I think It would be more exchange of information breaking down silos between systems of care. You know, we have some really good leadership, I think, and different in different segments of this population. But I don't think we've really looked at the data around. They're older adults. And I, you know, most people don't know how many homeless older adults we had in the last point in time count. Let's fix that we can do that. You know, that's just one very specific piece of community. And let's not just I mean, the silver tsunami, I get that. And but there are a lot of different segments of our population. Older adults have now many more healthcare options than generations before us had, you know, where outliving previous generations. Although I know we lost a year of lifespan, I think in the last year, but, you know, I think we have lots of good health care alternatives that can help us live quality of life as we age. But, I mean, silly examples of things that we need to do even in terms of customizing our housing. For people, when we build new communities, let's make them design so that people who might have a walker can actually get into the bathroom, you know, it's like, and they can get into the shower, they don't have to, you know, evolve over a bathtub. And I just had back surgery four weeks ago. And it came really home to me, the walker they gave me as I left Hoag Irvine, didn't get through the door of the bathroom. My husband had to take the wheels off and put them on the inside, and then I could get inside. Wow. But you know, I houses aren't designed for the aging population. We should not build one unit in any community that doesn't have those design features, grab bars, all of those things that will prevent falls and injuries. And I know I didn't go to those on the list. But there are plenty of those issues that we can help address so that people have quality of life.


That's more centered on around humanity, right, instead of building products and building things, we should really change the culture of caregiving.


Yes, I think that's true for all our community issues. I definitely believe in that. And by the way, the legislation, and the program, the billion dollars program that I'm working on is called Community Care expansion. It's it's about this specific issue, and not all addressing the needs of older adults. But that is the focus. And it's homeless or at risk is the investment is made in that part of our community. So in your right , there's a lot of money. There's billions of dollars in California. Most people aren't aware of any of these programs, though, and what the potential is for for them all. And we have I mean, we have such wonderful academic resources in this community, but again, they tend to be siloed. So that the solutions aren't readily known and shared. Yeah, yeah.


the good thing in Orange County is we can actually show models that are successful and address the concerns that we often hear particularly around not in my backyard issues. Around these are safe, these providing good options for people And I'll give you one example we built with jamboree about 10 years ago in Irvine, a community was built in two phases, 60 units of affordable housing, family type housing, 10 of them was set aside for people who had come from homelessness with severe and persistent mental health issues. Yeah, by the way, but the being able to show that those models can be fully integrated and successful into the community. And most models of affordable housing that have been developed, made up of those components, where you have a lot of affordable units, and then some that allow you to fund those apartments for people with special needs, and may live very good lives and successful lives in those communities. And typically, you could never say that person who lives in Unit three B has a mental health diagnosis, you wouldn't ever know that, because of the integration into the community in the care that's provided. So being able to demonstrate the success of those models, that allows us to get to the next one, which is the real solution we need, we need a lot more affordable solutions. And you know, even around places like Laguna Woods, where we see they have certain options, they have barriers built in, people who can't give us can't live there, they can't afford to live there. And they're not allowed to live there, you have to be a certain age. So there are all these policies that prevent a solution that can be very effective. So we have to get over those barriers between different segments of the population and, and create those solutions together.


Well, I'll give you the one about aging, adults with mental health issues, and dementia, we are exploring that we're going to be applying for an innovation grant to see if we can come up with a model. That's just a very specific solution for a very specific targeted population. But I think it's a good model of how we need to look more broadly at where the gaps are, and how together we can come up with solutions. Because if we continue to say, Okay, if you're over, if you're a veteran, this age, you shouldn't live with a veteran is a different age, you know, let's come up with solutions that work for all of the populations and you know, just being more facile about how we're going to deliver on this. But again, back to you back to the what it looks like in 10 years, let's draw the picture. Let's say what it needs to be. And let's use data to document what that really needs to be. Don't tell me that you've got this wonderful master plan on aging, and you've got all these meetings going on. And but if you're not talking to the community that has the need, you're not going to get to the solution.


Well, we know it's we've actually built it as a way built building a pilot, and it's going to take us a few years, even if we get money. We're not just going out there and doing it. We're saying we need feedback from all of the impacted groups around what this should look like, and how we're going to pay for it. Because we can't just say we're going to put two years of investment into we're buying beds, it's XYZ place and providing this because that doesn't fix the system. Yeah. And I think it's a good prototype. for how we should be looking at the system of care, because when I read that master plan on aging, and I've been at many presentations on it, I don't I can't visualize the answer in Orange County, you're gonna be able to say, okay, Irvine has this many new communities for seniors, they can do this. Let's get us all together to come up with what the model is, and build that model, not just, you know, pull off segments of that conversation and say, well, that group has a good answer. When you're ignoring the rest of the answer and where the gaps are.


Yeah. So we started the conversation about tough, you know, most important issues and concerns facing older adults. And you said that, you know, basically, that we're very disconnected in our system of care, delivery of care. And that, because we're so disconnected, people don't know about what resources exist, if they need them, and certainly we can't fill all those needs.


It's probably not one. I think there are roles for multiple entities. One unfulfilled role, I think, has been Carol optima. Until recently. You know, when you have Michael Han say, when he does the Point in Time Count, there was an aha moment for him. He said, These people are all my clients. But knowing 900,000 People are his clients. That's the That's a big disconnect. And I know Kaleem has some wonderful, new programs. We can't we've you know, so I think this conversation and conversations like this, really, we can certainly engage with entities and should engage with entities like Kaleem and CalOptima, but different segments of our population, different cultural solutions need to be provided in our homeless arena. We have nothing customized for them. You know, I see in Newport Beach, it's obvious to me that that's a population whose needs went out meeting because they stand out just physically. But another example of, you know, we it's not one size fits all, for sure. I mean, I would want to see, county government definitely needs to be involved in leadership, equity solutions need to be had data solutions, universities, I mean, let's bring us all together. But let's paint the picture of what we want. Okay,


so do you see this effort being an effort of that kind of convening, in terms of getting everybody on the same page and being able to move forward in some sort of, you know, collaborative


I'll take it back. I'll take it back to them and see what


you know, I think, you know, one of the gaps is we don't know what we have. Yeah. I mean, that was one of the bigger has with the Mental Health Services Act. When you look at state reports, and they tell us how we compare with other counties. I think that there's a lot of sharing that could happen that would be very helpful for us in terms As of understanding the issues, but I do know, you know, I've been working in the homeless solutions areas for more than 20 years. And I do know that the number one issue for counties is homelessness. So we better have that front and center, homelessness and how it affects older adults and how it will affect older adults.


but not in isolation. Because the way we provide the solution is going to be different for that person who's been diagnosed with cancer or diabetes or dementia. They're all going to need different care options. So you're worried about care, I think is the appropriate focus.


I really, really enjoyed our conversation. I if you can see in my notes, it's like all over the place. I have to process everything you just said. But thank you so much. It really is very helpful and meaningful


to I never stay in a box, Katie, on that out of the box.


for that. And thank you for especially during the time that you are experiencing right now with your family for making time for this I really, really


well, I am passionate about these solutions. So when I can help I want to be involved.


Okay. Well, if I may, I might come back to you and take you up on that. And there will be some recommendations that we will have to put together at the end of this journey. would really appreciate some time with you to think recommendations.


Okay. Of course. Okay, thanks. Thanks for your work. Okay.


Oh, I don't think so. Okay, wonderful. Okay.


So the primary goal today is to identify what needs you think are most important to the older adult populations, particularly the ones that you serve. And in this interview, older adults is identified as those who are 60 years and older. We want you to think as broadly as possible, taking into consideration the older adults, caregivers, families and their community. So I'm going to now share my screen so you can see a list of common issues and concerns impacting older adults. Please take a few minutes to read through this list. And then we will begin the interview


Quite a list. Let me look through this about halfway through here. No problem.


the list will stay on the screen, so you don't have to memorize anything.


Sure. So I'm the CEO and President of the Council on Aging in Southern California. And through our programs, we engage with about 100,000 older adults in our service area annually in a five county service area, Orange, Riverside San Bernardino counties in Inyo and mono counties, but we're headquartered here in Orange County, and where we've been serving the community for over 50 years. Great.


And thinking about Orange County and looking at this list of common issues and concerns. planning,


planning for aging is not listed on here. And I And to me, as we think about what we've heard from the community, and how people contact us, they typically have not planned well for aging, they have not planned for these things to happen to them.


Okay, I'm gonna add that to the list here, if you can just imagine it being added. So including planning for aging, and all of these other things listed on this list.


Just I guess one question I have for you first Katie is as we look at emotional well being is that really to encompass mental health in general, or,


yeah, you can interpret it however you'd like Lisa, and you can say mental health if that's a term and


that to me, I mean, I mean, they're they're elements of mental health, I think that are included in emotional well being. But I don't think that that's necessarily all encompassing. So if I think about what might also be missing here is, you know, mental, mental health support meant just mental health in general, I guess.


Yeah. Sure. If you look at the second line item is is behavioral health and mental health. Oh, I'm sorry, I missed it up there. Oh, that's okay. And then mental. Sorry. Yeah. And then these examples next to it, but if there's something else that's not there,


that's, that's better. That's okay. I missed that. I missed Okay. Okay. So now you want


Okay. Top three. Okay, I would say behavioral and mental health is number one. Housing number two.


Transportation number three, and planning for aging. Okay, I think about I think about planning for aging is that having a plan for aging sort of encompasses all of this, but it's one of the last things that people do. We've talked about that when we met the other day.


Yeah, yeah. And you can call that out specifically, that's fine, too. I think that is a very specific thing that we need to incorporate. So I'm going to ask you the following questions in relations in relation to that the four that you mentioned, and I want you to think about them. Think about these questions for each of them. So we're going to go one at a time. So the first one you mentioned was behavioral mental health.


Well, I think part of it is just, you know, there, there oftentimes are cognitive changes as as individuals age, and we're dealing with a demographic that typically hasn't acknowledged mental health is something that, that they need to request support on, they sort of from a generation that they oftentimes feel they have to tough it out, or they don't know where to turn. Alternatively, they don't know where to turn for resources. And that, in turn, can lead to many of the things that are listed here. It is example stress, worry, drug, alcohol, addiction, and so forth. So, but it also ties into the topic of emotional well being just this isolation and loneliness, which often happens in as people age, I think it's a it's an incredibly important area that needs focus. Yeah, and what barriers


exist to seeing improvements in this area,


lack of awareness of our resources, and that, and then an acknowledgement that it's okay to ask for help. And it's important to know that people aren't asking for like a handout, but they're asking for a helping hand.


Oh, definitely. I when I think about some of our immigrant population, they have endured some significant struggles in their efforts to come to America. And also they have cultures where you don't talk about mental health, you know, as well. So I think they're definitely different experiences, you have veterans that take a different approach to mental health and others might. Yeah, definitely. There's differences.


Well, that's a that's a loaded question. I mean, that's, that's a, that's a major undertaking, we're making some great strides with support from the health care agency. I think it's also worthwhile to mention that coming out of COVID, you know, we've got a whole level of isolation that we hadn't seen before. And, and then just, we've lost so many people, you know, as a result of COVID. So there's just much more that needs to be done to be able to support to support older adults, and to help them know, and it has to be more of a larger, pervasive sort of a plan than what we're doing today, we're making good strides, but there's much more to be done, particularly as the population ages. Yeah. And that's going to involve multiple entities here in the in the community, local health care providers, individuals, physicians, nonprofit organizations, the county, it just needs to be more aware that it's okay to ask for and receive help. And that talking about mental health is is, is is good for for folks, there should be an opportunity that you don't feel embarrassed to talk about mental health. I mean, just like you're talking about any other kind of knee replacements or whatever is going on, we need to be talking about mental health in the same way.


So now I'm going to talk about housing, which is your second choice. How and Why are older adults struggling


I just saw a statistic you yesterday that less than 50% of older adults have sufficient savings you know for retirement or have any actually any savings at all for retirement.


I think the other barrier that exists with long term care. So long term care is not covered by Medicare. And many people don't realize that till they're in a crisis situation. Yeah. And we will not have enough we know, we will not have enough beds and long term care to be able to support the need here in the county. Yeah.


I think so I think you have situations where older adults may anticipate that they're going to move in with their children. There, we also have issues with we see this in our long term, our work in the Ombudsman Program, where you see pockets of care facilities that maybe are Korean speaking, or Vietnamese speaking. But there's not enough of those to support the needs of the community, if people have linguistic issues that, you know, would not enable them to live in a English speaking long term care facility, let's say for example,


yeah, yeah. And then once again, what do you suggest is the best way to address this


Well, we need to identify ways that we can provide more affordable housing here in the county. And I know, of course, is the master plan for aging. You know, that's part of one of the things has been that's one of the issues that's being discussed. I think is the big is the big challenge. And


then lastly, you said transportation, but if you want to also comment on planning for aging this, how and why are older adults struggling with this issue.


We noticed as we think about as we think about housing, as we think about mental health, as we think about transportation, and not being able to drive anymore. These are all topics that people don't really want to talk about. And so there is no plan, families typically are not planning and then. And so consequently, the I mean, like, for example, the idea of taking away the keys from mom or dad or them giving up the keys, you know, it's not a conversation that anybody wants to have, particularly here in Orange County where everybody's got their own car and driving around by and large. So that becomes that becomes a real challenge. And, and it's just like a taboo topic. Yeah.


And in addition to the, to the barriers you just expressed, are there other barriers you'd like to mention with regards to seeing improvements in transportation or planning,


but one of the things that we've started to see in a lot of communities that that they are providing free transportation, not certainly not all across Orange County, but communities, communities are providing free transportation within their city limits, you know, to go to a doctor's appointment, or to go to the grocery store, or whatever. But these are just small, short term efforts, but we are seeing that these programs are successful.


Oh, I'm, I'm sure there are you have language barriers, that would be it would be different. One of the things that I think is going to be interesting as our population ages, you know, as we think about the freeway system, that is utilized by so many when we start having older adult, you know, 25% of our population is you know, 65 and over what's going to happen on our freeways, I mean, the average speed on the freeways got to be 7075. Can you have Can you envision having this much this many older adults on the freeway driving at that high rate of speed, or does it mean that we're gonna have to reduce the speed limits or what's going to happen will people just not do drive on the freeway. I haven't heard anything from the state of California about their plans to manage that element.


Yeah, that's a hard one. Yeah, exactly. Alright. So now we're going to move on for from these top three things. We're going to ask you some general questions. And then then specifically, in your role at the Council on Aging, I'll ask some follow up questions, as well. So generally speaking, I would love for you to describe how accessible and adequate the following care services are in Orange County. So we're going to start with geriatric care and geriatric care, we are defining as a branch of health care that focuses on the unique needs of older adults or the aging process. So just as pediatricians care for our young, we are referring to geriatric care is care for


older adults. Yeah, whatever you'd like, very difficult to access. There's a I don't know what the actual number of that that would be an interesting statistic for you to find out how many geriatricians are actually here in Orange County. But it's very limited number, there's some that are affiliated through UCI, I don't know one or two at Hoag, maybe. But very, very few. And this is a big and it's a problem nationwide. It's not just here in Orange County. But we have geriatricians really are very familiar with the needs of older adults and the impact that medications can have on them and so forth. So this limited number is deaf and you have a lot of the older adult population that never considered that they needed to see a geriatrician as opposed to maybe the internist that they've been seeing for years. So there's just a there's there's a lack of them. And then there's also a lack of awareness. We give presentations here at the council that describes what is a internist versus a geriatrician versus a gerontologist, versus a Geriatric Care Manager. And people were always paying attention to those slides. They, they don't know the differences.


Well, it's accessible for those that can afford it, you know, so. So Medicare will pay for a limited number of days, you know, following a hospital, stay, for example, I think it's up to 30 days. But beyond that Medicare does not cover that expense.


I mean, that's across the board, being able to actually get a mental health appointment, whether you're a child or an older adult here in Orange County is very difficult. Yep.


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


Yes, here at the Council on Aging, we have our reconnect program. Nami also provides programs I mean, there's a myriad of different programs, but many of them are not widely known in the older adult community.


It would be rental assistance, food access, it would be, you know, just other social services that are not healthcare related.


Yeah, yes, I think it's difficult oftentimes for older adults to know how to access them. Many might call the office on Aging, for example, for resources or perhaps 211, if they know that those organizations exist. We also utilize the answers resource guide that we've published, I've shared one with you. So that folks know about that, that gets a distribution of about to about 50,000 readers at least every year. But there's just a general lack of awareness of where to turn. And once again, because of a lack of planning, when folks do call here, they're often in a crisis mode. They're there it's not a pre planning, you know, situation.


Just one single thing, you can name more than one, I could give you a laundry list. This think I, I sort of come back to this, this topic of planning because I was fact, I was just talking with Todd Hansen about this today. There's a real need for a plan, we plan for so many other things in our lives that we do not plan for aging, we do not plan for transportation, housing, you know, all of these things. And unless we're starting to have these conversations, and let families know that this is something that impacts us all, we're just going to continue to have problems, you know, that. And it's and the, the other thing that happens is it drives families apart, you know, when you you, you've been through it with your own within your own family, right. So you, it can cause just problems among siblings, because there's, there hasn't been a discussion with mom or dad or grandparents about what this how to handle this. It can cause I mean, it cause really fractures in relationships forever. And so the importance of talking about aging and planning for aging, when the older adults can be part of the conversation is really critical. And that in itself would start to alleviate some of the problems, I think that we face around all of the different topics that you have identified. And there's no one that's really leading the charge on this in the county. And so it's one of the things that we're talking about that at the council that we could be doing a better job is initiating, helping the community understand that we need to initiate these conversations. And maybe if that's something that we can do through your work, Katie, I think that would be really interesting. Because if we start to engage the community to think about this, versus when they're in a crisis, it could make a big difference. A big difference, you know, but there's, yeah, we are talking about it.


Well, we are going to focus group, recently retired folks. And one of the things I think I'm gonna ask them is, if they've ever thought about planning for aging, so be curious to know how many people have done so.


And it has to be beyond making an estate plan and getting your wills and trust in place. It's the difficult conversations that oftentimes, families don't have.


I think the government can play a very important role in terms of helping to build awareness around what are the available resources, the importance of planning, and that we need to make Orange County a safe and good place to age and particularly and so we need to take proactive steps now to be able to help make this a better place to age when, in fact, we're going to have to catch up because we're not doing enough quickly enough.


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


Oh, there are minority populations, for sure. The underserved.


And then thinking about all the issues, including some of the ones we talked about today.


And then alternatively, what programs or services or maybe, you know, barriers to them not working in Orange County.


Okay, so, why they're working, they're working far better now that we're back out in the community again, when we were limited and not being able to be face to face with residents and long term care facilities or in their homes, or at senior centers. That was so limiting. And now that we're back out in the community making those connections, that's really that's how we that's how we make a difference in and being one on one, serving individuals or or in other cases, we, in order to reach more, let's say, through our high cap, our Medicare counseling program, we do a lot of work through our call center. So that can reach those that aren't able to, you know, come in for a face to face meeting at a senior center or whatever. So being out in the community has an incredible impact. And through that work in the community, then we find that stories about how we've helped individuals that are shared with friends and family, and that helps to spread the the the word. So I think that's certainly one one of the ways that we can really make an impact. And I mean, if I think about our ombudsman program, for example, when our ombudsman weren't able to go into facilities, how do you check on residents, you know, if you can't go in and walk down the hallways and see what's happening in facilities, you know, you you, you can't so same thing with our reconnect program, we're able to go out to older adults homes now and be with them. So. And I think the one of the things that is inhibiting our ability to reach out and serve more is just the lack of funding. So that's, so we so for example, the grants that we receive are typically for a three year period. And as our population is growing, the funding is not keeping pace with the growth of the population. And so oftentimes, the funding is flat year to year, we've started to see some more funding coming out of the health care agency for our reconnect program. But it's definitely not keeping pace with the growth of older adults. Yeah, yep.


Well, it's funding as if funding is important. And it's important thing, and helping. And this whole topic about planning, I think, is another to I'm really sort of zeroing in on this a lot lately, because I just think that there's something here, there's something that, that we need to do a much better, a much better job as a community. And just in the presentations that I've given. So far in the community, it's clear that there's just been a discussion with so many people, there's just, it's clear that there's a lack of planning, and there's so much more that we could be doing in this in this area, and getting people to have those conversations. So that's one thing. Funding is a big factor I'm gonna use when you think about what's going to make a difference in the community, whether it's, you know, it's mental health support, whether it's transportation, whether it's housing is funding is going to play a massive role in our ability to solve these problems. And who,


or what entity is best suited to address that issue.


It's not just one entity, it's going to have to be it's going to have to be a group of organizations, it's going to be the health care agency, the Board of Supervisors, the office on Aging, the California Department on Aging, and the federal government, it's got to be a if this is not it, I mean, this is not a simple problem to solve. If it was, we would have solved it by now. So this is a very complex problem to solve. There's not a, you know, a single answer.


And what about, you know, corporations and,


well, less than 3% of philanthropic funding supports older adults in the United States today. So and we talked about this also, yet, when we look at who the philanthropists are, many of them are older adults themselves. So we have to, we have to do a better job of planning, but also talking about the needs of older adults. And so maybe this discussion on planning will start to build more awareness because this does impact every family about the need to support older adults and family caregivers. Because that's, you know, and as we think about and I want to make sure that we don't overlook family caregivers, because as you think about I haven't really talked about this much, because if you think about the top three issues that I discussed, they impact family caregivers equally with the older adults themselves, right, whether it's housing, transportation, mental health, because the family caregiver is going to be actively involved in hopefully, in dealing with those topics. But you have, you have family caregivers, oftentimes that are family members that aren't involved. We just had a visit out to a gentleman that last Friday that he received one of our smile makers, holiday gifts that we do, and the gifts that he wanted and received was three white t shirts. That's all this this gentleman wanted. And of course we for that we put in socks and other shampoos and other kinds of things that the person might need. But he wrote us a note and he said, You know, I'm so thankful for this gift that you have sent me It's so unexpected and I'm so appreciative of it because of my age, I just feel isolated and, and useless. I have no value. So we went and met with we went to see and we went to wanted to meet this gentleman went to meet him. He's a Korean immigrant. He says that he he's a physician. He's a general surgeon, believe it or not. And he said that he spent most of the last 10 years in his room at a long term care facility by himself reading. And there are people around him, but he's just very isolated. He has a son that lives in Las Vegas, and he has two children that live in South County, and they don't have two sons. And they don't really visit him. He said, they're busy with their own lives. And he's, this man was brilliant. He had he was 94, sharp as a tack. And yet, here he is, he couldn't believe that we came to visit him. He goes, this is such a treat, when we thought we would initially go and visit for like about a half an hour, we stayed for an hour and a half. But this is just one example of someone that is just, you know, feels that they're completely worthless. And yet he was so sharp and so delightful, and just a pleasure devils are gonna go back and visit him again. But it's an ombudsman in and out now is actively involved. The Ombudsman, and this gentleman both went to the same engineering school in Korea.


So I'm basing my world I know, I know. So anyway, it was, but it was just it was just like a snapshot of this is why our work is important. And this is yet why you see an older adult with family members in an Asian family, which usually Asian families, oftentimes are very focused on their older adult family members, but he's just alone. And it was just really, he's got so much to say and offer about all of his experiences on how he came here survived the Korean War. He actually went to did interpretation and translation for the South Korean army, and then the US Air Force. And then, you know, immigrated here with $25 in his pocket. I mean, the guy was amazing. And we had no idea from this little handwritten note that was just so precious to have received from him. But I said, Well, if somebody feels that they're just, you know, useless, we need to go meet them. And so this, this is just one snapshot of what's happening in our community.


Oh, yeah. It's, it's a real, it's a huge, huge problem. So here's what's so when you think about that whole topic of mental health and, and yet, and so what are we going to do about that yet, he's, here's this gentleman that's living in a care facility that must have 75 residents, but he just, he just chooses to stay in his room, you know, and yet he has so much to offer and so sharp and so Oh, engaging and funny. And he's just he escaped out of the out of one area of Korea where the war was going on, on the top of our rail, commercial rail car with a bunch of free as if they was like a curves, like a curved real car. And he said to stay on it, they had to sort of like form this big human chain to just hang on, as the at once the train started moving. And they they went through tunnels, and if some people were standing up at the time, it got knocked off the train, and oh, my gosh, this guy's stories were just incredibly well, interesting to talk to. Yeah, yeah. So Lisa, in your work, what,


what kind of data metrics do you look at, either to assess your success or to assess the need.


So we have in all of our programs, the Ombudsman Program, the high cap program, the reconnect program, we are required through our contracts to provide data on information about the number of clients that we serve their ethnicity, if they're veterans, the type of we owned the savings in the terms of the high cap program that we provide, the number of complaints that we address to the Ombudsman Program, the number of pre and post surveys and our reconnect programs. So there's a lot of data that we have to track for the contracts that we manage.


Well, we look at the things we look for data from a variety of different situations. Of course, we've got, you know, Orange County, data that we rely on here. But then I also look at national trends, you know, whether that's data coming through the Kaiser Health Foundation, a RP, US Census you know, articles that you see in you know, a variety of New York Times, Washington Post those kinds of things. We get data from a variety of sources


You mean other organizations that you think we should talk to that you should talk to


I would think you'd probably you've probably got some of them. I can't think of any off the top of my head that I,


okay. If one does show up, then let us know, we'll be happy to include them in the process. So unless you have any final thoughts or comments you'd like to add, this concludes our interview. You


know, I would like to say, I'm so glad that you're doing this and of this undertaking, you know, this is this is this is sort of like, oh, I don't know, peeling back a lot of different layers of an onion and trying to figure out and there's no, there's no magic answer. You know, it's it's, it's very complicated. But, you know, I was just reading the earlier this morning, that the Orange County strategic plan for aging and the you know, that they have a data report that they're putting out, but one of the things that's highlighted in the data report is just the shortcomings of the data report and the difficulty of getting the data. So I think that approach that you're taking is particularly important as we think about having really measurable, meaningful data that we're going to be able to share with the community. And that's what's also going to get their get their attention and, and hopefully start to drive people more towards thinking about the challenges, how to how to support this, both from a government perspective, but also, if we could drive more dollars and philanthropy towards supporting older adults, this is a very wealthy community. And there's an opportunity definitely to support the needs of older adults, because it impacts aging impacts us all. That's one thing that's so critical, and yet it's often so overlooked. So, absolutely. Hats off to you and your team for doing.


Well, we're going to try our best as you saw. But we do think it, you know, however this ends, I think it will be a game changer in many ways, because we are starting this conversation, this this deep planning that's associated with it. You know, I just came from meeting with them yesterday, and we talked about doing a broader campaign about caregiving. And to your point I'll conversation about people don't think of themselves as caregivers. And so I would love to, like float some of those pieces with you and see if it resonates.


Oh, yeah, I think that's very, I think that's very important. By the way, you know, I said that I would introduce you to Erica Dan seckford, that was used to let head the office on aging. Yes, I thought I had her email address at Cal optima. With me, but I don't. So I reached out to my contact at the office on aging, and she's on vacation this week. So I haven't heard back from her. But I get that someone I definitely want you to, with, okay, because she has, she headed up the office on aging during the most difficult times of the pandemic. And so she saw, and because she was over all of the major, older adult contracts. And so she'll have a different perspective than Nadia Bhatia, who's just starting because Oh, my gosh, she saw us through some really challenging times. And, you know, like a seven or eight fold increase in the needs for Meals on Wheels. It was it was incredible how that just jumped up so dramatically. So she's a really important person for you, too.


I would love that. I can even try to source it to source her connection as well and see if I can find it. But if you can help with that. I think an introduction


would be Yeah, yeah. Very busy in our new role at Cal optimize. So but let me get that. And I'd actually like to talk with her. Also, she was just such a supporter from the county to provide some funding for the answers guide for the current issue of the answers guide when we were never able to get funding. And by the way, there was a one thing you might look at it was a few years ago, probably maybe, maybe five now. There was a grand jury report on the office on aging. I don't know if you ever saw that or not. Okay, so that grand jury report, maybe it's been more than five years. But there was a grand jury report and in that it said that the answers guide should be provided to every Orange County older adult resident because they they like they need to have something so they know where to turn and so that never happened. But that would be something I would be interested in and working Because I just older adults just don't know where to turn. You know, it's, it's if they're not accessing the internet, you know, that's another another problem. So


yeah, yeah. Well thank you. Thank you so much. Thanks available. I will definitely be in touch with you Lisa with things. Okay. This thing will go on until the end of the year. So it's a long process.


Yes. Good luck, and if there's anything that we can do to be helpful or whatever, just just let me know. Happy to be out.


I will. Okay, thank you. See you later here. Bye.


Okay, great. No, no, I'm good. Okay, wonderful.


Okay, in a moment, I'm going to show you share my screen and show you a list of common issues and concerns impacting older adults.


Yeah, so my name is Jordan, I am the Interim Director of Housing Services for illumination foundation, I work with older adults is specifically with older adults experiencing homelessness or who have recently transitioned to independent living and housing from homelessness. Traditionally, we primarily interact with older adults, and our recuperative care services and at our senior micro communities that are designated for seniors aged 55 Plus, but we do serve older adults across all of our services.


Great, thank you. Okay, so I'm going to show you share my screen right now, show you a list. Please take your time to read over the list, take as much time as you need. It's a lot on there. And then when you're done reading it through just let me know.


Okay, great. So the primary goal today is to identify what you think are the most are most important needs facing older adults that you serve. And so for older adults, we are considering them to be 60 years or older. And we want you to think about them as broadly as possible, taking into consideration the older adults themselves, their families, their caregivers, and the community. Okay. So I'm thinking about Orange County, and looking at the list that you see in front of you here. Mm hmm.


I think this is actually pretty comprehensive.


Okay, great. So of all the lists, that of all the needs that are listed on this list, Please rank the top three that you feel are most important. Do you want any context, so why I think they're important here are to do that later. We can do that later. Okay. So I would say housing, disability. And emotional well being. Okay, gotcha. All right. So for each of these three categories, I'm going to ask you the same set of questions, right, and we're just gonna repeat them three times. So for the first item that you selected, which is housing, right. power wire, older adults struggling with


this issue. Yeah. So you know, most of the older adults we work with are no longer in the workforce are no longer able to be in the workforce. So they're very dependent on fixed income. A lot of them may not have had the economic well being to be able to plan for retirement effectively when they were younger. So a lot of the times they're entirely dependent on Social Security income, potentially supplemented by SSI or SSDI. Or you know, whether widows survivors benefits, but because they're on fixed income, a lot of the times they're not able to afford housing. In the current housing market, particularly with the low vacancy rates and consistently increasing rents we have, we also find that our older adults oftentimes don't have the kind of informal network that could support their housing. So you know, family or friends that people who are younger, may be able to rely on, we find that our older adults aren't as able to rely on those informal networks for housing.


So I mean, I think that the overall housing crisis is the main contributor. There's just not enough housing unit. It's out there, which drives down vacancy rates and continuously drives up rents. I do think that that results in some particular difficulties with people who are older, a lot of the times they had mobility issues, they require downstairs units, which oftentimes are priced higher than upstairs units. Sometimes they'll need ADA accessible units, which they have difficulty finding, if they are able to find or if they aren't able to find it, then they have to request reasonable modifications and are often in a situation where they have to pay for those Reasonable MODIFICATIONS themselves, which make it harder to access housing, they also have increased need for different social support. So you know, being able to access medical care nearby, being able to access something like a senior center nearby, or some kind of social support. And they oftentimes have mobility issues, being able to reach our transportation issues being able to reach those support, so they have to live nearby those supports, which further limits the housing stock that they could look at.


Um, yeah, I mean, that the data I've seen this couple years ago is that that elderly women are the fastest growing homeless population, a lot of the times they weren't in the formal labor market when they were younger. I've had lots of clients who are taking care of family members, for example, right. So they, they didn't have the, you know, opportunity to build up retirement or build up the kind of resume that they could utilize to find a job that can sustain them when they're older. So I think that, you know, older women face some particular barriers. Because of that. I think that disability is the other big one that we run into, like I mentioned, people will need reasonable modifications, or ADA accessible units, because of disabilities related to their age, and they have a harder time accessing units that meet those needs.


Thank you. And what do you suggest is the best way to address the housing needs in Orange County for older adults.


I mean, ideally, like reducing barriers to building more housing and increasing the density of housing so that we increase the housing stock across the market to help try to drive up vacancy rates and drive down costs. You know, when vacancy rates are higher, landlords tend to be more lenient with the residents selection criteria, which makes it easier for seniors who may have more barriers to entry to be able to access some of those units. You know, for example, some of the seniors might have trouble looking up their credit, they may not fully understand how to develop their credit, they may not understand how to fill out online applications. So in a very tight rental market, all of those barriers they have are just amplified make it much harder. Sorry, I had something else with that too. Oh, just increasing the stock of housing that is suited to their particular needs related to their disabilities. So you know, increasing access to programs that could pay for reasonable modifications, having, you know, greater expectations across society, that units will be more accessible for people with disabilities would be helpful, I think as well.


Yeah, and then I think really trying to develop programs that work with our pop with the older population that's often on fixed income. So you know, a lot of rental subsidies right now are either like permanent rental subsidies, or they're like Rapid Rehousing where they're paying a significant portion of rent for either a limited period of time or forever, but having something like a flexible subsidy pool so that, you know, we could pay for $200 of rent $300 of rent for a variable amount of time, could really help push seniors on fixed income across the finish line and allow them to afford something like a room. Room rental or room and board. Yeah, yeah. Okay,


so now we're gonna move on to your number two ranked item, which is disability. And I'm going to ask you the same questions with regards to disability.


Yeah, so I mean, as as people age, of course, they need greater access to health care services, to be able to address any disabilities they have. So have, you know, I think that a lot of people with disabilities may have trouble because of their disabilities adequately accessing the health care they need that would, in turn allow them to be able to access things like subsidies to pay for reasonable modifications, some of the durable medical equipment that would help them live independently. So I think that, you know, access to health care with their disabilities plays a component. I also think that, you know, what Colleen is helping with this a bit, you know, access to some of the kinds of intensive care needs, they have to live independently in the community aren't really fully built out. And to the degree they are built out, there's there seems to be consistent, like staffing issues, you know, with finding qualified caregivers. So a lot of people we have who may be struggling to experience cognitive decline, or may have like advanced mobility issues have trouble continuing to live independently in housing, because they have trouble accessing that kind of consistent care that they need. And then there's accessibility issues, I think, with housing subsidies in general. So, you know, while housing subsidies for people experiencing homelessness will take into account disability, a lot of the times to access the kind of permanent ongoing subsidies many of these people need, because of their fixed income and their disability status, they have to be what's considered chronically homeless to that who have been homeless for longer than a year for periods in the past three years to qualify for these subsidies. So we're putting these older adults in a situation where they have to experience something that is a traumatic and be, you know, further jeopardizes their health, to be able to access the subsidy they need to stay stably housed. So, you know, that presents an issue. I also think that a lot of the services we do, there's a kind of a cultural competency issue, right, where this is a particular population with particular needs, and particular cultural norms. And the workers who are dealing with them tend to be younger than they are right, people are still in the workforce, of course, right. So they may not fully understand the perspective that our older adults are coming from and how to suit some of their particular needs. Just because of the age gap there. Yeah,


You know, the there's one kind of particular thing that comes to mind to me, which is a lot of the housing choice vouchers, right, that are targeted towards people experiencing homelessness, who are disproportionately older adults, of course, are, you know, non non elderly, disabled vouchers, particularly the mainstream voucher program with HUD, and that has an age limitation where participants can't be over the age of 62 when they lease up. So it seems like one of these, one of the key resources in the community that really allows people to have a choice of where they're going to live with this subsidy, excludes people who are elderly. You know, that may offend to try to prevent cherry picking and targeting these subsidies only to older adults. But I have worked with a lot of clients who are missing out on subsidies that would be able to resolve their their housing instability, specifically because of their age.


Wow, I didn't know that. So that's crazy.


Um, yeah, I mean, gender and race come to mind for me that you there's of course, an intersection there. And those vulnerabilities tend to compound each other. Right. So, you know, having that lack of cultural competency for the older population, that just adds on to not having the cultural competency for for, you know, gender affirming care or for care that is affirming if somebody's you know, racial or ethnic identity. So, I think that the older adults who also fall into some of these more marginalized groups are just even more vulnerable. goal.


Yeah. So, you know, I think that nonprofits and other providers integrating health care services into what they do is a key component, right. So instead of just offering housing, offering resources that could connect to health care, and just having institutional knowledge on how to navigate the healthcare system, can help ensure that there's equitable access for older adults with disabilities in really any of the programs that are designed to suit their needs, and I think that there is a lot of integration missing there, particularly with with homeless services. So yeah, healthcare access. I think that kind of in alignment with the cultural competency component, there's not really like peer mentors that are specifically geared towards the older population. And there's not really trainings on how to address some of the particular needs of this population. You know, for example, our work at a nonprofit, maybe we would like an advisory group made up of older adults, but looking at ways to kind of increase the cultural competency and understand some of their self stated needs.


Yep, yep. Okay, so I'm gonna go now to your third item, which is emotional well being.


Yeah, so, you know, I think the older adults we work with, you know, they're at a different phase in their life and, and the social supports, they need differ than a lot of the social supports, we tend to think of as as normal or tend to offer in society, right. So we'll actually have, I've had a surprising number of people come to us or recuperative Karason shelters, and they get very comfortable with the social element that's there, right getting to know all the other people kind of having people who are continuously checking in on them and seeing how they're doing. And when they make that transition to housing, it can be difficult from them, because they're losing a lot of that support that they previously had. And they have trouble knowing where to go to find replacements for that. So I think that social isolation is huge, we do try to address that with the senior micro communities where we're leasing out individual rooms, and we try to create a community out of that single family residential house that each person rented a room is tapped, so that the people there try to rely on each other a bit more for some of that, that social interaction and for some of that understanding, by living with people who are going through, you know, are in a similar situation or from a similar background. So I think the loneliness is huge. And I think that that is just really highlighted by the recent Surgeon General Report on loneliness, if you saw that, some of the negative health outcomes that come from that, you know, and that then, like I said, I think that transportation and technology understanding play key roles in that to where, you know, when our seniors move into housing, they a may not be able to get the different resources that they want to access or be, may not understand how to go about finding those resources for themselves. So they're really dependent on having somebody help them navigate the kind of the social safety net and find things like senior centers for that or volunteer opportunities. Okay.


Yeah, so I brought up you know, technology, literacy, transportation is key issues there. I think the cultural competency plays into this as well where you know, we have case managers and the case managers have particular services, they tend to zero in on right, and those may not be suited to the older adults specific needs, you know, they're going to kind of jump to the general populations needs. So, you know, they may not understand specifically that are seniors have a greater need for for services that could help with emotional well being than some of our other clients. So they're less likely to identify that and care plans or to notice that when they're doing assessments with clients, and to try to direct the client towards resources that can help with that. I do think that the seniors tend to be more isolated from some of the social networks that we tend to take for granted. So like friends, family, co workers, have tend to have less access to those than people who are younger. So they, you know, are that they don't have the usual supports to to rely on. So they're, they're much more dependent on what the the community can offer in a more structured way through things like senior centers, that kind of stuff.


Yes, I think there's once again, a cultural competency thing where people are part of multiple, you know, disadvantaged groups that, you know, it makes it even harder for them to connect with people who have a similar understanding and similar background to them. So I do think those tend to compound each other. You know, I think that people who are economically disadvantaged or have transportation issues have greater trouble accessing these resources. So that kind of subgroup as well. Okay.


Yeah, so, you know, I think that a lot of assessment tools that we tend to use don't do a great job of identifying how lonely somebody feels, or the level of social isolation they're subjected to. So I think changing how we assess client needs as a system can help to better include that emotional well being. I also think that we could do a better job of connecting people to some of those social networks that they may have, may be disconnected to so things like family and friends, we I don't think we do a great job of reconnecting people to that and trying to nurture those relationships. Because I do think that the older adults face greater barriers and maintaining those relationships as well. So they need additional support and help with nurturing those relationships. And then I think that our communities are really structured in Orange County, for allowing that kind of organic social interaction. So it's very, you know, you're very dependent on getting in your car driving to somewhere to go to go do something. But it's, it's much harder to be able to take the bus when the buses aren't coming super often, you have to take five different connections. Sometimes it can be hard for people to qualify for OSI access to get a bus that will come pick them up. So I think kind of how spread out things are creates difficulties as well. And then I think that with this population, that outreach to them for these resources needs to be done differently than it is with the general population because of some of the issues with technological literacy. So there needs to be a lot more direct person to person outreach with older adults, I think to let them know about the different resources that are available to them. And I think ideally, there needs to be kind of a peer mentor element to that as well. You know, talking to people who have come from a similar background, and are have experience accessing those services that deal with emotional well being helped convince them that those are, you know, safe places for them to go that will help them fill that need for emotional well being. Yeah, yeah.


Okay, so we're gonna move away from this list. I'm going to stop sharing that. And I'll just ask you some general questions about care and access to care. And then we'll go into your specific area of expertise. And talk about that. And then we'll shortly after that, and the interview. So I'll start by asking you if you can, please describe how accessible and adequate the falling care services are in Orange County, so geriatric care


not nearly as six So I suppose it's very difficult.


Yeah, because, you know, most of the geriatric care needs that we deal with are people who have substantive enough cognitive denied to look to claim that they really need like memory care assisted living. And being able to access assisted livings that are specifically suited to their needs are, we find this difficult because it, it tends to be pretty expensive. So for somebody on Medicaid or Medicare to be able to, to afford that, and also on fixed income is, is quite difficult. I find that like I HSS. And caregiving can be difficult, in particular with our population, because they're transitioning from homelessness into housing and for HSS. Part of it is a social worker assessment that's done in the home. So we need to get the person in housing, right. But to be able to maintain that housing, they need the HSS. But to get the HSS, they need to be in the housing and have the assessment done. So there's like a gap in care there. That has been addressed a bit with Colleen recently, there's a service called homemakers, which is supposed to be like an interim service. With while people are getting set up with IHSS. But we don't have a ton of experience connecting people to that to that yet. And when we talk to the providers, they have difficulty staffing up and being able to hire enough people to provide the service. So yeah, so institutional settings are difficult to access the homecare can there are some barriers there as people are starting to get access to that. I do think there is a bit of a quality control issue with IHSS as well. So the older adult chooses their IHSS worker, which is great, they should have that choice, right. But if the worker they choose isn't providing services that are adequate to their needs, I think it's kind of difficult for them to identify that. And, you know, report it and get the assistance they need and finding somebody who will help them to the degree that they need. So I think there's a little bit of a quality issue there. As far as other geriatric care, we're pretty lucky as far as health care goes, because we have nursing students that come through our senior micro community so that we find that we don't have too much difficulty being able to identify a client's health needs and get them connected to the appropriate health care services for them. That seems to be going pretty well for us right now. Trying to think other geriatric services. Yeah, well,


I think, you know, for most, most people who are not dealing with the population you're dealing with specifically, you know, geriatric care seems to be almost a luxury, because most people just have a doctor or an internist. So it feels like it's one of those. It's a luxury to have, if you if you can find a geriatric geriatrician to take care of you or your


loved one. Yeah, yeah. And that was, yeah, any kind of specialist Charisse is, can be, you know, we find that we, you know, we can get the referrals done, but the getting the appointment set up, it can take months, you know, so that's definitely a barrier that we noticed, we are, we did end up having to create our own medical group, the illumination foundation Medical Group for primary care that's kind of more suited to our client's specific needs. So it's more geared towards the people experiencing homelessness. But you know, by extension, some of the specific needs of older adults, for example, they've started doing some in home visits with our senior micro communities so that the seniors aren't having to leave their home to access the medical care. So we're trying to bring it to them more and more to suit that need. But we've definitely had to build out infrastructure to try to fill some of those gaps of bringing the health care directly to them.


Yeah, Yeah, there's something else called Long Term Care. Are you familiar with long term care, it's just the care that somebody receives throughout their lifetime as their aging and includes a combination of both medical and non medical care services. So it's usually case management where they follow the older adult, you know, through a variety of different challenges, not just health related.


Um, yeah, I mean, I think it would be great for programs to be funded. So that case managers have lower case loads. So we find a lot of the times the frontline staff that are interacting with our client consistently, like, at least once a week are case managers. So they're their best position to know the client understand what their needs are, and to address those in a timely basis. And the case labs tend to be a little high to kind of really provide some of the personalized care that they need, I think, and also, just from, from our perspective of our agency, we're a homeless services agency. So as we approach the services we're providing we're primarily approaching it from, you know, homeless services perspective, as opposed to, and like Aging in Place perspective, you know, or, or kind of understanding the specific needs of the older adult population. So there is that kind of cultural competency issue where we just were looking for the issues that people experiencing homelessness space, as opposed to the issues that older adults face.


Understood, understood. What about mental and behavioral health and substance use treatment is, are those services accessible and adequate in your opinion.


So that's another one that we tend to offer in house, our Medical Group has therapy and psychiatry, and then we hire substance use counselors across our various programs in house so that we're able to provide, you know, at least from a, you know, I'd say it's not like super intensive outpatient, but for kind of a lighter touch outpatient, we provide that for substance use to for our services, they tend to be pretty accessible, I will say on the behavioral health side that hiring therapists and other clinicians has been incredibly difficult. The pay that we can offer just isn't super competitive in the marketplace right now. And then also, it's working with this population, it's a lot of hands on interaction with people out in the field, and a lot of the therapists that we've tried to recruit seem to be more interested in telehealth just from their career goals right now, which doesn't quite suit the needs of the older adult population in some circumstances, I think. So I do think that behavioral health has been a little bit difficult. You know, I think that's kind of compounded to, you know, I'm not a clinician, but I think that, you know, being able to provide adequate clinical services to differentiate between what might be cognitive decline, and what might be an actual mental illness is a little bit difficult. And then I think with substance use, it's just overwhelmingly the perception is that the population of people with substance use disorder tend to be younger. So a lot of the population working, or a lot of the workers working with that population tend to be younger. A lot of the services tend to be geared towards people who are younger. So I don't think that there is a lot of focus on older adults, in particular with substance use, but I don't think that I've run into any, like particular barriers for somebody who is an older adult acting, accessing substance use beyond, you know, the the issues of technological literacy and transportation that we're talking about. Yes, yeah. And then


not adequate, not as adequate as they could be. I think so. You know, with food access. Once again, I think CalAim has helped a little bit with that where there is medically tailored meals now so they can get referred through their insurance to have a nutritionist, consult with them, see what their dietary needs are, and then give them meals at least for 12 weeks potentially longer, that are specifically suited to their dietary needs. Beyond that, though, I think a lot of food assistance as far as accessing things like Food Banks, you know, more traditional food assistance isn't very well geared towards the older population, because it doesn't take into account some of their specific dietary needs. And also doesn't take into account some of the difficulties they may experience with food preparation. So I do see that a bit. As far as some of those other human or social services, I think there's a gap for kind of life skills to where, you know, some of those skills that would really help people be able to function independently, and the community without the level of assistance that they may initially need aren't available. Like we're not, we're not teaching people what they need to do to live independently in the community for as long as possible. So a lot of the times people just get referred when they're in crisis and those services directly provided for them. Housing, I think, is very difficult to a lot of so you know, a lot of low income housing is funded through low income housing tax credits, right. So it's divided into extremely low income, very low income and low income, which is pegged to the area median income. But when the area median income is $90,000, and your senior is making, you know, $12,000 a year, the affordable housing that's designed for somebody who's extremely low income at 30% of that $90,000 Ami, that it's still designed for somebody who's making $30,000 a year, not somebody who's making $12,000 a year, you know, so a lot of like low income housing, I don't think is suited to this particular particular populations needs. And then there's just, you know, so much so many gaps in affordable housing in general right now that it's, it's difficult for them to access it.


I think it has to do with the economic well being and housing where, you know, the vulnerability of Social Security, and its failure to keep up with rising cost of living is just going to mean that their incomes lag further and further behind. Yeah, exactly. So, you know, I think that I primarily worry about the income that they need to survive just kind of lagging further and further behind what's needed to really survive in society, particularly in Southern California, where everything's just so expensive.


I think probably seniors who need some kind of ongoing institutional care but have difficulty accessing yet because, you know, by definition, they're, they have difficulty handling some of their activities of daily living. And that makes it so difficult to be able to try to navigate those resources by yourself, particularly when there's a shortage of those resources, or they're priced out of a lot of those resources. So I think that population of people who really need institutional care and have trouble accessing it, they're kind of stuck in a situation where they're waiting until they end up in the hospital or there's APS report. And even we find if there's an APS report, a lot of the times there's not much APS is really able to do.


Yep, yeah. So now thinking about all the issues facing older adults, not just the population user, what issue is being overlooked,


I really think that the social isolation of those independent living skills, those things that really empower people to live fulfilling lives in the community, as you know, normal non No, non older people would get out. Or missing. So, you know, a lot of the resources are crisis resources, right. So we're waiting until peep somebody's in a crisis to help them and that that kind of early intervention that allow people to function as they want to, I think could be difficult to access, but I could be a little bit biased there because I'm specifically dealing with people who are in crisis.


I think that the I mean, I have a pretty expansive view of it, but just kind of personal. But, you know, I think that government should be there to ensure a certain level of social wellbeing, right social and economic well being. That there, there's a standard that everybody kind of has in their head may expect for, you know, if they do everything, right, and society, this is, this is the deal, this is what I'm going to get right. And I don't think that our society really adequately provides that for a lot of people. And that, you know, government should step into ensure that that that social and economic standard is maintained for everybody.


Okay, so now drilling into your specific area of work and expertise.


You know, for for the particular nonprofit, I work out, I think there's a great integration healthcare services into the housing, which helps address some of the older adults needs in a way that didn't really exist five or 10 years ago, you know. So I think that that is, is working well. And I think that a lot of the expansions at the state level, are going to have disproportionate benefits for people who are older adults, like just, you know, the Medicaid expansions, the all the expansions of the lieu of services with medical services are, I think, disproportionately benefit people who are older adults, which is good. So I think that is working well.


You know, I think if somebody gets connected to a housing resource right now, particularly if it's a permanent housing subsidy, right, then it could suit their needs. Well, as also, I just don't think we're doing a good job at offering that at the scale that's needed. But like, if you access a housing subsidy through your your public housing authority, I do find it tends to be adequate for their needs, which is good.


I higher level of care is the thing that always comes to mind. So they, you know, are the only thing they're going to be able to access to some form of fixed income and being able to access you know, social security, SSI SSDI, we find could be a time consuming multi month process. And then they're going to need an assisted living waiver on top of that, which is another six month process while they're working on their own. And then once they have their assisted living waiver and their income, if it's social security, or SSI, SSDI, they need to get the amount increased oftentimes to be able to pay for the rent, because the assisted living waiver, it's only playing paying for the clinical services, wherever they end up that. So we find that getting people to that higher level of care can be an almost year long process sometimes. Meanwhile, by definition, these people can't handle their activities of daily living. And then also, we find that the number of assisted livings that will take assisted living waivers is pretty limited. And then, you know, it's some of them aren't places I would want to send my Grandma, I'll say like, they're, they're having to provide a lot of services for very little cost because they don't have much money coming again. But I'm very sensitive to but you know, I do think the older adults deserve more. So I think higher level of care is, is has been a huge barrier.


Yeah. Well, that's great. Thank you so much for your time today.


Yeah, they're gonna do a focus group for us as well. So, um, you know, it's that's a great suggestion.


I just did, Lisa today, so Okay, yeah, yeah, yeah, that's great. Well, if you can think of anyone else, even after our call, just, you know, ping me and we'll, we'll figure that out. And we'll add them to the list. This is a year long assessment. So there's so many different components to this, starting with the stakeholder interviews, and then we're going to do a bunch of surveys and such. So if anytime you have another thought, or you know, you want to re engage for some reason, please feel free to reach out. Okay. Well, thank you. So this concludes our interview officially, thank you so much for your time. You know, it's been super helpful to look at this issue through your lens specifically. So once again, thank you.


Yes, thank you so much for taking the time to talk to me and for your interest in what we have to contribute to this.


Yeah. And thank you for your work for the community. It's really just an incredible service you guys offer and so needed and I'm sure everyday you walk it through the doors and see a longer line of people in need. Yeah, it takes a it takes a big heart to keep, you know, showing up.


Well, thank you. I appreciate that. Yeah, yeah.


So the primary goal today is to identify what the needs, what do you think are most important to the older adults population that you serve, which are those like all over almost 60 years and older. So we want you to think as broadly as possible,


thinking into thinking into consideration. Older adults, caregivers, also families and communities. So I'm going to share my screen so you can see some common issues and concerns, like older adults. And let me share my screen real quick. Just


Yes. So take a few minutes, go over the list. And let me know when you are done. So the questions that will follow will be based on this table.


adults will be subjected to. Not right now, like right now just go over the list. And let me know if there's anything that is missing from the list, okay.


So a major thing that I don't really see here is


extreme heat. And being that we're a climate nonprofit, is something we think about a lot, one of the major impacts is going to be felt in Orange County.


last summer or the summer before in, like Seattle, and the Pacific Northwest where the extreme, they experienced, like unprecedented heat.


who are sometimes the elderly. And actually, a UC Davis study in 2021, that used satellite data found that metro areas have a greater temperature disparity between their poorest and wealthiest neighborhoods than any other state in the United States, in California, and so, you know, many of the low income communities and disadvantaged communities in Orange County


poor and there are a lot of folks who don't have access to air conditioning. That's what it is. And then also what we know is that


and 14%. So we're going to see really exacerbated heat impacts in those areas. And that'll be something that'll really impact older folks at home without access to air conditioning.


Thank you. Okay. So and then I could add,


I Okay, here we have, okay, you do have respiratory conditions on here. But I would add that something else we work on is gas exposure and indoor air pollution. And we know that three quarters of the emissions from a gas stove occurs while the stove is off. And for children, a child in a home with a gas stove has a 42% higher chance of having asthma than a child in a home with an electric stove. And so you could sort of extrapolate, you know, for respiratory health and asthma conditions for the elderly. You know, they're subject to those same pollutants, benzene and formaldehyde, and NOx emissions, which are really harmful to respiratory health, that are in that, that are produced Nox, when when gases burned indoors, and we know that in low income homes,


there's often inadequate ventilation when people are using these appliances in their most used living spaces. And so and then, in these also, in these vulnerable communities and vulnerable families and individuals living in these conditions, they're already living in environmental justice communities with more pollution, and more heat, and then they're having this indoor exposure at a time when they're going to be needing to stay indoors. Right. So, so yeah, the air conditioning thing, and then the fact that, like, first, some people talk about the solution for heat being like cooling centers, but it's just not sustainable to expect people for weeks at a time to like leave their homes, or months, we're going to have like the heat event that we had last summer here in Orange County that lasted like maybe a week or two where it was incredibly hot, and like you couldn't go outside temperatures of above 100. What the scientists say is we're going to have those events are going to last for months,


in the coming years, so we need people to have access to air conditioning at home. And there are there are other policy issues in place that prevent that, unfortunately, especially in affordable housing, which is something that we're working on. But that is a major concern.


My title is actually director of policy for Orange County for climate action campaign. We are a nonprofit climate policy watchdog. And we build we advocate and organize, to win policies that meet the scale of the climate crisis. And in terms of how we engage with the elderly, we don't necessarily engage directly with the elderly as like end users. We more we focus on policy change, and building sufficient political will to facilitate that change. A lot of times the folks that we volunteers that we work with happen to be older. But I think that's just because they're retired and have time to work on these issues. But we don't usually talk about the, you know, their particular health issues. We are not like a service provider in that way. We provide policy advocacy and like developing an understanding of these issues so that folks can advocate and use their, their latent sort of political and, you know, advocacy powers to to win policy change.


Great, thank you so much. So thinking about the Orange County and looking at the list of common issues, like at the table, and including the one that you are in,


Older adults, I would say number one would be access to cooling, access to air conditioning. And then I would say, I didn't even talk about transportation and mobility maybe second would be respiratory conditions by way of our indoor air pollution, infrastructure. And then maybe third would be Oh, we also have of course, you have on here environmental concerns drought, wildfires emergency preparedness. Yeah, you're gonna have, like emergency preparedness, we're gonna have an evacuation problem with elderly adults needing to get out of their homes that ties in with the transportation and mobility problem. We have cities continuing to build sprawl, housing, in fire, you know, wildfire, extreme wildfire risk zones, certainly in Orange County, and as you look, north, Yorba Linda Brea all those areas. Like, what is the plan there cities also don't have climate action plans. Not a single Orange County city has a climate action plan that protects its residents from climate impacts. And none of them meet California climate goals. And none of them has a adaptation policy that provides for things like evacuation. So we're gonna have these incredibly, you know, hot, fast moving wildfires with people living in housing and wildfire zones and No, no evacuation measures. And yeah, we're not going to have transportation folks will have to be able to use cars. They'll have to be able to drive their car, they have to hope that they have access on the road. So So yeah, I don't know.


um, yes, the number one was access to Cooling. Ah, and the third one is environmental concerns. Yeah, I guess. So.


So, I will ask you for the next questions. I will ask for each of the concern the issues that you mentioned the top three. So I will ask you for those following questions. So how and why are older adults are struggling with access to cooling.


because many Orange County neighborhoods like low climate impacts are increasing. So it didn't used to get as hot as it does. Now. Basically, it's getting hotter. And so their homes are built without air conditioning. And the addition of an air conditioning unit represents a rather large one time expense, and that can be hard to manage and plan for and pay for. So folks ended up not having it and then in terms of affordable housing. Actually, there's an issue with the public housing authorities in the county that do not. Let's see, they public housing authorities have these policies called utility allowances, which are a rather obscure, but they basically set the amount of utility like the assumption the assumed amount that a family is going to pay for utilities in their in this is unregulated affordable housing. And that amount is, is added to the net rent to equal the gross rent or sort of subtracted from the gross rent equal the amount that the tenant pays to the landlord. And currently, those policies to not incentivize building owners to install energy efficient heat pumps, which are much more efficient than air conditioning units, and so operate at a much lower cost. And so that means that a family or an elderly person living in an affordable housing units, for one thing may not be able to afford to run their air conditioning unit because we know electricity prices are increasing, SCE plans to increase rates another 45% Between now and 2030. And electricity prices are already not affordable for many families. And so you'll have them not wanting to use their air conditioning because of the cost of it. And then with this utility allowance issue, there's no pathway for them to


there is there's no way for the building owner, the building owner is disincentivized from improving the situation, so the situation doesn't change. So that adds to the problem. That answer your question. I guess the


Yeah, so it would be, yeah, it would be cost and then like that our climate used to be, it didn't used to get as hot. That's all. And so we have a lot of housing most of the housing in Orange County, which was built, like before the 70s, I believe. And so in a time when we didn't need as much cooling. So that's and then adding cooling is expensive. And then we have this


So where communities who have experienced historically and continue to experience oppression,


one thing, City's public housing authorities in Orange County could adopt energy efficient utility allowances, which is something that many other housing authorities in the state have done. And that basically incentivizes the building owners to install


heat pumps. And so they operate at lower costs for the tenants. And they allow the building owner to keep the housing affordable. And this would also support the supply of affordable housing. This is something we mentioned the Board of Supervisors just this week, we've been advocating around this, and we had some advocates ask for it. We have not gotten support for that from the Board of Supervisors. It would be amazing if if advance OC could help with that.


to cities, and actually cities can join.


There's the Orange County Power Authority, Community Choice energy programs provide a pathway for cities to provide funding for these for these sorts of programs like local distributed energy resources. And so that's why we worked for five years to, to bring the first Community Choice energy program to Orange County. And so it's it's had a lot of issues and its initial years, but we've seen some important reforms there recently. And so when we can grow that agency, it will enable, it will, it will provide additional resources, basically, for cities to be able to afford these local resilient energy resources like batteries and local solar and local wind power and other things to make sure that folks can keep keep the lights on keep their refrigerators on importantly, like you think about the elderly and medications that need to be stored. So yeah, that would be, that'd be another one.


Thank you so much for your answer. Now, I'm gonna go ahead and ask you the same questions for the second issue that you mentioned. So how and why older adults is struggling with respiratory conditions.


let's see, exposure to indoor gas pollution is the highest for our most affordable, most vulnerable families in Orange County, who, like I said, are already disproportionately burdened with pollution from other sources. And they're also living in communities in smaller homes with less ventilation.


And so we know that exposure to this gas appliance pollution is connected to a wide variety of acute and chronic negative health, negative health outcomes, and those include respiratory disease, and cardiovascular disease, et cetera. And we know that a leading source of indoor air pollution is gas stoves and new research from Stanford University last year found that gas stoves leak methane and other pollution into our most used living spaces around the clock because of leaky gas fittings, and stove connections and inland in house gas lines. And actually, in some cases, families experience more pollution from their stoves than the than the highways that they live next to. And the pollution levels caused by these gas stoves would in many cases be illegal if they occurred outside the home. But EPA rules don't apply to indoor air quality. And so it's perfectly legal for that pollution to occur inside the home. So the solution for that is to facilitate this switch to modern electric equipment, which is electric cooktops, especially induction cooktops, which are amazing.


But they, they do not create waste heat in the home. So no, no, heat escaped from them when you're cooking, are radically less than with a gas stove. And they eliminate that leading source of indoor air pollution. And they bring tremendous other climate and health benefits, particularly to those who need those benefits the most.


Thank you so much. So what barriers is see some see any improvements


Oh, my goodness, well, one of the biggest obstacles is the fact that in Orange County were served by the largest for profit gas only utility in the United States, which is called SoCal Gas. And they have a whole army of lobbyists on the ground that are working constantly to keep Orange County addicted to gas, basically. And so we battle with them. At every turn, they're always engaged with local electeds trying to sell them, you know, on continuing use of gas even though we know that it's not consistent with climate goals and not consistent with health goals. So that is perhaps one of maybe the biggest. And then but barring that, really it would be much easier. And we do have, like the inflation Reduction Act federal bill that was adopted by Congress and the President last year that is going to incentivize people to make these changes but but yeah, SoCal Gas is always pushing back in the other direction on that.


Which I should say also adds to all the heat impacts right and


Because IPCC says that eliminating methane, which is 95% of what comes out of a gas stove is critical to staying within this band of warming that we've always humans have enjoyed since the dawn of humanity, and that we are in the final years for, for avoiding the worst climate impacts. So the actions that we take now are extremely important. And yeah, so the IPCC has said we need to reduce methane pollution 30% below 2019 levels by 2030. So, which is like that goal gets further and further out of reach all the time, it feels like and it's always SoCal gas that is pushing back


And they're likely to have more people in the home and live in a smaller home where their exposure will be greater.


Yeah, thank you so much. Well, city should adopt


reach codes that require that buildings have all electric stoves and other appliances. And this has been done by more than 100 jurisdictions in the US more than 75 here in California. SoCal Gas recently had a win at the in the Ninth Circuit Court of Appeals, where they got two Trump appointed judges to find that the city of Berkeley's ban on gas appliances could not be enforced. But we don't think that's on very strong shaky ground on strong legal ground. And we know that reach codes are still very much within are feasible for cities. So cities can still implement a building reach code, that's that applies to buildings within the city and requiring requiring developers in the city to to build all electric and then requiring retrofits of existing buildings with a focus on putting resources into retrofitting affordable housing or say, senior housing to protect folks who live in those homes. But it requires a whole, like, cities need to adopt plans to do this.


It doesn't happen by itself. Thank you so much. Now I'm going to move on to the next issue they mentioned. I would


say it's because wildfires are more frequent and bigger and hotter. Is that was the question.


Okay. Yeah, well, if they live alone, then they it might be extra challenging for them to, to evacuate, maybe they're, they require certain medical equipment that they have to be able to transport with them that might be difficult, they might have limited mobility and difficulty, you know, packing up their personal belongings and getting out quickly. If there is a fire coming. They may not be familiar with technologies, like you know, cell phones and certain apps that might alert some people. But, you know, older folks might be left without that information. When it comes time to evacuate, and then because of their you know, others ties into the respiratory health issues. But a fire, you know, will exacerbate their, you know, any respiratory issues and breathing and so might make it more difficult for them to function in those circumstances. When it comes time


Thank you and what barriers to seeing improvement in this area. Environmental concerns, barriers to improvement.


hmm. Well, we have the fact that cities are not planning for the circumstances in large part, and cities continue to build in wildfire zones, build housing. I'm not sure how much of it is senior housing in particular. But surely there are elderly people who probably live in those areas.


So yeah, I would say both of those things contribute


your and other different services for different groups of older adults for different backgrounds.


concerning this, about regarding this environmental concerns.


Yes, because people again, with greater wealth will have more resources to to cope with the problem when it comes and they'll have more, they'll have better help around, they will have maybe less isolated. And they will have better access to technology.


And, yeah, that would be all those things would contribute.


Well cities should make plans for how they're going to


And that should be part of a comprehensive plan that that plans for all impacts in a city, which would be a Climate Action Plan.


And that should have, you know, evacuation routes and other emergency preparedness measures. Access to water, to ensure that, you know, like firefighters have the water resources they need and the time comes. species selection, actually of trees will be important. So to reduce flammable material around homes, we know that some trees are much more flammable than others. And that can be something that is part of a Climate Action Plan. Again, something that Orange County cities, the vast majority do not have right now at least well, there are six cities in Orange County that have climate action plans. And they're, of course, 34. Cities include the county and we have 35 jurisdictions. So a very small percentage that has a Climate Action Plan, and most of them don't, don't plan for those impacts.


That's all for the questions regarding this table. So I'm going to stop sharing my screen.


Thank you so much for sharing. So now move on to the next question. So the first one is geriatric care how accessible and how often would you think that services


I'm sorry, I don't really have an answer on that. It's not my area of expertise.


I am just very little bit that I know of friends who have tried to identify these resources seems like not very accessible. It has a cost. And that folks are I know people who keep have to keep parents out of state basically, because they can't afford to keep them


to say that probably, and probably inadequate.


I don't know. How accessible and adequate using those services are


Because I don't I know in Orange County that are there's not been a focus on using county resources to provide those services. I would say in the city of Irvine. I have heard good things like about you know, there's the Meals on Wheels  program and senior services, but I'm not sure if that's the case countywide.


oh, yes. As it is going to be extremely hot, and people are not going to have air conditioning, and it's going to be too expensive to buy it and the cost of energy is going to dramatically increase. And people are not prepared for it, they're not aware of it local electeds are not aware of or planning for it. And we're going to be even more energy dependent than we are now. And so it will present even more risks than it does currently. And the heat events are gonna get worse.


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


the government should act to create all local governments to create strong climate action plans that enable Orange County to benefit from historic funding that is now available from the state and federal government. Governor Newsom has made available $54 billion in climate funding in particular, and because Orange County cities don't have climate action plans, they're very much at risk for missing out on that funding. And that funding will be able to provide things like, like cooling for for vulnerable communities at home and in cooling centers, provide for job training to to for folks to install, you know, H vac people so that we'll have an adequate supply of people to do that work to provide for those distributed energy resources, like batteries and, and other other similar facilities that enable us to not be so dependent on the grid, which is subject to outages due to increasing wildfires in large part, which are only going to become more frequent.


so yeah, so that is definitely a comprehensive climate action plans that protect communities and prioritize vulnerable communities. That is what we need in Orange County.


Thank you so much. So thinking about older adults, residents and Orange County, who is getting the least amount of attention.


That would be the folks who have always been sacrificed for you know, in our fossil fuel economy. That would be low income people communities of concern bipoc People


who have who have not benefited from the creation of the problem, but but suffer the greatest impacts from it. So


yeah, so that includes older folks. younger folks.


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


Well, if I could nominate again, those same, I would say extremely is definitely being overlooked. They're not planning for it. There. It's it's really distressing, how little attention there is being given to it with our the lack of air conditioning at home with, you know, around 30% of homes not having access to air conditioning.


And building electrification policies being ignored by most cities, cities, not taking advantage of those possibilities cities missing out constantly on this on climate funding.


Thank you so much. So in addition to what we already have talked about, now, we're going to talk a little bit more in your area of expertise.


I would say it is not working for anyone, it is not benefiting anyone. Other impacts we're going to have are flooding, which we saw a bit of this year, and we can we know will get worse.


maybe even worse, because there, there'll be little warning of them, also there's going to be a tremendous amount of erosion when we think about beach communities. And sea level rise maps show show