While these kinds of disasters wreak havoc across all populations, the U.S. Environmental Protection Agency warns that some people, including older adults, are at heightened risk due to pre-existing conditions, weakened immune systems, restricted mobility and other health challenges.

San Francisco has already seen extreme weather conditions threaten the well-being of older residents, especially in neighborhoods like Chinatown, which city analysis has shown is particularly vulnerable to these threats.

In the past several years, smoke from wildfires and rainstorms have caused health and other problems for Chinatown’s older residents. Community organizations worry that the systems in place in the neighborhood are not enough to protect older populations, in part because of the challenges of accessing climate-resiliency funding.

“Climate change definitely affects our seniors’ quality of life as well as their health,” said Anni Chung, president and chief executive officer of Self-Help for the Elderly, a nonprofit providing an array of services for older adults in Chinatown and beyond since 1966.

Shao Ao Situ, an 81-year-old tenant of a single-room occupancy building in Chinatown, said he experienced eye irritation, fatigue and coughing when smoke from wildfires that raged across California and the Pacific Northwest in 2020 drifted through his neighborhood.

As COVID-19 was taking a disproportionate toll on older adults that year, the skies above the western United States turned an eerie orange, and the air filled with ash and toxic particles.

“I was severely affected,” said Situ, who speaks Taishanese and Cantonese.

Residential rooms in Situ’s building are dense and compact, measuring about 8 by 10 feet. A bunk bed, a table, a dresser and shelves take up most of Situ’s space, leaving little room to walk. His clothes hang over a single, long window. When smoke covered San Francisco that year, he said, he drew the window almost all the way down, allowing a small gap for ventilation.

“When the smoke concentration from the wildfires was high, I felt discomfort in my throat when breathing,” he said. Situ said his cough made it difficult for him to sleep at night. He looked for resources to cope with the situation. 

“I heard on TV that N-95 masks are the best at preventing dust and pollution particles, so we bought two boxes at that time,” Situ said, adding that government and community groups should provide more direct education to older people on how to stay safe.

He said his health problems persisted even after the smoke subsided.

[See photo essay: “For Chinatown’s Older Residents in SROs, Climate Disasters Pose Greater Risks”]

There are around 193,800 residents in San Francisco who are 60 and older. From 2010 to 2060, the city expects to see a 159% surge in its 60-plus population, according to the California Department of Aging. Meanwhile, the frequency and intensity of climate change-driven weather disasters are expected to increase.

Climate and health hardships that older residents like Situ in Chinatown and those in other parts of the city have confronted and will encounter in years to come have been on the city’s radar for over a decade.

In 2010, San Francisco’s Department of Public Health, with funding from the Centers for Disease Control and Prevention, was one of the first agencies in the nation to launch a program to investigate climate change’s effects on the health of residents and draw up contingency plans.

Since then, detailed assessments conducted by the department in collaboration with other agencies have outlined numerous health impacts San Francisco neighborhoods could face from air pollution, heatwaves, wildfire smoke, flooding and other hazards. Those reports noted that besides Chinatown, Bayview-Hunters Point, South of Market, Civic Center and Visitacion Valley could bear the brunt of the climate crisis.

In a system the department developed to gauge each neighborhood’s climate resiliency, Chinatown received the lowest overall score. “The elderly residents of Chinatown are especially at risk due to the neighborhood’s high residential density, overcrowded living conditions, and urban heat island vulnerability,” the department’s environmental health experts wrote in a report published in 2014.

The climate resiliency scorecard for Chinatown developed by San Francisco’s Department of Public Health.

Hidden health harms

Kinchiu Fung, 65, lives in a single-room occupancy building in Chinatown. Fung said his breathing was affected when wildfire smoke cloaked San Francisco in 2020. He said he was able to manage on his own. But some of his older neighbors expressed concerns about leaving the building during extreme weather, he said.

“The government should help the elderly if it has resources,” said Fung, who speaks Taishanese and Cantonese. He said more volunteers are needed to help older tenants with limited mobility during rainstorms.

Bifang Kuang, 84, who lives in a single-room occupancy unit in Chinatown, said she stayed in her room during torrential rainfall that pelted the Bay Area last January. “I did not get my medicine when it was raining,” said Kuang, who primarily speaks Taishanese.

Supplementing the city’s research into how climate change impacts health, universities across the Bay Area are examining both obvious and subtle impacts of extreme weather.

During heavy rainfall, older adults could break a hip or long bone if they slip on sidewalks, and the steep slopes of Chinatown and other hilly neighborhoods could worsen the impact, said Dr. Andrew Chang, a cardiologist and fellow at the University of California San Francisco’s Advanced Echocardiography program.

Extreme weather events can also affect diet. Some older adults who live alone and cannot obtain fresh fruits and vegetables during severe weather might turn to pantry staples or frozen foods that are high in salt, fat, oil and processed sugar, Chang said. Because older adults tend to have pre-existing conditions that make their bodies sensitive to sodium load, consuming salt-heavy products could trigger heart failure, high blood pressure or fluid retention, he said. 

Weihong Wu, 53, lives with her husband in a single-room occupancy building in Chinatown. During the 2020 wildfire season, she said, if she opened the window, she didn’t feel well, and if she didn’t open the window, the room became too stuffy. “It’s like, we can’t breathe,” said Wu, who speaks Taishanese and Cantonese.

“No one knocked on our door and asked if we are OK,” she said.

Wu said that during the rainstorms earlier this year, she couldn’t go out, so she didn’t have any food in her home. She said her older neighbors in the building “really needed someone to deliver groceries to them because they are unable to go grocery shopping themselves.”

Inclement weather can also deter people from seeking medical care. “Not only people who are getting sick from air pollution, but also people who probably normally should be seeing the doctor or getting medical care for certain conditions are choosing not to go be seen because they don’t want to go out when it looks so frightful outside,” Chang said.

Another concern in single-room occupancy residences and other older buildings is accessibility.

In 2022, San Francisco’s Aging and Disability Affordable Housing Needs Assessment highlighted accessibility problems like steep stairs and malfunctioning elevators in the city’s publicly funded single-room occupancy housing stock.

Compromised access intensifies risks for older residents in those buildings. For example, tenants experiencing exhaustion or other symptoms from excess heat or wildfire smoke might struggle to walk down several flights of steep stairs to reach a cooling or air respite center.

Housing experts say people who experience such health or mobility challenges should have a say in what would help them most.

“I think you need to engage the seniors themselves,” said Leslie Moldow, a principal at Perkins Eastman architectural firm, where she specializes in senior living design, and an adjunct professor at the University of San Francisco. “Have them be part of the solution for what they want.”

Financial barriers

In 2021, Mayor London Breed released the latest iteration of the city’s Climate Action Plan with an overarching goal for San Francisco to reach net-zero greenhouse gas emissions by 2040. While the plan focuses on emission reductions, it also emphasizes related health benefits, noting that walking and biking boost physical well-being, green spaces improve air quality and eradicating fossil fuel use in buildings protects against chronic ailments like asthma.

Breed this year announced $2 million in grants for organizations working on removal of greenhouse gas emissions from buildings, waste prevention and environmental justice. But many of the plan’s long-term goals come with sky-high costs, and officials say San Francisco can’t go it alone.

“External support, from state and federal governments, is needed more than ever,” city officials wrote in the Climate Action Plan.

A funding analysis for the Climate Action Plan by researchers at the University of California, Berkeley’s Center for Law, Energy and the Environment, estimated that the overall cost of reducing emissions across sectors that the plan targets ­could reach $22 billion.

The financial analysis of San Francisco’s Climate Action Plan prepared by researchers at the University of California, Berkeley.

That analysis is used “to make a case that much more funding will be needed in the future to fully implement the plan” said Richard Chien, senior environmental specialist at the San Francisco Department of the Environment.

Louise Bedsworth, the executive director of UC Berkeley’s Center for Law, Energy and the Environment, is one of the authors of the funding analysis. Bedsworth said her team is exploring the barriers to moving projects from planning to implementation.

“I think funding remains the biggest challenge,” she said, partly because the way funds for climate adaptation are distributed is compartmentalized.

“People don’t live in silos, and communities don’t operate in silos,” she said. “But that tends to be how our funding is still rolled out.”

In July, San Francisco released a Heat and Air Quality Resilience Plan, which proposed pathways for city agencies, community groups and other stakeholders to help San Franciscans cope with extreme heat and wildfire smoke.

Officials noted in the report that $12.1 billion in federal funding is available for home energy efficiency and weatherization projects through the Inflation Reduction Act and the Infrastructure Investment and Jobs Act. And $444 million is devoted in California’s budget this year to extreme heat mitigation initiatives. This is in addition to funding available from other government and private grants and programs.

Bedsworth said one of the challenges for small nonprofits in accessing funds from state programs and the federal Inflation Reduction Act is the complex and competitive nature of these initiatives.

The Chinatown Community Development Center, which owns and manages single-room occupancy buildings and other affordable housing, faces such hurdles. Nearly 1,900 seniors live in properties managed by the organization.

For years, the nonprofit, which also engages in tenant advocacy, youth leadership and other community work, has tried to improve the sustainability of its buildings and the Chinatown neighborhood. It has worked with local nonprofits to provide some tenants with climate-resiliency tools such as air filtration devices.

Malcolm Yeung, the center’s executive director, said the resources in Chinatown are “absolutely not” sufficient to support older adults in single-room occupancy housing during extreme weather events, adding, “But it’s not to say that there aren’t efforts underway.”

In 2017, the organization, in collaboration with San Francisco’s Department of the Environment, Planning Department and philanthropic groups, published a comprehensive assessment called “Sustainable Chinatown” that laid out strategies for improving sustainability and climate-resiliency while maintaining housing affordability.

Yeung called it a “mixed success.” Some goals were met, but others stalled for lack of funding, he said. The organization has explored creative approaches to make sustainability improvements that are less resource-intensive.

For example, when it was taking over public housing from the city’s Housing Authority to rehab and operate as affordable housing, staffers saw that tenants had installed unauthorized, energy-draining washing machines and clothes dryers, because they feared robberies and violence in communal laundromats in their building. The nonprofit removed the appliances, bolstered security and implemented community policing in collaboration with the San Francisco Police Department to alleviate residents’ concerns, he said.

That was “the single largest sustainability improvement in that building, and it was primarily because of operating changes,” Yeung said.

Yeung said whenever his organization is rehabilitating or constructing a building, it works with sustainability consultants to identify ways to improve operating efficiency and climate resiliency. However, finding funding for those upgrades, he said, is a hit-and-miss process.

The Chinatown Community Development Center sees the Inflation Reduction Act as a potential funding source to complete upgrades systematically. “We have not secured funds, but the initial process is rolling,” Yeung wrote in an email.

A number of large affordable housing and climate justice intermediary organizations are submitting applications to distribute funds through the act’s Greenhouse Gas Reduction Fund, Yeung said. The Chinatown Community Development Center has shared its sustainable rehabilitation recommendations with three of those applicants.

Yeung echoed Bedsworth’s earlier point that smaller organizations struggle with navigating the complexities associated with applying for this kind of federal funding.

“Communities of color typically don’t have anchor organizations that have the resources to kind of engage on that level,” Yeung said.

Policies determining funding

San Francisco has 110 publicly funded single-room occupancy buildings. Many others are operated by private owners or other entities. There are at least 19,000 rooms for tenants overall. Residents typically share a kitchen, living area, bathrooms and laundry facilities.

Many of the buildings don’t have cooling systems, adequate insulation and ventilation, or other mechanisms to cope with extreme weather.

The Mayor’s Office of Housing and Community Development oversees 1,021 affordable housing units in Chinatown that are managed by three organizations, including the Chinatown Community Development Center. Data for 942 households supplied to the agency revealed that 519, or 55%, have at least one senior tenant, the department reported.

“Seniors and SRO families are probably the two populations I worry a ton about because the vulnerabilities are very unique for each,” said Eddie Ahn, executive director of Brightline Defense, an environmental justice nonprofit.

Brightline Defense, in collaboration with its community partners, surveyed residents of single-room occupancy buildings in the city in 2020 and 2021. Of the 255 people across 54 buildings who responded, around 79% did not have access to N-95 masks and 73% did not have air filtration systems in their rooms. More than half the respondents said they had respiratory or other health effects during the wildfires.

Ahn, who is also president of San Francisco’s Commission on the Environment, said Brightline Defense worked with the Chinatown Community Development Center a few years ago to distribute about 100 air filtration units in Chinatown, the Tenderloin and other neighborhoods.

“But it only goes so far,” he said. “Part of the reason why our nonprofit exists is to affect policy change. It’s not just about, you know, 50 units here, 100 units there; it’s hopefully trying to increase access to thousands of units at a time.”

One policy the organization is focusing on involves CalEnviroScreen, a mapping tool that uses environment, health, socioeconomic and other data to determine which census tracts are most affected by pollution and other environmental hazards, and classifies those areas as “disadvantaged communities.” The California Environmental Protection Agency and other entities use it to determine where to implement programs and target investment. According to the tool’s standards, Chinatown is not designated as a “disadvantaged community,” which Ahn considers an incorrect assessment.

“It’s very clear that there’s a history of incidents in Chinatown and in the Mission District to have racial discrimination, disinvestment,” he said. “And overall, there are unique environmental injustices that are being suffered in each community, too.”

Ahn said his organization filed an advocacy letter with other community organizations, calling for improvements to the CalEnviroScreen tool.

“Population characteristics including poverty, housing burden, education and especially linguistic isolation exceed the 99th percentile in all of Chinatown’s census tracts,” wrote the letter’s signers. “Chinatown also suffers from serious pollution burdens.”

Letter sent by a coalition of nonprofits, calling for Chinatown to be recognized as a community needing investment by the CalEnviroScreen mapping tool.

Brightline Defense has installed monitoring sensors to gather neighborhood-level data on air pollution.

“So, if you have massive climate change events like wildfires, for instance, that are pouring smoke into cities, our most vulnerable are low-income households and families that can’t afford an air filtration unit,” Ahn said. “And that is typically an SRO tenant, for instance, or an SRO family. So, that’s the kind of targeting I think we need to demand of our environmental justice mapping tools.”

Community response

One nonprofit at the forefront of disaster preparedness for Chinatown residents, including older adults, is the NICOS Chinese Health Coalition.

Michael Liao, director of programs, said NICOS coordinates with community organizations to do periodic resource inventories to assess which groups can offer cooking facilities, emergency shelters, communication tools, transportation supplies and other resources during climate-related emergencies and other catastrophes.

“Over the years, we’ve also developed emergency communication protocols with multiple layers of redundancies, so that we could communicate with each other before the city is able to effectively and adequately respond to all of our needs,” he said.

In the past, the disaster preparedness initiative’s funding has come mostly from private foundations, like the Fritz Institute and the Walter and Elise Haas Fund, Liao wrote in an email. During his 18 years at NICOS, he said, the initiative has received government funding from San Francisco once and from California once. Apart from those times, it has continued either unfunded or covered through the organization’s unrestricted funds, he said.

“Although the government regularly touts us — Chinatown — as a neighborhood, that is one of the most prepared, there hasn’t been a lot of investment, in terms of financial investment, to kind of help make that happen,” Liao said. “It really came from a lot of sweat, blood and tears from volunteers of the community who were able to put in their time and resources.”

Liao said the neighborhood’s support systems were weakened during the pandemic. “Funding is always an issue, and now even more so than before,” he said.

Self-Help for the Elderly is also pursuing climate-resiliency interventions for older residents. This year, through the city’s Extreme Weather Resilience Program, an initiative by the Department of Emergency Management, the nonprofit and other groups will receive devices like air filters and portable air conditioners. “That’s really good news,” said Chung, who leads Self-Help for the Elderly, noting that her nonprofit will use the items in its senior centers.

But more systemic solutions are needed, Chung said: “We’re doing only a patch-up here, like a band-aid right now.”

On Lok, which pioneered the Program of All-Inclusive Care for the Elderly, also provides medical and social services to low-income older adults in Chinatown and beyond. It offers comprehensive services by combining primary health care and long-term care, so members with chronic illnesses or other conditions who might otherwise have to move to a nursing home can remain at home, said Dr. Ben Lui, the organization’s chief medical officer.

When climate disasters happen, Lui said, On Lok can activate its network of social workers, drivers and others to check in on its members. On Lok also helps operate federally funded housing for older residents.

For residents in those housing units, “we can actually do even closer monitoring, so we can even have our caregivers check on them to make sure they have the windows open during hot weather,” he said. “We can make sure that they are hydrated.”

Lui said the organization groups members by health risk, “so that when disasters or these extreme weather events happen, we can start with the highest-priority,” he said. 

City response

Various city departments have initiated programs, sometimes working with community-based groups, to support older adults and other vulnerable populations during extreme weather.

“I think that we are more prepared now than we were in 2020,” said Adrienne Bechelli, the deputy director of San Francisco’s Department of Emergency Management. “In 2020, we were more prepared then than we were in 2017, when we had our first major heatwave over that Labor Day weekend.”

San Francisco considers anything above 85 degrees to be an extreme heat event, and during Labor Day weekend in 2017, temperatures soared to 106, which likely led to the deaths of three older residents.

Even before the 2017 heat wave, there were indications that San Franciscans could be particularly susceptible to this threat. A study examining a 2006 California heat wave found that emergency department visits and hospitalizations rose across the state. Researchers noted that children up to 4 years of age and people 65 and older were at highest risk.

“This pattern suggests an important role for acclimatization and for factors related to the built environment,” researchers wrote in Environmental Health Perspectives. “In San Francisco, for example, housing stock is less likely to have central air conditioning both because of its age and because of the cooler climate.”

Bechelli said the city will face challenges in any kind of emergency response.

“I think that anyone who says, ‘We’re fully prepared and we’re ready to take on this hazard, no problem,’ is probably, unfortunately, mistaken,” she said.

The San Francisco Human Services Agency’s Department of Disability and Aging Services also manages care coordination for older adults, and during extreme weather events, staffers call high-risk residents to check for symptoms of dehydration, heat stroke and other medical emergencies, Joe Molica, the agency’s senior communications manager, wrote in an email. The department also shares safety information with community centers to broaden its reach, he added. 

The San Francisco Department of Public Health’s Emergency Preparedness and Response team has worked with NICOS to offer trainings in English and Cantonese at health fairs in the Richmond neighborhood, Tal Quetone, the agency’s public relations officer, wrote in an email.

In the past four years, the team has worked with companies that manage single-room occupancy buildings in the South of Market neighborhood to offer training on climate change, he added. In one instance, it collaborated with other departments to research the impact of heat for a building managed by the John Stewart Co., which prompted the owner to buy air conditioners for all 98 units, Quetone wrote.

But these programs don’t cover all older adults who face health risks during extreme weather, and city officials said social isolation is a challenge. The Department of Public Health is exploring how to work on emergency preparedness messaging with specialists and organizations that support older adults.

“One of the things we’re looking at right now in the Heat and Air Quality Resilience project is how can we identify first points of contact for vulnerable populations,” which might include clinicians, residential caregivers and building managers, said Matt Wolff, the department’s Climate and Health Program manager.

Emotional ramifications

While researchers continue to study the consequences of extreme weather on the physical health of older adults, they are also looking into how it affects mental health. Clinicians with the Climate Psychiatry Alliance, a network of mental health professionals, say they have noticed post-traumatic stress disorder, depression and other mental health conditions among older adults, especially those whose lives have been upended by disasters like wildfires and floods.

For some older residents of Chinatown, the anti-Asian hate crimes that occurred concurrently with extreme weather and health emergencies intensified their emotional anguish.

“We were particularly concerned during the pandemic of this kind of triple-whammy effect for our Chinatown seniors with not only the pandemic but also a lot of the climate change-related issues such as extreme heat and air quality issues,” said NICOS’ Liao. “On top of that, a lot of seniors were afraid to go out because of the rise in anti-Asian hate.”

Liao said fears about anti-Asian hate crimes remain.

“As we come out of the pandemic into endemic for COVID, there’s still a lot of the lingering isolation, mental health and loneliness issues that our seniors struggle with,” he said.

Liao said NICOS conducted a focus group, part of a study funded by the National Institutes of Health, in partnership with the University of California, San Francisco, with Chinese seniors in single-room occupancy buildings to understand what might contribute to resilience. The organization found that some older residents were doing due diligence when it came to verifying health information they received on WeChat and other platforms. This also could be a critical step in protecting themselves during climate disasters when misinformation and disinformation can be rampant.

“I know a lot of times we focus on more of the negative aspects — what are some of the deficits and the needs — but I think it’s also important to highlight that within the Chinese community, there’s a lot of resilience,” Liao said.

Yesica Prado edited the photos for this story. Zhe Wu translated the interviews with residents in single-room occupancy housing in Chinatown who spoke Taishanese and Cantonese.

About the Project

Older adults are among those most at risk during climate change-driven weather disasters. This series examines the physical and mental health effects of these events on older people and explores how these challenges are unfolding in San Francisco’s Chinatown, a neighborhood considered by the city as particularly vulnerable to the hazards of climate change.

• Q&A with Dr. Andrew Chang on the physical toll of climate change on older adults
• Q&A with Dr. Robin Cooper on the emotional toll of climate change on older adults
• Q&A with Eddie Ahn on how Brightline Defense takes on air pollution and environmental justice concerns
• Long-form story: Protecting Chinatown’s Older Adults From Climate Change Disasters Requires More Funding, Nonprofits Say
• Photo essay: For Chinatown’s Older Residents in Single-Room Occupancy Buildings, Climate Disasters Pose Greater Risks

This project was produced with the support of a journalism fellowship from the Gerontological Society of America, the Journalists Network on Generations and the Archstone Foundation.

The post Protecting Chinatown’s Older Adults From Climate Disasters Requires More Funding, Nonprofits Say appeared first on San Francisco Public Press.

The agency has taken a multifaceted approach to determine which neighborhoods will be disproportionately affected by conducting heat and flood vulnerability assessments, creating community resiliency scoring systems and collaborating with local nonprofits to gather temperature and humidity data.

Those investigations have revealed that Chinatown could be particularly vulnerable during periods of extreme weather due to a range of socio-economic factors as well as the built environment. Within the neighborhood, older adults living in single-room occupancy buildings are among populations at heightened risk. Reasons for this include physiological changes related to aging and financial barriers associated with making climate-resiliency adaptations to older buildings.

The San Francisco Public Press this summer interviewed residents in single-room occupancy buildings in Chinatown about their experiences during extreme weather events in recent years. The residents, who spoke Taishanese and Cantonese, which have been translated below, described hardships they experienced and steps they took to protect themselves, and offered ideas for support that could be beneficial for them and their neighbors in the future.

As droughts, wildfires, storms, floods and other catastrophes become more frequent and aggressive, each neighborhood, city and state will face its own set of adversities and health inequities. The story of how these challenges are unfolding in Chinatown offers a glimpse into how they could play out for older residents in other climate-vulnerable places.  

[Read more: “Protecting Chinatown’s Older Adults from Climate Disasters Requires More Funding, Nonprofits Say”]

Since the founding of San Francisco’s Chinatown, the oldest and largest in North America, its residents have experienced natural disasters that have threatened their lives and well-being. In the early years, the deadly 1906 earthquake caused widespread devastation. More recently, extreme weather conditions have caused suffering for some residents, especially those who are older and living in buildings that aren’t equipped to protect them from these hazards.

Shao Ao Situ, 81, has been living in a single-room occupancy building in Chinatown for about 30 years. He has experienced several extreme weather events, including the wildfires in the western parts of the U.S. that engulfed San Francisco in smoke in 2020. “The wildfires and resulting haze have a significant impact, especially on us as elderly people, because they affect our respiratory system,” Situ says. He says he had eye irritation, cough and fatigue due to the toxic air.

The building where Situ lives has individual rooms for each tenant. Residents on each floor share bathrooms, laundry facilities, a kitchen and a living room. Situ often watches television with his wife in the living room. He says one strategy that city officials and community groups could adopt to educate residents about climate disasters would be to reach out to multicultural media outlets that residents typically watch, such as KTSF. “We often get information through TV,” he says. “I hope more people can share this type of knowledge there. I tend to remember information better after seeing that on TV.”

When San Francisco was blanketed in wildfire smoke in the summer and fall of 2020, Situ says he mostly stayed indoors. He says he did not receive any support during that time or during other crises. “Where can we go for help?” he says. “We had absolutely no such advice made available to us.”

Units in Situ’s building measure about 8 by 10 feet, which is typical for single-room occupancy buildings. Inside Situ’s room are a bunk bed, a table, a dresser and shelves holding his belongings. There is a single window where he hangs his clothes.

When smoke and toxic particles from wildfires in neighboring regions drifted into San Francisco in 2020, Situ says he kept his window mostly closed, leaving a small opening for ventilation. He says he put up a piece of cardboard to cover the gap, demonstrating how he does that even today.

Situ keeps a stock of surgical masks and sanitizer. During the wildfires, he says he bought N-95 masks. “I heard on TV that N-95 masks are the best at preventing dust and pollution particles, so we bought two boxes at that time,” he says. “Not with government money. We paid out of pocket. The N-95 masks were very effective.”

Situ’s neighbors are also older. He says they would benefit from more education from community groups and government agencies on how to protect themselves during wildfires. “I think governments can do a better job,” Situ says. “One is publicity and guidance, such as holding lectures to introduce smoke and haze prevention matters and methods. I believe it will be of great help to residents, especially the elderly.”

Bifang Kuang is one of Situ’s neighbors. Kuang, 84, says she has been living in the single-room occupancy building for about 10 years.

During the severe rainstorms in the Bay Area this past winter, Kuang says she did not go out to get medications or groceries until the downpour lessened. When asked what support she had during the rain, she holds up an umbrella.  

For older residents in Chinatown, especially those who have trouble with mobility, walking up the hills in their neighborhood to get food, medications and other supplies could be dangerous during heavy rains. One single-room occupancy tenant told the Public Press that arranging grocery deliveries for older neighbors during those times would be helpful. Community organizations and city agencies report that scaling up support services and creating climate-resiliency infrastructure continues to be difficult due to funding constraints.

Yesica Prado edited the photos for this piece. Zhe Wu translated the interviews with residents in single-room occupancy housing in Chinatown who spoke Taishanese and Cantonese.

About the Project

Older adults are among those most at risk during climate change-driven weather disasters. This series examines the physical and mental health effects of these events on older people and explores how these challenges are unfolding in San Francisco’s Chinatown, a neighborhood considered by the city as particularly vulnerable to the hazards of climate change.

• Q&A with Dr. Andrew Chang on the physical toll of climate change on older adults
• Q&A with Dr. Robin Cooper on the emotional toll of climate change on older adults
• Q&A with Eddie Ahn on how Brightline Defense takes on air pollution and environmental justice concerns
• Long-form story: Protecting Chinatown’s Older Adults From Climate Change Disasters Requires More Funding, Nonprofits Say
• Photo essay: For Chinatown’s Older Residents in Single-Room Occupancy Buildings, Climate Disasters Pose Greater Risks

This project was produced with the support of a journalism fellowship from the Gerontological Society of America, the Journalists Network on Generations and the Archstone Foundation.

The post For Chinatown’s Older Residents in SROs, Climate Disasters Pose Greater Risks appeared first on San Francisco Public Press.

“The air was very stuffy during wildfire season,” Weihong Wu, who lives with her husband in a single-room occupancy building in the neighborhood, said in Cantonese. “If I opened the window, I didn’t feel well, but if I didn’t open the window and let the fresh air in, it felt so stuffy. It’s like we can’t breathe.” Wu said her throat was dry and painful.

As climate change exacerbates droughts, wildfires, floods, storms and other catastrophes, community organizations in the city are racing to put systems in place to both measure its impacts on residents and to provide the tools they need to support themselves during disasters.

Eddie Ahn, executive director of Brightline Defense, an environmental justice nonprofit in San Francisco, is on the frontlines of this work. He serves on several city commissions, including as president of San Francisco’s Commission on the Environment.

In multiple interviews with the San Francisco Public Press, Ahn described how Brightline and its partners engage in environment policy actions, highlight disparities in air quality data, provide air filtration devices to residents, and pursue other climate justice and sustainability work.

Below are excerpts from interviews with Ahn, which have been edited for length and clarity.

What personally inspired you to join Brightline Defense and pursue environmental justice work?

I have a background working in social justice issues. This was as a law student — I originally worked at the Assembly Judiciary Committee as an extern and got to work on a wide variety of legal issues associated with the environment and civil justice.

I like environmental justice work specifically because of the field’s interaction with a lot of different communities. I’m able to work with diverse communities and how they relate to the environment. Diversity is a lot of different things — it can be by income, race, cultural history or geographic experience. So, being able to experience all of that while working on such an overwhelming problem like climate change has been a joy and a challenge.

In 2021, Brightline released the results of a survey about air quality issues experienced by people living in single-room occupancy buildings across San Francisco. Since then, what efforts have been made to mitigate some of the concerns expressed by residents?

The challenges are ongoing. One, there’s been a lot of good reporting on this even recently talking about how many of the buildings, particularly on the west side of San Francisco and neighborhoods like Chinatown, Bayview-Hunters Point on the east side of San Francisco, really are filled with essentially aging buildings that don’t have things like a modern HVAC system — air conditioning, air filtration.

Those larger projects to retrofit these buildings or make them more resilient, those are typically really expensive projects — like we’re talking in the millions or tens of millions of dollars at least. So, in the meantime, trying to get them individual air filtration units can be considered a stopgap measure.

There are even more emergency-oriented measures that we worked on in the past, so that would be something like creating a do-it-yourself air filtration system, like taking a MERV 13 filter and stitching it together with a box fan using duct tape. But that in our minds is very much like a very last-minute measure — if you can’t access an individual air filtration unit, that is the measure you should be taking. But for us, we’ve really been pushing for increased funding and access to individual air filtration programs created by, for instance, the Bay Area Air Quality Management District.

Is the organization taking any steps to support older adults and other residents in single-room occupancy buildings, specifically those who are disproportionately impacted by climate change?

Brightline has been working with SRO tenant leaders for some time now, and this is a program that’s originally organized by Central City SRO Collaborative. They’ve maintained offices in the Tenderloin, but really, they serve SRO tenants across eastern San Francisco. We’re talking Mission District to South of Market to the Tenderloin to Chinatown as well.

Just to focus on the SRO population: Seniors and SRO families are probably the two populations I worry a ton about because the vulnerabilities are very unique for each. Seniors, they have easily interplay of different health issues at that point. And one of the kind of understandings about SRO seniors is that it’s harder for them to move out of SROs at the end of the day. This is often like their last housing unit they’ll live in before they pass. And then, for SRO families, you’re talking potentially crowding three, four people in an 8-by-10 unit. That happens quite a bit in Chinatown SROs, too. That itself presents its own set of issues for that whole age range that’s within the household, right? So, it’s everything from the lack of privacy, mental health issues, to having to share that air within that space, and not have the resiliency, the infrastructure, that you need to protect against climate change.

Thinking through policy changes at the end of the day: We have done direct distribution of air filtration systems. We did a program with Chinatown Community Development Center about two years ago where we distributed about 100 air filtration units in Chinatown, the Tenderloin, South of Market areas. But it only goes so far. Part of the reason why our nonprofit exists is to affect policy change. It’s not just about, you know, 50 units here, 100 units there; it’s hopefully trying to increase access to thousands of units at a time.

Could you describe Brightline’s air quality monitoring project, including the reasons behind launching this program in San Francisco?

It started out originally in community partnership. We were doing initial meetings through the nonprofit partners of our programs, so that’s both Community Youth Center, CYC of San Francisco, and Central City SRO Collaborative. So, CYC, that partnership is a youth leadership program. It’s meant to really connect high school students to environmental issues among other things. And air quality kept coming up because wildfires were starting a bit earlier. And so, there was an increasing awareness of, “This might be an ongoing issue,” and “What are the conditions in our local communities?” And that was a similar string we found in Central City SRO Collaborative and our work with SRO tenant leaders there, too.

Through that kind of community input, we applied for a state air quality monitoring grant. We were awarded it in late 2019. And then in January 2020, we were super excited to start up the program with a technical partner. Clarity is the partner that we’ve used a lot. I don’t know if you’ve seen these devices, but they’re essentially the size of a shoebox, you know, solar panel on top. They’re very resilient devices. And the good thing about them is that you can just throw them up and not worry as much about them over a long period of time.

With the Air Quality Monitoring Program, that was thrown for a loop because of the pandemic, which then came down in March 2020. So, it did delay our planning a bit for a few months.

And we were originally planning to roll it out in say, like, October, November of that year. But then the wildfires hit in August and September, which is when we started rushing out the air quality sensors, and we had done like a ton of community surveying over street corners where we should site these sensors. And in essence, it takes a lot of coordination and work.

And is the data being shared with the people who are in neighborhoods with poor air quality?

Definitely. We do try to break this down into more concise data reports and analyses. We’ve done this in various ways. We’ve done presentations before youth and SRO tenant leaders. We’ve done it in the form of writing. Social media and communications are another big part of what we do. Of course, talking to traditional media, too, is part of it as well.

But it tends to be more driven by, “What’s the crisis at the moment?” People often take the air around them for granted, and it comes baked into their existence. Only when you have extreme climate change events like wildfires that people are like, “Oh my goodness, what is the air right now? And where’s the air report?” And I think part of our work has been good in that — keeping people apprised.

Brightline has been doing a lot of work around the policy of environmental justice mapping. I was wondering if you could share a little bit more about that specifically. What are you trying to accomplish, including with CalEnviroScreen?

I think generally when we try to address issues around climate change, we want to make sure that no community is left behind. And for environmental justice mapping, the point of it is to ensure that we are having equity when we create policies that address environmental issues. 

CalEnviroScreen has had a long history now in the state of California. It was originally created under state legislation SB 535 as a way to define what is a so-called disadvantaged community.

The challenge in CalEnviroScreen is that it’s not a bad tool, but it has struggled to capture the Bay Area as a region accurately in the past. And they’ve gone through several versions. The earliest versions did not include Bayview-Hunters Point, and that was like a huge struggle to just even get the city and county of San Francisco recognized as having a so-called disadvantaged community that needed investment. And now, Bayview-Hunters Point, I think, is pretty well recognized at this point as a community deserving of investment and economic opportunity.

The next level challenge has been really trying to encompass more South of Market, more of the Tenderloin. So, there are little slivers of SOMA and the Tenderloin, but none of the Mission District and none of Chinatown is included currently in the map. And at Brightline, we filed essentially a coalition advocacy letter to argue for improvements to the changes. It’s very clear that there’s a history of incidents in Chinatown and in the Mission District to have racial discrimination, disinvestment, and, overall, there are unique environmental injustices that are being suffered in each community, too.

So, SROs, which we’ve talked about in the past, are older buildings built in the 1900s. And they don’t have the resiliency built into that. They don’t have the infrastructural improvements needed to withstand climate change effects. So, if you have massive climate change events like wildfires, for instance, that are pouring smoke into cities, our most vulnerable are low-income households and families that can’t afford an air filtration unit. And that is typically an SRO tenant, for instance, or an SRO family. So that’s the kind of targeting I think we need to demand of our environmental justice mapping tools.

What do you think about the Heat and Air Quality Resilience Plan launched by the city?

It’s a good start. I did look it over. And we have been supportive of their efforts around heat mapping. A big question is, “Where does the funding come from at the end of the day?” I think there are pathways for implementation, but people need to be prepared that this will have costs, and it will require enormous resources to do correctly.

Do you think, prior to launching this report, the steps that the city has taken to protect older residents and vulnerable populations have been adequate?

Overall, we could always be moving faster. I think that’s the challenge is that from an advocacy standpoint, we’re not moving quickly enough whether it’s serving our senior populations or addressing climate change. I do think that we’re grappling with problems in the state that we’re in, we should be creating big alarm bells for people. In other words, this is not something we need to fix 10 years from now. This is something we need to do now.

I think this is also true of just, philosophically, climate change as an issue — the idea that we can fix issues related to climate change like 20, 30 years from now is increasingly not true.

And yeah, I do think we need very aggressive actions in the next few years to even get to a stage where people are OK, and that they are hopefully surviving, if not thriving.

This Q&A, part of a series of stories on the health impacts of climate change on older adults, was produced with the support of a journalism fellowship from the Gerontological Society of America, the Journalists Network on Generations and the Archstone Foundation. Zhe Wu translated the interview with Weihong Wu.

The post Brightline Defense Takes on San Francisco’s Air Pollution and Environmental Justice Concerns: Q&A With Executive Director Eddie Ahn appeared first on San Francisco Public Press.

After the 2018 Camp Fire tore through Paradise and neighboring areas, claiming at least 85 lives and displacing 50,000 people, some older residents from that region relocated to Carson City, Nev., and nearby locations.

Months later, Dr. Elizabeth Haase, medical director of psychiatry at Carson Tahoe Hospital and Behavioral Health Services and a founding member of the Climate Psychiatry Alliance — a group of mental health professionals raising awareness of the effects of climate change on mental health — said she observed worsening health, including exacerbation of chronic obstructive pulmonary disease and rapid progression of dementia in some of the older people who had relocated from the Camp Fire zone.

“People can have a very dramatic decrease in their overall mental and physical health that’s connected to one of these climate events — that is likely to get missed, in terms of the association,” Haase said. One of her older patients developed pneumonia in addition to worsening of her chronic obstructive pulmonary disease and was hospitalized for several months, she said. Her patient’s mental health also deteriorated.

“In offering her the understanding — because I’m somebody that knows about climate and health — that what was happening to her now is linked to her experience in the fire was actually quite therapeutic for her,” she said. “And you know, a lot of sort of depressive and grief-related symptoms came out. And we were able to talk a little bit about what it means to be in your 70s and lose your home with absolutely no possibility, financially, of rebuilding.”

Like Haase, mental health experts based in the San Francisco Bay Area are exploring the ensuing physical, mental and emotional effects of climate change. Dr. Robin Cooper is co-founder and president of the Climate Psychiatry Alliance, and an associate clinical professor at the University of California, San Francisco’s Department of Psychiatry and Behavioral Sciences. She also has a small private practice in the city.

Cooper spoke with the San Francisco Public Press about what needs to be done locally to address climate change’s mental health toll. The following excerpts from the interview have been edited for length and clarity.

You’ve been working as a psychiatrist for decades, and in recent years, you’ve been exploring the threats of climate change to mental health. What got you interested in this field?

I have always been, outside of my professional endeavors, an activist. At the time that I began to learn about and think about and be introduced to the issues of climate change, it had that — “Wake up! Oh my God, this is a potential existential threat.” Once knowing about something that profound, I can’t turn myself away from it. And I began to be active in a number of organizations that were addressing climate change in its broader sense. But as I began to discover, I could use my voice most effectively in the realm that’s close to my work. So, I began to be involved much more in the health impacts of climate change.

A lot was being said about the general broad range of health impacts, but at the end of a talk, a pulmonologist or cardiologist or infectious disease person would say, “Oh, by the way, there’s some mental health impacts.” And I was shocked. I said, “Oh my God, we should be talking about that. We need to be the experts on that.” I met other likeminded psychiatrists, but our voice was very, very tiny at that time. And we came together with the idea that this was something we needed to take ownership of, know more about and be able to speak to it.

Could you describe how climate change affects the mental health of older adults?

So, you and I are both Californians, we know about the Paradise fire. Paradise was a community that had a large number of retirees. It was affordable. It was a place where people could go after years of living in other communities, buy a home that was going to be their place of retirement and live up the rest of their lives. The massive loss of their homes, their community, the place that they could live. These are people who retired, they’re on fixed incomes, who lost everything. So, when you lose your home, and you don’t have a lot of economic resources for rebuilding, you really have secondary emotional impacts. And so, where do you live? The loss of your social support — the greater level of poverty that you live out the rest of your life — interferes with the ability to make choices. And that has huge emotional impacts with depression, post-traumatic stress and a greater vulnerability.

If we look at the disasters that happened in Puerto Rico [in 2017 following Hurricanes Irma and Maria], particularly, the elderly were left on their own. They had no access to medications. Young people had gone to the U.S. mainland for jobs. So, the elderly were left on their own with little to help them recover. And those have huge implications for their emotional wellbeing and their physical wellbeing.

As extreme weather events continue to increase, what should local governments, hospitals, nonprofits and other organizations that are providing services to older people be doing now to strengthen the mental health infrastructure?

We’re in a big crisis, as you know, in health care delivery. We need to make changes in our health care delivery as we confront the vast kinds of troubles that people are going to experience from climate change. And that means shifting to funding and providing care in a more public health, community health manner using population-based ways of intervening. It means that the governmental agencies and those who pay for health care have to do that in a different way.

It also means empowering people in communities to do that before there are extreme heat waves and disasters. It means tightening up our neighbor-to-neighbor relationships, particularly for the elderly. That’s incredibly important, because they can be isolated, left alone, not able to care for themselves. If we have a public health model, and a model based on connectivity in communities, we can have partnerships. We can have buddy systems so Joe knows that Mrs. Smith, who is 86 years old and in her home, is alone and knows what she needs, and has someone to bring her to cooling centers, or help modulate continuing her medications as these disasters and climate events emerge.

Let me just give you another little example. Hurricane Sandy hit New York and the Eastern seaboard with ferocious impacts. Elderly people in this particular public housing that I’m aware of were stuck in their apartments for days without food, light or ability to get out because of the elevators not working. And then people came to the door. And they didn’t know if they were safe. They didn’t know if those were intruders who were going to hurt them, or people there to help them. It doesn’t have to be that way if we take care of some of these things before.

UCSF launched a climate change and mental health task force in June 2019. What did the group set out to do and what has it accomplished, especially for older people?

I would say our achievements have been in the realm of educating mental health trainees about the impacts of climate change in mental health. I believe that medical students need to be what we call climate literate in their educational endeavors. How can we train doctors, and anyone in health care, adequately, if we don’t train them to think about the most significant threat to our wellbeing of this century?

That task force is now being integrated more into this campuswide center on climate health and equity, which actually is a UC-wide endeavor that the Office of the President has supported that is multi-campus, although it’s primarily based at UCSF. I will say it is profoundly underfinanced.

Are you aware of other projects like that in the Bay Area?

There are things happening at many institutions, not with creating a task force, but other kinds of things. Stanford has a new faculty position for one person in the Department of Psychiatry to embed climate change and mental health into their department. Davis has a number of people who are exploring and doing research. But I will say to you, all of these things are siloed. Coming together is a really big issue in the realm of climate and mental health.

The surgeon general, Dr. Vivek Murthy, last month sounded the alarm about the loneliness epidemic in the U.S., and how social isolation has a detrimental effect on the health of older people. And climate disasters could worsen this disconnection, especially if older adults are displaced from their homes and communities. So, on a local level, what steps can be taken to alleviate the loneliness crisis?

I think it is enhancing recreational, social meal programs that bring people outside of their homes and engage them with each other in socially involved activities. We know that caregivers are so underpaid, and that there’s been a massive loss in numbers of people who are doing caregiving for the elderly, because you can’t make a living off of it. We have to fund caregivers, so that those who are isolated in their homes have regular connection.

Given all the challenges and complexities of investigating and implementing solutions to address climate change’s toll on mental health, what gives you hope for the future?

Hope is a funny word. Hope is not optimism. Hope is not like, “I can see our way out of this.” We are going to have very, very significant, enduring, unrepairable damage from the impact of climate change. What gives me hope is this new way of defining hope — radical hope. I can envision a better world to live in. And when I see what’s happening, I can’t turn away from it, I have to lean into it. And some people are saying now, hope is a verb we create out of the activism that we do to confront our wicked problem. And what we do now is not going to make this all nice and better, but it will affect the kind of world that we’re moving toward in the future.

This Q&A, part of a series of stories on the health impacts of climate change on older adults, was produced with the support of a journalism fellowship from the Gerontological Society of America, the Journalists Network on Generations and the Archstone Foundation.

See also:

• “Research on Climate Change and Health Reveals Risks for Older Adults: A Q&A With Dr. Andrew Chang,” 1/27/2023
• “Battling Despair Over a New Climate Change Reality,” 9/14/2021

The post Climate Change Can Harm Mental Health of Older Adults: Q&A With Dr. Robin Cooper appeared first on San Francisco Public Press.

Against this backdrop and with extreme weather events on the rise, physician-researchers like Dr. Andrew Chang, an attending physician specializing in cardiology at the Veterans Affairs Palo Alto Health Care System and postdoctoral research fellow at the Stanford Cardiovascular Institute, are investigating how the biological mechanisms of aging and a warming world will affect the health of older adults.

In 2022, Chang and his colleagues examined medical literature to study the intricate and nuanced ways that climate change-fueled disasters and other environmental factors influence the cardiovascular health of older people. They summarized their findings in the journal Current Cardiology Reports. In an interview with the San Francisco Public Press, Chang shared some of the concerns expressed by older patients during environmental disasters like wildfires, and explained the challenges researchers often face while gathering data on this subject.

Below are excerpts from the interview, which have been edited for length and clarity.

What was the motivation for you and your colleagues to embark on researching the health impacts of climate change specifically on older adults?

In the immediate phase, the group of people who most suffers from the effects of climate change are our older adults and some of our senior citizens, and the reason for that is sort of twofold. First is, there are pretty unique biological changes that happen to the human body with aging, which actually increase the susceptibility to environmental factors. And the second thing is, there are social factors as well which make older adults less resilient against some of these events. So not surprisingly, if you look at the casualty rates from both natural disasters, as well as long-term exposures to things like air pollution, disproportionately, it is older adults who are dying from some of these conditions or developing conditions or suffering from the effects of these things. I think, very quickly, it became clear to us that the study of climate change’s effects on human health disproportionately involves the health of our older adults.

Wildfires are an ongoing concern here in the Bay Area as well as across the state. And your article explored the relationships between climate change and wildfires and cardiovascular risk for older people. Could you explain how they are linked?

The biggest thing is that older adults don’t have the same barrier functions that younger adults and younger people do. And what I mean by that is that most of the injury that happens from wildfire smoke is from inhalation. So, you breathe in particles, and particulate matter we know is highly inflammatory, and it enters your body. It enters the circulation through the tiny blood vessels called capillaries that are inside of your lungs. Older adults don’t have barrier functions at those blood vessels that are as robust as younger adults. So, you kind of have more of a leaky effect, where more of those toxins are absorbed. And then they enter into the bloodstream. 

Now, not only are more toxins coming in, there’s underlying susceptibility. There’s just the normal process of aging that causes us to have reduced lung capacity. If you imagine that we’re already starting out with reduced lung capacity as an older adult, then losing even more of that is more dangerous. Similarly, just due to normal aging processes, the heart muscle becomes stiffer, the arteries are less elastic. So, any of these toxic effects basically become magnified. 

And then on top of all of that, of course, older adults are more likely to have preexisting cardiopulmonary diseases — things like heart failure or high blood pressure or diabetes — and all of those things work additively or multiplicatively in terms of your injury from air pollution exposure.

Were there any other particularly startling or surprising findings that you came across as you were doing this research?

I was really surprised how so many of the deaths that are attributable to heat waves or heat events were actually cardiac rather than things coded as heat stroke or heat exhaustion. Because, I guess in my head, it had seemed that the actual exposure to the heat itself was probably going to be the biggest determinant of injury. As a clinical cardiologist, it kind of reinforced to me that heat-related injury for older adults is a cardiac problem.

Were there any challenges that you and your team experienced as you were working on this paper? Did you run into any hurdles in finding data about how climate change will affect the elderly population?

The paper that you’re referencing is … our synthesis of what the entirety of the literature looks like. In terms of data, our group also does a lot of primary research using primary sources of data. In general, in those situations, there are some challenges. One of them is that a lot of exposures tend to be gradual, over long periods of time. Things like air pollution, for example, we know climate change makes air pollution worse. But everyone experiences some amount of air pollution at baseline. So, there’s a challenge of studying something that’s sort of insidious, and occurring over a long period of time, in terms of things like air pollution. 

On the flip side, studying things like wildfires or extreme heat events, which are very intense, very short exposures. Part of that is also challenging because it’s hard to gather data in the moment. When there is a natural disaster, say like a wildfire, the priority on the ground really is to evacuate people. It’s to make sure that they’re being safe, that they’re being cared for. And a lot of research ends up happening retrospectively, trying to kind of go back and cobble together what exactly happened. So, you start to lose some of that individual granularity. 

You can gather much more granular data. For example, some of my colleagues are putting air sensors in people’s homes and looking forward to future wildfire seasons to see how much does that impact their health outcomes. The challenge on that side is also that’s very granular data that tends to be kind of hard and expensive to do on a large scale. 

And are you currently doing any research?

I’ll speak more generally, just because these studies are ongoing. But some of the questions that we’re interested in generally are: What were the effects of specific wildfire seasons on emergency room visits? Did emergency room visits for certain types of conditions — say, asthma attacks, heart attacks, strokes — change before and after specific wildfire events? 

Other things we’re looking at are things like subclinical markers. What I mean by subclinical markers is: Is there an early detection system for injuries to the organs from these insidious, prolonged exposures? To give you an example, I look at ultrasound data of the heart in older adults — people over 65 — to look at over the course of five years or so of air pollution exposure. Are there subtle findings like subtle changes that happen to the way the heart moves? The way the heart muscle moves that may mean worse things are down the line? Can we identify these things early on? Can we identify people who are at risk for worse things like heart failure down the line from air pollution exposure? So that’s another thing that I’m interested in. 

In your clinical practice here in the Bay Area, do conversations about climate change come up with your older patients who have cardiovascular diseases?

The climate change issue that I field the most questions about are usually during wildfire seasons. I think part of that has to do with the visibility of it. When it looks like “Blade Runner” outside, the skies look pretty apocalyptic. I think it’s pretty clear to everybody: If you’ve ever tried to go jogging during a bad air quality day, it’s quite apparent that your heart and lungs are not happy with what’s going on. And I have to say most of our patients are also aware of that. I think that’s less of a thought during the extreme heat, because most people don’t immediately connect extreme heat events with heart disease, but I will definitely say I get a lot of questions from patients during wildfire season asking: What does this mean for me? What are the dangers to me? And most importantly, what should I do?

How can healthcare professionals help older people understand the risks of climate change?

We do know that unfortunately, older adults are less mobile and less able to evacuate in times of climate crises. I think one of the saddest statistics I’ve ever heard is that during Hurricane Katrina, over half of the people who died were over the age of 75. That really speaks to the fact that emergency planning has to be done in advance for older adults.  

I know a few of the environmental agencies do in general recommend that people at higher risk for harm from these situations have a disaster response plan. And having these types of disaster management plans is something that we can and should be talking about with our patients, particularly those who live in parts of the country with seasonal emergencies like hurricanes or wildfires or extreme heat waves. I think, as of now, that’s probably something that we as clinicians should be talking about with our older and vulnerable patients that we probably aren’t doing.

While older adults overall are vulnerable to climate change threats, your paper mentioned how those experiencing poverty and structural racism are at greater risk. Could you say more about this?

People who are at a lower socioeconomic status are almost always at higher risk. Part of that has to do with the fact that a lot of current solutions that have to deal with these things involve money, things like air conditioning for heat, and the fact that people who have money and means are more likely to afford higher quality care, so they are less likely to have developed some of these risk factors even if they are the same age as somebody who may be poor. 

In terms of racial, ethnic breakdowns, we’re increasingly recognizing that certain policies, for example, redlining, have marginalized certain groups of people such as African Americans to unfortunately live in parts of cities and communities that may be exposed to higher rates of air pollution — for example, near highways or industrial areas. And as you can imagine, having a higher baseline underlying rate of air pollution exposure means you’re more likely to be injured when there’s a spike in it from something like a wildfire. 

Anything else you wish to add?

I think, moving forward, we shouldn’t take a paternalistic attitude. There are a lot of things that older adults can also offer in the fight against both climate change and climate change-mediated disasters. There’s a certain resilience that you gain from life experiences. 

Also, older adults, a lot of them have this transgenerational thinking, this ability to imagine and advocate for a world for future generations — for their children, for their grandchildren, for their great grandchildren. That, I think, is really powerful. And in many societies, like First Nations societies, elders are quite respected and are important decision makers. Anything that we do in terms of policy, we need to make sure that older adults are equal partners in the decision making, and that we try to leverage their specialized skill sets or their strengths or their worldviews in order to craft our responses to these things, because we’d be surprised at a lot of the strength and resilience that we’ll find from our elders.

This Q&A, the first in a series of stories on the health impacts of climate change on older adults, was produced with the support of a journalism fellowship from the Gerontological Society of America, the Journalists Network on Generations and the Archstone Foundation.

The post Research on Climate Change and Health Reveals Risks for Older Adults: Q&A With Dr. Andrew Chang appeared first on San Francisco Public Press.

UPDATE 7/29/2022 — The federal government has agreed to allow Laguna Honda Hospital to stop discharging and transferring all patients out of its facility, according to a statement issued by Mayor London Breed on July 28. The announcement came two days after the San Francisco Board of Supervisors unanimously approved a resolution urging the U.S. secretary of Health and Human Services to suspend an order by the Centers for Medicare and Medicaid Services to move all patients out of the hospital. A separate resolution asked Gov. Gavin Newsom and the state health director to stop the transfers. Both resolutions expressed concern that relocating vulnerable patients would cause harm. Federal regulators had previously said they would require Laguna Honda administrators to relocate all patients before they would allow the hospital to apply for recertification needed to receive continued federal funding. Four of the patients recently transferred from Laguna Honda Hospital died soon after being displaced.

Administrators are overhauling policies and procedures to regain federal funding that is set to expire following the issuance of multiple damning inspection reports at Laguna Honda Hospital. They have until Sept. 13 to implement changes, which include a requirement to transfer or discharge all patients, before they can apply for recertification from the Centers for Medicare and Medicaid Services — which has the authority to restore funding for patient services. But administrators say they’re struggling to fulfill the centers’ mandate to move out all patients by the looming deadline.

Laguna Honda has room to house more than 700 patients (although as of July 18, occupancy is at 613) and accounts for 34% of all skilled nursing facility beds available in San Francisco. And the hospital’s interim CEO, Roland Pickens, said finding other suitable beds, ones that come with the same level of medical care, has proven to be a near-impossible task. Part of the challenge is finding beds for two distinct populations: those who are typically older and need high-level nursing home care, and those who are not usually elderly but require long-term treatment for psychiatric needs, behavioral disorders and substance abuse problems.

San Francisco’s health department created an online dashboard to show the progress of patient transfers. It shows that Laguna Honda staff are making about 1,500 calls a week searching for open beds. According to the dashboard, as of July 18, 40 patients have been transferred to skilled nursing facilities, and 16 were discharged, three of them to homeless shelters.

The requirement that Laguna Honda move out all patients before seeking recertification is leading some to foresee disaster for patients, their families and for a city already beset by homelessness.

“There’s no way — it’s unthinkable to try to relocate over 700 residents,” said Valoria Russell-Benson, who has worked as a nurse at Laguna Honda for 27 years. “A relocation or to close down Laguna Honda would end up in homelessness for a lot of our residents.”

The Centers for Medicare and Medicaid Services declined an interview request, but in an unsigned statement, wrote that ending a Medicare and Medicaid provider agreement was a last resort. The agency has agreed to continue funding patient care until Sept. 13 as the hospital works toward recertification.

Two consulting firms — Health Management Associates and the Health Services Advisory Group — are helping by conducting mock inspections, according to Dr. Derek Kerr, who worked at the hospital for 10 years. Following his involvement in a successful whistleblower case against the hospital, he became an investigative reporter for the Westside Observer — an online news publication covering San Francisco’s western neighborhoods — and has inside knowledge on activities at Laguna Honda. And full disclosure, he has also donated to the Public Press.

Kerr said the first mock inspection happened in June, and Laguna Honda is correcting deficiencies identified then. San Francisco General Hospital Quality Management staffers have been brought in as well, along with more nurses and more sheriff’s patrols, safety searches and visitor screenings. And narcotic analyzers will check patients when they return to the hospital after brief, permitted excursions.

These measures are meant to address the problem of illicit drug use in the hospital and the presence of contraband among patients. Kerr contends that these problems arose when the Department of Public Health made admissions policy changes in 2004 and introduced a younger population of men — some of them with substance abuse issues.

He said the elderly patients who formerly made up most of the hospital’s population cannot thrive in a “fortified institution” with drug scans, increased police presence and nurses searching patients for contraband.

“Those kinds of constraints are diametrically opposed to what nursing home care should be for elderly patients. They need a completely different model,” he said. “The risk is that you transform the hospital into a carceral complex in order to manage an antisocial subset. So that’s the problem. It might deform the hospital.”

According to a report presented by Pickens, Laguna Honda’s interim CEO, at a San Francisco Health Commission meeting July 19, a second mock survey will occur in August, and in September, the hospital will apply for recertification. If Laguna Honda passes an initial inspection, the Centers for Medicare and Medicaid Services will return 90 to 120 days later for a final review. If it passes that test, Laguna Honda could be in the clear by January 2023.

The post Laguna Honda Hospital Has to Self-Destruct to Survive appeared first on San Francisco Public Press.

The Legacy Film Festival on Aging runs virtually May 24-31.

A segment from our radio show and podcast, “Civic.” Listen daily at 8 a.m. and 6 p.m. on 102.5 FM in San Francisco, and subscribe on Apple, Google, Spotify or Stitcher. 

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“If you spend enough time around people that are in the end stages of their life, there are things that keep them going. And then there are times when, you know, they lose the will,” Correia said.

One of those things is seeing loved ones, he said. One facility resident he worked with had recently chosen assisted suicide, Correia said, after months of isolation under the pandemic visitation restrictions.

“That was really troubling to me,” Correia said. “Certainly there were medical issues, and he qualified for it. But he had a much stronger will at the beginning of this.”

Advocates have been pushing for the city to ease pandemic-related restrictions on people visiting their loved ones in these facilities for weeks. Their demonstration marked one year since health orders severely restricted visitation as the pandemic took hold in California. It also came a day after the city’s health department had issued an order expanding visitation by removing strict local guidelines and instead aligning with state policy that allows for indoor, in-person visits when they can be done safely. 

Safety requirements include screening any visitor for potential infection, testing and wearing masks. A county’s infection rate “tier” and a facility’s size, staffing and vaccination rate also influence how visitation can occur. Restrictions loosened last fall had until now only allowed for visitors to see residents through a window, from their cars or in some cases outdoors with social distancing. 

“It’s hard because some people don’t have outdoor space. It’s just hard to navigate,” Schneider said. 

Some types of visitation have been allowed from the beginning of the pandemic. The ombudsman has always been allowed to visit facilities, according to the city health department, and “essential visitation” has been allowed under acute circumstances like the end of a resident’s life or for legal requirements. 

While much of Schneider’s contact for many months was virtual, she recently began visiting some facilities. 

“There’s people who have no family at all. And that’s who we also try to focus on a lot, to make sure that they’re getting their needs met, because they don’t really have as much of a voice or the eyes and the ears that the family or other caregivers have,” Schneider said. 

An unsigned statement from the Department of Public Health said Laguna Honda Hospital, the largest skilled nursing facility in the nation, will offer in-person visitation in the coming weeks, as staffing allows. It also noted that the department does not determine how facilities comply with state rules, and is not an enforcement mechanism.

“The San Francisco Department of Public Health is excited that local conditions now support this alignment with the State to allow and encourage individual facilities to safely resume indoor visits,” the statement read. 

A segment from our radio show and podcast, “Civic.” Listen at 8 a.m. and 6 p.m. Tuesdays and Thursdays at 102.5 FM in San Francisco, or online at ksfp.fm, and subscribe on Apple, Google, Spotify or Stitcher. 

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First in line for the vaccine were a few hundred residents of the care facilities that Self-Help for the Elderly operates. When independent seniors became eligible, finding their own appointment online proved an insurmountable barrier for some.

“All the sites are English, for English speakers. Even though they might have a bilingual flyer giving you the information, but when you actually log onto the site, you have to be English speaker and tech savvy,” Chung said. 

And appointments have been going fast, locking out seniors who do not have someone to frequently check vaccine websites for them to schedule an appointment. 

“Unless you have a grandchild who’s very tech savvy and hover over the site for hours for you, seniors that are living alone with no relatives close by, don’t speak English and definitely are not computer literate are really at a loss,” Chung said.

In response to this kind of problem, San Francisco offered walk-in vaccinations to seniors at San Francisco General Hospital, but Chung said the lines there stretched for several blocks. And she stopped sending clients to the mass vaccination site at Moscone Center. 

“I have seniors that gone there, and they totally got lost,” Chung said. “It’s too big inside, it’s very chaotic.”

Meanwhile, community centers operated by Self-Help for the Elderly have been open since summer, serving as hubs for the distribution of meals and other resources. So the organization began working with doctors from All American Medical Group, a San Francisco physicians group serving a majority-Asian population, to begin distributing vaccines to its senior centers. The first doses were administered at Self-Help’s Richmond district center on Monday, where volunteers could offer visitors hot tea or water while they waited. That, combined with staff and physicians who could speak the patients’ language, helped put them at ease, Chung said.   

“They’re familiar surroundings. You have bilingual and bicultural health care and also volunteers,” she said. “It just works.”

A segment from our radio show and podcast, “Civic.” Listen at 8 a.m. and 6 p.m. Tuesdays and Thursdays at 102.5 FM in San Francisco, or online at ksfp.fm, and subscribe on Apple, Google, Spotify or Stitcher. 

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Now, vaccines are arriving in California and doses will be administered at nursing homes soon through a government partnership with pharmacy giants CVS and Walgreens, whose staffs will deliver vaccines to long term care facilities. Eric Dowdy, chief government affairs officer at Leading Age California, an organization representing mostly nonprofit senior care facilities, said the top priority for those planning the vaccine rollout is improving confidence in the vaccine, in part by combating misinformation that fuels mistrust.

“The pipeline, getting the vaccines to the facilities, that’s all going to happen. The supply is going to get ramped up and we’re not going to have issues with the vaccine being available. It’s just a matter of getting people to realize that it’s worthwhile taking, and that they’re not putting their life at risk doing so. And it’s very important. Really, at this point it’s our only way out of this pandemic so it’s crucial that people take this vaccine when it’s offered.”

— Eric Dowdy

A segment from our radio show and podcast, “Civic.” Listen at 8 a.m. and 6 p.m. Tuesdays and Thursdays at 102.5 FM in San Francisco, or online at ksfp.fm, and subscribe on Apple, Google, Spotify or Stitcher. 

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