I think you can talk to any member of the aging services collaborative. And that would be effective. Holly Hagler Meals on Wheels, Orange County, Lisa Wright Jenkins Council on Aging, I could go through the jack at Figure Resource Center, Mario Ortega, abersoch. All of their CEOs have a very specific lens. If you're talking to Mario, he has a very good eye into the Latino community in Orange County. If you talk to Hnun Nguyen at some length society, she has a really good eye into the Korean community, Elena and also so I think, one making sure that you're reaching those disparate populations, the LGBT Center, for example, they all have a very specific perspective. Our organization kind of reaches across many of those groups. We don't do it perfectly, but we at least attempt it. So the fact that I'm an Anglo gay man, that's only my personal perspective, when I speak in this interview, I'm trying to represent the organization and all of our constituencies. So when you get to these other organizations that are very specific to a culture or community I think you enhance your insights into that very specific community and that's really needed in Orange County. It's a diverse place


well, this concludes our interview thank you so much for your time you've been incredible Oh my god. Well, I just I need to conclude by saying that if you have anything else to share, please feel free to reach out or you can leave anonymous comment on our telephone our website. I'm gonna stop recording now. Let me know


All right, the primary goal today is to identify what needs you think are most important to the older adult population you serve 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 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 that list. And let me know when you are ready to begin and I will be asking some questions based on that list


I know it's small try to pack into one page. Okay, I can you know, let me know if I need to move up or down or enlarge any part of that let me know when you're ready.


Here, so my I'm the Assistant Deputy Director for adults and older adult mental health services. And so in my role, I oversee our older adult system of care. So along with the other adult programs that we have at the at the county of Orange in health care agency, we also have our older adult programs, that includes our recovery services, which is more of a clinic based setting, but we provide most of the services in the field or the or the home. Our shop and start programs, which some are related vote start is related to substance use for older adults, shop is like wellness checks are seeing how folks are doing in the community and making sure that they are connected and engaged in services if they need them. And then that also we have our FSP level of service for older adults, which is our which is our Oasis program. Additionally, which is a little bit it's not specifically over the older adults, but I do oversee in this room, the Housing Services program, and we have in in our housing, our mental health and substance use housing services, we have older adults specific housing system as well.


Yeah, thinking about Orange County and looking at this list of common issues and concerns impacting older adults.


Well, I mean, so behavioral and mental health. In your examples, there's tons of things just because it's our it's our specific, but I don't I think it all of the categories that I'm I would probably want to touch on or talk about today. I'm seeing there let me see if there's anything missing, but like I said it's more in the details of that behavioral and mental health area that I think that I think I would have, I would have stuff on because all the all the other areas housing, homelessness, access to food, being isolated, those are all things that affect us in behavioral health and substance use system and you already have those on there. So each of the other areas kind of affects substance use. I don't think there's anything missing from that just how it affects mental health and substance use is is the details that are probably okay,


well often needs on this list. You know, including anything that you suggested even though I know you think that what you said that everything's pretty much on here in terms of the category please ranked a top three that you feel are the most important.


For so for, for me, obviously behavioral and mental health, health care access and delivery and then housing, homelessness kind of tied together, but those would be the ones would be the ones Okay,


and I will ask you some question. And with respect to each one of the topics that you just identify are the top three.


I think there's a few things. There's, there's still a lot of stigma attached to, you know, behavioral health, substance use, especially right now we're seeing a lot of folks who started their  substance use in their 20s, or 30s, and now are in their 60s, but are being referred into our services. So we have this co-occurring mental health and substance use issues with folks in there, you know, who are are older. And so that's, that's become a, that's become kind of a big, a big issue that's newer, that we really haven't had to deal with in the past. We don't have detox programs specific to older adult populations. And oftentimes, folks who are having that kind of struggle don't really like that substance use treatment is so group focused in, in, in, in kind of that community focus about working on your substance use issue, and it doesn't work for older adults to be with really young kids in there, it just doesn't, that's just not how, like the issues surrounding that are so different. And so having specific focused services that they are substance use that are provided to older adults is something that we're lacking. Same for housing programs, right, we have a few of them, but but how to make sure that our housing programs that we have out there that provide our behavioral health housing, I'm talking about at this point, kind of provide the specific mental health treatment to folks who are who are experienced, experiencing homeless, but our older, older and age, again, that kind of sense of community and where you live. Oftentimes, that's that's a struggle when you're when you're living when it's, there's a bunch of younger people around you, and you're not, you're not really kind of fitting in with our community. I think an additional piece for mental health is really is really how we get services to our, our older adults. Transportation, around getting folks to their appointments is a struggle, getting like being able to provide services directly to like in the home for folks. Because there's oftentimes there's isolation, issues that surround that, like making sure that we get out to treatment. Because right now we have a kind of a crisis in hiring staff to provide service. But the numbers needed to kind of get out and make sure that we're meeting clients where they're at, is a struggle for us. We don't, we don't always have that it's new graduates who have never worked. Sometimes it's good sometimes that that is what people are looking for, but it's not always and so they're having folks who are who come into the system who have some experience and, and I've worked that that's helpful to our older adult population and feel more comfortable with the more experienced clinician. And so that's another kind of crisis that we're in right now. We have like food scarcity is an issue in in making sure and how we kind of wrap services, additional services around our mental health programs. We have referrals, but there's just not the numbers that we're seeing right now mental health some good like good conversation around it, and then Health Awareness Month and everything right, we have a good conversation around things right now. There's more. There's more information out so people try to access more. But we then we see that we have more people in our programs who have additional issues when we go out and visit with them that additional issues and in food and food scarcity is really a kind of a big piece for that is just in general referrals for health care and, and for other other needs, that those referrals that system of referrals for that, for that kind of stuff is not built up well for our older adult population. So those are those are some of the some of the areas where we're just kind of struggling a little bit or when we see, there's really a greater need is how we can wrap services around folks, not just, you know, they're coming to us for mental health. But we we see, our system is holistic system. And we know that older adults, when they come to us for their mental health issues have a multitude of others that we need to, it's very important, especially with health issues and medication management, super important for us to coordinate care around all of those things. While you may have just answered the rest of them, I told you, no, no, no. Stop talking. That's too much. No apologies.


I want you to I want you to continue. I mean, at some point I well, but no, no, no, really. I I just don't want. We don't want to we don't want you to think that yeah, I already answered your question. But let me find Well, kind of follow with the I know, some of the things that you may have already mentioned.


Yeah, so barriers, I did mention a few is being able to get to where our older adults are usually in their home. I mean, our goal is to get folks out in into the community, but a lot of but a lot of times, that's not always possible. And so making sure that we can get into the areas where we need to see older adults, making sure they understand how to access our system, it's it's a confusing system or for all of us, it's confusing with, if you have a mental health issue, it's it doesn't make it easier to try to access. And a lot of times because of stigma, especially with our older and older adult population, reaching out and asking for help on these things is not it's not something that's huge. So making sure that we eliminate stigma, making sure that we get the message out to people making sure that we advertise in the right place. For folks that they know how to access our system, making sure people understand that they, they're not going to have to go into a location or sit in a group with a bunch of kids who don't really have the same kind of issues as them. And really in built a good system. Some people may just think of oh, I need to go get mental health treatment, I needed to get my son to use treatment, but don't understand that there's services that are really focused for our older adult population. So getting that information and that message out to people is a big, it's a big barrier. We want to make sure that people know about us and know how to access and know the breadth of services they have to access.


Now are different experiences for different groups of older adults from different backgrounds, for example, where they live, disability status, income, education level, etc.


Definitely, definitely. Like those specific areas of focus. We have to take a look at in part of our larger system, right and so developing. Because not every older adults as a population themselves get their information in one way. But also lower income families get their information from another source and not everybody has access to internet and for older adults. Oftentimes they don't use internet, right. And so how we get that information, how we provide it and how we get it out. It definitely changes based on not just their status as an older adult, but also all those other factors that you just mentioned.


And we have to, we have to go to all the different communities, we have to have community events, we need to go and talk at senior centers, older adult, older, older adult, like places older adults frequent. And make sure that, excuse me, it makes sure that we that we really, that we really are finding out what's been difficult for people in the past, right. And so we know that sometimes people have difficulty accessing, and we can kind of make up in our minds. This is the reason why they've had different difficulty accessing some of those things I probably have done today, where I just may have made some assumptions. But realistically, unless I go and have a conversation, or ask folks about how we would have made their experience better, it's it or what what areas or barriers they're running into. And so we always want to make sure that we're getting out to people. Well, this would have made my experience better. But those are folks who actually were able to access, but we're looking forward to the people who weren't. And so how to get that information out with the million other priorities that we're working on. Those are all those are all big pieces, but I think community groups and the other groups that we attend, are helpful in that we put into, but that's always an ongoing process.


Okay. Okay. So now seems to have a question for the second topics that you pick, which is health care, access and delivery, right.


I think I don't think it's that different from how they're accessing mental health services. I think that there's


I get a message I get multitasking by accident. I apologize. I think that, especially right now are one of the things as it relates to us, as far as healthcare access and delivery, is that we have a lot of neurocognitive disorders that are kind of making it difficult sometimes not only make it difficult for older adults to access health care, but also to differentiate between a mental health condition and neurocognitive condition like dementia or Alzheimer's, right. So those that not only does it make it difficult to access the care you need, but it also, sometimes you show up in in a place that's not the right place for you. That sounded bad. What I guess I'm trying to say is we need to make the place you show up the right place for you to be able to get help. And so. So that's the access piece I'm talking about is. So folks, oftentimes show up at a health clinic or show up at a mental health clinic or show up at a substance use program. And that's not necessarily based on whatever condition they have the place that can treat what's going on with them. Not, hey, you showed up here, this is the wrong place, go there. But hey, welcome in. Thank you for coming to our clinic today. Here's some things that I can give you in here. And here's another program where you're going to need to go and I'm going to work with you on these other things. While and make sure you link there. So I think that that that access issue or that healthcare issue is that we're not we're not well coordinated as a whole health care system. Well, we're each of our individual groups is is really good at doing what we do. But we know with older adults, you don't always show up at the place where the right place right for you. And so that so we have to coordinate that system better. So that so that wherever you show up, it's the right place.


So again, and what barriers exist to see improvements in this area.


That I think the biggest I think the biggest barrier. I mean, one of the biggest barriers is that those systems don't talk well to each other. If you're if you show up at a substance use program. It's it's almost impossible for for that program to share information with other programs, right. And there may be a huge issue with that, that needs to be handled. But unless you can get somebody to sign a release of information to share information across, it's very difficult. You also another barrier, and so that that ability to share information is, is difficult. We don't have health, like large health record systems that that work together, right. And so if somebody wants access to some information about a client that I'm working on, they need to sign a release, they need to request the records they need, it goes through this process. And at that point, we may have already been doing something with a client that we don't even know about. Person who came in would have to tell us that they're getting treatment at these other locations, and how in order for us to know that and so just that coordination of health, for the whole person, it's so important for older adults, it's important for all of us, but it's really, it's so important for older adults, because everything's kind of intermingled. And we just don't have we don't have that that's the kind of the biggest barriers, the ability to communicate across health systems.


Yes, I mean, I think that that's, that's always the, that's my, that's gonna be my answer to all of those. And similar to the first one, it just, it's just really


there's so many, there's so many little things, two, stigmas one, but just so many little things that little, so many pieces of a person, that, that make them different, and want to access things in a different way. It's for some, it going to the mental health clinic is an okay way of doing things. And for others, the only way that you would want to access any treatment is by going to your primary care doctor, right. And for others, it's it's a, you know, a religious leader or other just depends on your on your situation. So there's so many things and it's in, I think, across, across our healthcare system across and I know across the county, right, this point, right now, we're looking at all of those things for everyone and how to, and how to get that message out in a multitude of ways. So that people, whatever category they fit into, there's something that makes sense for them in a way to access.


again, talking to talking, I mean, talking to the experts talking to the professionals in the field, I didn't mention that the first time, but also talking to the people who need the services, right, or family members of people who need services, going to advocacy groups, right, like talking to the folks who are who are advocating for our older adults and for but but it's, I think, too often, it's not because we're not thinking about it, but probably just because we're so busy. But I think too often we try to make up the reason or the view, the way to help people, instead of asking people will help you. And so I think they'll be like we have expertise, and we can figure out how to, we can explain to folks the regulations we have and the funding we have, and we can explain all that. And so that's the those are the questions that we just need to find out and more aware of and really be like, oftentimes, I know all the pros, I know what my programs, do I have several programs, I know what they do. Like those are the kinds of things that also make a difference. Like all of those things are are pieces of what helps people kind of feel good about coming into services and feel comfortable with us. And that's really what it's about is we don't want somebody to come once hate their experience and go away because we know they need help. So knowing that these two is


important Moving on to the third topic, which is housing.


I just think there's not enough. I mean, honestly, I think that's the probably the biggest piece of it is, and I don't want to repeat myself too much. But it's, it's a different older adults need different things in their housing and housing is. There's, there's, there's issues related to hoarding or there's issues related to having a lot of things and having to move into another, another home. Right. Not that those are the only things but there's, there's additional issues for older adults that we don't often see with some of the younger folks who need housing. But there's also medical care, and also all sorts of stuff. And so So yeah, it's it's, I think those are having homes specifically dedicated to our older adult population, with services specifically dedicated to our older adult population, which is just basically not enough to help to help support that. And so how we kind of focus on those ideas and areas so that we make sure that we're they're not forgotten when we're when we're developing new housing and new housing situations. In that, where's that we remember to wrap services around those housing, it's not just about building up a place for people to live. It's about having the right services there so that our older adults want to live in that location. Similarly, like what I was talking about the clinics and things like that, it's it's at wanting to be a part of a home because it has the things you need at it, instead of just having a home with nothing else like that, that it's a struggle if you're homeless to move into housing. Specifically older adults do that we don't have enough of them.


I mean, the major barriers are funding. There's another another barrier is is nimbyism, not not that folks are like, Oh, we don't want older adults in our but we don't want housing projects in our in our area, right, like, and so are we don't want mental health housing or we don't want bridge housing or so that continuum. We could we could, you know, buy up a bunch of properties. But if if the neighborhood or the neighbors are not helpful in that, and we have had folks in government saying no, these programs shouldn't exist in this area. That's that's a problem. And so nimbyism is a barrier, it really is whether or not people understand that, that they're just true neighbors anyway. It doesn't, it still still holds us back from kind of developing things forever. We at any moment, wherever we want to sell another piece.


Yes, definitely. And so some older adults tend to like to live in communities with other older adults and others don't write like so it doesn't, it doesn't necessarily, it doesn't necessarily mean that we have we have to have a community of older adults. But we have to think about even in even in the housing communities that we have that are not dedicated to older adults, we should we need to be thinking about what services do we wrap around this that would be helpful to an older adult who may want to live with with some young with younger folks, or just a wider variety of those not just an older adult site, right. And so still having those services available for for somebody with issues related to aging, but not necessarily only like you have to live in this spot because you're an older adult, like then those kinds of things are different. So yes, there. There's definitely differences, but I think for the older adult population, that's what's probably I mean, as it relates to housing, that's probably one of the ones that it's big.


Again, I think we need to take a look at and this one, this one I won't say the same thing I said the other times because I have people already telling me about like some of the housing situations that are in in my new role with the housing but but I do think that addressing In addressing needs for all, like ages and stages of life in our in our housing and our homeless, and our mental health and substance use housing, addressing those issues is really kind of the biggest thing is we can't say we can't leave out a population because it's not this is just a general program, it being a general program means that you may have older adults there. If just because I'm, you know, 65, 70 years old doesn't necessarily mean I want to go to the older adults recovery program, I might want to go to just the  clinic. And, and are we thinking about how we how we can make that easier for folks in all of our programs, not just ones dedicated to older adults. So I think, in housing especially we that's something that we've, like, Oh, we're working on older adult housing right now. So we're going to focus all the energy in on that. But we don't we forget that maybe there'll be an older adults who want to buy their houses, and we don't, we don't take that over there and focus that same kind of energy on what those services


need. That questions are the next set of questions. First one is geriatric care.


I would say it's, I would say it's adequate. But again, accessible, is the is the hard part, right is making sure that people know how to get to services, how to have there's not enough transportation, like most things are advertised on the internet. And that's not always the way that people get information. And and so the care I think, I think the care for older adults at the Locate the especially in the economics, really speak for mental health and substance use. I think that that care is really good and well rounded. And we have really good services for folks. It's, it's, it's making sure that people can access it. That's not That's the difficult, it's a difficult thing.


Well, I would say there's probably not enough. There's not enough so maybe not quite as adequate. Especially specifically dedicated with, with the,


there's definitely not enough beds, and definitely not with all of the services that need to be provided for, for older adults. What we do have is good. It's not a it's not, there's not enough. There's just not enough. And so as there's so the the numbers needing to get into services far outweigh the numbers, we have services that the artist provides, I would say, being able to access it is definitely difficult because there's there's just not enough. And then what's provided when you when you're there is good, but could be probably couldn't be better.


we have a very full continuum, we have a lot of services, provided we have a ton of those things. Right. How do we make sure that not only does the does the person who might want to seek treatment know about it, but a family member or somebody who's looking to pay for services, or somebody who's who, just as who's working in the field, but in a different area knows about all the things that we have, though, that's where we're, that's where we're struggling. What we have and what we can provide is very good in the quality of the clinician, the quality of the work is great. It's it's just making sure that people can get into services and have those especially with Seems like the transportation, like I said, making it to getting somebody to an appointment, making sure that we go out to those programs and get out to people like that's those are the things that we really need to focus on.


mentioned them at the beginning, but I I'm very interested in how many other people do and so that's that's the, that's where I think this is going to be beneficial is, is I'm my worry is that a lot of people don't, right, like, I'm not gonna go off on all the things I know. There's, there's several, and I know, and I know, pretty much all of them. But But in addition, the ones outside of that the county provides but but I'm, I'm not sure that a lot of people know, specific for older adults. And I don't know that they know that we have, even though it's in our name, I don't know that they know we have a specific program designed with housing, in our housing area, and in our in our mental health and substance areas designed for older adults. I don't know that many people know that.


I was gonna say if they don't, I want to know about that. And I want to know, like what we can do to advertise.


Yeah. I mean, so I think, again, I think that they're, I think that they're adequate, are adult protective services. Again, it's hard, and it's also so accessible, it's again, hard to know that from the outside, right. Social Services can't like they can't, if you make a report and EPS report, you can't all of a sudden, know everything about how that report got followed up on. Right, they don't share that information back to you. And so how how I would know, as somebody outside that, that those services are actually benefiting clients or that they're that they're that what they're accessing, is actually helpful to folks. It's hard. It's hard to say, I know that services exist. But I don't know if they're adequate or not, because I because we can't really get that information about about health, or I can't get that information about how how beneficial it's been for folks to go there. You only kind of see it, as you continue treatment with somebody, you might see that somebody's doing doing better, or that they're not having the same issues anymore, but you may not necessarily know. So it's hard to say I would say I guess I would say it because of the shortage and staff across systems, it's probably just not enough people to do the work to the quality or the level that would be important.


Like there was a lot of substance use, like new substance use, you know, in different types of substances being used, you know, 20, 30 years ago, right, and now folks who were dealing with that are aging into the older adult population. So I do think that substance use is going to be there was a big kind of a spike around that. I'm praying. And so I do think that folks who the the older adult system is going to we're going to see more and more substance use issues or substance use related issues with people, and then all the medications that people were on a few years back. Because of that, and people becoming addicted to it, we see a lot of opioid issues with our older adult population. So all so those things are kind of new. And I think over the next few years, we're going to not that it's new, but it's in our in our older adult population. We're going to see that increase as we kind of flow through time here and we're, we're we're over the next few years, we kind of see how that those issues in our society affect our our aging population. I think


I think housing like housing, housing in general. our homeless population is is also aging, right. And so they're aging on the streets, unfortunately. And so how and so that's going to be another issue as far as providing service. And then I would say those are probably on Just trying to oh, I mean, I don't know that it's new. But our food scarcity issue issues or being able to get, get a hold of resources that that are needed.


Inflation, it everything that's going on those those resources. While they're out there just aren't, I would say in the next few years, they're not going to be unless we do something kind of important about ensuring that resources are out there for folks, I think, I think over the over time, as well, well, it's difficult for all of us to kind of pay for the food that we need and health and have healthy options for nutrition. But I think that that's going to become over time. Also difficult for folks for older adult population. So I would say that's another issue over the next few years. So I say, like, access to food resources, healthy food, housing, and an SUV.


I think that, in general, the government needs to set up task forces, which I know they have, but really


or make a focused effort, kind of like what you guys are doing now. Really, really focused on on older adult issues, right. And there's going to be a huge, like, it's going to be a high a high percentage of our population is going to be older adults, here in here in a few years. Right. And so


how if we're not, if we're not really taking a focus, look at what's what services are working, what things are not, in, and what we need more of. That's the goal. Like, here, you're taking a big picture, look at like, here's what's going on for all of the folks in our community, whatever, however big or large that community is, depending on what part of government you're in, if you're not focused on that, in, in the years to come, we're going to be behind, and we're going to be playing catch up. And so that's, that's what government's job is, is to really say, like, look at our community as a whole and find areas where we're missing out on


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


it's a hard one. It depends on what you mean by it. So at least amount of services, I would say our homeless population, but they get a lot of attention, because they're, there's people always talking about it or or saying that it needs to be done. But the amount of services that are actually available to them. In the ease of access for folks were who are homeless is very difficult. If they're not in your face. That doesn't mean they need less help. They're just not there. Services, I don't necessarily think that's the case. And so I would say, you know, isolation, which we have a lot in posted neurocognitive disorders who can't necessarily kind of speak up for themselves, right. It's all family members or folks, those are those, most of the people I would say, get the least attention because they're not the squeaky wheel right. Now, it shouldn't be it's not the way it should be. I just think that's the way


thinking about all the issues facing older adults in Orange County.


I would say it's that issue about coordinating holistic care.


I would say that that's the that's the area where we're not I mean, I think people who are deep into this know about that right and and understand that but, but really not real realizing that I can show up five places and be told I'm in the wrong place. Even though, even though I'm just a person who needs help, right, and so that's the And for an older adult, I mean, not a blanket statement, but for an older adult, to get around to a bunch of different places to try to figure it out on their own. That's tough. That's difficult. It's difficult for anybody, but especially someone who maybe doesn't can't travel or doesn't have a family member to take them around or pick those or who can't access things online. Right. Those are those that's, that's what I would say is nobody's really thinking about a system where any place you walk in, you can you can, you're in the right place, right. And that's really for older adults, I think that's almost the most one of the most important things.


Right now moving on to our last set of questions. So in addition to what we have already talked about, let's dig a little deeper into your area of expertise. So thinking about your topic, which is dementia in focus, healthcare reimagined. So these are habits based on the California master plan. You're with mental health and recovery services.


Think that I think there's not really. I think so.


I don't know, I don't know that it's much different than what I just said, I'm trying to think of I think, slowly, I'll start with where it's working. Because what my what I just said is where it's not working that then integrative collaborative thing. So I won't say that again. But where it is where it is working, I think is, first of all, having the conversation started. Secondly, the understanding that there is a specific population, a specific group that we need to be focused on, understand, and, and talk to right and figure out what people need in, we're starting that process. And then I think that noticing the, that our population is aging and providing in establishing more and more services. And not going away. So in the past, we might have gone away from saying adult and older adult mental health for my area, right, it might have just been adult mental, everybody's an adult, right. But really focusing that there's more to it than then than just we provide mental health services. And everybody can come in here that really that there's a there's a difference, I think is something that over the last, especially through COVID, really COVID really shined a light on the fact that if you don't have something special setup for our older adult clients, you're going to miss them, they're going to fade away. And that's not and that's not okay, that's, that's not part of what we want our community or our culture to be about. And I think that that's being recognized more and more. So it's that COVID thing is always a double edged sword, right, it shone a really poignant light on all of the things that we weren't doing very well. And so in and I think that that's opened our eyes and so what's good now is see where we're missing. With our, with our older adult population, especially those as it relates to dementia like


Know what new or revised policies are needed.


For I mean, at a very high level, we need some, we need some opening up on our ability to communicate across systems, right, we really need to be able to have are like less. Regulation is a bad word. I don't know. I mean, let's just less stringent on how we share or how we communicate across systems and more. So policy changes, I mean, it's it's my, the biggest ones are at a really, really high level about allowing for or requiring, sharing across us


know who or what entity is best suited to address this issue.


I mean, I think, for some of it, the federal government, but that's not very focused, that doesn't focus very well. But there's some like really high level regulate, or pretty 1000 foot regulations that need to be changed to be able to do some of the work that we're talking about. But the little bit of that it's a cop out, because that means that oh, well, now I have to wait for them before I can do anything. So I would say the I would say in general, to two groups, community, grassroots organizations that can kind of talk about can kind of put into focus where we're, where we're missing things, and then the leadership of our healthcare system that can make some of those changes, or can work around like those regulations in order to better serve folks, right. So those, it's, you need that combination, though, you need to know from that organization, or client level, what's wrong, and then you need the people who have the ability to affect change in our system, to be able to make those changes. So because otherwise, if they're not working in concert, that, like, I can make all sorts of changes in my programs, I don't know if it's actually helping anybody. And there's a bunch of people tell saying, like, this is what we need, but they're not talking to the folks who can actually do those chain, then we're not doing the stuff that we want to do. So we shouldn't be working together.


Okay, now, what sources of data do you find relevant to your work in, in this area, you know, the mental health area that you're


So my data is the the one of the big things is our we call it a penetration rate. What it really means is the number of so our mandate is to serve medical clients. But that's not even really what we just, I would say, the number the percentage of older adults in Orange County, and and then we take a look at what the expected numbers are for folks, for folks who expect to need to access services. And so that's, that's one big number that we that we take a look at. And if we're lower than the state average, or we're just low, like it just seems like a lower number than what you would expect to see and and have folks access services, then there's something that we need to do. Right. And so that's a big data point for us is whether or not we're actually serving the numbers that we would expect, when he's should or might need to seek treatment. And if we're not, that means we're missing somewhere. And so we have to figure that out. That's probably the that's probably the biggest one. Another one is co-occurring substance use or co-occurring medical conditions with mental health. And what what that looks like and what we what services we provided so that we can meet the needs, again, meet the holistic that.


so you're more than welcome to talk to my to my to my Associate Medical Director who's over our adult programs, like I think I think those are folks to talk to you, the doctors and clinicians who provide the service on a day to day basis are a really good folks to talk to. I'm sure you have a wide swath, but I think that the people I mean, I think older adults, older adults are folks that would you should talk to, yeah, in the in the people who are providing service day to day who talk to talk to folks every day in their homes and in their clinics and in the community who can tell you like this is where this is where I struggle. This is I want to provide this, but I can't because of this reason. Those are all the folks I think are important.


Yeah, of course. Awesome. So this concludes our interview. Thank you So much for your time, you have been incredibly helpful to our research. If you find that you have more to share, please feel free to reach out to us. Our contact information is available on our website www.advanceoc.com And you can leave an anonymous voicemail on your telephone line at any time. And of course you can also reach out to me now you have my contact information.


I'm gonna I'm gonna stop sharing here we go.


So you know, my name is Tirana and I'm a part of the research team with advanced OSI. And we're a local nonprofit conducting the county of wonders older adults needs assessment. Thank you for your willingness to take part in this interview. The purpose of this interview is to identify the needs of older adults and to gather insights from your expertise and experience. The information you provide will be used for the development of the Orange County's master plan for aging. This interview will last approximately an hour and with your permission, our discussion will be recorded for transcripts and note taking purposes, the recording will be shared with any will not be shared with anyone. And after transcription is complete, the recording will be deleted. If you do not feel comfortable being recorded, turn off your camera and change your name your face everybody.


your responses are confidential, meaning that we will remove identifying information in our report. Please note that your participation is voluntary. And you may choose to answer any question in part full or not at all. You may also withdraw from the interview at any time. If you are unfamiliar with any of the terms that we use, please let us know and we will provide the definition or an example of where will we meet. Yes. No. Okay, the primary goal of today is that I identify the needs that you think are most important to older adults and older adult population, those 60 years and older, we want you to think as broadly as possible, taking into consideration the older adults, caregivers, families and their community. I'm going to share my screen now. And I'm going to share with you a list of common issues and concerns impacting older adults. I'd like you to review that list. Take a few minutes to review that list. And let me know when you're ready to move forward


now it's my Zoom screen covering anything because I know some time to does I see the whole paper Okay, cool.


Okay. Um one just jumps out at me as something that needs to be added. But


okay, so I was going to ask you that, specifically about older adults in Orange County, for the record. Please some of your name, your role and how you interact or engage with older adults.


So my name is Tammy McConnell. I am the Emergency Medical Services Director for the county of Orange. i My EMS resides within the health care agency of the county. By background, I am a registered nurse by education training. So I have experience in acute care, hospital public health nursing, and then of course, emergency medical services. Part of you know one of the main Well, a lot we EMS in general has a huge interaction with the adult population. I oversee the EMS system in the county, which means that it is this office that sets the policies protocols and treatment guidelines for ambulance companies paramedics, first responders in response to a 911 call for medical emergency and also for non emergency transport of patients. So you know, a large you know, section of the EMS system responds to the age group of over 60.


I think we really need to add, besides car accidents and falls, bathtub drowning or you mean drowning in general, but it's it is specific to bathtubs. And I only bring it up because I would, I don't know is is before COVID. We did a we were looking at all of the drownings in which there was a 911 response, expecting to be looking at a lot of and when I say drowning, I mean it's they're not, you know, they're, it's almost like a near swim, you know, it's there. They've the call comes out as somebody's in the pool, they're drowning, but they're not drowned so they could be already deceased or just needing to be rescued and then revived. So when we queried our system, really anticipating to see more drownings for the in in children. And then look trying to look at, you know how to look at prevention efforts. more from a barrier standpoint, we were very surprised to see the numbers of drownings associated with the higher the older adult occurring in the bathtub we actually saw in our data, more drownings of older adults than children, which was kind of mean, we knew it was there, but I guess we didn't realize it to the scale. Everybody assumes that drownings are mostly children. And that is not that was not the case that we found in our EMS data. So I think it's really important to at least pointed out now our EMS data is only going to be data from paramedics that have gone out to the scene. It does not it's not going to include data where the person is already deceased, EMS wasn't out there and it was just a corner call. So it's not all inclusive of of the entire number of you know, drownings that were they were deceased or they were revived but anyway, that's why I think it's important to include


thank you now of the needs on this list, including the drowning in the bathtub drowning Please rank the top three that you feel are the most important


What do you owe the whole the whole You mean


top three including your your ad of the bathtub drowning and this this is specifically for older adults here in OC.


health care access and deliveries got to be on my top in my top few emotional well being um


probably economic security if I had just picked the three with my unintentional injuries a lot when I look at these I feel like a lot of them can be combined like I see I see behavioral and mental health combined with emotional well being diabetes and obesity I mean that's a specific you know diagnosis but that's like a subset of diet fitness nutrition


So Sam, what do you have for you got it narrowed down to three. You have healthcare access and delivery as one. You have emotional well being economic security and then you also We'll set your


well just just just go with those three, by only up to plus three. Because I know this isn't all about me. So it's about the population in general, I just have a narrow focus because it's EMS.


And your, your expertise is important so, and your lens from your purview.


Well, it is my personal experience, that even as a nurse, I have difficulty getting an appointment in a timely manner. I have difficulty accessing my records. And I think and then also having family members who are older had constantly, you know, trying to coach them about No, this is what you need to do when you go in to make sure you get what you need.


I think that the you know, technology is good. But when a patient especially an older patient walks into a doctor's office, and is only greeted by an iPad to check in and, and put their name in. It's, that's not it's just I don't know what the word is. It's not as familiar to them as it is with the younger generation, and they're not comfortable with it. So to me, it, it's a barrier and and a lot of these places that have things like that, there's no person there to help navigate that. And so I don't know how many times I've gone into a store or an office. And there's an older person stuck trying to do something and I've stepped in to try to help them navigate it. I I don't remember what your question was, but


just what do you why why do you feel older adults are struggling with this issue. And in the health care access and delivery,


I think that the technology gets in the way. And I think that um I think the ratio of caregivers to patients or clients is disproportionate. I think it takes a lot, you know, a lot more time to educate and, and provide services to older adults than it is to a younger population. Yet, I just don't feel that there's enough I guess time and patience and staff availability to do that. And so I think that's suggest that that's a that's a problem with, they may be able to access it, but then the delivery is is is problematic. And let me give you an example. I mean, we run into this all the time with hospice services, and generally you're talking most you know, 95% of hospice patients are going to be over 80. And we run into this patients on hospice, they're on hospice, because they're dying. Yet there's something that happens that prompts the family or the caregiver to call 911. Well, when 911 is called, it's an emergency, we're trying to save a life, there's a disconnect, because the paramedics will come in and what you know, they're there to try and they're trained to take care of an emergency, save a life, transport the patient to the hospital. But the hospice organization doesn't want that patient transferred. They want to be able to keep that patient in in their home and be able to treat them there. Keep them comfortable there. But they lack the resources that would have you know that the family member or the caregiver could have access prior to calling 911. Like, that's what 911 does. And so that tells me there's a gap In the availability of enough numbers of hospice nurses or health, home health aides that can respond, in whatever circumstance it is circumstance it is to address what's going on with that patient to keep them out of the hospital, the whole point is that they're at home, there to receive palliative care to make sure that they're not, they're comfortable. So why is it that the family is if they don't, they must not have access to something they need to take care of whatever the problem is. I'll just end it at that.


Um, I think it comes down to cost, I think it comes down to money. I think that those with those with money, have the ability to hire somebody to be there 24/7 And to take care of those needs. But the families in the in the people that don't have that wealth, have to rely on themselves. And


so I think it comes it comes down to money. And money, the money would if if if money were the barrier, and there were gobs of money to be had, then there would be the money would pay for more caregiver resources. And it doesn't necessarily have to be a person. It could be maybe access to telehealth or having, you know, an iPad or something in the home to say, Hey, I'm having this problem. If the caregiver or the patient themselves can't adequately describe what's going on, you know, a picture's worth 1000 words, maybe they can, you know, have a video there. And they can show them this is my problem, or, you know, this is this is what's going on. And the person on the other end, the caregiver, the doctor, the nurse, whatever it is, they can say, oh, it looks like this, this and that. Why don't you try this, this and that. And so barriers to seeing improvements would be the lack of money to pay for those types of resources. That make sense.


Well, I think there's many cultural issues related to certain cultures. Trying to think of some, you know, don't don't allow you know, women cannot be seen or treated or handled by a male care caregiver. There's cultural.


There's cultural nuance, there's there's cultural nuances that have to be acknowledged and understood. I'm struggling to even tell you some of them. Why


you given you know, info about there are differences, because the question is, are there different experiences for different


Improve How do you improve I'm sorry, the address.


There needs to be more Um, geriatric, for lack of a better word, you know, older adult geriatric specific programs versus having a doctor's office that does it all. I think that geriatric programs are better at focusing and honing in on all those differences that affect that older population, versus a one size fits all in a regular clinic. So I think having more geriatric nurse practitioners, geriatric DEOs, and those types of offices, I guess, medical groups that provide that specialty care to me, to me, it's it's almost like we have, we don't, I mean, some of us do, but most children, you know, from pretty much birth to maybe, I don't know, 12 or 13, you take them to a pediatrician. But older adults just go to a generalist and internal Med, and I think it's only been in the last probably, I don't know, what 15 20 years where we've seen geriatric specific medical groups and plans and programs. And I think that is definitely the way to go. Basically, it should be mirrored like how we treat children, they go to that's a specialist. Oh, being older, it's in a geriatric a doctor who specializes in geriatrics and nurse practitioner, they're going to hone in on the geriatric issues more so than a general internal med family medicine doctor, that's my opinion.


I think they're isolated in their own homes. And, you know, also I think we're dealing with a generation that grew up having to take care of themselves, they don't want to rely on anybody else. So they don't want to, they want to handle it, they don't, they don't want to call and call for help, necessarily. And so I think that that kind of mentality feeds into why they're isolated and lonely.


What barriers exist to seeing improvements with emotional well being.


I, it's a double edged sword. I think technology is a bit of a barrier, but it's also not a barrier. You know, I think that if, if the person can embrace and understand and use the technology, it can be a great benefit to emotional well being, but to use technology in lieu of that human connection, and that human touch that face to face. That's the barrier, because not all not all older adults are comfortable with technology. And and if you say, well, we're going to put an iPad with everybody and, you know, that'll help them connect to people. Not all of them are okay with connecting and so if that's the, if that's the focus, without there being another option of face to face interaction. I think that's a barrier. And there's, you know, the technology piece too is I mean, and I'm not even of this age, that I you know, they can't their eyesight, they don't get it there has to be very large print, it has to be, you know, modified for them to even be able to see it and understand it.


Oh, absolutely. I think that different cultures and groups where they, you know, embrace and they actually, you know, live with their, they have, you know, three generations living. I think that's very I'm positive, but in families where there isn't that


are there different experiences for different groups of older adults from different backgrounds with regard to their emotional well being and where they live disability status, income education


this goes back to my comment about that generation. And, you know, I can only speak to my experience, but obviously, I'm a white, female. And, and in looking back at the older adults, in my own family, they're very self, self servant. They don't want to rely on others. There's, they're not in a family where you've got three, three, or even four generations living and taking care of each other. They see. Asking for help is a weakness, they don't want to be a burden to, you know, their family members. And so I think that mentality you know, feeds into and causes the, the loneliness on site, it's kind of like, they didn't they don't want to be a burden. So they don't ask, and so nobody comes by and that now they're lonely. So I do think that you know, I think all those things you said, the economic status, your cultural status, how you were raised, how you watched your, how you watched your grandparents age. And as you age yourself, it there's there's so many variables that affect that the emotional well being


I don't know they have a good answer. But I could tell you that was it a couple of days ago, when the surgeon general whoever announced that this country has an epidemic of loneliness, I was just kind of taken aback because, you know, normally, when the surgeon general says, we've got an epidemic of something, it's usually you know, something bad, you know, it's some disease, and you don't think of loneliness or anxiety or depression is like a, as a medical condition in which we need to, you know, that we can do surgery on and or throw a pill at. And so I think just the awareness that this population, or any population has emotional well being issues. will help. I don't know what the answer is to you know, what types of interventions you could do. But let me I'm gonna tell you a little story. When my mom was put into hospice, she was 62. So she was less she wasn't, you know, of Medicare age, my dad's the same age. My dad is a, you know, a, just a engineer type. Take care of his family is not, you know, just very cut and dry. Not a touchy feely, psychosocial person. And so when the hospice people sat down with them and said, Okay, as part of your benefit here, yes, we're going to provide the equipment and the meds and we can provide some social services, and, you know, to you and your family. And so, later on, my dad pulled me and my two siblings and said, Hey, I just wanna let you know, I sat down with the caseworker and they offered some social services and I told him, I didn't need any but if you guys need it, you can go ahead and tap into it. And I and I remember thinking to myself, you're the person who needs it the most. And and it was difficult trying to address that like you You're the one that needs to talk to somebody about how you're feeling about the fact that your wife of 40 years is basically dying, and you're taking care of her. And he's and but I realized that he wasn't going to do that he didn't want to open up to a stranger. It opened up to me a little bit, but he was not going to open up to a stranger. I don't know how you fix that. And it was interesting, because I thought, Man, the first person who needs the most counseling and kind of somebody to talk to is you Dad, you're like, No, thanks. But if my kids want to do it, I'm like, Yeah, so just kind of.


Yeah, yep. And I mean, you know, as a mental health professional, I have a lot of thoughts around that. And, but it's, it's a common, you know,


I don't know, if it's like a, if it's an age thing, you know, like, nope, take care. Like, I'm gonna power through this, and I'm not gonna I'm not going to acknowledge those feelings and know I'm okay. You know, if I as long as I don't address them, I'm, I don't know what it is. But.


Okay. We have about 15 minutes left, have a few more questions. I'll move on.


Oh, gosh, just because just everything is just so expensive. Um, I don't know that. Speaking from just kind of my own experience, I'm that type of


I guess, programs that offer support to offset the cost of your meds, provide meals, and other other things like taking, I guess it goes into a different category, helping you with getting your groceries and having toothpaste and having shoes. Unless your family members aware, and you're as an older adult, you're self sufficient. I suppose. I don't know yet that when they go to the doctor, they might get that information.


think the barrier of prioritizing other things over what older adults need, you know, there's only so much general fund, there's only so much, you know, there's only so much money to cover a variety of social services where you know, our public welfare services. So I see that as a barrier. It's a it's a pie. And so I don't see their piece of the pie getting any larger, unless more advocacy on their behalf is happened is happening. Unfortunately, though, that just means that if their slice of the pie gets bigger, somebody else's is gonna get smaller. So unless the whole pie is able to get larger, that's a barrier. That makes sense.


Well, the easiest thing is, you know, and this wouldn't be all encompassing, but increase their Social Security benefits. But you know, not all of them get Social Security. So like, the last thing would be maybe it complementing their, you know, what they received through social security with some community organizations that, you know, can can make them whole or can can help offset some of the things that they they can't cover under their basic income.


I mean, you could just assess each of them individually. Accessible, inadequate geriatric care.


I would say Geriatric Care has moderate accessibility and is not adequate. There's just not enough pro geriatric programs. Here, long term care.


And you can break it down if you you know, so I think


long term care are those people who they're not sick enough to be in a skilled nursing facility, but not well enough to stay home alone by themselves. They need some sort of support for their ADLs for their feeding for their meds. And I think that, that has limited accessibility, and it's absolutely not adequate. Like there's not enough capacity.


Behavioral health and substance use treatment,


you know, I think it's accessible. Um, but I don't know. Um,


yeah, I, I know it's accessible. And I but I don't know about it, whether or not it's adequate enough.


I would say it's moderately accessible and moderately adequate.


And I guess changing world in just biggest challenge that older adults will face in the next 10 years.


I see them becoming more isolated and lonely, because I don't think they're going to be able to keep up with the technology that's going to overtake our society. And I also think this is a pessimistic view, but our society it is is more and more violent. And while they might not be the targets of the violence I think that that's it That's a component. Okay, so basically the I said societal changes that will affect their, how they live.


I think that government plays should play a huge role in facilitating and bringing together all of the programs and groups and organizations that are either tasked with, have grants for or, or do it out of donations, all of these programs and try to then create PSAs or marketing material and, and target where the people are that would need it would potentially want or need access to those types of programs. I don't think government has the expertise to do it themselves. And I think that this is, you know, my opinion, Orange County is not a county that takes on the work itself they contracted out, which is fine. But I don't think it's enough to just contract it out, I think that you have to make sure that that the government is aware of everybody who's out there and what they're doing and help promote and market and get those services to the people that need them the most. And so using, you know, the technology Well, I think that your organization's doing with knowing where, you know, certain groups are knowing the areas where it's not just about socio economic status, it's, it's, it's it's about understanding where all of these adults or older adults are, I mean, we know that obviously, there's a lot of them in Laguna Woods and, and Leisure World, but there are pockets in neighborhoods with very large numbers of older adults. And maybe there can be some targeted PCAs are pomodoros that go out and they actually go out there. And they do the face to face work of communicating and talking to people to get them to understand where they can go for services or not just services but for assistance or whatever the programs are offering.


Last two questions, thinking about all of the older adult residents in Orange County, who is the who's getting the least amount of attention


you know, right off just my gut with with no particular reference is single, older males. Um, and I like I just I can't tell you why I think that other than the obvious that they tend to be more isolated. And I you know, I live near one so I know like, my this man is a hermit and, you know, women are more social generally and have friends and they have more family ties. I think men are not that men can't. But older single men have art to me the what some one of the most that need that are going to need more attention. And it's those two that that they don't think they need it, you know.


I'm sure there's something that I'm just not thinking of I


don't think I have a good answer for that. Well. I don't know that it's overlooked. But I think there's more. There's there's older adults that are living at home, that are probably dying sooner than necessary. Because they're home alone without proper care, and not medical care, but just proper, you know, daily care. Where if they were in a long term care setting, where they were at least being fed meals and checked on every day and offered a social, you know, hour, I think they would live longer. But I think that there's I think that older adults are dying more at home alone. Then I think that's overlooked. Okay.


So this concludes our interview. Thank you so much for your time. And you have been incredibly helpful in our process and our research. Please feel free to reach out if you you know, have more to share. You can reach us either on our website at dance osi.com Or you can also leave an anonymous voicemail on our telephone line 949-415-6898 at any time. That was incredibly depressing. Gosh, okay. Let me see. Let me stop recording


Alright. So the timeline, we are going to go over the questions right now. So the primary goal today is to identify what needs you think are the most important for older adult population that we serve. And we want you to think as broadly as possible. So taking into consideration older adults, caregivers, and families and their communities


as a segue one older adults, or caregivers


or caregivers, okay, families and in their communities. Okay. Yes. So for the following questions. I'm going to share my screen right now. So you can see a list of common issues and concerns impacted older adult population. So let me go ahead and share my screen. Yes. Yes, so you can take so please take a few minutes to read through this list and let me know when you are ready to begin.


so so to begin that first question, as I Were A records we want to know, to tell us you rolled and how you interact or engage with older adults.


So my name is Scott kitchen, the President CEO of sustain SoCal, which is a nonprofit focused on economic growth in clean tech, clean tech, economic growth and the sustainability initiative, acceleration in Southern California, we have a lot of different ground, we've worked in the past with a few organizations that have been assisting in working with the elderly, to help them to sort of work toward mainly transportation issues, how to get elderly around their community. And in looking at this also some little bit on the economic security side on the food side of the equation, but that's really been about it thus far.


Awesome. Yes. No. Thank you. Um, so have a nice on the list.


That's a tough one. Now see, I think, you know, looking at it only from my perspective, I think it's hard to even read, they're all super important. But what I know about, you know, thinking about


I can't even I can't even rank and they're all they're all super important.


In these terms were sustained. So kellermeyer organization could help I suppose. Maybe in those areas where I am where I see need is for sure answer the economic security,


So I'm going to ask you for the next questions. I'm going to ask you for each of the needs that you just listed. I'm going to ask you the same questions for each of them. Yes.


I think in particular, now it's the growing population, right. So there is a massive demand for a lot less resources right now. So we're seeing challenges, the resources that are available are being really stretched, and there aren't really enough. So I think we need to figure out ways to kind of create a, you know, a better economic security for the elderly, especially in light of the fact that there could be potential a drain on healthy though the, the rest of the money that's available from the government as well. And then regarding the health care access and delivery, same sort of situation, it's all has to do with a growing population, you know, we have every, all the resources are being stretched. And, you know, I think that people are generally speaking, busier, like, they're the kids, the families are all busier, for whatever reason, and they're going in different directions. And so it's, it's harder for them to to spend time with their elderly. So the resources, economically, the resources from the family are also stretched. Caregivers, from what I understand are also in demand and stretched, and there aren't enough of them. Nursing Home availability is gonna be a big deal coming forward. I mean, you talked about housing, etc. I mean, there's just a lack of everything, for this growing population of elderly that we're gonna be facing. Transportation, mobility is just one of these things that I see is a challenge going forward simply because we want it we want to enable our elderly to also be autonomous, let them get out and do their own thing as much as possible.


Thank you for your great answers. So the following question will also be for each of them. So if you want, we can go over for each of them for all the questions. But I know you just answer the first one for all of them. So that's okay. So the next one would be what barriers exist to see an improvement in this area, like in economic security area.


Barriers and account security. I think. Well, I guess, I don't know entirely, just kind of refer to my previous answer, just simply saying that the barriers are lack of availability, demand on, you know, the resources that are out there with the growing elderly population. Right. You know, I think that's, that's a barrier that I can think


access is, again, it's a challenge to the environment that we're in. So the barrier is, again, what I said before about the just a growing population. But if you look at I mean, I'll look at each one of these points here. Insurance costs, you know, from what I understand have gone up. I don't think that insurance, the government insurance or whatever, that's available, and I'm not too familiar with that. But it's, I think it's not doesn't cover as much as maybe as needs be the cost of medicine. You know, I think a lot of that service and government incentivize, but there's, I think that's also gone up available providers, again, developing providers, and most of them I saw on their caregiver caregiving and home services, followed nursing home availability. So all of these there just aren't enough. I mean, the barriers as far as I can tell that the aging population, and then who pays for all of that is another part of the barrier. Virtual health secure services could be part of the solution. There could be more growth in that area. But I don't see that as in any way. The barriers I think that's that's all I can think of there as well. The barriers to transportation and mobility.


Yes, you can go ahead and answer. Yeah. What the barriers for what you see. Yeah. And transportation, like improvements in these areas


are not super familiar with some of the busing and some of the homes and things have their own buses and transportation. But again, I know that I have an elderly friend that's in a community and it's just a challenge. Just to get access to that, that bus, and they can only go at certain times. And so she's sort of at the, you know, she's sort of restricted in terms of that. So it'd be nice if there were ways to get the older or elderly around the community kind of on their own free will, to some extent, and that that's transportation that could be coming down the road, you know, we look at autonomous vehicles and things like that. So the barrier really is just lack of availability for transportation, generally speaking for the elderly who can't drive. Right.


Right. Thank you. So moving on. I don't know.


I mean, I know that certainly, depending upon where they live in there, they're obviously how they've done in their careers or how their family's wealth is, I just, I don't know, I don't think I know the answer to that.


This is a referring to, like, from different backgrounds to say like, where they leave, disability status, income education level. Um, I don't know.


I'm not really sure what that question is, to be honest.


Yeah, I'm assuming that's true there, too. I just don't know. I would assume. Yeah. I mean, obviously, it's, you know, they have the infrastructure, they have family, and they're like, close the family and family and get them around. Or if they're on, you know, or if they have the means that they have a driver, you know, that might help them to I just


That's a good question, I think. Well, yeah, I think ensuring that, you know, we have available dollars from government to help us into this. I mean, I know that that's stretched. If there were a way to figure out,


jobs for those that are elderly, that are able and want to work, that might be a very interesting thing to explore. I know, that's being explored in various areas. From the perspective of, you know, sustainability, if we have an older working force, if we, if the elderly can work and are wanting to work, I think that would be that'd be great for the whole community.


Thank you. So what would you suggest is the best way to address health care act acts


don't really know much about the mechanisms of health insurance and cost medicine availability providers, all that. I would suggest, though, that, you know, in terms of, you know, the market, I think, I don't know, I mean, I haven't I don't know much about this area, to be honest. But I think it seems


given the growth of the elderly, the population of the elderly, it seems that if there were


just more access, generally speaking, if there were more companies more availability. That's all I can really think of that I just don't know, the mechanism by which this the care or virtual healthcare service is just not an area that I know much about.


Well, I think that there are a lot of pretty clear


solutions that are emerging. There are, you know, we have a lot of what we call last mile transportation technologies coming to the fore. And I think that a lot of those have been dedicated toward, you know, shopping, delivery of packages, parcels, cetera, et cetera. And I think that as we start thinking about the elderly This could be an opportunity to engage some of these technologies to help them transport elderly around our community, get them kind of wherever they need to go. And a lot of that last mile or two mile or whatever, a couple miles, could be could avail themselves of this, and I'm not necessary talking about autonomous vehicles, though, you know, we'll see that probably, you know, maybe in a decade or so, but maybe less than that. But there are other technologies that are coming up that you know, with small passengers, electric vehicles, fleet type technologies that could be employed for these for elderly


use. Thank you so much for your answers. So we can go ahead and move on to the next question. And I will read this one, I will stop sharing my screen. We don't need this anymore. Yes. So the first is geriatric care. Yes.


I really don't know much about that. I guess I guess in about 10 years, I will. But I don't now know how much how accessible it is. I know that. You know that I know some of the homes that they'll do the Holmes's, which seemed to be good and well run. I don't know if it's how accessible that is


Again, I don't really know much about them.


Again, I don't know much about that either.


I really just don't. So I really think will be the biggest challenge for older adults that we'll face. And the next thing is


generally, and I've said this a few times, which is part of why I think sustained. So Cal has been interested and wanting to be a part of the solution is simply that there are the resources are just not quite there for the population growth in that demographic. And that covers all those areas at first, that one page you showed me, I kind of looked down there and every single one of those pretty much as far as I could tell where resources were involved is going to be extremely challenged.


Again, this isn't an area that I know too much about either. And I'm not exactly sure how much they currently are in. But I know I mean, I know about various different packages and things but not in detail. My only sort of thought and I've heard on this, that there's potential of actually reducing some of those some of that spending for elderly, which seems a bit ironic in the fact that we're going to be facing one of the largest elderly demographics that we've seen in years. So the government needs to support I'm not exactly sure how I think they need to be a big part of how the solution works. I think the asking you to work in sort of on the innovative side, looking into ways to be more creative in terms of how elderly can get access to what their needs are and become more part of the community. I think that would be something that I haven't talked too much about that I would stress is that we need to really integrate our elderly into our community, you know, and, you know, easy jobs here and there are ways to kind of be more involved in volunteer roles or get them out and be part of the community. So I think being innovative around you know, community involvement would be a great way that government can be


can take part. Thank you, Scott. So thinking about older adults, residents in Orange County Who is getting the


I don't know. I really don't know who's getting the least amount of attention.


Well, I'm not exactly sure who's looking at what right now. But given my interaction with agencies that have worked with the elderly, and it hasn't been anything to recently, but seems to me that what I've sort of said in terms of just giving elderly access to opportunities to be involved in the community to get out and do more where they if they want to write, I think it would be overly beneficial for our entire community. We've talked about, you know, social equity, etc, I think that's one of the areas that oftentimes is neglect is the elderly, you know, getting them as part of the community. You know, whatever it is, you know, if it's just getting on volunteering, or it's getting a small job here or there, just be able to get them as being


interactive. Thank you, Scott. So in addition to four, we have already talked about. So let's discuss a little more into your area of expertise. And well,


Well, you know, the one that I've spoken with that I know about is transportation. It seems to me anyway, you know, given my sort of touch with the various agencies that have been in the space, it seems that transportation is a big deal, but climate generally speaking, you know, it's it's a challenge. I'm not really sure how the elderly are being currently affected by this. But I know that we have rising energy costs, rising water costs, all the utilities are going up. I don't know. But ultimately, that's, that's going to be a strain. You know, I think, and the energy costs are going up. And we have, you know, climate change, we have, you know, seemingly some hotter days and some colder days and more rain, some days, it's becoming quite variable. Not really sure, at this point, but those are the areas that we as an organization are starting to look into and want to sort of collaborate with folks on. But the only thing I know for sure about, you know, is that transportation is an issue. I think that you know, going forward, for sure, energy and water and all utility costs are going


up. So that's challenging, we would love to help. Not really sure.


policy wise, my goodness. You know, I think one of the biggest things that I've seen over my last several years with sustained SoCal has just been, you know, technology oftentimes moves moves quicker than policy and legislation. So I think that if we can figure out a way to, you know, ramp policy to the point where it can the least state even with technology, or at least, or just lags slightly behind technology, so that we can avail our community more broadly, not just the elderly of some of the technologies that exist today. You know, that would be very helpful. I don't know exactly how it applies to the elderly at this point. But again,


The issue of what issue I've lost track of the issue


of you mentioned about what's happening about climate friendly. So how that impacts


She's going to be more impactful on climate and climate side. So it's really the usual suspects. The California Public Utility Commission, the California Energy Commission. You know, I think that,


to see is probably more local activity. I know that there are some of the bigger cities that have taken more actions from local agencies, but ultimately, is going to be local government, I think that will drive this. I mean, if we can get some, you know, funding side will be a challenge, like I said, Because of resources and lack thereof. But I think if we can incentivize, maybe economically, maybe there's a job situation, maybe it's a way to integrate the elderly into the community. But I think ultimately that it's going to fall on the local government to take take action, there may be some public private partnerships that could come about. And I think that would be split, particularly on the side of the housing side. And that's, I consider that to be part of the climate clean tech challenge that we face. So mainly government, but I think private side could come in and public private partnerships.


And water sources. So a new work and air work.


Yeah, what sources of data you use relevant data, like you find relevant for you to use in your work.


See where it is. So the data sets that we gather, help us to identify trends. But then they come from all over the place, universities, agencies, governments, you know, and then within our membership, we have private, large corporations that track and look at things and ultimately, we're finding sort of gaps. So yeah, it comes from everywhere, to be honest, and then we just really focus on how we can be productive in filling the areas that appear to be needing.


You know, they're I guess most of them come from the research universities and the National Labs.


Well, you know, if you don't mind, I'll give it some thought. I'm sure there are some with my organization, there might be. We have one board member.


Maybe a couple. But let me think about that. Yeah, yeah, of course. Yeah. Let us know. When you, there's someone else that we can talk to. And we've been able to share the data sources do that. You find relevance for like this kind of work. They related to climate friendly aging. That would be great as well. Yeah, sure. Yeah. Yeah. It's


not an expertise of mine. Was that it's not a very super expertise of mine. Yeah.


Yeah. Thank you so much. Well, I'm gonna follow up with you. The people like that you might take up okay.


Yeah, so I can reach out there a couple of I can think of one in particular, that might be a good person to talk to. On our board, and there are other members I'll just be thinking about, like I say, this is a an area that sustained SoCal has been sort of on the fringes up for a long time. But it's clearly part of sustainability as a whole in our region. So we would be happy to engage, you know, wherever


needed. Yes. Thank you so much, sir. Yeah, we've been really quick. And so


It was good for the interviews here. Yeah. Thank you so much. Thank you so much for your time and have been like really You really have helpful and if you have anything that you want to share and if you like realize you miss something and you still want to share with us so you can feel free to reach out to me and let me now or you can contact like information i available on our website or you can leave like a voicemail anonymous voicemail to our telephone line but anytime Yeah, if you feel like yeah, you need to share something else that you can always reach out to reach out to me or maybe and yeah, I will start recording right now. Okay, so


The primary goal today is to identify the needs do you think are the most important to the older, older populations or user, those who are 60 and older, we want you to think as broadly as possible, taking into consideration that older adults, caregivers, families, and their and their communities. So I'm going to share my screen right now and show you a list of common issues and concerns that I impacting the older adults, when meaning go ahead and share my screen


yes. So please take a few a few minutes to go through the list and when you know when you ready.


so much. So for the follow up questions, I will ask you, they will pull from this table.


I will go up No, like the question the following questions I will ask you will refer to the table.


I will ask you some specific question regarding the table. Yeah. Okay, so


I live with my parents and their parents in law, um, all of them are currently in their 70s. And, you know, over the years, I have been either living with them or helping them with various duties. So it's, it's challenging, sometimes.


Thank you for sharing. So thinking about Orange County and looking at the list of common issues and concerns. Impact impacting like, the older adults, is there anything missing that you see


thing is I don't know whether it's there. It's like the for the immigrants. is There a row there for immigrants, like language barriers and cultural differences. You don't have


it there. Right. Believe it or not, and they're okay. We will go ahead and add that. Okay.


So, it's mainly that it's not there. Because I came from an immigrant, first generation immigrant and then I see you know, for my parents and in law there are foreigners. And you know, language is a big issue. Yeah, like,


fear is under Yes. But yeah, I will go ahead and add they want to just mention and also


So of the needs of the lists, including the ones you, you just mentioned you added to the list. As Please, can you rank the number with the number three top from the list that you think that the most important


I think it differs depending on the year but the population I'm talking about


the population of older adults, I think it's hard to rank Alzheimer's disease, dementia,


behavior and mental health and and housing


thinks you said so for the next questions,


I will go ahead and as the for the three needs. So you ranked the top three that you ranked, I'm going to ask you for each of them, I'm going to ask you the following questions. So for the first one is how and why are older adults are struggling with Alzheimer's disease and dementia


I guess I'm not an expert on the etiology of the disease. So I think when people get older, and especially now, they compared to many years ago, wherever their older population, like average age is older, and there are multiple factors that contribute to the development of the disease. So one of the factors like actually one of my colleagues, is studying the key environmental factors, but I know there may be some other reasons too. So so but I know older people have a higher risk and increasing risk for developing Alzheimer's disease and dementia, and it could cause tremendous impact to the to the older people as well as their family and caregivers.


Thank you for your answer, and what barriers exist to see an improvement and this area of Alzheimer's disease and


My wish list is that we understand, like fully the mechanisms that are logical reasons why people develop Alzheimer's disease and then you can develop the preventing either through like vaccines, some some sort of vaccine or sort of medicine that can cure the disease, but I don't know, I guess there's no such miracle medicine or prevention measure at this time. So it's likely that disease is multifaceted, that means that there are multiple reasons. So it makes it difficult to develop a prevention


I don't know. So I'm not an expert in this area. So I guess like for higher income groups, likely, you know, the family or the children of this elderly people may make it you know, more resources to take care of those them. So, but for those that lower socioeconomic groups, they they have little resource to deal with the disease. So like the disparity issue always exists, including the Alzheimer and dementia outcomes, but I don't have much knowledge of you know, very specifics about this


Thank you. We will go here and I will ask you the same questions for the next need that you you mentioned. So, how and why I older adults is struggling with behavioral and mental health.


And the thought of is that when you're younger, you never thought about what will happen in the next few years. So, like, when people get 70s 80s, they're like, they started to lose their friends and they, they have also lose their capabilities. things they can do easily in the past, and, and also the illnesses and diseases started to get on them. So all of those like physical illness, and so they feel uncomfortable, they feel pain, and they don't have good sleep. And also the negative thoughts, or what will happen to me, you know, if my friend passed away. And so all of those started to kick in, which rarely happened when people are younger. So


yeah, it's just that the time you have to count


toward the end. So I think it's also their guilty that sometimes they need their children, or the other caregivers to help them. And they don't want to bother their loved ones, but they have to. So that helped us. And their, their life relied on the others.


so I think that that's all why, you know, they may cause a lot of mental stress, hopelessness and


I'm also reflecting on myself. I feel without a lot of patience, and tolerance on children. So like, our parents do that to us. So when we were very young, and you can you know, how kids started to learn walking, right. So, you know, from numerous failures. And there, I think it's naturally we know, working to be patient with children, we know they're going to grow up, they're going to learn how to do it. But for elderly, I feel no we don't have we don't have the same level of patience, and tolerance there. And also, no matter how we try, even surely the outcome is not that you will learn how to do it, you will, you know, that eventually the outcome is decay. So you know, the lose of capabilities. And for, for the elderly, it's like no matter how I'm going to try. It's hopeless.


it's very different, but I hope that everyone would know that every everyone will go through that stage and we need to be more patient and tolerant with older people.


Like, are there any different experiences for the different groups for older adults from different backgrounds regarding behavioral and


yeah, again, from my own personal perspective, I think that there is a lot of difference in terms of culture and the, the immigration status, so culturally, I know, like people who are grown up in the US tend not to live together with their children. But some other immigrants, especially some from like Asian countries. I came from China so The tradition is to live with one of your children. So, and but, but that tradition may not be blending well with the US


mainstream I get a sorry I was clicking on something. So,


you know, it creates a lot of complexity


if they think like the elderly population think that they would want to live with children, but then children grown up here don't think they they should you know live together and take care of the the their parents and there is this that may cause fights across generations.


and also the, I know some people would want to live in the senior centers or like a retirement community for certain culture but not others


that may also lead to various behavioral and mental health problems and also physical problems


and some culture or sub populations may may


I guess, have more social interactions with their neighbors and their friends, while certain other people may have may tend to be like more more inward type and do not socialize very well and and at the elderly age that is more problematic


and what do you suggest is the best way to address your mental health health


big issue. I think this needs to be worked out with multiple stakeholders and multiple interventions or like systematic changes.


Ah, so, let me see if I can give some examples. So,


maybe raise awareness of the importance of the mental health problems among the elderly is and also for the entire society and initiate the programs that can can socialize the, the elderly, in their community in their neighborhoods, and, you know, create activity or senior centers that can promote the interactions activities of the seniors and also initiate programs that can do more of the prevention to to help with delaying the time to getting Alzheimer's disease or dementia and also create


thank you so much. And now we'll go ahead and ask you the same questions for the last me that you mentioned, which is housing. So how and why are older adults and struggling with the with housing


I work with Santa Ana community for my environmental house disparity research. So I know during especially during the COVID time it's it's a big issue because if you have very crowded housing then someone gets there. And then the virus will be spreading more easily indoors and you get a high concentration of virus and a high risk of infection among the family members. So I know like in this Santa Ana communities, multiple generations alike are likely to live together under the same roof. And the crowdedness of housing, um, you know, can generate multiple problems. So COVID infection is one thing, more of the tension, you know, disturbance of the privacy space is another thing and that creates a lot of, you know, stress and more severe outcomes among that relationship disturbance among the family members and and also, other environmental problems such as, you know, indoor pollution, and like, you find someone's smoke, there could also be


chance of getting exposure to tobacco smoke, etc.


a lot of those elderly population do not have much of the earning. So, the affordability is an issue. Like for for my parents, for example, they weren't they, they, they are paid through their retirement Ben bike in China, they're in their own country, it's, if you convert that to the US dollars, it's, it's a very small amount, so they cannot afford to rent an apartment. So I have been working like living with for some years. But it's not the ultimate solution. Because as I mentioned, if you're living under the same roof, you know, you have if especially remote high generations, you know, like pupils


and how they view the world and how they deal with things are quite different among multiple generations, so you living under the same roof will definitely cause


So there, they can only afford to live in subsidized housing. But the opportunity to get the subsidized housing is is not not very high. And so I think it's it's not been available to everybody.


I was asking they why Yeah. Why I'm felt like the older adults are we're struggling with this feature. So yeah. You did answer.


Yeah. Listen is in addition to affordability, also the type of housing. So you know, when people get older, they some of them are getting disabled. And then like in when they were younger, they have no problem climbing those stairs. So at the elder age, it becomes very challenging. And so you know, it's not not every types of houses is suitable for them. Yeah.


Yeah, I guess one is affordability and and the other is the location of the house. So I know so Some of this subsidized housing is built near your places where the price house price is relatively cheap, such as the locations close to the freeways and highways, there's not much of a green space. So I don't think that's good environment for the elderly population. And also, it will be good if you build such houses, close to like supermarket, close to like walking distance to this location. So that will encourage the older people to walk and to do some things on their own, which I think would be beneficial to their overall health. But if you you know, these houses are located in this and desirable locations, then that discourage them to walk and do the errands on their own. And also they actually are exposed to environmental hazards, which would be bad to their house, including air pollution and noise and other sins.


I definitely think so. Just you know, lower income people cannot have bought housing in in good location, and with those good facilities, so.


government here should definitely do something to


subsidized housing in good location and well designed


Now we're going to move on to the next question. We Amina as I share my screen is not going to use this anymore.


like the health care that focuses on the needs as we age.


help, I guess I don't have the reference to compare it was. I don't know.


Well describe how accessible and adequate you think that those services are like the directrix services to health care for older adults.


So I have mixed feelings. So I the only experience I have is, again, my parents and parents, you know, so for my parents, they are immigrants, and they are low income. So then they can get medical and through the medical they can access to their family doctor and then get referred to the other physicians and if needed, so I feel I'm grateful that they can be taken care of so that but they're the obstacle is that they I have to help them to prepare all the paperwork because the language is is the issue. And the other thing is that they are limited to their everything they have to go through their family doctor, so sometimes there's delay in getting really what they need. So, but that overall that is experience is great. However, for my parents in law, it's a different story, because their income is much higher than my parents. But but you know, so they're not qualified for the low income, housing insurance. But I was told that they need to pay a few $1,000 per person per month to get their hair house insurance right now. They are, they're not paying that. Because they have, they're still in the process of getting their green card. So they haven't been in the immigrant status. But I was told, even if they are going cardholders, they still need to pay a fortune to get their house insurance. So I don't know how they're going to do if


it's just too much for them, you know, almost like all the dollars they have of each month are going to be paid to the house


Thank you for sharing that. How accessible and how adequate you think those services are


How long is do you mean, is that is that like, a few, a few years


For the long term here is this refers to like other areas services, that helped me both the medical and non medical needs of people with a chronic illness or disability, who cannot pay for themselves for long periods of time.