Hands to Help Seniors
Burbank, CA Speaking at the C4A Conference 2023: Mapping the Future of Aging and Disability in California, held here May 9-11, The California Department of Aging had a number of team members come to describe their data collection methods and how they look forward to using the data for inclusion.
That translates to providing better services to minority groups like African Americans, Asians, Hispanics, the LGBTQ community and Native Americans. Marina Castillo Augusto, Equity Officer, California Department of Aging, said that she is the first Equity Officer at the California Department of Aging. “We have a responsibility to lift support services,” she said, and that means looking at subsets of the senior community which may have very different needs than the overall senior community.
Ross Lallian, Chief of Research, California Department of Aging, said that the research focus of his group is on the LGBTQ community to better understand service gaps and to drive policy and program decisions. Recent research has found that members of the LGBTQ community that have been out for many years go back into the closet when moving into assisted living or a nursing home.
Therefore, Lallian’s group is working on a LGBTQ+ study of older adults. “We are studying aged 50+ who are more likely to live alone. Two thirds report not disclosing sexual orientation to LTC facilities,” said Lallian. The Department of Aging is studying:
They plan to survey at least 2,000 people in a statewide coalition which will be guided by a LGBTQ+ Advisory Committee comprised of older people who identify as LGBTQ, service providers, and members of the Area Agency on Aging (AAA).
“Having these trusted voices help distribute these surveys is critical. We would like to do the survey on a regular basis. We plan on making this data public. Research and policy folks will be able to use this data for advocacy,” he said. The goal is to improve access to medical and social services.
Amanda Lawrence, Master Plan for Aging Project Director, California Department of Aging, said that they were working with U.C. Davis to do a formal evaluation on how to better serve local communities and to lift diversity.
“There’s a lot to be gleaned from speaking with our diverse communities. We should care for them as they age, and treat them with dignity and pride. We are all different and we all don’t start in the same place,” she said.
Sarah Steenhausen, Deputy Director of Policy, Research, and Equity, California Department of Aging, agreed. “Everything we are doing is trying to infuse equity. Everything we are doing requires stakeholders,” she said.
It’s nice to see that there is a smaller government agency working on these important issues for minority seniors. They are likely to be more nimble and be able to get things done more quickly than other larger State and Federal agencies.
Burbank, CA Speaking at the C4A Conference 2023: Mapping the Future of Aging and Disability in California, held here May 9-11, panelists on the “Aging In Community: The Affordable Housing Crisis that No One is Talking About” panel lamented the lack of government incentives to build affordable housing.
Cherly Brown, Chair, California Commission on Aging and Former Assembly Member said, “Someday you’re going to get old. There are an increasing number at risk of being homeless.” She pointed to the high poverty level of seniors in California.
She said that the poverty levels of seniors, paired with a and lack of assets (seniors have an average of $54K in assets, which is the median cost of just one year of living in an assisted living facility).
Meea Kang, SVP Development at Related California said that “Independent living is primarily how folks have been aging in their own homes. As seniors age, they often need more care and support. One step beyond that is assisted living and Board and Care facilities (6 beds or less). One step further would be skilled nursing facilities. As a commission, our goal is for advocating and providing for a range of services for long term care.”
Unfortunately, only two, IHSS and skilled nursing, have government funding. “This is causing seniors to fall into homelessness at rapid rates. There are over 200K living in assisted living facilities in California today. The majority of the residents in assisted living today consider these homes their permanent living space.”
Tim Dunn, Associate Director of Housing Development at Mercy Housing at Laguna Honda Hospital in San Francisco said that Mercy Housing (a non-profit) is working on housing projects with 23K units in the country and 10K in California, all deeply below 60% of the poverty level.
“Service enriched housing is one of the options for the senior population,” he said. Mission Creek Senior Housing is a project that is about 15 years old. Rents are only about $300 a month for residents with subsidies, roughly a third of their income as rent. There are also services on the site. “There is a resident service coordinator to make sure people get IHSS, transportation, etc.,” an important factor.
Residents get annual health surveys of Activities of Daily Living (ADLs). There is also an Adult Day Health Care Center on-site. They can then go to their apartment in the evening with IHSS support. “It’s not 24-hour care. We don’t do IHSS, but we do get people connected. One of the things you can’t do is plan for unscheduled needs. We can’t administer medications. San Francisco has experienced a great lost in assisted living which was historically small mom and pop facilities which are now no longer financially viable,” he said.
Laguna Honda Hospital Campus is a 62-acre site with capacity for large development, right on the muni line. The city is allowing development of senior housing, which can support 250 to 300 units. The city of San Francisco will provide free land and about $50 million in capital financing.
However, he said that, “Even with all of these resources we still are hitting a barrier with doing the licensed care. This particular property is currently on hold due to financing issues,” he said. Hopefully development will start next year.
Two other panelists, Dan McDonald, Deputy Director of Lending at Community Vision California Capital and Consulting and Michael Siglala of Innovative Development and Living Solutions of California worked on a project called Magnolia Crossing for years.
It’s a textbook case of a project that works but was developed about ten years ago and the model unfortunately isn’t financially viable anymore. McDonald said, “I joined in 2012. I had worked for a bank working with private and memory care. The only financeable projects at my bank were large wealth developers. I began to believe that affordable assisted living was possible,” he said.
This project worked because U. S. Bank purchased the tax credits (assisted living waivers). “What we would like to do is replicate how to do this in other communities. The expansion of the assisted living waiver program(would help and many other programs with the state would provide the money that the community needs,” he said.
Sigala said, “I always worked in urban planning, and wanted to do some development. I was the primary caregiver for my mom. I saw this as a big emergency need for seniors, how do we house them? One of the first people I talked to was Dan.” In Clovis, they developed a project called Magnolia Crossing senior living community.
They had a mixed income model of home like assisted living project. There were a total of 48 units, developed in 2013, and they did it as a non-profit. They received $10 million in funding to do a project that had never been done before. The project was three homes about 10K square feet each. One had 16 units of memory care, 36 other units were assisted living. They were studio units, where everyone had their own bathroom.
“Isolation and loneliness are two of the main factors influencing the senior community. We have 35 full-time caregivers, LVNs, cooks, care and support staff.” There are both very low income on Medi-Cal living with private pay. 10% of their residents are over 100 years old! The new market tax credit program was the only program available at this time (you had to show a commercial component (services)) to make it work. “The Assisted Living Waiver program is great but it’s unpredictable. The reimbursement rates are 10-20% below what they could be to make this feasible,” he said.
Burbank, CA Dr. Joshua Bamberger from UCSF Family Community Medicine appeared at the C4A Conference : Mapping the Future of Aging and Disability in California, held here May 9-1. He described a fascinating study of the homeless that he did right during the height of the COVID-19 pandemic.
On a panel entitled Aging in Community: The Affordable Housing Crisis That No One is Talking About, he said “March 17, 2020 I left UCSF and started surveying people in the homeless shelters in San Francisco.” 3,500 homeless adults were moved into housing, mostly using tourist hotels. “We can house everyone if we want to. “We’ve proven that during the COVID crisis.” Each of the 3,500 people were given a medical assessment. He found that most people really didn’t need anything other than a safe place to live.
“The vast majority need a decent, permanent housing with some on site services. About 10% need more,” he said. He noted that when they did the survey, most of those over 50 had a diagnosis of congestive heart failure. About 90% of those with congestive heart failure used methamphetamines.
Dr. Bamberger said that by augmenting the existing permanent housing with support services, this helped the homeless dramatically. Also speaking on the panel was Dr. Margot Kushel, Professor of Medicine at UCSF and Division Chief for the UCSF Center for Vulnerable Populations and Director of the UCSF Benioff Homelessness & Housing Initiatives.
She noted that homelessness is a function of structural assets and the presence of a safety net. “In California, in 2023, you do not need many vulnerabilities to become homeless.” She noted the lack of affordable housing, income inequality and structural racism.
“In 2023 in California we have 24 affordable housing units available and affordable for every 100 extremely low-income households. We have 1.3 million in this group.” She said that in San Francisco less than 5% identify as black, yet 37-38% of the homeless population in S.F. is black. In 1990, 11% of the homeless are 50 years or older, while today 50% of homeless are 50+ (data according to the HOPE HOME Study which has been done since 2013 and is funded by the National Institutes on Aging).
Of the people 50 and older who were homeless, 44% had never been homeless before. This is unlike the larger pool of homeless, many of whom had drug addiction or mental health issues. Of the 50+ group, 44% had never been homeless before.
She said that the late onset homelessness looked very different. They led very typical lives but had low-wage jobs with no pension. These people typically had a crisis, like a marital breakdown, they or their spouse had an illness, or they had suffered through the death of a spouse or parent. Many had been caregivers for their parent, and then lost their job and their home.
She noted that more than a quarter meet the criteria for cognitive impairment, and nearly half had problems with Activities of Daily Living (ADLs). “50 is the new 75 for the homeless,” she concluded.
Like Alzheimer’s disease, Parkinson’s can be a devastating disease which can take a heavy toll on your body. There have been few new treatments for both diseases, which has been disappointing. The disease hasn’t gotten a lot of attention from researchers until last December when a report said that Parkinson’s disease strikes 90,000 older Americans each year, 3x the previous estimate of 30,000 per year. See a neurologist if you suspect that you or a loved one may be noticing shaking and other symptoms of Parkinson’s disease.
A paper published in Nature Magazine showed that tiny spurts of exercise throughout the day are associated with significant reductions in disease risk. The researchers used data from fitness trackers collected by the UK company Biobank. They looked at the records of 25K people who did not regularly exercise, with an average age of 60 years old. They followed them over the course of almost seven years. Those who engaged in one or two-minute burst of exercise three times a day like speed-walking or rapidly climbing stairs showed a nearly 50% reduction in cardiovascular mortality risk and about a 40% reduction in the risk of dying from cancer as well as all causes of mortality. This shows that it’s not necessary to do vigorous workouts—every little bit of exercise helps.