell, his next-door neighbor rung one of his daughters because she noticed that at night the light in the living room was on but nobody picked up the phone. His neighbor has always an eye on him. In his words:

“How you doing?” She calls me. And then, in the night, “Close your windows; close your shades.” She’d tell me that all the time.

Curious, I ask why he needs to close the shades. He replies:

Guys drive-by and shoot. I see guys, some of these guys, up here drinking, and using that dope. And they don’t care; they’re shooting at one another. They don’t have to be shooting at you. […] They don’t care who they’re shooting, they just be shooting. And some of them don’t know how to shoot.

My ears suddenly become more alert to the sounds of the street. Samuel continues:

So I always hit the floor when they start shooting. That’s the best thing you can do, when they start shooting. Lay down. You can get hit anyway, but this is safer. Fall on the floor. You have all the bullets have to go through a lot of stuff before they get to you. If you open the window, the bullets will go through that easy.

Samuel tells me how much he usually enjoys looking at the tree outside, but his neighbor would then tell him “Stay out the window.” Maybe he learned from his guardian-neighbor to insist on the right spot where I should leave my car when he remarks:

“Just like I told you when you came in here, I said I be the one to guide you.”

[One of  six stories on living alone in San Francisco published in Elena Portacolone’s monthly column in the newsletter of Planning for Elders -September 2010 – February 2011 The project is part of the UCSF Community Partnership Initiative]

More Veterans To Receive Options for Living Independently Under New VHA Partnership with National Resource Center for Participant-Directed Services - RWJF

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Veterans of all ages with disabilities will gain additional support in 28 states under a new program designed to help them live independently, with more choice and control over the services they receive in their homes. Through a contract with the Veterans Health Administration (VHA), the National Resource Center for Participant-Directed Services (NRCPDS) will provide training and assistance to VA Medical Centers that are implementing participant-directed services for Veterans.

In 2008, the U.S. Administration on Aging’s Community Living Program partnered with VHA to create the Veteran Directed Home and Community-Based Services (VD-HCBS) Program. The Program allows Veterans of all ages to have more control over services provided in their homes to allow them to continue to live independently in their communities. Veterans enrolled in the program can manage their own flexible spending budgets, decide for themselves what mix of goods and services can best meet their needs, hire and supervise their own workers, including family and friends, and purchase items or services that help them live more independently. We call this approach "participant direction."

The NRCPDS at Boston College is the only national center of its kind that helps people of all ages and disabilities get the support they need to live as independently as possible. The Center provides research, policy, training and assistance for participant-directed programs. In addition, NRCPDS has a National Participant Network that works with these programs to ensure that they are designed and implemented with the needs and preferences of the individual at their core. The Center will offer a wide variety of training and technical assistance to staff at VA Medical Centers for the benefit of Veterans in the VD-HCBS Programs.

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TIME GOES BY | Old People Driving - A Documentary

by Ronni Bennett

In a comment on a recent post here, Mage B who blogs at Postcards mentioned that her driver's license has been confiscated because she had lost consciousness.

It is one the greatest fears elders have – to give up driving, losing the freedom and convenience we have experienced all our lives and to become dependent on friends, relatives or public transportation (which isn't all that good in many places) for everything we need or want to do away from home.

A new documentary film titled, Old People Driving, sensitively explores the emotional and psychological aspects of giving up driving. The 35-year-old producer, Shaleece Haas, tells me that her goal is to dispel some of the myths about older drivers,

“but I didn't want to shy away from the fact that most people will outlive their ability to drive - usually by seven to 10 years - and that all of the alternatives to driving pale in comparison.”

According to Shaleece, there are three million drivers older than 85 in the U.S. and most people believe they are a menace on the road. However, Julio Lacayo, who is the older driver ombudsman for the California DMV, tells us in the film, it is a myth that old drivers are the worst drivers.

Although elder drivers have a 16 percent accident risk compared to other adult drivers, he explains in the film, those under age 25 have a 188 percent accident risk. And while teens most often kill others, old drivers are mostly a danger to themselves.

Shaleece's poignant film tells the stories of two elder drivers - Herbert Bauer, age 99 and her grandfather, Milton Cavalli, 96. Here are the three of them.



Milton has been a car buff all his life, starting with his first Model T when he was 14 years old. He still owns three of them and a Saxon too, which he drives with confidence. “Age has nothing to do with it,” says Milton, sounding like me on this blog when he explains how some people are old at 50 while others are still capable at 100.



Herbert, on the other hand, has been planning for what will be his last day behind the wheel of a car, intent on stopping driving “before someone invites me to change,” he says. When asked if he will miss his car, he says, “I plan to.”



Leading up to that final drive, Herbert visits a bicycle shop to try out an adult tricycle. He has broken his hip in the past and has trouble mounting the trike because the seat is too high for him. I was struck by the young sales girl who, standing nearby, is oblivious to Herbert's struggle.

But he doesn't give up and works out a deal with a friend who still drives to trade his car for her tricycle. Shaleece shows us that sometime later, it sits chained to the side of his house unused because, Herbert explains, his left leg has gotten worse.

On the fateful day of his last drive, Herb is careful not to break his perfect record of no accidents in 80 years of driving as he notes that his last left turn is coming up. It is a powerful moment when he removes the car key from his wallet to give to his friend who drives it away as Herb slowly walks into his house.

Nevertheless, Herbert says giving up driving is a triviality compared to giving up someone you've loved all your life, as he did when his wife died. Losing the freedom of a car is “nothing by comparison.”

Both of these men, the oldest of the old, accept the limitations of their age with astonishing equanimity and in Herbert's case, a humor that I hope I will develop should I live as long. “If you have to live by yourself,” says Herbert, “tell yourself you're in good company.”

Here is a short clip from the beginning of the 24-minute film:
You can find out more about Old People Driving here.

Shaleece Haas has made a remarkably beautiful film that everyone – old, young, caregivers - should see. It will premier on Sunday at the Mill Valley Film Festival, will be screened at the Hot Springs Documentary Film Festival on 16 and 19 October and will be shown too at the National Transportation Safety Board symposium on older drivers in Washington, D.C.

She hopes to it will be broadcast on television soon; DVD copies for personal use may be purchased online for $20.

Treating the Loss of Muscle, or Sarcopenia, of Aging - NYTimes.com

Image via CrunchBaseby Toby Bilanow

Loss of muscle mass affects about 10 percent of men and women over 60 and is a major reason the elderly lose mobility and cannot live independently, researchers say. Now they are looking for ways to prevent or reverse the condition. As Andrew Pollack of The New York Times writes:
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TIME GOES BY | Big Brother is Out to Control All Elders' Money

by Ronni Bennett

Recently, Cowtown Pattie of Texas Trifles blog sent me an eight-page brief [pdf] from the Center for Retirement Research at Boston College titled What is the Age of Reason? In Pattie's words, it is a “chilling read” and she is not wrong.

The four authors of this brief are identified as a senior financial economist with the Federal Reserve Bank of Chicago, a senior economist with the Federal Reserve System, a professor of finance at New York University and another professor at Harvard.

Among them, they acknowledge funding from the National Science Foundation (NSF) which is a federal agency and the National Institute on Aging (NIA), a division of the National Institutes of Health that describes itself as “leading the federal effort on aging research.” Bear with me – it's important that you know the genesis of this document.

The authors note that the views expressed in the brief

“do not represent the policies or positions of the Board of Governors of the Federal Reserve System, the Federal Reserve Bank of Chicago, or the Center for Retirement Research at Boston College.”

Whether the views of the NSF or NIA are represented is not stated.

Four of those eight pages of the brief are a title page, references and endnotes, so there's not much text.
The majority of the brief, including four graphs, gives a short overview of studies the authors analyzed which, they say, show “The prevalence of both dementia and cognitive impairment without dementia rises rapidly with age” and that older adults make more financial mistakes than mid-age adults.

All right - so far, so good in that this is true for SOME old people, although the information is nothing new. This is what academics do – slice and dice each other's work, sometimes to good effect and sometimes not, and issue thousands of briefs every year most of which sink into oblivion. But then the authors get to their conclusions ominously titled, “Possible Policy Responses”:

“In response to this problem, several policy approaches are possible and government intervention is probably desirable, although the ideal form of intervention remains unclear.” [emphasis added]

The authors immediately dismiss their first and only benign policy suggestion for government intervention - to strengthen financial disclosure requirements to the public – by stating that “we are skeptical that improved disclosure will be effective in improving financial choices.”

Then the brief begins to get scary – remember, this all targets elders. The second suggestion involves “financial driving licenses,” the requirement to pass a test before being allowed to make non-trivial financial decisions. They ask a whole bunch of feasibility questions including the all-important, Who would be required to take the test?

Well, not me; I will resist clear to the barricades. Reading this brief, I'm beginning to have some sympathy for the teabaggers who object to too much government.

In their final suggestion, the authors step all the way across the line into totalitarianism with “mandatory advance directives” in which adults would be required by a certain age to sign a document placing management of their assets with a third party if they become incapacitated.

That's already too much to stomach, but it gets worse.

“...a fiduciary could be appointed to approve all 'significant financial transactions' involving the principal’s funds after the principal reaches a designated age.” [emphasis added]

In regard to that diabological idea, the authors admit that “it might be perceived by some older adults as an unfair restriction targeted against them.”

DUH!

Not content to pull Social Security out from under elders (as too many in Congress are currently attempting to do), now they are thinking up ways to take everything else old people have.

As I noted above, thousands of such studies are written each year and most sink out of sight before the ink is dry. Some of them sometimes work their way through the bureaucracy to become policy or law. I have no confidence that this one, that would give the government or its appointees access to trillions of dollars in elder assets, will disappear.

Remember that two of these researchers work for federal agencies involved with monetary policy of commercial and investment banking, two others with major universities that are paid to supply the federal government with policy research, and the funding for this project comes from two other federal agencies.

Read the brief for yourself here [pdf].


TIME GOES BY | Big Brother is Out to Control All Elders' Money

A Day Through The Eyes of a Blind Woman: Part 2

by Tom Babinszki

In part 1, we followed Lisa, a blind woman and examined what kind of challenges she faces using everyday technologies, such as a coffee maker, an alarm clock or a microwave. In this part, we will follow Lisa to work and see how she uses her computer, her mobile phone, or how she orders from a restaurant.
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Transitions to Independent Living Communities: Life Satisfaction and Later Life Happiness

Robert Butler in the preface:

We at the International Longevity Center see independent living communities as an important and often highly desirable channel for one’s later life. To that end, we have worked with professional organizations,businesses,and policymakers to better understand older people and the factors that help assure what we call “healthy aging.” We recognize that a full understanding of the culture of aging, health care, appropriate living options and even good design play a critical role in determining thesuccess of independent senior living for individuals, their families, the community, and society itself.

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Patient Money - Cost-Effective Ways to Make Homes Safer for Older People - NYTimes.com

By LESLEY ALDERMAN Stay put or sell? That’s the question many older people ponder as they move into their 70s and beyond. Most older people settle on staying put, according to a recent survey by the Home Safety Council, a nonprofit organization dedicated to preventing home-related injuries. (From the source of the survey, you can see where this column is heading, right?) Read More: Patient Money - Cost-Effective Ways to Make Homes Safer for Older People - NYTimes.com

Adopt An Independent Living Approach Rather Than Medical Model of LTC Services

By Leah Farrell, Policy Analyst, in the Center for Disability Rights blog The traditional model of long term care services emphasizes a medical approach to meeting needs, often involving unnecessary high cost professionals. The independent living (IL) approach to long term care services vests control of services in the consumer rather than the professional. Many of the services that are widely perceived as “medical” are simply a part of daily life to a person with disabilities. The independent living paradigm supports an integrated life in the community, with personal care workers providing needed assistance in tasks ranging from dressing and bathing to managing breathing devices, feeding tubes and catheters. Tasks that hospitals routinely train family members to perform can also be done in a home setting by other laypersons under the direction of the individual or their family member. THE PARADIGM AT A GLANCE DIMENSION MEDICAL MODEL (“Traditional”) INDEPENDENT LIVING MODEL The table below conveys the contrast between the medical model and the independent living model. The fundamental difference between the two models is the contrasting perspectives of people with disabilities versus professionals on the practical realities of living with disabilities. The IL approach is hailed by people with disabilities because it not only produces higher consumer satisfaction, but it is more cost-effective than the traditional medical model. The medical model over-relies on expensive medical professionals and a paternalistic approach to service delivery. Thus, the dominant traditional system is insufficient to meet the needs of the consumers and is more costly to NYS. CDR urges NYS to shift toward an independent living approach by placing control over services with the consumer and reducing dependence on costly professionals. Table As the table conveys, the IL model views the problem as caused by the environment, not the individual. For example, the problem is not that a wheelchair user cannot walk; it is that a ramp is not provided for access to the building. The problem is not that a deaf person cannot hear; it is that sign communication is not available. It removes the blame from the person and the disability (which is non-controllable) and places the responsibility on society (which is controllable). A disability becomes limiting only in the context of an environment that does not accommodate the disability. When the barriers are removed and supports are provided, the disability becomes a manageable part of a full lifestyle. BENEFITS OF INDEPENDENT LIVING The IL approach promotes advocacy, barrier removal, self-help, peer support, and consumer directed services. These concepts empower the individual. This approach results in a distinctly different experience than a person has living under the traditional medical model, which focuses on trying to fix the broken person. Advocacy involves both systems advocacy to affect policy reform and self-advocacy to ensure individuals can attain the services they need. Because disabilities vary drastically, barrier removal directly addresses any obstacles to a productive community-based life for each individual. A systemic approach to barrier removal is also a necessary component to IL because it impacts everyone with a disability as opposed to individualized problem solving—which mimics the medical model approach of treating the broken person. Self-help and peer support are essential to the IL model because they embody the concept of independence within the context of a positive and shared disability identity. Individuals with disabilities offer support, advice, and resources to other people with disabilities so they can live free from agency and institutional controls. People with disabilities receive training on independent living and learn skills which allow them to reduce their reliance on state and federal assistance programs. Finally, consumer directed services allow individuals to receive the services (medical and nonmedical) they require in order to live independently. A consumer directed approach removes the controls from the traditional agency and positions people with disabilities to be in charge of their services and supports. [The concept of consumer directed services is explained further in Vol. 4 of Reforming Long Term Care Services in New York State.]