I don't I haven't worked with, you know, anyone with long term disability. So I don't know. But I overall so my parents case, I feel. It's, it's good. So my dad had a surgery some years ago. And I think there's yearly follow up for him like doing regular check and see whether he's fine. And like, It has been five or six years. Since it's surgery. He's still doing that. So I think it's good if you have insurance. But still insurance is a big thing, I think.


you. How adequate and how accessible using those services


I don't know. I have no experience with that.


through my parents, I don't have exposure to mental health. You know, for the mental health part more, it's more about my child. So like in high schools and college and there's education about mental health, how you're going to deal with that.


think you know, like, if I go with some for the primary doctor, I don't think they ask them questions about mental health.


I don't know. But one thing I forgot to mention is that they live in a subsidized housing facility and I think I said before COVID or early in the COVID time, they mentioned to me that there there were some programs initiated by the Substance housing facility, asking them to like do a diary. You know, what, what about their feelings, emotions, and also just encourage them to record the positive things of life on a daily basis. And then after a bunch also they're going to, you know, get a reward of you know, that's good. So I feel there, there is some program there to promote the positive mental health.


Yeah, but I don't know this for the clinical setting.


I never used to those. So because my parents are capable of doing everything. So at this time, I


the cost of the health care, I really want like the government to ensure that everyone living in Orange County and in larger areas have health insurance, affordable health insurance, so they have a peace of mind that they are covered for any of the house issues they may have.


I guess go back to the diseases, Alzheimer's, dementia, and mental health problems they are facing. So the rates are really high. And I heard stories of friends and others, you know, what happened for a family with those elderly with such disease, so it's just devastating.


of course, the, you know, climate change. And I'm interested to work on, you know, the impact to the local, regional and global communities, including the elderly, because they are less capable to cope with a lot of those changes.


Oh, one thing, one other thing is that now everything is getting to the, I guess,


So you have to, especially I think in certain populations or areas in the world, everything you do is through the phones to the computer. And a lot of those elderly populations may not have the techniques or skills to to deal with those issues. So like payment, that like, right for for my parents, I have to set up all the payment of other gas, fuel and electricity and other things. They just cannot do those by themselves. I cannot imagine for someone who do not have children or who do not have people to help them what they're going to do.


think first of all government should put to the elderly population as their priority any of the planning purposes. So, we know that because of the you know, averaging age or life expectancy, improvement, we are getting older and older in the general population. So


put this as as the priority, like when you design for the communities, you I think we tend to think about our children in our schools, but not so much for the elderly, like their activities and their needs. Okay, and how to accommodate their needs is, for instance, hospitals, and access to the facilities. So I think that's the number one thing.


needed to work together. So it's not just one planning department. It's also multiple stakeholders. They including the the social services, the health sectors, insurance and practitioners, and also working with public health's people, like my colleagues, and to promote the prevention and to some of the other programs that's cost effective in reducing the disease risks. And and also the other, you know, it's yeah, this this question is very general, I think of Americans, if, you know, we want to go to like each direction


But I tend to think about the sub populations within these two boys. Either because they have the least power, or because they have the tradition of not speaking out. So I'm thinking about, you know, the homeless people and the people who have lower socioeconomic status, as well as the population who do not traditionally speak out. I know, you know, I'm trying to use and I know, the Chinese population do not speak out. So I feel some of them are not, not well,


We're sharing that. So thank you. I'm thinking about all the issues like that older adults are facing in Orange County. So what issue you think is being


What issues have been overlooked, what you share is been overwhelming. For the elderly population,


I guess I have limited knowledge of what has been done.


Ah, I don't know. I can only think about my own case. So I think for like undocumented


immigrants, for instance, I, you know, I have, from my research, some limited interaction with undocumented immigrants in Santa Ana. So I feel


using the resources that are available to to them, even though you provide those resources to them, they just worry about, hey, I have to contact with government people. And that may put me in that risk of you know, other things right. So then they then they try to stay away with any of these programs that can be beneficial to them. I think the other thing is, you know, I already mentioned the the insurance, the insurance of this immigrants, either undocumented or documented immigrants.


Now, the next question will be more in your area of expertise.


climate change, I have been working on Um, wildfires and extreme heat, both of them can be causing a lot of harms to the older population. So for people who live in the areas with high risk to wildfires than the older population, you know, due to multiple reasons, like they have attachment to their property, and they have pets in their property, and then they don't think they are at risk or whatever, so that they may not choose to evacuate into when it is needed. Right. And also, they may, like one of our studies show too, that people living in this areas may not have like internet, so that they may not receive the information. And also they may have less capability of like physical to move themselves quickly from the hazardous area and risk. So this all put them at a higher risk and under general population for wildfire event, or, and wildfire smoke.


for the extreme heat, we all know that the elderly population is much higher risk caused by the extreme heat, because they cannot regulate their body temperature as well as the younger people. And a more dangerous thing is that those elderly population don't think themselves at risk. So they always think, you know, when they're questioned, they always think, okay, some other people are risk, you know, but not themselves. So then they may


house risk from the extreme heat. And, for instance, if we use cooling centers as a strategy to mitigate the heat impact, not only people are using the cornea centers, and elderly people also think it's not a lab trendy or not good. And it's for, you know, some very weak and people with illnesses, so, they don't want to use the accordion centers. And some people are also isolated. So the leaves are no, that's, that's very dangerous, they live alone, and they don't have the channels to receive information. So, you know, under certain extreme disaster events, then they may Yeah, might be at higher risk than the others.


Thank you so much, and when new or revised policies are needed


So, again, I think multiple stakeholders need to work together. So, I think the disaster preparedness plan or climate change action plan needed to have a specific section focusing on the elderly population. And that will take into account you know, their vulnerability, their specific situation, such as living alone, such as, you know, access to the information, and also language barriers, and also tailor that to the elderly population, that they tend not to think themselves at risk. So the communication part is also important. So, you know, raise awareness education sessions, on the climate change, impact,


also get the preparedness plan. So it's not just awareness but also like actionable preparedness, and action plan. So, and those action plan It really needed to be practical and easily implement terrible. So it's like public health department and social services and clinical practitioners need to work together


think multiple and it is the, like public house department. I guess essentially, every government or sector, I think needed to be involved in the in the prevention mitigation stage for the climate impact, because it does affect every aspect of our life. For instance, for the wildfire, mitigation, you can involve public health agency, and EPA, and the like Forest Management Act and the healthcare sectors. Right, so all of those


Yeah, I use multiple data sources for my research. So for the environmental side related to climate change. I use NASA data, like a climate to climate parameters, and EPS data, you know, air quality, and even sightline data. And then for the health side, I work with multiple data sets, including Southern California, Kaiser Permanente electronic medical record data, you see house, University of California house system data and the birth certificate data, hospital admission and emergency room visit data. So these are our lot of data.


we also analyze government documents for their climate action plans and to say, you know, what are the gaps, whether there are differences by different cities, and why.


Thank you so much for sharing. So, yeah, that's, that's all the questions and then


stop recording. Thank you so much. We almost like me.


No, I don't think so. Great, we can get started then. The primary goal today is to identify the needs you think are most important to the older adult population you serve. That's defined as those who are 60 and older, we want you to think as broadly as possible, taking into consideration the older adults, caregivers, families and their communities. I'm going to share my screen so you can see a list of common issues and concerns impacting older adults. So please take a few minutes to read through the list and let me know when you are ready to begin. I'll share that list now.


Yes, I can see. So feel free to take a few minutes to review and let me know when you're ready.


Okay, I think I'm ready. Okay. Definitely.


So I'm here today representing the Cal savers retirement savings program, you know, which is the state relatively new retirement savings program designed for, you know, the private sector workers who work for employers that don't offer a retirement program. So, you know, we were created by law, in order to address this retirement savings access gap that exists in the state right, where we can see that nearly half of Californians are projected to retire into economic hardship, meaning that you know, retiring with an income at or below two times a poverty level. And, you know, the legislature at the time thought that one of the key drivers of that was that there are millions of Californians, they estimated about seven and a half million Californians at the time, who, you know, are working for employers that are offering some sort of retirement saving. So in order to bridge this access gap, they passed the bill that created the CalSavers program, which, you know, not only authorized the creation to calsavers program, but also requires that employers, you know, that certain employers facilitate their employees access to the program, they don't have, if they're not, you know, sponsored retirement plan, so basically creates this mandate on California employers. So that being said, obviously, you know, our focus is on the economic security of older adults, right, helping people or encouraging people and giving them the tools necessary, as early as possible, so that they could say for themselves, build up the next day, and hopefully, you know, be able to sort of to retire with some economic security and dignity, and use those resources to address some of the other, you know, common issues or needs or concerns that that you guys are mentioning here on the list.


Okay, thank you, and of needs on the list, Please rank the top three that you feel are most important. Right, well, let's see.


I would say Well, again, you know, from our perspective, to helping people to build their, you know, their economic security in retirement. You know, I'd probably say top three, for a program like ours would be, you know, economic security, housing, obviously, that's one of the big, biggest, you know, one of the largest common expenses that that focus, especially, you know, older adults have, and then healthcare, of course, health care access and delivery, I'd say, you know, those two probably being the two biggest drivers of income insecurity or, you know, economic insecurity for older adults.


Thank you. And so for the next few questions, we will be going through each of these three needs that you've identified. Right. Well,


as I said earlier, you know, we've identified this huge access gap, you know, with folks who are who are, you know, given the tools to, to save for retirement, right. The research shows that the folks who have access to a payroll deduction savings program are 15 times more likely to be saving and on a path toward retirement security. So, you know,


you know, folks aren't given the tools, the education resources that they need to, you know, be able to prepare themselves financially for their retirement, you know, they'll they'll be at a disadvantage. And obviously, those that disadvantage, the access gap tends to affect, you know, poor folks, right, lower to moderate low to moderate income workers are more likely to not have access to a means to save for retirement. Workers of color, right, two thirds of our estimated eligible population are workers of color. Two thirds of them work for small businesses. I feel like I've gotten off track.


Right. So I think I think that's a that's, you know, a key driver of it. So, you know, as, as Americans are, you know, in California, in particular, are, you know, healthier, and living longer lives at the same time, they're dealing with this rising cost of housing and health care, and their, you know, their everyday needs, even at grocery. So, you know, the lack of preparedness, that that we think is, in a large part is driven by, you know, the lack of, of a lot of folks to access the tools that they need to save for retirement has sort of created this situation where, you know, older adults are ill equipped for their retirement years. And we're hoping to address that by addressing this access gap.


So as we work to make sure that more California workers have access to the tools that we know, work to get them saving on and on a path toward retirement security, that's, you know, definitely one barrier that we're working to address. But then, you know, financial education, financial literacy, trust of both, you know, financial institutions and government institutions have an effect on, on, you know, people's, you know, willingness to participate in programs like this. And then also, you know, the weight of everyday living expenses, right. I'd say those are probably the biggest barriers right now. Thank you.


So, you know, as I mentioned, you know, we estimated the eligible population for our program, so the people who were, you know, most likely to work for employers that, that didn't offer retirement benefit. You know, again, two thirds were people of color, bout half or Latino, you know, two thirds and work for small businesses. So if you, you know, spent your career working for a small business, you were less likely the access gap often tend to affect, you know, with, with less education, right, folks with with only a high school degree or less than or, you know, with with a high school diploma or less than high school diploma are less likely to have access to workplace based savings program, and, and, you know, that access gap shrinks with with, you know, higher educational attainment. So, yeah, there are definitely, you know, certain demographics are affected by the problem more than others.


Well, you know, again, from our perspective, it was it was really addressing that access gap, right, making sure that that regardless of those conditions, and that no matter where a person works, they should have access to, you know, to some way to save automatically from your paycheck. So whether that's, you know, with their employer signing up for calsavers, or whether it's, you know, their employer going out in the private market and starting their own retirement plan. You know, our goal or The you know, the legislators go when they pass the bill and created our program was to ensure that as many working Californians as possible, have the tools, you know, easily available at work to get themselves editing and all the passwords, retirement security.


Right. And again, this, you know, isn't so much our area of expertise. So, you know, I would just say, you know, from, from our perspective, you know, the, with the rising cost of housing in our state, combined with, you know, the, you know, the the fact that there are so many Californians who aren't prepared when they reach retirement age, to make up for any lost income as a result of either retirement or the inability to work, that, you know, that contributes to a situation where folks are having difficulty, you know, maintaining


You know, again, just just answering from our perspective, we're hopeful that, you know, when people are able to, you know, build more resources over their working, or their working years, that they'll be better able to absorb the increased cost of living that they might experience when when they reach retirement age or, you know, when they, you know, become older, older adults.


Right. So again, from our perspective, because that access gap, you know, it does affect more demographic, or certain certain demographics more than others, then, yeah, we would assume that, that yeah, they're the folks from those demographics when they reach retirement age or or, you know, their older adulthood might experience those problems more than more than others.


you know, again, you know, I'm sure there's tons of policy proposals that other interviewees have have suggested, and that I would probably advocate for in my personal life. But, you know, speaking as a, as a, as a government official representing this program, you know, from our perspective, where our hope, again, is that by getting more older adults prepared, you know, for their, their older adult years, throughout their working years, that we'll be able to, you know, relieve some of that pressure that that older adults are facing when they when they reach retirement age.


Thank you. And now we're getting on to the third topic. Okay, you can just answer however you feel is appropriate.


Right. And again, you know, that that just goes to the rising costs. And, you know, when you combine that with with certain folks, you know, inability to prepare, properly, or enough for further older years, it definitely creates a situation that, you know, create some pressure for for older adults who have a budget who are living on a budget.


Alright, so again, from our perspective, right, we're hoping that that by giving people the tools that they need to save that, you know, they'll be better equipped to, you know, handle some of those costs when they reach their, their older adult years.


We would we would, you know, imagine that, that those demographics are probably affected by the, by the, by the rising costs of healthcare more than others. Thank you. So, you know, again, we're working to, to help make sure that, you know, folks are given the tools that they need to prepare themselves for their older adult years by addressing this access gap that exists


in the state. Thank you. So I have a few more questions. But that is it for the list. So I will just stop screen sharing now. The following questions are more geared towards Orange County specifically. But feel free to again, answer however you feel is appropriate. And if you don't really know or don't feel like you are the best person to address it, you can feel free to skip the question. So the next question is, can you please describe how accessible more than adequate, the following care services are in Orange County, starting with geriatric care.


I wouldn't be able to make an assessment,


no worries. And the next few are for long term care, mental health and behavior, substance use treatment, or human and social services.


Yeah, I probably wouldn't be able to speak to those, especially, you know, the unique situation that exists in Orange County would be outside of my exhibitions. No worries, thank


You know, I'm not sure I'm the best person to answer that question either. Because, again, you know, speaking as a, as a state official representing representing the program, I would need to focus on, you know, the specific, you know, issue that we're trying to address through through our work and program, which is, you know, trying to make sure that that more more older adults are, are, you know, better prepared for their for their retirement here, financially.


So that's a great question from our perspective. So I think that, you know, the calsavers program, I think, provides, like a really good, you know, example of, you know, smart policies that the government can enact to help to, you know, make life a little bit easier for older adults. You know, we're also a good example of public private partnerships, right, where were overseen by a transparent, you know, public board, but we're run by, you know, the day to day operations and investment management is done by by private sector, financial firms. So, I think that, you know, there are a lot of opportunities out there examples like calsavers, you know, where you're identifying an access gap, or identifying, you know, in an issue that older Americans are, or older Californians, older Orange counties are, are experiencing, and then creating public policy to, you know, directly address those those access gaps. Or, you know, the situation that exists for older adults.


Thank you. I wouldn't be able to answer that question. I don't think you answer the question either. I'm sorry. No worries, no worries. So in addition to what we've already talked about, we can dive a little deeper into the area of income security as we age. Yeah, sorry, go ahead.


Yeah, no, I mean, you know, that's, that's an interesting question. And it's a tough one for us to answer because we're, we're a relatively new program, right, we've only been up and running since 2019. And when we look at the population that we're currently serving, you know, our feasibility study had identified, you know, not only those demographics that I mentioned earlier, that, you know, were more likely to suffer from this access gap. But also, younger adults actually are the ones who are who are more likely to be working in places that don't offer a retirement program. And that has turned out to be the case for us, too. So more than half of our current participants right now are under age 45. So, you know, it's, it's hard for us to say, at this point, you know, what direct impact we're having on, on older adults, but, you know, we're excited about the fact that, you know, so far, we've already got, you know, more than more than 54,000 Orange County participants in our program who have collectively saved over $43 million, they probably wouldn't have been saved, you know, without without this program. So, you know, even though our demographic that we're serving right now, tends to be younger, you know, we're hoping that by by by encouraging folks to start saving when they're younger will have an impact on you know, not only The current generation as they start start aging, but also creating sort of a generational change in terms of, you know, saving and and you know, long term financial security that we're excited will hopefully benefit, you know, older, older, California and for generations to come.


I don't think you know, we have any from, from our perspective, at least, as it relates to, you know, to Cal savers, we actually just passed a new bill last year that expanded our mandate. Previously, the mandate only apply to employers with five or more employees. Now, it's down to employers with one or more employee. So and, you know, given the fact that the smaller the business, the more likely it is, they did not have access to your retirement program. You know, we estimate that that's going to bring on an additional over 300,000 eligible employers statewide, and about three quarters of a million eligible participants. So again, just continuing to work on this access gap and making sure that, you know, folks, regardless of where they work, where they came from, you know, what size business they work for, that they'll be given equal access to the tools that, that, you know, we know, they need to get to get saving on passwords, retirement security. Thank you,


I think that it, I mean, it's going to sound terribly egotistical, but, you know, we, we like to think that we're going to do a pretty good job in addressing and addressing some of it right. But it's not, it's not we're, you know, we're obviously not, you know, the silver bullet, right. There are other smart policies that could be made to, you know, relieve some of the pressure that that a lot of Californians are experienced, especially in their adult years. But, you know, we're, we'll be working hard to make sure that as many Californians as possible argument, it's one thing to prepare themselves for their adult years.


Let's see, you know, I guess the most relevant data that we, you know, use right now is, you know, data that we have about California employers, right, that's how we identify, you know, who the employers are, who are out there, how many employees they have. So, you know, that's how we determine whether or not they are subject to our mandate. You know, census data, data about national trends in retirement savings, and income security, and in older adult years, are obviously extremely valuable to us data about how how private sector retirement plans work, you know, the costs associated with with, you know, not only maintaining those programs, but also the cost that gets passed on to the participants. So that we can make sure that we are in line with, with, you know, the general industry trends and making sure that, you know, we're remaining competitive and most importantly, giving, giving our savers the best opportunity to, you know, build a larger nest egg. And then, you know, information, especially from from local communities about, you know, which communities within the Orange County need the most support in terms of, you know, not only access to the, to the retirement savings, but also getting the education that they need to understand why this is important. And help alleviate, you know, this, this knowledge gap and trust gap that sometimes prevents people from taking advantage of programs like this. So, you know, that's why we're always really excited to get connected with local organizations that are doing, you know, work on the ground, in communities across the state, because those are the folks especially when they're working in, you know, financial coaching, financial inclusion, stuff like that, because those are the best partners that we could, you know, potentially work with to make sure that folks in Orange County are aware of this program and you know, feel comfortable participating in when they get access at work.


Or maybe the community partner we Yeah, so we


get it from Multiple sources. So we get it from episodes, you know, data about, you know, you know, local information about, you know, specific demographics within certain geographies like Orange County, that we would get from from local providers. We get it from some academics, and you know, from like, I want to say philanthropy, but that's not the word that I'm looking for. But like Foundation, and stuff like that. And then other data we get from government sources, right, like employer data we get from EDD. And we get information about which employers are already sponsoring retirement plans from the federal government. So yeah, there's there's multiple sources, you know, depends on the data that we're talking about. But what is most interesting, and I think relevant for me, especially with my work is doing the outreach and education for the program is that, you know, that local level demographic data, and then figuring out who the community partners are, so that we could work together to make sure that that, you know, folks take advantage of these tools. When they're offered, it works.


You know, off the top of my head, I can't think of anyone. Obviously, don't know, your full list. But you guys, you know, seem like you too are experts in this. And and I've actually pulled together, you know, organize a really diverse group of stakeholders. From what I can see from what I read on read on the website.


Thank you. Oh, absolutely. Yeah, please do. Great. Thank you. So that concludes our interview. Thank you so much for your time, and you've been incredibly helpful to our research. If you find that you have more to share, please feel free to reach out to us. You can email me or you can contact us on our website. That's www dot advance oc.com. Or you can leave an anonymous voicemail on our telephone line at any time. I will stop the record


I think that, you know, certainly just starting with the easiest, which is social, economic, you know, if you're poor, you don't have a lot of places to get out and go to, and it costs money and gas, if you're rich, you know, you live in, you know, a cool, high rise senior apartment living in South Orange County that cost $12,000 a month. And as a result of that you have very different aging experiences.


I think the best way to address mental and behavioral health, again, is to provide services closer to the people who need them, especially in socio economic deserts, if you will, I mean, think about the, the, probably the millions, but certainly 10s of 1000s of seniors here in Orange County who cannot drive or have low levels of access to just going out and having an afternoon bowling or playing a card game at a local center or something like that, for them to have, you know, we need to reach out and engage and pull them in, because mental and behavioral health is certainly my PhD is not in aging and so forth. But as one who observes and has family members, who are aging as well, the more community engagement, the more engagement there is, the better the behavior, mental health outcomes.


I think some of the same themes are critically important here as well, access, that means everything from just being able to drive to somewhere or have someone come and check in on visit on people. I mean, I think the worst stories that all of us ever hear are so and so fell down and broke his hip, and he couldn't get to the telephone, he didn't have a life alert on and laid there for two days or worse case, you know, someone died, and no one knows about it for a couple of days. So I think having a better alert system, you know, some way of people partnering with a cadre of seniors in their area, so that they do have access to services, and someone is checking up on them. I mean, seniors, or at least the ones who have come here to North Orange County continuing education, many of them come for enrichment classes like to take an art class, you know, to maybe start a beginning session of a new language, those sorts of things. And I applaud them because they have made the effort to register to get up to get going to dress to look professional. But more importantly, to take the time and effort to engage and learn and interact with a community of people learning as well as engagement are the keys to, in my opinion, better mental and behavioral health.


How do they know about services, and I hear from my colleagues, you know, in the county, oh, my gosh, we have this program, we have this service, you know, we're offering this situation or activity or lesson or whatever, at this center, and so forth. So I think the county and social services are, are well aware of some of the barriers that we're talking about. But the people who need to consume them are not aware. So figuring out, they are not on Instagram, possibly not on Facebook. So driving someone to a website is not necessarily the most effective way. So I leave it up to the professionals. Each and every organization has a public information officer. They have a public relations and communications office. We can figure out how to sell cars to people or it certainly insurance and scammers are excellent at getting through a to people, so maybe learn some lessons from, from the experts who are able to climb over those barriers and get access to people so that they know about the really cool opportunities services, especially in mental and behavioral health. There, there are ways to get that information out not my expertise. But certainly the expertise of folks in the county in the areas that I've described.


I would say, I would say, so everybody has to go to the grocery store as an example. But rich people go to the grocery store much more frequently. And I guess I'm making an assumption. And it's a closer experience to them. We're all aware of food desert realities. And I think, again, that is attributable to socio economic pockets. So it's harder for people to rent just do a quote unquote, drop by a grocery store, because the grocery store is not close by. And so my sense is providing those opportunities that are more local, certainly, in terms of access to just good food, that would be a cool thing in and of itself.


I think I've you know, kind of attended to that and some of the other and answers to other questions, which is communication, access engagement, and bringing the services more closely to boots on the ground in the community type of experience.


I think, you know, certainly, in Orange County, it's just access to transportation, socio economic drawbacks, especially right now, when we're facing inflation. And there is an extreme fear among older people right now that they're going to lose their social security. I talked to someone last night, who said, I am afraid that the Republicans are going to take away my social security. And we all have assured her that that was not eminent by any means. I mean, I can't predict the future. But I think that that sense of anxiety and fear is becoming a source of certainly detriment to behavioral mental health, but it is also proving to be a barrier.


I think the number one is many people live on fixed incomes, they may have not had an opportunity to participate in a in a pension program, as well as you know, 401k situations, I don't think that I'm straying much from the facts. I wish I could pull up a quick infographic, but many of the things that I'm talking about today disproportionately impact single older women, those who've been divorced or are divorced, men seem to make out a little bit better because they've been the head of household. And they have had, you know, full time jobs for many, many, many years, while women especially in the 60 plus 65 plus 70. Plus, in particular, were not part of the workforce as a result, they're social security check is a smaller, they don't have access to their husband's pension fund, nor access to the 401k. So a disproportionate amount of impact on socio economic, mental and behavioral health is accruing to women. As more of them, seek shelter in their cars or or losing access to housing.


I guess, you know, working with within the county structure and our state and structure, if one of the results of this interview and the query that is producing the data, leading to just two decisions, you know, data driven decision making. So if this data leads to decision making, it should be readily apparent that the data that certainly I'm referring to, as well as the experience and analysis in play, hopefully can drive policy decisions and that policy decisions, drive budgetary expectations, and, and execution, if you will. So using the last example as the case in point that is, older women who are single, and they're especially in their 70s. It's a mental and behavioral health tool. Yeah, it's more than just sitting around watching things. It's again, a mental and behavioral health tool in terms of mental stimulation as well as social engagement. So that it's the whole plethora of skills that we've talked about today. For those to be top of mind, especially for women. In the in the funding priority, there's plenty of money, I know we're going into recession ish type of budget deficit spending here in the state of California, that will trickle down to counties and localities. In the meantime, the funding formula should be based based on data. And that's what you're collecting. And I think it will reveal a preponderance of disproportionate impact for women in the socio economic especially negative side of that, especially as they age.


A geriatric care. B long term care. And then human and social services.


I would say it's pretty much not adequate. I mean, I guess if you're looking from one to 10, I would put it at like an eight, pretty much not people are not aware of, but it's not adequate. And it's certainly not accessible.


I would, I would, I mean, if you're wealthy, you know, you can pay that 6 7 8 9 10 $14,000 a month to live at ages or Covington or, you know, Leisure World or whatever. So it's, you know, those, those are different levels of access. But if you're someone who we'll say has a total all and monthly budget of let's just say, three to $5,000 housing is an extreme feeling of scarcity, I would imagine I think.


And then mental, behavioral health and substance use treatment isn't isn't accessible and adequate.


I would say it's not accessible and certainly not adequate. They don't. I mean, unless they're on the streets, which is absolutely horrific. But it's not like, you know, mental behavior, substance. All of those things that you were just talking about, are available even in senior centers or senior apartment buildings. I mean, the I find it hard to imagine that those kinds of services are available or adequate in any kind of scalable fashion.


Well, that's where the bulk of the meaningful money can come from private entities. You know, whether that's a housing complex or so certain, certainly, health care, if people have a lot of money, they're going to be able to stay in their house, maybe downsize but pay off a house subsidized or gain access to behavior, physical and mental health. But if you're in a modest, static, stable income, even that seems adequate. Those those sources are going to be stretched if not become increasingly insecure, including housing is number one, number two, transportation. And number three is just socio economic security. That is food, clothing, and of course shelter, as I as I just mentioned.


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


I would say that socio economically challenged, be that from any demographic group.


I think it's not being overlooked. But it needs to be clearly at the top of the list, which is housing insecurity along with that is food insecurity.


Okay. So this concludes our interview. Thank you so much for your time, you have been incredibly helpful, you know, and being gracious with me today with all my technological issues. But then still helpful for our research. If you find you have more to share, please feel free to reach out to us. Our contact information is available on our website events oc.com. Or you can also leave an anonymous voicemail on the telephone, and our telephone number is 949-415-6898. And you can leave at any time.


Okay, well, if I I'm curious and would be interested in what the outcomes of your findings if you don't mind sending those along when they're concluded.


Okay, so in a minute, I'm going to share with you on my screen a list of common issues and concerns impacting older adults. If you're driving, I can read them out to you. If that, yeah, I can do that. Yeah, so. So the primary goal today is to identify what needs you think are most important to the older adults populations that you serve. And for older adults, we mean those who are 60 years and older. And we want you to think as broadly as possible taking into consideration older adults, their caregivers, families and the community. Okay.


Sure, my name is Erica Dan Zack and I am currently employed by Cal Optima health as a Director of Program Management in our Enterprise Project Management Office. But for the purposes of this interview, I'll be interviewed as an individual and my professional capacity as a gerontologist, I hold a Master's Degree in gerontology. And prior to my current assignment at Cal Optima, I served as the Orange County Office on aging director for both the office on aging and veteran services.


Great, thank you. Okay, so I'm gonna start reading off the list to you. Okay. So the list is read in alphabet quarter, Alzheimer's disease and dementia, behavioral health and mental health, cancer, caregiving, communicable diseases, community and family safety, diabetes and obesity, digital divide,


diet, fitness, nutrition, disability, economic security, emotional wellbeing, environmental concerns, health care, access and delivery, heart disease and stroke. Homelessness, housing, pain relief, physical comfort, personal care management, respect, respiratory conditions, tobacco use, transportation and mobility and unintentional injuries.


know, that's pretty comprehensive. You know, I know it's an alphabetical order and not an order of priority, but definitely happy to see that. Nutrition is considered, and also transportation. Also housing or affordable housing, access to health care and the digital divide are kind of what bubble up to me is highest priority.


Oh, good. I'm glad that you were thinking that way. Because I'm going to ask you Next, identify your top three.


Well, based on experience, I would say that, you know, while working at the office on Aging, we always tracked unmet needs. And year after year, it was always affordable housing, transportation, and nutrition.


Okay, great. Okay, so I'm going to ask you the following questions for each of those three things, and we're going to take them one at a time.


I think that it's always been an issue, especially in a high cost county like Orange County, but even more so in recent years as a result of the pandemic and just the economic pressures. So, you know, for the office on Aging, it was always our mission to support seniors to age in place and to be able to support their independence in their home for as long as possible. But when that became is not possible anymore. The options were either to hire a caregiver, which is not covered by any sort of insurance or Medicare benefit. Unless you're very, very low income and fall within the medical guidelines, in which case, you may be able to get linked up with In Home supportive services, although that's very limited. But most people can't afford to hire or privately pay for a caregiver to come into the home to support their independence. So then families often look to placement in long term care facilities like assisted living or skilled nursing facilities. And again, those are very limited because skilled nursing facilities have very strict requirements in terms of what makes you eligible, right. And insurance, most of the time just covers limited stays. And then for assisted living, that, again, is private pay. And unless you're, you know, in the top percent of income earners, most people can't afford to privately pay for assisted living. So it's not only a challenge to keep up with maintaining your own residence, but then when that's not possible anymore, the the other options are just really, really expensive for most seniors.


I think some Well, simple supply and demand, of course, so affordable housing units do not match the demand for them. There's always been extensive waitlist for affordable housing units, senior apartment complexes. So definitely the need to construct more housing units at affordable rents are one factor. Think another barrier is just senior friendly communities. You know, most of the senior apartments are embedded in communities and neighborhoods where you have those that are working and active and, you know, don't really need the conveniences or accommodations that senior living might


Yeah. And do you feel that there are different experiences for different groups of older adults on the issue of housing.


And my experience, I've seen some cultural differences, certainly among the Asian populations. There's a value system with our older adults in the family and keeping grandparents and aging family members among the mix in the primary home, right. But for other cultures, that really is embedded so much in keeping the seniors part of the primary home.


Oh, I wish I had the answer. I really do. But I think that it's not a one size fits all for sure. And being able to communicate the assistance that is available in ways that makes sense for certain populations to to ensure that equity even you know, not and it's not just translating materials on housing brochures or social services and supports, but being able to connect with seniors where they're at and being able to bring services to them in their native language and be able to assign care navigators or even you know, community health workers that might be able to work one on one because it can be a very overwhelming system to navigate for anyone but for i for older adults that are already challenged with either you know, technology barriers or language barriers. I can imagine that it's especially difficult.


Okay, so now we're gonna move on to your second item, which is transportation and mobility.


So again, I, you know, it's been an issue for a number of years, I think. on a macro level, Orange County, unlike other major metropolitan areas, we don't have a mass transit system. So you rely on your car at every age group relies on their car to get around. But for seniors who may be facing a new diagnosis of Alzheimer's or another dementia may be at risk of losing a driver's license. If they are not able to drive and don't have the ability to operate a vehicle, we don't have I think sufficient alternate transportation options that are specifically geared towards seniors. And Orange County have very, I mean, it's not as as geographically spread out as some other counties, but we're pretty large county geographically, and we have some rural areas that aren't in proximity to a bus stop. And so access to fixed route transportation, as well as, like ADA paratransit services that need to be within so many miles of a bus stop. There's gaps in the county where those services just don't run. And so being able to provide adequate transportation for seniors that make sense that's accessible, that they can rely on to get to medical appointments on time. Mental health appointments, physical health appointments, even rides to the senior center for socialization, I think, definitely need to ramp up with the aging population.


Yeah. And what barriers do see exists, that would not allow us to see improvements in transportation for older adults.


The high cost of transportation. And I think


what comes to mind is, I think of younger generations being able able to kind of navigate like rideshare services, Uber or Lyft, or things like that. I don't know that older adults feel as comfortable ordering a ride on an app on their phone, you know, or that family members would even feel comfortable to put their 85 year old mother in an Uber with a stranger. So but, but to have services like that, that are customized, to provide that door to door, and even assisted transportation. And I think that a lot of transportation services have drivers and vehicles, but they don't necessarily have people that are trained to assist older adults that may have mobility issues, or need assistance getting in and out of the car or in and out of a wheelchair and taking, you know, inside the entrance of a of a medical building, per se. So that would be another barrier.


I would say that the county has done a pretty good job with regionalizing transportation services. So and I know each city has the ability to apply for transportation dollars to put into like senior mobile mobility programs, but not every city prioritizes that with that funding source. So I mean, you could be sort of a victim of where you live if your city isn't investing that way. So there could be some inequities there. And then, again, technology barriers and language barriers, if that's the direction that transportation services are going, I could see that being a barrier or challenge for certain populations.


Well, we need more funding, that's for sure. Because they don't know All of the transportation services that we have currently are meeting the needs or can definitely size up to meet the growing demand. And I think that there probably needs to be more coordination with Orange County Transportation Authority, the city's the county. There's not I don't think there's one solution for something as complex as transportation. Yeah, yeah.


Okay, it's now we're gonna move over to nutrition.


Oh, that's what this issue has definitely evolved. I think, like pre pandemic versus post pandemic, or even during the pandemic, I should say. The funding was always level and so the services were always level. And so year over year, we could expect that a certain amount of meals would be provided to a certain amount of seniors on an annual basis throughout the county. And no one really came on or off the program unless there was attrition. So there was always long waiting lists for services, like home delivered meals, because of a fixed amount of funding and resources. And so in order to be eligible for home delivered meals, you had to meet certain criteria that prevented you from being able to shop and cook your own and prepare your own meals at home, or have some sort of functional disability that prevented you from shopping or preparing meals at home, or some other co occurring conditions. So there was very strict criteria. And and there still is, to some extent, but I think that that got a little bit more flexible during COVID. And then, of course, there's the lunch program at the senior centers, where seniors could go and congregate and enjoy a nutritious meal, but also get the benefit of socialization, right. So when COVID hit and all the senior centers shut down, those congregate lunches turned into just grab and go meals. So seniors were able to go grab, you know, X amount of frozen meals that they needed for to get them through the week. And then they could come once those meals were consumed and grab and go another batch. And there wasn't a whole lot of criteria around that other than you had to be a senior. And you had to attest that you weren't participating or receiving any other nutrition benefits from anywhere else. But the demand for that just exploded during COVID. Because I think seniors had a lot of fear about going to the grocery stores and exposing themselves to to COVID. And so they just felt more comfortable being able to get those needs met and on a grab and go basis. And there was a lot of fear around supply chain issues and food scarcity and all the rest of it. So it just kind of blew up in terms of demand. But I think that it showed that the demand was always there, there was always a need. It's just that it became more available with COVID Really funding where we could really increase the amount of meals and services being provided. I don't think that I don't think that seniors were not hungry one day and hungry. The next I think the need was always there. And it just COVID kind of uncovered all of that right. And ended with home delivered meals, same thing. I mean, you had to have that criteria that I said in the beginning, but with COVID There was a lot of flexibility where seniors could receive home delivered meals, just by being aged 60 and over. And that was really to ensure their safety and make sure that they stayed safe at home and got their meals delivered to them rather than having them exposed going out in public or going to the grocery store, you know, Costco warehouses or what have you. So. So I think once all that COVID, relief funding has quieted down, the need is still there. And so, I, this is kind of at the point that I was leaving the office on aging. But I'm, I was hopeful that the state heard the voices of each of the counties and saying that we've just kind of uncovered this sleeping giant of a need. And we need to make sure that we have sustained funding and resources to be able to continue to provide the services at that level.


Yeah, it's quite a neat, I remember seeing the long lines of folks, and then just the fear of going out, right.


What, what barriers exist to seeing improvements in nutrition, but I think we're talking about food insecurity as well, right.


Yeah. And I would have to say that this food banks are part of that equation, too, not not just the providers that had county contracts to provide elderly nutrition services, but the food banks were definitely impacted. And even some supplemental food programs. Through distributions that were popping up, all throughout the community, were always busy. I even saw it in my neighborhood, you know, at the mall, up the road, they would block streets and people would just lift the trunks of their cars up and, and have food dropped in. So yeah, I think it was definitely eye opening the what a huge need. And now today, looking back, we still have inflation to deal with so high cost of groceries, a gallon of milk is not what it costs, you know, four years ago, or even three years ago. So for seniors on a fixed income, I think that that's especially challenging. Not that's certainly a barrier.


I think so. And I don't know that I mean, you know, if you're, if you're hungry, you're hungry. But what I saw was a lot of creativity around or flexibility I should say, around menu offerings. For government funded nutrition programs, it always had to adhere to very strict dietary guidelines with you know, sodium and vitamin C and the all the nutritional components that make up a meal. And it was really nice to see some flexibility from the state and the federal government during COVID to be able to ease up a little bit on those restrictions. And number one, because you couldn't guarantee with supply chain issues that you could get certain ingredients and so sometimes you just had to put a meal together with what what you could get right. But also the flexibility allowed for some cultural menus that weren't available under traditional programs. So we were able to see contracting with like Vietnamese catering companies or Vietnamese restaurants and be able to provide food that Vietnamese seniors enjoy. And and same with like the kosher meals and hello meals. Middle Eastern menus and just a lot more creativity going on with seniors. So yeah.


I think just exactly what I just said the sustain funding to be able to meet that need that was uncovered during COVID That isn't going to go away. And then also being able to continue with menu flexibility and nutritional flexibility so that we can see some of that creative menu offering and variety with food choices.


Yeah, yeah. Okay, so now I'm going to segue into a whole nother section of questioning has nothing to do with the list that I was referencing before. I'd like to ask you to describe how accessible and adequate the following care services are in Orange County. The first one will be geriatric care.


Um, I would say inadequate and difficult to access. Scale like, Yeah, I mean, geratricians are few and far between, I think most older adults are resolved to stay with a primary care provider that is just, you know, general family medicine to find a specialist in geriatrician is very few and far between.


Yeah, and that has to do with cost long, long term care is extremely expensive, unless you have long term long term care insurance, which is also very expensive. Most people don't. I think the average cost of an assisted living facility is six or $8,000 a month. And that's probably for like a shared room. If you wanted something private, it would be probably along the lines of like, eight to $10,000 a month for something nice. So that that's, I mean, just sheer math, only a certain percentage of the population can afford that. And in terms of there being a sufficient amount. I mean, for the people that can afford it, I'm sure they would think so. But for Yeah, for the for the general population, or for those that are low income. I would say that the options are very slim. There are some long term care facilities that have like medical beds. And now that I work for a MediCal managed care plan. I know more about this from the inside. But again, the requirements are very strict. They're very limited. And there's still a lot of people that need that that either can't get in or don't qualify, because it's it's just far too strict.


For older adults, specifically, I think, again, that's probably poor poor unfortunately. I know that the health care agency has some specialty programs for that, but for the most part, there isn't. specialty programs that are geared toward older adults. specifically, that they're forced to be directed to mental health and substance abuse programs that are geared toward the general population.


Yeah, I mean, I say medium because there's so many great programs that are that exist. But one of the barriers is just lack of awareness that they even exist in the first place. And I mean, I can't tell you how many older adults or family caregivers would reach out to like an office on aging call center or other service Adult Protective Services, and say, Oh, my gosh, I wish I knew about you sooner. I wish that I had reached out sooner, I just didn't know that this type of service even existed. So that I mean, that's, that's heartbreaking. But then again, you only you only start seeking services when you need them when you're at that point in your life, right. So caregivers don't reach out until they become caregivers, or until they encounter a situation that they need help with, with an aging parent. But mean, they haven't crossed that bridge yet in their lifespan. So


Well, I'm gonna kind of go back on the original priority list that I called out, because when I think about 10 years from now, I think Alzheimer's and dementia is going to be a real big issue for our, our county, our society. We've We've come a long way and medical advances to try and keep physical bodies working well, but I think Alzheimer's and dementia, we have yet to find or kept up with the pace of those kinds of advances. So with the aging population growing, we know that those with Alzheimer's and dementia are also going to grow. And when we talk about all those other services that aren't adequate, like long term care facilities, caregiving social services, that's scary to think about. Because that's going to present a huge gap.


Yeah, though, I think there was a recent feature in the register about how many people they expect to have Alzheimer's or dementia in the future, maybe like, half of all older adults or something like that.


That's a tough question. That's a tough question. I don't I don't know that the government is the answer alone. I think that it's a cross cutting issue that affects communities


all over and I think that I think that the government's involvement in providing adequate tax dollars and funding to programs for seniors that cannot afford for private pay Services


is a benefit for everyone in the community. Right, because housing housing is health care and I'm new, having properly nourished seniors that are taking care of affects everybody in the society. Right. So I think that I don't ever criticize the the lack of government involvement or support. I just unfortunately, the funding has been flat for many, many years. And so as the population grows, so, too, has the funding for for the programs that exist.


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


I think those that are isolated. Those that we don't know about our I think are the scariest. Because those that are already plugged in and engaged with senior centers, community centers, they have social support through their church or family, friends, people know about them. So they know when something's changed, or there's been a decline, you've got eyes on those, but for for seniors that are isolated, particularly like our homeless population, I don't think that our shelters are adequate, are adequately equipped to care for seniors and people with disabilities. I think, for homeless and Housing Support Services, to have seniors in the same type of housing setup as families with young children probably isn't the best mix. So I think those that are already isolated, already vulnerable, I think it could be a really scary situation.


I don't know if it's being overlooked. But I certainly hope that it's getting the attention that I think it needs. And that is addressing technology barriers. I think what again, that was a big issue that COVID Put a big magnifying glass over. Because never before was our world more reliant on technology than during the pandemic. I mean, that's how we did our work. That's how we communicated with our doctors, our mental health clinicians, our family, our friends, everybody turned to technology to be able to stay connected. So for seniors that don't have access to technology, either. They don't have Affordable Internet access, or they don't have devices, or they don't know how to use the devices that they have. I think that that could only create further isolation, which breeds you know, mental health issues, and then you're not seeing your doctor as often as you need to and not being connected to family and friends. And so I would like to see more investment and prioritization around addressing the digital divide.


Yeah. Okay, so now I'm just drilling into your former role as the Director of Office on aging.


I think that the the outcomes that we were looking for with the funding that was received for the programs that we were mandated to provide, also that they were effective to the degree that they could be with the funding that was available. I I think that the transportation for the senior non emergency medical transportation program was an excellent model. And I would love to see that continue and be expanded because it was a great transportation solution for seniors to be able to get to medical appointments, pick up prescriptions, You know, that type of thing. So that was a great and that that always yielded really great customer satisfaction. Families love that program seniors love that program. And you really felt like this was making a difference for somebody. The elderly nutrition program I think worked really well. There wasn't anything else like it being offered in the county in terms of home delivered meals or being able to go to Senior Centers for a hot meal and socialization is kind of it. So yeah, that definitely worked well. And then I would say that the information and referral call center being available, it's kind of like a 211. But with a specialty and older adult and caregiver resources really worked well. Because seniors prefer, I think, to talk with them a live person, and be able to bounce ideas off of and kind of get some options with resources. So to be able to talk to a live person and not have to kind of click through a menu or navigate a website, I think works really well.


From my vantage, I didn't really see any programs that were broken or not functioning.


And I think to that one of the beauties of the state funding is that it wasn't so prescriptive, but allowed for us to be able to customize things to be able to meet our own community's needs. So then we pass that flexibility and creativity on to our contracted providers, and they came up with some really great models. So for example, they bundled case management, and in home assistance with their home delivered meals clients, because if you're already frail, and you qualify for home delivered meals, chances are that's not the only need you have and so to pair them up with a case manager at the onset, that could coordinate other services and needs for them as well as get you know, homecare in I thought that that works really well. But I don't know that that model exists in other counties, right, because they may decide to kind of separate that out. So


It's hard to think that I feel I've only been in my current assignment for like 10 months, almost 11 months, but it feels like a lifetime ago. If I was in the office on Aging, I'd be like, we need this now today, but I'm a little more removed now.


I mean, I can't think of like if I had a magic wand I mean, I can definitely think of like model programs, model model, senior centers, and certain regions or zones that are working really well and thriving. It would be so nice to be able to see that offered county wide. I look at like the Leisure World model the Laguna Laguna Woods village model in South County and think what a great microcosm that they have a combination of long term care and active communities and peer support because you're living among people in your age group. You've got all the The activities at your disposal and you can choose to participate and be involved at whatever level you want. You've got social services on site, transportation, I mean, it's just such a mecca for aging in place, and how wonderful that would be if that was available county wide.


Yeah. I mean, we talked about this a little earlier about government's role, but outside of government, or even including government who are what entities that is best suited to address the needs of older adults.


That's always a tough one. Because when you think about like, the senior centers are all independently owned and operated by the city. So the city would have to be involved. And then when you think about government funded programs from federal funding or state funding, well, that flows to the county level. So the county would definitely need to be have a seat at that table. And then you have network of nonprofits and community based organizations that are actually the boots on the ground doing the work, because even the county wasn't providing any direct services. I mean, other than the call center, all of the services were contracted out to community partners. So it really is a true partnership that is going to resolve this. It can't be one person. I mean, I get that there needs to be kind of like a quarterback. But it was never I don't think the vision or the design for for government or for one entity to be the solution.


Yeah. Yeah, for sure. And for seniors to like that there has been this trust to with government, they're not always ready to, you know, go into social service building or a public assistance building and get help, but they may feel a lot more comfortable going to their local community resource center or food bank or church or, you know, I mean, there's just a level of comfort there. So we wouldn't want to be the answer for seniors.


Yeah, yeah, for sure. I mean, we're talking to about 100 different stakeholders in this initial part, with the interviews, then we're going to go and do focus groups with almost 20 Different targeted priority populations, including incarcerated and the unhoused. And then and homebound seniors as well. And then we're going to do a provider survey of folks that are hired professionals working, you know, with older adults, and then we have a community survey that will follow that, as well. So, you know, the county is, is really going all in, you know, to do this very thorough assessment. You know, and we would really appreciate it, you know, any kind of referral to anyone else you feel we should talk to in this process.


Yes, yes. Well, you know, the office on aging is part of the steering committee for this. We can't talk to her because it would be a conflict. But we've talked to other members of her executive team at the office on aging.


Yeah. Oh, good. Okay. Yeah. Yeah. Good. That's great. No, it sounds like all bases are covered. i It's awesome to see this work getting off the ground. It was I was involved in the very early stages when we were thinking about a county wide needs assessment for the aging population. And really, it came from the state's master plan for aging. We wanted to put together our own master plan for aging in specific to Orange County. So I just love that this work is getting off the ground because I wasn't able to stick around to see it through but it's just nice to know that it's happening.


Well, you're a part of the effort. Now so we'll be sure to keep you abreast of the developments. And if there's anyone else that you can think of or any other new organization you think we should connect with for any of those other study instruments, please feel free to reach out at any time.


Oh, thank you so much. It was nice speaking with you, Katie.


Same here. Okay. Well, I wish you a wonderful evening. Thank you so much for making the time.


So the primary goal for today is to identify what needs you think are most important to the older adult population you serve. That's defined as those who are 60 years and over. We want you to think as broadly as possible, taking into consideration the older adults, caregivers, families and their community. I am going to share my screen so you can see a list of common issues and concerns impacting older adults. So I will share now


So please take a few minutes to read through this list. And let me know when you're ready to begin.


I think just starting off with how FAM adds to this conversation, housing, affordable housing for seniors, we see a tremendous amount of need when it comes to being able to maintain housing, housing, with fixed income, and so that would be a priority area, but also speak to homelessness, the increasing average age for people who are experiencing street homelessness is also on the rise. And taking into consideration the actual physical age of the person, given the circumstances of being on the street and the more rapid aging, their physical and their physical condition is known as homelessness is a big one. And then I don't see it on here, I do. Transportation.


Sure. So I'm the CEO for Family assistance ministry, and then we provide systems to move people through their, from their state of crisis into stability, providing them with support and their case management, coaching, financial literacy, financial aid, food support, nutrition, aid, and housing, and emergency shelter.


Thank you. The next question is thinking about Orange County and looking at a list of common issues and concerns.


You know, just one slight deviation between homelessness and housing, shelter, emergency shelter or recuperative care that might fall into well I guess it could fall into caregiving or health care access, but it's not specifically outlined. So I'd say if I was to add one, it would be that, shelter emergency shelter navigation center. Okay,


thank you. And I know you listed a few already but of the needs on the list, including the ones that the one that you just suggested, Please rank the top three that you feel are the most important.


Top three, housing is number one. healthcare access and delivery is number two.


And because transportation is number three,


thank you. So we will go through a series of questions for the three areas that you have identified.


Well, I'll do the, I'll do two perspective on it, number one with limited income and potentially increasing costs, right. So it doesn't always spends a lot to have enough income to support the increase in costs. And so it goes into second piece which is the general housing affordability and the lack of true affordable housing. So I think it's both an income as it's driven by income, and resources as well as the landscape and the shortage of affordable housing that exist.


For sure, thinking about the requirements to access affordable housing, it is a bit of a survival of the fittest, you've got to be super persistent in order to gain access. And that means  definitely, and identifying different processes and being able to follow the different processes to gain access to affordable housing. It's, it takes a certain level of privilege to be able to do that both physically and mentally, not work wise, you know, it's much more supportive of a process if you have somebody who will be around or guide you through the process or help you navigate. So there is that plus, if there's any barrier that's presented due to cultural background or language limitation, there's not a whole lot of accommodations that are created within the system to access affordable housing.


Thank you for sharing. And what do you suggest is the best way to address this need and issue


build more affordable housing throughout the county, don't concentrate the need, or concentrated poverty and have it integrated within communities that are a variety of socio economic backgrounds. So county wide strategy, more affordable housing. And then also, I think that there's a lot of value with the older adult population to also pair people with socially competent navigators and support team members to help them through the process people who understand the process and can take someone and support them through.


Thank you. So moving on to the next topic.


I think it's the frequency and the complexity of accessing medical services primarily, can be a challenge. prioritizing what is most important in a given point in time, focusing much more on the reactive nature, I think of health care and addressing acute care, versus what could be more preventative care, just given the overall investment in engaging with the healthcare system.


It's so broad, I think that the kind of per visit, payment structure for the healthcare system may promote more visits, versus the focus of the outcome that they're seeking to achieve. So I think it's driven primarily by the payment structure for health care.


It's been my experience that yes, that is that is the case, oftentimes driven by healthcare insurance provider, or lack thereof.


Thank you. And what do you suggest is the best way to address this issue and need.


So being able to access safe and reliable transportation, I think that there has been some efforts to create more flexibility Within the transportation itself or the public transportation that's offered, access has been one services that's highly utilized by the folks that we see at FAM but it doesn't really allow for a lot of that independence that people are seeking, you know, it's on schedule. It's with other folks. Uber ride sharing has been successful as route as well, but not without assistance, and so I'm not sure.


I think the transportation is much more about the cost of it. I know that certain, depending on the level of need, certain folks will qualify for the ride share, but not others. And so it seems to be a decision based on the monetary exchange. Thank you.


I will say yes, and much more driven by the ability to use technology.


And I would say that we're creating a path for that simple to access a service much sure what that will look like. That's the biggest challenges, it just becomes so complicated.


Thank you. So that is it for the needs section of this interview, and I will stop screen sharing.


I would say this is probably outside of the scope of what we provide. So not a lot of familiarity. Okay.


Not highly accessible, and again, focusing on the South Orange County region.


Yeah, I think when we see clients and older adults in need that come to us with the decision of staying within their current housing situation and need, oftentimes driven by financial needs, may weigh the reality of additional care that may be necessary. And so then the pathway to compensation and getting them on a plan made and apply that they need longer term care. And so being able to connect them to a resource locally, so that they can stay within their community has been very challenging.


Similar response. Yeah. You know, if we can find a provider, and they're typically not located in South Orange County. Okay. Thank you.


What's funny that we are one of three organizations, social service organizations that provide care in South Orange County around accessibility and housing. So I would look at the Advance OC, see per capita what that equates to, but it is. It's low.


I think the technical divide and technology divide will continue to be that that wedge will continue to grow. I think that runs into the opportunities to access transportation and support. I think if the lack of affordable housing continues to grow at the rate that it has. We'll see some additional consequences to that as well. And an access to nutritious food. You know, we've seen that and the disparities and access to that as well. The direct correlation with health, the health outcomes.


Thank you. And in your opinion, what do you think the government's role should be in meeting the needs of older adults in Orange County


adequate amounts of safety net resources, increasing SSI increasing opportunities to to purchase food and not making folks rely on additional systems that are also funded by the government. streamlining that resource to not really force older adults to navigate through complicated systems and really be limiting adequate care.


Um, that's a tough one to say, because it's going to be the folks who are not engaging with systems, and are the folks who are figuring it out or not figuring it out. I think that we have a population of undocumented people that are here and have been a part of the workforce and are now aging. And I didn't know if we're, I don't know if we know them.


I don't think it's being overlooked. It's something that's not being given the attention that it needs and that's around affordable housing. Okay,


thank you. So, in addition to what we've already talked about, let's dive a little deeper into your area of expertise. So thinking about I know you mentioned affordable housing a lot.


Yes. kind of goes back to affordable housing, we work with older adults, it's in the symptoms that they're experiencing because of affordable housing. So yes, I would say that the core is affordable housing.


I think some of the demonstrated, the projects that have demonstrated success have a social service integration as a part of it. That allows for more than social emotional connection within the community, but also true support and transportation and more of a whole person approach to the delivery of the services on site. So I think that that is how it's working. And people people stay and you know, seem to more positive outcomes and folks who are heavily rent burdened or unable to maintain or overcrowded and when we think about intergenerational housing as well and what's what does that look like there's the benefits, but then there's also the responsibilities that are connected to that type of setup. So certain things to consider save quite affordable housing, by definition and then you have housing that is made affordable by the circumstances.


Thank you, and what new or revised policies are needed.


anything in California is a challenge and tremendous amount of  pressure to seek one. Now, there are additional costs for developing So fees in California projects ensuring that they they do work and enticing developers to take on projects with senior housing. There's there's so be opposition, and by people who don't want anything built, and we still need the support of the local council to approve the projects, and then you've got the density on these products as well, with senior housing. It's been my experience that parking has not been as much of a concern. So you can bring with those waivers that make it more feasible.


If we're talking about the policy issue, the ground folks like Housing California, they do a great job at supporting with with housing development, I think, do you see us as a good one also to align around this place around social determinants of health. Now, although housing today's made me much more aligned with health, it's still categorized as a social determinant.


We use data around the health system, the frequent utilizers of the emergency services, calls for service data that indicates poor health. And then looking at how, you know, how does that align with the resources that we have to offer. So if it's a matter of needing additional care when discharged, and they're in a situation where their financial burden that we will be able to step in and build that bridge from, like in that crisis to more stability.


You're talking to the hospitals. Yes, I would think through also the impact for the updated, updated Senate Bill around discharge for the emergency departments. And that criteria to identify any additional social determinants of health that would need to be addressed before or during discharge, that would be an important correlation.


To the government, it's important to consider as well, because we do as communities have to prepare for our, our, our aging population, and so what are what is being done to help support that, you know, my loss would be build more affordable housing, for sure. But there are other ways to also help prepare.


Of course. Okay. Great. Thank you. So that concludes our interview. Thank you so much for your time, and you've been incredibly helpful to our research. And if you find that you have more to share, feel free to reach out to us. Our contact information is available on our website, which is just www dot advance oc.com. And you can also leave an anonymous voicemail on our telephone line at any time. So at this time, I will stop the recording


Okay, so the primary goal today is to identify what needs you think are most important to the older adult population. And we define that as older adults 60 years and older. Now, the adults that you serve now we want you to think as broadly as possible, taking into consideration the older adults, caregivers, families in their 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 of course, let me know if you need to enlarge or move up and down or however you like.


Okay, okay, great. So far record, can you please tell us your role and how you interact or engage with older adults.


So I work in an organization called Justice in Aging. We are a national legal advocacy organization, whose mission is to use the power of law to fight senior poverty. We engage in several different types of advocacy on behalf of older adults, low income older adults, including impact litigation, technical assistance to service providers and people in the Aging and Disability Network. And we also provide trainings to that network as well. We do not provide direct representation to older adults. So my work is informed through a policy and systemic advocacy lens. It is not based on individual client representation. The only time we would represent older adults is in class action or systemic litigation. And my work for the past two years has been in part to help the state at the state level the master plan for aging, I co lead the equity in aging advisory workgroup, which assists the California Department of Aging on implementation of the master plan with a focus on equity. I can keep going, but I think that probably is a good start starting point.


So I don't know where it would fall. But I do know that in particular, for given the communities that live in Orange County, we know nationally and internationally that there is a significant amount of racism, that older adults of color continue to experience in many forms, but especially in healthcare access and delivery. So maybe that gets to the access to culturally and linguistically appropriate care. But I think it's it's a related but different issue. So I would think about discrimination. I would think about both race based discrimination but also ageism, and the ways in which it's hard for people to older adults to find employment. So maybe that's economic security. So I I feel like there's a there's a category here around protecting the rights of older adults that is missing that could encompass anti discrimination health care, anti discrimination, employment, etc.


Yeah, all of this on this list, hey, Please rank the top three that you feel are the most important.


This is hard. So I would probably pick economic security health care access and delivery. And was one more community and family safety. And the reason why I was also I can, coming in a close fourth and fifth, our housing and homelessness. But I think the answer there is economic security. Because I see those as related. So if you are economically secure, you have access to safe and affordable housing. So those would be my topic, it would be the health, economic security and Community and Family Safety.


I'm gonna dive into a little bit deeper of all of the each of the three topics that you just identify. How or why are older adults struggling with this issue.


Orange County, much like the rest of the state is a very expensive place to live. And for low income older adults, who rely on a fixed income and largely rely on a combination of government benefits and other assistance. They have difficulty making troubles making ends meet. And that means sometimes not being able to pay for basic necessities. That means sometimes to my point about housing, that means potentially their housing is in jeopardy, it means a lot of older adults end up cutting pills, right and making sacrifices in terms of health care, because they're afraid of costs so that positionality puts older adults across the state, but especially in Orange County, because Orange County is so expensive, in a particularly vulnerable situation. So the more resources in support that we can provide, that would allow older adults to achieve economic security. That would be sort of answer number one on why that issue is so important.


Oh, gosh, there's a lot. One is budgetary constraints. So, you know, we are in a world where it's a fixed pie, unfortunately, both at a local, state and federal level. And what that means is that a lot of other issues end up you have to make some hard decisions about who gets what resources, unfortunately, that combines with, I think, a notion that a lot of policymakers have, where they're not thinking actively about the needs of older adults, we have we as advocates for older adults have not done a very good job in telling the story. And so what that means is when and organizing, quite frankly. So we don't have a good ageing organizing base to be able to fight for more income supports at a local, state and federal level. I think in part there is and this is probably consistent across all three that you'll ask me about, but there's in part ageism, that is baked into how people are thinking about these programs, and whether they're thinking about these programs, and whether they think those programs are worthy of support. You know, I think that what we're talking about is access and increased eligibility to government benefits programs. And there are a lot of stereotypes about who are on those programs, and who benefits from those programs. So those would be some of the barriers. I also think it's a really complicated policy question because there There's local county level support. There's state support, and there's federal support. And all of those are different actors trying to provide some meaningful level of assistance to older adults in terms of their economic security. And then I think it's also just important to mention that we are in a very politically sensitive time and politically charged time, which means that a lot of things that should have bipartisan support don't, and it's hard to get people across the aisle to agree. And that's really more on a national level, but it's one of the barriers that impacts people from getting what they need.


Right. So that's, you could probably spend an hour just talking about that. So, you know, I, our policy work focuses mostly on low income older adults. If they are otherwise healthy, in a medical sense, and they have secure, you know, income with a pension and investments. And they own their property, they might even own multiple properties. income supports is not an issue. But for folks who are low income for and we know, those are disproportionately people of color right. For disproportionate populations, that becomes even more of an issue. And I think it's important to articulate that, like, the low income piece means that we're talking disproportionately about older adults of color. And that in communities of color, there are disproportionately higher rates of disability, all those three things are connected, they're not causal, but they're disproportionate in each of those. So we're talking about various, it's probably important to paint like a very clear picture of who we're talking about. And I would imagine in Orange County, where you have really affluent communities, and you have communities that have less resources, that divide becomes even more apparent. I'll also say, and this goes to another issue is like, both across the state and in Orange County, is we have a number of immigrant, older adults. If you are here without status, it is even harder to achieve economic security. Because there are policies in place that actually prohibit you from qualifying for the types of services and supports that would give you more economic security.


Oh, gosh. Because the root causes of the problems are so complicated, I think it requires multiple solutions. But the clearest solution to me is increasing the economic support for low income older adults in Orange County. And you could do that through a mix of federal state and local policies. But ultimately, that would be both giving more support and increasing who qualifies for that support.


And then move on to the second issue you identified, which is health access and delivery.


So this issue is, you know, one of the reasons why I picked income before was because many low income older adults are on fixed incomes right there on a they get 800 something dollars from Social Security for their SSI. And that is a very specific issue that older adults face and people with disabilities. on the healthcare side, we know that as you age, your health needs typically increase. So we're talking about a population when we're thinking about them being low income, we're talking about a population that has higher health needs. higher health costs. And they experience, unfortunately, multiple systems of care. Because we don't have universal health care in this country, we have a very fragmented delivery system, which means that someone could be qualifying for Medicare, they could qualify for Medicaid or medical here in the state of California. And they might qualify for some other benefits, too, that are related to their health. All that means that we're leaving a population of low income older adults to navigate a very complicated landscape of delivery. Does it include food and nutrition, all those things are wrapped up in health. And there's lots of different systems that are trying to provide care. And that's ultimately if you're eligible for that, right. So the reason why it's important is there's increased health needs across the population. And the way that we're trying to meet the care for these people, is very complicated. It is not simple, and it's not user friendly.


And what the area exists to see improvement in this area.


So I had mentioned, you know, the primaries, the way that we think about health is through Medicare and Medicaid, or Medicare medical, I'll start with Medical. Well, because that's state specific. And there's lots of barriers, you know, there's barriers to people applying for medical because they're afraid of a state recovery, for example, which is a policy that allows the state after you pass to come and collect, recoup the costs of your care from your estate. And there are federal limits to that. But that's a policy that a lot of people are really scared about, and they don't enroll in MediCal because of that, which then means they're paying out of pocket for health care costs. And that impacts their economic security, right. So on the medical side, there are policies in place that prevent people or scare people from being enrolled. Similarly, even when you are enrolled, there are a lot of issues around can you get the care that you need. You know, depending on where you are in Orange County, there may be providers. And there may not be providers who provide the services that you want or need. And that's I think it's important to think about health in lots of different ways. So here, I think there was a separate, maybe there was something separate on mental Oh, behavioral mental health. So I think of all those as the same thing as like part of the big umbrella. Do you have a dentist, all those different pieces. And that can be really hard to piece together as an older adult, because you're navigating lots of different people. Because you have both Medicare paying, you have medical paying. So and the other piece of this is long term services and supports, which I think is listed.


Maybe it's not listed, I would add that under health care access and delivery is access to home and community based care. People for the most part, do not want to go to a nursing facility. They don't want to leave their home. That's a broad brushstroke. And there are some exceptions to that general sentiment, but most people don't want to go to nursing facility and we know that upon admission. The health outcomes generally are worse when people enter nursing facilities. So it's really important that people get the care they need at home. And some of that is telehealth. So there's a note here about virtual healthcare services. But that's also you know, someone coming to help you with activities of daily living. That's also someone coming to do your laundry, cook your meals, do all the things that you would need help doing. So I think it's so when we think of about Home and Community Based Care, there are a lot of issues accessing that in the state and in Orange County, you might be able to find a dentist, you might be able to find a mental health specialist, you might be able to find a primary care physician. But you might not be able to get someone to come help you with activities of daily living. So that becomes increasingly a large barrier. And then I would cite before what I said about we're leaving a population that tends to have lower health literacy to navigate a very complicated set of programs.


And then, are there different experiences for different groups of older adults from different backgrounds, like where they live disability status and education


Um yeah. So I would cite you, I would point you to the Commonwealth report, the Commonwealth Fund issued a report last year around discrimination in the US healthcare system, that older adults of color, I think they said I can't remember if they said 60 and up, or 65 and up. Enough experience. And it's pretty systemic 30 40% of older adults of color report being discriminated against in healthcare settings by their providers. And similarly, there are providers who are who discriminate against older adults based on their age, older adults report not being taken seriously being treated as children having their complaints around health care not taken with the same weight. So all that comes to a head for folks. And then I would say if you're lower income, it's going to be harder for you to get the care that you need, even if we have some supports in place to try and get you that care. And if you live in particular, in areas that are not as urban, it is harder to find those providers. And it's harder to get transportation to those providers if you can't otherwise get yourself there. So all that is exacerbated when we think about the who. And those barriers are not experienced in the same way by the same population.


What do you suggest is the best way to address this issue.


So like income and economic security, there are a lot of root problems. And it's really complicated. We're not going to be a universal payer system anytime soon. But what I would suggest is similar to the income supports is that we need better and more culturally appropriate care for older adults in the healthcare system. That includes one that is anti racist and anti ageist. It means that they can get the providers that they need in the time and language that they speak. We need a better care infrastructure for older adults in Orange County.


Moving on to the third topic that you identify, which is Community and Family Safety.