meaning like maybe where they live, their disability status, maybe income or education levels


generally with affordable housing, it's just income qualification now on on disability or mental health, we're also building mental health M HSA funding is going into and they also So have a component right for the older adults. So there may be specific housing, right, that needs to be built. If you have, you know, mental health, substance, you know, use challenges. homeless housing. So if you're chronically homeless, that's where it's a different type of housing, is your your intervention is permanent supportive housing. If you're chronically homeless and severe, you know, severely and persistently, mentally ill. You and that population needs greater number of wraparound services. And that's how that housing is built. So yes, there are different needs. That's generally across the population, though. For seniors, the that key component is more the aging, so somebody who needs or has mental health or substance abuse issues, it may, it may be different for a child than it would be for an older adult, but the general adult population and that senior, you know, same interventions are needed. Yeah. What about,


I mean, absolutely. I mean, each, each development that comes online has to look at their actual population. So if we're building senior affordable housing, that that property is going to look at the seniors that actually took the housing. And I'm not a gerontologist. But I mean, I am literally at my 94 year old mother's house today, telecommuting, which I do every Friday. And so I you know, have a unique insight on that, I mean, there's a lot of different needs, when you're 70 versus when you're 80. Versus when you're 90. They're, they're they're very different. I think, anything, your cultural background, where you live, I mean, I just noticed, because we grew up in Riverside, and thank God we can afford my mom's senior living here. Which in Orange County would be almost, it'd be tough. Yeah. So I think and then, I think it's the same. This is, you know, my, my general opinion, is that people project on homeless or low income, that somehow the needs are different than the general population, and they're not. If you come from a certain cultural background, you still have those ties, or things that you've just been raised, you know, doing that are important to you, that may be different than somebody else. If you're aging, it doesn't matter. You know, you're low income, you're rich, now you're rich, you've got more, you've got access to resources. But it doesn't mean that your choices are different. It doesn't color your choices. You still want to have a choice you still want to live in next to your family, or you want to live, you know where you've lived your whole life. Just because you're low income doesn't mean that choice went away for you. Or that it should be limited. Because that's in the Housing Choice Voucher Program. That is the choice of the individual. So I think that's important to keep, you know, in when we're building this out, is that that choice still exists.


Yeah, thank you for that. You've really important things to mention.


Yes, if it's housing and homelessness, Good. Is it equal in every category is that 60 year olds, seven year olds, 80 year olds, and then you just ask the question, because those needs are different. And then finding for us, you know, we always say we need additional funding to fund more housing choice voucher, right. individuals that need rental assistance, if we had additional funding for that Rental Assistance Program, we'd be able to meet more needs. And then in the built environment, like when we're developing affordable housing, I think we just need the information. And then is, you know, I know, there are our funding, I know, Cal Optima has PACE program and other that looking to get, you know, a development that could combine that as the services right for the affordable housing. Company components. So that's my, that's my answer.


Yeah. Those are all good points. I'm sure you can go on for another three hours on that issue. But let's go back and revisit I know you kind of combined housing and homelessness together in some parts. Um,


yeah, we, we need. I think we just need a different shelter environment. I don't know what age that starts. If that's 70, but an individual that's 70 year old that may be finding themselves in a transitional our emergency shelter, I don't think necessarily is getting what they need services wise, while they're there. Now, obviously, the ultimate goal is to transition them to housing as immediate as possible. But they're individuals that find themselves homeless and need daily living activities. That's going to be a different environment, it's not necessarily going to be at your bigger shelters. So it's one of the most heartbreaking things I've seen in my career because I was over homeless programs for a while, but it grew up so much needed to have its own department and rightfully so. But seeing 75 year old on a concrete floor, we've done much better, you know, over the years, but I think it's just looking at the you know, the those homeless needs and I think they're acute, right, because their access health care at the time if you find them street homeless, it's the way they're going to address their diabetes. There are other things that are out of control. Right, that is to get them into some sort of housing or shelter immediately. And then those that need that, like I said they need daily living activities, it's just something it's it's one of the hardest things to fund and wrap into that that shelter service. Yeah.


It is it seems to be more recuperative care when it comes to an older adults. And again, I'm not a geriatric specialist, but I don't think I have to be to know that the CO occurring conditions that aging brings on is, is, is different. And then that's on top of it, they have serious persistent mental illness and substance use, are just talking about somebody that's, you know, most of our homeless are going to find ourselves, they're gonna find themselves with those co occurring conditions, but there's also some that are going to not be seriously persistently, mentally ill they might be less than that. Or that might be just substance use, or extreme poverty. And but their aging, right, just the things that they're going through, is probably more you no recuperative care, like you said assisted living kind of non congregate shelter living situation. Yeah.


No, I think for this probably changing for for low income, because that's the population right that we serve for low income older adults that access to health care, right. That and access to transportation. I mean, if you've got to get to health care, if healthcare is not coming to you, then transportation is a key. And you know, having that person be able to age in place, right. And, I mean, your economic being low income is also in itself, just another pressure, another stressor, to, you know, that the conditions, you're already going through between you just getting older, you're getting, you know, higher blood pressure, your whatever is going on, you can't walk as well. And the access to healthcare is access to a walker, right, it's access to hearing a, it's access to all that. And that's more difficult for a low income individual on a fixing, deciding between the portion that you're paying for rent, right, and then you need to pay for food. And that, then you are needing, you know, other assistance for you to be able to age in place. And then if you need somebody to help you shower, that's extremely expensive. And as a different, you know, you have to get that subsidize, that's not something that a low income individual affords in the regular, like a senior living type environment. So when an older person


That's a good question, because I think the shelter systems grown up a lot. I'm not as clear when we had sort of bigger shelters, and then when we were clearing the flood control channel, and there was an immediacy in older adults or just in a large shelter. That isn't, that isn't something that's that's there. I think the individuals try to exit them out to more appropriate board and care environments where they can get that kind of service. Wow,


that's a lot of coordination for an older adult with a variety of different challenges. Not just the housing factor. Yeah. Okay.


Now it's knowing the needs of the low income seniors. Is it additional connections to mainstream benefits that we need to coordinate in the system better, such that, and we're working with the housing authorities, for instance, in Orange County are working with CalOptima, MOU to ensure that the people who are getting on our rental assistance, not just older adults, but a great portion of our, our housing authorities, voucher program, our older adults, that's it's a great portion of who we serve on our programs. But we're trying to work on that this individuals have received a voucher making sure that they're connected to Cal Optima, because generally, they're probably they're their client, they're probably Cal Optima eligible. So I think in the system, just coordinating that, right. So that the individuals may have access to a benefit. I'm low income, and I need this Walker. So yeah, this is who I can go to now I can tap into this benefit. And stay, you know, where I'm at.


Today, just being able to access, like you said, resources for all of the holistic needs that they might have. It may be through your program, but then it may be through account optima and other agencies. Yeah. Okay. So, I'm going to move into a whole nother tangent that has nothing to do with the list that you saw earlier. So now we're going to talk a little bit about the continuum of care. And if you don't have an opinion, you can just pass a you don't have to speak on something you don't feel comfortable speaking about. But we would like to get an opinion from a variety of people, not just, you know, purely experts in that area. So we just would love your opinion regardless. So can you please describe how accessible and how adequate the following care or services are in Orange County. So for geriatric care, very similar to we talk about pediatric care, so care for children, we're talking about geriatric care care specifically geared towards older adults.


As tough I haven't had, we don't have to, we don't help people get access to that. So the only thing that I noticed to speak I have personal experience in geriatric health care with my mom who's not low income. And I, I know for certain that the health care system needs geriatric specialists. Yeah, somebody who is 80 years old is completely different than somebody who's hit 90. Yeah, but I don't in Orange County, I don't have knowledge on that.


Yeah. So that's what I'm talking about those, as the daily living activity needs increase, right, that spectrum is they they moved in, and they were perfectly capable at 70. And now at 80. Though, you know, somebody that can come visit or, or just do showering or something like that, that it's, it's needed, especially for low income individuals, because the housings paid for we have these subsidies, right. But there's, there's, you know, other than connecting to potentially like a Cal Optima benefit. Yeah. Yeah.


Are you aware of any services or programs dedicated to serving the needs of older adults when it comes to


We have been working with them for years they have you know, that when they built their plan, they also looked at the needs of that they have an older adult separate pot, right for CSS WAS IT support and services um, They have an adult population, which the the older adults are also part of, but they have a specific carve out for older adults specific card about for transitional age youth, for instance. But yeah, definitely on the mental health services, healthcare agency, the MHS a program. There are services. Great.


Okay. Yeah. And and did you see when I say housing, it's also housing for their caregivers, generally, those caregivers tend to be low income. So let me I worked a long time ago with SCAC Senior Citizens Advisory Council, and we would go to them and and we were talking about senior housing, and they made an entire statement on how housing for, you know, their caregivers was just as important as housing for themselves, because they, their caregivers were coming out of county or, you know, yeah,


You know, it's, it's interesting, I think, yes, in a relative way.


Like everything, it has its cycles. And it's tied to economics. So there have been times where the housing has been less expensive, where condo developments were coming in at a price that people could afford, right. And the rents. It's pretty acute, though, right now. This is one of the highest peaks and housing on affordability. So that means, generally, we need more affordable housing than we've ever needed.


Alright, I'm, I'm all about partnerships. In trying to to get it developed, so to duplicate that or to have duplicative services doesn't make any sense. But I, I think it needs to be public private partnership. And I really strongly believe in that. And then we need to look at where there are just absolute gaps. Yeah. So yeah, yeah,


I'm looking at low income and I have no idea of they're receiving less attention than middle income, older adults or different attention. I don't know clearly, I have a rental subsidy that's only available to those that earn 50% Ami or below. So that's a resource that somebody who earns 60% Ami, who probably is considered low income in Orange County, because our median incomes are so high right, and our rents are pretty high. So If I could see that there are benefits that you know, low income individuals have that moderate, you know, older adults don't have. So it's hard for me to answer. If, if there if I see a distinct gap you know, one versus the other. Yeah, yeah, that's fair.


And so now I'm gonna ask you a very similar question. But so thinking about all the issues facing older adults in Orange County, and this could be drawn upon personal experience as well. Just completely overlooked. I don't I don't know


about overlooked. I think the the greatest place for investment is housing and aging in place. I mean, I know I hate to sound like a broken record. I don't think it's overlooked though. I think that with the resources we have now, people are trying to, to use those resources to their maximum to help me we can I just don't sure we have enough resources to fill all the needs. Gotcha. Gotcha.


Okay. So I'm leaning into this work that you do around housing and affordable housing and permanent supportive housing. Yeah, I think.


I can't hear you anymore. Let me pause the recording. Actually, I'll keep going to see if he come back.


the primary goal today is to identify what needs you think are the most important to the older adult population you serve. Those who are 60 and older, we want you to think as broadly as possible taken into consideration of the older adult, caregiver, families and their community. I'm going to share my screen so you can see a list of common issues and concern impacting older adults. Please take a few minutes to read through this list and let me know when you are ready to begin


and when you're ready, just let me know as I can scroll now.


Okay, I got to the emotional well being okay.


Okay, thinking specifically about older adults in Orange County.


Sure. So I am the Director of the Office for family life for the Roman Catholic Diocese of orange. I don't directly deal with older adults on a regular basis, but I oversee ministries and help train ministry leaders and volunteers who visit the sick and homebound or care centers to visit the elderly as part of their volunteer work in our churches. So sometimes I will get to encounter some of the elderly, but I'm kind of a step removed from direct contact most of the time, I'm working with volunteers and staff people who visit the elderly and the sick and then also interact with them at our churches.


Thank you thinking about Orange County and looking at the list of common issues and concern impacting older adults.


Um This might fall under emotional well being or safety maybe but I know sometimes. Or even in recent years, there has been concerns around like violence towards ethnic groups. And so in our diverse community here in Orange County, we have elderly of multiple ethnic backgrounds and so I do you think there is maybe some fear and actual violence that's been done against some of our elderly of certain ethnic groups so I didn't see that directly listed in the examples or issues and it might fall under Community and Family Safety maybe. But I know that's been a concern.


Thank you for sharing up the needs on the list include the one that you suggested Please rank the top three that you feel are the most important.


So I might be biased just because of the context that I'm working in with older adults. But I would say the emotional well being the healthcare access and delivery. And then


I think in most recent years, we've had the pandemic, which created greater isolation, even more so than before. So I think there's, although things are more open now, and people are gathering together once more, or were able to visit our elderly in more places, I think there's been an impact. For the many years that there was a lack of connection. Even now, the ability for some of our church volunteers to go back into some of these care centers to visit the elderly, it hasn't fully come back yet. So I think there's still some disconnection from, you know, the church community, we're not even able to go visit. And also, some, some of our elderly have family members nearby, but many children of our elderly have moved away, you know, the cost of living in Orange County is very expensive. So their children tend to settle and other areas where it's more cost effective for them. So then there's a distance there, and more challenges with staying connected to family members, especially children and grandchildren. And if if you're healthy, you're able to go visit but if you're not, then you don't get to see them as much. So I know those are some concerns that affect them in their relationships, and then also their well being because of a lack of connection.


What barrier is just to see improvement in this area


Well, I think for us as the church, you know, we're kind of waiting for more care centers to open up to allow visitors, things like that. I'm not sure if that's a barrier. It's just I know, we understand the situation


Yeah, I'm not sure. I don't know if I have an answer to that.


I mean, I there are differences, but it's hard to really like, make broad strokes. I think, you know, some of it is based on kind of your culture and how your culture treats the elderly and they're positive. They're aspects of certain cultures that really help with the emotional well being but also other negative aspects that maybe bring them down. So there is that kind of there's differences, but I think there's pros and cons to All of them. I think also things like financial stability, affect emotional well being. And so that also varies across socio economic groups. So yeah, there may be some who, maybe they feel financially stable, but they don't have connections to family members. So that, you know, there's less worry and concern around finances, but maybe feeling a lack of connection or missing your family members. On the flip side, there are some who maybe their family is nearby. There is a tradition of gathering frequently and including your elders. Do I know what to do if there's an accident, or I'm diagnosed with something, but like really varies. So I do think there are differences. And I see differences people told me about the differences. But it's hard to it's hard to every case is pretty different.


I think it would be helpful if there is a broader awareness of maybe the loneliness and isolation of those who are elderly or who are sick or homebound. I think one thing that we try to share in our parishes to have more intergenerational ministries, where even right now a lot of our visitors to the sick and homebound are older and age themselves. So how can we encourage younger, you know, teenagers or young adults or those who are kind of the grandchildren age, to be a part of these ministries as well. So I think there, there could be a raising of awareness and an invitation for more people to make those connections with the elderly, so that they're not forgotten. And then, I mean, I think so much of emotional well being has to do with things, feeling that, you know, feeling cared for, and having things like your finances and your housing situation to be stable. So I think, you know, broader resources and stability in those basic human needs areas contributes to emotional well being as well.


Um, I think they're well, so in certain language groups, I think there's not a awareness of all the resources that are available to them. Some people understand that our health care system better than others, and so just even understanding, you know, the insurance and what's covered and how to get care, we encounter that, I think there's a great need for some navigation assistance. Some people have access to that, but not others, or they don't even know to ask for just even the availability of social workers, some places are really good about providing the social worker is to guide and others, you know, you have to ask for it. So it's pretty uneven Lee distributed, I think in terms of access to certain resources, and then certainly in your language. So I think that's also a barrier sometimes, although, I mean, all places, Orange County probably has a lot more than some other places. But I do find individuals are still struggling to get access and to know even what to ask. And then let's see. Sorry, I had had thought but it flew out of my mind as I was explaining my answer.


If it ever come back to you, you can you can mention at any point I'd be you want to so have some time to think about it.


Oh, I think also, with things like advanced care planning, there are some groups who, you know, they take care of that as a part of estate planning or all that and and they get it done in a timely manner before there, they need to use it. But I do think there are many communities where advanced care planning is they don't even know what it is. And so I know that's something that we've been trying to do in the churches to inform our parishioners and raise awareness about the need for advanced care planning. And, and to be able to support them in doing that in their language.


Yours I mean, I've heard, I've heard there are certain cultural groups. For example, with the advanced care planning, I've heard there are certain cultural groups that were that's very challenging. And I mean, I come from a cultural group where that has traditionally been challenging, but I've found that with, at least individuals that I've spoken to, there is more of an openness, or there's a recognition that this is important. And this is important to do. So I think maybe a barrier could be this perception that, you know, if we bring this topic up, it's going to be rejected outright. And that may may be a barrier or kind of a discouragement. But I think we should maybe overcome that and try anyway and find ways to raise awareness and educate families. I don't know exactly how, but I do. I've heard that there is a barrier, like a taboo. And I realized that too, because I've felt that in my own community, culturally, but when when you actually talk to individuals, or you allow space for family members to share their experience, and then there's opportunity for people to realize, like, Oh, this is actually really important. And this is a way of caring for my loved one, or preparing for things that are going to happen, or will likely happen. So I think that might be a barrier, at least with advanced care planning, and just kind of understanding what happens or what could happen as your health declines and you need to prepare to die. So I think the barrier is kind of this feeling discouraged, not wanting to offend in certain cultures. And we, maybe we need to overcome that and find ways to raise awareness anyway.


But there are different experiences for different group of older adults from different backgrounds when it comes to healthcare access and delivery. Um


I do see that those who have had either family members or friends or someone in their circle, who can really advocate for them as they go through a treatment journey, or you know, whatever it is, like, they tend to fare better and feel like they're being taken care of, and they get what they need. And those who kind of lack that advocating voice, don't necessarily get the same experience. So again, this is kind of I don't have like numbers to show but in just talking to different families or different ministry leaders. There is kind of an uneven experience and getting treatment or getting care, depending on whether or not you have an advocate, you know, whether it's your son who happens to be a doctor and speaks on your behalf or a parish nurse who says go ask them to do this. I think the advocate piece is for those who have it, it's very helpful and for those who don't, it could be a disadvantage.


Well, I think even just education around the fact that you that you do need to advocate for yourself and then providing resources of the for people who can do that for you. So not everybody has children who are right there or has a caretaker or a spouse or someone who can play that Roll for you. Some people can do it themselves until you're in poor health. And then maybe you don't have the wherewithal to do that. So I know for us, I'm trying to encourage like faith community nurses, or parish nurses, so that at least there's somebody at our church community who can provide some guidance. Because if you have somebody like that in your family or circle of friends, that's wonderful.


When you think about caregiving, how a lot older adults struggling with this issue


for caregiving, I think it's because some older adults are caregivers for like their older adult spouses. And so I think that's really challenging. There can be caregiver burnout, and then sometimes it's the caregiver who actually ends up suffering more. A lot of times, you know, family caregivers within the family, they're not trained, they're not medical personnel. Or they might have to give up their work prematurely to take care of their spouse. So I think there's kind of a reliance, maybe even an expectation of that happening and a family but not necessarily a lot of resources for those family members to rely on to do that successfully.


We just have a lot of older adults. I know that's a barrier.


Yeah, I'm really struggling with the barrier question here.


I think it just like anything that prevents, you know, older adult from getting the care giving that they need.


Oh, I see. I see what you're saying. So I mean, I think with the caregiving issue, a lot of it is you know, lack of resources. So if you have, I mean, it kind of depends on your condition, right. So some people just need extra help. And it's at a level that your spouse can do it, it's not a big deal. But if you have greater needs, but not the resources to like hire someone, or then then it becomes challenging, or even if it's like a, you know, sometimes the health care issue does need to be taken care of by your spouse or your older child. But then there's still housework and financial management and just other life things that need to be taken care of. And some people can pay for that kind of assistance, but some people cannot. So I think some of that lack of resources, places a heavier burden on you know, spouses, but also children who are not so young themselves. I think now that our lifespans are so long, sometimes you're taking care of an older parent, but you're you yourself are in your 50s and 60s. So it's that places a heavier burden if you don't have resources and support to take care of not only the person who needs care, but just the regular household responsibilities and tasks


their different experiences are different group of older adults from different backgrounds.


So if you don't, or or if you have children or family members to informally care for you


it's the informal caregiving, I think, for some, there are burdens that are associated with it. But for others, it might, it might be actually more comforting to have a family member care for you. So there's, there's, you know, pros and cons to that. I think some people, if they're able, it's nice to be able to do that within the family and maybe even preferred. I think the burden or I think the challenge is, if it's more than your family member can handle then then it becomes difficult. For some people actually might prefer that. Whereas other people, maybe they can, maybe they can afford the home health and the nurse at home. But I don't know, that's great that they don't, but they still miss their grandchildren or so I think it varies and it kind of depends. Yeah, depending on your circumstances and resources and whether or not it's traditional for your family to be taking care of you.


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


I think resources for informal caregivers is pretty important. As I mentioned, as the population is getting older, I think there's going to be an increasing there, there's gonna be increasing number of families who are caring for an older person in their home or within their family, even if they're not living with them. And so I think just resources for those caregivers. Not even necessarily the actual older person would be really helpful


Can you please describe how assessable and adequate geriatric care services in orange carry


jer cherry. Geriatric Care is basically just like any health care that are more toward older adults.


I think there's there I think there's availability and there's been yeah, there's availability


Yeah, I think it's available and it's, it's accessible. I'm not sure that everybody gets to use it, but but it is, it's there.


I'm not sure about like health care, because I'm not really. I don't like that doesn't come across my work specifically. Yeah, I'm not sure if I can speak to that.


That's okay. How assessable and adequate mental behavioral health substance use treatment services in Orange County


I mean that I believe is accessible as well


not sure how much it goes out. Like to the homebound for example, I think it has to be self initiated or someone has to initiate for you. And I don't know how I don't, I don't know that it reaches some people who might need it who aren't reaching out for it themselves.


Yeah. Can you please describe how accessible and adequate human social services in Orange County


I think that kind of varies, depending on what it is, I know a lot of elderly have trouble with housing, for example, not that they're going to be homeless, but kind of finding the right level of housing according to their needs, you know, kind of within their, their price range. Because, you know, some, there's a very broad spectrum between, like a nursing facility where you get 24 hour care and supervision and independent living. I think there's a lot of, there's a lot of possibilities in between and not all families know about or even know where to A identify what's appropriate for their older loved one. So that's something that we've encountered with housing at least Yeah.


I guess I just feel like there's so many challenges already. I don't know I'm getting better or worse and we hope it'll be better in 10 years ah


I mean, I think everything is challenging I


think there's maybe kind of the connections with just kind of staying included and a part of society. So I noticed I noticed digital divide is one of the lists on one of the items on your list here. And I think that's the, you know, increasingly we have technology tools and AI and all these things kind of infiltrating every aspect of our lives. And that that gap kind of grows as older adults don't adopt certain things. So whether it's in health care access, you know, I think a lot of our hospitals are using things. There's like an app where you make appointments, or you get test results. So I think there's that both of the technology and also even just recognizing that there's going to be more older adults with our aging population. And I do think there's a you know, if if, if nothing happens there, there could be a growing disconnect. Certainly on an individual level, for older adults who aren't, you know, adopting certain tools or staying connected to their family members, who are their children or grandchildren. So I think that will be a challenge that kind of keeping them connected with each other and with kind of the rest of the world as things are changing so rapidly.


You mean, in terms of like legislation, or funding or


Well, I do, I do think it, I do think the government should kind of ensure that


older adults have the resources and access to the things that they need as they grow older, whether it's, you know, the the human things that you mentioned, you know, housing, food, and then health care. And to, particularly to provide resources for underserved communities, to help kind of even things out there, I think that would be good for the government to do. I think there are nongovernmental organizations who are trying to do that too. But they need you know, financial support and and information and data and things like that. So I do think the government has a role in filling in gaps.


Thinking about the older adult resident in Orange County, who is getting the least amount of attention


maybe the undocumented Yeah, definitely a documented and those for whom like English is not their primary language


Yeah, I would say those are probably the main main ones.


I mean, I don't know. Yes, there are varying degrees of health and capability. But, you know, if people retire at 60, but they live till they're 85, that's like 25 years of contributions that they can still make to society. I do, I don't see that. I don't see that. As much as I think there could be, especially if there's going to be so many older adults, as the years go by like there's, I can't imagine that there's no space for them to be a part of our lives and


in more than just a alright, I don't think that's part that's a need for them to


I say that, but I recognize that in a decade or two, I'm gonna be moving into the age of myself. It doesn't have to be work or a job but what role can they have in society in the community and in staying active and continue to share and I think that has to do with emotional well being to you know, feeling like you're still part of the community feeling like you still have something to do. There's still something for you to share with or contribute or bring life and meaning to so that's something I haven't really seen. Yeah.


So this concludes our interview. Thank you for your time, and if you have anything else to share, you can also reach out to us I'm gonna stop the recording now.


Good morning. Good morning. My name is Ron Barnes. I'm a part of the research team at Evangel. See in our in our organizations, the nonprofit conducting the county's older adult needs assessment. Thank you for your willingness to take part in this interview. And the purpose of this interview is to identify the needs of older adults and to gather insights from your expertise and experience. The information you provide will be used for the development of Orange County Master Plan for aging. This interview will last approximately one hour and with the With your permission, our discussion will be recorded for transcription and note taking purposes, the recording will not be shared. And it will be deleted after transcription. If you do not feel comfortable being recorded, turn off your camera and change your name attached to the picture. Your responses are confidential, meaning that we will remove identifying information in our report. Please note that your participation is voluntary. And you may choose to answer any question in part full or not at all. You may also withdraw from the interview at any time. If you're unfamiliar with any terms or use, please let me know. And I'll provide an explanation or definitions. Yes. Thank you. No. All right. So again, the primary goal of today is identify the needs that you think are most important to older adults and adult or adult population. Those 60 and older want you to think as broadly as possible, taking into consideration older adults, their caregivers, families and their community. So I'm going to share my screen and I have a list of common issues and concerns impacting older adults.


so I'd like you to take a few minutes to read through this and let me know when you're ready to move forward.


Thanks. So thinking specifically about older adults in Orange County. First off, for the record, could you please tell us your name, your role and how you engage or work with older adults.


My name is Dominic Makiko. Work with the Orange County Sheriff's Department. And we see or we we work with older aging adults, sporadically throughout the jail system in terms of providing resources, both in custody and post release.


So think about my Orange County and looking at this list of common issues impacting older adults. Not that I see no. Okay.


Behavioral mental health so anxiety, depression, etc emotional well being. And


I would say housing, portable and long term housing options. Okay.


Well, just just from where I or my team works with those individuals in custody, a lot of those individuals leaving don't have family and friends or loved ones. So they're leaving with nothing essentially. They do experience a high level of anxiety and depression because they are leaving without any of those options or people or loved ones. And, and many of them be complacent to short term temporary shelters, but they're looking for something more viable in terms of long term housing. Many of them are not working. And so affordability in Orange County is very challenging for those individuals to find housing options that they feel are appropriate


Ah, you know, I think it's, you know, personal opinion is probably more wraparound services, both for the individuals who work at work within custody, and then post release, I think that a lot of them fall into drug addiction and, or alcoholism, because they don't have anything else to go to when they get released. So whether I mean, it sounds, it may sound, you know, unfamiliar but having a not necessarily a mentor, or aging population, but maybe just people they can talk to, I don't know if we want to call them mentors or not, but you know, people that can engage in conversation, talk to engage with check in with them, get them involved in other activities, which they are hobbies that they may have worked, or did prior to, you know, losing loved ones, etc, I think, thinks that those are some of the things I just don't know what the terminology would be for this population. I know, you know, traditionally we'd like to use mentor but, but something in that those lines would probably be really helpful. The other thing, though, is a lot of these individuals Leave and don't know how to navigate through the system, whether it be our healthcare system, or housing system, or even our, you know, reaching out to NA and a systems. And so having a, someone that we probably call a peer navigator. I mean, someone like a peer navigator that could help them navigate through the system to determine what they're eligible for, what they qualify for how they can get resources in the community would be really helpful.


I would say yes, but at the same time, I would say even though the experiences are different, the resources that they need are very similar.


I think it starts with, well, for me, because my you know, we work in the jail system, I think it's it's mostly developing reports and relationships with individuals when they're in custody, whether that be through Correctional Health Services, or Sheriff's Department, case managers. That starts the process of letting someone know that there, there's help for them, there's people form there's, there's assistance, as opposed to these individuals just leaving and not sure of what to expect when they walk out the door.


I would go back to say the same thing. I think it starts with the the in custody component of reaching out, starting to build a report, case management, follow up services, post release, direct linkage, as opposed to just, you know, flyer information. So we got to do, you know, some people say warm handoff, I like to think of it just as a literally whatever it takes, that means we got to walk them to the next person who's going to assist them or drive them to that next bodily, it has to be a direct handoff to resources.


That was definitely education. So I think that that, to me is is finding the right people who fully understand how to navigate through the housing system within Orange County to assist these individuals with both short term housing, long term housing and even in shelters or temporary placement until they can get into the next phase so to speak, but I think it's finding the right people to navigate through the very complicated housing system, Orange County.


Now, can you please describe how accessible and adequate each services Geriatric Care


Yeah, I honestly I'm not sure I can answer that specifically. Um,


You know, and connecting. Yeah. And that's so so some of them do provide feedback. It's it's feedback, because we follow up with them. Right. And the hard part is when when we say accessibility, there also has to be a once. And so I think, I think that's where I'm struggling a little bit, because I don't want to say there, the county doesn't provide accessibility, but I think there's a fine line between accessibility and the want to do it. Right. So if you don't want to do it, I don't want to say it's not accessible. Because the at that time, you may just not want to do it, right. But then there's also the other half of me that thinks that there may be a lack of accessibility, or confusion with what's accessible. And maybe that's why some people do not reach out to the services. And so I you know, I'm torn between the two, I don't have an exact answer for you.


Again, that's a tough one for me, because we don't I mean, we follow up post release, but especially long term, the longer you go, the more challenging it becomes. So I think for us with the jail system, I think once you get past that six month mark, it's very challenging to continue to follow up and and determine what services are available and received. Right. And so I think the definition of long term may be different for different people. But for us, services are accessible for those individuals that that six month Bart it's hard to tell in terms of percentage and numbers just because we lose track of a lot of those individuals, especially if they're not on probation or parole. So for those people on probation or parole, we can follow up with probation and parole officers to determine what their success level is in terms of engaging in these resources. But for those individuals who are not on any type of supervised probation or parole, you really have to do your due diligence to try to track them down.


And I know this is an interesting one, because I'm wondering if you have, you know, inmates that will be released to like a nursing home or some kind of long term care facility.


For the most part, we won't and and that's because, again, the majority of them, it's voluntary, right. So all the services in the jail are voluntary. And so are individuals that we work with the majority of them don't want to get released to nursing homes right there. They, as crazy as it sounds, they would rather be homeless, then move into some type of nursing home with too much structure. And so what we hear a lot from our clients or our population is they don't want all the structure. They want, they want the comfort of the housing, but they want it on their terms. And so most of them will choose to be released to the streets, unfortunately, as opposed to going directly to some type of housing. That's why a lot of them choose shelters because shelters will allow them to kind of freelance with no restrictions, right you right, come in the morning, you get breakfast, you shower, you leave throughout the entire day, there's really no expectations and then you check back in at night. And that's what a lot of them like.


Now, this is the one that you talked a lot about how accessible and adequate our mental behavioral health and substance use treatment services.


I would say they're very accessible. I think we do a good job in the county of making sure those are accessible. The challenge is not enough. Bed Availability. So for people that do that require more than just outpatient care. They're looking for some type of residential detox residential treatment. That's where as a county we struggle with because we don't have adequate beds for those individuals.


I'm sure we do. I'm just not familiar with them. In our side of the shop, we really try to meet the client where they're at at that time. So Young, old in the middle doesn't matter, right. So in terms of us placing someone with a addiction problem, or even someone that's just homeless, for us, it doesn't matter. You know, in terms of age, race, gender doesn't doesn't matter to us, we just try to find them a place a safe place to go.


And then last service is human and social services.


I don't have a fair answer for you on that one, to be honest with you. Okay.


Ah, you know, mental health would be probably a huge priority. And then most likely health care are aging. Population, one deals with a lot of mental health issues, which are not really talked about to be honest with you. And then our aging population also has a lot of health issues, and they don't know how to navigate through the system. So I think those are the two big challenges facing them.


I don't know if we've ever done that. Because I think we we always assume what they need, but I don't know if we've ever gone directly the source to ask them.


And we're doing that in this assessment. Just so you know.


Okay. Perfect. Yeah. See, there we go. Finally, finally getting there.


Yeah, good question. So after, after identifying what the needs are, I think government naturally will have to provide funding targeted towards those needs. And I know one thing that's probably going to come up, and it's going to be a challenge for Orange County is finding suitable housing for these individuals. There's that whole thought of, you know, not in my backyard, you know, so you can put people wherever you want, I think it's a great idea, but just don't put them here. And so I think that's a challenge. And so from the government, I think, one funding to making sure we have resources, but then I think three is is added adequately educating the rest of our population or society, why it's important to provide these services to our aging, aging population. So we move on with our lives. And we're not at that aging point yet. And so people just feel like, well, they're gonna figure it out and do their thing, or because they've already gone through everything. They should have everything set up, they should know how to navigate through the healthcare system, or they should know how to deal with anxiety and depression, when in reality, they don't, you know, so I think educating the population is huge.


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


Ooh, that's a good question. I don't know. I mean, I'll probably be biased and say the ones incarcerated. Right, but I would I don't know. I mean, I would probably say that we forget a lot about the people in the nursing homes, right, like, because we, we assume they have meals and beds, that everything is fine. But I think those people are suffering from a lot of mental health issues just being there, you know, just being there and being alone. So yeah, I don't know, I guess I'll be biased because that's my expertise of the jails. But I think you could definitely argue for some other some other areas of the county as well.


I would say mental health, I would say mental health, I think, you know, when when you showed me the list here, and I was going through the list, I think naturally, we start thinking about health issues, and we start thinking about health care, and we start thinking about homelessness. We just We just assume that, you know, because they have a health issue, meaning something more physical, right, that that's the number one priority, but we we neglect the mental health side of things. So I would say that, that mental health is a huge, huge piece to to our aging aging population that we overlook. Okay.


So this concludes our interview. Thank you so much for your time, you've been credibly helpful, you know, to our research, and if you find that you have additional information to share, please feel free to reach out to me. Or you can contact us through our website, and that's oc.com and we also have an anonymous, confidential voicemail, telephone number 949-415-6898 that you can call anytime.


Thanks again and yes, I'll share with you or let me stop recording.


write. Hate the primary goal today is to identify what needs you think are most important to the older adult population that you serve those who are 60 and older, we want you to think as broadly as possible, taking into consideration the older adults, caregivers, families in their community. I'm going to share my screen so you can see a list of common issues and concerns impacting older adults. Please take a few minutes to read through this list and let me know when you are ready to be able to see the list. No, no,


not yet. It might take a while. Sorry about that.


And, you know, let me know if I need to make it larger, make it smaller. And we actually tried to figure this out when he easier to read but it may not be the easiest thing to read. So let me know I can totally score down or up or down however you like. So just take a few minutes to read through it and let me know when you're ready to begin.


Okay, yeah, you know, we can get started.


So for our record, can you please tell me your role and how you interact or engage with older adults.


You know, our organization. And I myself, we we work with unpaid family caregivers. Across the economic spectrum, we provide our services free of charge. And we're funded by state and federal funding. And we are the exclusive agency. Our exclusive group, our caregivers. And so we are part of a statewide system of Caregiver Resource Centers. Our services are not means tested. It's kind of been repeating myself here, I'm just saying another way that you don't necessarily have to be eligible for MediCal or Medicare. And because our target population are adult caregivers, caring for adult loved ones with cognitive impairments, the adult caregiver can be of any age 18 and over. We do have a large proportion of caregivers that are older adults 60 And over, usually caring for their spouses. And then we provide social support, which includes individual counseling, group counseling, support groups. And then we also provide information and assistance to a lot of older adult resources, because a majority of our folks work with older adults that are either frail or I have a cognitive impairment which includes Alzheimer's and dementia. And then we also provide tangible services such as respite care, which we pay for a similar to what Cal Optima pays for Kaeleen. But our clients don't have to be caring for somebody that's a Cal Optima member. It can be anybody and we provide respite, we actually pay homecare agencies to provide respite care. We also purchase goods on behalf of our clients sometimes to help them with durable medical equipment that's not covered by insurance for their loved one or, or assistive devices that helped them care for their loved ones or sometimes even things like incontinent supplies, which they are working towards getting covered through either commercial insurance or Medicaid or Medicare. So, it is a program that's been around since 1989. Now, we seem to add our data shows on a statewide level on a local level, is that a lot of clients, a caregivers are having to provide a lot of complex medical care in the home to their loved ones. And not only, you know, things like G tube feedings or changing dressings or, or managing multiple medications or administering certain medications, they're also doing this in the context of


folks with Alzheimer's or dementia, or clients that have Parkinson's, or that have Huntington's disease, ALS, or some of the other adult onset issues that occur. So, you know, those are the things that we provide. And what we're seeing in our population, the things that they're looking at, is one is the caregiver themselves, trying to get some emotional well being. And because it is difficult to provide care, especially if they're older, that emotional well being tends to also affect their health. Because as they're caring for their loved one, they tend not to care for themselves, or the older adult caregiver, that's one of the issues that we see happening, and that we try to help them avoid. That is, you know, we're as diligent as they are about taking their loved ones to their appointments, they may be foregoing their own appointments, or as diligent as they are about giving somebody their medications, they're less likely to maybe follow their schedule, as closely. Now, what gets woven into all of that, is economic security, especially for the older adults who, you know, every November or so have to decide about what they're going to do with their Medicare. So there's that kind of, you know, that exacerbates their not only emotional well being, but it also affects their economic security. And it also affects directly their health. So that's where we see especially the older adult caregiver, and caregivers in general, how Because Because, again, you know, a lot of a lot of our clients do we have a majority of clients that are working, not 30% are working full time over 50% are working, that one they want to because they're supplementing their income.


I don't mean to cut you off, but we are gonna get back to a lot of these issues that you just mentioned. So yeah, so what I do want to refer back to this list. Oh, yeah.


So it would be the economic security, which I said, you know, caregiving off course, and then that emotional well being, and then kind of in the rank order, it would be for us directly. We deal with caregiving, and that emotional well being a caregiver, and then the categories that our caregivers are expressing is this health care access and delivery for themselves or their loved ones.


Okay. I actually haven't asked my question. No, no, no, no, no problem. No, thank you. Thank you. But I just want to make sure you know, I asked all the question in the correct sequence. So when we do the transcription, you know, I'm not missing anything. So that was that was question number one. Now number question number two, really referring to this, this chart or this graph. Let's start with thinking about Orange County and looking at this list of common issues and concerns impacting older adults.


No, I think I think that it's, it's, yeah. Okay. Yeah. The only thing I would say the only thing I would say though, is that this list Yes. The age range of people that look at this list is not these are issues that are very universal to a younger adult population. There's nothing magic about being 60. And over, that minimizes any of these things. Especially in Orange County, which is a very affluent, expensive place to live.


would have this on their list of issues. Okay, personally,


I'm gonna have you do that shortly. So what I've actually right now, so of the needs on this list, right, including those that you want, you haven't you said that according to this list, you're not seeing anything missing. So just based on what we're seeing on this list, Please rank the top three that you feel are the most important.


And this was for the older adult. So I would say health care, I'm sorry, health care access and delivery, that would include mental health, economic security. And I would say, transportation and mobility. Now, last lesson would be housing. I just want to pick four, three, or four, three out of four.


Okay. So I would go with economic security, health care access and delivery, and.


Okay, and I will ask a series of questions, short questions, or each of the three. Okay, so we'll start with the first one that you identify, which is economic security.


I think it's the you know, it's a generation that was it's still relying on on Social Security is the primary source of income.


our health care system with regards to Medicare, and premiums to be paid. And other expenses are the costs of living, especially those that don't have affordable housing is outpacing their incomes. So it cascades from, from that. I think that that's it, it's this as this this age group has still is still relying primarily on Social Security


have personal resources or other retirement accounts that can supplement a lifestyle that make them relatively secure.


I think the cost of health care is one barrier. And the cost of housing is the other barrier.


For example, where they live, their disability status, income, education level,


I would say yes, I mean, those that immigrated here, and are able to have at least 40 quarters and with Social Security, have to rely on SSI or they have to rely on family. So I think the immigrant myself being from an immigrant family, you either start saving early or if you have family members that come over later in life, they haven't contributed to the system. So therefore they're not going to get as well. They essentially have to become impoverished to get anything from the system. So that that has some economic security issues. And again, you know, it's just a matter which popular which demographic we're discussing. I, I couldn't speak to, you know, the other demographics in terms of what economic security means to them or, or why, what barriers they have you know, other than, you know, maybe inequities and in in employment, discrimination when it comes to employment, whether it be, you know, the traditional due to race or just access to education at a younger age, or just access to opportunities. But yeah, I just don't feel comfortable speaking to that.


That's fine. That's fine. Well, I think, to educate, what we do,


is we educate the caregivers that are not older adults, that are caring for an older adult, and families that are caring for an older adult. When we address that we we educate them on the realities of aging, and the cost of aging, and what they need to plan for in the future. It's not something you can start planning forward at the age of 60, or 65. If you haven't been paying for it before, then by either getting some sort of long term care insurance, or for somehow managing your finances or having a plan for creating your own social support system within your family, then you're going to have to rely on what what the system has. And I think that, you know, that's one of the ways education, but not education, as you're older, it's education. Prior to that, and also certain aspects of when you become an older adult, trying to understand how to make social security work for you. And some of these economic things, you know, I really don't know, I mean, I'm just looking at economic security is as it's hard to, to look at it other than it doesn't start when you're older. It just starts before that. And then after that, you're just at the mercy of how you and you and your your years of work, and have to rely on your own financial investments prior to that.


That's fine. So now going back to the second issue, you identify, which is health care access, and delivery. Right.


I think part of it is the complexity of the healthcare system, the complexity of understanding your benefits, and the different forms of contracting, especially if you're on Medicare, and you're dealing with commercial plans, and having to re enroll every year. The cost of premiums, the costs of co-payments, how they are administered, the different contracting in a managed care environment, which most people are, are having to deal with. Managed Care is very difficult when you have to rely on a gatekeeping a primary care physician and formularies they change every year. So every year instead of having comfort in the fact that you do have Medicare you're also now have to think about which supplemental plan you may want to buy which supplemental drug plan you're going to have. And you have to balance that with how much it's going to cost you. And then, you know part of the other health care piece is understanding what is going to be reimbursed by your insurer. So that's it you know, that's what I that's what I said


It would just have to be a tighter regulation of the commercial market for which is, which is kind of unpopular. But yeah, streamlining, streamlining, the Medicare plans and streamlining the process for re enrollment and the formularies. bulk purchasing have a single payer system for pharmacy to get to start with, and really redefining the rules of some of the managed care contracting, so that, especially older adults, don't have to worry about being charged for something out in network or be worried about which whether they're seeing the right specialists or whether or not the drug is on the formulary, it's covered this time, and whether it's generic or non generic. So I think that that's, that's, you know, the solution would be expanding the Medicare benefit, and the medical benefit. So that once you're over the age of 65, there is no wrong choice in health plans, or Drug Formularies. And that, you know, the benefit follows you, you don't chase the benefit from, you know, insurer, insurer or group, medical group to medical group, it just goes with you. And it's applied equally to whoever you choose to be your provider.


Why I think the language capability, I think one is one because, you know, even even if you not only is it complex, even if you speak the language, like it's just the complexity of it all in, you really can't have a native non native speaker, hearing some of these complex explanations about especially when it comes to medical and insurance terms, in terms in formularies, to really understand it, unless they're getting it directly in a format that they already know and language they recognize and can understand. Because even that is nuanced. So you know, again, a lot of this definitely thinks those that are non native, non English speaking, when all the materials are complex, and complicated as it is, even in written form, they need some explanation. So I think that that's partly then and again, trying to get providers that are culturally competent. Because it's not always about the actual clinician that's providing the care that needs to speak the language. I think you always want to have the best, the most competent or the best clinician, regardless of what language they speak, but somehow facilitating at conversation, and that again, ethnicity does matter. For some people. Studies have shown that, at certain certain rate, racial and ethnic groups prefer different styles of medicine and in prefer different types of interaction. So you just need culturally competent and Representative clinicians providing the health care. And the next question you


probably already answered or partly anyway, so what do you suggest is the best way to address this


Well, you know, promoting, promoting an understanding of the needs of an older adult in terms of language


and understanding having some cultural sensitivities. So that that's it and then having clinicians that are representative of their culture when at all possible


And the third last topic that you chose was transportation and mobility.


It's just the cost and the fact that we live in a very, there not a lot, there are not a lot of walkable neighborhoods in Orange County, in the sense that you could walk to your care provider or could be driven a short distance to your care provider, in any way, shape, or form or, or accessible to grocery shopping. It's, it's just you need to have the public transportation system is, is not does not facilitate that for an older adult. There are two, the windows of ride times and travel times are or are just too long. For some older adults, especially if you're impaired, sitting and waiting 45 minutes to a half hour prior, prior to an appointment or after an appointment adds adds tears, some difficulties accessibility for those that are that require accessibility that ambulation or are using an assistive device like a walker or a wheelchair. It's just the public transportations doesn't suit that in the private commercial transportation is expensive. You know, Uber requires a great deal of technological, you know, these little bit of technical savvy that. holder or no, they're just trying to catch up with. But also, again, it's not the least expensive way of travel, it's actually the most expensive or similar animals. So I think that that's why your transportation also leads to isolation. The lack of transportation, the lack of being able to get out sometimes limits folks who otherwise if they had transportation would be able to be less isolated.


What barriers it's nice to see improvement in this area.


One is in are the barriers are the cost of door to door service, the limited availability of public transportation in Orange County. And the again, it's it would be just the cost of any other alternative transportation if you don't already, if you cannot still drive and maintain a vehicle.


I think it depends on how urban the urban communities the more residential communities in Orange County, I think where the socio economic incomes may be higher it is actually has less public transportation and creates more isolation for those that are living in those those neighborhoods that are considered non urban. And also your services are probably further apart. But yeah, with regard to ethnic you know, I just think it's more of a urban versus suburban issue with regards to the transportation


Again, discounts for seniors, increased bus routes at certain periods of the day and expansion kind of the what used to be the dial ride or access bus service with congregate trips


some sort of true ride sharing program that emanates From service providers such as number one be access to transportation services sponsored by the medical groups or health insurance companies that ensure that people get to and from their physicians an expansion of rideshare services to and from congregate meal sites and then an expansion you know how to deliver on delivered meals or, or services that can somehow can make and subsidize or make manageable the cost of having certain things delivered to the home instead of having senior get in and get transportation but, but I know I support, I think the solution would be more opportunities for the senior to leave their home than to have things brought to them to increase their socialization so so it has to be some sort of increased public transportation increased Agra ridesharing into strategic areas, whether that be shopping centers, health care centers, or even senior centers where other programs are occurring.


All right, moving on to the next set of questions. I'm going to give you four subcategories and I can I'll just read out the four read all four and then I can we can come back to each one of them. Okay, first one, geriatric here. Number two, long term care. Number three, mental or behavioral health or substance use treatment. Number four, human or social services.


for geriatric care. I think it's probably I think it's, I think it's adequate. I'll give you think it's adequate. And I give that with a very biased perspective. In that there are a lot of physicians, primary care physicians that work with a lot of issues that not only older adults have, but younger adults have. And I don't know if Geriatric Care necessarily addresses it any better sometimes. And so I think that we can always use more geriatric physicians don't get me wrong. But I think we just need to educate physicians that we have now that are working in a primary care world to see geriatric issues similar to other disease groups that they would screen for. Because there are the physicians are out there to create another subspecialty creates another Access Challenge for seniors. Because if you're telling me that my primary care physician who happens to be across the street is not the best position for me, but that I should take a 30 minute bus ride, if I could get one to a geriatric physician that's in another city. That's probably going to limit my ability to get even a cursory screening for some of my issues. So that's why I'm a little bit suspect about these specialties. It just creates a demand and it creates a perception that even just on the base level, you have to go there or you're not going to get what you need. And I'm, and I think their perspective is it's been Better to have something than nothing, or have something and hope for the perfect and habits so inaccessible, that it becomes detrimental. So, so I think geriatric care with regards to the initial screening is fine. It doesn't most geriatric patients that we work with, end up seeing a specialist anyways. There isn't a general geriatrician, but is actually dealing with the cancer when dealing with the Alzheimer's dementia or dealing with the Parkinson's are dealing with the liver functioning or develop delivery, you know, dealing with hypertension. You know, they're already seeing specialists. And the specialists, you know, work on titrate. And so, geriatric care, I think is is fine, long term care is, is only good for those that have mediCAL, and everybody else is just struggling, I think the long term care is unaffordable on two levels at the skilled side, unless you are there for acute care covered by Medicare. And for long term, it's just inaccessible to the average family to pay the rates that exist without some sort of subsidy. And I'm talking about assisted living residential care facilities for the elderly, and for even, you know, memory care. It's just, it's just not affordable. So similar to affordable housing, it's very in Orange County is very poor. Because of their cost of real estate, provide different reasons, just mental and behavioral health. Yeah, that's it's under, it's not provided well. But again, it's it's something that is on even for, even for adults that are commercially insured, there is no mental health equity. So it's still I would rank that as very not as accessible but could be improved. So sign scale, you know, again, it needs to be improved. human and social services. Ah, you know, I think that, that there are a lot of programs. They're just not well coordinated. And the incentives to coordinate are not there. Because of the way they're funded. Especially the governmental programs experiences that government programs are relatively inefficient, and very, very expensive to run, and I run a program that state and federally grant funded. And I've worked in government, and I've just seen it, it's just, there's just no sensibility sometimes in managing the money well, and redirecting it in the right way. So I don't know if I did a good job of that. But, but I think that just going down the list here, you know, long term care. Options in Orange County are kind of poor, not very good. mental and behavioral health is just not good all around. At any age group needs to be improved human and social services. I think they're fine, but they need to be improved, because they're not gonna say fine. I think there's a enough, they just need to be very coordinated. And the issue of Geriatric Care, I think there's enough, again, we just need to educate the physicians we have without having to create a whole sub specialty again, where you have a few far between end up forcing people to chase something that may not help them or overlook a resource that's more available. So I think we should you know, we need to train train our train the dogs, so I don't know if I answered your question. Thank you. Okay.


Now, what do you think will be the biggest challenges for older adults will face in the next 10


I think the same challenges that we've had since I started it's always about been about it when I say that. I heard I heard the term silver tsunami. I graduated with my master's degree in 1988. And in 1989, I worked professionally and silver tsunami was what everybody talked about. So that's over 35 years ago. Nothing has changed. Nothing has changed. It's always been about health care, it's always been about affordable housing, it's always been about minus the first three I pick, it's still going to be those things. Because their foundation.


If you always feel like Medicare was going to go bankrupt in 1990, here we are 25, 30 years later, Medicare is going to go bankrupt in 2025 2425. It's a very cynical view, except for the fact that I, I can actually go back and your archives, microfiche, and you can look at the headlines on aging issues, and they're all the same.


You know, it's just really, it's those things. And I think that it's just because we adapt to it. As we get older, that it just we're always behind. You know, Medicare was never enough. Or in terms of finding providers, you know, your Social Security benefit was remember more than enough, boarding cares, were never really the first choice. And paying for them was always difficult for families and older adults, long term care facilities, again, you wanted to pay with medical, otherwise, you choose your Medicare and your days, nothing's really changed. And actually, it's gotten even more complicated when managed care kicked in. So I think 10 years from now, I wouldn't be surprised that we're still talking about this same list. is the same one we use that is what we use now. So it is it is you know, it is a cynical view, but it's probably I would, I would I would say just based on experience, I don't know where if 10 years is really enough time to transform anything. Certain changes have been made, there probably are some improvements. But again, it's it's it's still, I would still say that this list would be very, very resonate well, 10 years from now. And I would suggest that if you're talking to me 10 years from now, I would pick the same three items that I think today.


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


Yeah, you know, I think that the government's role in Orange County, probably would be I think, I think that they need the government's role in Orange County should be to support the independent nonprofits


businesses that address the needs of older adults, to be supportive of them in a way that eliminates to the best that they can some of the inefficiencies in in how funds are distributed. And that's difficult to say I I don't know. I mean, so that's a philosophical, political question. And I just think that sometimes it's it's the government's role is whatever it's mandated to do. And if they're mandated to do something to do it in a way that it probably is, eliminates as much of the complexity or red tape, so to speak. I don't know if I mean, I don't know I think, again, affordable housing is not just a senior issue. It's an everybody issue. And our local governments are having a hard time dealing with it. On a broad level, much less even the local level. So I think that government really is something that we cannot rely on to provide the comprehensive solution. So government's role needs to be to partner with local nonprofit agencies, but to take the lead from them in terms of understanding the efficiencies, and service delivery that they extended


that. You know, there's the right one. So, so yeah, that's a that's a difficult question. So to summarize my answer, I say, the local government just really asked to have a role as a partner, but not not necessarily the lead the lead, they should be directed by the service community. And, and their role is to minimize the difficulties in accessing funds and spending them efficiently.


Now, I'm thinking about all the older adults residents in Orange County, who is getting the least amount of attention.


Oh, I think that definitely the folks that are not qualified for any of the entitlement programs. I think that as a percentage, a lot of the programs that address those that aren't means tested. still require. And I'm talking about title three programs, even though they're not means tested, which means they're available to anybody that's 60. And over, they still require that half of the people you target would qualify for entitlement programs anyways. So the people that are really being missed. And especially because in my organization, that's where the carrier resource was created to address families that didn't meet any of the entitlement requirements. There definitely is that middle is that middle income family, that whatever that is, nowadays, they cannot afford the daily weight of a licensed nursing care facility, Oregon care, or can pay for in home care. on a consistent basis. If you can afford that, it's an inherent is. It's never it's never it's not that there aren't services available. For somebody to live in the community, and thrive in the community. There are services and vendors and providers. It's just can you afford them. And if you can't afford them, you're at one end of the continuum. Relatively, I would say wealthy in this day and age, if you consider that a memory care facility can run anywhere from starting at 7000, up to $11,000 a month, you know, memory care, to impoverished America where your benefit as a MediCal beneficiary, and if you're lucky enough to be medical and Medicare eligible with no shared cost, you're community based, and even healthcare options are far more robust than the average retiree that has maybe a small 401 K or even Airties 401k has maybe a small pension because they worked a job and they're Medicare and are just trying to live off of that in a home. That nowadays probably you might have paid off, or you still may have a small mortgage on those who are when's that at 65 and 60. When you know 62 They're the ones that are struggling is the older adults, they're working till they're 70 to 75 because that's just what they have to do to pay for their gas pay for their utility bills. Because we see that a lot, because again, our clients are caregivers, family members, and they express this, they see that they're caring for their loved one. You know, how am I going to deal with this, my mom and dad, or my aunt and uncle or my spouse is lucky, I'm here to be able to support them. And even I'm struggling. Because I have to supplement some of their things to give them the care that they need. So, so I think that that's, you know, I even forgot the question, but that's where I see this.


But that's the group. That's the group that middle income.


Okay, so thinking about all the issues facing older adults in Orange County, what issue is being


I think, you know, I think we've overlooked


I think the only thing I would say, is that have we we kind of overlooked, maybe coordinating the resources that we already have. It's not that it's not that, you know, these are not valid issues. But, but maybe consolidating them and saying, Look, if I'm looking at emotional well being, then I'm addressing behavioral and mental health. And then I'm also addressing health care. So maybe collapsing these things into broader categories. If I'm looking at economic security, well, that also means I'm probably looking at housing. And, and there's this old adage about legislating by body parts, you know, you create laws and things to, you know, this is how we're going to pay for you to address an issue, and a person's right index finger. And we're gonna have a set of rules and laws and reimbursement methodology for how to reimburse you for character, that right index finger. What are we going to, and you start to have all these competing legislative interests that don't work well together. And so I'm looking at some of these things and thinking, you know, there still is a bias to, in terms of older adults already account for huge amounts of the federal budget, just in Social Security, Medicare and MediCal alone.


From a policy level, I think we just need to look at that. And see.


These are all real issues. But if we keep looking at them individually, we're never going to have to be, we're never going to have enough money to address them individually. And the more we as a group, or as an advocacy group, you know, say that we need more and more and more, the less and less, it becomes a legitimate ask, when you look at what's already being spent out there. And I'll share this with you. I used to work with people in my other professional life that wrote Medicare regulations. And they worked in Washington, DC, and they just, you know, just kept pointing to the budget and had kind of, you know, after work and just in casual conversation, yeah. You know, this is always a federal government spends more on people 60 And over than it does in its defense Budget. And this is even after 10 years of Afghanistan, you know, fighting that we actually were at war, and our defense budget is still reasonably a little bit more maybe even a little bit less than what is being spent already on older


Just because older adults are high utilizers of health care, older adults, or are using Medicare, Medicaid, there are social security benefits, which is fine. And, you know, that in and of itself is something so, I think that where we need to look at is, hey, we need to start grouping these things. things and not and not creating competition between, hey, you know, we're just going to look at Alzheimer's and dementia, but we're not going to look at hypertension or Parkinson's disease, or we're not going to look at this, you know, everybody, everybody has a special interest within a special interest within a special interest. You know, well, emotional well, being doesn't mean mean anything. We need more behavioral health. Well, you know, maybe is just an offshoot of emotional, you know, we can't be raising money or, you know, being so siloed in our thinking with these issues.


Okay, so I'm doing a time check. It's world six, I have a few more questions. And again, you were continuing. Okay. Yeah. All right. So in addition, I'll try to speak up a little bit, a little bit. Now, in addition to what we have already talked about, let's dig a little deeper into your area of expertise.


Oh, you know, older adults in Orange County. What's working for them is that it's a very, it's a cohesive system. Orange county's fortunate that we have one, one organization that is dedicated to the caregiver, at any age, especially the older adults, and it's already integrated through the Office on Aging, with the other title three programs, and is also integrated, or works with, collaborative with individual nonprofits. So in that sense, that's where it works, because at least focuses the state and federal funding at one level. And and which comes to the cost, then is, we're able to, to work with others, to maximize the use of that. You know, I think it's just the same thing that that happens everywhere. If when you have older adults, caring for another older adult, or somebody that's impaired. There's no supports to ensure they run into the same issues that the older adult does, with regards to what I said, economic security, my short being, but I'm going again, you can't fix up but at least we have an agency like ours that can address that. And I think the focus should be not to create more agencies, but to again, consolidate and, and work on issues. That are specific. I mean, what I want to say is that organizations can't specialize in everything. So we don't we don't specialize in everything that works with older but we do specialize in working with caregivers at any age, and address their issues and point them in the right direction so that we can have no wrong doors. They can access what they need to access, whether they're the caregiver or it's for their loved one their caregiving. I don't know. I think what doesn't work is when you have a lot of competing interests, and you get a lot of silos where people just focused on. Caregivers just don't deal with Alzheimer's and dementia. We work with that. The caregivers deal with Parkinson's caregivers deal with hypertension caregivers with a lot of other comorbidities that go with that. So you can't have a specific agency all the time that says we only work with caregivers that work with Alzheimer's. Yeah. So what works is, you know, again, kind of putting these things together. So I think that that's where we do well, where we don't do well, I would, I wouldn't. I don't want to. I wouldn't want to say that we don't do anything well within our area caregivers, but we're always just limited by what we're funded. And that's all you can. All you can say is the funding could be is always limited and sometimes a little bit short sighted.


What new or revised policies are needed Writing, again, your your area of expertise.


Oh, yeah policies, I think a lot of it would be like tax credits for family caregivers. Additional lead time for family caregivers recognizing that similar how they recognize maternity other family leaves, because we're finding a lot of caregivers are are providing more care, more supportive services to families at discharge from acute care and long term care settings, more statutory requirements, that these long term care discharges from acute care and rehabilitative facilities. And even physicians that they refer back to that they address first and foremost that they address and identify the family caregiver when they know that we're working with somebody impaired, and that they be more strongly there already, but more strongly mandated to seek out the Caregiver Resource Center system, which is statewide, I mean, every every area in California has a caregiver resource center that they can refer and identify family caregiver to. So I think that that those kinds of policies, you know, addressing the financial needs of caregivers, whether it be through tax credits, or through additional Lee, and non discriminatory, you know, not having your employer say, oh, you know, we might not hire that person, because they're caring for an older adult, you know, things like that. So those are the kinds of policy changes that I'd like to look at


Well, I think the biggest area is our legislature, they can pass those laws at the state and federal level, especially when it comes to to taxes and especially when it comes to family leave statutes.


And what sources what sources of data do you find relevant to your work, if any of


you, we, we collect, we do our own. We do our own needs surveys, we, we actually report to a statewide evaluator. So we look for that data to come back to us we we actually ask our caregivers what they think they need. Again, the demographic of a family caregiver. They exist in every demographic. They exist in every culture. They're not just limited to a zip code area. You know, they're not just you're not going to find a pocket of family caregivers, out in Silverado Canyon. that's any different than family caregivers that are in downtown Santa Ana. Family Caregivers exist everywhere. And again, across that age, from 18. To on up, so I think that the data were looking for is data that reflects what their needs are, and what are the needs, what we're hearing, is that I'm being sent home, or while I'm having to care for a loved one at home, with complex medical needs, that I'm not trained for. And I need training, because the alternatives of placement are not really an option for us at this time. So I think that that's part of what you know, we're I think that that's the kind of data we need, that that kind of experiential quality of data that we collect from our caregivers that are telling us this that I need, I want to be trained. And then I also want to have information on how this can be financially doable with what I have, or what my loved one has. So that I'm not spending money or losing resources, I happen to provide care.


I think that there might be I'd have to think about that. But I would, I would say that knowing who you are going to talk to, I think yeah, the bases covered. I just think that again, the master plan. for aging is not just about talking to people 16 and over. I think the master plan for aging is talking to folks, especially caregivers that are experiencing vicariously, not vicariously, but through experience of being a caregiver of what they can anticipate when they get. Because they're seeing the issues from a whole different perspective. And they're trying to prepare for it. And the master plan for aging, I think provides provides everybody an opportunity to see what it's like to age and address those issues and some of the people that are best to kind of talk about what they're afraid that they see happening when they get older. I will tell you, because a lot of this is not coming what I'm what I've said is not going to resist from reading the charts looking at the population we serve. You know, it's not Jack like thats saying Gosh the medical medical system is complicated, even though I would say that myself is my caregivers, caregivers, we serve to say that Medicare doesn't cover that. It's how much to pay for in homecare, it's how much to pay for, you know, give me You mean that a long term care facility is, is I can find Medicare for long term care, but I can't find medical for assisted living or memory care. It's that it's that kind of thing. Now, it's more about what are we doing for the 40 somethings that are caring for the 70 Somethings, and then realizing that I'm not too far away from that. And, and especially those that run into a disability at the adult age, that all of a sudden become disabled, which is also part of this master plan. What happens if I become disabled, prior to age 60.


qualified yet or a median, that middle group, but I'm not going to be fully disabled, I am functionally impaired, that I essentially I am having to address the rest of my life in much the same way that we're kind of describing the challenges of the older adult. So again, I think that we talked about, you know, caregivers are a great, great, and the younger caregivers are the great ones to look at and get fresh eyes and say, hey, you know, you they'll tell you right away what they think the problem is because they don't want to experience what some of some of them are experiencing with their loved ones, the surprise and the shock of what it takes to really be age well in this in our society. Right.


Yes, by all means, right. So this concludes our interview out. Thank you so much for your time, you have been incredibly helpful to our research. You know, if you find that you have more to share, please feel free to reach out to us. Our contact information is available on our website, www.advanced oc.com. And you can leave an anonymous voicemail on our telephone line. And then of course you can just also reach out to me.


Hey, I'm sorry, I got on there late Tammy. Sorry. I'm sorry, I got too late.


Oh, no, no, no, not a problem. I'm going to stop the recording now. Okay.


To the primary goal today to is to identify what needs you think are the most important to the older adult population you serve. Those are 60 years old and older. We want you to think as broadly as possible taken into consideration of the older adults, caregiver, families and their community. I'm going to share my screen so you can see a list of common issues and concern impacting older adults. Please take a few minutes to read through this list. Let me know when you are ready to begin.


Think specifical things specifically about older adults in Orange County.


Certainly, my role. At Second Baptist Church is Executive Director of Operations. I interact with all members of the church and encounter senior citizens who attend or are at home home based but consider themselves members of the church. We have over 3500 members and I would venture to say about 40% of them are over 50 probably 35% or over 60


Thank you thinking about Orange County and looking at the list of common issues and concern impacting older adults. Is there anything that missing from the list


I don't I can't think of anything. Just when I something comes to mind I see it on the list. So it's very good. Thank you. Just one one item Wait let me just double check I'm sure.


Where senior citizens are bombarded with telemarketing phone calls and are subjected to financial hardships as a result of pursuing something that is being offered to them.


Thank you for sharing. Of the needs on the list including that you have suggested. Please rank the top three that you feel are the most important


that's tough. Um I think affordable housing would be critical for senior citizen, I think emotional well being which kind of ties to Alzheimer's and dementia and


maybe emotional isolation they may have lost a spouse or their children don't live in the area.


Good, thank you. When you think of affordable housing, how or why are adults struggling with this issue.


Unfortunately, they probably are retired or should be retired and their financial security is much more volatile than perhaps someone who's younger and able to work and gain the resources necessary to pay for their housing. I also am concerned about the increasing cost of property taxes. You know, a senior citizen going into retirement thinks that their property taxes are going to be at one level, but as they continue to escalate, but that person is retired, that really takes from the limited funds that they have. And the fear of becoming homeless is increased exponentially.


What barriers I think, the I'm not an expert in this area, but I am not seeing a whole lot of affordable housing that is safe and structured for senior citizens, meaning they may have mobility issues, or transportation issues where they might need to use public transportation. Excuse me, or maybe wheelchair bound. I don't know of a lot of affordable housing that accommodates those, those concerns and challenges.


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


Absolutely, language is a big barrier in Orange County. So being able to communicate with those that they encounter, if they need assistance, is a challenge unless they have someone with them, who's able to interpret for them. I also think that there are fears associated with whether or not someone is a legal citizen. And, you know, harassment that sometimes occurs from governmental agencies, fear of perhaps being separated from their family members, is another dynamic in in the diverse population that we we enjoy in Orange County. And then racism is huge, not only in the Asian or Latino, but also in the black community. Here in Orange County, that results in people receiving poor care and treatment in the hospitals or at the doctor's office, if they are experiencing pain or some kind of symptoms seeking relief. The assumption is that they're perhaps just seeking to use drugs, which may not more than likely is not the case. They just need some help and some relief. And we've we've seen that in Orange County as well.


I think it has to be a collaborative effort to understand the needs of senior citizens, from senior citizens and then with real estate developers who have the ability to create communities that are safe and accessible for senior citizens. I also think that city and county government can provide incentives for developers to to create affordable housing that specialized for senior citizens, perhaps who are wheelchair bound have encounters that are lower, and just making accommodations for them. Even like in the tubs, you know how we see. Walk in tubs that are available for seniors who perhaps can't lift their legs as high as a younger person. Those types of accommodations really need to be sought out and provided for senior citizens.


So when you think about second item issues that you think that is the most important for older adults, which is the emotional well being Yes, how are why older adults struggling with this issue.


Um, because I, I, when I encounter older adults, I see a marked difference between those who have family members who are residing and interacting with them. And those who do not. So there are many senior citizens who are either widows, widows, widowers, they're their family members no longer live in Orange County. Perhaps as they get older, their friends have passed away. And so they become isolated, and almost retreat in a shell if they're not able to get to church, or their community organizations, that that creates even more loneliness and separation, which has a major impact on their mental capacity.


What barrier exists in seeing improvement and this emotional well being area.


So I think there is a lack of safe safe spaces for senior citizens to find community. That is kind of an alternative to perhaps family members, or church or just a social environment where they can go and enjoy life with people like minded people in their in their age group. It may be a diverse environment, which is wonderful. But just allowing them to create community with people of their own age, or even younger people. I've seen programs where grandparents are volunteering at elementary schools, and they're able to speak wisdom into the children, but also enjoy the effervescence of young people in their lives and build relationships that nurture both ways. So those are some of the thoughts that I have.


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


I would imagine so, um, I think culturally there are different celebrations festivals that some groups enjoy that others have no idea about, but maybe they would be interested in learning. I think there's a great opportunity for Orange County to share those festivals in the meanings behind them with one another to amplify and perhaps broaden the the perspective of people from different cultures.