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Job and care services to immigrant elderly on chopping block in California.

Byline: Harvey I. Barkin

SAN FRANCISCO -- They're not the right age. They don't have trendy achievements you can e-blast. And not too many people want to talk about them. Sandy Close, New America Media (NAM) executive director, calls them society's new invisible members. Many speak languages other than English, and they include elderly Filipinos.

They live in the periphery, teetering at the edge of the poor house. "They're one step away from the poorhouse. One health problem away from it. One lost job away from it," says Senior Community Service Employment Program (SCSEP) Director Roxanne Murray.

These are the elders aged 55 years and over. The Family Service Agency (FSA) of San Francisco captured their plight on video, entitled "A New Class of Poverty."

More than half of unemployed older workers have been looking for jobs for more than two years. And according to a National Academy on an Aging Society research brief, "nearly three-fourths of workers ages 47-65 remain in the work force-the highest proportion since 1950."

"You realize that in order to get a semblance of a quality life, you must continue to work well into your 70s and 80s. I just had a 91-year-old woman exit our program," says Murray. "This is not the American dream we anticipated. We prepare people for employment through work training with non-profit organizations and some public institutions ad agencies."


FSA serves over 400 individuals and their families "who, without intervention, would have been homeless or jobless without access to resources," says Murray. FSA serves "a proportionate ethnic, gender, racial, LGBT and disabled population of San Francisco and Marin County. Many of these individuals had been gainfully employed prior to the Recession. I get lawyers and engineers."

"It changed in 2007," she says. "Access to jobs became more difficult and it became our goal to help these senior workers find the pathway to jobs. We used to serve the traditional low-income. Now we've expanded to include the new low-income."

Older workers also have growing rates of underemployment (working part time but desiring full-time jobs), hidden unemployment (not seeking but want unemployment), and mal-employment (working at jobs well below their education or career level). In 2010 nearly one million low-income older adults were in this underutilized pool, yielding an underutilization rate of 39 percent, according to a study.

Even with the numbers screaming for help, SCSEP's budget was cut from $2 million to $1 million in June last year.

Language barriers

Recently, NAM held a media briefing on the Bay Area's vulnerable ethnic elders-vulnerable in the sense that these elders have Limited English Proficient (LEP) capacity and they still have to contend with the Great Recession.

More than 3.3 million of America's seniors do not speak English as their primary language. A partial language breakdown by the National Senior Citizens Law Center (NSCLC) puts at the top: Spanish, Armenian, Chinese (including Cantonese and Mandarin), Russian, Vietnamese, Tagalog and Farsi.

To the immigrant young and mobile tech worker, language is a job barrier that must invariably be conquered. But to vulnerable ethnic elders, it might as well be a wall obstructing access to necessary healthcare services. Like understanding medical appointment dates and locations on complex forms that NSCLC Staff Attorney Anna Rich says she would find hard to understand. Or navigating through the impersonal extension mazes of telephone-accessible service.

Like displaced school-graders, some of them disabled and handicapped, and others with plights unheard, ethnic elders are also prone to unkind budget cuts that further marginalize them.

Uncaring cuts

"Cuts without caring," says Family Bridges CEO Corinne Jan. The cash-strapped state government, sniffing out ways to economize, subjected Hong Fook Adult Day Health Care Centers (ADHCCs). FB, according to Jan, gets about 10,000 mostly Asian immigrants every year, 60 percent of them frail elderly. FB operates two of the largest ADHCC (out of the six they have) in the state, says Jan.

Elders don't have fun at ADHCCs-it's not a senior center where they learn crafts, dancing or socialize. ADHCCs were started as a community-based alternative for seniors with usually five to four different chronic illnesses, so that they would not prematurely go to a nursing home. It would prevent them from tying up emergency rooms and much-needed hospital beds. About 35,000 seniors receive ADHCC services in California, says Jan.

ADHCCs are medical models where seniors come three to five days a week to receive nursing services, occupational therapy, nutrition therapy, physical therapy, social services, recreation, transportation and meals. "The nurses will help you if you don't get to see a doctor too often," Jan explains. "It's the vigilant monitoring that makes the difference."

"If you eliminate ADHCC, In-Home Supportive Services (IHSS) is not the answer because IHSS is not a medical model," Jan argues. ADHCC got its start during California Governor Jerry Brown's first stint in the 1970s. In January last year, Governor Brown proposed to eliminate ADHCC.

But AB 96 created Keeping Adults Free from Institutions to replace the ADHCC program. "Governor Brown vetoed it, which left $85 million not for KAFI but for transitioning the 35,000 seniors elsewhere," says Jan.

In March, ADHCC ceased to be a medical benefit. In June, agencies started the class action Darling vs. Douglas to halt the elimination of ADHCC. The lawsuit was settled in November with the creation of Community Based Adult Services. The new program has stricter eligibility criteria, which are still being argued in court.

The stricture came about, probably because of a reported number of fraudulent operators in the industry. Nevertheless, Jan says, "the innocent should not be punished with the guilty."

Lost lifeline

"Meanwhile 35,000 lives lost their lifeline in ADHCC. They will have to go to hospitals if they have emergencies. The state was trying to save $177 million per year but ended up spending over $3 million, not counting legal expenses," Jan says.

The situation isn't much different with IHSS, which provides home care to frail elderly, those with disabilities, or those that need any assistance in performing activities in daily life. This would mean someone who needed help moving from bed to toilet or going to the doctor or preparing food to eat or eating that food. IHSS is a one-on-one care for those who have Medi-Cal.

"Just like ADHCC, IHSS has been on the chopping block for years," says Anna Rich, NSCLC staff attorney. "At first, they tried to cut services to elderlies who had cognitive impairments. Seniors with dementia or Alzheimer 's disease who needed reminders to eat or to do other necessities in daily living. They also tried to cut domestic services, including grocery shopping. They probably reasoned out it wasn't a necessary service and neither was having fresh food."

"Our studies revealed IHSS recipients make up 49 percent who speak a language other than English and more than 60 percent who are from racial and ethnic minority groups in California. Compare that to nursing homes which are predominantly occupied by whites," Rich explains.

Because of the diversity of language spoken in California, there are strong Federal requirements protecting the rights of ethnic elderlies to healthcare access, such as the requirement that each county must provide translations for IHSS recipients. But Rich argues that the state could just come up with the translations and easily distribute them to all counties.

Recently, a 20 percent across-the-board cut in home care hours was passed by the state legislature. In March, the court decided the cut was a violation of the Americans with Disabilities Act of 1990. The judge even decreed that translating the complex forms into several languages was not enough.

But even if resources and funding were available for the frail ethnic elderly, their peers who are still able to work are beset by the staggering impact of unemployment brought about by the recession.
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Publication:Philippines Daily Inquirer (Makati City, Philippines)
Geographic Code:1U9CA
Date:Jul 25, 2013
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