Do you remember wondering about those classic public health commercials that repeated, “Help! I’ve fallen and I can’t get up”? We also remember the lines to the ditty – “Ashes! Ashes! We All Fall Down”.
I do. My parents were approaching that age when I first acknowledged the sheer challenge we face against time. We moved away to California, so I wasn’t there for my parents later in life, and they passed before becoming that feeble, a circumstance I think was a blessing in disguise.
Now, I’ve reached that stage myself – albeit long before I thought I would – and to put it bluntly, it sucks.
Ashes! Ashes!
“Ashes! Ashes! We All Fall Down”: When the Safety Net Recedes
The View from the Porch Floor
Case in point: I was scheduled for a doctor’s appointment down in Palo Alto, an hour-and-a-half drive on a decent day (though I can make it in an hour on an early Sunday morning). As I walked out to the porch to let my morning coffee kick-start the day, a sudden coughing fit took hold.
The next thing I knew, I woke up flat on the floor with coffee spilled all down my front. I hadn’t planned on taking another shower, but there I was. I managed to get up, started coughing, and sat right back down again. My butt hurt from the hardwood floor, and the sense of powerlessness hit me.
I now understand the raw helplessness in those old commercials. I’ve had daytime anxieties and nightmares about this happening in public. Once at Costco, I came close—not falling all the way down, but collapsing against a display case. The real nightmare, though, is having it happen behind the wheel at 70 mph on a busy highway.
Today was one of those rare days when my wife, Donna, couldn’t drive me. I thought about trying to drive myself, but coughing episodes while driving are a recipe for disaster. Getting angry at traffic or inducing rage on a crowded train isn’t an option. So, what happens when “the fall” occurs and you’re left stuck on the floor?
The VA Sanctuary vs. The Bureaucratic Distance – Ashes! Ashes!
Yes, as veterans, we can go to public emergency rooms or civilian clinics and have the VA cover it. But for me – and many like me – going anywhere other than a dedicated VA facility is deeply uncomfortable.
In a civilian ER, the questions are always the same. They probe into military trauma and underlying issues that I never want invoked except under the watchful, understanding eye of VA staff who already know the background. At the VA, there’s no need to reopen old scars; they know the context, they treat, and you leave.
But now that physical limitations make traveling a major hurdle, the fundamental question becomes: How do I get there? A three-hour round-trip commute via unreliable local transit just to have a specialist check a minor routine update seems incredibly wasteful. Yet, the questions abound while the answers remain buried in a bureaucratic miasma.
“Help! I’ve fallen, and I can’t get to where I need to go.”
Background Report: The Livermore VA Clinic Closure & Its Impact
To understand why so many East Bay veterans feel abandoned, one must look at the history of the Livermore VA facility and the decade-long push to restructure local veteran healthcare.
[Historical Foundation]
1930s–1940s: Est. as a Chest/TB Hospital
1995: Integrated into VA Palo Alto System
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[The Restructuring Push]
2003–2004: CARES Plan target for closure
2018–2022: AIR Commission lists full shutdown
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[Systemic Impact]
• Travel Burden: Central Valley to Palo Alto
• Bureaucratic Friction: Civilian vs. VA Care
• Civic Pushback: Local VFWs & Mayor Ignored
- 1. A Brief History of the Livermore Campus– Ashes! Ashes!
The Livermore VA Medical Center campus (located on Arroyo Road in the Livermore wine country) has a history spanning over seven decades.
- Origins: Established in the mid-20th century as a specialized chest and tuberculosis hospital, the 113-acre campus provided care and open-air recovery for veterans.
- Integration: In 1995, the facility was officially integrated into the VA Palo Alto Health Care System to serve as a key East Bay hub for outpatient care, sub-acute beds, and long-term nursing/convalescent services.
- Upgrades: Over the years, tens of millions of dollars were spent on seismic retrofits and facility modernizations, turning it into a stable sanctuary for veterans in Alameda, Contra Costa, and neighboring Central Valley counties.
- 2. The Closing Push & Modern VA Plans– Ashes! Ashes!
The move to close or repurpose the Livermore Division is not new; it spans multiple restructuring initiatives:
- The CARES Plan (2003–2004): Under the Capital Asset Realignment for Enhanced Services (CARES) program, VA leadership slated the Livermore hospital for closure. The rationale offered by the VA was that infrastructure was aging and that shifting to smaller Community-Based Outpatient Clinics (CBOCs) would modernise delivery.
- The AIR Commission Era (2018–2022): Mandated by Congress under the VA MISSION Act of 2018, the Asset and Infrastructure Review (AIR) report formally recommended completely closing the Livermore Division and shifting primary care and specialty services to regional centers like Palo Alto or newer outpatient sites.
- The Current Reality: While outpatient clinic services have been shifted toward regional centers or decentralized clinics, the loss of a fully integrated, localized East Bay VA facility forces aging veterans into grueling 2- to 3-hour commutes across congested Bay Area highways or public transit networks just to receive specialized care.
3. Community Opposition & Unheard Voices– Ashes! Ashes!
From the moment closure proposals were introduced, local stakeholders fought back:
Why Opposition Was Sidelined: The VA’s national strategy focused heavily on demographic shifts and asset consolidation. National administrators prioritized closing older inpatient footprints in favor of outpatient networks, viewing the high land value and facility age of the Livermore campus through a budgetary lens rather than evaluating the localized emotional and psychological sanctuary it provided to area veterans.
Civic Leadership Put Off: Local leadership, including mayors of Livermore and regional representatives, consistently voiced strong opposition. City council resolutions were passed demanding the preservation of inpatient and sub-acute services. However, local officials repeatedly faced bureaucratic delays, canned responses, or unfulfilled requests for direct engagement with high-level VA decision-makers.
Grassroots Veteran Advocacy: Veteran organizations, including VFW Post 7265 and regional chapters of the Association of the United States Army (AUSA), spearheaded rallies, letters, and public testimony. Veterans argued that forcing elderly or disabled patients to commute to Palo Alto created severe health risks and financial burdens.
Ashes! Ashes!
Conclusion: Standing Up When the Safety Net Recedes
“Ashes! Ashes! We all fall down” – it is an inevitable reality of growing older that our bodies eventually slow, our stability falters, and we need a hand getting back up. But falling down physically should never mean being cast aside administratively. Grassroots efforts spearheaded by local organizations like VFW Post 7265, alongside local civic leaders who refuse to be brushed off, represent more than just a fight over a building; they represent a fight for dignity, accessibility, and the promise made to those who served. We may be getting older, and our limbs may not work the way they used to, but as long as we can speak up, write, and call out on an open channel, we won’t let our community’s needs be lost in bureaucratic silence. It’s time for the VA leadership to finally pull up a chair, listen to local leadership, and help us restart the engines.
Perspective: The Human Cost of Bureaucratic Distance
When a healthcare system looks at a map or a spreadsheet, it sees miles, patient ratios, and facility operational costs. But when an aging veteran looks at that same map, they see the daunting reality of three hours in transit, the physical toll of a coughing fit behind the wheel, or the humbug of navigating a civilian ER where nobody understands their history. For decades, the Livermore VA campus wasn’t just a collection of medical offices; it was a local anchor, a sanctuary where veterans could receive care without having to explain or justify who they are. Closing or scaling down these localized lifelines forces the most vulnerable among us to bear the heaviest burden, transforming routine care into an exhausting, high-stakes ordeal.
As always – be well, be alert, be informed. Popi sends…
Other Random Thoughts: Holistic Time Management
Ashes! Ashes!
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