It's education, it's advocacy. It's, it's, you know, people like Teepa, Snow, who, in David Troxel, who write books and do podcasts and educate people on how to care for people with memory loss. It is finding solutions to make, make it affordable to get the care that they need. You know, right now, the going rate for a one on one caregiver is probably $35 an hour. Even if you're wealthy, it's very expensive. And so if you, as a family say, Hey, we're really struggling with this idea that mom's becoming more forgetful. And I have a job as the son and If my mom were to become more forgetful, and, you know, I don't know what to do. I got kids and you know, I don't think she saved by herself. If, if I choose to hire a company, they're fingerprinted. They're drug tested, or life scanned. You know, I know that they're reasonably vetted out, I can call former employers. And I more than likely, I'm probably going to get a really good candidate. And I could even be specific about what if I have a preference on male or female caregiver or things like that. And then the length of stay, but I'm going to pay for it. It's $35 an hour is the going rate. Some are over $40 an hour. And there's more services that go into that. If I choose to find someone through a friend of a friend, and they're not through an agency or a company, I run the risk of bringing that person in and if that caregiver falls, maybe because my mom is, you know, is about to fall or she needs help and the caregiver follows that caregiver consuming. How do I not know that that person has done bad things in their life because they're just through a friend of a friend, but they're only charging me $20 an hour. So I have the risk of getting sued at the risk of them, you know, having a record. There's just there's no checks and balances, there's no oversight, you know, I can't you run a huge risk of going that route. So I don't recommend that. But, you know, at the same time, there's a lot of people out there that can't afford $35 an hour. The other option is you know, moving into a community where it's also very expensive unless you have you know, there's there's different government programs that help out But there needs to be more of them. And so I think, from a big picture standpoint, you know, with advance oc is to advocate for more grants more dollars to be sent to more, you know, adult daycares to give the caregivers a break during the day or more. More government programs are state funded programs to support, you know, the VA or, you know, Alzheimer's OC, or Alzheimer's Association and everything that, that huddled around people with memory loss. It's, it's only getting worse and more and more people are getting diagnosed. And you know, there's really no cure or solution, in my opinion. And so there needs to be more support around this this area.


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


Yeah, good question, Katie. So, you know, in some cultures, you know, they're they keep mom at home, you know, is, you know, there's Hispanic cultures, Asian cultures, where everyone has a grandmother living with them. And that's a beautiful thing. And it's very much of a cultural thing. And so, you know, I think, as advocates in the industry, I think it's, at the end of the day, it's it's seniors choice of where they want to live and what they want to do, whether it's living with family, or moving to a community. Either way, there's some family situations that are really good, and there's some families, so if situations are really bad, that neglect that senior, and they're just sitting in a room, and they're really not engaged or doing anything, and that quality of life is not good. And then there's some communities that, that do an amazing job. And a lot of them do, the vast majority do a great job. And, you know, after working in senior living for 20 years, I'm a huge fan of that option for a lot of people, not for everyone. In some people just do better in smaller environments, you know, whether it's just with the family, or what we call boarding cares, which are these residential homes where six people can live. I think it's, it's good to educate ourselves, if you're new to this. Of all things senior living, to know what your options are. In primarily right now, for the vast majority of seniors, they can either stay home or bring in home care, if they start needing care, they can move to a senior apartment, where it's just like someone my age, who you know, I'm in my 40s. But if I were to get an apartment, I would sign a year lease. And same thing with the senior with the senior apartment, you sign a year lease, and they may do a potluck, they may do some bingo, but I'm pretty much on my own if I was in a senior apartment. And then there's independent living, assisted living memory care, skilled nursing hospitals, l tax, there's a lot of different ways that that people can live. But I'm just a huge fan of education and advocating and letting people know what their options are. And, and then so they can make an informed decision. And unfortunately, you know, I think in some cultures, they really don't explore some of those options, when they probably should. You know, and the seniors, oftentimes wait until something happens before they need to make a move, meaning, you know, I want to be as independent as possible for as long as possible, and then they get macular degeneration they can't see and they have to lose their license. And, you know, they can't live independently anymore. And then what happens, they get groceries delivered, there's a lot of services that are, are helping, you know, there's Meals on Wheels, which is a great program. But then there's, you know, there's, you know, some seniors that need more than that, and then they wait until something happens, they have a broken hip, they have a TIA or a stroke, or, you know, God forbid something happens, then their quality of life and assisted living is not as independent as it could have been prior to that fall, or stroke or whatever. Because that shortens our length of stay in assisted living because they waited until it was a traumatic event where they needed hip surgery, for example, and then moved into an assisted living in the senior living communities want to advocate to get seniors in earlier in their lives to really enjoy the excursions going to the racetrack and the casinos, and museums and the theater and all the fun things that they're doing. You know, live entertainment with music. There's lots of clubs and committees and groups and they could be independent and have a great purpose. They're in these communities. Oftentimes, people wait, you know that the average length of stay in assisted livings two years in so it shortens that length of stay because they wait until something happens. And I think if more seniors did more homework earlier in their lives, they might be more open to that idea.


Yeah, I think, you know, they don't like to cook for themselves for one, you know, is they cook their whole lives for their families, and they get tired. And there, you know, a lot of times, not all of them, of course, but a lot of seniors, they're just like, I don't want to cook this big meal for myself. And so it becomes convenient for a lot of seniors to do the fast, not fast food, but, you know, the frozen food and the easy stuff. And they're not eating as much. I mean, it varies, obviously, this, this is a very broad topic. But the ability to exercise, you know, maybe they go on a walk, but they don't really take advantage of all the different groups, and, you know, senior centers and hospitals have, you know, the colleges have seen their programs, there's so much out there, that if they were to like, you know, just be a little bit brave one day, say, I'm gonna go try this exercise class out this this Zumba, or, you know, this yoga or whatever it is, they, they would probably really enjoy it. Yeah, I mean, I'm, again, I'm not a doctor, but I think it, I look at nutrition, fitness diet, I look at it as more of a holistic approach, whole body approach where this ties in a lot of different things, it ties in their sleep, depression, again, that that mental fitness of staying active mentally, as well. You know, I think those are some of the challenges and opportunities.


What barrier assists to see improvement in this area.


I think there's a ton of groups out there, and they'll do a good job of trying to market themselves, you know, whether it's digital campaigns, or, you know, direct mail or, you know, partnering with doctor's offices, or senior centers, or skilled nursing facilities, like, you know, all these different groups that have services, and many of them are free, you know, they all do a good job. But I think, you know, when people get mail, they just throw in the trash, you know, this is all junk mail. And I think it's, I think seniors need to be more open to opportunities to stay engaged, and stay active. And not just think everyone's out there trying to steal their money. Or how can they, you know, sign them up for something that they they're not interested in, and a lot of us local, there's a lot of stuff in their backyard that they don't even know. So I don't know what the solution is there. I think, you know, I think over time, you know, every, every year, the way we market, how we, there's geofencing, where we can target different places where seniors go, there's, you know, digitally, there's just a lot of things that we can do, but at the end of the day, it has seniors have to be open to it, because, you know, they have to be, you know, they get stuck in the routine. And, you know, it's just harder to change, it's hard for anyone, but, but at the end of the day, they have to be open and maybe that comes from the doctor, us, you know, saying, you know, you need to look at more programs to stay active, you know, and to live a great quality of life. And so, it's hard when they have memory loss, you know, they're, they forget what we tell him in so we're trying to navigate those waters with the POA but letting them still feel like they're in control. But, but we also take care of people who are 65 and better, who are still working and still very active and independent and still live a great quality of life. So So for our group, we do a little bit of everything. But I, I, I challenged young seniors to really listen to podcasts and read books and network with other seniors about, you know, things that they're doing and, you know, stay active and stay involved, you know, join a rotary club are the Gideons are one of the service organizations and have a purpose. And I think if if more people did those kinds of things to you know, hanging out with their neighbors, and you know, I think the years and years ago and the generation of the seniors that we're talking about, they were a lot closer to their neighbors, where a lot a lot of times nowadays, they're you know, they don't they don't talk to as many as they used to because they moved away and they just haven't made a priority to Spend time with them


Yeah, I mean, there's let's go financial first, you know, my background was more private pay. So is we want to merge the private and public sectors together to, you know, to make sure the seniors have what they need, you know, number one is they got to eat, they got to have housing, they got to have a roof over their head. And so, you know, that's an ongoing challenge. And I don't have an answer for that either. My personal background is I'm not as you know, I don't have as strong background in the public side of, you know, low income housing, or homelessness, it just wasn't an area that I spent a lot of time and so I can't comment too much on that. But, you know, for that middle market, person who, you know, didn't have a great job, but lived in had a home or even an apartment, but you know, was kind of middle market, there's tons of options that are out there, that are easy to vet out, you know, the communities, everything has reviews, nowadays, you can go in and tour you can call you can there's referral agencies that are these guides that are helped clients search and navigate and find senior living communities based on their budget. Or I have $100,000 in savings, and I have, you know, I get an income of, you know, five grand or three grand, and I, you know, have a little savings, little mistake, what are my options, and so these advisors will tour with me, and they'll show me around, whether I'm low income or not. If I'm independent assisted memory care, it meals or not meals, there's these advisors really help, you know, with educating people on what their options are based on their budget and geographics, and some of that kind of stuff.


When you think about respect, how or why older adults struggle struggling with this issue.


I think the, you know, I think it's a generational thing. I think they come from a generation of respect. And, you know, I think sometimes there's plenty of younger people who, who can be respectful and are respectful, but then they come across a few people in even if it's just through media, or TV or the internet, where they perceive that think it just depends on where you go, and who you interact with, but I always believe if you're kind to others, good things are gonna come back and they're kind to you. You Yeah, I think training can be better in our industry, in the senior industry, where, you know, it's not just the initial training is ongoing education, it's company culture, it's little things like, you know, making sure your staff feels appreciated, you know, and that doesn't always have to be a monetary thing. It can be personal notes. And if the staffs taking care of I feel like even if I'm working at a senior center or a daycare, where that senior is going to go back home at the end of the day, if even if I work at a grocery store, you know, if the staff is better appreciated, better train and not just initial training is ongoing training and continuing education, how to talk to older adults, you know, if they're struggling with you know, I can't find my, my, you know, my credit card or something's messed up, like just to be patient with them. You know, so I think is as is an industry. I think crossing all industries, we can do a better job of being more patient with seniors and helping them you know, when we can there's tons of services, you know, that that help people like, there's remote patient monitoring, it's also called RPM where they can track you can track like your pulse, your blood pressure, how many steps your oxygen levels You're a lot of different things. So there's a lot of technology where it's really easy for the seniors who are not tech savvy to, to use to live a better quality of life. And it's all through the cloud where it can go straight to the doctor's office. Again, it's just about education. And it's all paid by Medicare, which is great if the, if the senior has Medicare, if they're 65 Plus, where, you know, there's, there's lots of services. And another big thing is psych, Psych. So if a senior has schizophrenic or bipolar, they're suicidal, they're pain seekers, they just have really challenging behaviors. There's behavioral health, which is paid by Medicare, again, through home health, you can have a psych nurse to one hour talk therapy with seniors, it's all paid by Medicare. But no one even knows even within the senior industry. No one even really knows this exist. And so what do they do, they wait until they're in crisis mode, and do a 5150 to get this person admitted if they're a danger to themselves or others. But there's plenty of other healthier options for everyone involved, the person that's around that senior and the senior themselves to, to, you know, try to minimize and reduce that risk of needing to get to that, to that level. And as an industry, we're also all have a goal to reduce hospital readmissions. So that's a big thing over the last few years of, you know, not having people admitted for the same thing over and over, it's costing the hospitals a lot of money. Now, the hospitals are being financially penalized for these hospital readmissions. So they're trying to do a better job through utilization, you know, in social services and case management to make sure when they're discharged, that they have a safe place to go and have a good plan to make sure they're not going to be readmitted for the same thing, whether it's physical therapy, occupational therapy, speech therapy, or this, you know, psych program, behavioral health program, sometimes is putting in putting someone on hospice, which again, is paid by Medicare, where they can provide, provide comfort measures at the end of life to make sure that they're pain free, and, you know, and can live a great quality of life, you know, through through that time of being on hospice, you know, whether it's a week or six months. So there's great services that hospice provide with educating families of what that process looks like. And, and again, making sure that they have the choices that that are available, and that they're pain free and not having to continue to go back to the hospital, or skilled nursing facility, it can be comfortable at home.


And you please describe how assessable and adequate geriatric care in Orange County


accessible and adequate or accessible. Yeah, yeah.


I mean, if you really look, there's a lot of options. I just pick us personally, I know a lot of the assisted livings. I know a lot of the senior centers and adult daycares, and a lot of the different nonprofits that support and surround the geriatric community, I think there's a lot there can always be more, there's never too much. There's plenty of seniors that are really struggling with not being able to eat or cook for themselves or not being able to drive, you know, to the doctor's office. And so that's one of the reasons this is we do primary care as we go to them. If they are not, don't have the ability to drive, we have our doctors and nurse practitioners, we go to their home, or the assisted living community. And so we're big believers in bringing in services to the senior instead of bringing them out. It is you know, if I have memory loss, and you're taking me out of my home, which is I'm all about my routine, it might mess up my day. Yeah, we have what's called a circadian rhythm. And if, if that's upsetting to take me out, and I'm in a waiting room, or there's other people around, and I go in and see the doctor. And, you know, it may or may not mess up my day. And so it's just really convenient to have our providers and our team who were on mobile, we have 56 providers today in three states to go to the seniors in there in the comfort of their own home. So I think more services that can provide that concierge style of medicine, and not just medicine, but services, to get people to have transportation to do the services that they need. There's a lot of nonprofits out there that have buddy programs where, you know, we need more volunteers and this industry to go say, Hey, we're gonna assign you three people, three seniors who are really struggling with blank you And, you know, this one doesn't drive. So if you take her out to lunch once a month, you know, or go bowling or, you know, just go for a picnic at a park, you know, go for a walk, it can be the smallest thing where you're playing, you know, running with someone. And it just, there's something that they get to look forward to all month long, or, you know, it doesn't have to be too much. I think there's a lot of different nonprofits and organizations that do a lot of amazing things that people aren't aware of. And the best way to learn about them is just to start touring these communities and starting with the ones that are closest to you, you know, whether it's the local senior center, or joining a support group, or you know, whatever it might be, and the nonprofits are amazing, Katie, the, you know, one of them that that a nonprofit that we're going to be starting at Guiss Med, or senior Doc is going to be for our hospice, where it's basically, it's similar to like, make a wish foundation for seniors. And we're not going to use that phrase, but just so you understand, what we're trying to do is we're trying to grant a wish for them to see a loved one they haven't seen that might live out of state, or to help pay for a move into a senior living community or pay for furniture or pay for the rent, to the loved horseback riding or go in a hot air balloon, like will create an experience in sometimes just putting a roof over their head or giving them some, some meals or you know, time together. And so we want to honor the seniors in our nonprofit that we'll be creating this year to have an amazing experience when they're on hospice. So that's one of the one of our goals this year.


Yeah, most assisted livings, you know, I hate to give out any numbers or statistics, but most of this communities that serve seniors are not at capacity. So the they have really robust marketing teams to advocate educate seniors on what their options are, they don't, they're available for two or seven days a week, where, you know, someone could walk in and say, hey, I'm interested in options for myself or a loved one about how much it cost and the size of the apartment and your culinary experience and what activities are going on. And so the vast majority of communities, the vast, vast majority are not at 100% capacity. So it really just comes down to affordability, it comes down to you know where that person wants to live, if they want to live in your loved ones, or just stay close to home where they they know that that bank they've gone to for the last 20 to 30 years, they know that they have their hair stylists that they love, excuse me or barber and so that they feel comfortable and want to stay close to home. And that's an option. But again, I think it's it's it just comes down to educating them and for them to take the initiative to go to one of these places, and they don't have to be sold anything. It's just, hey, I'm here today, just looking at my options for the future. So I know what's available, and the time comes that I might consider senior living options. You know, I'd like a quick tour just to just to get an idea of what it costs and what services and amenities you guys offer in that in that marketing director. I'd be happy to take that person around. And you know, show them you know, tour of the community.


Yeah, there's another tough question. There's some Jerry Sykes or Jarrow Sykes where people go in, you know, they're struggling with with mental illness, whether it's long term or short term care. I think they do a good job with what they have. You know, a lot of it comes down to insurance. Most of these stay pretty full. Unfortunately, there's, there's a huge need for for more of them. You know, so um, It's a challenge and you know, I don't have an answer and I think it's it's a, we have to attack it from a lot of different angles. To do the best we can job, you know, is an industry is we can. I know one of them closed down recently in Orange County. From what I heard, it's called Newport Bay Hospital. They were one of the leaders in a big Gero Gero site that like Hoag Hospital and St. Joe and Saddleback would all refer to and it closed down during the pandemic. So there's some other really good ones that are that are out there. But, but from what I see an orange county there's, there's less not more I know Garden Grove hospitals bringing building a Jarrow, Psych. And I think there's one other hospital in Huntington, Huntington Hospital has has one as well. But yeah, I mean, that's, that's there can never be enough of support systems around the area. Yeah, yeah. And I think they get a bad rep for all the challenges, you know, that they experience. And, you know, I think they do a really good job and have a lot of people with big hearts and care. And I think going back to the respect pieces. I think as an industry, we want to call the people who the seniors who are in these places, I think we use the different verbiage and how we talk to seniors and around them. My preference, at least in the assisted living world, where I come from, as we always want to be called communities, not facilities. The people who live in them are residents, not patients, in the places that they live their apartments, not rooms. And so, you know, I think if we change our language, sometimes it makes it feel more resort, like more community, like, a little bit more of a positive spin, and very, everything's so clinical, where, you know, we don't want the linoleum floors, and this, you know, smell of bleach, you know, walking in these places, and everyone's in scrubs. And we want that feeling for the people who are who are living in them or staying there for a short time, even in skilled nursing to feel more comfortable and not feel like they're, you know, in a hospital, you know, with the hospital stigma, what their food is, and they create amazing experiences are beautiful in all sectors of the senior living. But I think if we can really educate ourselves, and sometimes we just don't know, right, like, if you're, if Katie, if you didn't know anything about Senior Living, and you're using those, what I call the F word is facility, not community, I would just say, hey, you know, this is this is how we call it, we call it community here. We call them residents, not patients, and you're like, Okay, we can I can switch my language. But I think the more people we tell to use different, it's our frame of reference, but to, to share better words on how we communicate with the seniors and talk about the places that we're supporting. Overall, it will improve our our industry. So I think, you know, coming up with all the different buzzwords and use this not this, it helps our industry grow.


Yeah, I mean, there's always new development, there's new communities being built all the time. There's, I just think that the baby boomers are coming that we all know that that, you know, I hate this phrase, but we call it the silver tsunami you are, there's 1000s and 1000s, in Orange County alone that are going to be turning 65. And a lot of them don't have a plan. You know, and if they're diabetic, and you know, they're struggling with driving, because they can't see anymore. How did they get to the grocery store, and they don't want to live in a community. Maybe it's not severe. There's there's not I think there's for that middle market to higher market, I think we're okay. I think for the low income. I think Orange County is going to struggle and, you know, the more dollars we can add more grant dollars that we can try to try to get the better for, for this initiative.


Yeah, I mean, I think we have the right people in place everyone I network with and know From the industry has a huge heart and has a similar goal, you know, they're all in this in this industry for the right reason, the vast majority anyway, or it's not just a money grab. But you know, there needs to be more more nonprofits more support more of the service organizations, focusing more on seniors, you know, an example is, you know, everyone talks about, you know, teenager suicide, but what they don't know is more seniors, in my experience. There's more suicides with seniors, and there are teenagers, but no one talks about that. In my history, there's been three to four suicides in the communities that I've worked in, you know, all male, of course, you know, it's just tragic, you know, whether they lose a spouse, or, you know, they just have stuff going on in their life, you know, that they, but but no one talks about, you know, senior suicide. And so, the more service organizations like the Elks or the Rotary, or the lions, that spends more on more time and dollars and support for the seniors that, that they can be serving, as opposed to saying, Hey, we're gonna put in this new, you know, handball court at the school down the street or do something at this park, I think there's tons of opportunities that seniors can benefit from that people forget about, I think if, when the city does the, you know, the mayor does the state of the city. You know, I think there should be more emphasis on, you know, anything senior related, and not just, Hey, we're putting our deck together, I'm gonna go up, do my speech, we're going to talk a little bit, we'll spend one or two little bullet points on seniors, okay, we knock that out, let's talk about the Chick fil A, that's opening up, and they really just kind of skim over it. And there needs to be more emphasis on seniors. And so I attend a lot of the state of the cities, and there's just, it's just kind of high level, and it really doesn't, you know, for the vast majority of them anyways, they don't really spend a lot of time in this space.


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


I think, you know, loneliness is a big piece. And and I think it's that, hey, I just, you know, whether they just retired or, or they're in their 90s, you know, I think a lot of people experience loneliness. You know, there. You know, there's, there's a lot of relationships with family members that are not good. For whatever reason, you know, where, you know, even though there's a daughter that lives down the street, she hasn't talked to mom more than once a year or twice a year, she may get a call, because she's busy with her kids, or they're just relationships, not there for whatever reason, and the quality of life for someone to wake up and stay in their pajamas all day and not have a lot going on. You know, maybe there's some beautiful angel out there who used to be a neighbor of someone that's kind of looking after them, or a former colleague, you know, or an old college roommate, you know, that might help out with someone, but there's a lot of people who, who don't have anyone to rely on. And so they have to make a decision earlier in life to make decisions for themselves. So the State of the County doesn't have to make decisions. If they get dementia, or if they can't, they come to a place where they can't make decisions for themselves anymore. And so that's a challenge. But, you know, the, for me, the low income is, is an area where I'm a little bit more naive, and just not as is experienced with but I think that's going to be the area where, you know, advanced OC really needs to focus on.


Yeah, I want to be mindful of the time but if you can spare me a few more minutes, because I just have one more question that I want to ask you.


Yeah, I mean, I don't I don't think I have another nother Good. Good point here. Katie. I think I've kind of covered it all. You know, I think there's a lot of other diseases that a lot of people have that they don't talk about, like something is, you know, you may think of as silly as incontinence, you know, but it may be embarrassing to me if I'm mean continent. And every time I get in a car, or I go to a doctor's office, right, you know, I have accidents or leaks, and I'm too embarrassed to go by depends. And now it affects my ability to go in and leave or, you know, there's not a lot of emphasis on, you know, Parkinson's, you know, there is a Parkinson's foundation, but they're relatively small. And when people go out and advocate and go on these walks, like the Alzheimer's walk, or walk, or you know, or or, you know, people that support cancer, or breast cancer or whatever, it is a Relay for Life. There's a lot of dollars that are being raised for advocacy for education for training, finding, finding a cure, but there's a lot of other things that affect seniors that people don't think about. Yeah. And so, you know, there's it not only do they not think about it, or aren't aware, they just, they don't even know it exist, you know, that incontinence is a reason why mom doesn't want to leave her house, but she's too embarrassed to tell me is the son. Yeah, and so they're there. I think, you know, we do a lot of Doc talks and education and in services for staff, or we're talking about, you know, a lot of these issues, that even the communities who, for the people that work in senior living, don't, aren't even aware of. Yeah, I think there's, there's a whole thing around, you know, you know, with sleep and a lot of different things that can affect a reason why someone's not living the best quality of life that they're overlooking. And so that's our job. As a provider, we look ourselves as like the quarterback of, of our new tagline here at SR Doc is called guiding you to better health, you want to be that point, person, that point the physician is to help with medication reconciliation, where we have all these different specialists recommending different medications, and some of them may not make sense, or they overlap. We want to help, you know, recommend different specialists or let's go get you know, our you know, whether it's blood or you know, a different type of specialist or, you know, there's a lot of different things that we can recommend or physical therapy that they don't even know is an option to build up their strength because they're slowing down. We want to be the point person because a lot of people think they're in control of the seniors lives, whether it's the adult child, if if mom starts to slow down or become more forgetful, there's a thing we call MCI, which is mild cognitive impairment, where they don't really have dementia yet, but they're starting to become a little forgetful. They're in that gray area. And so technically, they can still make decisions for themselves. But they're struggling to make good decisions. So we can help educate and share what their options are. To give them the best quality of life, but I wouldn't say there's one thing I if I were to say one thing, it's just a, all the little things that can add up to why someone's not living a good quality of life.


Yeah. So let's continue our interview. Thank you so much for your time, you can think to me, okay, thank you.


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


Yeah, we tried to, you know, fit in into one. Yeah.


I was joking. It's a pretty long list. Okay.


You're not the first person who says that. But anyway, if you've given it to me,


You are answering this as somebody we have identify as an expert in health care.


Okay, so just as a healthcare, Okay, gotcha. Right.


But then, of course, you know, we all bring our own personal experience and knowledge. So understood.


Let me just keep going through this list to work so hard for this man.


Okay, okay, so for our records, can you please tell us your role and how you interact or engage with older adults.


So in my profession, I am involved with cancer. And our health system is focused on treating, preventing, and helping people survive with cancer. So the population that is very common, who has cancer is the older populations. And so we see folks who come in who have early stage to late stage diagnoses who have other medical issues on top of their cancer, we also see people in a prevention setting who want to prevent their cancer. So that's the context of where at work, what we see folks


It's a pretty comprehensive list, though. Tell you that.


Think just with when you have cancer on they're going to start there. I don't see screening and prevention. Right. So even older folks need to be mindful if they haven't gotten cancer, that they still have a higher they have may, in fact may have a higher risk of that. So although it's a list of common issues that impact folks I think it'd be important to call out the prevention aspect of it screening


Yeah, just I think that prevention is screening there.


I saw someplace where you had sort of community activities and such. Just trying to look for where it was, you know, again, places where people can congregate, and, you know,


be together to do activities together. Yes, I don't know if I see that on here.


Those are sort of like community centers that cater, there are some living living centers that have activities. But if you were just in a community, for instance, is there a civic or community center, and it can be culturally, you know, sort of tailored to what neighborhood it is, as well. So I think understanding that there's a cultural barrier, as were around it is important. And I'm not seeing that so much per se on here. So just knowing that we have different segments of population, and especially as you get older, and you have this insecurity, being around people, and having activities structured around your culture, I think also helps engagement


will be under the broader umbrella of emotional well being. We give you some examples.


Yeah. family, church neighborhoods. Yeah, exactly.


Okay, well, of the needs on this list, including the ones that you just mentioned, please rent the top three that you feel are the most important.


Think behavioral and mental health is really important. I think the digital divide is very important. I think behavioral and emotional well being kind of linked together, frankly, those categories, but then I think the other one that I would put on there is is the economic security.


Yeah, I mean, you can use the first you can, you know, I mean, you the you can use behavioral, because I mean, they all find fall under health. Because it's the same thing, you have to have access there. And availability. So there's a Venn diagram that pretty much covers it. So you know, I don't want to marginalize one thing versus another there. But I do think in one bucket, it is a, you know, health, mental health and well being so All right, if you're making me pick three, then I would go health care access and delivery, behavioral mental health and digital divide.


I now want to repeat your choices. I don't want to double count. Okay, so, all right, got your top three. Now I'm going to ask you a set of questions of each of the three that you just mentioned. So the first question is, when you mentioned that we see the health care access and delivery.


Yes. Yeah, I think I think one is is I mean, it's multifactorial. Some of it is the cost. Some of it is the insurances. It's listed on there. Some of the just so many barriers for them to make an appointment and actually get to the appointment. Right. So that, you know, overlaps with transportation or the digital divide. So I think all those things have very much again, crossing relationships.


think one of the barriers here is a is cultural. I think we there's some cultural sensitivity, but I think there are folks who just stay very secluded in their communities or their neighborhoods. Oh, sorry. Public transportation is although there's so many great things about Irvine in Orange County, I don't think public transportation is that good here. And so I think that that's something that makes it harder for folks and


now aren't they are different experiences for different groups of older adults from different backgrounds, for example, where they live, disability status, income, education level, etc.


Yeah, I do think that a couple things, one, people who are coming from more affluent backgrounds or families or neighborhoods may have an easier time accessing some of these things. I also do think that people who have strong family support would also be, are also very good. But I think when you have lost that sort of family support that generational sort of living together, it creates that gap.


Yeah, I think that's where I came up with that digital divide aspect of marriage. Because if, you know, if I wasn't there, my wife or my kids weren't there to help my mother, learn how to use an iPhone, you know, or the, you know, internet on the computer, I'm not sure how she would ever do that. And she would still be writing checks and using stamps. I think there has to be, you know, proactive education around this. So that we can, you know, it's a different type of teaching someone who's 70 75 years old, than it is someone teaching who's 20 or 30 years old. So I think we need to be tailored in how we, you know, tailored to how we teach, but also tailored to how we develop programs. I mean, if you or I had trouble on a website, you can almost imagine that, you know, our parents have no chance to do anything. So that I think we don't make it easy for folks to access or enable themselves to get access.


I don't think it's necessarily unique to the older population. I think it really speaks to the lack of resources that exist for mental health in general. And, you know, we see the same issues in the younger folks, the middle age folks and the older folks. Again, and even if people wanted to try to seek the services, they're sorely lacking in many communities, mental health professionals, whether you're an MD or not, I mean, those are, those are just hard to find quality, quality providers. And so I think it's not unique to the older population, I think, what again, leaves them isolated is that if they can't find something proactively, or they don't know how to, then it just kind of gets left along to the side.


I think we need to, you know, increase the number of mental health workers or facilities that we have. Be, I think, again, if we have this digital divide, which, you know, can now have been shown post pandemic to connect a lot of people where they didn't have local access, you know, our elderly population is going to struggle the most with learning that. So again, education and simple platforms to connect them.


Yeah, I think that does affect it, as well. But these days, everyone, everyone has a cell phone, and they're connected. And so you know, think it's a matter of how we are sending the messages and how we're building trust with folks. And you know, and then how will making it easy for them to do it. But I think one of those three things always fails. And that's why you don't allow people to have the access that they need.


Again, I think it's going to require a proactive approach of, you know, believing that we have to improve some outcome. Maybe it's number of appointments or number of people who click on the sites, and again, build an educational and access tool that connects people to those services. I think until we're actually sincere about stuff like that, it's gonna be hard to show demonstrate the fact.


Yeah, technology is tough. As you get older, and we're all experiencing that as far as ourselves. And you know, the screens are getting smaller, and the buttons are getting smaller. There are physical limitations that older folks have that younger folks don't. There are, you know, in technology like that is not intuitive to older folks. There are a few things that are intuitive without headin training. And we know, you know, there are certainly some but I think there's there's a hesitation to change or shift. Again, if you're not used to the fact that you can send checks to your bank by texting a picture of it, there's going to be a suspicion that someone's going to steal your information and such. So I've seen this a lot. My mom had the hardest time doing that stuff. At least one there's a digital tracking and the other one, it's like, it's just you know, it was fate. So you know that that change management aspect is tough, but then when we will if you just convince people to change, but don't give them the tools that actually help them do it.


Again, we're talking about digital divide,


I think, again, tailoring a lot of the programs websites, you know, we always talk about in health about, you know, creating documents that can be read at an eighth grade level. Right. That's, that's what we do. I think it's equally important that we create tools that can be utilized that 75 year old level, right. That's the actual dexterity and the understanding of a page. I don't think we ever really consider that aspect of it. In the older population.


Again, I think if you have family support, it helps a lot, it obviously gets frustrating, but I think that's those are good things. So


Think, you know, again, it's gonna require structured education, and an actual sight that a 75 year old can navigate. So it needs to be pretty simple, big visual, big buttons. You know, understand that people will double click like crazy, my mom used to keep clicking two or three times on things and then you don't even know what page you're on. And so you know, that's, that's, that's unfortunately, the facts.


Okay, we're gonna move on to the next set of questions. The first one is geriatric care.


Again, having lived in Orange County only a couple of years and geriatric care being a very broad term, but I am impressed with the number of sort of elderly assisted living facilities or communities around. I think it's, it's good, that despite the high cost of living around here, that there are communities like this. So I was I was surprised to see as many as I did. I'm not saying that makes it adequate. I was just, you know, you just assume, you know, you're in downtown Manhattan, you would not see many, you know, older assisted living places. And, you know, this type of real estate is just as just as pricey. He is downtown Manhattan. So


Again, I know those exist around here. I think I think folks who have means have choices with long term care. And I think that's where it can sort of fall off quickly.


And the next one is mental slash behavior, health or substance use treatment.


I think, again, reflective of the rest of the country, it's underserved here. And it's, it's not unique to Orange County. In the meeting recently, I, I asked someone I said, Well, everybody thinks it says it's really important to have mental health facilities. My question then was put agree in Orange County, where to locate that mental health facility and build it, because then nobody wants to live next to a mental health facility. Right. Everybody's been supportive of it, but not in my neighborhood. And so I watched this happen in Charlotte, and, you know, our center built a mental health facility, but it was out in the country out in the near the cornfields. I mean, it was not in downtown Charlotte, you know, where the people needed to. So again, you're creating, again, transportation barriers and other other geographic barriers. But that's just the reality of, of putting in services and, you know, people wanting certain things in the neighborhood.


I've seen that be well program, it's not to say older adults, it's more of a, you know, takes the program to you situation, which I think is pretty novel. I haven't seen that in many cities. I think it's hard to expand that. Because it requires a lot of personal capital. But I think from an idea standpoint, and you know, no, you're not going to have a huge facility, then, you know, that's a way to think that's better than a hotline.


This, so this, next is the last of the series.


My impression is they're they're decent, but I don't know if I can answer that fully informed.


Older adults in the next 10 years, multiple health issues that will require more care and more attention.


The next is going to be the cost of living. And then third, is the technology divide will continue to get further and further.


Yeah, I think, you know, there's always a role for government, whether it's state local, to, to really prioritize some of these things. I think it's hard for local entities to do that. So if the broader governments prioritize these things, and put incentives in for, you know, or RFAs for people to, you know, do these things. I think it's a good thing. I think that's the responsibility of lawmakers. I know they have tons of competing projects and other things. So yeah.


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


the least amount of attention among older adults, is the question. Yes. I think it's the the mentally ill standpoint


I think one of the big things is the homeless in this aspect, the housing sort of insecurity.


Right. Last set of question, we're almost there. So in addition to what we have already talked about, just like to dig a little deeper into your area of expertise, so thinking about your area, which is well, actually under our, I guess, are based on the master plan for aging, puts you under the Health Care reimagined or healthcare as we age. And then, of course, as a cancer specialist, what are some ways that your area is working or not working for older adults in Orange County


we're really focusing on prevention and screening. We also are working to to treat people holistically. So to have a different alternative routes of treatment, like acupuncture, traditional Chinese medicine, aromatherapy, and these other things that are less pharmacologic, and more holistic. I think, you know, it's hard for older older folks to just take drugs for everything. So this is, this is an area we've hit it to, to offer those services that are particularly cater to older folks. And some of the struggles they might have. We know that neuropsych testing and those types of things are very important. And that is, those are all things that at least at City Hall are really focusing on.


I think we still have trouble engaging folks. Right, making sure that we're where we really focusing on access. People who are, you know, who can leverage these services, I think it's hard to engage them and get them into the building or onto our website.


When network revise policies are needed.


I think there needs to be more incentives or grants out there that focus on an older population. I think again, they kind of is you start getting to those older folks, it just kind of starts homogenizing with someone who's, you know, 60 versus 75, then we know that there are real challenges between those ages. So, yeah, I think that is, that's an area where we can be better.


think you have to, it's not going to be a single area. I think, again, you have to think of the the government's right, municipalities. And it really needs to be something that you know, elevates all of the stakeholders together


what sources of data do you find most relevant to your way in


You know, in our day to day work, we we use data of you know, number of patients coming in how the outcomes are how the the perception is of our ervices we rely on, you know, patient or family based councils that can provide us opinions. And pieces of data that we use, it helps us predict out, you know, from the county census, about aging and other things, incidences of cancers and helps us predict out where we need to focus more of our effort per se.


A lot of people you could talk to so but you have to gather data.


Well, with this current phase, which really the first of many phases are doing, what we call the state photo interview, which you are a part of, we only have until the end of this month, we have a span of six weeks. So we started this process, the middle of April. So next phase, we're moving on to your provider survey, which was going to ask you, after we complete this interview, whether you know, may be able to perhaps future assistance to distribute a survey. Reach out to Nancy again, later on the time comes. Definitely.


I think you could talk to, you know, people who are on the front lines around this. So talk to the nurses who work at an emergency room that are seeing these people come through up to paramedics or police force, who get called for, you know, sort of crimes or incidences with elderly whether it's they hurt themselves at home or whether they've been a victim of some something. I mean, I think those are those are raised in different issues from different perspectives.


All right. Last question, when we follow up with you if necessary. Yeah, of course. Oh, here we go. So this concludes our interview. Thank you so much for your time, you have been incredibly helpful to our research. If you find that you have more to share, please feel free to reach out to us. Our contact information is available on our website, www dot att soc.com and you can leave an anonymous voicemail on our phone line at any time. And of course you can also reach out to me personally. Yeah, great.


Okay, good afternoon. My name is Tohron Barnes, and I'm a member of the Advance OC team, the research team specifically and we're a local nonprofit conducting the counties. The county of Orange is older adults needs assessment. Thank you for your willingness to take part in the 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's master plan for aging. So this interview will last approximately an hour and with your permission or discussion will be recorded only for transcription for transcription purposes. The recording will be deleted after transcription. Okay, if you do not feel comfortable being recorded, turn off your camera and change your name attached to the picture. And fine, your responses are confidential, meaning that your identifying information will be removed from the report. Please note that your participation is voluntary. And you may choose to answer all questions in part full or not at all. You may also withdraw from the interview at any point in time. Okay. So if you are unfamiliar with any terms are used during this interview, please let me know. And I'll give you definitions or examples. Okay. Sure. Yes, you do. Thank you.


So the primary goal of today to identify the needs that you think are most important to older adults, older adults in Orange County, and this is 60 years and older. And we want you to think as broadly as possible, taking into consideration the older adults, caregivers, families, and the community. Okay, I'm going to share my screen. All right, it's gonna be a list of common issues and concerns impacting older adults. Want you to take a look and let me know when you're ready to move forward.


Okay. Oh, Lord have mercy. Or do I have to make it bigger


Let me I have to scroll up and down for you. So yeah, okay. Okay. Yeah. Then I'll scroll down. So you can see the complete list. Just let me know when.


You know, the only thing that I can probably give you information on his transportation. Okay. So that that would be it for me. Okay. Yeah, transportation and mobility. Yes, absolutely. That would be mine. Right. That's it.


Sure. My name is Joanne Jacobson. I am the senior community transportation coordinator. For Octa, I manage several programs for seniors and disabled. One being the senior mobility program. That is a program that is funded primarily through measure M two cities are given by monthly funding based on sales tax revenue, and their population of 60 years and older. And each city designs a transportation program for their senior residents based on the needs of their community. So I manage all of the cities, there's 32 out of 34 cities that participate. So I manage that program working with the cities. And sometimes the seniors because my name is on the s&p web page for on the octa side. So I get a lot of calls from seniors. I also manage another grant. It's enhanced mobility for seniors and disabled. And it's a program where government agencies and nonprofits can apply to receive vehicles and operating money and capital money. And we put a call for projects out every couple of years. So I manage that program. And then I manage an adult day we do a transportation subsidy for six nonprofits that transport their participants to and from the facility. Those though aren't always senior, some are, but it's disabled, a lot of mental disabilities but dementia to Alzheimer's. That kind of describes it.


Thank you. So thinking about Orange County, and all the older adults in Orange County, and looking at this list of common issues impacting older adults.


I don't think so. I don't see anything that I would think is missing. Okay.


And of the means and listed, Please rank the top three that you feel are the most important for older adults in Orange County.


Um I would say transportation is number one


economics security, and then I can only see down to health care and while you can put health care and delivery, okay, health care access and delivery.


um aging, and they don't losing their driver's license or they decided not to drive or they no longer have a car or a vehicle. They can't get to places they can't get to doctor's appointments, they can't get to grocery stores, they can't see their friends. So transportation is a big issue when you start getting older and you're coming on losing your driver's license.


Um, I say that because I get a lot of calls from seniors and they can't afford the transportation, even our access, our paratransit service is $3.60. Some of them are hesitant that that's that they're on a fixed income. That's a lot of money. So I get this a fair amount that cost for transportation is an issue for them.


Why are older adults older adults struggling with that issue, because they


can't get to their doctors, a lot of times, our paratransit service was just on strike, they just resolved their strike, they were on strike for a couple of weeks, I can't tell you the calls I got with people crying because their their elderly mother could not get to her doctor who one of them was a radiation or chemo appointment, because she's in a wheelchair, and they don't have a vehicle to take her in a wheelchair. So I was getting a lot of calls like that, that. That missing appointments, because they don't have the transportation or they don't even know about it. They don't know that there's low cost transportation, they think that the only thing out there is Uber. So they have no idea that there's these low cost transportation programs for seniors.


I'm getting the word out. The word needs to get out that there are a senior non emergency medical, there's my program. There's 211, they have resources there, people just don't know. So I think I think you need to get the word out. And another good resource for people is 211, because we work with 211 and providing transportation information, but there's a lot of transportation resources with them and people would know to call 211 Orange County


Yeah, I just see these the seniors that are on fixed incomes, and the rents high, everything's high. So it's hard for them sometimes to afford food afford transportation. And when we were in the pandemic, there were a lot of senior centers that had a nutrition program for lunch for seniors and they would take the s&p transportation from their home to the Senior Center, have their lunch and do their lunch program. But when they all shut down for COVID We actually had to go to our board of directors and got approval to deliver these meals to seniors homes, because we don't normally allow that for the SMP program. But we asked our board of directors if we could give it and allow the cities to deliver meals because these people weren't getting food


and what barriers exist to see an improvement in the area of health care, access and delivery


that I can't speak on that Well, I just know that they have a hard time getting to facility sometimes. And that's really, that's really all I know about is their transportation to these medical appointments, that they miss them often. And I have caseworkers call me because they're looking for transportation because some of their senior patients can't make it. They're not coming to their appointments because they don't have transportation, or they can't afford the transportation.


you're, if you're getting, it's more difficult if your primary language is not English, it's harder to get around. You know, people in Newport Beach, they don't have the same issues as somebody living in Santa Ana or Garden Grove, they do not have the same transportation issues for the most part. So yeah, I see it in the language spoken. If you're able to speak in English, it's easier for them. But also the socio economic, it's definitely when you when you when you're a little bit below, you know, your income is lower than, or you're at the poverty level, which I get a lot of calls from, from seniors that are at the poverty level. And it's hard, it's really hard for them. And they oftentimes don't know where to go. And especially then, when you're talking immigrants, or even just people that don't speak the language very well, they're lost a lot of times you hate to see that.


You need to get the word we need to get the word out there more. I mean, even if we put ads on our buses, our buses are rolling billboards. You know, did you know that there's a senior mobility program and or, you know, just just advertising, letting people know that there is. And I had one city that actually ran ads an ad in the movie theater in Yorba Linda about their senior mobility program. That was huge. They got so much publicity from that. And so many people signed up and finally found out and even their family members found out Oh, look at there's this transportation, and it's $1 for a taxi, you can go anyplace in the county. So it's, you know, thinking out of the box and being creative, like the city was, and they they contracted with a movie theater, and it had before the movie was shown they had big ad on the screen letting people know so it's, it's just really getting the word out in creative ways.


Do you have any other innovative ideas for addressing mobility and transportation issues,


um, that one is a really good one. We could, you could put, put an ad on on our buses. But like with the senior mobility program, each city has their own program. And if you live in Garden Grove, you can only use the program that is for Garden Grove. So I don't see that really as you know, it would be hard to put that on a on a bus and advertisement on a bus. But any any type of advertising, even cable ads, each city should have a cable ad I think a lot of seniors look at cable TV, like the city like Santa Ana has cable channel, they should put stuff up on their, on their channel, their cable channel, because a lot of seniors will use that. I find that a lot of seniors and it's starting to change but they don't use social media that much, or they don't know how to use it. But you know, people are getting older so it's they're starting to, but as of now I don't think social media is the best place for that. It's more like you gotta its just gotta be out there. Even, you know, if you put a flier up in a grocery store. You live in Laguna Woods, and you go to the Vons and Laguna Woods and they have a bulletin board up, put your fly around, you know, just in your community, but just get that advertising out there.


Oh, no, no, no, no, no, no. No, no, that'll never happen. Never happen, because each city gets a different amount of money. So Newport Beach has a huge program, Villa Park, not so big, each city and it depends on the funding they get, and the residents and what the needs are no, no, we would never have that. Everybody's different.


No, no, no, no. No, because each city knows what what works for their residents. They're all they're all a little bit different. So


well, I hear what you're saying. But I'm talking about, like, if you can change it for the future, and it could be more equity, you know, across cities and improving


would be that would be nice. That would be nice. If everybody could offer everything be great. Let's have a taxi program, you can go anyplace in the county for $1. You know, I think that would be great.


I guess I don't quite understand what you what you're what you're kind of looking for.


The number one issue is we need interconnectivity between counties. We need I had a lady that called me the other day mad, mad mad because she could not get somebody to a medical appointment at UCLA, and they live like in San Juan Capistrano. There is no connectivity between counties. That's a huge issue. And that's that's everybody's issue. It's not just Orange County. But when you have these people in Orange County that need to get to USC, UCLA, Cedars Sinai, they can't get there on on any type of transportation, that's not going to cost them $500 One way and literally $500. So so that's a really that that's a big issue, that I think that's all the counties coming to it well, especially orange in LA, because I do get people that are calling me wanting to get to a doctor at UCLA, how are they going to get there, they're in a wheelchair, and the family can't take them. So that that's a really, really big issue right now.


Um, I think it's just, it's just letting people know that there's 211 out there that can help them find transportation, that there's senior, non emergency medical, that there's the senior mobility programs, there's our access program, our paratransit program, it's just getting the word out, I think that's the biggest thing is to get the word out educate people. And we do go out and sometimes do presentations at different senior living facilities, senior centers, etc. to kind of let people give people an idea of the things that are out there. And I think even more of that just to educate the community.


All right, so this next question is going to be about different services for seniors.


I don't know. I honestly I don't know all I do is have grants that I'm responsible for. We do have transportation programs for several dementia Alzheimer's facilities, and we work with the facility Alzheimer's, Orange County and Alzheimer's Family Services where We provide a subsidy and they, they transport their participants to and from, and we pay for a portion of those trips. So that would be it like what I'm doing, I don't really deal with like medical, besides the transportation end of it.


Mental health, behavioral health and substance use treatment.


I don't, I don't really do anything with those either.


And then social or human and social services.


Again, we have some nonprofits, my day counts, community senior serve, there's like five of them, that we provide transportation subsidy. So it would just be the transportation to and from these facilities that we would provide. And it would be for most of them are seniors, not all of them. But when you're talking Alzheimer's facilities, it seniors, but all we do is provide the transportation.


Again, my perspective comes from transportation. Or are we prepared to make sure that they know about their cities program that there's many there's age well, and avisar that are going to take them to the doctor, it's we need to, again, my big thing is the market, you've got to get that that information out there to family, to the seniors, to let them know or people that aren't even a senior yet, but are going to be in 10 years, and they might need this service. So just so that people know about it, because so many people I get calls had no idea that there was low cost transportation for seniors. No idea.


funding. We need to we need it needs funding.


Yeah. That that would be great. That's a huge one. Yeah. Yeah, that would be that that that's important. That's really important. And when you talk to these people that have no way to get their loved ones to UCLA, without it costing $500, one way. I mean, that's it's huge for these people.


I don't get them that frequently. I do get them. Maybe 10 a year. Okay. So it's not super frequent. But I do get, I guess it's on my mind, because I just got one yesterday.


Again, I think as homeless seniors and people 60 years and older, that are living in their cars living on the streets, and sometimes we don't even have account for those people. We don't even know who's out there sometimes. So I think my personal opinion is just it would be seniors that are living on the streets or in you know, for the senior mobility program, they have to prove that there are to use a transportation that they live in that city. If they live they say they live in Costa Mesa because they live on the street and they're staying in Costa Mesa but they don't have an address. So they can't use a program because they don't have an address. So I just see that it's kind of unfortunate, you know, they fall through the cracks


related to transportation and mobility that,


you know, I'm sorry, I don't know more for you. But, you know, all I do is transportation. So I don't, you know, I don't, I don't really get involved with anything else. I just see things on the periphery. But everything is really just transportation related.


Okay. Well, this concludes the interview. Thank you so much for your time. incredibly helpful to our research, and if you find that you have more information to share in the future, please feel to reach out to me. You can go to our website events oc.com Or call our anonymous voicemail at 949-415-6898 at anytime. Okay. Thanks for keeping you abreast of you know, with the project and then also you'll get our monthly newsletter about So, yeah, that'd be perfect. Thanks again so


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, take it into consideration of the older adult caregiver, family and their community. I'm going to share my screen so you can see a list of common issue and concern impacting older adults. Please take a few minute to read through this list and let me know when you are ready to begin


and when you want me to scroll, then let me know because there are a few more items on the bottom


Okay, my name is Kennedy. I am. I'm a I'm a registered nurse. I'm a supervisor in LTSS. I've been in the department for over


seven years. So when it comes to LTSS, we have different programs. We have CPS, we have


MSSP, and the new introduced CalM. And LTC, which is a long term care where we have older adults that stays in a nursing home as their residents. And I'm I'm supervising the L LTC. Which is the nursing home or we call it long term care facilities where


we are CalOptima has members residing there for you know, depending on the medical needs, social and whatever the need may be, yeah.


Would have career behavioral mental health some Let me see.


I think pretty much is not a natural is is is missing is all all the factors we have, you know, you can define them. And know you have some chronic chronic problems there like at attack and yeah, or diabetes. I think we can add in dialysis, you know, dialysis centers where they can get dialysis centers where they can get dialysis, you know, yeah, sometimes is a big problem. Yeah.


Up there, on the list, including the one that you suggested, Please rank the top three that you feel are the most important.


Pretty much the most important. I mean, depending on the I can write, you say you have a lot of the chronic issues. You know, you have so many chronic diseases, which is all over the place. I think homeless homelessness, behavioral and mental health you know, chronic chronic health problems. Yeah, combine all of them together. And most importantly, we can cope. We can talk about the economic, economic security, you know, because most of the older adults are retiring without with not enough money to take care of their financial needs. Yeah.


When you think about chronic diseases or chronic health, how or why older adults struggling with this issue,


you know, that they're struggling with issues is is a combination of many stuff, you know, most of the way they struggle with it, you know, they're, they're chronic in nature. It starts long time ago, and that's what they call polypharmacy. Because they have the text, so many medications that say you see an older adult with diabetes, and hypertension, and some other chronic issues, you will see most of them might have up to six or seven different medications they're taking. So in the older adults, it might be quite difficult or kind of challenging for them to remember what to take or what not to take in. And most of the older adults are non compliance with their medication. That is, how many years do I have to live, I don't want to be bothered with a whole lot of medication and, you know, this medication, they have a lot of side effects, that affects you know, their day to day activities, you know, some of them might experience some side effects related to most of those medications, and they're going to stop taking it, you know, so,


yeah, then what barriers exist to see improvement in this area.


barriers to exist is more of providing in service, you know, there have been people out there to, you know, to educate the importance of taking those maintenance medications, because these medications are like, they're gonna take you for rest of their life. It's not like, like, if you're, if you have hypertension or diabetes, we are expected to take your medication daily, you know, so most of the older adults may not be able to comprehend what you're trying to tell them to do, so they won't take it so education in services is number one. Number two is most of the older adults though they don't have access they do not have access to caregivers who can come to their house and help them most of them actually prefer to be independent but their mental and physical capacity don't actually you know, give them what it takes to be independent so they might say I want to live in my house that then who helps them to reminds them when to take their medication you know, who comes there to help them to cook if you look at the county and state program most of the time they don't cover a lot of hours for the for the older adult and you know not but not everybody has you know walked to gain like insurance or whatever to provide those services. Most of the most of the earlier though they don't even have health. Some of them qualifies for health insurance, but most of them are limited you know, you know how Medicare medical use codes and Part A Part B so it kind of affects how they I mean, how they get access to the medication and how they get caregivers most of the elderly adult they're qualified to get a caregiver as they don't have it. And cost of living in California is another problem because even if they have they're gonna get caregivers they're qualified is so difficult for for for employers, employers to find caregivers to provide care because whatever the state or the Fed or the private individuals are paying these people are not enough for them to live and provide those there is a multiple factors. That's you know, yeah, but more more often I can I can see having assets because of you know, limited insurance or limited financial capacity of the older adults some of them retired poor because of the kind of job they did, you know, so you have to have a lot of money to something to supplement whatever you're getting from government so it becomes a challenge. Yeah.


you know, you know how sometimes you know how chronic chronic health is more is selected to they'll tell you due to research and what I'm gonna be more rational on this. They're gonna if you read a lot of literature it's gonna tell you Oh, high blood pressure is more of you knoq this ethnic group, or cancer of this is more of this ethnic group. You know, you see, you look at a limited, I'm a black man limited. My black folks are an example. The study that says, oh, high blood pressure, diabetes is more of black people. I don't see that genetics. I see that's more of a standard of living. because if you don't have enough finance to eat good food to eat, maybe won't be dining on salad and things if you're if you belong to the poor and well, I call it um If you belong to the poor society, you end up as an older adult as a young or middle adult eating junk food, because that's where you can afford, you can only afford McDonald's three times a day. So when you eat it, every time you develop, diabetes will develop high blood pressure. So if that particular ethnic group, don't have access to the finance, to live better, they're going to tend to develop diseases related to what they're eating. Finally, a lot of literature has said, Oh, we have, you know, these people, if this ethnic group is more of this, and this ethnic group is more of that. My own experience, I don't think is more of a ethnic group, I will see it as a social social structure where the economic put you where, where you belong, due to your will I call it the economic power to live a better day, don't don't get me wrong, there are still some genetics problems that predispose you to to get in a disease in our birth, you know, yeah, you see, if you belong to lower class, US, the percentage of you having chronic illness is higher. So I'm not I'm not, I'm not going to classify based on race, I will classify based on economic power and social belonging. That's how I say it.


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


Um, you know, it's more of what I said before is, is, the best way to address it is not like a common, like, there's no silver bullet, you should or need to get get a salt, you know, is going to be kind of providing education, trying to make sure that people are prepared, when they're still in their 40s or 50s. For them to know, now I have diabetes, and I'm going to be taking these medications, if I stopped taking it, because see, all these chronic diseases, that's why they become chronic, because our bodies tend to compensate a lot. As I have a high blood pressure, when I'm young, in my 20s, I might still be running the very high blood pressure, but my body's compensating, that is 40s, my body's trying to make sure I adjust to whatever I'm getting, but when I'm start getting old, the body's getting weak. When you're when the body gets wakes, you know, you get very weak, that's when the these these chronic problems tend to, you know, come out, you know, so is starting to educate people, you know, this social class, is there's a lot of factors there. You know, there's no, I'm not getting into that. How can we make sure they have access to financial support, because what we have now is majority of elderly adults, there all the time, that report and the economic things are not getting better financially, you know, prices are going higher because of inflation. They're getting little money paid, they can even go to grocery shop and buy the healthy stuff they should be getting. So the government has to do a lot in the financial part of their life. You know, not that they don't work hard. Most of them work hard because of the kind of educational exposure they had in life. They are they are they are not the top class. They won't. They are not the middle class, they walked in the lower class, they retire with a very low Dane, you know, pension, or some of them don't even have patience. Most of the elderly people basins, they'll base their retirement on Social Security, which in California is not going to buy you anything. You know, you know, most of the programs so badly people might not have even financial, when they spend what they have their money on. They might not even be they won't even have enough money to do this more pain. There are drugs that are going to get it as I need to eat, I don't need that drug. So the social factor on the financial part of it is is really really, really affecting them a lot. You know,


You know, what you see a majority of homelessness has to do do with. If somebody put this house for rent and put it at $2,000 a month, that's what he's gonna be whether you're 20, or you're 90 doesn't really I know, state has some program that helps the elderly, but it;s not it's not it's not. It's not broad. He's not. He's not all I see is not good enough. To supplement for them to, to have, you know, somewhere to live. And as I said, majority of the homeless people more have behavioral issues, some of them have some mental problems. How can we most of them, actually, they finally they gave up in life, I don't care I've been in the streets, the money I'm getting is not even enough to put the roof on. So put a roof over my head. So when they live in streets, they they get they get accustomed to live in the streets. And most of them takes, you know, most of them are drug abusers. The only way they can get this drug is to be in the streets. So we had the education out there, you know, where is the the anti drug abuse efforts geared towards the elderly don't think is only young people, you know, that let people get they get, they get distracted, they get kind of confused, or they get they get depressed, most of most of them are related to their financial or social social status in the community. So you see them practicing or trying to try out some different drugs. So drug drug problems is not is not exclusively for young adults or young guys, no, it affects most of the guys that are homeless or their homeless is a big problem. Homelessness does not discriminate, or the young. If you go to homeless, I mean, any of that comes you look at the number of people there, you see that the older adults are more in number than younger people. You know, it's because of how the the society how the society structured, the older adults are not actually being taken care of the way they should. This Social Security and other things, there is not good enough. There has to be more programs geared towards protecting the elderly. But I bet you not everybody has a pension. Not everybody walked to end benefits. Majority of athletes depends on this social security they get from the federal government, and cost of living in California, security cannot help them maybe that's why they are homeless. So when you guys do this program, the state or the Fed has to develop more, more programs that gets into financial incentives, how can we give this elderly has actually worked for us, you know, the adjustment in the Social Security or cost of living is now really it doesn't help a lot. You know, you don't go to grocery shop you want to buy when you buy something from let's say, Ralph's, or average. Oh, so this is for elderly people. This is for young people, we all pay the same price, you know. So most of those good stuff, their financial standard cannot make them get cannot let them get it because most of their lives they live in, in a budget. They live in a limited income that they get monthly. So the state should get I'm not saying it's going to be easy, but instead to get towards a program they're going to be providing, you know, for elderly having food banks. You know, that's what they did. Do we forget that we still have the elderly people going around, you know, COVID went away, those programs went away with COVID. So the elderly people then give back to the society and start struggling, you're doing.


So is really is really is going to take a lot to change it better. I think I think the state is trying to move towards kind of figuring out


programs to help but if we don't hit the major part of it is the financial and economic class. Yeah, that's what I say go to homeless camps. And look how 50 is, I mean, 60, 70 people, I mean, year old people are homeless there, you know, it pains me when I got there better. It is what it is.


Yeah, what barrier exist to see improvement in this area.


There's another thing I've kind of noticed last time I went out, because I volunteer one time to go, if you don't believe you have a problem, you there's no way to take care of it. You know, so this homeless people or homeless and lay out homeless adults or whatever there, they used to live in on the streets at a time they don't see it as a problem is a limitation. Or how can I do this so that life can have a carefree life takes over their day to day, the way they live day to day. Sometimes they don't, because they, the one of my guys said they get used to the get used to the streets. You know, so is acceptance is a limitation. But every limitation, you know, if people don't accept they have problem, there's no way you can take them out of it. That's where education in servicing, talking to people, you know, going into, you know, it's like, all these things. We don't wait to people get to that age, or people get to that stage to start bringing in telling them I know, beginning services them telling them educating them, you know, if we can get towards all the adults, from 50 to 60, we try to change a lot of things about their life, the way they live, the way they see chronic problem, the way they see homelessness, the way they see everything, you touch it you get them young before they get to that stage, because once they get in there is like they don't care any longer. That's what they're gonna ask you, I don't care that your medications will helpl, I'm not taking it. I don't want it. But if if if you're trying to start taking your medication when your 40s and 50s that you know the importance of missing missing a dose, that if you don't take them when you're 50, 60 Nobody cares when you get somebody who is going to convince me to take my medication, I don't care any longer. You know, that's exactly what's going on out there. So here's the limitation. You know, and I think um, I don't know why I keep talking about finance. And economics is a big deal as far as California is concerned. Whatever you like you do you provide, you go to the community, you provide them whatever they need that the minute you go, he goes away. In I remember I went on some one time to to visit some homeless people. They have all these chronic wounds, all everything. So I saw the LVN doing the dressing change. I asked them I know it's good. The nurse told me I don't I'm trying to do the best I can. There is no program to link them up. We can't link these people in any program, because when the only time emergency room will take them is when it becomes so obvious when they are in a critical condition. If you send them they don't even have a doctor, though they don't even have anyone they follow. You know, you say, I will tell you honestly, we think, or the adult has some has access to health care. I don't think they do. Most of those older adults in the homeless population. They don't even they don't, they don't have any doctor that follows them. What can I give you, even the doctors nah, their hands are tied. They have partisan what they call defensive medicine, they do the little minimum bets they can do to prevent loss. That's all they do. So it's really it's a really, it's a big problem in our society, though, you know, it's not what we can solve in a minute. But we're making, we're making a move and the earlier we study, the better if you start letting people understand what let's say I have high blood pressure. Now, as I'm walking, maybe I didn't save enough money in my retirement to to be able to continue taking the fancy form medication I take, once I go to Medicare or medical now I start getting medication that is not actually what I'm taking when I have private insurance. Utilize a limitation there is a problem because now they're giving me medication that is different from what I'm picking when I'm a young when I'm still walking when I have all these HMOs are these blue shield's. Now I have Medicare and Medicare, so we're not going to authorize you with we're not going to give you general meds, we're going to give you a metaphor, and that's how you're gonna get. That's what you're gonna get. You know, maybe, actually, maybe I'm going off. I'm going off the point where


you have a lot of knowledge to share different experiences for different group of older adults from different backgrounds when it comes come to homelessness.


Yeah, yeah, I think there's different experience based on based on ethnic background, because you know, some people I will use myself, I'm a foreigner, I'm not an I'm not I wasn't born here. I just I migrated here a long time ago. So I asked me, I cannot see my parents become homeless. Yeah, that's my upbringing. You know, all my friends, my parents can raise the homeless themselves, that they believe in life. But when you have a society where their upbringing, some some cultures are there, let me go, let me talk about let me use I don't know, if you're Vietnamese, or that population, they into extended family, they'll it's like a unit, you know, they cannot see, yeah, or the adult go on the street. That sector, that's a group of, you know, ethnic group protects their elderly population, then it goes to my, my own African American brothers that everybody's on his own. You know, they don't have that. And nuclear. No, I don't mean as a foreign I cannot see my parents become homeless, even if it's what I have, I'm going to make sure I prevent them from being homeless, even if they are not getting any government support. So that being my own support that some other cultures do not see that way, you know, culturally, if they believe that if if their parents didn't plan, to to have a garden, you know, startups when they're young, that's their own problem. If they find yourself in the state that let it be what it is they keep living not with their lives. So cultural upbringing norms and what you believe what the particular race believe affects how people see idli you know,


Ah, the best way to address the issue is still what I'm still saying before. Because the American society we're in culturally, you're on your own, you know, is, is still letting people understand when they are young, that hey, I need to, I need to save for, for the rainy days, in and you know, not everybody, because of the kind of jobs and kind of class we belong is able to actually save any money. So some people say, Oh, I'm gonna get social security when I retire. But when you retire in this security may not even be enough to pay your rent. You know, so is the only way we can do is still help have programs which you're trying, you guys are trying to develop programs are geared towards helping the elderly. Now that they had them, some of them not that they didn't plan, some of them, they did plan that where ever they found themselves when they get old, messes everything up. Due to the the society you live in, you know, the the inflation right now is very high. You know, whatever they pay you as a social security money is not going to do it, it's not going to pay your rent, it's not going to do anything for you. You know, so all those stuff is is really is problematic. You know, yeah, the city, the county, the state should do more financially. I don't know how they're gonna do that, you know, not everybody has a roboust pension system, or not everybody saves money. Not everybody do have houses, most of the most of that leadership that become homeless is not their choice, because they don't have a place to live. Okay, then you go to nursing home, you live there a couple of times, Oh, you don't qualify any longer. Do you know that nursing home, discharges people to a motel. If a nursing home discharge you to a motel with a seven days voucher. As an adult, as I know that after seven days, the motel kicks you out. If you don't believe me was going on in this society to them, that's what they feel they get to be everybody's everybody's trying to practice defense, they're gonna say, Oh, he's she want to leave or he want to leave, he doesn't have a place to go, then the only possible place we can give him or her vouchers to go into a motel. Okay, the person you're discharging into, to go to live in a motel for seven days voucher, we don't even there's no, you haven't linked or connect this person to a medical doctor who are going to continue taking care of their chronic problem, that when they were in your facility, you were giving them medications for high blood pressure for diabetes for everything. Now you put them in a motel. He's got to see him on this, you're gonna see him on the street after seven days without any medication. So you see the cycle, and then he becomes sick again, he goes to the emergency room that made him they put them in a nursing home nursing home, put him out again, and society. Because everything is well defined, you have to have this to get this, you have to be you have to have this, like everything has a class, you know, if you don't have this medical problem, you're not gonna get this. If you don't have this, you're not gonna get this. So it kind of put limitations on even the nursing homes, even the assisted living facilities. They have their for profits, you know, they're gonna make money to return wherever, wherever they are. I know there's a program out there or they call it assisted living whatever it is, you're gonna have so much money coming in as a retirement for them for you to for you to be in those homes. Not everybody got any money coming in. You know, some people some people don't even walk, they don't even donate what they get is a very small money from the minimum they can get from Social Security. And because of most of our elderly population, are hooked up with drugs and most of them alcoholic, you know, whatever money they get. Before actually, that's something I noticed in the society. Most of these liquor shops, give them credit. You know, all these young adults, they go there, they get all the drinks they want. Once they get that Social Security, the first thing they do is to go pay all the liquor shops they Oh, oh, give them like three or four. Bring them like three or four days the money is finished nowadays in society, then those liquor shops at the time start giving them credit, again, based on what they're going to get, if you go to downtown Los Angeles, you know, that's what's going on are those small, small shops you see there that sells alcohol, they have a book, they bring the book out, you're gonna see the list of people are in harmony there. Because those people are not, if I don't pay, I'm not going to get next month. So what they do once they get that small check, they get, they go spend alcohol shop their own, they don't talk about food. So there's a lot of social stuff going on out there. Because I've been exposed a lot in the community. That's why I'm able to tell you what's going on, you know, will all this problem be solved in a minute, know that let's see a movement towards addressing those issues. And as I say, most of these are older adults, they're used to the street. Yeah, you know, they need to accept that they need help for you to convince them, you know, yeah, tell me what's going on, you know, if a facility can discharge someone who doesn't have a home gym or motel and is accepted in the society we live, that's the problem though.


Who are going to diagnose them, they don't even have a doctor who are going to tell them they are bipolar. Or they will have a doctor, they say they're going to tell them they have anxiety, I'm going to put you on this medication. Or you're depressed, they put they put a social worker that follows you around to tell you what to do. Because nothing is there's no incentive for them to go. Nobody cares. Nobody talks to them about them, even if you talk to them. Let's say like, all these non for profit goes to them, talk to them in a day, talk to them, they're not going to come back for the next six months is like you do you do some say, as I said, continuity is a problem we have in all the programs that's been developed by the state, you put up a program, you have someone go out there one day you talk to them, you're done. None.


What barriers exist to see improvement in behavioral and mental health for older adults. we have to get we have to get some teams out there. We have to they need to have access to mental health programs. You know, dedication needs to be there. Even if it's through sending them even if let's say when they're getting those their social security checks, we're going to put up a pamphlet there we got to put down like some in service with their check for them to read. If I'm depressed this way I go if I have anxiety this way I'm go you know, the question becomes, you see some doctors this they say oh, we don't take medical we don't take Medicare we don't take this I've said you see now there have been some doctors now that believed that passionately. They don't even take insurance. Yeah, they have security in there again, if they see homeless guy they kick them out. You know, so So the education having access to these programs and the program having continuity not one not one day program, you know, you develop this there has to be way to monitor it. There has to be a way to monitor the effectiveness of what you're developing. What I've seen that there's so many programs out there that nobody monitors they just get it out there handed over to private people to run for state those private people out there for profit. still sell without we're not going to monitor it. We have given it to one this private agency to take care of is is a big problem. Yeah.


Yeah. Yeah, most of you know what I said before, ethnically, you know, most people don't have because socially, ethnically and financially It defines it divides the group. Socially, let's say financially, if you don't make enough money, you're not going to have access to mental health programs. Because your insurance, most of the doctors, or most of the providers will tell you, we do not take your insurance. Ethnically, most people do not have access to education. When they are old, nobody's talking to them, nobody's coming to them, nobody. They don't get the in surveys, that hey, if I'm depressed, if I have anxiety, if I have this, this what I do, and nobody that don't even have money, even if you tell them that, oh, this is the medication for depression, you should get to the Do they even have a doctor to go to to get those medications. Now, when they become when they become chronic, or when they become when they're in their manic stage, you call 911. They put them in a hospital, then after the hospital is again, for profit, wherever they are, they will say non for profit, or for profit, you know, the hospital have you for a couple of days. Now they discharge you you go, what they do, they give you, they give you some pills, they give you maybe 30 days worth of this depression pills. Those when you decide to the community, you're taking these pills for 30 days, after 30 days, you don't have access to it any longer. You don't even have insurance. Don't even have a doctor who will prescribe it. The hospital has done the minimum best thing they can do. We're trying to defend ourselves from lawsuit. That's why we assess you. That's why we discharge you. Now we follow them. Yeah, for the older adults. We were reactive so we react to their problems we're not proactive. Yeah, so I said