Yeah, so I saw it in here. The reason why I picked it was because I saw that one of the examples was elder abuse. And this is a big issue that older adults experience in Orange County, but also outside of Orange County is potentially being taken advantage of by people they know, both in a financial sense and also not having their wishes respected when we're thinking about healthcare outcomes or other situations. So this is a really big barrier for folks. And it relates to problems that we've talked about before around. Like, it's one of the ways in which ageism, is commonly manifested in our society is the improper treatment of older adults through elder abuse and fraud and other things. Elder abuse, neglect and exploitation, I think it's the word that you use. So this happens too often, unfortunately, and we don't have a great system in place to handle reports. And I will also say this kind of relates to health too. And maybe actually this could be a separate. I'm just seeing Oh, well, I think it's maybe we'll get to it when we talk about different groups of older adults. But I think it's particularly tricky for older adults who have cognitive impairment. It ends up being this really complicated. He Said, She Said, and we don't have a good system to honor and recognize the wishes of the older adults, especially when they're in then when they might lack capacity to be able to make those decisions. Like, it's Some days, there are good days, and there are bad days. So our system is not really built in a way to prevent the elder abuse that we want to prevent, while also recognizing and honoring the wishes of the older adult. There's other stuff out, I'll wait for the other questions to


answer the rest of the three, still gotta ask them to what barriers exist to see improvement in this area.


I don't think there's a one size fits all on the question of elder abuse and elder justice. We want the older adults to come up with and be able to lead what that looks like for them. And it's going to look a little different depending on who that older adult is and what community they're in and what they're comfortable with. I'll also say I picked this one, because I think that, and this is skipping ahead to the next question about different groups of older adults. But I picked this one because I think we sometimes think of older adults as a monolith, and one group. But that actually doesn't recognize the diversity within the older adult community in a place like Orange County. So I would say concerns around immigration, fall under Community and Family Safety, am I going to get recorded to ice is my family member gonna get reported to ice that falls under Community and Family Safety, I would also say things around police. And I think you call it public safety here. We have lived through some really awful and continue to live through some really awful instances of police and state sanctioned violence against primarily communities of color. And so we have older adults who are handling all of that, right, who have to worry about whether their child or their grandchild is going to make it home at night. So that it was hard to pick three, but it's why I think it's so important is like, there's the elder abuse elder justice piece. And then there are also these very rich, diverse experiences within the older adult population that fall under this notion of community and family safety. And we don't have an infrastructure to provide them those things.


And of course, either different experiences for different older adults have different backgrounds.


So I think, folks with cognitive decline, and that is disproportionately black and Latino, older adults, they have higher rates and higher rates of undiagnosed Alzheimer's and cognitive impairment, actually. So it's higher for them, the more complicated for them. It's also more complicated for immigrant older adults, as I said, as well as black and brown older adults, because they're worried about police violence. I also think, you know, one connection that I want to articulate here is like, we think of we might think of APS Adult Protective Services as a neutral, you know, sort of government service. And there are instances we know of where older adults of color are hesitant to contact APS because they are afraid that APS will then that will trigger a call to law enforcement. And there's a lot of distrust against law enforcement in communities of color. So and then you you tap in like, how are we doing for older adults who don't speak English. That's a whole other, you know, we don't even have a great system for those English speakers, let alone folks who don't speak English or don't speak English or have limited English proficiency. So if again, it's just like health and income, it's going to be harder for folks who experience structural discrimination.


I mean, I will say I think part of it is crafting community solutions that are grounded in what older adults want. And that's going to depend on each older adult, but we need to take time to listen, we need to take time to think about prioritizing their wants and wishes and needs in developing solutions. But I think it gets really complicated because that bucket in particular touches on so many different areas.


Okay, moving on to the next question or next set of questions. First one is geriatric care. I'll just read off all four of them, we can come back to them. First one is geriatric here. A second one C long term care, C mental behavior, health substances, substance use treatment. And the the fourth one, it will be a human or social services. So geriatric care. And again, the question is, if you can describe how accessible and adequate these care or services are in Orange County,


I don't have Orange County specific information. But I know across the state, that there are lots of gaps with all four of those types of services. And nationally, we do not have a healthcare workforce that is trained in geriatric care. There's just we have a shortage. Similarly, one of the other things that you asked about was long term care. Like if we think about long term care as an umbrella, not just nursing facilities, but getting help with care at home, it's really hard to get that care. You have to even if you qualify, you have to jump through a lot some hurdles. And then the last one was with mental health, like behavioral health care,


That one I won't I won't speak to as much. But I will say I think what we've seen in our state, and specifically in Southern California, is that we have a crisis among our older adults, both because of COVID-19. And what that's done, and how many people quite frankly, in that generation have died because of COVID-19, or our link at or dealing with long term effects of long COVID. And there was the shooting in Orange County at the church. That Taiwanese church, I think it was the shooter himself was an older adult, and the victims were older adults. Similarly, in Monterey Park, same thing. And what to me that suggests is that people are not getting the mental and behavioral health support that they need. When I think about the issue, you know, to me, I think about well, we're not going to change the Second Amendment. We're not going to change the Supreme Court's thinking around access to firearms, and we can't change Congress with we can change Congress by our voting but that's about it. But we can make sure that people get the care they need. Both of those older adults in Southern California were screaming out for had had lots of mental health needs. And what happened to me suggest that they do didn't get what they needed. So I'll say I'll say that much. And I think it's important to say because that at least one of those examples, both of them are Southern California, but one of them was in Orange County. So


So I think we're gonna have challenges with workforce, in having the number of people to provide the care and services that we need, or that older adults need. And that we'll have problems with the economic security of those older adults. And that we are increasingly in a dark kind of moment in our state and country like issues of climate change will impact older adults. And oftentimes, they're going to be the ones that are least resourced and positioned to respond. There was a really interesting article that The New York Times did, after Hurricane Ian in Florida, that talked about how many of the victims both the people who died and the impacts of the hurricane were hardest hit on older adults, older people in Florida. And I worry that as we go through extreme drought and extreme rain in this state, that that will be a very big challenge for them. And so I talked about workforce issues, income supports climate change. And then healthcare, like making sure that they get the care they need. It's going to be a continual problem in the next 10 years. I also think I was just one last thing is, as that population grows, that's part of the issue is that our system is already broken, and can't respond quickly enough to the growing population that's out there that needs the services.


Well, the government's role should be you know, you can, you can answer however, what you want. Yeah.


So I think the government plays lots of different roles, they can make it easier and more user friendly. For older adults to access programs and services. They can do a better job on outreach and education, to make sure that older adults in their communities know about the services that are offered and build relationships with those older adults. So they trust public officials. And they also have an enforcement responsibility. Because the government is paying for these services. If there is discrimination in health care if there is discrimination in elder abuse, they have a responsibility to enforce local state federal laws and ensure that people are getting what they need free from discrimination.


Thinking about all the older adults in Orange County, if you can, who is getting the least amount of attention


interesting, I would say probably older adults who are numerical minorities. So that would include, for example, LGBTQ older adults, undocumented, older adults. Older adults of color and older adults who have are experiencing cognitive impairment. Again, a lot of overlap between those populations or among those populations. And I will also say older adults who don't have advocates. So that would include family members who can advocate and help them figure all this mess out. It would include people who, you know, like sometimes in these, they have a case manager or a social worker, but I worry most about the people who fall into those buckets that I previously named, who don't have someone helping them. I think those people often are completely forgotten about and are really unconnected to the landscape that we have to provide services for them.


Yeah, older adults experiencing homelessness, or housing insecurity, that is such a big one. And we aren't talking enough about how across the state but including in Orange County, the fastest growing number of people experiencing homelessness are older adults. You can age into help into homelessness, meaning that you were previously homeless, and you just became older. And or you can be housing secure, but then as an older adult, lose access to your housing. And what we're seeing is it's both of those right, that are happening. But in particular, it's the second group of people who are losing, these are people who already are in housing, and we have set up a situation for them, that puts them out on the street. So I would say that's both a group that we're not thinking about too much. And I would also think about them as an answer to your this most recent question.


housing, housing security, among older adults. I think is a is a really big one. And that we know falls on people who you were asking earlier about different groups of older adults, right. So it, it's disproportionately black and brown people and also people who have mental health issues that are aging that are in that group of people. So


I just have a few more questions to, to wrap this up.


I'll say I think what's working is that. Trying to be thoughtful about the answer here. I think what's working is that we increasingly are seeing attention to issues of equity and inclusion, and recognizing that, that has a legitimate part in these conversations. So I think what I said earlier about older adults not being a monolith, is increasingly a more widely accepted notion. So I think that's a good thing. And certainly a shift even from four or five years ago, in terms of how we're thinking about these issues. That same success makes me worried because in many areas, including, I will say probably more politically conservative areas of Orange County, we have seen significant backlash to issues of equity and inclusion. So while on the one hand, it seems like many of us are becoming more comfortable thinking about those issues. That's not everyone and it's met with some significant resistance. I'll Also say for thinking about older adults themselves. You know, I have, I've heard stories both in Orange County and out of Orange County where older adults themselves might have might hold discriminatory views. And that's really challenging because you are, you both have to continue to provide services, because they you know, regardless of how they might view a particular subject, and it's challenging in, in addition, because the environment in which they grew up in a social context in which they grew up in is very different than the one that we have right now in 2023.


And when new or revised policies are needed,


specifically on the equity and inclusion piece, or on,


we need is in all the policy solutions that we can then so what I would really encourage, for example, Orange County, as they think about their own master plan, is for each of those goals. For each of those initiatives, they should have specifically how the policy will improve or advance equity, and how they plan to measure that. at a statewide level, we have some of that, depending on the measure, depending on the initiative, and sometimes we don't, but I think it helps center it in a way that makes it very obvious. And that makes it easier for you to evaluate whether you are meeting that goal. I'll also say that requires good data collection and good data analysis. And I would encourage the county to invest heavily on that piece, because that tells you where you are now. And then it allows you to figure out what the right goals are moving forward. And whether you've met those goals. That is a really important step in thinking about equity, you have to understand which it sounds like the county is already doing through its stakeholder process and everything. But I would say like, Really take your time to unpack that. And in each goal, make a very clear articulation. I wish we had done more of that at a statewide level. We did some of it depending on the initiative, and then we didn't pending on other initiatives. And I think that was a lost or missed opportunity.


I don't know if there's one entity I think there are it will require lots of different entities because the issue of equity and inclusion is so broad, and impacts so many different communities in many different ways that you need a coalition. You need people who work with immigrants, you need people who work with law enforcement, you need people who work with those who are homeless, all at the table to address those issues of equity and inclusion, because it's going to play out differently. I mean, that's the whole point of equity and inclusion in this like, there is no universal experience. So there has to be a broad coalition of people. And I think that's an opportunity, quite frankly, for people in Orange County, who might not work with older adults directly. But maybe they work for example with the Korean community, or they work with the Taiwanese community in Irvine, or you know, like, there's very specific Vietnamese in garden grove like there are very specific communities in Orange County. It's also an opportunity for them to think about the older adults in those communities. We provide services to the Vietnamese community that they're not thinking about. Well, that's true. What are their specific concerns, how does their age impact what they're bringing into the office to work on. So I think there's an opportunity in all the master plans to build broad based coalition's and get people who are not otherwise thinking about aging in their work to come to the table and think about the older adults that they work with. You okay.


So obviously, census data is a big one. The state has a has multiple dashboards. So there's a dash and equity dashboard. There's also at DHCS. There's an LTSS dashboard, that is helpful. And then I'll say on the health side, there's really good data out of the UCLA CHIS survey. And I'm trying to think if there are any other obvious ones. Those are the big ones for now.


I think it would be interesting for you all to connect with either a local or state disability advocacy organization, because that's been one of the ongoing balancing acts in the at the state level is how do we think about aging and disability, but also make sure that we're not conflating the two. So there's local advocates in Orange County would encourage you to reach out to them if you're not already. I would be more than happy to put you in touch with state folks too.


What this concludes our interview, thank you so much for your time, you have been incredibly helpful to our research. If you find that you have more to share, please feel free to reach out to us. Our contact information is available on our website, www dot att soc.com. And you can leave an anonymous voicemail in our telephone line anytime. Or you can just reach out to me.


I was gonna say I know I knew Tammy so thank


you let me just stop the recording for now. See no boy. Oh my God, he's fine. Here we go. Yeah, you guys


So the primary goal today is to identify what needs you think are most important to the older adult population user. Those who are 60 and older, we want you to think as broadly as possible, taking into consideration the older adults, caregivers, families, and the community. I'm going to share my screen so you can see a list of common issues and concerns impacting older adults. Please take a few minutes to read through this list. And let me know when you are ready to begin and I will follow up with some questions regarding that list


So this is the I tried to fit this in while one page, so feel free to let me know if I shooting larger but up or down or however that makes you comfortable. So just take your time reading through this.


And let me know I'm reading through this list and determining which ones are


just just read them and I'll ask you a set of questions okay.


Yes, I am the program director of our Alzheimer dementia program at OMID, which we sort of outreach to the community, we educate them on brain health and caregiver classes. And at the same time, we sort of invite people to do free memory screenings. And in this process, we will determine whether further steps need to be taken based on the score that these elderly populations are receiving, to connect them to their primary doctors or to a neurologist, and then we provide case management for them. And then we assess their needs, such as what it is that you're inquiring about. And once we assess their needs, then we have our case managers connect them to social service linkages as to as needed, and also allowing the caregivers to get involved with the health of their loved ones. So that this way a load is taken off of their shoulders, but also educating them how to communicate more effectively with their loved ones. And also to determine whether the caregivers also are in need of self care and therapy, and so on. So it's sort of a family disease, Alzheimer's, dementia, and we try to take care of all the individuals in the family. That's one part of the work that I do. I'm also in charge of the reporting aspect of our isoa program. Prevention and Intervention program with the seniors where we again, it's very similar, we outreach to the senior community, anyone over 60. And we provide positive living positive aging, self care classes and all sorts of classes for the elderly. And along this process, would we also determine whether individuals are in need of services based on our outreach, and then we also again, provide them case management where we sort of before they go into deep into depression or any sort of mental health challenges, we sort of prevent that from happening and provide them the services they need, whether it's housing, health care, transportation, any other needs that they have. And then we sort of stay with them on this path for anywhere between 3 months to a year. Once they get them going and they're back on track and especially connecting them to Social isolation groups so that they're not isolated, and then be discharged as cases.


No, it's pretty inclusive with all the needs that are out there. You know, one of the major needs is transportation, which I see here. Food is a second housing is another top three,


No, I don't see. I mean, it's pretty well covered.


Okay, so the next question is, of the needs on this list, please write the top three that you feel are the most important.


When we say economic security that applies to so under economic security, I would think food security would be under that. Also being able to provide so I would say as a package economic security.


And I'm going to ask you some sub questions for each one of the three that you just shared.


One because they like their independence and or don't want to be living with their family members, their children, it can become very toxic, the environment of the home when they are living with their children, and their grandchildren sometimes. So they like their independence, and it gives them a peace of mind to be independent. In order for them to be independent, they need separate housing. And because of the high cost of rent and housing in Orange County, it's very difficult to find housing that accommodates their income, or and there are really no section eight openings anywhere, it's very difficult to find those as well.


Well, the cost is definitely a barrier, the average low income housing for a senior they have to pay a minimum 1000 to $1,500 a month for a one or two bedroom apartment. So where are they going to get this kind of money to begin with and if they are on SSI, so social security, supplemental income, the maximum that pays for each person in the family would be anywhere thing I believe has been 1002 to $1,200 or so. And they have to qualify for it. And there is a process of applying for it. And who's going to do that for them. So all of these we do as case by our case managers help them out with all this paperwork, which is very helpful.


Well, ethnicity plays a huge role. culture plays a huge role. I know what the Hispanic community, the elderly is very much protected, I want to say because it's part of the culture to keep the parents at home, no matter how long. But on the other hand, also there is the issue of not providing the needs that they have. Because they don't see that my mom needs to go to the doctor, my dad needs to go to the doctor, they don't need mental health. If they are dealing with dementia, it's ignored because of the lack of education. So that community is dealt with in that way. So we have this struggle with Hispanic community at least as far as our organization has. Even if they are diagnosed with dementia, not steps are taken towards taking care of it or slowing it down or anything like that. As far as the Persian community is concerned. They are really willing to To get the education, they come from mostly educated backgrounds. And the idea to live independently is very big for them, they don't like to be dependent on their children. So that's the experience that I have. As far as the other cultures, again, it varies between the two that I spoke about depends on the family and the kind of relationships people have. But generally speaking, I find that older adults are a lot more


happier when they are when they have their independence.


I think the housing housing is number one, because it allows them puts them at ease, that lowers their anxiety levels, anxiety can turn into depression and isolation. So it's a huge preventative measure, but then to not go there, to those places. So providing them housing, providing them food accommodation, and, you know, just a very healthy income, like a supplemental income that will allow them to, you know, access their basic needs, we find that people are very, very happy. And also finding them community, senior communities, where the same language is spoken within that community. And we've seen how they flourish how they come out of their shell, we have two examples of that in one in Woodbridge manor in Irvine, there's a Persian community, the large Persian community, living in that community and they socialize, they don't feel isolated, they're very, you know, healthy, even if they are dealing with personal issues. But because of that socialization, and being part of the community, it's very helpful to them. Another one is in Aliso Viejo at Liberty, there's a very low 80% of the residents are Persian Farsi speakers. So I mean, I go there quite often I see Oh, my God, it's like a city. Everybody engages, they barbecue, they go to events together, they trans, they help each other a lot when it comes to their needs. So that is definitely one of the ways to brand to prevent this from happening. So creating community centers that the mother language is spoken.


Well, you have all these different transportation, or whatever organizations that we refer to like access age well, but the problem with those is that, first of all, they need to speak English in order to access them. Secondly, they're not always on time, sometimes they don't even show up. So they're not very dependable. You can only use them to get transportation to for doctor, medical reasons. But these people are in need of socialization. So when you don't give them transportation, they're isolated, if they're not living in those communities that we were talking about before. So when you give them the transportation access, I remember, maybe I want to say about a year, year and a half ago, Uber was offering seniors a free ride for about a six month maybe four to six month period. It they loved it. They went out they used to go to the park to parties socialize to the doctor, it was very very very resourceful for them.


What barriers exist to see improvements in this area.


Language timeliness and dependability and also limited limited access to where they want to go to the


the limited Yeah, I guess limited access to their location, which they want to go to. They're very restricted with that.


Are there different experiences for different groups of older adults from different backgrounds.


Oh, no, I think overall, they probably have the same experience with access unless they have caregivers who give them rides, it's different. But again, their caregivers are mostly the children who work full time. So even though some of them are living with their caregivers, but the caregiver, they're really isolated, because all day long, they're alone. And they're all socialized. And when the kids do come home, and their caregivers do come home, there's really no communication, there's not a lot of shared love, let's put it this way. Because they're exhausted, they're tired. They've had a  full day. And they don't want to deal with, you know, their elderly parents. So that is definitely. And they don't want to take them places.


I think I know IHSS as provides caregiver. Source sources of caregivers. But here's the situation, the children who are the caregivers are providing housing for their parents. So they have a really a right to collect, because they're spending the night with them, they are providing a lot of the services that their parents need. But also on the other hand, I think, perhaps if there was a budget, where IHSS would provide a caregiver who would be able to come in for, let's say, bathing them, taking them places, taking them to their doctor's visits, and so on. That would be ideal. services that their children will not be able to provide for them. And moving


on to the third one economic, economic security, again, how or why are older adults struggling with this issue.


Because a lot of them have never worked in this country. So they don't have social security income, their only income is on. And a lot of them if you if you do have a green card. If you're a resident, but only have a green card, you're not qualified to get money through SSI, once they become citizens. They're pretty good about knowing how to apply for it and getting the resources. But again, it's not enough to cover everything, all their needs. So they have to depend on their children, they become a burden on their children. And that creates a lot of conflict and stress.


Well, I think the major catalyst in the economic crisis part is the housing. If that is provided I think, the remainder of the income, the SSI income is sufficient enough for them to be able to survive on that money. But housing is a big issue. So if housing is provided, I would definitely say this problem will be resolved.


Yeah, I think you know, with as I said before, but the Hispanic families, they okay with keeping the extended family at home and living with they sort of accepted that there's a two bedroom apartment and I can have seven people living in this two bedroom apartment. They don't. They don't struggle with that. It's amazing. They're very resilient when it comes to that. But when we see other ethnic backgrounds, let's say Persian community, that's the majority of the biggest community we work with. They struggle with that everybody has to have their own bedroom, everybody has to have their own space. And if you're getting into my space, then there's conflict and so on.


Persians are very spoiled, I do have to say that.


Again, you know, housing, providing housing, in a community where the language is the language of their mother and basically, or another great thing that has happened in the last two years is that a lot of daycare health service. Organizations have opened up that pick up the seniors in the morning, provide them breakfast and lunch at this, these daycare centers. And then what they do is they transport them back to their home. So they really don't feel as isolated anymore. They're socializing during the day. And they're not as much of a annoying factor in the home when the kids come home. Because they've already had a full day they're socialized, and then are tired and they want to go to sleep sort of. So providing these kinds of daycare centers would be ideal to keep the parents busy. And these daycare health centers also provide case manager and some of them, some of them provide case management.


Great, okay, we'll move on to the next set of questions. And the first one is geriatric here. Let me know if I need to read a definition of this


for the elderly, right. Care. So just to clarify, it's a care for the elderly, right.


Yeah, I'll just read that. So geriatrics, geriatrics is a branch of health care that focuses on our unique needs as we age. Just as pediatricians specialize in health needs of children. geriatricians and fellow geriatric health professionals specialize in the health needs of older people.


I don't know too many. To be honest, there's a lot of family practitioners who don't specialize in geriatrics. Out of 10 farsi speaking doctors that I know of, who are family physicians, probably one of them has that specialty. And the rest of them are just family, even though they the majority of their patients are seniors, but they don't specialize in that area. Oh, sorry. I think there's a need for it for sure.


When you say long term care, what do you mean by long term care.


So we're defining this as a variety of services, which help me both the medical and non medical needs of people with a chronic illness or disability who cannot care for themselves for long periods.


I'm not at all familiar with any, it's very hard to access them. You have to I mean, we've had individuals who were physically not capable of taking care of themselves. They were becoming homeless, and they could not find a place to move into, because they were not officially disabled. And they didn't have that recognition by the state or by the county. And even if they were still pining a place for them is very, very difficult. Because they don't want to go to a rehab center. So it's like these long term facilities are really non existent.


How about mental or behavior health or substance use


There are a mental health we are a mental health ourselves. So we provide the services to the community and we have services in different languages. So it is available, and it'd be seeing a growing number of organizations providing those services and the counties really working with us and referrals and everything, which is great.


Um, mental, mental, behavioral health or substance use


substance abuse treatment. There are facilities with substance abuse, which is again, a culture based rehabilitation sites, but they're extremely expensive. And some of them don't take insurance. So that's a problem.


Do you know of any service or services or programs in Orange County that provide mental or behavioral health care to older adults,


You mean the actual government agency social service agencies,


It is, if you know the language, if you know the phone numbers, if you have the connections, if you have the network, it is accessible. But if you're out there on your own now if you're tech savvy, yes.


Accessing transportation, again, going back to the top three really continue being the biggest problem because I don't see any of these posts going down


government role is to expand services that are already providing to the senior community.


Right. Okay. Okay. Yeah. And thinking about all the older adult residents in Orange County, who was getting the least amount of attention.


middle eastern population is getting the least attention. Because they sort of have been compacted into with other ethnic backgrounds, they don't have their own separate identities. So there is no budget assigned to them, there is no funding assigned to them. And as an agency, ourself, we struggle with that because our population has largely been forced to speak in population, but because they're not recognized as a separate ethnic group. Therefore, the funding has not been there to provide them services that perhaps the Hispanic community gets as a lot of funding for the Hispanic community has a lot of fun funding for the Asian community. But when it comes to the Farsi speaking community, it's very, very rare that there's no particular funding for that.


by the government, however you like to answer that I


I think there is a need to provide help to the caregiver community. Whether it's financial help, or just taking the load off their responsibilities, more funding should be there for the caregivers. Again, housing for seniors that are able to live independently is also there's a need for that. And again, transportation is also very important for them to be able to access the their needs.


Now, just one last set of question for you. So in addition to what we have already talked about, let's dig a little bit deeper into your area of expertise. So thinking about, you know, what we have, it's the How to reimagine dementia in focus. That's your area of expertise.


Okay, so when it comes to mental health and reducing the stigma that's attached to mental health and dementia falls under mental health, or any other other mental health challenges, I think what's really working for the Persian community is education, and outreach. It has really worked for us in the last 10 to 13 years since we were founded. And our focus has really been on education, because it's the only way people will consider even getting the help that they need. So that has really worked for us what has not worked is you cannot put all ethnic backgrounds under one umbrella. Every culture has their own needs, and their own way of approaching mental health. And so therefore, you need the native language speakers to outreach in those communities. You need to provide incentives to these different community members for them to sort of participate and get the help that they need. Because a lot of them, I don't want to use the word ignorant. But there's a lack of education there. And it's very how hard to sort of, you know, reach deep into the communities to make them understand that if somebody is dealing with dementia, or early onset memory loss, you have to get help for them can't just let it get to where you know, this person is going to be a danger to themselves or to other people.


Well, boy, I'm not a politician. But I would definitely say we need to have more education in our schools, when it comes to mental health. I think a lot of the younger population needs to feel familiar with the needs of the elderly, so that they're more compassionate and understanding, especially if their caregivers, teaching them how to communicate better, how to be more effective when it comes to communicating with the elderly population, because I hear a lot of grievances from the elderly populations to all my grandchildren are ignoring me, my children are ignoring me, they don't understand me. So that really will help with the elderly is mental health, under stress and depression and so on. So education and the younger populations, for them to understand the needs of the elderly population and their loved ones. So policies, you know, providing funding for curriculums, you know, in colleges and schools. policies, such as providing more they health care, communities, for the elderly, in different languages, with their own social groups, is very, very helpful. I know there are some, but it's very hard to get into them. They're very limited and transportation is hard to get to them. So there's so many barriers.


You mean the government entity or private


I think a lot of smaller nonprofit organizations already are doing the work. And they have the expertise. So I don't think big agencies like OC health and health care agency need to get involved because they don't have the expertise. Each of these small nonprofits already have their niche populations. They're already been working with them. They already have the data. They already have the experience. They just need funding to expand their programs. And I'll give you an example with our own Alzheimer's dementia program, we're running out of funding in the next few months. So the funding needs to be there to sustain these programs, these pilot programs that have been initiated by these small nonprofits.


While we collect our own data, we have collected a lot of sort of surveys, throughout educational programs. We have numbers when it comes to our case management. We collect that data, we collect data through our memory screenings. So we have different sections that we collect data on based on the type of work that we do.


Is there anyone else you think that we should talk to


I mean, I would suggest program directors that all these non small nonprofits who are dealing with these smaller populations,


because I think the white population has less limitations than the minority populations, because they don't have the language barriers. They're more knowledgeable When it comes to accessing health and resources. It's the minority populations that don't have this information. I mean, literally, I know Hispanic families who travel over the border, to get dental work done, where they can get it done here, and they have Medi Cal. That's the sad part. But a lot of providers are not taking them on because they're not network and network with Medi Cal. So a lot of the senior population who's on Medi Cal is not given the providers, they don't have access to the providers, because the providers don't want to be part of the network, because the money is so I mean, I understand both sides, because I'm also working in the provider industry, I know how much money they get paid, which is minimal, for all the work that they do. It's not about the minutes that they spend with the patient. It's their overhead, their utilities, their rent, all of that should be considered. As you know, yourself, the elderly population is growing very rapidly. The population next 10 years is going to probably double, if not more.


Hey, coming to our very last question. Of course.


I knew the answer to that, and you can help us find the funding so we can sustain our program are already doing.


Right. Well, well, let's talk about that. So. But this concludes our interview. And I want to thank you so much for your time, you have been incredibly helpful to your research. If you find that you have more to share, please feel free to reach out to us. Our contact information is available on our website www.advanceoc.com And you can leave an anonymous voicemail on our telephone line at any time. And what I tell everyone is that of course you can reach out to me if you think of anything else that you wanted to add or just Hey Tammy, you should do this. Let me stop the recording.


Okay, great. In a moment, I'm going to show you a list of common issues and concerns impacting older adults. And I want you to take a look at it. You don't have to memorize it, it'll stay up for the remainder of our interview. But I want you to go over it take some time to read it through and then I'll start the interview with that okay


Okay, thank you, welcome. Okay. So once again, the primary goal today is to identify what needs you think are most important to older adults,


especially the ones that you specifically serve. And in our case, we define older adults as those who are 60 years and older. And we want you to think as broadly as possible, taking into consideration older adults, their caregivers, their families, and the community. Okay.


Yeah, so I have two roles. My full time job is as the executive director for United and homelessness with Orange County United Way. My other role is a volunteer role is I'm the vice chair of the continuum of care board for Orange County. So I have some knowledge of homelessness affecting older adults from both of those roles.


But we are not an older adult specializing agency. It just so happens that we have had older adults that we have assisted through our wealth involvement with SSI program, just a landlord incentive program, helping people who have experienced homelessness get access to apartments, out in Orange County through our network of property owners.


Yes, yeah. Yeah. So I can probably speak more to systems and homelessness than I can to actual direct experience working with the population.


Okay, so thinking about Orange County as a whole and looking at this list, right in front of you.


I don't think so. But again, I am not an expert at older adults. And so this is where I'm hoping I could be helpful. And I certainly know homelessness, and I know the homelessness sector. So I'm hoping that's where I can be be helpful for you. Oh, absolutely. And feel free to say, you know, I don't have enough information to comment, if that's the case. Okay, great. So


of this list that you see in front of you. And given your perspective, what would you say are the top three


But from my perspectives, the only parts that I would really hear about would be connected to housing, homelessness, and then an alongside that economic security, and so people just not having enough income having a fixed income that doesn't allow them to be able to continue to survive in Orange County as our living costs increase. Yeah.


Okay, so I'm going to tackle each one of those


each of those. So let's start with the first one, which is housing you mentioned. And you notice that we'll separate housing from homelessness as two different kinds of domains.


The the biggest things that that I hear about are older adults who have a fixed income. So retired, you know, they're no longer working, and the cost of housing increases. So, you know, the landlord raises the rent. And they're no longer able to afford that rent increase, and how the cost of housing has been rising very dramatically in Orange County over over the years, but particularly the last couple of years, rent has increased at an amount that has been very, very challenging for people with a fixed income to be able to afford. And so putting older adults into a really difficult position of today years, their income towards their housing costs, or do they use it towards health costs, food, other things like that. And so I've seen a huge rise in the number of older adults who are looking for homelessness, prevention services, and rental assistance to be able to remain in their home.


Those are the main areas that I see when it comes to housing. Great. And what barriers exist to seeing improvements in housing for older adults.


There aren't any rental assistance options.


That that is the biggest barriers that there


there is a there aren't any funding, there isn't any funding available for rental subsidies to help keep older adults


sustained in the housing that they're currently in, unless they're able to access some kind of tenant based voucher, but the waitlist for tenant based vouchers are extremely long. And it can take years before your name might appear at the top of the list. Yeah.


rental subsidies, so being able to meet that gap between the person's income and as rent is raised.


So having rental assistance to be able to help people stay in the housing. Many people have been in that housing for many, many years they've been


successful there, and that's their home and no longer being able to afford it.


Okay, so now we're going to shift into your number two, which is homelessness.


They're struggling with it, because they have fallen into homelessness. So they had to leave whatever their housing situation was.


with homelessness is that the homelessness sector is not set up to care. Well, for older adults.


We are seeing a huge rise in older adults experiencing homelessness. So there was a big jump between our 2019 Point in Time Count on our 2022 Point in Time Count. And I'm not sure if you've asked for any data from the homelessness management information system around the number of older adults who have entered into that system over the years.


You've probably already done like Katie, but if you have that might be that would be a really good dataset for you to look at. The number of adults that have come through


have been signed up in HMIS, who have entered the homelessness sector in some way shape or form and that number has been rising every year. The National Research Dennis Culhane is the leader the lead researcher in the country around older adult homelessness and it has been rising over the over a few years and is expected to continue to rise


In the homelessness sector, as I mentioned just isn't set up our shelters. You know congregate shelters are not ideal for people who are older.


high enough and easy enough to get in and out of is a challenge.


You know, a congregate shelters is a challenging environment for anybody, but particularly if you are a holder, and if you've never experienced being homeless before, that can be a very frightening environment to be in and a very challenging environment, if you have any kind of cognitive decline. That's, you know, it's coverage shelters are not an environment that's conducive to healing.


And we don't have many non congregate shelters in, in our county. And we certainly don't have any non congregate shelters that specialized with older adults. So the challenge that I see in front of us is that we know that the number of older adults experiencing homelessness is going to continue to grow and it will start growing exponentially. And the homelessness sector needs to get ahead of that to be prepared for a good response for those who sadly, will fall into homelessness. And we also need to have a much better response on the homelessness prevention side of things to be able to try to keep people housed, so they don't fall into homelessness.


And then, you know, emergency shelters are just sort of that band aid to try to help somebody resolve the homelessness crisis. But for older adults, you know, we're not looking at a population whose income is going to increase, we're not looking at a population who are likely to go back to work to be able to increase their income. And so we need housing solutions that are specific to this population. And we just don't have enough of that either. I think we have one, development of permanent supportive housing for older adults, the City of Anaheim led the charge with that one. And that's that's it, to my knowledge, we don't have anything else. And that development is full, there are no vacancies, they're


going to need here, hundreds of units of permanent supportive housing to be able to help resolve the crisis for this group of people. And it's going to need to be specialized to their medical needs. So their unique medical needs as well. Yeah, yeah.


think there isn't there, there aren't specific funding streams available to create


supportive housing solutions for older adults. And so developers are faced with a, you know, a challenge, if they have a project that's ready to move forward, there isn't anything to incentivize them to make it specific to older adults, I would imagine it would also be more expensive to create housing solutions for older adults with the medical or potential medical needs and accessibility components to creating that kind of housing. So the new kind of incentives to help developers be more to help it be more financially viable to create that kind of housing would be good.


a lack of attention or realization that this is the fastest growing population among our homelessness community, and that


we're not doing enough about it. I think people just don't know. And there needs to be a lot more awareness around this to gain public interest and public support. So that could be the creation of more housing, because creation of housing is going to take next three to five years before this will come online, and then another bear. And so that's another barrier is the timeframe to build that kind of housing. And then that means that we need something in the meantime, we need to be getting creative. We need to be looking at motel conversions or mall conversions. We need to be getting really creative about how to bring housing online for this group of people in a much faster way than the traditional permanent supportive housing model.


And are there different experiences for different groups of older adults when it comes to homelessness.


For those older adults who have that significant medical challenges


And I know of older adults that are living in their car dealing with cancer.


yeah, for older adults who have got those significant health challenges, I would say that that is a different experience than those who are healthy.


And the those who have got those significant health challenges are certainly going to find interfacing with the homelessness sector much more challenging, because it's just not set up to meet those kind of medical needs. And certainly anybody who's got


health challenges, if they are also experiencing homelessness, there's just that that's just an almost impossible situation to try to


resolve health crises, while not having a stable place to live is incredibly challenging.


Yeah. And I will say the other part connected to this is that we don't have any hospice care for people who are experiencing homelessness, regardless of what age they are. But anybody who is in the situation where they need hospice care, and they have been living outside for some time or in their car in or unstably housed, we don't have any hospice care for people who don't have a permanent address.


Yeah, yeah. Yeah, it's, it's tragic. Yeah. Yeah. Wow. So in the hospital, you know, we're just costing everybody much more money than it would be if we were providing hospice care to meet their needs. Yeah. Yeah.


We think we need to have across this sort of spectrum of the homelessness response, we need better diversion. And prevention options for older adults experiencing homelessness are on the verge of experiencing homelessness, the ideal would be to divert people away from the homelessness sector to begin with, so they wouldn't fall into homelessness.


We know that won't work for everybody. So our emergency shelter system, you know, we're big County, we've got 34 cities, three different service provision areas. But it would be wonderful if each service provision area had a solution for older adults emergency shelter, that actually, you know, a specialized shelter or a specialized part of a shelter that was able to meet the needs the physical needs of an older adult population while working on some other kind of solution. And then also, we, you know, to be able to help move somebody out of a shelter, we need those housing options that are specialized to the needs of older adults.


Okay, so So now, I want to segue over to your number three ranked item, which is economic security.


I have limited knowledge here. Um, so I'll I'll speak to what it is that I'm aware of, which just is that is that fixed income again.


the cost of living increases on has been increasing pretty dramatically puts people in a very precarious situation.


lack of funding to be able to have some kind of rental subsidy.


Do you find that people who are economically in fall into homelessness mostly


we have a the primary drivers for homelessness across the board. I don't have the data specifically for older adults, but I would, I would say it's a very likely guess. So that's the same reasons across the board. But the primary reasons people fall into homelessness here in Orange County are economic issues.


Is that people can't find work that provides enough money for them to be able to rent somewhere, or they can't find housing that's affordable. So those two are obviously completely interconnected. But you know, wages haven't increased at the same rate that housing costs have. And so that hits anybody if there are older adults that are working, that would certainly be an impact to them. And then older adults on that fixed income, obviously, are really really struggling as the cost of living increases all around them, but their income doesn't. Yeah.


Sounding like a broken record here, rental subsidies.


You know, if they fall into homelessness, is there a way for them to be able to be reconnected to worse,


taxing on somebody's physical and mental well being. There's a lot of information out there that that talks about an I don't have it had I apologize, Katie, but people experiencing homelessness age at a much more rapid rate. So that would certainly be something


worth looking into. But somebody who's out on the streets who's experienced living outside or in their car, and they might be 55, but they present with the health challenges as somebody who is in their 70s. So the homeless population are aging, just due to the stress and the anxieties of living outside. It causes that physical and mental decline to happen much sooner than it does in the house population. Yeah, yeah. I can see that for sure.


Okay, great. So now we're done with this list. So I'm gonna stop my screen sharing. And now I'm going to go on to


a conversation around how accessible and adequate various different care systems are. If you feel comfortable responding, please feel free if you can also take a pass on it as well.


I'm gonna pass on that one, too. I just have knowledge of a very few cases that I wouldn't want to use to speak to the entire system. No, yeah. When you're working in the continuum of care with homelessness.


I am not but I haven't been on the frontlines for a long time.


Yeah. So that doesn't mean that they don't exist or that perhaps those on the frontlines would. My role on the on the CRC board is we're mostly responsible for the distribution of HUD funding and state funding. To service providers in Orange County. We certainly we don't fund mental health services through the COC. We do. We fund rapid rehousing and permanent supportive housing.


Some emergency shelter activities. But yeah, we don't fund mental health services. So I that's just outside of my realm of expertise. Yeah, sure.


Pass As well, so sorry, no, no problem. And once again, we're gonna be talking about this population. You know, I mean, if you feel comfortable responding if you can pass,


you know, time. What do you first, the biggest challenge for older adults


in 10 years, I would say it will be the silver tsunami of homelessness. Yeah.


I think in 10 years time, we are going to have seen a significant rise and older adults falling into homelessness. We're already seeing it. We're seeing it in, in affluent cities like Newport Beach. We're seeing it all throughout Orange County.


And I would imagine that in 10 years time, if we don't start to take this seriously, and if we don't start to allocate funding and resources, to be able to stem the tide, that we could indeed have this silver tsunami of homelessness, on our streets, in our shelters, and in our hospitals, as well, but people don't have anywhere else to go. Yeah. And in your opinion, what do you think the role of government would be in meeting


Yeah, whichever, whichever. But this is a county report. So maybe, maybe county first.


We know that it costs more to let people fall into homelessness, regardless of what population they are,


then it tends to help keep people stably housed. And so to me,


I would love to see the county government looking seriously at again, broken record rental subsidies to be able to help keep people housed to keep them safe and secure in their housing.


And with that, it will lead to come a lot of creativity, you know, does that look like some kind of shared housing model if perhaps the older adult has got, you know, extra rooms in their home to be able to increase income in that way and being able to incentivize, you know, the older adult to have somebody move in with them.


And funding a program, you know, to be able or an organization to be able to oversee a program like that. Getting creative around, providing those rental subsidies.


And then being able to make sure that older adults have got access to the care and support they need to be able to maintain the housing situation that they're in.


And in thinking about all older adults, all older residents in Orange County, who is getting the least amount of attention


it's not going to surprise you say, older adults experiencing homelessness. Yeah. Yeah. And I think, especially, you know, we have, when we look at this, we talk about two different sort of subpopulations, amongst older adults experiencing homelessness, you have the older adults who have been living outside for some time who have just been aging living outside. And then you have older adults that fall into homelessness for the first time as as an older person. For those people, it's incredibly shocking and jarring. And I think I spend a tremendous amount of shame attached to that. But what we're often seeing are these are older women whose husband has passed. And they're being left in an incredibly precarious situation.


And there is not enough. You know, they have been deeply overlooked. But they are they are in our homelessness sector. They are experiencing homelessness all throughout Orange County, affluent cities, not so affluent cities, it doesn't. It doesn't seem to matter. And they just people don't know about that aren't aware about that. And I think if people were they would be moved and motivated to help. Yeah.


Yeah. Yeah. You know, when people think about housing and homelessness, they see these headlines with all these millions and billions earmarked for housing and homelessness. Do you feel that because they're seeing these sort of lines, that the issue they feel like the issue is


I think it's it's challenging for people if they live in a location where visibly, they're not seeing homelessness changing. So if they live in an area where they are seeing encampments, I think that's a challenge for people to think that things are being effective. And there certainly


there are solutions in the homelessness sector that we know work, there are best practices that we know work, including permanent supportive housing.


But sadly, yes, there are millions going into homelessness in Orange County there are there are not billions going into homelessness in Orange County.


you know, whatever dollar amount is being talked about being able to connect that to the geographic area


you know, we there, there isn't enough funding to match the needs. And so that I think, is challenging when people see, you know, money being put towards something. And it can seem like a large amount of money, but in certain areas up and down California, that amount of money is not actually proportionate to the need that we have.


Okay, so now I'm going to drill into your specific area of expertise, housing and homelessness. mention some earlier but I'd love for you to expand on it.


I would say the Anaheim permanent supportive housing for older adults is an example of something that is working in our community.


And we need we need a lot more of that needs to be reproduced at scale. And at various locations throughout the county. Yeah, that would be an I believe it's called Esperanza. That would certainly be a an example to look at.


Yeah, yeah, there, they would be a great contact and Grace director, or Karen Cardwell.


Thank you, of course. I didn't mean to interrupt. No, no, that's okay. The other agency that I think of in our community who has some specialized in older and slightly specialized in older adults will be wiseplace. And Brateil Aghasi is the CEO of wise place, and they have done a lot of work with unaccompanied women. And they have done a tremendous amount of work with older women who are unaccompanied. So she would be a really good person to talk to to get into that there's like specific so of what they've done or what they've seen and what the needs are. She would be a great person to talk to. We spoke there last week, I spoke to her.


And they're building they're building credit supportive housing, so it's really,


yes. Okay, perfect. Glad you got connected with her.


But aside from that, I'm really not sure what else is working for this population. Do you think the, the, the committee that you're on


I can't remember what it's called. Yeah. The continuum of care. Yeah.


So this last year, we did allocate a seat on our CRC board, for somebody representing older adults. That was the first time that that's happened. And that was something that I have to advocate for and felt very strongly about because we have not had sort of a focus group looking at that.


So we actually have somebody with lived experience of homelessness as an older adult who has been appointed to that safe. So a gentleman called center Bob is what he's affectionately known as, Robert Morse is his name. But if you wanted to talk to somebody who has lived


you know, going through homelessness here in Orange County, he would be a great person for you to talk to, he'd be able to give you that firsthand knowledge of, of what it was like. And he remains very connected to the homeless community. And so could speak to what's happening right now. But he would be a probably a really good person for you to talk to, to get that true insight. Right.


And then, also appointed to the board was Kelly, Bruno Nelson from Cal Optima, and she's actually getting her PhD, in older adult homelessness, so she would be another really good person. Yes. So you should talk to Kelly.


Yeah, she would be a great person for you to talk to. And I know that Cal Optima has got some pretty innovative things in the works to help come alongside older adults with housing crisis. So she would definitely be a good person to talk to.


what new or revised policies are needed.


Think in the homelessness sector, one thing that could be good, or even.


See, I don't think we have enough data. And I know that doesn't directly lead to a policy. But it helps us get there, I don't think we have enough data around how many older adults are experiencing housing insecurity and our risk of falling into homelessness. And HMIS data can gather people that actually become homeless, you know, and have gone to an access point or have ended up in an emergency shelter or enrolled in some kind of, you know, homelessness assistance program. But the number of phone calls, for example, from people who are, you know, trying to figure out how to make ends meet.


I don't know if 211 has got access to that kind of data. But as I've been sort of talking to people, you know, senior centers get calls for help for people who


are really struggling, but I don't know, if we have as a community, we have access to enough data to know kind of what the scope is that we're looking at in terms of housing insecurity,


for older adults. And so there could be potential to look at, you know, policy, or presenting some kind of procedure for when calls like that are received, to try and to gather more information. And being able to ask the right questions to get the right information. I think you have a similar campaign that Orange County Veterans Military Family collaborative, it's a mouthful, put together, let's call it ask the question. And so that's just a much broader question, to be able to act to kind of get a conversation going, that can give you a lot more information about the situation. And so I wonder if there may be


And I've heard from friends that, say, Meals on Wheels that if you ask anybody, you know, or you're an older adult, if they are experiencing housing insecurity, they will say no.


But without realizing that if they weren't getting their help with food, that they wouldn't be able to afford their housing. And so they are in fact, housing insecure, but they're not they're not making that connection.


Let's say it does not enforce your hypothesis.


I think the policy would then be leading towards a better triage system for when older adults are presenting.


You know, with housing, insecurity and being and then funding for better resources to be able to address that housing insecurity so that we can get ahead of it as opposed to waiting until somebody falls into into


Homelessness and then having to resolve it there, which is going to be much more expensive for taxpayers than if we could get ahead of it. Yeah, yeah.


I would say 211, as the sort of porch portal for many calls that are received


senior centers, I would imagine would have access to a tremendous amount of,


You probably need to do like a community wide campaign for a while, like to try to


ascertain what it is that we're really looking at. Yeah.


I think that the other action that I would really like to see is a specialized focus group really coming together at the, or a commission from the county,


looking at homelessness for older adults.


And solutions for this because I know that we have


the Council on Aging, like so I know, we have, right we have specialising in homelessness and we have specializing in older adults, but we don't have a place for those to crossover and what needs to happen. And that's something that


will happen very soon, because we need it. Great. Okay, I can actually recommend that we do one during this assessment,


in particular, so thank you for raising that. That's definitely a possibility.


Okay, great. You've named quite a few. So thank you so much for that during the whole interview, I've written them all down.


I don't know if you've connected with Natalie, who is the head of homelessness for Newport Beach. But she's been another person, who's been on my radar, she has mentioned that she has been encountering, you know, a growing number of seniors in Newport Beach, experiencing homelessness. So she would be a good person to talk to on this side. And she's out in the field, you know. So she would again, have a lot more of that hands on knowledge around what it's been like to help people access systems. Yeah. So she would be another really good contact.


And I could provide you with Oh, yeah. That'd be great contact information. Yeah. So I'd say among the ones that you've you've mentioned.


You know, I know many of them, but Natalie will be one that I would like to get in touch with Santa Bob would be


and grace or Karen. Yeah. All over Anaheim housing would be great. Perfect. We have already looked into Kelly Bruno Nelson.


You but I, I always think about calling her Kelly Bruno Mars.


I think I have to like, stop myself before I go there.


But, yes, we have spoken to Kelly. I didn't know she was doing her PhD on older adult homelessness. But that She is yes. Yeah. Yes, I would really appreciate that. And I'd love to talk to them, especially on her views around Newport Beach. And because then that makes it very systemic, then it it becomes more or less of an issue about


you know, poor areas, right. Not being able to afford the house cost of living. The cost of living.


Yeah. Yeah. And she will be able to give you I think, you know, and I know you're writing a report, but she be able to give us some stories, you know, of specific people that she has come alongside.


Yeah, from Newport to be able to share some of that. But yeah, I'll put you in contact with all of those people. Thank you so much. I really appreciate it. And if you think of anything else that we should know about or other people that we should talk to, please feel free to reach out. This assessment is going on for the entire year, and actually it's


And just let us know if anything comes onto your radar. Yeah, we know of it. Actually, we


I check it all the time. And it goes, we we manage that data website for.


And so we reference the dashboard that goes up to the state.


And we collect that data. And, of course, we're in touch with Karen over at 211, because she collects that data for Orange County.


Yeah, yeah. Yeah. But yeah. The last in time count.


The last one was 2022. Yeah. Yeah. Probably won't know. It'll be next year. 2023. Yeah, they we got off kilter in COVID.


But yes, it should. It'll be 2023. Okay. Okay, thank you. Well, thank you so much for your time, I really appreciate it.


Once again, we have an open door policy. So just reach out to us if you have additional information.


perfect. The other piece that just popped into my mind, and I don't know if you're connected with Doug back on this is that the commission to end homelessness has got authorized a survey to happen among people experiencing homelessness who are unsheltered. And so just making sure that you've got that connection to that dataset, and you'll be able to pull that for older adults, because that, again, is direct feedback from people experiencing homelessness, that their interactions with the homelessness system. Yes. That was mentioned a couple days ago, in our call with the county. perfect good. Yeah.


Okay. Well, thank you and have a great three day weekend. I hope you do have Monday off.


And hopefully we will see each other at some point, you know, in person. Okay. Thank you.


Thank you, and I will see you on email when I get you introduced all these people. Awesome.


in a minute, I'm going to show you a list on my screen of common issues and concerns impacting older adults, they will be listed in alphabetical order in no particular order ranking. So if you could take a minute just to look over the table, and whenever you're ready, let me know. Okay.


Well, I have a decade, several decades of experience working in this community. Currently, I am working for an organization that's implementing a number of programs providing housing and support for older adults and vulnerable populations. It's called advocates for human potential and they are managing billions of dollars of California funding. A lot of it focused on solutions around housing and support for older adults. Oh, wonderful. Okay.


Okay, so now I'm going to share my screen and share with you that list I was talking about.


Sorry about that. Trying to fit everything on one screen. Take your time and read it through. And


whenever you're ready, let me know. What is the I will


Yes, I will be asking you to rate your top three issues from this list. Or if there's anything missing from this list, you can add it to this list.


Oh, wow. And then it says injuries is that the last


unintentional injuries, car accidents, falls,


I can zoom in. If you want me to scroll, I can do that.


Now I can I can read it. I actually came up with my own list as I was thinking about getting on this call, so


And, okay. You got one. Yes. One thing that's missing, though, uh huh. Data Data Collection.


Did you happen to read the the report from the


Yeah. Yeah, the 18 sources that just resonated with me, because I'm working in a data world. So


I think the answer would be different, depending on whether I was looking at it from an individual's perspective or from a system perspective. I think from the system of care, the disconnect between issues around health care in general health care access and solutions in the system of care around behavioral health, Alzheimer's and dimension dementia. You know, I think that's a that's a huge issue is the disconnect between those issues, and then based on my experience in working in homelessness, affordable housing, and would be another major one. So it's really an inter section between some of those issues that I think are the big issues in Orange County. Yeah,


great. So I'm going to ask you a series of questions on those, let's say four things that you just mentioned. And you know what, we'll go through them one by one, and you'll get to, you know, share your knowledge and expertise on each of those areas. So let's tackle health care access first.


I think it depends. So how old they are, I think solutions are more readily available once people reach some of those milestones of age 65, you know, availability of Medicare and other resources. But if you are considered an older adult and have significant behavioral health issues, you can't access easily the same system of care that you might have been able to access. So that would be just one example of a disconnect. And I think most people are not fully aware of what community resources there are, and also their ability to pay for it. I think there's a big disconnect there between what's available through a Cal Optima type program. And what might be available to someone who qualifies in terms of age for Medicare plus can afford to pay based on their Medicare income for a supplementary program. So I think it's not a simple answer. But there are many barriers to accessing health care across the system of care.


Yeah, well, you mentioned barriers, and, but in terms of the system of care, and improving the system of care, what what barriers come to mind for you.


I think, accessing the information about what's available and who to talk to about it. And there's also the digital divide in terms of accessing information, but you and I might just text into a search engine and find answers to not everybody can do that, particularly people who have grown up in the Orange County system of care and don't have access to an iPhone or other digital technology to get those answers. They're not even aware of all the resources that might be available through the senior centers or the other. There are so many disconnects in our system, I think, to me, that's the biggest barrier to accessing services and Mitel be there. I know there are hundreds of programs focused on seniors in Orange County. Probably not. Yeah.


Absolutely. You know, I've been working for the last couple of decades in behavioral health and housing. And there's a real disconnect between the kinds of resources that someone with severe and persistent mental health issues is able to access and even within what seems like comprehensive system of care through Cal Optima, and some of the new Calayan resources. One of the big disconnects is for people as they age, like the rest of the population, experiencing issues around dementia, complete disconnect in the system of care for people with a mental health diagnosis and getting support for Neuro cognitive issues as they age. Yeah, in fact, we're working on an innovation program to address that specific issue, because we expect that like the rest of the population, people with severe and persistent mental health issues will experience dementia, but we have no housing and support solutions for that population at the moment.


Well, I think it comes down to using all the technology tools that we have available, we can't rely on. We often say we're speaking to the choir. Those of us in the systems know the answers, but that's not who we're talking to. How do we address sigh Social isolation. How do we address the needs for financial resources to address housing options as couples find that they no longer qualified to have both sources of social security because one of them passed away. There are so many needs for custom information and resources. We're not doing a very good job about using most of them.


So now I want to switch over to behavioral health. More specifically, I know you mentioned that earlier. But if we can expand on what you said earlier, regarding behavioral health, how and why are older adults struggling with this issue.


It's different for people who have already been identified when they younger in the system. But one of the big outlier populations are the homeless, older adults. And if you look at that data around that point in time counts that we do every in Orange County, every two years, what we're seeing is a significant growth in the over 50 population. And most of those needs cannot be melt met, in our current shelter system. It's not designed around the physical needs of homeless older adults, bunk beds are not going to go climb up on the top of a bunk bed. You know, that's not a solution that's viable for most older adults. And so our whole system really needs to be customized for this population, to meet that specific need, and particularly for people, well, another population is people who are survivors, women who are survivors, typically of domestic violence. as they age, their needs are not being met met either in our system of care. So there are a lot of gaps. But there are also differences in behavioral health. A lot of people as they age, addressing issues around depression, social isolation, which are not the same issues, as our system of care is used to dealing with. They're more accustomed in behavioral health dealing with severe and persistent mental health issues. And this is not what these are. These are issues around just isolation. And as people age, often they have co occurring dementia, as we just talked about before. And so those needs are really they're not even able to be met in the behavioral health system. If you have a diagnosis of severe and persistent mental health issue, an issue, you cannot be treated for dementia in our system. It's excluded from meeting criteria for some funding.


You're making it hard for me to use these interview questions, because you're taking it all together.


I know. I just do that because I want to see integrated solutions.


Right, right. Right. No, that that works. That works fine. I asked earlier about different experiences for different groups of people.


and just talk about my experience in working with a behavioral health committee working specifically on older adult issues. So I've been on a committee on that topic for several years. Yes. So she can give you a lot of insights into that the experiences of older adults have typically been ignored. I think that's an outcome that we found in our work. They are typically grouped together with adults and not seen as having unique needs. And that's a dilemma. We put together a resource book on resources for older adults in behavioral health. We found two things they were very limited in what was available and where you could access it. And we actually thought we've done a good job by getting it to one, one and being integrated into what they were able to talk about. But we certainly found that there weren't enough resources that were focused. And another big takeaway is the master plan on Aging, oddly mentions mental health or behavioral health. Yeah, yeah. Yeah, they mentioned


it only in context of social isolation and loneliness and things like that. But to your point, not, maybe some more severe clinical perspectives on that.


breaking down the silos doing a better job of communicating between agencies sharing data, being more focused on outcomes. Okay,


want to segue over to Alzheimer's and dementia. Anything different you'd like to say about how older adults are struggling


I think, again, there are disconnects. in how we receive that information. There are a lot of resources. And I'm 77 years old. So I can speak as a peer in addressing these kinds of issues. And most of my colleagues and peers in my community life concerned about this. But do they know how to access resources do they know how to plan and if they have financial resources, the answers are very different than if you are living on Social Security, and have a limited income. We have I have individuals who I've been close to over the years, and one of them has developed Alzheimer's in the last few years. She lives in a very robust program, and no longer recognizes any of us that she had a house that recently sold for over $6 million. She doesn't have to worry about financial resources. Most of the people who I know particularly those with a mental health diagnosis who were living on Social Security and more limited income, any of the solutions around housing, assisted living memory care programs are just not accessible to them. So the only programs that might be accessible to them. Programs like there's a program that I'm actually working on with the state to provide more funding. It's called residential care facilities for the aging RCFVs, the acronym and the focus of that program is to make investments in those what are often referred to as Borden care homes. They might be a six bedroom house where someone shares a room with someone else. But even in that program, most people pay 1000s of dollars a month. So if your income is around 1000, for disability, that's not available to you. So the state is actually subsidizing this housing, and has a program called prevention and preservation. So they look at these facilities, they're making an investment in rental subsidies. And they're also rehabbing a lot of these houses throughout the state. And they're giving counties money. And Orange County recently got about 16 million to make this investment.


But most people don't know that. Boarding care homes. They're licensed homes. And most people aren't aware of that model little


that's very that's a that's a big step in the right direction. Absolutely. Yeah. You're tackling the unique needs of older adults as they age. It's very, very different from everyone. And then the second issue is the housing issue. We're being very active with that.


Yeah. And we're also and I can talk about senior housing communities. From my jamboree perspective, you know, we developed a number of very good programs for seniors specifically as they age. But it's really the model is really, that model is really around affordable housing, affordable housing for seniors. But what's often needed is supportive housing for seniors. And so we're beginning to see some of those models being developed. One of our partners in Anaheim developed a senior community, which has a number of units for formerly homeless folks with a mental health diagnosis. I know jamboree has others under development in Huntington Beach, and other parts of the county, they have veterans programs, which is specifically some of the units meet the needs of the Vietnam population, veteran population, so you can customize the model within those new units. But that customization really needs to be much more available and provided in Orange County to meet the needs of this specific population.


Do you notice different experiences for different groups when it comes to


Yes. I mean, that's kind of a given. I live in Corona del Mar, we have a beautiful assisted living facility, I understand the memory care part of their program is 18,000 a month. Wow.


And that comes with an ocean view, I hope.


you think about, you know, the average income of seniors, particularly if they've grown up in Orange County, maybe now, they might have some people who have an asset in their home, have choices that other parts of our community can't make, they can use that investment to buy into an assisted living community with all sorts of options. If they develop memory care issues, that's going to be there. But someone on disability income just has no access to that.


Absolutely. Long Term Care Insurance, certainly a segment of the population. Is this the family who's going to have to provide those resources. And in some cultural communities, certainly that is the model. You know, we don't see too many unhoused older Latinos, or Asian American community, they, the families have the culture around taking care of other generations. But if you talk about other communities, that's not part of their model. And maybe they're working themselves to provide retirement resources and they struggling, you know, we often hear about the sandwich generation trying to provide the resources for the young adults and the older adults. So it is a big dilemma and different populations are able to deal with it differently. No. You know, and like all their affordable housing options, very limited turnover in those units and availability to access them. If you need to be thinking about this, you've got to get on a list many years. in advance.


Well, I think we, you know, this is a much broader issue than as it applies to older adults, that applies to all the segments of community. Affordability is a huge issue. The statistic I read last week said, in order to purchase the average priced home in Orange County, you needed an annual income of 178,000 a year. That that's not accessible for, you know, young college graduates or people who've been in, you know, air, police officers, teachers, they don't have that income. So we need to look at solutions around housing affordability throughout our community. But then we also have special requirements for older adults, in how we address their needs. Because sometimes just affordable housing on its own isn't enough of the resources. And jamboree has a really good history of providing some alternative models. They have a community in Huntington Beach that the city provided them to manage and I own and remodel and make into a nice community. But they have onsite case managers and staff who's supplement their housing model. And also in Mission Viejo, they have another community called heritage villas, which is a beautiful model to allow older adults to age in place. But those are few and far between. Yeah.


I'm done with this list. So I'm going to stop sharing my screen, we're going to go to a series of questions about how accessible and adequate our care system is. So the first one I would like to ask you about is geriatric care.


I think staffing levels are inadequate. I can speak to specific examples at the Oasis Senior Center, they have a geriatric specialist. And I think that's a resource that should be at every senior center. I'm not sure if it is. But I think people with specific expertise need to be available to the broader community. And my experience has been that staff has been excellent.


Yeah, but not not as widely available as it should.


And I'm not sure that people know even in Newport, that it's there. Yeah, that's part of the issue. You know, we, we smile, and we say, well, they've got a great gymnasium there, we see all those people working out. And my background, as you probably can tell, is in Australia, and so as my parents aged, I was very aware of resources that were available in that system of care. And I don't think we have anything like that here. Yeah, yeah.


Depends how much money you have. Yeah. And basically, not even with people who have financial resources, and I'm always going to share anecdotes I'm sorry to digress but I have a friend who was a teacher, her whole career in LA. Her parents both live they were divorced, but they both lived. Over 100. Wow, she found that she was supplementing their long term care. As they aged, they didn't have a lot of financial resources. So she was paying for them. Her mother, particularly I was aware of to live in Borden care in Costa Mesa. And one time she went on a trip. And she asked her friends, if we would drop in and see her mother, which we were all happy to do. And, you know, we loved her mother. And, you know, we've met her and other social occasions out of the house. But I think without exception, we were just horrified at the status of this home. And it was 24 hour care. And she was paying 1000s of dollars a month for this. But I wouldn't have put my mother there. But she didn't have any choices. So I think even if you can make those investments, what's available is not very


No, we know there are huge gaps in that system of care, we do have some really good full service partner programs for older adults. And that's connected to housing solutions, where not only does that individual get a housing, affordable location, but they get what is referred to as full service partner wraparound care. And there are good programs. It's called the Oasis program. Older Adult system. I don't know what it stands for, but you get the idea. It's it's focused on on that population. But, you know, that's maybe serves a couple of 100 people. Yeah. And we know from their analysis of the system of care that there are many people who aren't knowledgeable about what that is, or maybe they don't meet the severity level, specific populations, as I mentioned, all the women with who were survivors of domestic violence, not many options available for them, unless, unless you're working and, and bringing in good salary. Most options aren't available to you. Yeah.


Oh, yes. Yeah. Yeah, I mean, it's acknowledged. And that's another disconnect in our system of care. It's only been recent, that behavioral health is really acknowledged that that's part of the needed system of care. And I think they're beginning to address it. But I think as a county, we've got a long way to go in those solutions. And being able to talk to older adults about this. I mean, it's the typical model, if you've got an issue, people self medicate, they address, whatever the issue is, whether it's loneliness, grief, or other other issues, they address it with substances. I'm hearing a lot more about using CBD, which is not necessarily a bad thing. I'm always intrigued to hear I don't know if you know, Dr. Trin, is with Alzheimer's OC, I love him. He's doing a great job of, you know, normalizing the discussion around that. But I think we, you know, we were not really having those discussions. Yeah.


Yeah, I wrote his name down. He's probably somebody we should talk to as well, in this in this process, about human and social services.


Well, there are a lot of different programs. And, I mean, I always say it's pretty easy to one one will get you there.


That's interesting. Do you think that let me let me just ask you a quick question about food for In a minute, when we're talking about social services, people, I'm sure you're aware of talking about this food cliff that we're going to experience as benefits from the pandemic go away. You know, one of the things that I think when I have honest conversations with people in the community that work in food insecurity is that they're not quite sure, they're really not quite sure what the need is. Because if you give free food, there'll be a line of folks, right, and some people will, will show up even maybe they're, you know, may not have necessarily have the need. And possibly the need increased because of a variety of different reasons. But there's a lot of people that also feel like, even if they increase food access tenfold, there'll be a tenfold increase in people accepting these services.


Well, I wouldn't say it's a simple issue. I think, in fact, I just had an aha, within Allegan digress. I think delivering social programs to people can be facilitated through delivery of food. I think there's an opportunity for a Meals on Wheels program, to use strategies to engage with people, as they might be showing symptoms of dementia or other issues. But we don't we look at it as this whole separate system. And I think I've often heard people who work with faith based programs say, I'm never going to turn someone away, they might have driven up in their Mercedes or their Lexus, but I'm never going to turn them away from the food program here, because they think they need that. And we don't know their backstory. And I think that's the big takeaway. And what I heard you just describe is, the providers don't know the backstory, either. And I think it's, the big issue is, we don't do a very good job of understanding what the stories are, and why someone needs that supplementary source of income. And on a personal note, I have a 50 year old daughter, who, since COVID, began has become disabled. She and her daughter have zero income, zero, she's on a food was on a food program, she just got a denial letter. And it's probably every time she they renew this program, she gets a denial letter, you didn't fill out the form properly, you didn't give me this piece of information that I asked for in the right place on the form. We said we were gonna call you at this time. And even though my daughter says, I sat by the phone for an hour, nobody called You didn't answer the phone. So to me, that's the disconnect in the system. And I can call that woman whose name is on a piece of paper and say, you said you were going to call but you didn't call. So now we have to appeal this. So as of first of June, my daughter, and my granddaughter who is her in home support person has to qualify, again, to get a couple of $100 worth of food. I mean, the system is broken. When I describe that. Yeah, so my personal experiences, if people managed to qualify and get some healthy food and think about homeless folks who get that EBT card, until recently, they couldn't get a hot meal. Don't give me cans of food that I have no way that prepare. I mean that the whole system was just set up incorrectly. I've often had people living in our affordable supportive housing, and they pay $300 a month in rent. And their income was three times that. They ran out of food. They couldn't afford to buy good food. And often I'd be visiting our apartments in Anaheim. They just couldn't access that part of the service certainly qualified and we're deserving of that. But the system didn't support them in that so I'm always a little skeptical about the pushback that I hear from food providers. You know, there's so much food waste in our system that we can do a way better job in getting healthy food resources to people that need them and talk about families and how they need taxes. I'm digressing from older adults, but often they're part of this family. That might be the one making the dinner in that house.


Because if you don't have housing, everything else is you're probably going to die. Yeah, you're gonna die sooner. So I think for Orange County, we definitely have to address that first.


They can do a lot in facilitating solutions. But back to our original conversation, if we don't share information, and we're not knowledgeable about what the system is and where the gaps are, we're not going to do a very good job in getting the outcome that we want. We keep doing it the way we've been doing. We're not going to get a different


And what would you say to somebody who says, well, there's so much money, probably unprecedented amount of money in housing right now.


I think it's a huge opportunity. And we if we being thoughtful about how we're investing it, I think we can make see a major impact on that. But when we see pushback from cities on developing affordable solutions, I've been on the Senior Citizens Advisory Committee on Housing until I had to drop off because of my new job. One of the things we heard was, there was a wonderful site in Anaheim Hills, and was a church, the whole not in my backyard movement. Stop that moving ahead, it was going to be an assisted living Memory Care program. For people who were had financial resources to pay money, it got shut down. So unless we can implement those solutions for all parts of our population, the money might be there. And there is money for supportive housing for older adults, and some of these solutions and our Orange County. I think we have the smarts to make good solutions and investments. But we're not doing a very good job communicating with each other.


So thinking about all the issues, some of which we talked about today, but others that were on that list, all the issues facing older adults, one issue is being overlooked.


gather and use all the sources that we have for data, and analyze them, I don't think we can get the best outcome. And I know you believe in data.


Music to my ears, Helen music. Yeah, I mean, there, there are too few of us who, you know, operate with with that mindset, but I think more and more people are starting to. So that's that's a positive sign.


But I liked the question around the 10 year, because I bet my mind frame it a little differently.