If you’ve been watching TV lately, you may have seen actor Danny Glover or Joe Namath, the 77-year-old NFL legend, urging you to call an 800 number to get fabulous extra benefits from Medicare.
There are plenty of other Medicare ads, too, many set against a red-white-and-blue background meant to suggest officialdom — though if you stand about a foot from the television screen, you might see the fine print saying they are not endorsed by any government agency.
Rather, they are health insurance agents aggressively vying for a piece of a lucrative market.
This is what Medicare’s annual enrollment period has come to. Beneficiaries — people who are 65 or older, or with long-term disabilities — have until Dec. 7 to join, switch or drop health or drug plans, which take effect Jan. 1. By switching plans, they can potentially save money or get benefits not ordinarily provided by the federal insurance program.
For all its complexity and nearly endless options, Medicare fundamentally boils down to two choices: traditional fee-for-service or the managed care approach of Medicare Advantage.
The right choice for you depends on your financial wherewithal and current health status, and on future health scenarios that are often difficult to foresee and unpleasant to contemplate.
“I’ve been doing it for 33 years and my head still spins,” says Jill Selby, corporate vice president of strategic initiatives and product development at SCAN, a Long Beach nonprofit that is one of California’s largest purveyors of Medicare managed care, known as Medicare Advantage. “It’s definitely a college course.”
Which explains why airwaves and mailboxes are jammed with all that promotional material from people offering to help you pass the course.
Many are touting Medicare Advantage, which is administered by private health insurers. It might save you money, but not necessarily, and research suggests that, in some cases, it costs the government more than administering traditional Medicare.
But the hard marketing is not necessarily a sign of bad faith. Licensed insurance agents want the nice commission they get when they sign somebody up, but they can also provide valuable information on the bewildering nuances of Medicare.
Industry insiders and outside experts agree most people should not navigate Medicare alone. “It’s just too complicated for the average individual,” says Mark Diel, chief executive officer of California Coverage and Health Initiatives, a statewide association of local outreach and health care enrollment organizations.
However, if you decide to consult with an insurance agent, keep your antenna up. Ask people you trust to recommend agents, or try eHealth or another established online brokerage. Vet any agent you choose by asking questions on the phone.
“Be careful if you feel like the insurance agent is pushing you to make a decision,” says Andrew Shea, senior vice president of marketing at eHealth. And if in doubt, don’t hesitate to get a second opinion, Shea counsels.
You can also talk to a Medicare counselor through one of the State Health Insurance Assistance Programs, which are present in every state. Find your state’s SHIP at www.shiptacenter.org.
The website offers a deep dive into all aspects of Medicare. If you type in your ZIP code, you can see and compare all the Medicare Advantage plans, supplemental insurance plans, known as Medigap, and stand-alone drug (Part D) plans.
The site also shows you quality ratings of the plans, on a five-star scale. And it will display your drug costs under each plan if you type in all your prescriptions. Explore the website before you talk to an insurance agent.
California Coverage and Health Initiatives can refer you to licensed insurance agents who will provide local advice and enrollment assistance. Call 833-720-2244. Its members specialize in helping people who are eligible for both Medicare and Medicaid, the health insurance program for low-income people.
These so-called dual eligibles — nearly 1.5 million in California and about 12 million nationwide — get additional benefits, and in some cases they don’t have to pay Medicare’s monthly medical (Part B) premium, which will be $148.50 in 2021 for most beneficiaries, but higher for people above certain income thresholds.
If you choose traditional Medicare, consider a Medigap supplement if you can afford it. Without it, you’re liable for 20% of your physician and outpatient costs and a hefty hospital deductible, with no cap on how much you pay out of your own pocket. If you need prescription drugs, you’ll probably want a Part D plan.
Medicare Advantage, by contrast, is a one-stop shop. It usually includes a drug benefit in addition to other Medicare benefits, with cost sharing for services and prescriptions that varies from plan to plan. Medicare Advantage plans typically have low to no premiums — aside from the Part B premium that most people pay in either version of Medicare. And they increasingly offer additional benefits, including vision, dental, transportation, meal deliveries and even coverage while traveling abroad.
Beware of the risks, however.
Yes, the traditional Medicare route is generally more expensive upfront if you want to be fully covered. That’s because you pay a monthly premium for a Medigap policy, which can cost $200 or more. Add to that the premium for Part D, estimated to average $41 a month in 2021, according to KFF. (KHN is an editorially independent program of KFF.)
However, Medigap policies will often protect you against large medical bills if you need lots of care.
In some cases, Medicare Advantage could end up being more expensive if you get seriously ill or injured, because copays can quickly add up. They are typically capped each year, but can still cost you thousands of dollars. Advantage plans also typically have more limited provider networks, and the extra benefits they offer can be subject to restrictions.
The main appeal of traditional Medicare is that it doesn’t have the rules and restrictions of managed care.
Dr. Mark Kalish, a retired psychiatrist in San Diego, says he opted for traditional fee-for-service with Medigap and Part D because he didn’t want a “mother may I” plan.
“I’m 69 years old, so heart attacks happen; cancer happens. I want to be able to pick my own doctor and go where I want,” Kalish says. “I’ve done well, so the money isn’t an issue for me.”
Be aware that if you don’t join a Medigap plan during a six-month open enrollment period that begins when you enroll in Medicare Part B, you could be denied coverage for a preexisting condition if you try to buy one later.
There are a few exceptions to that in federal law, and four states — New York, Massachusetts, Maine, Connecticut — require continuous or yearly access to Medigap coverage regardless of health status.
Make sure you understand the rules and exceptions that apply to you.
Indeed, that is an excellent rule of thumb for all Medicare beneficiaries. Read up and talk to insurance agents and Medicare counselors. Talk to friends, family members, your doctor, your health plan — and other health plans.
When it comes to Medicare, says Erin Trish, associate director of the University of Southern California’s Schaeffer Center for Health Policy and Economics, “it takes a village.”
Although many feel the democratic urgency of voting this election cycle in the US, it is not uncommon to hear, “My vote won’t count anyway.”
Associate Professor of Political Science at SFSU and Researcher, Jason McDaniel addresses the importance of local elections as a “foundation for democracy” and a “pathway to racial-ethnic equity.” Whether it be, city, county, or state jurisdiction, local law supersedes federal law and can more accurately represent the sentiment of its community.
Entrenched in the SF Voting Data, McDaniel cautions that RCV can be a contributor to the confounding nature of ballot response but its results are that of a lower democratic deficit. He finds that complexities within the SF local election and lack of information lowers voter turnout for communities of color.
The US follows the First Past The Post (FPTP) voting system, in which you vote for one candidate and the candidate who receives the most votes wins the election. At the Ethnic Media Services briefing on October 6th, McDaniel reviewed Rank Choice Voting, also known as Instant Runoff Voting.
When RCV is used, candidates are ranked from 1-10 (depending on the number of candidates). If a candidate immediately has an outright majority (50 percent plus one), then that candidate is declared the winner of the election. However, if none of the candidates have an outright majority, then the candidate with the fewest votes is eliminated and their votes are redistributed based on their voters’ second choice rankings. The process continues until one candidate’s adjusted vote number hits an outright majority.
Ranking candidates requires more knowledge of all platforms and of RCV. McDaniels comments, “Reformers who want to change democracy often overestimate what voters care about…The vast majority of voters don’t have strong preferences for more than one or two candidates.” The idea of voters having multiple informed preferences in nonpartisan, local elections is quite novel, unheard of, and is likely a barrier to participation. Research shows that it is possible to recover the loss of voter participation.
Benefits can outweigh the implications of using RCV in a few ways:
This particular method of voting can mitigate “spoiler” candidates, where a candidate that may be a third choice wins an election to a split vote.
The candidate that wins better represents the majority.
Voters can cast “sincere” votes, unbridled by the burden of a “wasted vote”. Independent third-party candidates can be represented by a genuine vote, but if they are dropped during the process of RCV, then another candidate with a similar platform can receive that vote.
It can reduce negative campaigning because it may lie in the interest of multiple parties with resembling platforms to advocate for one another.
It can reduce polarization by rewarding moderate candidates. There is no research to support this yet.
Why stop at local elections?
India, which generally employs FPTP voting, explored a version of Rank Choice Voting in electing their 14th and current President, Ram Nath Kovind. President Kovind is only the second Dalit president elected in Indian history. RCV secured a notable win for someone like Kovind, who overcame countless adversity in his path to a presidential win, while accounting for the public vote in a substantial way. After his win, Kovind addressed the Indian populace, “My win should prove that even honest people can get ahead in life.”
An ongoing dialogue around voting processes can be beneficial for our communities and for reform. If not to change the process, then to better educate everyone around us.
Anni Chung, SF resident and CEO of Self Help for the Elderly, “Rank Choice Voting has always been a mystery to me, even now, after all these years.”
Voting can only be effective if understood. Keep the conversation going and go out and vote this November 3rd!
Srishti Prabha is the Assistant Editor at India Currents and has worked in low income/affordable housing as an advocate for children, women, and people of color. She is passionate about diversifying spaces, preserving culture, and removing barriers to equity.
Are you caring for someone – perhaps an elder – who is seriously ill? Do you look after a disabled son or daughter? Perhaps you’re in the ‘sandwich generation,’ raising children while you worry about and care for a parent? If you answered yes, you’re already in the Caregiver Club. If you said no, consider changing your answer to no, not yet. To quote Rosalynn Carter, President of the Rosalynn Carter Institute for Caregiving, and former First Lady of the US:
“There are only four kinds of people in the world: those who have been caregivers, those who are currently caregivers, those who will be caregivers, and those who will need caregivers.”
The Caregiver Crisis in the United States is rapidly getting worse. Each day another child, spouse, relative, or friend is faced with providing care for someone who can no longer look after themselves because of increased frailty, illness, or trauma. They become responsible for that individual’s physical, psychological, and social needs. Experts warn of the increasing strain this trend will place on society in the coming decades. About 43 million friends or family members in the US are primary caregivers today for adults and children with disabilities, or someone recovering from surgeries and illnesses, or coping with Alzheimer’s and other chronic diseases. Many are themselves aging. Caregivers – primarily women – provide 37 billion hours of unpaid care annually – $500 billion in economic value, according to one estimate. 10,000 baby boomers turn 65 each day. The growing population of people who will need 24-hour personal care has been likened to an approaching “slow-moving tsunami that has no end.”
Caring for a loved one can be enriching and rewarding; the experience creates opportunities for personal growth. Caregiving brings out the best in us; we approach it with love and compassion and are devoted and determined to do our best. However, long-term care demands sustained attention and is physically exhausting and emotionally draining for both the giver and receiver of care. Relationships are affected. Significant changes need to be made in daily lives to adapt to new realities. Caregivers are frequently unable to pursue normal relationships or lead normal lives. Life can become stifling with increased stress and anxiety. Caregivers themselves need support, without which they face burnout or become ill. Caregivers in the South Asian community additionally deal with unique social and cultural issues that need to be addressed in a targeted and sensitive way, making the problem more challenging.
As we grow older, we all want to “age in place;” live safely, comfortably and independently in our own homes and community, in our comfortable environments. The reality is that we will lose this ability at some point. Many of us also worry if another: an aging parent, relative, or friend can continue to age in place. We worry about the day when their ability to manage their own lives independently begins to diminish, and about what would happen then. The question is not if this will happen, but when. These concerns are often triggered by changes we observe in their behavior.
Gerontologists, geriatricians and other aging experts offer excellent advice on how to prepare for such an eventuality – advice we should heed. The first consideration is the elder’s ability to independently care for him- or herself – to carry out what are known as the Activities of Daily Living (ADLs). Can they feed themselves? Move about on their own, get in and out of a bed or chair? Bathe or shower? Use the toilet? Dress and groom themselves? Next, evaluate other activities necessary for independent functioning, known as Instrumental Activities of Daily Living (IADLs). These include remembering things, cooking and preparing meals, cleaning and maintaining the home, shopping and buying necessities, running errands, managing money and paying bills, speaking or communicating on the phone, and correctly taking prescribed medications. If any of these present challenges for your loved one, then he or she needs some kind of support and/or care.
When a concern is identified, experts recommend a family meeting with everyone involved, including the elder, to have open and honest discussions with the goal of getting the best possible care for the elder. Discuss his or her requirements and anticipate future needs. Consider all the available options and constraining factors to meet those needs. These discussions should include financial and estate plans, care planning, and Advance Directives. The costs of keeping the elder at home together with professional assistance if required, have to be weighed against the financial and emotional cost of moving him or her into an assisted-living facility. Perhaps a phased approach could be implemented. If dementia or serious illness are considerations, medical professionals should be consulted and their advice factored into the decision making. The more prepared we are, the more advance planning we do, the less stressful and more rewarding caregiving will be.
If you answered “yes” to my questions above, you’ve already experienced the challenges of caregiving, and I have an important message for you. It’s critical to start with self-care and self-compassion, otherwise, you will burn out. Linda Abbit provides excellent advice in her recent book The Conscious Caregiver. As you take on these roles and responsibilities, she says, it is important that you understand, recognize, and address your emotions. At various times you will feel guilt, resentment, fear, grief, depression, anger, or embarrassment. It is okay if you do. Address your feelings consciously, and discuss them. Be kind to yourself. Make time daily for self-care. Abbit recommends making a happiness list. Put down all the things you like, and make time to enjoy them. Meditate. Adopt breathing practices. Listen to music. Eat healthy and sleep well. Stay active and get exercise. Commune with nature. Practice gratitude. Pamper and reward yourself occasionally. It’s okay to vent; bottling up your emotions will affect your health. It is essential that you accept help – even seek it – from others. You cannot do it all. Delegate to others what and when you can. Be an advocate for both yourself and your loved one. Learn to let go of what you cannot control. By first taking care of yourself, you will be a better caregiver.
The tsunami is coming! Will you be ready?
Sukham Blog – This is a monthly columnfocused on health and wellbeing.
Mukund Acharya is a co-founder ofSukham,an all-volunteer non-profit organization in the Bay Area established to advocate for healthy aging within the South Asian community.
As we become caregivers to our parents, many of us come face-to-face with Alzheimers disease for the first time. The impact of Alzheimers can be devastating on families, with patients, spouses, children and caregivers having to make tough choices from difficult decisions.
K.P. Unnikrishnan, a management consultant who lost his vibrant 70-year old mother to Alzheimers, eventually had to place her in a care-home and endure more than ten years of visits with a parent whose memory of him had faded completely.
Another family shared their story of a mother-in-law who was physically healthy but who kept trying to take a bus out of town.
As some of us approach middle age and are afflicted by a forgetfulness we laughingly blame on senior moments, there is an unspoken fear – what if this happens to me?
Alzheimer sufferers face a gradual decline in verbal skills, forgetfulness, memory loss, anxiety and depression, leading to frustration, irritability and helplessness. As symptoms escalate patients may tend to repeat words or phrases, have hallucinations, show changes in personality, get lost in familiar territory or wander off.
How it presents
Alzheimers presents in two forms. In early onset Alzheimers, symptoms appear before the age of 60. The second more common type is late onset Alzheimers that presents after the age of 60. Rarely does it strike individuals as early as 30, but after the onset of Alzheimers, the average life span is usually about 8 years, though some patients have lived for over 20 years.
What causes Alzheimers?
The cause of Alzheimers is not well understood. Currently tests can help determine what type of dementia some patients have (for those who have an awareness of their problem) and if any treatable action is necessary. Some patients undergo tests to rule out other diseases causing dementia – such as a brain tumor, infection, stroke or a vitamin deficiency.
Can it be prevented?
Despite recent advances however, there are no definite treatments available that have been shown to stop or reverse the progression of Alzheimers.
In the US, FDA-approved medications do help to manage symptoms and delay progression, but currently there is no prevention for Alzheimers.
In recent years, researchers have begun to explore behavioral interventions in preventing and slowing the progress of dementia. Evidence from observational studies show that when people participate in cognitive leisure activities in middle and late life, it may have a protective effect on the development and progression of Alzheimers disease and other dementias.
Research says, ‘stay active’
One prospective study from the New England Journal of Medicine tracked 500 subjects aged 75+ (without any baseline dementia) over a 5-year period; the study evaluated the risk of dementia against a baseline level of participation in leisure activities.
Results showed that those who regularly read, wrote, played board games, solved crossword puzzles, did arts and crafts, listened to music or played a musical instrument had a reduced risk of developing dementia. The study also showed that social dancing was the only physical activity associated with reduced risk.
Research has found that listening to music or playing an instrument can maintain and improve memory. Another excellent way to keep a patient active is to dance to music; it maintains gross and fine motor skills and helps improve balance. Participation in arts and crafts projects that stimulate creativity – molding clay, painting, stringing beads, knitting, crocheting, flower arrangement as well as hobbies like puzzles, reading and writing, – enhance a sense of pride and fulfillment and offer a venue for free expression.
A word of caution
Remember that these activities are not intended to keep a patient busy; rather, treat them as an aid to provide meaning in a patient’s daily life – tools that enable them to learn, play, contribute and interact socially while feeling safe with others.
It’s important too, that the leisure activity chosen is appropriate to the patient’s cognitive skills, language level, attention span and physical mobility limitations. If the activity is too difficult, it can frustrate the patient and if the activity is too simple he or she could feel humiliated and depressed.
The benefits of staying active
These activities have benefits; memory training, using memory devices like word lists or mnemonics, has been shown to have a positive impact in the area of the brain cells that processes memory.
Functional magnetic resonance imaging has shown reverse brain changes in mild cognitive impairment (a precursor state to dementia). The comparison of before and after images of memory training show increased activation and new recruitment of brain cells in this area of the brain.
Any activity that combines mental, physical and social stimulation offers the greatest benefit to patients in whom the illness has manifested. The success of such activities, however, depends on whether the task is meaningful, gives immediate pleasure and helps patients recapture their dignity and respect.
In the interim it seems prudent for those who are elderly and approaching middle age to continue to challenge ourselves in social and physical leisure pursuits and give ourselves a fighting change with the vagaries of aging and Alzheimers.
The information presented in this article is offered for educational and informational purposes only and should not be construed as personal medical advice. You should consult with your personal physician/care giver regarding your own medical care.
Meera Kymal is a contributing editor to India Currents
Once upon a time, our elderly were hard working, productive adults. Then, as they aged, society began to place less value on their existence; adding insult to injury, many elderly today often find themselves in the embarrassing position of being dictated to by their children or carers, without any recourse to self determination.
Self determination is the process by which a person controls their own life. In our youth we have this control and tend to underestimate its value. Only as people age and gradually lose their independence do they realize that self determination matters in how they live the remainder of their lives.
Traditionally in India, the joint family structure allowed for elderly family members to be taken care of organically. But, as industrialization, urbanization and migration changed how societies function, the bond that held families of various generations together began to fracture, become fragile or even become non-existent, leading to the rise of a new paradigm- that many families and communities everywhere face today – how do we as a society create a system that allows for our senior citizens to live their lives with dignity, independence and self determination but with the safeguards of physical and financial security? And how do we deal with the issue of depression that creeps in with social isolation and loss of purpose as people grow older?
After a long and successful career in the tech world, Archana Sharma started Samvedna in 2013 with the aim of making a discernible difference in the lives of seniors. This was very personal for her because her parents are fiercely independent and wanted to live in their own home, but started to find it difficult to do so without some help. Archana first started with a senior activity center but soon realized that many seniors do not have the mobility to avail of its services. It led to her to create her home service enterprise.
Archana defines her mission as “provid[ing] best in class senior care services for the elderly to help them live happy, active and independent lives, in the comfort of their home and community through interactive caregiving.”
Samvedna’s services are concentrated in the Delhi NCR region and have grown over the years to include elder care services, dementia care and counselling services for geriatric ailments, primarily to fulfill the need for in-place aging.
Elder Care services are companionship-based for seniors who live alone but want to live independently. Trained counsellors and social workers visit regularly and encourage activities based on the seniors’ interests. Home management services are also available for general house maintenance.
Another service called General Wellbeing helps seniors with bank visits, medical appointments, managing hospital stays and other social engagements. This service becomes invaluable when the social worker is able to understand and communicate the technical details of a senior citizen’s medical diagnosis.
Deepak, a Bay Area resident, has been using Samvedna for the past four years and says, “They have professionally educated staff who visit my parents regularly. It gives me peace of mind knowing that my parents are being taken care of, and I get a daily email with an update on their condition.”
Samvedna also provides in- home, long term care . In this case, caregivers often live with the family. The in-home attendants are screened by Samvedna and specially trained in the nuances of senior care with sensitivity, especially in cases of dementia.
Samvedna also provides services to help elderly people diagnosed with dementia, as well as support for their caregivers or family. Its comprehensive service starts with a thorough initial neurological assessment, and specific programs are then recommended to the client based on the results, whether it is cognitive stimulation therapy or social stimulation in a group environment. Each care plan is reviewed and monitored regularly within their team of multidisciplinary specialists.
But as Archana says, “early detection is key,” to diagnosing senior citizens accurately, giving them the right treatment and helping families cope with the disease. Unfortunately, either because of the stigma or a general lack of awareness in India, dementia is often not diagnosed until it has progressed to a moderate or advanced stage. Samvedna also has a support group for caregivers, which is invaluable because caregivers are often lonely, depressed, emotionally drained and physically spent while taking care of their loved ones.
The fact is, extended families of seniors lead busy lives, with demanding jobs and long commutes. This 21st century lifestyle has changed the social dynamic of families, whether they live in India, abroad, or even in the same house. As a society, we need to do a better job of acknowledging this and finding solutions to help our senior citizens live a meaningful and dignified life.
Entrepreneurs like Archana Sharma and Samvedna are doing just that.
Anjana Nagarajan-Butaney is a Bay Area resident with experience in educational non-profits, community building, networking and content development and was Community Director for an online platform. She is interested in how to strengthen communities by building connections to politics, science & technology, gender equality and public education.
Nishka Ayyar was named Daily Point of Light Award Number 6213 by Points of Light, the world’s largest organization dedicated to volunteer service. Nishka Ayyar received this recognition for her ongoing commitment to working with elderly seniors and promoting inter-generational connections between youth and seniors in her community.
Music Buddies is a student run volunteer initiative founded by Nishka Ayyar of Saratoga, CA. Inspired by the relationship she shared with her own grandparents and their positive influence in her life, Nishka started Music Buddies to bring companionship and joy in the lives of elderly people who live alone or in senior communities, separated from their families. Her organization enlists student performers from middle and high schools across the Bay Area and puts together fun weekend entertainment programs for the senior citizens. The program typically runs for about an hour and includes music, dance, stand- up comedy etc.
“I am delighted to receive this award and honor. I feel very fortunate to live in a community where volunteerism and service are highly valued and many parents and kids participate enthusiastically. The Music Buddies experience reinforces my belief that by bringing our oldest and youngest citizens together, we can mitigate many social isolation issues of both the seniors and the youth alike, and build healthy and happy communities everywhere.”
Daily Point of Light Awards are given five days a week in the United States and the United Kingdom to honor individuals and groups creating meaningful change to meet community needs; efforts which often lead to long-term solutions and impact social problems in their local communities. President George H. W. Bush was the first president in American history to institute a daily presidential recognition program from the White House, conferring 1,020 Daily Point of Light Awards on citizens and organizations making a big difference in other people’s lives and solving community problems. Points of Light continues the recognition and honorees receive a signed certificate from President Bush. The 5000th award was presented at a special ceremony at the White House with President Barack Obama and President George H. W. Bush co-presenting. The nonpartisan award was adopted by former Prime Minister of the United Kingdom David Cameron in 2014, and the tradition has continued with his successor Theresa May. More than 6,500 Daily Point of Light Award recipients have been recognized in the United States and the United Kingdom.
“The Daily Point of Light Award recognizes exceptional individuals who are using their time, talent, voice and treasure to improve the lives of others,” said Jaqueline Innocent, Vice President, Recognition Programs of Points of Light. “These points of light, like Nishka Ayyar, make an impact on individuals while also helping build resilient communities.”
“We have a lot of requests from senior centers all over the San Francisco Bay Area and we are constantly looking for student performers to join us. We invite student performers from all over the Bay Area who are interested in participating, to join and help us celebrate our senior citizens and bring joy in their lives through these interactions and performances. Interested performers can join by submitting the student performers form on the website.”
To learn more about Nishka Ayyar’s work, visit www.musicbuddies.org or write to email@example.com.
About Points of Light
Points of Light, the world’s largest organization dedicated to volunteer service, mobilizes millions of people to take action that is changing the world. Through affiliates in 250 cities and partnerships with thousands of nonprofits and corporations, Points of Light engages four million volunteers in 30 million hours of service each year. We bring the power of people where it’s needed most. For more information, visit www.pointsoflight.org
Splayed on 75-year-old Kamala Krishnan’s bedside table are three books: Life After Death by Deepak Chopra, Reaching to Heaven by James Van Praagh, and Love and Death by P. Rajagopalachari. These books are a constant reminder that the hereafter is no further than an arm’s reach away.
Krishnan’s is the typical story of the elderly Indian American immigrant. After the death of her husband, she moved to America to live with her daughter. “Truly, I wish to die and not trouble her like this,” says Kamala Krishnan, with a betraying quaver to her voice.
Krishnan’s daughter, Kshetra Srinivasan, admits that this exhortation frequently occurs and usually accompanies a disagreement over something as trivial as a dinner menu that might consist of something as egregious as a green salad. “In India, only cows eat raw food like let-tooce. Here…” Krishnan shakes her head with patent dismay. It’s not really the salad that is the subject of the discourse between mother and daughter. The subtext is helplessness, loss of independence, cultural chasm, and a normalizing process that is frighteningly unfamiliar.
Seniors who immigrate to the United States to live with their children face the daunting challenge of having to adapt to a new way of life. Their frame of reference is limited to their families who, more than likely, are ambivalent custodians of tradition and culture. These seniors face language problems; receive limited or no economic or health benefits; encounter family conflicts; are not fully aware of programs for seniors and are at a loss to spend their time productively. They feel lonely and fall victim to depression and delirium.
Dr. Rita Ghatak, Director of the Geriatric Health Services at Stanford University Medical Center, confirms the cultural issues embedded in older adult care. “Listening and quiet acceptance go a long way,” she replies to my question of how our generation should cope with supplanted elderly parents.
The brochure that is handed to Stanford Hospital patients has this introduction to her program: “Welcome to Aging Adult Services (AAS) at Stanford. This is a program devoted to meeting the needs of older adults and their families and providing them a continuum of care with support and resources.” What leaps out at me is the phrase “and their families.” It seems a much-overlooked aspect of adult care. “The family is the advocating unit for adult care,” Ghatak emphasizes.
Usually medical advice is sought as a last resort among South Asian families. As adults age, common symptoms like tiredness, apathy, and memory loss mask parameters of more chilling diseases such as Alzheimer’s, dementia, and chronic depression. Families are fooled into believing that these issues are part of the natural process of aging. “Besides, anything to do with mood and cognition has stigma associated with it,” Ghatak adds. So even if families are in the know, they sometimes don’t seek medical attention.
Ghatak relates a case where the parents immigrated to the United States to live with their children. The father, who had undiagnosed borderline dementia, had trouble adjusting into the affluent (and isolating) neighborhood, which exacerbated his condition. The family was forced to address the father’s ailment the day he went for a walk, got lost, fell, injured himself, and was taken to Stanford Hospital. The doctors at the emergency diagnosed and put him on a treatment course for dementia, which worked well. But once he got discharged the follow-ups were not performed. Besides overcoming the stigma surrounding the diagnosis of dementia there was the more practical issue of medical insurance coverage.
Insurance is such a huge problem that internist Caroline Stratz blames the system for failing the elderly, calling it, “the Mediocrity of Medicare.” In a heartfelt piece she wrote for the Los Altos Town Crier on January 20, 2010, Stratz agonized about having to withdraw from Medicare because of the steep drop in reimbursement rates. “When I started my practice nearly 10 years ago, colleagues advised me against accepting MediCare patients because reimbursement rates are low.” But Stratz held on to her ideals about the kind of medicine she would practice. Then this year, Medicare reimbursements dropped by a further 20 percent and she could no longer justify the lowered compensation.
The price of healthcare is so steep that, without insurance, the elderly have few options. It is estimated that in 1996, average annual managed care spending for depression was $6,777 and for dementia it was $11,114.
So what is the solution? According to Ghatak, to forestall medical costs, the elderly need a regimen of good diet, good exercise, and engagement with the family, community, and society.
Sarada Sankaran’s story is a textbook case of engagement. She is 71 years old and is a self-confessed computer addict. She habitually delves into the brightly lit stratum of our sphere that we call connectivity via cell phone, email, Facebook, and a blog. She drives, watches CNN/MSNBC, practices yoga daily, goes to the library, and is currently working on a Tamil drama script. She is sprightly, alert, and converses with her college-age grandchild well beyond the midnight chime of the grandparent clock. “I’ve adapted to this culture,” she says, “I have no qualms about shedding the sari and donning sweatpants. I’m in this country for my grandkids and I need to be able to relate to them. I believe in the power of now.” Truly amazing! But hers is not the typical story; it is the inspirational one.
Most elderly parents in the South Asian community help the family unit in definable ways: housekeeping, cooking, babysitting, helping with homework and, in some cases, driving grandchildren to activities. It is when role, responsibility, and ownership are not clearly defined that problems crop up. When Krishnan moved into her daughter’s house, she happily took on the task of cooking for the family. However, as the grandchildren grew into teenagers, the idea of eating grandmother’s freshly prepared Indian meals daily challenged their assimilated palates. Krishnan’s role in the household slowly began to erode, leading to her morbid fascination with death and despair.
Isn’t depression just part of aging? According to National Institute of Mental Health, temporary emotional experiences of sadness, apathy, grief, and despondency are normal. However, if these conditions persist, and they interfere significantly with the ability to function, then treatment should be considered. To recognize that a problem exists is the first step to a cure. In most cases, that is probably the hardest step. When parents are burdened with the demands of jobs and rearing young kids, the needs of elderly grandparents are bundled and swept behind the phrase “when I have the time.”
There is a glow in Krishnan’s eyes as she returns from a trip to the grocery store. “The girl there recognized me,” she says sounding breathlessly like a young girl herself. “She gave me this packet free!” Krishnan reaches inside her bag and pulls out a packet of biscuits. Such a small gesture, with such a large reach.
According to Himanshu Rath of Agewell, a charity providing support to the elderly in India, “Collectively we celebrate the old. At home, we often ignore them. We say: ‘Have you had your medicine? Have you eaten?
Here is the remote control.’ And then we get on with our own lives.”
Initiator of the punctuated Google group, THATHA’s “R” US (thatha means grandfather in Tamil), Krishnamachar Sreenivasan understands how easy it is to fall into a blue state. His resume lists The Mitre Corporation, SRI, Hewlett Packard, and Agilent as employers. He is considered an expert in the field of computer performance evaluation and analysis of multiprocessors. The weeks following his retirement, however, his achievements were cold comfort. “I woke up in the morning and the only thing I changed was my remote battery.” It took great effort and considerable control before he came to grips with his changed situation. “I realized that there’s an unfavorable bias towards seniors. I had to do something to impact people around me.” He started a radio show on KLOK 1170 AM, a community service call-in program that airs every Wednesday from 11 to 12 pm every week, which aims to connect volunteers with those who need help.
Shifting the lens to the other end of the generational view, I queried some teenagers on living with elderly grandparents. “I love my grandmother, but I don’t understand her and she doesn’t understand me,” said a 14-year-old, adding, “She obsesses about food.” A college graduate explained that it was nice to find the warmth of her grandparents when she came home from school. “Not that I shared deep emotional moments with my grandparents,” she added. Her grandparents were there through her middle school and high school and she grew up with lots of religious events, good Indian food, Indian music, and Indian television.
Hesitatingly, she admitted that she’d been more attuned to their company when she’d been younger, but by the time she left for college, there was a large language, cultural, and generational barrier. “I did envy my Caucasian friends who were able to share a deeper emotional bond with their grandparents that was not complicated by language and culture.”
In September 2009, New York Times columnist, Patricia Leigh Brown wrote an article about the 100 Years Living Club, an all-male Sikh group of elderly immigrants. The group meets regularly at a mall in Fremont, Ca. to stave off feelings of isolation and alienation. According to Brown, late-life immigrants come to the country clinging to hopes and dreams of family togetherness, only to find that American society isn’t responsive to these cultural expectations.
A Growing Trend
Studies indicate that America’s ethnic elderly are the most isolated group in America and, yet, this group continues to grow. According to the 2007 census, one in three California seniors is foreign-born. It is estimated that the elderly constitute four percent of the global population (419 million) and there are approximately 350,000 Indian American elders, nationwide.
In his book gravely titled The Gray Dawn, Peter G. Petersen argues that, with the increase in life expectancy and decline of birth rates, the numbers of seniors will continue to grow, creating a demographic shift. The magnitude of this shift will result in seniors outnumbering the working age population. This will have a dire consequence on the economies of developed nations. This is partially borne out in Japan where it is predicted that, by 2015, one in four Japanese citizens will be 65 or older. As this shift in balance continues to dilate, Japan is looking at its trade surplus withering into deficit, driving industry and innovation overseas.
As public policy shifts are considered, ethnic seniors need to be part of the proviso. This group’s spiritual, physical, and psychological well-being becomes a critical parameter to social and economic prediction.
Local programs like the Community Ambassador program for Seniors (CAPS) and the India Community Center(ICC) offer a plethora of possibilities for seniors. ICC’s seniors program is designed around clubs and activities from simple socialization, yoga, and Bollywood dancing to round table discussions. Sankaran is an active member of the ICC senior program. Krishnan is a registered member, but finds it difficult to make it to the sessions. Krishnan informs me that conversations at the ICC Senior Center are wince- and wonder-worthy, ranging from daughters, daughters-in-law, financial crises, recipes, oil spill, medical problems, travel to India, and Bombay Jayashree ( a Karnatik music vocalist). Everybody is encouraged to participate.
One Friday afternoon I see Outreach cars pull in like grand limousines at the ICC-Cupertino parking lot. From these cars the elderly slowly emerge like stars, dressed in swathes of silk and serge. They grandly ascend the steps to the facility. I watch the way they enter and mingle with each other. This time, place and moment is theirs. They own it. I quietly leave, reminding myself that my time is just around the corner.
(Names of seniors have been changed at their request to preserve anonymity)
Jaya Padmanabhan is a prize-winning fiction writer and is currently in the process of writing a novel.
Hindi movies like Baghbaan and Lage Raho Munnabhai pillory the boomer generation for contemplating nursing homes, assisted living facilities, and retirement homes for their elderly parents. Newspapers decry the oursourcing of senior care with articles titled “Old Age Homes Against Our Culture.” But the times, they are a-changing. The harsh critical glare of disapproval is dissolving under the circumstances of nuclear double-income family units. Living in elderly group housing with nurses and doctors on call and the ability to talk about “the old days” is sounding more and more attractive. Canadian resident Saroj Sood voluntarily opted to live in a South Asian Assisted Living facility in Surrey, UK. She quoted the Vedas as justification for her move. Sood explained how the last of the four stages of a Hindu life, the “sanyasa” stage, requires renunciation of society and meditative solitude.
In the United States, South Asian elder institution options are limited to just a handful. In my research, I was able to source only two: AristaCare Nursing Homes, catering to elderly Indians, with three locations in New Jersey and Pennsylvania, and a retirement facility, ShantiNiketan, in Tavares, Florida. ShantiNiketan is advertised as a retirement community for Seniors of Indian origin. Iggy Ignatius, the founder of the community project, says that he wanted to give it an “ashram” feel. The gated property consists of 54 condominiums, 35 of which are sold. There are Assisted Living facilities in the Bay Area catering to other ethnicities: Aegis Gardens in Fremont for elderly Chinese and On Lok Senior Health Center in Oakland for Filipino Americans, but none for South Asians. Is our diaspora equipped to handle the growing numbers of elderly?
Outreach’s Senior Transportation Program offers transportation options for seniors that can take them to any destination within the county. http://www.outreach1.org/seniors/seniors_mainpage.html. (408) 436-2865
India Community Center
With locations in Milpitas, Cupertino and Fremont, the India Community Center offers yoga classes for seniors, round table discussions, Jollywood dance classes opportunities to participate in theater, knitting club, bridge club or even a computer class. Subsidized lunches are provided to seniors as part of the program.(408) 934-1130 or check the website: http:indiacc.org/node/293
CAPS – Community Ambassador for Seniors Program
CAPS ambassadors serve seniors and their families by assisting with questions related to identifying local resources, programs, and services in the Tri-City area (Fremont, Newark, and Union City, Ca). Senior Helpline: (510) 574-2041
Stanford’s Adult Aging Services (AAS)
Stanford’s AAS program offers consultations, assessments, home visits, and general outreach assistance. Here is a list of some of the options:
• Geriatric Out-Patient Clinic and Consultation Service (650) 387-6777
• Dementia Support Program (650) 723-1303
• Partners in Caring (650) 725-4137: A program that helps older adults in their homes
• Strong for life (650) 725-4137: A muscle strengthening exercise program
National Indo-American Association for Senior Citizens (NIAASC)
National Indo-American Association for Senior Citizens (NIAASC) started in 1998, serves Indian American seniors across America, “through information, referral and advocacy services.” http://www.niaasc.org/
Seniors are encouraged to visit Artesia’s Senior Center where they can form clubs and intermingle. The two big deterrents for South Asians, language and diet, were addressed by the Oldtimer’s Foundation, a community-based organization that began serving a weekly vegetarian Indian meal, cooked by a local restaurant owner and paid for by the county’s office of aging. (662) 272-5276
The elderly Indian man wanders through the neighborhood, talking to himself and pausing uncertainly every now and then. His clothes are soiled and his eyes are vacant. A neighbor, observing him from behind the blinds of her living room, sighs. This is the third time in 10 days that she has seen him outside, unaccompanied and obviously disoriented. The old man lives next door. His son and daughter-in-law are away at work, their children in school. The neighbor knows that no one will be around till 5:30 p.m. She reaches for the phone to call the police.
Ill and aging parents. A heartbreaking reality that most of us will have to cope with sooner or later. The inevitable reversal of roles, as the hands that once deftly buttoned our shirts and led us confidently across a crowded street, now reach out to us for help in performing the basic tasks of daily living.
It is estimated by the U.S. Administration on Aging that a full 25% of all households in the country are involved in caring for a family member, usually a parent. While the number may not be quite that high in the South Asian community, it is nevertheless increasing rapidly, as more and more families are choosing to bring aging parents and relatives from their native countries to live with them permanently.
Typically, the caregivers are adult children with kids of their own, often known in the media as the “sandwich generation”—caught between childcare and elder care. Research has shown that almost 65% of women in this country will have to deal with extensive or partial elder care issues.
Chandra Deshmukh, a Marin County resident thinks that “sandwich” is an apt description of a person in her circumstances. “I have two little kids and a father who is often in hospital with complications from diabetes,” she says. Her father lives in Houston, Texas with her older sister, and Deshmukh has already flown to Houston three times this year to help with his care “dropping into my husband’s lap the kids, their homework, dinner and piano lessons.” She says she has learned to live with a constant sense of guilt, feeling inadequate at work and incompetent at home. “There is this nonstop worry in my head that I am not doing enough for anyone—my kids, my husband, my employer, or my father, whom I am very close to,” she adds.
According to Rita Ghatak, a Palo Alto based psychologist and specialist in elder care, guilt is a very common feeling among adult caregivers. “The feeling of helplessness and guilt can be overwhelming at times and in trying to take care of everything themselves, these women, (and most of the caregiving is done by women aged 35 to 50), fail to look after their own needs,” she says. Ghatak knows, because she has been there herself. For 14 years, she was a long distance caregiver to her parents who lived in India. In that time she flew to Delhi 16 times to take care of, first, her father who suffered from Parkinson’s disease, and then her mother who suffered a stroke in 1995. “I was completely stressed out,” she remembers ‘There were times when I was so tired and worried that I could not think straight. I wanted to be in both places at the same time.”
Ghatak is also CEO of Older Adult Care Management (OACM), a private organization founded over 15 years ago, and considered a pioneer in the field of elder care. The organization provides a comprehensive care program for adults through quality home care services like trained health aides, family counseling, case management services, and elder care education. OACM has virtually no South Asian clients, because, Ghatak says, they are largely unaware of the variety of elder care resources available in the community. “It is not that they want to be ignorant, it is just that they do not know where to go for the information. Sometimes a parent’s illness catches us unawares and we are unprepared to handle it,” she says. Lack of information led to less-than-desirable situations like the one described at the beginning of this story. In this case, the elderly man was referred by the police to the county-run Adult Protective Services. In turn, OACM was contacted and Ghatak ended up sending an information packet in the mail to the caregivers. She never heard from them but she hopes that the family was finally able to get some help and take care of their father.
When it comes to taking care of one’s parents, most adult children are lost in a maze of emotional and logistical issues. Some diseases like dementia (a common form of which is Alzheimer’s disease) or Parkinson’s disease, both of which are on the rise worldwide, according to the World Health organization, make home-based caregiving especially difficult. Still, how can one send a parent to an outside facility? Will that not amount to abandonment? How would the parent take it? What about the cost: emotional and financial? Decisions like these are hard to make and even harder to justify to relatives and siblings who are watching from the outside.
Using trained help, strangely enough, is one of the last options considered by many South Asian caregivers. “It is expensive but more importantly it could be seen as pawning off your responsibilities,” remarks Deshmukh, whose has just succeeded in persuading her reluctant sister to hire a door-to-door service to take their father to the doctor for regular appointments. However, using trained help could ward off potentially dangerous situations. “If I had to do it again, I would definitely use trained help,” confirms Inderpal Grewal, a full time professor and mother of two little girls living in El Cerrito. Grewal had just given birth to her second child when her mother, who suffered from acute rheumatoid arthritis came to live with them. To Grewal, it was spotting the little things that could prevent the bigger things from happening that drove her crazy. “I was always worrying about things. Are the bars in the bathroom safe? Is the house too cold? Is the bed okay?” she says. “In spite of all this my mother caught pneumonia, because we had not kept the house warm enough. Old people are more fragile than they appear.” Subsequently, her mother went to live with another sibling in Connecticut where a home health aide came to look after her needs several times a week.
Taking care of a parent can create stress and awkwardness between siblings.
Rashmi Rustagi is a stay-at-home mother of four in Palo Alto. Her children range in age from 5 to 15 and take up much of her energies and time. Rustagi’s parents live with her. Last year, her mother suffered a stroke and became almost bedridden, needing constant care. The subject of who would be the main caregiver came up often at family discussions with the other siblings. Though each of them make financial contributions towards their mother’s health care, Rustagi feels that she was chosen because “most often it is the sister who stays at home or is the wealthiest who gets to take care of the parents. The others plead work pressure, or lack of space or money.” Rustagi feels a little taken for granted because she ends up putting in so much more effort and time than her sisters and brothers do. Lately, she says, she has taken to keeping a log of the time she spends looking after her mother’s needs like taking her to doctor’s appointments, or the physical therapist. “Not the expenses, mind you, just the time,” she hastens to add. “And one of these days I am going to show it to my siblings just to let them see for themselves how much effort it takes to just keep things going.”
To many South Asians, taking care of a family member might mean flying half way around the world several times a year. As Ghatak testifies from her experience “it takes a heavy toll on your family life.” Even so, bringing the family member over to the U.S. may not be a logical solution because of the high cost of health care and the emotional cost of uprooting the person from her native culture. In addition to this, says Grewal, the person often finds herself confronting a racist health care system in America, “one that believes that most immigrants are out to rip off the system.”
Pradeep Joshi, a co-founder of the IndoAmerican Community and Service Center (IACSC), and a commissioner serving on the Senior Care Commission of Santa Clara, agrees that seniors who come over from India have to deal with isolation and a loss of empowerment. “And without MediCal, healthcare is prohibitively expensive,” he stresses. “A recently passed immigration law states that those seniors who immigrated to the U.S. after October of 1996 are not eligible for Supplemental Security Income (SSI) or MediCal. This will definitely have a negative bearing on family decisions to bring a parent over.”
All too often, the “sandwiched” adult, torn between making time for the kids and the parent, feels like the rope in a tug-of-war game. Ghatak suggests a few simple guidelines to make the task easier. Planning ahead is the essential key to elder care management. Confront the situation and talk about it and if the parent is capable, involve him or her in the decision. Scope out the services available in the community, clubs, recreational centers, senior centers, and groups that the parent might be interested in joining. If the parent is handicapped or suffering from a debilitating disease, look into the possibility of hiring home care aides. And above all, make time for yourself, to exercise, socialize, rest and maintain recreational outlets. Lack of proper care of oneself might lead to stress-related illnesses like chronic headaches, ulcers and depression.
With over 200,000 South Asians in the San Francisco Bay Area, it is inevitable that senior support networks are springing up within the community. Apart from sporadic activities organized by the local temples, mosques and gurudwaras, the Icse in Santa Clara runs an excellent senior program that stresses independent living. The Center hosts lecture programs, yoga classes, computer and writing courses and a variety of social activities for South Asian seniors from day outings to cultural programs.
Looking after a relative or parent can be an enriching experience and the ultimate expression of love and compassion from one human being to another. Deshmukh’s children are learning this valuable truth as their mother packs her bags for yet another trip to see their grandfather. In the Rustagi household, life is just a little richer, as grandparents and children learn to share their living space and their experiences with each other. “It finally boils down to this-there really is no right or wrong way to do things. Accept your limitations and just do the best you can,” states Ghatak.