Monthly Archives: February 2010

Cheryl Jones prepares Margaret Bass ("Mother Bass") for breakfast. Photo by Josh Meltzer

A home-care aide I know once scrubbed an elderly client’s toilet with balls of used tinfoil and denture tablets — because the old woman was too poor to afford cleaning supplies and too feeble to do the cleaning herself.

Many aides do less rigorous, but no less important, activities. They cook meals, check blood sugars and bathe people who can no longer bathe themselves. What they do — some for just a few hours a day — makes the absolute difference between a person staying home and a person going into that most-feared institution: the American nursing home.

Which isn’t just sad, it’s expensive. At an annual cost of $77,000 per person, prolonged nursing home stays force most middle-class elderly end up on Medicaid — just like two-thirds of all nursing home residents in America.

Among the many cuts to the state’s MassHealth program proposed recently by Gov. Deval Patrick, the most myopic is the one that calls for the administration to stop paying for personal-care or home-care attendants who serve patients fewer than 15 hours a week.

Sounds reasonable, at first glance, to remove the benefit from the least needy of the recipients. But anyone who has spent time in the company of a home-care aide will attest that those few hours a day are absolutely critical to the client who needs an insulin shot or her therapeutic socks changed or his invoices sorted so the light bill gets paid.

In fact, researchers working at Boston’s Hebrew Rehabilitation Center for Aged found that when screening to see who was at the greatest risk of institutional placement, seniors who could no longer take out their own trash ranked near the very top.

“Taking out the trash is a relatively time-limited task,” said Elise Bolda, health policy professor at the University of Southern Maine. “And yet without it you really can’t continue living in your own home.”

Paying a home-care agency $19 an hour for part-time chores and companion care seems like a steal compared to the $219 per day it costs to fund a semi-private room in a nursing home.

Medicare-funded home health programs have also come under attack in Congress, with reform proposals calling for millions of dollars in cuts that seem at odds with the Obama administration’s stated cost-savings goals of reducing hospital re-admissions.

Sure, it’ll cost four times as much to put aunt Agnes in a nursing home, the logic goes, but if that money is coming out of a different taxpayer pot, we still get to claim the home-care savings, right?

Right now 76 million American baby boomers are slouching toward retirement, a demographic shift that’s unprecedented in the history of the world. When Medicaid and Medicare were designed in the mid-‘60s, family members lived closer to each other, not as many women worked and people with chronic illnesses didn’t live as long as they do today.

Forty-five years later, we’re left with a confusing array of home-care offerings with different payment requirements, eligibility criteria and reimbursement systems, not to mention coverage limitations that make for huge gaps in services.

I know a 60-year-old woman, an executive secretary for a hospital president, who was too young to retire, and yet she couldn’t afford to pay a home-care aide to watch after her 69-year-old demented husband while she worked.

Veterans Affairs benefits paid most of his adult-day care bill for several months, but when his dementia worsened and he could no longer stay at the center, a social worker told her there was nothing else the VA could do to help her keep her husband at home. “We’re sorry, there’s no program for that.”

Who’s going to take care of us baby boomers when we’re old and frail? Who’s going to help us take care of ourselves?

The politicians need to be asking these questions rather than masking them with disingenuous talk of cost-savings and so-called reform.

An interesting Q and A in today’s Boston Globe traced social decay in the United States to the widening gap between the poorest and the richest. Kate Pickett and Richard Wilkinson, authors of “The Spirit Level,” posit that economic inequality is the root cause of problems like teen pregnancy, obesity, mental illness and crime — all of it fostered by divisive prejudice and rampant tension between the classes.

Wilkinson told the interviewer: “The quality of social relations seems to deteriorate in more unequal societies. People trust each other much less….In Sweden, people don’t bother to check your tickets on the train or bus. And it just feels so much nicer.”

People have asked what I’ve found most striking about the privileged enclave of Cambridge compared to my Roanoke, Va., hometown, a culturally and environmentally interesting place that also happens to be one of the most segregated places in the South, with 68 percent of the city schools’ children qualifying for free or reduced lunch (compared to the stage average of 29 percent).

The Globe piece made me zero in on an intangible difference that’s been gnawing at me these past several months. I’ve noticed a surprisingly greater level of trust among strangers here in Yankeeland (with the huge exception of Boston-area drivers, who you can never, ever trust to stop for a red light or stop sign; note that I’m talking about trust, not necessarily manners). Maybe it’s because we’re in insulated Cambridge, the intellectual capital of the East Coast . There’s a great deal of diversity here, yes, but the diversity is more ethnically and more economically diverse.

The lack of bureaucracy at Cambridge public schools is comparably stunning. For instance, when you check your kid out early from school, they don’t make you sign out at a computer. In fact, Donna — most of the secretaries are named Donna, for some reason — doesn’t even ask you to sign out. She just calls your kid down and waves you along.

At my son’s elementary in Roanoke, you sign your child out on a computer, which actually takes your picture — at the least-flattering angle possible, typically resulting in several chins beyond my normal two. You feel like your photo just might turn up on a Most Wanted poster. (And don’t get me started on the local pediatrician factory, where the surliest front-desk clerks in history treat all who walk in the door as if they’re trying to pull something over on them or, worse, they’re uninsured.)

The high schools offer startling contrasts, too. Students at Cambridge Rindge and Latin may leave campus to eat at nearby restaurants (sorry to say, it’s my teenager’s favorite thing about school this year). Whereas when the new Patrick Henry High School opened a few years back, administrators decided to literally lock the students inside the cafeteria, known by staff and students alike as “the cage.”

Comparing Roanoke to Cambridge schools isn’t fair, I know, especially considering that wealthy Cambridge spends almost twice as much per pupil as Roanoke does. That gap is about to widen, with the potential layoff of 200 teachers because of state budget cuts proposed by Gov. Bob McDonnell. (Here’s a thoughtful column by my colleague, Dan Casey, on the topic.)

A friend and civic leader predicted recently that we’ll be surprised by the uptick in cultural happenings in the ‘Noke. There’s so much interesting stuff going on now, it’s impossible to get to it all, he said, noting expanding offerings in theater, music, film and more. He also praised The Big Read, the valley’s collective effort to encourage reading, soon to kick off with a discussion of Ernest Gaines’ “A Lesson Before Dying.”

I loved that book, and I love that Roanoke’s undercurrent of groovyness seems to be widening by the minute. I just wish we could harness the same kind of excitement around improving our schools. Perhaps the No. 2 book on Roanoke’s Big Read list could be “The Spirit Level,” a book that could foster dialogue about the complex social inequities and poor educational opportunities that lie at the heart of our region’s slow growth and high dropout rate.

Because the Roanoke I know and love is surely two cities, a place where the twain rarely meet — except on the inside of a cafeteria cage.

Fresh from his 14-day trip to cover the devastation in Port-au-Prince, New Yorker staff writer and man-about-the-world Jon Lee Anderson was in no mood for the likes of the uptight waiter who served us breakfast at the Harvard Faculty Club.

He’d just witnessed people with missing limbs, the charred corpse of an alleged thief who’d been murdered on the spot by executive order, a presidential palace smashed “like some monster had jumped on it 1,000 times.” He’d even helped Nadia Francois, the woman he profiled in the Feb. 8 New Yorker, get food for the wounded and starving in her small community, located perilously in a hillside ravine.

When Nieman fellow Boris Munoz dared to change his breakfast order, Anderson bristled at our waiter’s grumpy response. I wondered if he wasn’t being a bit hard on the waiter, but when Anderson described his time in Haiti, I understood the annoyance: There are so many more important things in the world to grumble about. Scrambled eggs or starvation in Port-au-Prince?

Anderson, 53, is based in Britain but travels the world covering devastation in places like Uganda, El Salvador, Iraq, Afghanistan and post-Katrina New Orleans. He came to the Lippman House Monday night to attend a presentation by his longtime pal, Munoz, a journalist based out of Caracas, Venezuela. As a bonus, Boris arranged for him to talk to our group about his work over breakfast the next day. Humble and intensely thoughtful — and man, can a job get any cooler than his? — Anderson was one of our best speakers yet.

When someone questioned whether he’d crossed the line in helping his Haitian story subject get food, he described a gaffe he’d made earlier in his career while covering the Mexico City earthquake: He was trying to interview a grieving mother when she snapped, “Get away, you vulture.” The incident has haunted him ever since. Guided him, too.

“You have to help if you can. I couldn’t leave someone with a gunshot dying on the sidewalk,” he said, adding that he’s seen young photographers do just that.

It’s something not often talked about in journalism — the relationships we make with the people whose lives we chronicle. I’ve wrestled with it myself, having been accused of getting too close. As long as you’re excavating your way toward the truth, I believe there’s nothing wrong with being friendly with the people we write about, or caring, or acting accordingly, within reason. In other words: To do honest journalism, be a person first.

Last year I read Pulitzer winner Anne Hull, someone I greatly admire, describe her refusal to translate street signs for some Hispanic immigrants she was following — because it might have slightly changed what happened in the story. I wondered: If she hadn’t been writing about the women, wouldn’t she have done them that favor? Would that small courtesy really have changed the way her piece came out — other than them not being furious at her for hours afterward (which, ultimately, may have changed the outcome even more)?

In Anderson’s view, his favor was justified because he knew Nadia wasn’t “playing me,” or otherwise trying to manipulate what he wrote or did. He also included the fact that he’d helped her in the story. I would argue that his deed helped him get closer to an honest portrayal of Nadia because it strengthened their mutual trust.

“Journalistic mistakes are not as important as moral and ethical mistakes,” Anderson said. “It’s not about how I feel about myself or some code that was enacted in a hallowed chamber.”

Messy, complicated stories like Nadia’s should leave readers feeling “ragged, sore, raw. Because that’s the way life is,” he added. “Everybody should feel a little bad afterwards.”

The genius stroke of the Nadia profile was that it offered a slice of the chaos from the viewpoint of someone who didn’t represent the worst of Haiti’s devastation but nonetheless offered a powerful window into it. Nadia’s story was more nuanced than most of the staggering profiles of people in grief we’ve been reading in the newspapers. She had been deported from the United States for armed robbery, forgery and, later, re-entering the country illegally. And yet when Anderson first spotted her, she was walking the streets trying to find food for her community, an unlikely hero with a row of children trailing “behind her as if she were some kind of Pied Piper,” he wrote.

When I asked him to articulate how he came to settle on Nadia as his main character, he described a process familiar to many reporters who try to explain complex issues through the lens of a single person. The challenge is in choosing the right person, someone whose story allows for context and intimacy.

“I didn’t immediately know she was my story. At first it felt a little off-the-wall, too peripheral,” he said. But gradually over the next several days Nadia’s truths came tumbling out, and Anderson realized she was emblematic of Haiti itself: the country’s complicated link to America, the way she and her desperate enclave underscored its poverty. “I have always thought Haiti was a shame with a capital S,” he said. Telling her story was a “simple way of re-explaining what poverty is to people.”

It was also a way of conveying his own long-held feelings for the place — something he thankfully seems to manage everywhere he goes, including the Harvard Faculty Club.

Here’s an update on Vanessa “Mama V” Carpenter, the Roanoke County missionary who has “a whole country to mother” in Haiti: She flew to Port-au-Prince on Jan. 18 and has since then been helping the USNS Comfort coordinate surgeries. Judging from her frenetic blog postings, she’s on a souped-up version of her usual overdrive — too busy to document what she sees around her, but eager for people to know all the needs.

Rescue workers are sending the worst cases to the Comfort, a Naval ship Mama V has long been affiliated with. Its commanding officer told me last spring that she was “like some character out of a movie,” able to navigate the bureaucracy in Haiti while bridging the cultural gap between the Haitians and the Americans who man the boat.

But as Mama V posted on her blog last week: “Working in Haiti was hard before the devastation. Now it is next to impossible.”

“I know you are seeing bad things on the news and reports of looting. We are seeing none of this. Just adults and children in shock,” she added.

Mama V’s helpers in Roanoke are busy trying to find host families who are willing to temporarily foster a child when Angel Missions resumes flying them back to Roanoke for surgeries too complex to perform on the ship — missions she’s been coordinating for several years now, as documented in my Mother’s Day story last year. For more information on that, or to donate to Angel Missions, check out her blog.

There’s also a great tale about Vanessa’s efforts to work with American Airlines flight attendants who fly in and out of Haiti, resulting in another project to help the devastated country. This, from a woman who once talked a stranger sitting next to her on the airplane to Port-au-Prince to fund a clinic there.

The numbers are not yet tallied, but the deaths could top 200,000. Dominican novelist Junot Diaz called the Jan. 12 earthquake that devastated Haiti nothing short of an apocalypse. “The numbers are abstractions to us,” he said at a Harvard symposium last week. “The U.S. lost 60,000 soldiers in Vietnam, and yet that war haunts this nation still.”

The Pulitzer-winning author’s point: That we can’t imagine the unspeakable pain in Haiti. He spoke at a symposium co-sponsored by Harvard’s Committee on African Studies and the DuBois Institute, part of a panel that also included doctors Marie-Louise Jean-Baptiste and Jennifer Leaning, and public-health crisis experts Gregg Greenough and Patrick Sylvain. The Barker Center meeting hall was packed with students, activists and scholars alike. Some nuggets from the talk:

• That the Dominican Republic’s aid and solidarity on behalf of Haiti surprised people like Diaz, who recalled the 1937 genocide of Haitians by Dominicans and the complicated, racist history between them that existed for most of the past century.

• Diaz: “We belong to a civilization that seems quite happy having a nation of people so close living in such misery that an earthquake could put the entire nation — not just the bodies — at risk.” When the audience burst into applause at this comment, he chided, “There’s too much work to be done for clapping.”

• 40 percent of Haitians have never had any health care whatsoever, and only half of the country’s children have been immunized against measles, Greenough reported. Among the biggest risks he foresees is the spread of measles, malaria and Denghe amid the 450 camps set up for the displaced.

• Leaning said she was particularly worried about children who are orphaned and/or separated from their parents. “They’re very vulnerable to slavery, abuse, precipitous adoption. . . . . As well-meaning as adoptive parents think they are, we need to help adults in Haiti take care of the children there.” She said this within hours of the arrest of several members of an Idaho Baptist church for trafficking as they tried to take 33 Haitian children out of the country.

• Jean-Baptiste, a Haitian-born Cambridge physician, described a a 56-year-old Haitian woman who can’t sleep or concentrate to work since the earthquake (Boston has the third largest Haitian population in the United States). The woman lost one of her three children to the earthquake, and a second child has been displaced. “There’s nobody I know from Haiti who hasn’t lost a family member, a close friend or neighbor,” Jean-Baptiste added.

Haitian immigrants are always thinking about Haiti and going back, many of them building houses with remittances they send home rather than saving up for retirement here, panelists explained. Many of those houses have been destroyed, so “this is a human tragedy with physical and mental health losses and financial losses,” Jean-Baptiste said, adding that Haitians have a strong stigma against seeking counseling or psychiatric care. “Remember, PTSD doesn’t only last a year; this is something that will be with people for a very long time.”

Sylvain fears that by March people will be so hungry and destitute they might resort to taking food by force in the countryside. “You’re seeing a reverse migration with some people returning to the countryside but without the necessary support there or kinship established.” He fears the country’s renewed friendship with the D.R. could be jeopardized by so many Haitians’ moving closer to the border. “There are just so many waves of potential for people getting even more distressed,” he said.

As Paul Farmer put it in his recent Miami Herald editorial: “A plane full of requested personnel and supplies circling overhead while people die is the right metaphor for the challenges facing us.”