Thursday, March 5, 1998
In Seaside, an elderly man has to choose every month between buying food or paying for his medication. In Pacific Grove, an 80-year-old woman whose Section 8 housing unit went condo now lives in a small shed.
In Salinas, a retired farmworker couple who can no longer pay rent crowd in with their adult children on welfare. In Carmel, an impeccably-dressed little old lady locks her front door so the neighbors won''t see her unpack her Salvation Army brown-bag lunch.
This is the face of elderly poverty in Monterey County. It''s not about starving in the streets, although there are homeless elderly here. It''s about skimping and worrying. It''s about canvassing the church groups to find the best free meals. It''s about counting pennies at the end of the month and choosing between another few cans of beef stew, or that high-blood pressure medication you really need. It''s about putting on another sweater as you turn off the heater, or begging the landlord not to raise your $300 rent, because you have no family to help you move and you can''t lift your furniture by yourself.
How do we define the elderly poor? "It depends who you ask, and on what day," says Vicki Bamman, executive director of Monterey County''s Ombudsman for Long-Term Care.
The US government uses a dollar amount. According to the US Census Bureau, 2,200 of the 35,500 people aged 65 or older in Monterey County fall below the federal poverty line, which stands at $7,890 per person, per year. That''s a laughable amount of money to survive on in this high-priced corner of the world.
Other social service agencies use different dollar amounts to define who is poor enough to receive their assistance. The federally-run Food Stamps program uses a poverty threshold of $810/month per person, or $1,087 for a couple, to qualify for their aid. The HEAP program, which subsidizes utility bills with state funding, uses a poverty threshold of $838/month per person, or $1,122 for a couple. The Salvation Army is a bit more lenient, offering utility subsidies to couples whose combined monthly income is under $1,417.
The standard definition of "elderly poor" in our county is someone who lives off a $650 monthly SSI (Supplemental Security Income) check from the department of social services. To be eligible for that check, you must be over 65 with an income below the federal poverty line, and you may not have more than $2,000 in assets, excluding your home and car. "With the cost of living in this county, $650 is not a lot of expendable income," says Mary Goblirsch, program manager for the department of social services'' Area Agency on Aging and Community Services.
Ironically, if you get that monthly SSI check for $650, you are no longer eligible for food stamps. Seems the government feels you''d be making too much money if they gave you both.
Viveca Lohr, executive director of the Peninsula''s Meals on Wheels program, uses a different definition of what it means to be elderly and poor in Monterey County. "It is someone who has to make a choice between needs," she says. "When you have to choose one need over another--a roof over your head, or buying food--I consider that poor."
The Meals on Wheels program delivers hot meals to 200 homebound elderly from Marina to the Carmel Highlands every day, and serves an additional 125 to 150 daily congregate meals at its senior center locations. Because of the program''s Title 3 funding restrictions, Lohr explains, they are forbidden to ask clients'' income levels. They deliver meals to any homebound seniors who are unable to shop or cook for themselves. "But realistically, the majority of the people we serve are low-income," she says.
Whereas most of the elderly people who show up for their congregate lunches pay the suggested $2.50 donation per meal, only half of the program''s home delivery clients are able to pay the full $5 suggested donation for three daily meals. "More and more we find that people are unable to make this contribution, because they are being forced to choose," Lohr says. "It''s a real pride issue. We would rather see people take our meals for free than starve, but sometimes people ask us to stop delivery because they can no longer pay the $5."
What do those elderly clients do, if Meals on Wheels home delivery stops? "They don''t eat," Lohr says.
Some elderly clients ration their food carefully. "They come to our on-site congregate meals, eat half the meal and take half home for later," she says. "We see people who are literally starving. Our delivery people report there is nothing in the house. The cupboards are bare. Some of it is affordability. Some of it is, they just can''t get out [to shop]. They tell our volunteer drivers, ''I''m so hungry.''"
Nevertheless, the Salvation Army Good Samaritan Center in Sand City doesn''t see a lot of elderly homeless stop by to take showers or enjoy a cup of free hot coffee. But that''s not because these people don''t exist. "It''s too hard for them to get here," says Salvation Army outreach worker Carlos Lopez. "If they''re camping out under the wharf and they have a bad leg, or back problems, they can''t walk over here with any consistency. They want to come here, to use the basic services we provide, but they just can''t make it."
The elderly homeless are "more shy" than other homeless men and women, Lopez says. "Rather than panhandle, they''re more apt to make themselves less visible," he says. "It makes it hard for us to get to them."
Appearances are Deceiving
"People have this stereotype that everyone on the Peninsula is rich and white, and it''s not true," says Kimberle Herring, director of the Sally J. Griffin Senior Center in Pacific Grove. "You don''t always know. Your neighbor may look fine, but he may really be on the edge."
Women often outlive their husbands, and can find themselves in serious financial straits down the road. In wealthy neighborhoods of Carmel and Pebble Beach, local health care professionals say, elderly widows are living in half-million-dollar homes they can''t sell, scraping by on fixed income checks that barely provide enough for daily living needs.
"In Pebble Beach, people perceived to be wealthy are really asset-rich and cash-poor," says John O''Brien, chair of Monterey County''s Area Agency on Aging. "They may own a home worth hundreds of thousands of dollars, a home they bought 50 years ago, but be living on a small fixed income."
And if you are widowed and elderly, and you become so frail or ill you need round-the-clock custodial care, you may find that your fixed income of several thousand dollars a month won''t begin to cover the costs of a home health aide. O''Brien, who also heads the home care agency, Central Coast Senior Services, says that round-the-clock home care can cost from $3,000-10,000 a month. And you have to pay for that all out of pocket.
"The irony is, if you have some income, you''re often worse off than if you have no income and you qualify for MediCal," O''Brien says, adding that the county is able to offer only "limited" services for the non-poor, low-income elderly. "If you are at or below the poverty line, there are more services available to you than if you are low-income, the so-called ''near poor.'' Then you''re just on your own.
"The misconception is that if you have some money, you''ll be alright. And that''s not true. You may have more choices for a while, but that''s all. You may have done all the things you were supposed to do, worked hard, put away a little money, maybe $20,000. And now you fall in the hole."
"What do the near-poor do?" he asks. "They go without. Without medication, without their doctor''s appointment, without food."
Food or Medicine
Valentine Rivera has been just making ends meet for most of his 67 years. "A lot of senior citizens are in the same boat I am," he says philosophically. Rivera was born to a Mexican-immigrant farmworker family outside Fresno. As a small boy, he used to join his older siblings and parents in the fields, picking fruit and vegetables in the pre-dawn hours before school. He spent his entire adult life as a farmworker in the Salinas Valley, until an on-site accident in 1953 destroyed two discs in his lower back and left him permanently disabled.
Worker''s compensation ran out long ago. The disability payments ended two years ago when he turned 65 and Social Security kicked in. Ironically, Rivera''s Social Security checks came to so much less than his disability payments that he and his wife Maria had to move out of their low-rent Salinas apartment, and are now sharing the $600 rent on a small Seaside home with his adult stepson and the son''s young daughter.
Rivera''s monthly Social Security check comes to just over $1,000. From that, he pays $300 towards rent, and another $180 or so on utility and car bills. Medicare and his Secure Horizons HMO pay doctors'' bills, but don''t cover his diabetes medicine, which comes to $150 a month, or his high-blood pressure pills, which cost another $50. Other monthly bills leave him with about $200 for food and clothing for himself, his wife, and his adult daughter and her two children, who moved in with them last fall.
"Medical bills are killing us," he says. "As soon as my wife turns 65, I can get her into Secure Horizons, and then she''ll only have to pay $10 for each doctors'' visit." Right now, they owe a $500 dentist bill. "I can''t remember the last time I bought a pair of pants," he says, adding that the family gets its clothes--and some food--from the Salvation Army.
Yet the Riveras make "too much money" for free MediCal, or for the food stamps program. If he participated in MediCal, he would be subject to a monthly co-payment of $420, which he says is way beyond his reach. And food stamps? "We used to get $10 a month in food stamps, but it was hardly worth it to go down to the post office and sign for it," he says. He asked for MediCal reimbursement for his telephone line, and was told the telephone is a luxury. "But I need it, to call 911 and to get my prescriptions," he points out.
Once Rivera called his Secure Horizons representative, to ask why he wasn''t getting reimbursed for his medical prescriptions. "They asked me what county I live in, and I said, ''Monterey,'' and they said, ''Oh, we don''t pay for prescriptions there,''" Rivera says. "So I said, ''tell me where you do pay, and we''ll move there. We''re homeless anyway!''"
When money gets tight, Rivera does without his medication. Last November, when his daughter and her two children moved in with his wife and him, he went without his diabetes medicine for an entire month until his shakes got so bad he went to the Salvation Army. They still pay half his prescription bill, "until I can get back on my feet." The Salvation Army has been a big help, he says. "Before I went to them, I''d run out of medicine before the end of each month, and I wouldn''t buy more until the next Social Security check," he says.
The Riveras keep hens in their backyard, to supplement their food supply. They eat some of the eggs, and trade others with neighbors for bread or milk. They buy low-fat milk for themselves, regular milk for the children, bread and vegetables, and the Salvation Army gives them canned fish and vegetables as they need it. "I don''t like to take too much from them," he says. "I don''t want to take advantage." Most days, Maria makes soup for their dinner. When funds are low, there''s just one thing to do. "We add more water to the soup," Rivera says.
In thanks for all the Salvation Army has done for him, Rivera brings over a few trays of donated doughnuts, provided by his landlord, every morning, for the homeless men and women who stop by the Sand City center.
"Sometimes I sit and reminisce," he says. "When I was younger and working, I thought that when I retired, Medicare would take care of me. But our government is trying to take from Medicare. Isn''t there something else they could take from, like nuclear weapons, and leave the poor people alone?
"What will happen if my stepson gets married, and we have to move out? Will my wife and I always have to live with someone else? We were born here, we''re US citizens, we worked all our lives here. Now we live on one Social Security check. We''re the forgotten citizens. We''re being pushed out."
The Riveras'' story is not unusual, according to professionals in the field of elderly care. As federal and state funding is being cut to Medicare, MediCal and subsidized housing programs, the elderly poor and near-poor are feeling the squeeze the hardest.
"The nearly poor are our biggest problem," says Carmen Hernandez, executive director of the local Salvation Army center. "They have a strong work history and are receiving Social Security benefits, but because of the high costs in this area, they find it very hard." These elderly needy are very reticent to come by for help, she says. "They don''t come here for assistance unless they really need it," she says. "They might show up for that little extra bread or produce, or just to find a listening ear. They are so overwhelmed with financial difficulties."
Where to Live?
The biggest local problem, according to professionals in the field, may be low-income housing for the elderly. "While the senior population is growing and service needs increasing, our greatest local concerns are for the moderate- or low-income residents who cannot afford to spend their last years in the community that has been their lifelong home," says Vicki Bamman, whose agency helps place elderly locals in assisted living facilities and nursing homes.
Bamman estimates that half of her elderly clients have very real difficulties in meeting expenses. "If you ask them if they''re poor, they say no," she says. "They don''t think of themselves as poor. But they are torn between compromising their standard of living, and wanting to leave something to their heirs. They want to spend as little as possible on themselves. They''re outraged and panicked when they find out how much services cost."
Of the 60 residential care facilities for the elderly (RCFEs) in Monterey County, Bamman points out, just one on the Peninsula and 11 in Salinas accept SSI reimbursement. But that figure is deceptive, she adds, because virtually none of them have free beds. On the Peninsula, there isn''t a single available low-income RCFE bed.
What often happens, she says, is that elderly near-poor are either pushed into skilled nursing facilities that do accept MediCal--a wasteful proposition, as many of these people don''t need the higher level of care offered in the nursing homes--or the individual or couple "spends down" their money until they can qualify for MediCal. "If you''re absolutely destitute, you might be in better shape than if you have a little bit," she says. "The Sicilian grandmother who has raised her children and grandchildren on the Monterey Peninsula, now finds she cannot find placement on the Peninsula and she has to move to Salinas. That''s not fair."
The "NIMBY" syndrome (Not In My Back Yard) is alive and well when it comes to housing for the elderly poor on the Monterey Peninsula. The attitude seems to be, according to local professionals in the field, "put them in Salinas." Bamman gives the example of a 68-year-old homeless man who begins acting out on the street. He is picked up by the county''s Adult Protective Services, given a three-day psychiatric assessment at CHOMP''s Garden Pavilion, which then tries to place him. "If that person has no medical problem except dementia, and no money, he will find no placement on the Monterey Peninsula," she says.
But even there, strings can be pulled. "Politics, who you know, if you know how to work the system, and if you are vocal and articulate, all goes a long way towards placement in a low-income facility," Bamman notes.
Ellen Mills, head of information and referral for the Alliance on Aging, counsels elderly clients on a variety of issues. She agrees that affordable housing is a top priority. "There are just a handful of low-income housing options [for the elderly] in Monterey County," she says. "On the Peninsula we have Pacific Meadows, El Estero and Portola Vista, and they all have waiting lists. We could use 10 Pacific Meadows, and they''d all be filled."
Section 8 housing, a federally-funded program for low-income residents, pays about two-thirds of a person''s rent if he or she qualifies. Unfortunately, Mills says, the local Section 8 office is so swamped that they haven''t been able to place anyone from their waiting list for the past two years. There are thousands of people waiting for placement, Mills says, and the office has stopped accepting new applications.
People are living longer, and their money is running out. Mills has one client, a woman in her early 90s, who lives in an upscale RCFE on the Peninsula. "She''s got enough money left for less than two years in the facility," Mills says. "She never thought she''d live this long. It will get to the point where she has no money left, and she''ll be out on the street."
Elderly people paying $650 a month in rent can get by on a $900 monthly SSI check, until medical problems crop up and they are suddenly facing $200 or $300 in monthly prescription bills. "Where do they go then?" Mills asks. "I have one lady in Monterey, in her 80s, who has basically no money left for food at the end of the month." How does she eat? "Sometimes she doesn''t," Mills answers. "Sometimes neighbors bring her food. She wouldn''t go to a place for free meals if her life depended on it. These people are proud."
People are also emotionally attached to the communities they''ve lived in for so long. There are more low-income housing options in Salinas than on the Peninsula, but a longtime Peninsula resident balks at the idea of "leaving home." Mills has a woman client in Carmel whose Section 8 eligibility expired because she refused to leave Carmel in order to use it, although she is now paying $600 monthly rent out of her $650 monthly SSI check. The woman has no other income.
When the folks from the Alliance on Aging or Meals on Wheels find an elderly person in serious need, someone who absolutely cannot get by on his or her own, they usually turn the case over to the social services department''s Adult Protective Services division. "But there''s only so much they can do," Mills cautions. "The money isn''t out there."
And you can''t force help on someone who doesn''t want it, unless that person is certified as incompetent. "They''re proud," says Sue Appel, supervisor for Adult Protective Services (APS) and the department''s In-Home Supportive Services program. "They don''t want to apply for services. Or they don''t know how. Or they''re not a citizen, and so not able to apply."
Alone and Losing Control
Elderly people living alone often don''t notice, or don''t want to admit it, when they begin losing their faculties. If no one is looking out for them, they can get their financial affairs in such a muddle, that it takes months to sort things out.
Appel tells the story of one elderly client who was bumped off MediCal''s SSI list when he received a small inheritance. The inheritance money quickly ran out, his medical bills were piling up, and the man didn''t realize he could reapply for MediCal until an APS staffer went into his home and showed him how to fill out the necessary forms.
APS workers see all kinds of situations when they go into clients'' homes, Appel says. "We find roofs leaking, plumbing not working, and no money to fix it," she says. "People who at one time were able to purchase a home are now unable to maintain it."
As government-funded subsidized housing programs are being phased out, more and more senior housing units are coming off the subsidized market and being placed on the open market. "As this happens, seniors are losing their living areas and find themselves unable to compete on the open rental market," says Mary Goblirsch.
Goblirsch points to Pacific Grove, where nearly one-third of the residents are elderly. "I know women there in their 80s, people who never thought they were poor, who have lost their housing and are living in little sheds. They''re really struggling for suitable housing."
A monthly check for $650 doesn''t go far towards guaranteeing people any kind of security in their old age, Goblirsch concludes. "It''s a terrible squeeze for elderly people," she says. "We are balancing the books on the backs of old, poor people." cw