Editor’s Note: Openhouse founder Marcy Adelman, PhD, shares with the Bay Times her testimony from the recent public hearing held Thursday, January 26th.

Comments of Marcy Adelman, PhD:

San Francisco has made much progress in the last decade to create more welcoming, LGBTQ friendly senior housing, services and programs, but there is still so very much to do.

Approximately one in 6 seniors in San Francisco is LGBTQ. It is projected that by 2030, with the aging of the baby boomers, the San Francisco gay and lesbian senior population will double.

Our community’s seniors and older adults are adaptive and resilient, but we face unique obstacles to aging well.

What are the challenges? Solutions?

1. Discrimination: San Francisco senior providers and senior facilities are receptive to LGBTQ issues, but do not provide enough services that are inclusive and welcoming to LGBTQ older adults.

Solution:  LGBTQ senior cultural competency training to make existing senior housing and services more LGBTQ friendly. It is more cost effective to integrate services rather than duplicate them. Openhouse has been conducting LGBTQ senior cultural competency trainings since 2004. As effective as this program is, it is too small to meet the demand.

2.  Fear of Discrimination: A major barrier to accessing needed services is fear of discrimination. Because of fear of discrimination, LGBTQ seniors often go back into the closet to access needed services or, at risk to their health and well being, do not access appropriate services at all.

Solutions continue to support and expand existing programs that increase LGBTQ senior outreach and visibility, community engagement and senior leadership.

People who feel empowered and connected to each other are less likely to retreat into the closet.

3.  Caretaking Concerns: Spouses, adult children and siblings are typically the primary caretakers of frail seniors. But LGBTQ seniors are more likely than heterosexual seniors to live alone and to be without help. The lack of informal support systems puts LGBTQ seniors at risk for isolation, poor health and higher risk for placement in assisted living or nursing home facilities.

Solution: Continue to fund and support a range of housing and service options such as Openhouse’s 55 Laguna project for low income seniors, Openhouse’s housing program that assists seniors to locate LGBTQ friendly housing, San Francisco Village’s membership model that helps people to age in their own homes by facilitating access to in-home services, co-housing developments that help seniors age in community and home modification programs that help seniors age in place.

4.  Health Risks: Research has shown that senior members of our community report higher rates of chronic illness (diabetes, asthma, HIV) and mental distress (depression, anxiety and isolation) than their heterosexual peers. Living alone and minority stress (living with the chronic stress of stigma) are known to increase a person’s physical and mental health risks.

Solution: Continue to fund LGBTQ senior health and wellness programs.

Click here for full article.

Seniors who live longer generally have some sort of disability or need help at some level of living. Sandy Markwood, CEO of the National Association of Area Agencies on Aging, indicates that the focus needs to be on being able to help these seniors live at home as long as possible as nursing home cost could rise to average $72,000 a year.

Long Term Care at any level, in the home, assisted living or nursing home can add a tremendous cost to seniors and their families.

Read more here.

Why? Because seniors are thought to have a significant amount of money sitting in their accounts.

Financial scams also often go unreported or can be difficult to prosecute, so they’re considered a “low-risk” crime. However, they’re devastating to many older adults and can leave them in a very vulnerable position with little time to recoup their losses.

It’s not just wealthy seniors who are targeted. Low-income older adults are also at risk of financial abuse.

And it’s not always strangers who perpetrate these crimes. Over 90% of all reported elder abuse is committed by an older person’s own family members, most often their adult children, followed by grandchildren, nieces and nephews, and others.

Review our list below, so you can identify a potential scam.

1. Health Care/Medicare/Health Insurance Fraud
Every U.S. citizen or permanent resident over age 65 qualifies for Medicare, so there is rarely any need for a scam artist to research what private health insurance company older people have in order to scam them out of some money.

In these types of scams, perpetrators may pose as a Medicare representative to get older people to give them their personal information, or they will provide bogus services for elderly people at makeshift mobile clinics, then use the personal information they provide to bill Medicare and pocket the money.

2. Counterfeit Prescription Drugs
Most commonly, counterfeit drug scams operate on the Internet, where seniors increasingly go to find better prices on specialized medications.

This scam is growing in popularity—since 2000, the FDA has investigated an average of 20 such cases per year, up from five a year in the 1990s.

The danger is that besides paying money for something that will not help a person’s medical condition, victims may purchase unsafe substances that can inflict even more harm. This scam can be as hard on the body as it is on the wallet.

3. Funeral & Cemetery Scams
The FBI warns about two types of funeral and cemetery fraud perpetrated on seniors.

In one approach, scammers read obituaries and call or attend the funeral service of a complete stranger to take advantage of the grieving widow or widower. Claiming the deceased had an outstanding debt with them, scammers will try to extort money from relatives to settle the fake debts.

Another tactic of disreputable funeral homes is to capitalize on family members’ unfamiliarity with the considerable cost of funeral services to add unnecessary charges to the bill.

In one common scam of this type, funeral directors will insist that a casket, usually one of the most expensive parts of funeral services, is necessary even when performing a direct cremation, which can be accomplished with a cardboard casket rather than an expensive display or burial casket.

4. Fraudulent Anti-Aging Products
In a society bombarded with images of the young and beautiful, it’s not surprising that some older people feel the need to conceal their age in order to participate more fully in social circles and the workplace. After all, 60 is the new 40, right?

It is in this spirit that many older Americans seek out new treatments and medications to maintain a youthful appearance, putting them at risk of scammers.

Whether it’s fake Botox like the one in Arizona that netted its distributors (who were convicted and jailed in 2006) $1.5 million in barely a year, or completely bogus homeopathic remedies that do absolutely nothing, there is money in the anti-aging business.

Botox scams are particularly unsettling, as renegade labs creating versions of the real thing may still be working with the root ingredient, botulism neurotoxin, which is one of the most toxic substances known to science. A bad batch can have health consequences far beyond wrinkles or drooping neck muscles.

5. Telemarketing
Perhaps the most common scheme is when scammers use fake telemarketing calls to prey on older people, who as a group make twice as many purchases over the phone than the national average.

While the image of the lonely senior citizen with nobody to talk to may have something to do with this, it is far more likely that older people are more familiar with shopping over the phone, and therefore might not be fully aware of the risk.

With no face-to-face interaction, and no paper trail, these scams are incredibly hard to trace. Also, once a successful deal has been made, the buyer’s name is then shared with similar schemers looking for easy targets, sometimes defrauding the same person repeatedly.

Examples of telemarketing fraud include:

“The Pigeon Drop”
The con artist tells the individual that he/she has found a large sum of money and is willing to split it if the person will make a “good faith” payment by withdrawing funds from his/her bank account. Often, a second con artist is involved, posing as a lawyer, banker, or some other trustworthy stranger.

“The Fake Accident Ploy”
The con artist gets the victim to wire or send money on the pretext that the person’s child or another relative is in the hospital and needs the money.

“Charity Scams”
Money is solicited for fake charities. This often occurs after natural disasters.

6. Internet Fraud
While using the Internet is a great skill at any age, the slower speed of adoption among some older people makes them easier targets for automated Internet scams that are ubiquitous on the web and email programs.

Pop-up browser windows simulating virus-scanning software will fool victims into either downloading a fake anti-virus program (at a substantial cost) or an actual virus that will open up whatever information is on the user’s computer to scammers.

Their unfamiliarity with the less visible aspects of browsing the web (firewalls and built-in virus protection, for example) make seniors especially susceptible to such traps.

One example includes:

Email/Phishing Scams
A senior receives email messages that appear to be from a legitimate company or institution, asking them to “update” or “verify” their personal information. A senior receives emails that appear to be from the IRS about a tax refund.

7. Investment Schemes
Because many seniors find themselves planning for retirement and managing their savings once they finish working, a number of investment schemes have been targeted at seniors looking to safeguard their cash for their later years.

From pyramid schemes like Bernie Madoff’s (which counted a number of senior citizens among its victims) to fables of a Nigerian prince looking for a partner to claim inheritance money to complex financial products that many economists don’t even understand, investment schemes have long been a successful way to take advantage of older people.

8. Homeowner/Reverse Mortgage Scams
Scammers like to take advantage of the fact that many people above a certain age own their homes, a valuable asset that increases the potential dollar value of a certain scam.

A particularly elaborate property tax scam in San Diego saw fraudsters sending personalized letters to different properties apparently on behalf of the County Assessor’s Office. The letter, made to look official but displaying only public information, would identify the property’s assessed value and offer the homeowner, for a fee of course, to arrange for a reassessment of the property’s value and therefore the tax burden associated with it.

Closely related, the reverse mortgage scam has mushroomed in recent years. With legitimate reverse mortgages increasing in frequency more than 1,300% between 1999 and 2008, scammers are taking advantage of this new popularity.

As opposed to official refinancing schemes, however, unsecured reverse mortgages can lead property owners to lose their homes when the perpetrators offer money or a free house somewhere else in exchange for the title to the property.

9. Sweepstakes & Lottery Scams
This simple scam is one that many are familiar with, and it capitalizes on the notion that “there’s no such thing as a free lunch.”

Here, scammers inform their mark that they have won a lottery or sweepstakes of some kind and need to make some sort of payment to unlock the supposed prize. Often, seniors will be sent a check that they can deposit in their bank account, knowing that while it shows up in their account immediately, it will take a few days before the (fake) check is rejected.

During that time, the criminals will quickly collect money for supposed fees or taxes on the prize, which they pocket while the victim has the “prize money” removed from his or her account as soon as the check bounces.

10. The Grandparent Scam
The Grandparent Scam is so simple and so devious because it uses one of older adults’ most reliable assets, their hearts.

Scammers will place a call to an older person and when the mark picks up, they will say something along the lines of: “Hi Grandma, do you know who this is?” When the unsuspecting grandparent guesses the name of the grandchild the scammer most sounds like, the scammer has established a fake identity without having done a lick of background research.

Once “in,” the fake grandchild will usually ask for money to solve some unexpected financial problem (overdue rent, payment for car repairs, etc.), to be paid via Western Union or MoneyGram, which don’t always require identification to collect.

At the same time, the scam artist will beg the grandparent “please don’t tell my parents, they would kill me.”

While the sums from such a scam are likely to be in the hundreds, the very fact that no research is needed makes this a scam that can be perpetrated over and over at very little cost to the scammer.

CA Healthcare Foundation article (July 2011)
All too often, necessary conversations about the intensity and type of medical interventions patients want at the end of their life fail to occur. In part this is because death is not easily accepted; it’s also due to a health care system that rarely asks patients what they want. Yet without these conversations, and a way to document them, patients can end up on a runaway medical train, undergoing ineffective, unwanted, painful, and expensive treatments while their psychological, emotional, and spiritual needs are poorly addressed.

To help patients have their say if they are unable to speak, CHCF has supported the use of Physician Orders for Life-Sustaining Treatment (POLST). POLST is a standardized medical order form that indicates the specific types of life-sustaining treatment a seriously ill patient does or does not want.

What makes POLST powerful in California is that, unlike a health care directive, it is signed by the patient and physician and becomes a set of medical orders. And unlike a directive, the POLST form moves with the patient as part of the medical record and must be honored across all care settings. When used with an advance directive that names a proxy decisionmaker, POLST would reduce the initiation of unwanted or medically ineffective care, reduce patient and family suffering, and ensure that patients’ wishes are honored at the end of life.

Currently 32 states have implemented POLST or are developing similar programs. A California law in effect since 2009 requires that POLST be honored in all care settings and gives immunity to providers who honor a POLST document in good faith.

Read more here.

Reliable Caregivers believes that the best care comes from the most highly qualified caregivers.  We provide ongoing training for our caregivers to help them learn and grow in their profession.

Caregiver Wellness, Tuesday, August 23rd:

The purpose of this in-service is to develop a greater understanding of the elements of wellness and how it applies to the quality of life for a professional caregiver and their clients.  The attending caregiver will come away with self-identified tools to increase their own well-being as well as that of their client.

• end-of-day exhaustion (mental and physical)
• an upset in the “internal body clock,” causing a biological mix-up between day and night
• reduced lighting and increased shadows
• disorientation due to the inability to separate dreams from reality when sleeping
• less need for sleep, which is common among older adults

Tips for reducing evening agitation and nighttime sleeplessness:

• Plan more active days. A person who rests most of the day is likely to be awake at night. Discourage afternoon napping and plan activities, such as taking a walk, throughout the day.

• Monitor diet. Restrict sweets and caffeine consumption to the morning hours. Serve dinner early, and offer only a light meal before bedtime.
• Seek medical advice. Physical ailments, such as bladder or incontinence problems, could be making it difficult to sleep. Your doctor may also be able to prescribe medication to help the person relax at night.
• Change sleeping arrangements. Allow the person to sleep in a different bedroom, in a favorite chair or wherever it’s most comfortable. Also, keep the room partially lit to reduce agitation that occurs when surroundings are dark or unfamiliar.

Nighttime restlessness doesn’t last forever. It typically peaks in the middle stages, then diminishes as the disease progresses. In the meantime, caregivers should make sure their home is safe and secure, especially if the person with Alzheimer’s wanders. Restrict access to certain rooms or levels by closing and locking doors, and install tall safety gates between rooms. Door sensors and motion detectors can be used to alert family members when a person is wandering.

Once the person is awake and upset, experts suggest that caregivers:

• approach their loved one in a calm manner
• find out if there is something he or she needs
• gently remind him or her of the time
• avoid arguing or asking for explanations
• offer reassurance that everything is all right and everyone is safe

written by the Alzheimer’s Association – Click to view the entire article

Working memory holds information in the mind for brief intervals, an ability essential to mental functioning. The new research reveals that younger brains switch very quickly between two different neurological networks — one encodes short-term memory, while the other is activated when we need to pay attention to something new. For older brains, the switch is harder.

The findings, published in the April 11 Proceedings of the National Academy of Sciences, have some important implications in a world where multitasking is seen as an essential skill.

Researchers at the University of California, San Francisco (UCSF) used sophisticated brain-imaging techniques to uncover why the brain responds differently to multitasking — or remembering to complete a task — after a distraction. And they found that something more fundamental than just memory is involved: The brains of aging adults are far less adept at switching between the two neural networks, one for memory and another for attention.

Using magnetic resonance imaging to track blood flow, researchers asked two groups — one whose average age was 24 and another whose ages averaged 69 — to briefly view a nature scene. When a face suddenly popped up, the subjects were asked to determine the age and gender of the face, and then asked to recall the original nature scene. The brain scans showed that the memory-encoding networks of the younger group fired up again right after the unexpected distraction, quickly refocusing on the nature scene. The brains of the older adults proved more rigid, failing to disengage from the interruption and reestablish the neural connections needed to switch back to focusing on the original memory.

“This study provides the first understanding of the neural brain mechanisms responsible for multitasking and memory in older adults,” says the study’s senior author, Adam Gazzaley, M.D., director of the UCSF Neuroscience Imaging Center. The research also shows that working memory is very fragile, he says. “Over the course of seconds, one interruption erases memory quality.”

The research provides a “biological window” into some of the “inefficiencies” of the aging brain, says Ronald C. Petersen, M.D., neurologist and director of the Mayo Clinic Alzheimer’s Disease Research Center.

Work is already under way in Gazzaley’s lab to develop brain-training software that might help older adults better cope with interruptions.

 Stein, Loren – AARP Bulletin – May 3, 2011

Slide Show Relaxing, Touching the Memory, Music Helps With the Final Transition.Related
Lens Blog: Music in the Face of Death (July 3, 2011) The music begins: a song to hold death at bay, a song to embrace death, or to praise God. A Vietnam veteran asks for a song in Vietnamese. One man asked only for songs with death in the lyrics, to force his family to talk to him about the future. He was ready to talk about it. They weren’t. So the therapist sang Queen’s version of “Another One Bites the Dust.” “Amazing Grace” and other spiritual songs are most often requested just before death.

James D. Williams, 85, of Brooklyn, who is dying of cancer, says, “Right now I am on borrowed time.” A therapist, Charla Burton, visits to sing hymns with Mr. Williams and his wife of 61 years, Daphne, 79. “The Lord has kept me and I am very grateful,” Mr. Williams says. “With the backup of my wife. She holds on to me.” Both were born in Belize, and their songs, part of their spiritual practice, have a joyful Caribbean lilt.

In Oceanside, N.Y., Merle Gross, 73, is dying of breast cancer. Sitting beside an ocean inlet, she and Ms. Burton make selections for a songbook she wants to leave behind. If there is time enough, it will include songs for every member of her family, all the people she loved and her dog, Shayna.

And in a Manhattan housing project, a mother cradles her 6-month-old daughter, Cecilia, and Meredith Traver plays a lullaby on her guitar, softly singing the words, “Papa is going to buy you a mockingbird.”

One of the youngest patients in the program, Cecilia Havre, has a genetic defect, Trisomy 18; half those born with this disorder do not survive beyond the first week of life. The baby smiles at her mother, Chantel Vazquez, and her father, Eddie Havre. Cecilia is deaf, but the music soothes her parents. Cecilia is thriving in hospice — or end-of-life — care and may be moved to palliative care, where treatment may be incorporated.

Rose Vuolo, 86, an Alzheimer’s patient on Long Island, has had visits from Ms. Burton for four months.

Rose rarely speaks. “She has gotten progressively worse,” says her grandson, Paul Motisi. “It’s become constant confusion.” Except sometimes when Ms. Burton visits.

Ms. Burton plays the Cole Porter song “Begin the Beguine” — the lyrics of which even Cole Porter said he could not remember without the sheet music. Yet on a good day, Rose sings along, with perfect pitch and range. It was the song she and her husband danced to at their wedding.

Millicent Wilson, 94, who is dying of colon cancer in the Bronx, stopped singing after her husband died and she got sick, says her son, Mark V. Wilson, who stopped working to take care of her. But because of her music therapist, Yelena Zatulovsky, his mother is singing again.

At the end of a song, she asks him, “Mark, why don’t you dance anymore?”

DeChillo, Suzanne, The New York Times, New York edition, July 4, 2011 – page A14

Goon, Emily. “Catering to their needs” Quirk’s Marketing Research Review Feb. 2011 pg 26

The US Census Bureau projects that every age group from 75 – 100+ will increase from 95% to 902% over the next 25 years! This means adults are living longer… and there will be more seniors 70+ as part of our population than ever before in our history. Considering women are waiting later and later to have children, those 40 – 55 are discovering that they’re responsible for their young children AND their elderly parents; thus, the term “sandwich” generation.

While there are lots of resources to help us raise young children, no one really prepares us for making decisions and helping manage the needs of our senior parents. There are many more options available but none of them are simple as the senior themselves as a point of view that must be taken into consideration.

In general, seniors want to stay independent as long as possible. They want to remain in their home, surrounded by their memories and personal items. While this is an ideal scenario, many adult children become concerned as to their parents’ ability to care for themselves. Thus the most popular question I get asked is “How do I determine when they are unable to care for themselves and need to make a change?”

The simple answer is “bills, pills, spills, and skills.”

Bills: Can your parents keep track of all their bills? Are they paying invoices on time? Are you confident they won’t get any of their utilities or basic services cut off because of failure to pay a bill? Often, the first phone call adult children receive is that it’s “cold in the house” and it turns out the utilities have been cut off because of multiple missed payments. If that’s the case, you need to take immediate care giving action.

Pills: While only their doctor knows the real condition of their health, many seniors don’t always share their most intimate details with their children. If your adult parent is experiencing multiple health challenges, is on a variety of medication, or is struggling to maintain the medication doses prescribed by their physician, it’s time to look at care giving options. Missing a blood pressure medication or mixing up doses of different medications, is certainly cause for alarm.

Spills: According to the Centers for Disease Control and Prevention’s (CDC) National Center for Injury Prevention and Control, 15,800 persons 65 years and older died from an unintentional fall and 1.8 million seniors were treated in U.S. hospital emergency rooms for non-fatal falls in 2005. Or put another way, every hour 1.8 seniors died and every hour 205 were treated in emergency rooms for fall-related injuries. When your adult parent has fallen or is at risk of falling because they are unstable on their feet, you need to look seriously at your care giving options.

Skills: Can your adult parent still drive safely? Can they cook and feed themselves 3x a day with a nutritious meal? Can they get to the grocery store to purchase fresh food items? Is there expired food in their refrigerators or cupboards that they might be continuing to consume? Can they keep accurate track of appointments? If they find any of these skills challenging, you should probably look at your care giving options.

Assisted living (or Residential Care) is for adults who need help with everyday tasks. They may need help with dressing, bathing, eating, or using the bathroom, but they don’t need full-time nursing care. Some assisted living facilities are part of a retirement community, or are close to a nursing home, so the senior can move easily if their needs change.

However, many seniors wish to remain in their homes for as long as physically possible — and to do that safely, many seniors need some type of assistance.

When you hire a caregiver, you’re hiring a professional with companionship skills — one who likes serving, supporting, and being with seniors. They’ve been specially trained to help support individuals’ needs from cooking and light housekeeping, to bathing, dressing, and running errands. It’s difficult to think that a virtual stranger could arrive in your home and immediately fit into the routine of the household, but it is possible. It’s important that the relationship is based on a foundation of trust.