2,500 Shades of Grey

First published in the San Francisco Bay Times
http://sfbaytimes.com/2500-shades-grey/ 

Recently I attended the annual Aging in America Conference, hosted by the American Society on Aging (ASA). Movie puns aside, aging issues are multifaceted, and dare I say, exciting.

Each year the ASA conference hosts over 2,500 professionals in aging— from social workers, educators and administrators to lawyers, self-identified “policy wonks” and a myriad of corporate sponsors. There are panels on caregiving, spirituality and aging, policy and advocacy, mental health and aging, and more. Pricey private homecare agencies vend their services, and start-ups hock high-tech senior gear. Still, the spirit and much of the content of the conference reflects an ethos grounded in the grassroots and that is highly alert to issues of social and economic justice.

In “Aging A–Z: Inequality, Power, and Resistance” we heard from ASA Board Chair Bob Blancato, who detailed the Trump administration’s efforts to eliminate critical senior services. Blancato urged us to take action: “We should never forget the importance of grassroots responses to these challenges.”

According to Blancato, despite administration attempts, and due to advocacy efforts on the part of aging activists and everyday people nationwide, funding for critical programs like Meals on Wheels were ultimately maintained, and in many cases, augmented. Blancato told the crowd, “Trump has moved to engage people.”

Author Nicholas Di Carlo, LCSW, coauthor with Carroll Estes of the upcoming Critical Aging Policy: A to Z, called on attendees to engage seniors in collective action. Referencing the current administration, he said, “This time period has been a master class for thinking about social welfare, power, trauma, and the importance of collective memory in the process of resistance.” Or, as another presenter decried, “We have to get political. It’s not just for children!”

The conference brought a wide-ranging view of issues to the fore, with over 800 presenters—from topics like, “Ending Senior Poverty: Why We Can’t Wait,” and “What’s in a Dress? A Cross-Dressing Case Study for Elders,” to “Emerging Trends in African American Male Caregivers.”

As a therapist, I was drawn to the panels on Mental Health and Aging. We know that older adults face significant barriers to mental health care. Further, certain populations, including LGBT elders and elders of color, are at increased risk for a variety of mental health challenges while facing additional barriers to care.

A history of abuse and stigma within mental healthcare prevents some from seeking help. Jill Gover, PhD, Director of the Scott Hines Mental Health Clinic, LGBT Community Center of the Desert, reminded attendants of so-called “conversion therapy.” Gover said that “there’s still a great deal of mistrust. We have to remember that ‘mental health’ practitioners were the enemy.”

In “Aging and Mental Health: A Collection of Voices,” Denise Boston, PhD, and Dean of Diversity and Inclusion at the California Institute of Integral Studies, urged therapists to ensure that a multiplicity of voices inform our work. According to Boston, to treat diverse needs, clinicians must work to understand clients’ intersectional identities, including age.

Fielding a question from the audience about how to communicate “cultural humility” to a client, Boston quipped: “What’s needed is more than cultural humility, it’s cultural responsiveness. It’s: How are you gonna advocate for justice?” Referencing the recent police killing of Stephon Clark, an unarmed black man in Sacramento, she asked the room, “Will you show up for Black Lives Matter? With what we know about the trauma of the prison industrial complex, will you work for prison reform?”

Fellow panelist Doreen Maller, LMFT, PhD, and Chair of Holistic Counseling Psychology at John F. Kennedy University, stressed the need to look at mental health as societal and cultural health. According to Maller, “Therapists need to work more like social workers; think outside the consult room. Agencies have boiler plate protocols, but clinicians need a range of approaches to really ‘meet the client where they are.’”

One clinician working in a retirement community in the Bay Area piped up. “I struggle,” she admitted. She then asked, “What’s an appropriate setting for an 85-year-old who needs to be wheeled up to his room (regularly) because he’s had too much to drink? The treatment programs are full of younger people and the issues are different!”

Kathy Langsam, MA, Senior Adjunct Professor at Golden Gate University, agreed. Treating substance abuse in senior communities requires tailored services. Fortunately, said Langsam, we are finally seeing alternatives to the AA model. Harm Reduction (a model based on clients’ willingness to work toward less harm, but not requiring abstinence) has gained traction. Still, AA or abstinence-only programs are what’s available to most seniors. This is especially true for seniors who live in nursing homes and residential communities.

“They won’t spend money on harm reduction groups, but they’ll let us play bocce ball,” quipped Maller to nods and applause.

In “Using the Strengths and Resiliency of LGBTQ Elders of Color to Create Change,” Aundaray Guess, MAPR, Director of Programs at GRIOT Circle, a Brooklyn-based organization serving LGBTQ seniors of color, declared, “We don’t do bingo! … Our members have so much more value—to put a card in front of their face doesn’t speak to their lives.”

Unfortunately, even if agencies offer programs that speak to the needs of diverse elders to combat issues like social isolation or mental illness, barriers in access keep many out. Most seniors can’t afford to pay full-fee for mental health services and many subsidized social services, when available, are eligible only to the very poor.

Many providers want to serve older adults, but end up opting out of programs like Medicare, overwhelmed by the red tape and disincentivized by low reimbursement rates. I have personal experience attempting to navigate the labyrinthine “credentialing process” to become a Medicare provider. After innumerable hours on the phone and online, I’m still working on it.

But there’s good news: a lot of great work is taking place. Locally, Valerie Coleman, Program Analyst with the Department of Aging and Adult Services, spoke of engaging “nontraditional partners,” such as merchants and universities, to ensure age-friendly city planning. Shireen McSpadden, Executive Director of the Department of Aging and Adult Services, and Marie Jobling, Executive Director of the Community Living Campaign, shared plans for the roll-out of San Francisco’s “Dignity Fund,” which sets aside a growing portion of local funds for senior and disability services.

From providers using cognitive behavioral therapy for chronic insomnia and free in-home therapies to reduce depression, to innovative programs like GRIOT circle’s “Still Standing”—a program training LGBTQ seniors of color in public speaking and community-based health education—change is afoot.

As Jose Albino, director of programs for GRIOT, said: “We enlist the seniors in our agency. It’s a great time to embolden our communities. We’re riled up!”

Fairley Parson, LCSW, is an aging-advocate and psychotherapist in private practice in San Francisco. She can be reached at fairleyparsontherapy.com