 So, homogenous neighborhoods in terms of percent Latino, and we're also looking at perceptions of neighborhoods in terms of neighborhood cohesion. The second question we're asking is, is the relationship between neighborhood factors and caregiver mental health conditional on co-residents? So here we hypothesize that these neighborhood factors might be really important when caregivers and care recipients reside in the same household. And we also kind of want to entangle if these neighborhood effects, if they're affecting mental health just because at the individual level or if they really have a context within caregiving. And so by looking at co-residents we can really get at that. So for this study we're using the Hispanic Epis. So as many of you know that's a longitudinal data source of older Mexican Americans 65 years and older living in the Southwestern US. And in wave seven the elderly individual was asked to name someone they feel closest to or they can rely on for help. So we interviewed 925 informants. 850 of these were focal relatives. So we really wanted to focus on family members. So there were a couple employees so we didn't want to focus on paid caregiving. We wanted to focus on family caregiving. We also wanted to make sure that we're actually talking about caregivers because these are informants and they're not necessarily providing care if the older adult doesn't need it. So we removed any older adults who are primary, who are responsible for their own financial, self-care and household tasks. So this left 700 caregivers. And today our analytic sample is a little smaller so it's 442. And this is because the caregiver, the neighborhood cohesion factors were asked in a previous wave. And so we only have the data available for about half of these caregivers, okay? So we're using 442 caregiver and care recipient dyads. So here's a description of the caregiver sample. For depressive symptoms we're looking at the CESD. And here you can see that actually the number of depressive symptoms reported is quite low. So with the CESD, a 16 or higher is a cut off risk for clinical depression. And here we see that the mean or average is about 4.39. Also caregivers tend to report really high life satisfaction. So about 80% or 2% that they are very satisfied with their life or extremely satisfied with their life. As discussed earlier, most are female. The average age is about in midlife, so about 56, but there's some variation from 18 to 89. So we have a few spouses in there as well. The majority, 74% are children of the older adult and about half live with the care recipient. For socioeconomic standing, we're also controlling for Medicaid status. So about 14% of the caregivers are Medicaid recipients. We're also controlling for self-rated health. And so about 56% of the caregivers report good or excellent health. Also we control for caregiving intensity. So we asked how many hours per day do you provide help with ADLs and ADL related tasks? And the average is about three hours per day, which is a lot of time spent on caregiving. For the care recipient sample, so all the information from neighborhoods we draw from the care recipient part of the sample. Neighborhood cohesion is based on factors, like you feel your neighborhood is close-knit, you can rely on neighbors, your neighbors are trustworthy, these types of things. And here we're just using the whole neighborhood cohesion scale. We're also looking at percent Latino, so for the older adults about 82% live in neighborhoods or the average percent Latino neighborhoods is 82%. We're also looking at percent immigrant too. For cognitive health, the average on the MMSE is about 20 or 21, which is indicative of mild cognitive impairment. 39% are Mexican born, 62% are female, and the average age of the care recipient sample is 86. So first I'm gonna present the results from our regression analyses. So in this first row, this is the OLS regression of depressive symptoms. The second column is results from logistic regression of life satisfaction. So here what you can see is that both percent Latino and neighborhood solidarity are related to caregiver mental health. And you can see here that percent Latino is associated with lower depressive symptoms, so the higher percentage of Latino in the neighborhood, the lower level of caregiver depressive symptoms. And you can also see that percent Latino is related to life satisfaction, so caregivers who provide, so for each increase in percent Latinos associated with the higher odds of higher life satisfaction. You can also see that percent immigrant is not associated, but neighborhood solidarity is associated with caregiver health. And so I also looked at the individual items to see what exactly about neighborhood solidarity is important for caregiver mental health. And the two factors that were most closely related were you receive help from your neighbors and also your neighbors can be trusted. So we're thinking that it has to do with these support exchanges in the neighborhood that are really beneficial to caregivers. Also that crime is really important. So if you can't trust your neighbors, this is also really distressing in terms of the caregiver relationship. In terms of our second question, we are looking at living arrangements or co-residents. Perfect, okay. And so among older adults and caregivers who live in the same household, we see that only the structural factors or percent Latino is actually related to caregiver mental health. And then whenever we separated it and we looked at living arrangements in terms of older adults who do not live with their caregiver, it looks like neighborhood cohesion is more important for caregivers and care recipients who don't live in the same household. And so what we're thinking is that if you can't live with your care recipient and you're having your care recipient live in it, a neighborhood that's characterized by a lot of disorder or low levels of cohesion, this can be especially distressing in that you can't rely on neighbors in terms of support and caregiving. And we also ran interactions in the full models and we found a significant interaction in terms of the structural factors for percent Latino by living arrangements. And so here you can see, this is the predicted depressive symptoms based on the interaction. And you can see that caregivers and care recipients who live together, they tend to report higher distress levels as we expected, but percent Latino seems to be especially protective for caregivers and care recipients who live in the same household. So in terms of what this means for interventions, we think that caregiving is a really important social issue. And that one way we can address this issue is by altering the built environment or targeting interventions for caregivers in neighborhoods. So we really want to emphasize that education of caregivers and how to effectively mobilize neighborhood support networks is very important. Reducing social isolation and crime since we found that trustworthiness of neighbors was really important for caregiver mental health. Building strong community resources and also altering the built environments to encourage social interactions. And this is really important for not only supporting caregiver Latino caregiver mental health but also cultural or personal preferences for aging in place. So overall the study speaks to importance of both time, so this particular cohort we're looking in place for Latino caregiving processes. Okay, thank you. Our next presentation is by Silvia Mejia and she is the chair of the population department at the Collegio de la Frontera Norte in Tijuana in Mexico. She received her master's degree in psychobiology and a PhD in neuroscience at the National University of Mexico. She's been a part of the national research system in Mexico and the National Council of Science and Technology in Mexico. Her area of research has been on aging and health and especially the social, psychological and medical factors related to cognitive decline and dementia in Mexican and Mexican American populations. And she's been collaborating with the Mexican Health and Aging Study since its baseline in 2001. Welcome Dr. Mejia. Thank you very much. I'm very pleased to be here. I have to say thank you to Rogelio and to Jacqui for inviting me. I am going to present a part of our research I've been doing with my colleague Rogelio about, we're going to change this subject. We're going to work on, I'm going to present on cognitive impairment and try to look at what are the social factors that can be related to this cognitive impairment or cognitive decline comparing Mexicans and Americans. So it's a quite a change of subject but I will go back to those other variables that are more social and more psychological. Why studying cognitive decline? I think this is a repetition for most of you but the problem of the increasing age is it comes together the dementia problem 46.8 millions of persons with dementia in the world. It's projected to be 74 to 75 millions in 2030 and 131 in 2050. And the worst part is that 58% of the people with dementia live in low and middle income countries. So Mexico and also the minorities in the US are populations at risk for dementia, very high risk. So we have to look at the factors associated to these cognitive decline or cognitive impairment. What do we know in Mexico? We know Mexico has a 6% prevalence of global dementia that cognitive impairment without dementia or what is also called malcognitive impairment is around 29%. This is very high and there are many questions around this number. We also know that dementia increases or cognitive impairment increases with age, decreases with years of education and is higher in movement. Those are the most known evidence. And what do we know among the different ethnic groups in the US? We know there's a higher prevalence of dementia and cognitive impairment among blacks and Hispanics compared with non-Hispanic whites. And what else bring us to this point trying to understand that the social and psychological factors around cognitive impairment is that we know that biological and environmental factors go together to determine many of the health problems and chronic diseases. So we wanted to be sure that it's not only a risk factor problem that maybe it has to be with health behaviors with depressions, with the networkings and also obvious with the access to mental health. So our general objective was to examine cognitive decline and it correlates among Mexican and Mexican Americans. Specifically, we wanted to know, we wanted to measure changes in cognitive function in the elderly over a 10 year period. Now that we have the M-Hus 2001 and now 2012, we have the data, like Terrin said yesterday, we have to use the data. And it's a big opportunity to identify predictors of cognitive decline. And also another specific objective was to compare the effects of those predictor variables between Mexican Americans and Mexicans. These are all the predictor variables we used. So don't worry, I am going to talk about them around the presentation, but I had to organize these predictor variables in 11 groups, the social demographic and educational attainment, the migration variables to the fact that in the Hispanic embassy, we have a big amount of people that migrated, but also we have some Mexican Americans that were born in the U.S., family and social networks, psychological factors, occupation, access to health, health behaviors, functionalities, sensory limitations, medical conditions and functionality. These are my 11 groups of predictor variables. And these are the variables that I can compare between the two data sets, between the two studies, and that were, with a lot of work, the variables that I merged for both data sets. Who were the subjects? The subjects included in this analysis are 65 and older. So I left out all the M-hust subjects that were 65 and less for the analysis, trying to compare with the embassy. The Mexican Americans come from the embassy study. I used wave one for time one of cognitive status and wave five for time two. That was my period of analysis for the cognitive decline. In the Mexican health and aging study, I used wave one and wave three, 2001, 2012. So the first thing I had to decide is how to classify cognition in both of these data sets. It's not easy. I have a lot of problems deciding this kind of thing, but HEPIS-E has the M-M-S-E and M-HUST has the cross-cultural cognitive examination. So what I did was, for HEPIS-E, based on age and educational level, I classified subjects as normal above the first quartile. And for M-HUST, this is a job we have been doing with the scores on the CCE and it's already published. So I use the norms for age and education. This is my flow chart of the sample selection for both studies. So I started with the 3050 known subjects of the HEPIS-E at the first wave and with 4872 from M-HUST. And then, obviously, I had to take out those who were not cognitively assessed and then I selected from them those who were normal, those who had normal cognition in time one. These are the ones in HEPIS-E and these are the cognitively normal subjects for the M-HUST. Obviously, because I wanted to see how they were going to decline. So I had to leave out all the impaired subjects, all the cognitively impaired subjects for HEPIS-E, 763, and there's a mistake here. It's the same number. So I, sorry, I have a mistake there on the number. However, what is important is that I am using only normal subjects at time one and then I went to time two in both surveys and did the analysis of who were follow-up, who died, who lost, and who refused to participate. And this is my number of subjects for the HEPIS-E 902 and for the M-HUST 1869 subjects. But obviously, I had to look at the selectivity of the follow-up so I analyzed what happened with the subjects and what we can see here in the graph is that the follow-up is higher in the M-HUST than in the Hispanic HEPIS-E in red and those who died are more or less the same, but the lost are higher in HEPIS-E. So this difference is due to the lost. And trying to see what variables can explain some differences between the died and lost with the follow-up, I find that in general, I'm not doing this in very detail, but men died more in men were responsible for these lost in the died and women were responsible for the lost in those who were lost through the panel research. Age was greater in both those who died and those who were lost were older and the education was lower in those who died and higher in those who were lost that is also predictable. And when I look at the migration, I find that both of them had higher number of people who migrated those in the group that died and in the group that were lost. So what happened after 10 years in both studies? I find that 76% were normal, 77% were normal in M-HUST were still normal and 23% were cognitively impaired while in Hispanic empathy, I find 67% were cognitively normal and 33% were cognitively impaired. So there's a higher proportion of subjects who are or persons who are cognitively impaired in the Hispanic empathy than in the M-HUST. And if I look at these rates by sex, I find that in the M-HUST women are more impaired than men while in the Hispanic empathy, the rates are the other way. I find 37% of the subjects were men, the ones that had a cognitive impairment. I don't want to stop here, but these are my descriptives trying to compare cognitively normal and cognitively impaired in the M-HUST and in the HEPISY. And I only wanted to tell you, or I only wanted to point out to the variables that are significant. There are not so many in both of the studies, but the variables that are different significantly are those that I want to call strong variables. Age is a strong variable for cognitive impairment. Education is also a strong variable. Nobody said it. Migration, obviously, is a strong variable because M-HUST has a very small amount of people who migrated. But when you go to the family and social network, psychological factors, occupation history and occupation history, all of those variables do not show very big differences between the normal and the cognitively impaired. For health, we find several things that are also important, like diabetes that is very important in both groups, Mexican and Mexican Americans. Hypertension is more or less the same in both groups and vascular disease, cerebrovascular disease is higher in the M-HUST. But I don't want to stop here and go on showing you if I do the cognitive, the regression analysis, this is what I get. So again, age, education were present. If they both, age increased the likelihood of impairment, education is the other way, obvious for the higher education, less cognitive impairment. The age of migration is interesting because those who migrated being 18 years or less, they have a higher risk of being impaired in the embassy. The being married or not married is also very important for the M-HUST. Being employed at the moment of time one was also relevant for cognitive impairment in the M-HUST. And I can go on showing all the results. However, this picture is a picture different from what happens when I divide the groups by sex. So yesterday I was tempted to change the title of my presentation and tell you this is a gender effect of cognitive impairment because everything changed. So what happened? If I look at socio-demographic and educational attainment, M-HUST showed an age effect for men and for women. However, in MPC we find an age effect only in men and an education effect only in women. Migration, obviously, this is not a very different result from what we expected men are those who have this effect on cognitive impairment. The family and social networks referring to being married or not is important to determine the cognitive impairment in the M-HUST, not in the MPC study. And one of the psychological factors that was not there when I looked at the global regression analysis model was the external locus of control that after dividing by sex, it came out as a predictor of cognitive impairment in men, not in women. And again, the sensitive matter of the religion being important or not, it is important. Now, for women, I should not mention this. It is now important for women in the M-HUST, but not in the MPC. So there's a light now towards the Mexican population. Occupation never worked, it's important for men, no health services for women in the M-HUST, no money for healthcare for women also in the MPC. They all had sensory limitations, vision and hearing limitations. Those were found in women in both studies. Diabetes, like I said, is a condition still there. And the IADLs are only predicting cognitive impairment in women in the MPC. And I think this is a very interesting result. Okay, so my conclusions are that the proportion of cognitive impairment among both populations is different. That the rate is higher in women among Mexicans and it's higher in men among Mexican-Americans. This can be discussed through the negative acculturation model. I can conclude from my chart where I was comparing both data sets that there's a common pattern of risk factors between groups on the strong variables. That is also predictable. But there's a different pattern related to social variables and that there's a gender effect in strong and social variables. And I will stop here. Thank you very much. All right. Thank you. Thank you. And this has been an excellent panel and I'm gonna take the prerogative since we started late to have questions and answers. But first I wanna raise just a couple of questions. The first presentation showed us that cultural patterns are really important and especially in the satisfaction of giving care. And it makes me wonder what about our transnational families? Are these cultural patterns being reinforced across both sides of the border? And it suggests that they are but maybe more emphasis on how that occurs across borders would be helpful. Also these presentations raised questions for me about caretaking for divided families in immigration studies and the literature recently has been showing a lot of parenting across borders. Well how are these families taking care of the elderly across borders when you have the younger generation in the US working and their elders, their parents aging in Mexico and making it increasingly difficult for them to cross back and forth to take care of those parents. And some of the immigrant young people that we've interviewed have expressed deep regret of not being able to be there when their elders are dying or they're terminally ill because of the border restrictions and lack of ability to cross borders. Then in another study that we did, there were some entrepreneurs here in San Antonio that started virtual networks. They had Facebook pages and webpages and I was amazed at the virtual communities that were arising to help recent immigrants discuss resources for health, resources for solving immigration issues. And I'm wondering how neighborhoods might be defined when we have these now these virtual neighborhoods because people were responding and helping and being very neighborly online. So we might not just have neighborhoods that are fixed in a social spatial context but also online neighborhoods and virtual communities. And when you're talking about the concentrations or lack of concentration in neighborhoods, I think these are very important issues but there's a lot of sociological research talking about new versus old destinations. So while the new destinations tend to be less concentrated, there are also a lot more hostility because people sometimes they are in those new destinations don't know how to cope with different cultures coming in and they're not as many resources particularly for language, their language barriers for getting care. If you're an elderly person and you depend on children for translators, this becomes very difficult, especially when parents are aging. And again with the cross border caring, if you're depending on social media, are you depending on communication when you have cognitive impairment, how are those communications going to take place and who's going to be the person who's translating for the person who is cognitively impaired for those caretakers across the border on the other side. So these are just some issues that I think need to be discussed and we're open to questions and discussion from the audience over here. I think we have a microphone here if you can. Dr. Mendez-Luck, I appreciated what you said about how Marendi Smo and other cultural issues that we have thought were there that you still did find them, but you mentioned a changing landscape and that some data is showing other things happening rather than that. Could you just talk briefly about what you meant by the changing landscape and what other evolutions are happening that are kind of in contrast to what you found? So what I was referring to was some of the demographic trends that we see in our countries and I named a couple of them, just changes in workforce participation by women, reduced fertility and delayed fertility by women. And just the fact that our populations are getting older and so how that changes the face of caregiving for families. And another one that I didn't mention that I had thought about was migration, not just migration across borders, but intranational migration. So younger people moving from their hometowns to other places for purposes of employment and how that changes the structure and the nature of the family when it comes to the time where elder care needs to happen and how does that work out? So all of these different changes that we see in the Americas happening to families all the time is certainly going to press on the family's responsibility to caring for elders. And so those were some of the things that I had thought about in terms of the changing landscape and the fact that some of the findings that I showed that in these things, how they played out differently, whether they were Mexican caregivers, immigrant caregivers or U.S. born caregivers, they shared similar views but yet not completely the same. And so to me that indicated at least in this sample that there's some kind of shift occurring in these views and I just wonder in the future, really what does that mean for elder care knowing that we have these other external forces affecting elder care? Yes, right here. The built environment, would you give us some ideas of how a built environment can be altered? Because I agree with you, the altering that would help but I'm not sure what you mean by that. Yes, I was thinking more about like the walkability of sidewalks, so I mean, if you're an older adult and you have some activity limitations, it can be a lot harder to navigate if they're not sidewalks. So that's just like one little example of altering the built environment. Also creating more institutions and support in aging communities, so areas where older adults can socialize and these types of things are I think are really important when you're limited in terms of your life space. Yeah, thanks. Yes. Stop out. Yeah. And a very, very specific question. Most of your, most of the people who were taken care of were parents, about 50% or so, if I remember your data correctly. Yeah, 75. Yeah, 75 or more, that's good. Yeah. So the question is about the depressive symptoms of the caregivers. Right. Have you looked at how many siblings there existed? You know, thinking of myself, if I'm the one who has to give care and I have five siblings and they don't do anything, I probably would get very quickly depressed. Right. And since we are dealing in this population with larger families, there probably are siblings and I'm just curious. Right. So we have looked at a number of siblings in the Hispanic Epis. We're also looking at it in qualitative research. So we have interviews with dementia caregivers living in California and we're finding just that. So people in these really, really large families, you would think there'd be more sharing of care work, but it actually falls on one person and that's when it creates the most burden when you can't mobilize other siblings in that type of care work. And what we find in the Hispanic Epis is actually that caregivers to immigrant older adults, they have the smallest types of networks in terms of people they can rely on for support and those kind of networks. So it's really important for caregivers to older immigrants. Okay. And I think there was a question over here. Hi. This question is for Kate. Very interesting paper. I was wondering if you could say a little bit more about what you think that, I mean, I get the better outcomes for Latinos in high concentration neighborhoods. That part seems pretty established, right? Could be selection too, but it's well established as a result. But I was hoping if you could say a little more about why it's in places that are experiencing particular growth in the Latino percentage. I mean that, for instance, is related to either a retreat from other groups, right? Their enclaves are basically just entrenching, I suppose, or if it's basically new growth because I would have thought that basically a new approach of a lot of new people in the neighborhood might be also social disorganization because it's not, you know, diversifying ethnically as well. No, that's, yes, that's exactly right. I'm glad you asked that because, yeah, that's a piece we're really trying to unpack is the extent to which these low concentration communities that have significant social and compositional change, I think it's actually related to some of the reasons you brought up in the discussion about the extent to which you may not know about resources, what impact of communication strategies and I think if we imagine communities that have low levels of concentration and then an influx of a new population group, again, going back to old Chicago school theory there is impaired potentially communication because you may be speaking different languages or there may not be language of origin newspapers or other kinds of institutional arrangements that people can draw from And it just may feel, I mean in the way that you described it too, it may feel disorganized in some sense that there's so much rapid change, that the change alone has an impact on health. But I think getting to sort of the practical matter of where people could draw on resources, it could impede effective communication on that front. Does that kind of get at what you... Yeah. But say a little more. Sorry, but the change in Brazil Latino could be, I mean are these neighborhoods growing and it's mostly newcomers, is there a lot of churn in the neighborhood, that kind of thing. Yeah, another way we've described them as neighborhoods that are churning in some sense. So anytime you have residential instability and that also goes back to the theory we're describing, you have structural change in communities, you just don't have a sight line. I don't know if anybody's read Death and Life for Great American Cities, but we always got to Jane Jacobs and the idea that, right, notions of eyes on the street and the idea that you have a familiarity with other people's patterns and engagement even if you don't know them. And so I think the extent to which we're just seeing a lot of compositional change in communities, regardless of its orientation, just changes the vibe and it kind of goes to Sunshine's work a little bit. I mean you mentioned homogenous neighborhoods and the extent to which caregivers can draw on those resources. Some of which are physical, some of which are social. One more, this will be the last question. Well, my name is Nadia Flores and thank you, Rogelio, for inviting me to this conference. I barely, a couple of years I started doing some work on health, but before that I wrote this book Migration Trust Networks and it is, I explain in this book, the social networks of undocumented immigrants from Mexico coming to the United States. And I'm just seeing these papers, this work, important work that you're doing on health and how the social cohesion in these neighborhoods and solidarity is helping for this health outcome and depression and other outcomes. And I wanted to say that, you know, like I really think even though I don't talk anything about health in this book, I think, you know, I will really recommend for you to see these because what happens is that it is, it is a transnational process, like you're saying, Harry, it's really people are doing a transnational effect because so many migrants undocumented is really, they really have to build this collective efficacy to really be concentrated in these neighborhoods and to what extent it might have some positive outcomes, but then also we need to think about how these isolation, like you were thinking about, you know, how to draw resources to these neighborhoods, how to, you know, what is happening really in these neighborhoods, are the people, the Latinos in these neighborhoods, do they just like all neighborhoods, like is Los Angeles or these are neighborhoods with undocumented immigrants? So there is a lot of questions and indeed, you know, and also the transnational, you know, what's happening with the parents in Mexico and the people here. So yeah, so there is still a lot to look into and to answer. So anyway, but thank you. Thank you. And these were excellent presentations. Thank you very much. It's going to take about a 10 minute break. Bathroom break gets up in a drink. Panel six will be starting about 10 minutes. Thank you. Mexico in the USA. Okay. All right. Thank you. Oh, that works better. Thank you. So my name is Evettis Martinez. I'm a public health anthropologist, and I'm at the College of Medicine at Florida International University. I've worked on minority aging, both in Baltimore City and now in South Florida. So first, I'd like to thank you for inviting me to be part of this excellent conference. I've been wanting to participate in this important meeting. And so I'm glad to be able to do so today and hope to participate in the future. The papers you are about to hear focus on influences of legal, social and economic context on healthy aging. At the end of the paper, I've been asked to make some comments and attempt to make some comparisons with aging in Florida and some references to Cuba for comparative consideration on why place matters. So I'd like to introduce our first speaker, which is Fanny Sleiman from Uname in Mexico City, and she will speak on aging rule based policies, outcomes in the Mexican states. The Social Science Institute for this opportunity. Well, I am a Mexican lawyer, so I am doing our research about aging laws and regulations. So you are going to listen here, some different conference, because I am now working in a project, a 10 years project about these rules and regulations in Mexico. Well, in this project, we have some research questions. And the first of these, we want to say more about what is the main approach of these laws, because in the public sector, we have two main approaches that are driving this issue in Mexico about the older person. And also, we want to know about the regulation on laws in Mexico about older person. In the first law was approved in 1997, so we have only 19 years with these laws in each of the Mexican states. And the third research question, it's about the dimension that are covering these laws in Mexico. The methodology that we are using now to analyze these laws, well, we have 32 Mexican states, but we only have 31 laws at the state level and one federal. So the state of Sinaloa is the only one that does not have a law about older person. And we are doing with these laws. In Mexico, we have at least a written law system. This means that every law to be binding for citizens and authorities must be published in the official journal of every state. So if you don't have this publication, you don't have the binding of these laws. We are analyzing also the mining data with Atlastee about these laws trying to know what are the most frequent words in these laws. Trying to know if these have a human rights approach or they have an assistance approach. We also are trying to discuss what are the main topics in these laws because we have health, we have care, we have many issues in these laws and they are very different in each state. Let me see. Well, in the public sector, we have the tension of those main approaches that are the assistance approach and the human rights approach. In all these laws and regulations, we have a mixed approach, but we have, in some of them, prevailed the human rights approach and in the other, the assistance of older persons. This is a graphic with all these laws that were approved in the Mexican states and in the federal leader. I want to say that Colima, that we were stating approved in 1997, the first regulation for older persons. After that, it's important to say that in Mexico with these of the written system of laws, some states like Chiapas have been approving in these 19 years, not only one law, they have three laws. In this moment, they approve in 2004, the third law about older persons, in 2006, the second and in 2015, the third law. They are changing about the topics that are included in these laws, so it's very important that in these 19 years, there are many states that are changing also this approach in their laws. About the data mining in Atlastique, we are looking for what are the main works that are using these regulations. We have, these laws are in Spanish, so we are trying to know what are the main works that we are using. Rights is one of the main works, and we are trying to know what are the other works. A system is the second one that is important in these laws. But he is appealing one new word about the private sector, that is the family that we are, has been a very important part in these Mexican laws. What is happening about the public sector approach? We want to know how many states in Mexico are having these human rights approached, trying these older persons as persons, trying to give these rights in these age. We have the green color, the 17 Mexican states that are having this approach, and we are trying to know what is the difference with the other approach, that is the assistant approach. But really in the content of these laws, who is in care of these families, who is in charge of the older person, we believe that the state, the Mexican states have a really, they must be in this part of the equation, but what is happening? According to all these laws, who is in charge of Mexican older persons are Mexican families, and all these laws, these 32 laws say that Mexican families must fulfill their social function. And what we are talking about when we are saying social function. First of all, I want to say that in this photograph, we have seen older person taking care of older, oldest person. So I don't know what is this meaning in the Mexican laws that they say that that families must take care of these older persons when we have a new structure of Mexican families. The social function of these families that must provide, and these laws tell us that families must provide shelter, food, law, accompaniment, care, and recreation between many others of these things. In this context, we have a new actor in our approaches, the public approaches with the human rights, assistantialism, and the new actor is the family that we name here families, because the weights and balances in these state laws are telling us that the family is the main actor to be in charge of older person in Mexico. Perspective of these state laws, where they say that we have Mexican families must take care of the persons, and the government role is only to regulate this private issue and criminalize their views, negligence, and violence action against these older persons. This political environment, we know that we have the authorities they really don't, no matter that in the title we have these human rights approach in many of these laws, there is a lack of knowledge in the practice about this human rights approach. Also these laws are overestimating the Mexican families capabilities to be in charge of this issue, and we have clienteleans as an opportunistic political enclave that is very fancy in the political arena. The consequences are for our preliminary result in this research. Well we can see that there is a food involvement of government in the issue of older persons. We have another estimation of the Mexican families capabilities where we have this about the clienteleans. Well in general this is the situation about the Mexican state laws. This is very important because as I told you, we have a written system and every law must be published in this official journal. If you don't have this publication, you don't have this binding between citizens and the Mexican authorities. Well this is my presentation and thank you very much. Thank you. Our second paper is by Jennifer Salinas who recently moved to Texas Tech and she's talking on why place matters in understanding the disease burden of older American, older Hispanic Americans in the southwest for county analysis. Jackie Rogelio also for inviting me to come and talk to you about some of the work I've been doing. I was another one of the original emerging scholars so I've been to this conference numerous times and you know I've just really appreciated the opportunities that this conference and the group of people who come every year have given me and have supported my research over the years. So I did just change institutions so literally two weeks ago so I'm still kind of kind of getting over that but so in case you want to email me don't look for me at UT anymore look for me at Texas Tech. Announcement or information. I did change my topic a little bit from what I have in the brochure in part. As I started to do the analysis I realized that what I really wanted to look at we really couldn't do with the Hispanic Epis. We had done a lot of research in El Paso looking at cross-border healthcare utilization of middle age and older adults and was hoping to make some contrast using the Hispanic Epis but didn't do that but I feel like you know we really need to understand the context of the the data set of the cities in which Mexican Americans live and try to better understand what resources are there and which ones are important. So hopefully this talk kind of leads me into the resource access down the road. Okay so I'm going to give you a little bit of a background on the context of disease and aging and four counties represented in the Hispanic Epis. These aren't arbitrary counties that I picked out actually these are two are at the border in the border region and two are not as close to the border region but a few hundred miles at least and these aren't arbitrary because actually these four counties represent about half of the sample so they're important that way too so it's about 1400 people. Okay and so I'm going to use kind of some statistics from the CDC and the US Census Bureau. I am a demographer I like to use those Census Bureau and CDC numbers to kind of give some some context and rationale of why we should be looking at specific contexts counties cities within the Hispanic Epis to understand context. Okay and then I'll review my methods tell you my results in my discussion. So so really my career has really evolved through the Hispanic paradox I think that's part of what's gotten me interested in Hispanic health has really kind of been the framework for my research that I've done and I think in one way or another we're all here directly or indirectly because of this Hispanic paradox or the paper that Cocos and Jean MacCurriel wrote you know 30 years ago now. Okay and I think that it's it's really helped us bring a recognition in the literature that there are variations between Hispanic ethnic groups. It's not just one group of people in the United States there's actually Mexican Americans Cuban Americans and their health really differs right and it's also provided kind of the basis for multiple data sets with the Hispanic Epis which we've talked about quite a bit but there's also you know the Boston Puerto Rican Health Study the Soul Study which is a newer study and the Mesa Study etc etc. Okay so we've learned a lot about different ethnic groups within this Hispanic umbrella but I think we've not necessarily scratched the surface on the socioeconomic context in which these groups live and how they might vary. Keep wanting to go to my laptop and I got this. Okay so why does place matter? Okay so this is from the Pew Research Center and what you see here is these are kind of the not necessarily the epicenter of the Hispanic population but larger cities in the United States and what you see here is that the majority of Hispanic groups are on this list but outside of Mexican Americans live in environments that are kind of mixed where there's multiple Hispanic ethnicities residing in a metropolitan area or city. The exception being the Mexican American population. It's an old map but I think the map is relevant. This is from 2000. This is a Carlishe Box map that I like to use but I think that the real message here and I don't think that the border region has changed that much that really there's a very high concentration of only Mexican Americans or Mexican origin population that lives you know in southwest United States. Okay so the majority not only are the majority of the Hispanics of Mexican origin but the majority of the population is of Mexican descent so it's really important contrast compared to places like Washington DC, New York, Miami where there is a mix of ethnicities. Okay and so you know just thinking about neighborhoods in the southwest in the border region where I live a neighborhood a Hispanic neighborhood is the whole county you know I'm the minority in my neighborhood. Okay but we also often assume that because there's this majority living in the southwest that the health experiences and the aging experiences are the same. Are the same for somebody who might live in the border compared to somebody who might live here in San Antonio or live in Los Angeles. Okay and this is one example where that might be different so this is county level obesity 2004. What we can see here is that everything's kind of orange obviously dark red means high prevalence but what you can see here is that there's somewhat of a difference between kind of Texas and the rest of the southwest where kind of the obesity epidemic is starting to hit Texas in 2004. This is 2013 it's kind of like cancer right it's just kind of exploded where you know we hear it on the news but really to kind of look at it on a map really kind of has a pretty big impact but what you see here is you know that the kind of prevalence has kind of spread through the southwest so the environment that Mexican Americans that have been living in places like Texas have been exposed to this context this obesogenic context for much longer than say Mexican Americans who live in New Mexico or and in California. Okay so I am using four counties from the Hispanic Epis. I'm using Los Angeles, El Paso, Bear County which is where we are right now and the Rio Grande Valley for for those of you who don't live or Texas or are unfamiliar that's really south deep south Texas. Okay and what you see here is kind of the white counties or the white columns are Los Angeles and Bear and in terms of economics there's a lot of similarities right less poverty higher rates of Hispanic or excuse me high school graduation but there are still some distinctions surprisingly Los Angeles actually has a fairly high immigrant population much higher than San Antonio or Bear County. So I was kind of surprised at that because we always assume that Hispanic communities have high proportions of immigrants as well but really San Antonio is kind of established U.S. born Mexican origin city or county in this case. Okay and then the two blue or the two border counties have much more similarities in terms of poverty low education levels low insurance coverage rates and higher rates of not visiting the doctor. So in actually in the Rio Grande Valley which is kind of characteristically high concentration of poverty we see that nearly 34 percent of the population is uninsured and similarly about 30 percent of the population has not been to the doctor. Okay and these are the mortality and kind of some health statistics that I got from NCI CDC website. Okay and so you know we tend to kind of affiliate poverty with higher burdens of disease and in some cases that is true but in some cases it's not true. So for the case of cancer the highest incidence of cancer actually happens to be in LA but the highest rate of mortality from cancer is right here in San Antonio. Okay so if you look at coronary heart disease the highest incidence again or the highest rate of mortality from heart disease is LA and the Rio Grande Valley and the lowest happens to be in El Paso which I'm not sure why that is but something I'm going to try to find out. And then another common concern that we have because of the obesity rates that are growing in the United States is diabetes right the prevalence of diabetes. So the Rio Grande Valley in particular has been kind of targeted as a place where we have a high burden of diabetes and diabetes comorbidities and these statistics say yes that's true however the mortality rates from diabetes in the Rio Grande Valley are pretty low compared to what we would expect and especially what we would expect relative to the obesity rates where nearly 40% of the counties in the Rio Grande Valley are obese. Okay well I think we have some new opportunities for the Hispanic Epis because it is a quite large sample and like I said it does have a fairly substantial sample from these four counties and so it's a way for us to maybe use it a different way to disentangle the impact of or the effect of this ethnic community this protection this protective effect that we sometimes see in Hispanic communities or Hispanic neighborhoods and we can disentangle that from kind of this socioeconomic context of the larger county or city in which this population lives and hopefully we can try to try to disentangle what's driving these health and mortality differences because they're not all the same. Okay so here I'm using the Hispanic Epis and I'm using the cohort or using waves one through seven. Okay so it's 3050 people however I'm only looking at the four counties which actually represents about half of the sample. Okay the largest sample being down in the Rio Grande Valley. So my outcomes are going to be mortality or survival to wave seven causes of death these are causes that are reported by the next to kin and confirmed by NCI or some of them have been confirmed by NCI and then new onset of health conditions and the conditions that I look at are disability, stroke, heart problems and new onset of diabetes. Keep in mind that this sample is 65 plus so oftentimes things like diabetes, heart conditions start earlier on in the life course. Okay so here are some kind of demographics about the the sample in terms of these four counties so in some ways the county samples kind of are very similar in terms of age however level of education although the sample has a relatively low college education just because of their age cohort the Rio Grande Valley sample has significantly lower overall educational attainment at three years. Okay the other thing that's kind of important to note is the differences in income where the two samples from El Paso and the Valley actually are kind of primarily or a third of those two samples make or reported making less than $10,000 a year whereas the two samples in Los Angeles and in San Antonio actually the majority made or reported making more than $20,000 a year so these samples are are quite different in terms of economics which the difference between $10,000 and $20,000 is probably not that much but at least there there is some some contrast there okay and interestingly and I think this is consistent with the census data that the sample in LA actually is primarily immigrant whereas the sample in Bear County or San Antonio is primarily U.S. born so the other two samples are about 50-50 okay and then finally interestingly when we look at health behaviors really not too much differences between the three counties except for the Rio Grande Valley where there's much smaller incidents or prevalence of having ever smoked or having ever drank we're only 20-25% of the sample down there has tried either one of them or is willing to admit that okay so this is results from my GE modeling so this is a coefficients that I'm showing here and this is predicting new onset of cancer heart problems diabetes ADL disability stroke and then finally the survival or mortality and what we find here in the sample is that there's really no difference between El Paso and the Valley in terms of new onset of any of these conditions however there was differences between Los Angeles and San Antonio in terms of heart problems diabetes and then mortality whereas the sample in Bear County had a lower likelihood of developing heart problems during the follow-up period higher likelihood of developing diabetes and a higher likelihood of dying within the follow-up period the seven waves so it's about 20 years okay and I just kind of highlighted the in the yellow some kind of marginal but I'm not going to talk about the marginally significant because the the sample I think is large enough that if they were significant they would be significant okay and then finally this is the odds ratios for cause of death by county this is controlling for the demographic characteristics and the behavioral factor so this is taken into account that kind of difference in immigrant us born status and what we see here is that there's no real difference between cause of death for cancer and cardiovascular disease that's what cvd is there but actually in all three of the El Paso Bear County and the Rio Grande there was a higher likelihood of reported dying of old age and a higher likelihood of dying from a stroke relative to the sample in Los Angeles okay so based on the the us census statistics and the CDC statistics that I presented earlier there's no real consistent pattern in terms of the context in which this population is living not all cities or metropolitan areas are poor low educated in terms of where Mexican-Americans are living in this country so it's really important because we always make assumptions about where the Hispanic populations are living okay and so the factors that are affecting health and mortality in this in these populations are probably more complicated than simply just ethnic concentration and probably go much further beyond neighborhood in the southwest okay and so we would have expected because of the socioeconomic differences between the two border counties El Paso and the Rio Grande Valley and LA we would have expected significant differences between between them and LA and we really didn't see that so not sure what's going on there and also because of those behavioral differences down in the valley I would have expected to see some differences between the Los Angeles County sample and we really didn't see that okay so this is really preliminary work work that I started before my big move and so this is clearly something that I really need to tease out and really kind of want to get a handle on before I go and try to publish it but I think we really need some more in-depth analysis looking at contextual factors in these counties or counties like this where the minority is the majority where Mexican Americans are the majority right and understand what are these mechanisms that interact so you know why is my risk difference living here in Bear County as it would be in Los Angeles what is it is it just you know cultural factors or is it the larger context in which people are living and I think that we need more larger scale studies I know this goes against what what the trend has been that we need to have you know national studies and looking at what the general trends in are across the country but I think what we're doing what we do that especially for a population like this is that we're missing these nuances we're making assumptions about a population a larger population a large a very large geography so I think that we need some some more larger scale comparative studies looking at Mexican Americans in these large population centers okay that's the Rio Grande Valley thank thank you Jennifer okay so I'm going to make a few comments and then for like I said draw some comparisons to the work that I'm doing in South Florida and then open the floor to questions I think the two papers highlight the importance of context to understanding Latino aging the and the factors that influence healthy aging as well as I think they point to the diversity of lived experiences of Latino older adults depending on where they reside in the paper by by Fanny Slayman and Veronica Monteseoca they examine the diverse laws pertaining to older adults throughout Mexican states and give us an important legal framework to think about I think laws you know down the line sort of turn to action that have real depending on sort of how they're enforced give make a difference in people's day to day lives so I think it helps us think about legal approaches to improving the lives of older adults at the same time I'd like to know how these laws are being implemented and what impact are they having so I think a future analysis of the impact of the laws and programs would be important in the second paper by Jennifer Salinas looks at the importance of place of disease in four communities studying the Hispanic epi's and finds indeed that place matters but how it matters is unclear I think as she hinted I mean I think there's different approaches that could be taken to understanding what are the dynamics behind the numbers comparative studies definitely are needed but also I think you know traditionally we look at socioeconomic status and now we're starting to look at neighborhood dynamics context is important and it's also very complex so thinking about innovative methodologies for looking at context especially perhaps mixed methods approaches that I was glad to see some qualitative studies to to really contextualize what goes on in the day-to-day lives of people so I'd like to focus the rest of my comments on a few themes highlighted by these studies and others presented earlier and draw compare comparisons were appropriate with other Latino populations namely those in Florida and I'll make some brief comments on what's going on in Cuba especially with changing laws and the themes that I'd like to focus on is the expectation and capacity of families to care for older adults especially this notion of familism I think we need to think about sort of I think there's the value of familism and a lot has been written about familism but the value of familism and people will express their desire to care for families but what is really their ability and what are the actions what is really going on when I when I was doing my dissertation work among Cuban Americans in the late 90s and in Miami people would say no and these were already people average age about in their 70s they would say my dad is in a casita and I was like what is this casita no my dad is in a casita and I was like okay and then I found out the casitas were assisted living facilities but they were they would call them casitas because they couldn't bring themselves to say that they actually put their parents somewhere but they really didn't have the financial resources or the health themselves to care so here um life expectancy is very high for Cuban Americans and they and they did not have the health or resources to take care of their parents and so they would say I live in a casita so and and that small assisted living facility is very popular in a lot of people's like convert houses and there's like two older adults per bedroom and maybe a three bedroom house takes care of six older adults and that's become a very popular setup with its pros and cons especially in terms of regulation of how well they're regulated so there's the inadequate distribution of public resources and health care and also like I said earlier the diversity of lived experiences of Latino older adults that we need to continue thinking about so can the family be expected to provide care so despite a move to towards a narrative of human rights and away from viewing older adults mere recipients of assistance slain notes that the family is still held as central family must fulfill their social function of shelter food love care and recreation the presentation highlights the multiple problems at the shift of responsibility from the state to the family or just the delineation of the responsibility of the family poses obviously that also raises the issue of the not insubstantial number of older adults who may not have families either because of decreasing fertility rates or because of migration and those that don't have family nearby so for example in Miami Dade County which is a majority minority Latino community 20 percent of older adults live alone and sit and the majority of these are women so we also know that Hispanics who live alone are higher risk of poverty and one in four older adults in Miami Dade lives in poverty so the actual availability of care may be scarce we conducted a study as a community based study throughout housing and senior centers in which two-thirds of the older adults lived alone and those who live with someone lived with their spouses not their children 13 percent of these older adults had no children 11 percent had one child and for those who live those children lived outside the neighborhood so a lot of people had only one child they live nowhere nearby the majority lived over an hour away so in the samples an interesting finding we found we talked some about depression 30 percent of the sample classified as potentially clinically depressed using the CESD and at least half of those had been on had been non-diagnosed so there are racist issues of the adequate health services and and diagnosing depression we found significant correlations between depression and social support family function and lowliness so social engagement family ties has a I think has a really important role in maintaining health that needs more exploration and in another analysis of disability among Hispanics in Florida using census data we found cognitive disability twice as high as whites and it is as high as among the Cuban and Puerto Rican females with similar rates to African-Americans mobility rates showed a similar pattern and we also observed a social gradient but I think it would be important to know um how is this tied to occupation as Dr. Bertrand Sanchez um so elegantly detailed um yesterday so these numbers merely point to the potential need for care support and services in the and support and services in the population it does not take into consideration like I said the observable changes in family attitudes and ability to provide care also older adults expectations to for independence so and the strains that families are are facing if not the family then who so there are inadequate resources to serve this population in terms of funding and also culturally appropriate care so I'm involved with the area agency on aging in Miami Dade I'm on their board and so that agency is only um only about 28 percent of those people who reach out to the agency go unserved because we don't have the resources so a common complaint is like I call the agency and there's no services but there's just not the state and federal funds trickling down for the high need of the population and that has to do a lot with federal funding and state funding and how the funds are allocated um so we have a hundred and seven thousand I think older adults that meet the poverty threshold for us for services and twelve thousand are served by the local government so there's a lot of people that are not tapping in and if they did there wouldn't be the resources there and it's not for lack of trying to get their resources um so um as a older adults are twice Hispanics are twice as likely to need long-term care services and supports for old as older whites but there's inadequate inadequate services also for caregivers and I think inadequate not only in that they're not available but are they the services this is something I'm looking into are they the services that old that caregivers want what kind of caregiving support will be accepted by Hispanic caregivers um inadequate services has a cascading effect on caregivers who are largely women caregivers the caregiving is associated in declining physical mental health and increased health care utilization and mortality so what I'm like saying by cascading is that if there are not adequate supports for caregivers those caregivers will get sicker and they will need care and so um it's a long-term imperative to promote the well-being of not only older adults but family caregivers so um my side note on Cuba is that Cuba is an interesting micro example of the evolution of aging policy micro because while Cuba is relatively small there's 11 million population and it's shrinking but it's also aged and it's relatively homogenous with the except for rural urban divide and regional differences in the percent of older adults but it has a high like 21 percent of older adult population so because of this population aging ironically what's happened is that they erase they're cutting back on social benefits because they cannot afford the previously um secured social benefits for the older adults and this is having some um sociological implications and I think there'll be short and long-term implications including sending older adults back into the workforce increasing dependence of older adults on family members and creating big differences between those who can get remittances from um family in abroad and those who don't have family abroad so it's increasing the inequality among older adults in Cuba um so and they're also doing in the most recent laws there's a shifting responsibility to the family which creates dependence which puts older adult at risk of abuse I think um so it's uh be interesting to look at keep an eye on what happens in in Cuba and I know there's a couple of um people doing qualitative research looking on the impact of day-to-day life on that um so my closing remarks are that beyond the quantification of health and social issues we need to consider the or elucidate the lived experience of older adults beyond physical and mental health there's also the issue of social inclusion so when I hear about sort of like the changes in Cuba the the laws and what what is the role of older adults in in advocating for themselves in these contexts um what process do they have in the what role do they have in policy making how are they a part of the conversation as noted throughout the meeting there are different ways of aging based on education occupational experience health status political culture and migration experience the emergence of new forms of sustaining uh social organizations we learned about earlier in um Mexico through Monteseo Castpaper for older adults outside the traditional civic and government groups offer opportunities for older adults to advocate for themselves no longer to no longer be seen as passive and forge a collective identity thereby forcing a dialectic between these organizations and the state that necessitates a move towards social justice but one must also take a cautionary note that the two advocate for one's rights and be heard varies greatly by one's socioeconomic status and the place in societal structure and lived experience so what do countries throughout Latin America and the United States with its substantial Latino population usher in a transition of economic and social policy to manage the inevitable aging of the population and preserve quality of life and equity for older adults I think the principle of human rights may serve as an important organizing framework it's not something that we usually I think talk about especially in the United States as human rights framework for social participation um but I'd like to see more of that I'd like to see more of this framing of uh of the rights of older adults and engage healthy and engagement by older adults themselves as the meetings conveners know the heterogene heterogeneity of Latino communities calls for comparative analysis of the community as an important context and understanding how characteristics of physical social and economic environments give rise to disparities in Latino health one of our challenges moving forward I think is the diversity of context and how we move away from the homogenizing narratives and think about policies at a macro level that facilitate healthy aging for an active aging for diverse Latino communities at a micro level I'd like to congratulate the conveners and the participants for starting us on this path and taking us so far and considering these issues and I'd like to thank the conveners for letting me be part of this conversation and with that I'd like to open the floor to questions yes yeah I think I published on this copy back in 2003 in America there is a trend towards criminalizing the behavior of people who are mentally ill and I'm I'm concerned professionally about what's happening here with our state laws in Mexico how do the various states address the issue of mental illness and alleged dangerous behavior okay in older adults yes yes in Mexico we have some programs I want to tell you that in Mexico City that we have a left government since 2000 they are taking care really of older person because um after this left government all the Mexican states are in the race to gain the votes of older persons so um in this situation well we have that for example in Mexico City we have many programs that uh that we name the the angel name that is uh a purpose for older person that he they have this mental illness with the purpose that you can know who is your family in case that they have some problems um but in Mexico we are trying to regulate this situation but not criminalize so we have a different focus in this um illness so we are trying to know how to recover more of these uh potentials of these persons older person but trying to have the the communication with his family you know but the public um regulation they are trying to to have um a file of all these older person and with the moment that you can know who are your family who is maybe somebody who could take care of these persons but communities are very friendly with these persons so we don't have this problem when when these persons are on the streets and they are lost so they receive the help of the community but all these waves about 20 year period and then you looked at conditions and for communities we have a lot of mobility in this country so what's also protocol someone and in way one lives in Laredo and then dies in San Antonio so yeah it's the death attributed to San Antonio to Laredo what do you do yeah I mean that's it yeah people that move around but people move around a lot but I think that from what I've observed is that many older adults don't have that same mobility as younger generations where they kind of stay put so yes maybe you know an older adult was living in Laredo and you know his or her family lives in San Antonio that mobility may occur but I find that particularly in the border people tend to stay pretty close to home even some of the adult children I find might educate and then come back so it is a challenge but the initial wave as their location of where they they lived more question and then we need to okay this question is for Jennifer I just wanted to maybe clarify a point on one of the slides you had the the seven year more survival is what it said mortality is actually mortality okay so just want to make sure so it looks like there's a mortality protection perhaps for LA versus the three Texas locations I was wondering is that does that look like it's some sort of a Texas effect or you also mentioned that LA has the higher proportion of foreign born if perhaps that's attributed to that or what your thoughts are on that yeah yeah I mean I'm not sure but I think that could be it I think that you know the resources available to older adults in Texas I think are probably much different than they are in California so you know I'd like to try to look at one of the other counties from California to see if there's if it's really a city effect or is it the state effect where it's maybe being driven by policies within the actual state in terms of resources well thank you start briefly with the next panel in Cuba Puerto Rico Mexico Brazil and then we've also taken a look at Latino aging within the United States LA San Antonio Bear County Rio Grande Valley and so forth and one of the things that we want to do now is to invite people here as part of the panel who are on the ground dealing with issues related to the aging of the Latino population here locally in San Antonio so we have three panelists and we'll go let's see Juan I think you Juan will go first and then Adelita yeah and then Mercedes so I'll go ahead and introduce Juan Flores Juan Flores as the executive director of La Fe policy research and education center he's an expert in in the policy on the Latino population particularly with with respect to health issues health policies in the in the Latino community he's always been an advocate and a partner in trying to get conversations going between researchers academicians policymakers and and practitioners okay Juan thank you saludas a todos uh I'm going to focus on a particular agency and that agency's experience and approach and address addressing aging issues in mescan americans on west side of San Antonio and that agency is called La Fe policy research and education center first want to point out a few sort of awarenesses that we have or understand as an organization we embraced bienestar the concept of bienestar it affirms our cultural experience our holistic values to achieve and maintain an optimal optimal quality of life for ourselves and our families we're aware of the big questions in terms of the aging of the u.s populations the potential impact on economics social and health impacts but we're also aware that Hispanics in the u.s and in texas rec second or third as the fastest growing uh senior population in the u.s and in our state we also aware that the dual fact that we're a young population our median age of 27 compared to 42 for non for white non-Hispanics and the fact that his Hispanics will bear the brunt of paying for social security into the future concurrently we're aware that both young unfortunately young and aging Hispanics are a disadvantaged position for achieving financial security and the healthy aging because of inequalities and inequities that worsen our risk la fez approach if you will to promote and help improve latino bienestar encompassed policy analysis and research civic education and advocacy constituency development and outreach it included an underlying caution in working with researchers with large public agencies and large nonprofits from large non-profit social service agencies to agencies like arp american heart association etc we feel that even though time has elapsed and folks are getting better at working with community we still need to be cautious and we're cautious because i don't know if you're familiar because i've dicho in espanol you know todo para ya y nada para acá right everything your way and not our way so that's why we're cautious and working with entities we are aware of the increasing progress in aging research the increasing attention to latino aging research we're really happy to see more latinos and latinas engaged in this research however we know the reality that between there's this bridge between uh research outcomes and policy and program application is far from complete you know that to be the truth and in particular for people of color seniors of color and low income populations our first question at la fe was really simple when we started to engage around latino aging issues what is the bienestar of latinos ages in texas would you be surprised that no one had an answer okay i was looking across the state i checked with the bair county council on i mean the area council of aging reports i texas aging reports you know you know some researcher got a wild scheme to just put together a nice report even if it's just a good comprehensive descriptive report that tells me this is kind of what we look like in terms of demography social economic and health where is that report we asked that early on in 2006 so you know i knew there were research papers around but that i'm just a simple person okay so one of the first things we did it art is to put together a descriptive profile statewide along all of these dimensions in the process of doing that one of the things that came to our attention was the fact that we had this growing population of latino seniors caring for children so i'm just going to very quickly highlight over a period of several years some of the initiatives that we took on and fundamentally they were the same in terms of again that approach we conducted a literature research we collected data from targeted communities we analyzed and gave back the data to the seniors so that we could ask them you know what you need to prioritize these issues what's the more important to you and then we engaged them in training and advocacy because they needed to be part of the solution so if you look at this particular graph one of the initiative we began was the abuelos y nietos juntos programs where we gathered some grandparents discuss with them and asked them to teach us about their concerns we then did a survey with grandparents then we gave that survey back to grandparents then over a period of time we engaged them in advocacy training one of the other things we did in terms of senior financial security here in the west side of san antonio we conducted a survey and targeted census tracts with 150 seniors we had a project called senior business dot engagement project where we conducted another 315 surveys and targeted census tracts of west side san antonio the follow-up process we met with 80 seniors we asked them to prioritize them out of that group we identified about 25 seniors who wanted to be trained around advocacy we did an environmental assessment with senior leaders if you will folks who are recognizing the community so to go to the local iglesia we had another project called senna in 2012 that went for two years which was called community engagement nutrition action program the processes in each case were the same in working with seniors this doesn't want to change there it is i'm going to just highlight some statistics and not get too much into them so for example this is a look at demographic data from texas bear county san antonio congressional district 20 and then select census tracts in the west side just to get a flavor of whom we were targeting and in our case with our initiatives on the west side we were targeting these census tracts so you see that the majority in that census tracts is compared to the state population of latinos at 38 approximately in that time 2010 in the west side it was an excess close to 100 97 97.2 97.3 95.4 91.3 so that was the populations we were targeting and looking at the age breakdown you have to excuse me but the charts a little bit off just concentrating on the how do you get this back to reverse someone helped me here sorry i got it now thank you and look at this chart real quickly the bottom two in terms of the population of 50 to 64 you'll see that between the difference between at the state level and the census tracts and then the population uh 65 and over is the bottom one and you see again texas bear county the congressional districts and census tracts and again this was just the idea so that we could understand who we were targeting in the areas that we were working with in terms of the survey here's some of the differences that we saw relative to home ownership and we included because arp was one of our supporters they wanted to know the membership but you see that home ownership was very high uh overall in the state home ownership and then in the targeted districts age 65 all of them over 50 percent in terms of home over home ownership yeah oh okay five minutes thank you i'm gonna just uh highlight some of the issues that people discuss in terms of top needs and worries and seniors you had infrastructure issues sidewalks lights speed bumps you had neighborhood environment issues graffiti park cars vacant lots homes that were not safe safety issues drug users in the area prostitution lack of police patrols crime related issues then we also have seniors top scene the seniors needs that they felt were not available versus those they felt that were worried about and you can see that the top three as far as categories were infrastructure social services and neighborhood environment these are something a little bit more broken down you notice again here infrastructure this is a response uh where seniors were asked to identify three or four needs in the areas and infrastructure again you see 165 with the highest uh neighborhood environment 126 safety was large so again it was kind of consistent there was a one of our saveries that we had had to do with um financial security i want to go back financial security with the major issue in these neighborhoods and you see here in terms of do you have enough money for each month and so on in all the cases i won't belabor the specifics but in all the cases financial security was a major issue in terms of retirement including even in terms of enough money for burials funerals the overarching point here relative to our work in the these communities with these projects that i don't speak to a lot and don't have a lot of detail for you in terms of just time and effort here is the actual training that was done with the seniors themselves and you'll have one person that's going to speak that's going to indicate something that we started then where you actually now have a coalition of grandparents that are actively addressing issues important to them to making that issue from making that issue more visible to specific policies at the local and state level relative to caregiving particularly targeting grandparents and the care of children there's also another group called the west end coalition that still exists today that we initiated that is involved with the police commissioner that is involved with city government that are addressing some of the issues that use that are in the compass in these surveys the investment in time and effort to really develop seniors to be their own advocates is substantial and unfortunately we don't do enough of it i realize we all want to take care of seniors but i think most seniors want to take care of themselves thank you i'll leave it at that an associate professor in the school of nursing at the university of texas health science center here in san antonio and she's an expert in public community health nursing as well as clinical nursing research and her research and and work deals with building healthy communities through enhancement of public and community health grounded in socio-ecological model framework to prevent disease and to promote health and well-being kind of synopsis of what's going on in san antonio with elderly and i was asked to focus mainly on health i'm a public health nurse i've been tough for a number of years and do a lot of work on the ground here across the lifespan but one and i have done a lot of work of course with seniors latino seniors here in san antonio and so just to kind of give you an update or know where we're at here in san antonio looking at one in four um hispanic older adults face food insecurity and the way we eat is so critical to our health i mean it determines uh our weight it determines our height it determines everything so this whole idea of food insecurity of not knowing where your next are not having access to food healthy food that meet the daily requirements that we all need to have on a consistent basis is what we consider food insecurity if you look at that one and four hispanic adults food insecure 6.7 households uh with a hispanic older adult face food insecurity severe food insecurity meaning at least one member of the household has missed meals due to lack of food and i believe when we talk about grandparents this becomes very significant when grandparents and kids are in the home um hispanic older adults also have access uh difficulty accessing services that we know that can provide food like the food bank like how to apply for snap cards and can of benefits and things like that so there's a great need for that case management to bring those services to uh grandparents to bring them to the older adults 35 percent of hispanic older adults are eligible for snap snap program but may not be able to access that now how does this relate to health that the whole idea about food food insecurity certainly people that are food insecure are at greater risk for health issues chronic health issues if you will 60 percent of food insecure seniors are at greater risk for depression just depression there may be some isolation but again because i cannot feed myself sufficiently i may not feel good if i don't feel good i'm not necessarily going to feel good about myself 53 percent at greater risk for heart attack and we'll talk about that in a little bit more um but asthma we don't necessarily think about asthma as being a health condition that we see with a lot of seniors but actually it is and sometimes related to what they do eat because if it's a lot of processed food you're going to be exposed to a lot of environmental content contagions that are going to impact the immune system and over time that could cause that asthma to occur and then that plus a heart condition you've got some congestive heart failure as well so food insecurity sets up a lot of health issues to begin with that we're seeing in on the ground not only in the hospitals but actually people living in in homes and dealing with these problems now what barriers to combat some of the food insecurity issues well first of all let me give you some statistics on on food insecurity of one mentioned a program called senna that we were working together on where we did some surveys with 200 older latino seniors in san antonio on the west side of san antonio of that to the 224 of them said that they cut portions or skip meals and that they are also a quarter of them also had to deal with should i pay for my meds or should i pay for food and that also is going to contribute to those chronic disease issues that we talked about so i wanted to really help you know really bring focus to that that there are a lot of people out there particularly seniors that live on a fixed income are having to make these decisions on a daily basis should i pay for my medicine or should i pay for my food and if i'm going to pay for my medicine maybe i'll get half of it where i should be taking one every day for a month i'm just going to get 15 because it's cheaper for me to get that so real decisions that people are are are thinking about um although there are programs available and we've 35 percent of eligible seniors benefit from the programs a lot of it is because they don't know they're there they don't know how to get to it they don't have transportation to get to it they just cannot access that just as i said here uh and there's also a a perception that the benefits are just too low uh for the effort that's required to apply for them and i don't know how many of you and again what what you know about the snap eligibility requirements and then the paperwork that has to be filled out and how often you need to be free certified for those it's a lot of work and that's a policy issue too determining um you know at the state level how many forms you want them to fill out how many things you want them to do and so sometimes people just can't just don't think it's worth the effort to do that the other of course is language barrier cultural barriers but also transportation transportation is a significant issue for uh for the older hispanic how do i where do i go where do i if i'm only at home is the bus going to be taking me there and again referring back to senna um when you think about people that rate their health good of those 200 the people that according to the people that rated their health very poorly had transportation issues so again you start seeing how things are related and there's a connection between that it's playing here in san Antonio as well as every everywhere else in the nation so transportation is a really really significant issue uh via there's a lot of work with that but we still have some ways to go to make it more more accessible other things with health that are certainly related to the nutrition nutrition is diabetes we know that there is a an epidemic in the country but here in san antonio we're at twice the national average here in san antonio so diabetes is a very significant issue it also is in terms of dementia and Alzheimer's disease or early dementia and i put down Alzheimer's here but there are all different types of dementia a lot of dementia results from ischemic attacks from high blood pressure strokes and things like that so a lot of those dementia issues are also related to food how you rate your health and then other compounding chronic diseases and then you continue to struggle with affordable health care 2013 hispanic older adults were much more likely to be uninsured than hispanic i've been on hispanic seniors so um you would think they're 65 and over they're on medicare but you know that medicare will only pay for certain things and there are certain parts of medicare that are still not or i'm sorry there are certain things you still can't access even though you have medicare a medicare you have to go part a part b and part c and now you have to have part d for the medications that you have so there's a lot of different complexities if you will with medicare so just because someone is over 65 does not mean everything is covered as well the other one thing that we know is not covered at all with medicare or my eyeglasses are hearing aids and those are very significant issues with seniors certainly hispanic seniors so most of this out of pocket costs for health care it can be 31 percent of their budget for those at the lowest levels lowest income levels so again medicare is not necessarily the answer for everything as i said self reported fair or poor health hispanics are more much more likely to report health is fair or poor than non hispanic whites so again that health disparity of just how i rate my own health and then we don't think and then if we think about medicare periodontal disease periodontal disease as healthcare professionals we know and we're trained to know that when there are some gum issues periodontal issues that's a harbour harbouring for more chronic diseases because that's the entryway into your body of infection of bacteria of viruses and things like that and so dental work in medicare are not compatible there's no there's no coverage for dental care as well so this is a very significant issue with the older adults who has no other form of insurance because that dental work is not covered there but we know as healthcare professionals that this is a leading implication of heart disease blood pressure control significant if you can't control your blood pressure you're more at risk for strokes heart attacks everything else so again hispanic hypertensive rates are on par with non herpanics but mexican americans are one of have lower one of the lowest rates of hypertension control and in san antonio when we did our work with senna uh the majority of adults there when they were asked about a health issue this was their main health issue is hypertension and not being able to control that and then uh finally obesity we know uh we have a problem with obesity across the lifespan not only with childhood obesity which we're trying to get a handle on but obesity across the lifespan and mexican americans have a 41 percent obesity rate compared to 31 percent of whites uh more census tract with more than 13.1 of seniors are less than 64 percent or less likely to have sources of healthy food and we don't often think about it and um before i turn on but you of course obesity is related to a lot of chronic diseases that we all know of diabetes cardiovascular disease um uh uh strokes all of that but the one thing we really need to pay attention to is the whole idea between food insecurity and obesity we sometimes don't think uh that they should be going together but in fact they actually do so someone whose food insecure uh can be very obese can be overweight uh the coexistence of these two has been researched very very often and they are intricately linked together and the consequences of economic and social disadvantage so just looking at where the cheap food is if i need to eat where is my cheap food is going to be with the fast food industry with the processed foods with everything else that are very calorie dense which means i may only going to eat one serving of it but it has a lot of calories in it so you you know again the whole idea of obesity and hunger coexisting does not it seems like it would would not exist together but in fact they do and as healthcare professionals we're often struggling with this in terms of uh getting students i teach nursing students and getting in in terms of getting students to understand this i said well let's say it doesn't make sense why would somebody whose food insecure not able to get food be obese and so we have to go through the root causes which we call social determinants of health because they're determined by the things outside of us and so i think um i'll end with just there are so many things in terms of social determinants of health that can help in certain with these particular issues but food and food access and access to healthy foods is certainly one way to do that and i think that's where all of us are are are focused on and not just the individual with that particular issue but what's bringing that issue into uh the healthcare encounter or into the community as well so i'll stop there and then i'll be available for any question that we can go on and now i'll uh introduce myself as Bristol she is the founder of uh grandparents raising grandchildren coalition and uh which has a number of uh support groups and there was a recently an article in the revard report that talked about the organization and the work that's going on and a trend that we often forget but as we have seen household kind of changes that we've seen the incarceration massive incarceration and so forth taking place impacting uh um grandparents that have very limited resources and all of a sudden they're finding themselves raising children again with this thank you um i'm gonna just kind of piggyback on what you both said because uh michelle is passing out some flyers and we put on um a flyer kind of with the uh work that we have been doing and just to give you an idea um i'm a grandmother raising five grandchildren and uh i came to the abuelos and yet those uh support group out of my need of um connecting connecting with somebody that might help me because i had no resources i had five children from the ages of three months to nine years and i was a single grand i was a single grandmother and uh working towards my retirement and i work for the uh health and human services at the time and so when i got the five i have one children for about a year and then after the year i got four more so they came in in two sets and so um one of the things i had to make a decision was how do i provide for these children and how do i give them what they need and so um i didn't know how to do that and i didn't know to transition from being single to now being a parent and then going through the emotional detachment of caring for my son and and the situation they were in to now focusing on taking care of the grandkids so one of the things that happened is my my physician is the very wise man he um he introduced me to alanon and so i started getting uh self help uh help through uh alcoholics anonymous and alanon and he not only uh gave me uh i went through a depression and so he did not only treat my my medical symptoms but also treated my spiritual and my and my well-being so i attended these meetings and got stronger and trying to detach to the that my son was not able to provide for his children or their mother but actually now taking responsibility for myself and the children that was a really hard decision to make and then uh the other thing that we i had a lot of problems with is when i when i enrolled the children in school they had um i had to go to the to the walmart and they had you know list of all the supplies that they have to get and it was overwhelming and i had one child in a carrier and three children running around saying i need this gram i need this and so i i remember just being there and feeling overwhelmed and i just started crying and i said i can't do this i can't not take these children so there was a time i had to say do i take them or do i not you know and going through that depression again it was very difficult so i did decide to take them and um i didn't know that these children are damaged you know they've seen a lot of things they've been through a lot of abuse and so i i couldn't understand why they were having so many behavior problems and they couldn't they couldn't remind me you know it's like i have five little children all over and so i didn't know how to do that and and so i i again i had to just like learn to just be with the children so one of the decisions i had to make is whether i put them on medication or not you know they were telling me you know these children are gonna my my six-year-old's a boy his name is Augustine and in the second grade they were evacuating the school i mean the classroom because he was so out of control and so they would call me at work and i'd have to leave work because he was having meltdowns and i didn't know what a meltdown was and you know and so um i had to make a decision to quit my job i could not be doing this running they changed him daycares three times you know then i was paying so much for daycare that it wasn't even worth for me to work i thought so it was just really a really trying two years of what am i going to do and so after two years i i really had to pray um food stamp snap is not a big help for grandparents you know i worked i keep benefit i work for tana medicaid and food stamps so i had to sit down and make my budget you know is it easier for me to just stay home and apply for food stamps you know but um then they count your resources you know i had my car paid off uh you talk about um when you get these children we don't have furniture for them i had an empty room but i didn't have where to sleep put them to to bed i had to borrow a crib for the little baby when i got him when he was three months old and then the other children came a year later i didn't have beds for them so i just threw blankets on the floor and you know i have dressers for them so we just stacked up you know clothes that they have so then um budget decisions you know that we have to make what do we do i ask for help and uh you know there was no help in that area so we um you know i applied for the one-time grandparent fee a thousand dollars i didn't qualify because my car was paid off so what do you do you can't sell your car i didn't have car seats for these babies i had a three-year-old that was wearing 18 months clothes she had failure to thrive she could not i mean she was a tiny little girl when i got her she had sorry she had diarrhea and she was throwing up so i had to get her to to medical attention i called the office and i said does this little girl have medicaid i have friends and so we chatted she had no medicaid mom had not renewed her medicaid so then now what do you do i had to call cps you know so uh to get them so a lot of grandparents get these children without any legal paperwork i mean you hear statistics you hear how many the other day we went to the health collaborative meeting and they're talking about all these statistics you know about about children that are being abused or children that are that are neglected but what about the ones that do not get reported that nobody reports those children and those are children are getting abused and neglected so um i like i said i didn't have car seats for the children i was driving around with you know for the few days and you know trying to like what do i do i ran out to you know walmart and bought me two car seats but now you had five children in a in a highlander you know i had four children in the backseat two car seats two little ones you know sitting with one so you you just have to adapt i didn't know what to do so then uh that's one thing and then the other thing the food insecurity you know what do you do you can't put enough food for those children you know summer i was very thankful for wig with the baby you know they gave me the formulas that was so i couldn't afford it the behavioral issues we have a big problem here in san antonio where there's not enough psych psychological i mean psycho behavioral health thank you psychiatrist that would be able to diagnose my children and so you know when they were through cps you know they had a doctor we would go there and then once once i've adopted them then you have to transition and look for your own child uh behavioral health it took me three months to get a mental clarity you know and then um the decision to whether to put him on medication or not it was i had to be told if he was diabetic with you with whole his diabetic medication and then i had to shift okay you know maybe he is sick and so those are the kind of things that i've dealt with personally so going to the grandparents meeting back i thought we have to do something so we spoke to other grandparents other grandparents again empower them with knowledge what could we do another granddaughter grandmother and these forums that has my name and delia's name delia martinez and i we decided we were going to do something she went and sat at judge sakai's office at seven o'clock in the morning waiting for him to get there so she can speak to him and she did she says give me five minutes and he said come on in so now we've had a luncheon with attorneys with the with the child court with so we've had a this kind of uh um meeting with them and they listened to us and they were said okay now what do you want us to do so we would like the task a legal task force to help grandparents uh look to see how they can help their grandchildren so now we have that we have an attorney that stepped up and we have a workshop once a month where we have 10 grandparents at a time and she assesses their needs and then she could either find pro bono attorneys or we can do a low cost judge sakai is also willing to do a wait their fees for some grandparents so this is the kind of advocacy i wasn't trained at that time by kwan but now he's training it and how to do advocacy work and so delia and are going out to the community and saying these are the needs i mean you talk a lot of grandparents have to make the decision do i take one pill do i cut it in half and you know to be able to put food on the table for these grandchildren and um they're living on 800 social security and with i have one grandmother and with two children that that she's taking care of we have great grandmothers taking care of a great grandchildren and uh there was one in particular we had a resource fair and out of the resource fair we had we we came up a hundred people signed up there was 80 households all together they were caring for over 200 great grandchildren one grandmother that showed up there that asked me for help she's 83 years old caring for seven grandkids under the age of 10 you know and so she i mean i took her to the resources come to home boistown they'll give you parenting classes go to o a g uh attorney general because then you found you know cast child support and she says but the father said undocumented i said it doesn't matter as long as you have that now you can go apply for food stamps i know the steps that they can take to apply for certain benefits you know you have to take this action before you're eligible for 10 of so now we you know we're we're empowering grandparents like that guiding them what our goal is to have a one stop center we're agencies you know where grandparents can come and we can say you know what this agency can provide this this agent and then run it with grandparents like one said empower them to to ask for what they want you know and so this is what we're trying to do and so we need the community support we need the community to to step up and say you know i can help in this so i can i have one grandmother that she needed diapers for her grand grandbaby and she had to take three buses to go get and all they would give her is one little thing of diapers you know and so we're looking at how we can help that grandparent i mean we have grandparents on with the walkers they have to get on the bus to go get some help and uh what can we do to help them you know uh right now uh again we spoke at the at the health care collaborative and uh we're we're trying we're partnering with Incarnate Word to to help uh train medical doctors not only to see you know treat the high blood pressure or the diabetes but what is causing it what are their stressors for me has been respite for me has been i'm one person and i told my grandchildren you know i i've taught them how to be self-sufficient for for safe i'm not here and one of my 14 year old granddaughter said to me a few months ago grandma why do you treat the other grandchildren different than us you know because i have to i have a daughter that has three kids and she's married she says you treat the other grandkids different than you do us and i said i'm not i'm not your grandmother i'm your mother you know i we were taken we were robbed from being the grandparent at this for the for our grandchildren and so we cannot have that mentality that i and i want to i feel sorry since sometimes i'm like no you can't have that no you talk about diet i mean i try doing diet for ADHD you know take sugars away take all this stuff my grandparents reset my grandchildren resent me you know that that grandparent that's a grandchild can have a donut and you can't you know and so my grandchildren now reap reap every label well this one has read diagram and we can't have that you know and so we have to teach our grandchildren we have to teach them how to eat and i'm very very grateful that um you know for for the abuelos and the adults what because they've uh they've given me the hope you know that we can make a difference and we can make a difference to our grandchildren the other thing is when i retired i was 57 years old and i had to i was invested in the company in the state so i had to retire without without insurance i have no medical benefits and i said god you're my physician you know you're my doctor i've had shiggles twice you know um and so i couldn't afford the medication so what i did is that you know i my granddaughter with with packs of alcohol with with baking soda try to die uh um the discomfort and the blisters so they they wouldn't pop all over the place so those are the things that we do have to make a decision what's the best thing for for me you know and i thank god i haven't gotten any i don't take any other medication but vitamins and i try to exercise and so um you know we we learned so we're we're teaching other grandparents that you know uh you can do it you can do it and we're here to help you in any way we can on this thing we identified the key the key um stressors you've touched in a lot of them and then in the back we have statistics and then what our common obstacles are is attorney fees you know uh no legal rights for the children lack of knowledge of the legal rights and then the language barriers then we have the sandwich generation our some of us are taking care of um we have one grandmother taking care of a six-year-old and 102-year-old mother in law and so uh you know you're running around to to elementary school and then you're running around to you know taking her to to the doctor so there there's a lot of stress there's a lot of stress in this in this area for these grandparents and i haven't i had not heard that conversation before you know of what are we doing for grandparents that are raising grandchildren and so that is my our mission is to bring out awareness and we started this what in february one when we had our first meeting the what do we want to do and so we said we want to go and so god has opened a lot of doors and we're now you know speaking in different areas um i was invited to speak at a forum for um tanaf and i'm going there on in on the october the 6th and so we're going to we want to change policy we want them to start looking at you know tanaf is 95 dollars in the state of texas for one child that that is if you qualify okay in in louisiana they send me a report in louisiana that the the the standard there is 222 so we have to take a look at the policy across the states you know what what is california doing i saw you know i worked in california as the social worker for for 13 years and uh uh the the social economic there versus san antona i mean texas it's it's it's night and day you know 395 dollars is for one child there and here is 170 something you know it's just how do you raise your children you know like that of course housing is cheaper here but the food is not um you know and you have to feed them and so you might have a place to live but you can't you know we don't have a how to feed them and so tanaf uh you have to be under 150 under the poverty level you know and a lot of these grandparents are but they might not have legal access you know legal representation for these children so they can apply so we're going in a circle here you know what do you do one of the biggest fears my all my grandkids have is uh grandma what's gonna happen to us if you die you know what's where are we gonna go and um i'm hoping my daughter can be able to take them but she has to qualify they'll go back to the state and then this she'll have to petition the children and if she qualifies for taking the children then they'll place them with her if not they'll go to foster homes so i've had a conversation with all of my grandkids and i go through you i go by the college and i drive them by the college since i've got them and i said you're gonna graduate from that college and i told the older one lilia you're gonna make sure that paul graduates he's a baby and if grandma's not around i want you to promise me that they're all gonna get an education i said because i probably won't be around much but you know god's gonna give me there enough time to get you through college so um the school called me one day and she says the counselor she said Mercedes you've got to hear this conversation that little boy that was evacuated by the room that little boy that was causing that evacuation she said he was now in fifth grade last year and she said Mercedes i heard agi talking to another little boy and he said um do you know what college you're going to because now they're thinking of promotion graduation to sixth grade to middle school and he said do you know what college you're going to and the little boy said no and she said uh you don't know and he said no do you he says yeah he said well what college are you graduating he says UTSA you know and uh ironic i'm here but uh but that was his conversation and it makes me very proud you know the school has been a tremendous support for me and um i just had a talk to the grandparents at brothley elementary before i came here and i said you know those pillars up there those pillars of character they're not on the wall i said each teacher the principal they live on here and they've been an inspiration to my family i said and that's why i keep coming back and talking to you all because now we have a support group there for grandparents raising grandchildren out of the abuelos and yetos we have another support group there and um just now i had three grandmothers that came up to me and says can i speak to you you know i need that i need that legal help i have some flyers we're going to have a a seminar from uh Catholic Charities i've went and knocked on their door and they're going to have a seminar for grandparents that are raising grandchildren to give them legal um information and services if they they qualify or provide them and so we're that's what we're doing out of the abuelos and yet those uh they've empowered me enough to be able to want to make a difference to other grandparents and tell them you know what we can we can change we we've gone to senator menendez we said we want to build we want to build introduced to legislation to to have the other thing is that if the child the mother gets child support for this child and now the child is taken away and is put with a grandparent that income doesn't go to the grandparent that grant that mother keeps getting it until there's a court order to stop that child support and so we want to we want to change that we want to change it that the money goes to the child follows the child you know because that's what we're that's what we need the money for to provide for these children you know they a lot they don't come with money so it addresses all your concerns and all your statistics you know that there's their numbers but nobody's hearing really what's really the issue about the grandparent what they go through so um in that one of the things i just want to say in rafaelio too i know you do a lot of demographics um teaching the nursing students about the communities and having them do surveys and community assessments the census now tells us in your area if you want to think how many grandparents are taking care of kids and their ages so that data is really available to think about because your community really need that support and in the west side most of my students do their community assessments on the west side or the east side and that area is having grandparents taking care of grandparents much more so than uh the north side one east side etc so there's a disparity there as well and much needed services in in the spanish area of town we need to highlight that and i'm gonna single out adelita as a researcher who knows how to exchange and partner and collaborate okay and that's why earlier when i mentioned least the perspective that we took as an agency and working with entities is what are you going to contribute to this right now look at the issues that are being encountered with grandmothers so you want to do a survey you want to publish a paper you know you're an agency wants to do certain things what are you going to contribute right now and that's what grandparents are learning to do you know and in spite of the fact they have tremendous amount of the need so the i just want to re-emphasize that and again highlight adelita and the work she's done in the community as a researcher and how she brings to get as much as she can brings the resources of the university into the community brings in nurses and students into the community you know and so you know i just wanted to again you know emphasize that and and that's with any entity you know all right so if we can thank the panelists and we have time for a few questions housing navigator for the layer counting agency for the alamo area council of governments one of the things that uh recently in a meeting i attended we found out that they are grandparents that are living in senior communities and a lot of sudden are responsible for the grandchildren and the first thing that they have to do is they have to leave the senior community because the kids are not allowed in this happens a lot in the affordable housing you know tax credit properties and also in the saha housing you know that we have many senior communities here as part of my job one of the things that we're doing at the alamo area council of governments is um advocating for changes and to allocate certain amount of units you know in our community for section eight and affordable housing and public housing for these cases for example if a grandparent it lives in a senior community and is forced to take care of his or her grandchildren so that they could easily you know um uh transfer uh transfer from that uh senior community into a multifamily community that meets you know their financial uh situation so i want you to be very much aware of that Mercedes and Adelita and um because i am going to be needing you to be able to continue this advocacy movement uh we are also doing this to uh around the 13 county area that comprises the alamo area council of governments um talking to the stakeholders the mayors and and the council and the city planners and all this that in many cases and and you know there is a lot of members here in this area in many cases they oppose uh the the the construction and the development of affordable communities so this is one of the examples that we have to really introduce our communities around our catchment area to our conscientize them of the need because it's not only you i am fortunate enough you know to have grandchildren that i do take care of them a lot because they want to and they want to be with Avila but uh not everybody has you know it's not that lucky thank you thank you another question or comment yes i i really want to thank for your testimony and and all the work that is being done on on grandparents taking care of children um i happen to uh also do some research in South Africa looking at the um grandparents that are raising grandchildren that are all fans from people dying from HIV and AIDS and we're finding that indeed hunger hunger is a very large predictor of of depression indeed and these grandparents and and uh what is most significant is when these grandparents have lost their child right the the taking care of the child the child caring of the the child that is sick with HIV and AIDS and then keeping the grandchildren the interaction effect is huge so um i think you know this is very important to to be aware of these situations and and and this is just giving me so much input and what these parents are going grandparents are going through over there as well right so i really appreciate your testimony on this thank you time for one more question if we have any all right thank you very much this has really added a lot of for very good perspective to the conversation