I think transportation. One is an issue in every region. Honestly, I don't think anyone really loves their public transportation and mobility options. However, here in Orange County, there is a lot of issues that come with that the idea of transportation and mobility. And older folks more susceptible to things like COVID, right. We don't want to put ourselves in that position to be in a crowded bus for over an hour. So that safety concern but then also public transportation is not widely available to everyone in Orange County. Right. And even when it is available, right, you then have to spend maybe two hours or more to get somewhere that's further than 10 miles, right. So that barrier to access public transportation is very high here in Orange County, which is an issue. And public transportation, really the only option to do daily transport is through the bus system, right, we don't have a large scale Metro in Orange County that can get you to those. Like I call them daily errands, right, or to workplace or whatever, we do have a metro that can get you to other cities, right, but there's only one stop. So you have to transport there, you have to transport over to the other city, then you have to get onto transport bus to get wherever you're going. That can be a whole, like, a whole day thing. No one really has kind of time to do that, in fact, so public transportation is a big issue. Right, we have, I'm in Irvine. So here in Irvine, we have big wide three lane roads, sometimes four lane roads. And what we see with road design is that the bigger you design the roads, the more lanes you have, the faster people go, that's just a fact. Right. But the smaller roads that you have, the less roads that you have, like mentally, we go slower. And so that makes roads safer, that makes folks want to actually go out and maybe bike or walk somewhere. And then when you also have these wide big lanes, like we have a lot in the Orange County cities, there's also more lights that couples with that, right, so then people are stopping at higher frequencies while they're going 50 miles per hour or more. That's very dangerous. And you potentially get hurt or even worse killed, right. And so all of these things kind of compound. Sometimes, older populations of folks no longer have a license or never drove in the first place. And so are reliant upon some of those public modes of transportation. So then we go back to the first issues. Hours of operation i see is another one on here, which is a big issue and not, oh, sell frequency of local transit services. That's a great thing. Right. That's again, a lot of time. ADA accessible stations, yeah, and buses, right. So all of that is very big, and then compounds with a lot of the other issues that vulnerable populations, including older populations face that are on this list.


I mean, the biggest one for public transportation, at least is investment by individual communities, and then the valuation from our communities. Right. And a lot of that goes into like what do our local municipalities What do our our state government place investment in valuation in and here, it doesn't appear right that public transportation is seen as a public good, right otherwise it would be heavily invested in would be a priority to make happen.


members of our communities, often the more privileged members of the community against more public transportation, because it is seen to some privileged folks right as against the values that they hold of increased profit and businesses and increased privacy and neighborhoods and all of this other stuff that goes against the valuation of public transportation for All right, everyone can use it. And so I would say the barrier to entry is that valuation by members of our community and by local municipalities and our state government. And then, for the other piece of it of like safe roads, and all of that jazz is, again, going back to valuation is like, a we value getting somewhere fast, by ourselves as more important than how we invest in safe roads. And so it's kind of a change of the culture, which is the barrier, I believe.


Yes. Yes, always. There's a lot of issues with public transportation and how it seemed for some populations, how it's used for some populations of folks.


for entry goes into that as well. So payment, right, like, public transportation here isn't free. If you have to have a car, you have to pay for a lot of things in order to have a car. And all of those kinds of things correlate with again, our our older population and some issues that they face, right. Some of the things that are on here, like economic security and like financial wellness, right, some older populations lose a lot of economic security as they age. All of these things correlate with our different populations.


of it plays into what we're asking of our local municipalities, our city council members, our mayors, our counties, right, what we're asking them to invest in in terms of transportation, instead of asking them to invest in, you know, widening lanes, right, maybe we can ask them to spend that money on taking a lane away and putting in more bike infrastructure protected lanes, or improving right our public transportation, or increasing routes. Right. I think a lot of that goes to what we as a community demand of our, our local governments.


Thank you. And now we're going to address the third thing that you mentioned, which is Community and Family Safety. And I'll go ahead and go over the same questions again with you. Yeah, I think the lack of that,


yeah, I think in Orange County, and I'll I'll broaden it to for our, you know, our US context, right. But in terms of our culture here, we're very less reliant on the community and family like sphere. That's not for me to say, but I can see how it plays out right, in impacting a lot of the other things. So when we look at our older populations, because the community sphere is less valued, right, there's less care on the community of individuals to care about a lot of these public goods that service a lot of our older populations, right. So the same thing as investment for public transportation, if we were to care more about the community sphere as a culture, we would see more public transportation, because we would understand that like the ability for all to get anywhere, with, you know, safe, transportation is really important for the safety of all and for the care of all and then family safety. So I think it's also important to note that when you look at things like gender based violence, sexual based violence, and a lot of these things, it correlates with a lot of issues of that, or it correlates with that idea that we don't necessarily care as a culture about this. Community sphere, right.


a lot of issues to lack of access for gender based care for sexual violence based care, right comes because we're not placing investment in those offerings for all people, right. And a lot of the work is put on nonprofits is put on, you know, individual organizations to do that work versus a community based system. And so I would say, I kind of lost what the first question is for all of these a little bit. But I would say that, like this idea of community and family safety is an issue within our region, because there's less


valuation in it. Yes, I think you mentioned that. Yes. communities.


Yeah, I'm gonna see the same thing, I think, an investment within a lot of these services, right preventive, and, you know, you know, after the fact, is really the barrier, and then how we provide these services and offer them. Yeah, that's, that's what I would say is really the barrier is how we are offering them what the valuation is by our local municipalities and state government, and then how they're offered and publicized. And, you know, the response.


Are there different experiences for different groups of older adults.


Yeah, of course. Different cultures care differently within these community and family spheres. Because that's ingrained in what the values of that family unit are and what that community unit are. No. And are providing this Family and Community Unit and safety and valuation, then the broader community is placing maybe and more negative valuation on that. And so the resources that are being provided from our local cities and region are less so for those folks than they are for the ones that are placing the negative valuation on it.


gonna say right, what we demand of our local cities and our state government through both our vote right, but also what we're demanding of them to place investment in, in budget, right yearly budget, in terms of services, is the one thing I would say that we can do. But what I'd also say is that and I'm going to go back to how like a lot of these things quarterly, right is what our housing looks like for vulnerable populations. What our transportation looks like for these vulnerable populations, what our services are as public goods, as public resources is really important to providing that community and family safety. Because if your only option, right, is that one bus, or if your only option for housing is to live, right with six other folks in this one unit. Then a lot of these other things are going to negatively correlate.


Thank you for the answers. Now we're gonna move to the next question. Sorry, can


Okay. I think it depends on which community in OC and then you know, where you live. So overall, I would say, for the region, not very accessible.


play into the fact of who can access it and who can't. So that in and of itself makes it not accessible for our


I would say the same thing. If you're able to access those on a more frequent basis. And again, you're in the right area, it can be very, very good. But if you're reliant upon other folks to help you do that, if you require services in order to help you access more long term care, right, get on a waiting list or have to schedule something out a month in advance, right, that takes a lot of time and energy. And then if you're not in an area that has access to that on a quick basis, right, then it can be very inaccessible. So that and again, and and of itself means that for our region, it's not very accessible.


What about mental, mental behavior, health, and substance abuse treatment. what was The last part of that, oh, substance abuse treatment.


Okay. So that one is also interesting, because we're looking at our older populations too. And so within the context of, at least the US, right, mental health and substance abuse have both been seen negatively. And services have only really grown in the last like 20 years in that barrier of our social constructions of what it means to have mental health issues or what it means to have substance abuse issues, right, has only been starting to deconstruct like in those last years. So then when you look at access for it, one, we have to look at what kind of barriers exist for folks in terms of that social construction of those issues. First Mmm. And then that also plays into what are our local cities, what our county is providing in terms of those resources because of those social constructions of what it means, right, and the valuation that's placed on them. And then if our cities habit which I work with a population of folks that can have immediate access, right, our students no matter if they're traditional, or non traditional, have access to substance abuse, prevention kids, training groups, all of that mental health facilities. We want to be increasing that. So luckily, for me, it's a conversation always in the accesses there. Which then parlaying out into the wider OC region, I would say the same as that there is access but again, it couples with a lot of those issues of what the investment is, from our local cities, what the investment is from our county, how, how widely communicated, that is what the access to long term healthcare is. So in and of itself for that, I would say not very good.


I don't, I only know of our programs for UCI in the surrounding communities. So that in of itself is an issue. Right, but


Because there's a whole bunch of different things falling underneath that category. But in and of itself, I would say not very well, in terms of access for folks, but it does exist.


Thank you. We'll get on to the next question as what do you think would be the biggest challenges older adults will face the next thing is


I think some of the biggest challenges in our region, right are a lot of the same issues a lot of folks will face in terms of increasing population needs for housing, but low cost housing, right. That's a big, big issue, but especially our older population will face because sometimes there's a greater correlation of need for you know, first floor units for single family homes for like this aging and the idea rate of of no stairs, all of this stuff, right. So greater need of housing. But then coupled with that are some of our environmental concerns for older populations, right of, you know, their access to respond in kind for extreme heat for drought for all of these environmental concerns. So I think those two are really big things that will play a part in the needs of older populations, in addition to the things that are always in need, right in terms of that health care piece. So geriatric care, long term health care, mental health issues, all of that stuff is in addition to what I think in the next 10 years will be a big issue for older populations.


I think the government's role is placing higher investment into all of these issues that right we talked about and that are on this list of things. If we place more investment as like local governments and as a county then I think the valuation from the community follows right because Community Health is


And so I think right that investment in All of these things from our local governments is like the most important piece. Or what demands we're making of our city councils of our elected officials.


I think that's a good question in terms of like, all of these things.


For me, like, on my outsider perspective, right. I see a lot of I see a distinguishment, between our older old population of folks who are in North Orange County and have like, a lot of these compounding things that we talked about, right, versus our older old folks that are in South Orange County and get access to a lot of these long term health benefits of environmental beauty and access to a lot of these community care things that we talked about. So that's what I


So I would say our North Orange County old old folks


Okay. Well, I think it depends on who is doing the looking right. I think a lot of our local nonprofits, our local organizations that are doing this work, see all of the issues. But I think our local governments, depending on which government and city are overlooking a lot. And you can see that by like what, you know, I'm saying that we need to place investment in by what other folks are saying we need to place investment in things like public transportation, right. But older populations aren't really part of that conversation, environmental concerns as well. But I would say it doesn't necessarily, it's not what issue, it's who is looking at the issues is what determines what's overlooked.


Thank you. Now moving on. So in addition to what we already talked about, so now we're going to go more specifically to your area of expertise. Yeah, I


think a lot of what I already said, right, of how folks are aging in is really hurt by a lot of the investment that isn't being placed in our communities in Orange County. Like I mean, it's a problem for everyone, but especially our older populations that have lacks access to some of the ways to respond to these things. That's an issue for everyone. Right. And so that compounds itself with a lot of the things we talked about with like public transportation, with roads with access to care, and all of that stuff.


Yeah, honestly, I would just say a lot. Maybe let me give you a good answer for that first, though, is that a lot of our Orange County cities don't even have climate action plans. Right. And so that is first needed in order for us to even know what problems each city in Orange County needs to address in order to respond to climate change. Right. So I would say, like for revised policy, or new policy, right, is start with a Climate Action Plan. And actually, you know, commit to it as cities.


Yeah, that's a good question. So a lot again, there's so much data about populations of folks and how it correlates with different things to do with sustainability issues, including climate change. One really big one that we talk about with a lot of students is how like food insecurity, how health concerns and community concerns, compound with sustainability issues, like climate change intensification in certain areas of Orange County. By like, what access folks have to respond to a lot of those issues, right. So when you see these maps, like put next to each other, it's like North Orange County areas, and then pockets of like the middle of Orange County. And so it's, it's super important to be able to look at how these issues correlate, because they're interrelated. But that data is important to have in order to uplift and highlight those narratives so that we can continue to do this work.


Yeah, let me after this, I can send you a student did a project a couple of years ago at the start of COVID. And it's my favorite thing that I had a student do here of like an ArcGIS story map of all of those concerns. So I'll find it after this, and I'll send it to you. Oh, that'd


be amazing. Thank you so much. And I guess that yeah, that's the last question. The other question is just like, I can like, follow up with you. If anything's Oh, you can also contact me if you missed something or if you want to share something else. And I mean, sharing those like sources will be amazing as well. So yeah, it's like very, very like helpful like information you provided and helpful so it's great like yeah, very helpful to our research. And also sort of like I mentioned like, you can also contact like information or go on our website and leave a message like emails to our general email that we have so you know this email me Yes, sir thanks for Sharing.


No, I think we just like go right into the questions.


Okay, great. So the primary goal of today is to identify what needs do you think are most important to older adults. The older adult population you serve specifically, and that's defined as 60 years and older, we want you to think as broadly as possible taking into consideration the older adults, caregivers, families and their communities. I'm going to share my screen so you can see a list of common issues and concerns impacting older adults. And please take a few minutes just to read through the list or let me know when you're ready to begin that I'll share my screen now.


So I am administrative assistant at hope Community Services and I help within I'm like a program assistant with I'm a program assistant within the senior programs. So I usually help in providing services regarding our ESL and citizenship classes. And I also do I also help and coordinate part of the food pantry that we operate as well. And I also, I also assist in our community committee, haircuts which we when we provide free committee haircuts for all the seniors on like, the third Monday of each month.


I think overall, the list is pretty thorough, these are the ones that I would consider like to be the main issues that older adults do face.


Thank you. And of the needs on the list, Please rank the top three that you feel are most important.


Um, I think the first one would have to be economic security. The second one would have to be transportation and mobility. And the third one would probably have to be behavioral and mental health.


Okay, thank you. Okay, so for the next few questions, I'll be going, we'll be going through each of the three needs that you have identified. So first thinking about economic security, how or why are older adults struggling with this issue.


So a majority of the older adult I serve they are on SSI and SSA, and are like not SSA. Sorry, it's just like us like Social Security and like the SSI, but even then, because of the cost of living has been rising California, it's been very hard for them to like, just budget everything to you know, to just like accommodate to their basic needs. So one of the major things that they face is that they don't really have food insecurity. And so that's where a lot of our food pantry programs like does come in to help with them because, at least for them, or I can only speak for the Vietnamese seniors, like and Asian American seniors that I do help. Because these seniors, well, Majority of the ones that I've been talking to, they're, it's hard for them to cook with things that they're not used to. Right, so we for our food pantry, we serve them like culturally appropriate ones. Spam, something easy for them to cook and that they know that they can consume. Because like if you you know have like meal prep for them. And also, like, just any, like, employment wise there are, most of them are because they're 60 and older, they aren't healthy enough or like not like in the best condition for them to work. There are some of the seniors that do work, but even then it would be like they would they're retired, they're like, retired, but they would do like, you know, meager like side jobs where just to cover like a little bit of rent because you know, rent has been increasing for them as well. Oh, Um, yeah. And they also because of their background, a lot of them are like immigrants and refugees, they haven't had education at all. So like, they're not very literate. A lot of them they do come to office whenever they get mail, whether it's like an English predominately, it's usually English like letters or Vietnamese letters they come in, they don't understand because they just some of them like, are like literate at all some of them they have they're like, partially literate. So it is hard for them to like obtain, or just it's been hard for them throughout their lifetime to obtain, like employment opportunities that can provide like a living wage for them. But even now, like in California, like nothing's a living wage, unless you're making like, at least 80k. And they don't make that.


The biggest one, I would say is like, culturally competent services. And that's what a lot of our organization aims to do. We provide like, you know, for our food pantry provide that cultural competency and like, you know, food staples, but we also provide our ESL and are in our citizenship classes, because we make sure that these are in languages. And I guess for like other seniors, as far as like they, a lot of like minorities, they don't really have a safe space where they can just like come in and gain access to the resources. So like, it's nice to think that our organization does provide that but as well as like other organization like Asian American Senior Service seniors, Senior Center Service, seniors, oh, my God, I literally don't know their name. It's called ASCSC though. But they're one of our partners, and they provide that for the Chinese American seniors. So that was one of the barriers, um, literacy is also a big barrier that I have seen. Yeah, probably like, if I could like break down like cultural competent, like resources, and language access to resources as well. So probably those two.


I would say yes. But again, like I can only talk for like, at least the Vietnamese, American seniors. And it's just like, mainly, like, there are at least like Southeast Asian seniors that are background, you know, they're from war torn countries, like come here without nothing. So and that would definitely have to be different than maybe seniors are South Asian instead. But also seniors that are also maybe the East Asian, for any, like other non Asian minority group. I can't talk too much about that. But I would assume they would be different.


I would say because it maybe this is like a very biased point of view. Because a lot of the services are given within community based organizations, because a lot of these community based organizations and I can name like, a lot of the ones that we worked with, within the API Task Force, is that and they predominantly do serve seniors, is that we, we have the people with the lived experience in the neighborhood, or at least in these communities that understand like, Okay, why do these backgrounds, so I think one thing that could help this is like to fund more towards these community based organizations and like, improve their capacity, because a lot of them are operating in like low capacity, like our team is relatively small, so we can't increase capacity for a lot of our programs, as well. So I think like the biggest one would have to be like capacity building for like, community based organizations.


Yeah, um, so I, because like California is, so it's like a commuter state, it's very hard for them to get anywhere, because one, a lot of them, they don't, they can't afford cars. They're also in a condition where they shouldn't be driving cars because it's dangerous for them. Secondly, most of them they do take public transportation, but even then, like, there's so few bus stops and even if there is a bus stop, like it does, it may be dangerous in dangerous areas for them. Right or it's like not like assessable like, because of like, this also ties into a lot of issues but then like the homeless population as well like and like how the city government governance like take care of that like a lot of it seniors, they can't stand for a while a lot of them like that I do serve they use they do use like some sort of like walkers or like canes. So like, they have to wait at bus stops that aren't like that don't have like no benches for them for like long periods of time. And sometimes like the bus transportation schedule isn't like it is sometimes like there's like, it's like a leave like a gap between like when they get picked up and everything. So I think like, that's probably like a major issue with them. And then again, like affordability, like there are senior passes, but I don't think that the at least Octa they do promote the fact that there are senior passes, and that a lot of seniors do know how to enroll into that, or at least get to obtain this in your past out of like a lower rate for them.


Okay, thank you, and what barriers exist to see improvement in this area.


Again, it would probably be like in language, accessibility, like, cuz Octa, they usually promote all their things in English. And a lot of the seniors that I work with, like are only like, our, like, low English proficiency. And they only speak like Vietnamese, or like, again, like some of them might not even be literate in Vietnamese as well. So that that's like a major barrier.


I would also say like it would probably will be because like, again, like the geographical areas and where many of these communities are based, like for example, a lot of Vietnamese seniors are based in like Westminster garden grove. So like the bus stop areas around there may vary from like, Irvine where it might be a little safer for like, Chinese American seniors or like Southeast Asian seniors as well. So I think it just depends on like the geographical area that might be like facing that I think commuting wise but like regarding cars, it might be the same.


Okay, thank you. And would you suggest is the best way to address this issue and


probably prioritize safety and like making sure that like the resources that are offered by like transportation companies like Octa, like maybe like even like Uber like these, like, you know, ride sharing companies that like, it is in language, and they do make it like accessible, and they provide accessibility by reaching out towards community partners.


Thank you. And thinking about now, behavioral and mental health, our wire, older adults are struggling with this issue.


It also ties into respect as well, because that's like, just like my background as a kid growing up in like the community. But I guess like mental health is like a very, it definitely is a taboo thing and like the Vietnamese American community, like they just don't like really, they tend to, they don't understand the concept. It's something new for them. And then a lot of the seniors that like, you know, immigrated here, like, they have so much trauma from like, the war and they haven't, or like they never learned or, you know, had resources to you know, cope with like, they're you maybe some of them, they do have PTSD, some do have depression and also as well as like, it doesn't even like stem from more trauma there could also be trauma like family generational trauma that they face, like back in Vietnam, and so or as well as like, the struggles like assimilating into America as well to make sure that like, Oh, they're forced to like you know, work so hard without like with nothing to you know, have a better life. Yeah. I feel like there's a lot of like aspects to consider when it talks to like behavioral mental health for older adults because they don't have like a I guess they don't have the background in it or like they weren't you know, they unfortunately didn't have the opportunities to like understand mental health. One, like, like Yeah, within like, like behavioral mental health because there's like, I think like the examples like listed like there's a lot and just like depends on like, each one


ya know, not, not really maybe whichever one you think is most prevalent or most pressing


thing. Yeah, I think right now it probably be forgetfulness, either like forgetfulness and anxiety. Those are probably like the top two that I would prioritize in my experience, since like, you know, as you go older, like you're bound to like forget a lot of things and Does like impact their daily their daily activities because like, one of the things that we do is that in order to us to, you know, continue to be in contact with a lot of our clients, and to make sure that they're okay is that, you know, we need their phone number, but even then a lot of them are like, Oops, like, I forgot my phone number, we're like, oh, that's not good. Like you, we can't forget our phone number because we need to make sure like, we contact you and have your contact information to make sure like, we can do like, you know, these checkups with you. With like, our Senior Program Manager. with anxiety, I've seen it stem from there's a lot of different factors stems in predominantly like, it could be like, you know, from war, from, you know, being in America. And lucky enough, I'm very glad that our seniors do live in like a Vietnamese enclave where they're able to have, you know, these in language resources available to them. But then when it gets to situations where they have to contact some form of like, you know, government social services that, you know, do predominately operate in English, like they get some anxiety about that. So, like, they like, refer to us, and they get scared, and they're like, can you please call us and we're, like, as much as we can call them for you. Like, there's only like, a limited amount that we can do. And then like, they're like, just do everything for me. I'm like, and I can't do everything for you. Like, I can't like, like, Thank you for trusting me with your social security number, but I don't even like feel comfortable, like handling social security number. I was like, That is like one of the major things that at least, like when I provide the services, like something I see often, when I you know, have like, meet up with the seniors.


Thank you for sharing. Yeah, and what barriers exist to seeing improvements in this area.


Um, I guess the top one is, like the fact that mental health is like, or, like mental health is like a very taboo thing, in Asian American community. And that's something that we just like, had to accept and like, you know, develop ways to, like, address them culturally, and competently. And as well as like, you know, do it in language. And because some of the terms that when you translate mental health, like, doesn't get translated like properly, like, it's hard, translating, like, emotional boundries, for example, into Vietnamese, because there is no concept of that behavioral health as well, like, you know, stress, like they just like, like, you know, in order to promote these ways to have like coping as well as these resources, like they have to be done ways that are like in language, and like, try at least try to mitigate the gap between that translation for the seniors who make sure it's as close as possible to what we understand in English to what they understand in their native language.


I would say in some of the topics, it might be the same, for example, like needing a caregiver like, and that might be the same within like, across all Asian American community, like older adults. But definitely like for Southeast Asians, like their anxiety and depression is going to vary from like, you know, like a South Asian, older adult, or a East Asian or adult or even like Hispanic, Latino, older adults. Yeah, so I think like in those aspects, like more of like, the mental health-wise the background that or at least like the background for factors acting into whatever goes on mental health is probably going to be very different. Because like, varied experience from like, the home country.


Definitely in language resources, and make sure like, they're culturally competent to make sure like, okay, they understand like, oh, like, what is it emotional boundary or like, what is like depression and was like, oh, it's depression, okay. And making sure like, you convey that to them. Slowly. I think, if you just like, go out there with programs be like, bam, here's depression, and why it's okay. That may, you know, actually have like the opposite impact of what you were expecting. When you're like, talking to a senior, be like depression, or like, I don't wanna talk about depression. So you have to, like, slowly ease into it and make sure like, they're comfortable with the idea of mental health first before like, addressing, like your specific topics like anxiety, depression, stress, like that.


Thank you. Yeah. So that's it for the these, the list that we're using what we have a couple more questions, but I will stop screen sharing for now.


Yeah, geriatric. So geriatrics is a branch of health care that focuses on unique needs as we age. So, just as pediatricians specialize in children, geriatricians specialize in the needs of older adults.


Or should I just like to say, I would say it's like a product of, at least for the Vietnamese seniors, I know, I would say around it was five or six. So like, probably like average, they do have a lot of access down here to providers that are Vietnamese, and that they are family doctors, they tend to have, like, a lot of providers that like are very like that overlap with each other as well, when I look at my clients. So geriatrics for them is not the provider to at least their system is not too bad down here.


Are you referring in terms of like nursing homes,


or long term care, it can be a variety. So it's just it just defined as services that helped meet the needs of medical and non medical needs of people with chronic illnesses or disabilities who can't care for themselves.


I would say what ---, it just depends on your insurance, actually. So a lot of our, a lot of our seniors are on Medi-cal or Medicaid, well most of them are. So if they are on a plan that does allow for it, and I would say like, probably it'd be like a seven, like they are allowed, and they are happily, they do have the opportunity to have that care. But for our non insured, or, you know, for our clients that don't really have it, it's very hard for them to gain access to that care. In Orange County, or at least down down in the areas of like Westminster, Huntington Beach, Garden Grove, we do have a lot of nursing homes, because I think lately, like a lot of people have been seeing the needs, and they have like, and, all these nursing homes are pretty good around the hospitals. Like, can they do it long term, because in my own personal experience, like I had both my both my grandparents, I had prospects and both my grandparents have to go into nursing homes, and like, the care there is great, it's just that there's a lot of issues with like health insurance, because everything's like, you know, for profit, unfortunately. Um, but yeah, like I, I would say, like, it definitely is hard for, it just depends on like, the health insurance plan that the senior has, but I would say like, it really isn't accessable if they don't have insurance at all. And even if they did have insurance, at best, it would probably be like four months of like coverage, and they would have to find ways to like, cover it out of pocket.


I think in terms of having the resources out there, it is out there. I was like, a decent amount. I'm actually I'm gonna not that's not sorry. I just need to think about this for a little bit. I think in terms of having the resources out there, there's not a lot because again, in the area that I serve, mental health is very taboo. So like, even like therapy is like a hard one. But even having like the in language therapists, and like culturally competent therapists, like those are very rare. In terms of the seniors outreaching for these services. I would say like they don't it's very rare for them to seek out like behavioral mental health resources, even like substance use abuse as well. Because I guess the dynamic in the community that I've seen is that they don't tend to rely on providers they just tend to rely on like family or like they tend to rely on like their friends instead to like, I guess, like, help them because they don't have they don't really understand like mental health is like is like a field within health that needs like actual professionals.


Oh, there's a lot I think it's very great down here like cuz because we live. We live I literally live in little Saigon. And like, they automatically like, they're usually yes, there's usually someone or in the office, there usually is someone that can help have a Vietnamese person, so it's not too bad. And then also, a lot of the community organizations down here, we do partner up with SSA if needed under a contract to provide like, um, you know, fairs and opportunities to provide like to help register and refer a lot of the Vietnamese seniors as well. And this also doesn't go for like Vietnamese seniors. Like there's a lot of nonprofits out there that help for like, Hispanic Latino seniors because at least in Santa Ana like, it's very strong down here. So the um around like the civic center plaza, there is like a lot of like Hispanic speaking um providers that can help for like referrals.


I would say if I could limit it, to like the top two or three, it would probably be like economic security. Because the SSA that a lot of these seniors get are the Social Security and uh and the SSI, if they are elected eligible for it, it's not sustainable at all. Because you know, like, next 10 years, like, we're the, I guess, like, the economics down here is was like really bad. So hopefully, they don't, it doesn't hit them too hard, but I would assume it's not sustainable. And there's, they're going to have to find ways to make sure like they are able to afford the cost of living. And also mental health like, I would say, like, more like behavioral health wise for like dementia, because it is, a lot of our seniors are much older, and they're the aging population down here, is very vast. So I think a lot of seniors are going to have to be facing dementia, as well as like the mental health, mental health illnesses that are tied to that. So like depression and like, feeling like, you know, worthy feeling like, they have a purpose in life, because a lot of them they do, at least the seniors here, like they struggle with having a sense of purpose, because they're like, Oh, I'm older now, I don't really feel that I have a role to play. And so maybe those are probably the top two that I would addressed. Or like, those are the challenges that they would face.


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


Um, I would definitely say, firstly, making sure that they can provide resources and when I mean, provide resources, it means investing into organizations that can provide these resources. So like, you know, again, like earlier, I said, capacity building for community based organizations because as much as like the government knows, like, they have the resources to help, they just don't know how to distribute it out, like properly, they don't, they can't connect it, because a lot of what the seniors need is that they need a connection. And like, whether it's like an emotional connection, most of it has to be a more open and emotional connection, as well as like just like any, like physical like maybe like, like any type of relationship because that's what they've been needing. So, if like, the government can like provide funding towards community based organizations down here, that you know, allows them to obtain culturally competent and culturally appropriate resources and provide this shoot that down towards the seniors and making sure that these community based organizations have the capacity to to need that will be like amazing, because that's what I've been seeing within like at least the role of community based organizations in language, I would I would also say more appropriate in language translations. I because as much as like they can distribute out so many flyers and like the translate it, most of the time these translations aren't accurate. They don't make sense. For example, and this isn't to like name drop anyone, I guess one of those because of the redetermination, redetermination process that's been going on for like medi-cal They've translated some fliers regarding like, okay, medi-cal, make sure you keep your information updated. Here's what's going to happen because the COVID-19 public health emergency ending the translations on that wasn't, or at least in Vietnamese, it wasn't like, it didn't make sense. Like, if you read it, you wouldn't like understand it. So it was kind of like all over the place. So if they could just like, you know, take a little bit more time, instead of just putting everything into Google Translate and making sure that it's appropriate for the language and for the seniors, and making sure that because like, there are certain words like, again, like, even in like medical, or like, even like medical, like basic, like everyday usage, like, it's, that word may not exist in English, or that word may not even exist in Vietnamese. So one of the things that, like, our office tries to do is like, we take these translations, we go with our senior program manager, and then we go over it in order to make sure like, okay, can the seniors understand this, because if you can't convey the information properly, then there's no point no one's going to understand, and they're not even going to be able to get the resources that they need. So I think that would be like a second priority if the government could just like do anything, like maybe just invest into translators.


Yeah, thank you. And thinking about the thing about all the older adult residents in Orange County, who is getting the least amount of attention


I'm thinking broadly in terms of like ethnic minority, but even then, like, my knowledge between that is very was lacking, I would definitely with say any Southeast Asian group besides Vietnamese, as well as South Asian groups, they typically are groups that are very forgotten. It's lucky enough that, its fortunate enough that the Vietnamese community population down here is so like large that a lot of services are being provided. Or, you know, Southeast Asian groups, such as Cambodian, Thai, Hmong, Laotian, they don't -, their community is so small, that they don't tend there tend to be for lack of a better word forgotten, since they don't have or, like, they don't also, like have, like, for example, like, I think an issue is that a lot of things like our like data, like database and log number driven, that because like, they don't have so many people, it's hard for them to like, even, like, get resources or like, you know, even get translation, like there, I see, it's very rare for them, um, as well as for, like, South Asians, like they, they, because they're so little like, they just, nor combined into just like South Asians as a group but even then, like, the minority, like the groups, they're like, different, like, Pakistan, the Pakistani community is different than the Indian community. And like, even then, like the Indian communities, like here was so huge, as well as Native Hawaiian Pacific Islander groups, they, I think, like mentioned, like, they definitely are, like, very forgotten. And because, like, there are also so like, all these groups are so like, combined into Asian American, I think, like, it's like, a good thing that there's, there's like a big need to like disaggregate all the data, because like, even then when you like, Major, when you put everything up to Native Hawaiian Pacific Islander, okay, that encompasses so many groups, there's like Tang group Chamorros like those communities, like like, even like groups that I still don't even know my by myself, because like, the information like just passes over their head, like there's no focus on them. So I would say, like those, I guess, like those three categories, or like, like those groups that often like are forgotten, for lack of a better word forgotten.


That's a good question. Because if it's overlooked and I probably don't even remember myself. I would have to say literacy. They just I think, because like when you assume that, you know, at least in the American system down here, you assume that okay, they Then they're educated, they're older, maybe they can read, some of these seniors can't read, they are not literate, whether it would be in their native language or in English. So even then, like, you have to figure out ways to if you have information to provide that information in a way that they can understand. So like, I think, luckily for us, we have connections to ethnic ethnic radios, like ethnic media, where the TV stations are, you know, very, there's a lot of Vietnamese TV stations down here that can provide the news. But sometimes even that can be mixed in or literacy can also sorry, literacy can also be mixed in with disinformation that is a very big one within I guess, like the Asian American community, because you can like provide information. But if they can't comprehend that, again, like, then that what they really understand from that is going to be different than will most likely be different than what you are trying to convey. So like, because I think you can see from COVID Like disinformation and misinformation was a really big thing. And even with like the political elections have been going on, that has been like a major thing as well. So probably like those are probably like overlooked. I think they're just like, not, there's no like concrete plan to address them.


Thank you. So in addition to what we've already talked about, let's dive a little deeper into your area of expertise.


Um, I would have to say that I think there's a more, there's an easier focus on hunger, because that's something more tangible that you can impact. Or like, at least address, because I know that there are a lot of community based organizations that are providing a lot of food banks, a lot of food programs, like we are one of them, we provide our pantry that happens like every third Sunday of the month. And at least on our capacity, we can serve like 120 to 150 people and like. So I think hunger is something that's being addressed at a better rate, because again, like there's, for example, Community Action Partnership OC, they also have food banks, and they also extend it towards like low income families and seniors. I think our partners, ASCSC, and the Vietnamese American Cancer Foundation, they also provide these food banks as well. And they those two, they definitely predominately serve seniors. So I think hunger is something because it's easier, because you're just making sure like, okay, the seniors need food, and here's how we provide food. In terms of poverty, it's something that it is harder to address. And at least on our part, it's hard for us to address that as well, because I think it's just more based on the systems like you have money, we just can't like give free money. So like all them are, like, you know, social social security and SSI if they're eligible for it. And so, I think like, even for poverty, like the best thing you can do, off the top of my head is like providing like, financial workshops, but even when you even when you provide them the knowledge, it's like, they can't use that knowledge if you don't have anything. Yeah.


Yeah, thank you, and what newer revised policies are needed


I think, in regards to poverty a policy that off the top of my head, would probably just be lowering or at least, like expanding the eligibility for the seniors or just making like, having like, economic safety nets is also something that, you know, governments can like make that like, really that have our policy for and invest in, and as well like, expand that eligibility. So safety nets is something that that can be like made a policy but also it is difficult because you need funding for that. So, as much as I would want that as policy, I think realistically, that is something hard for at least, you know, governments to do. If they could, that'd be amazing. In terms of hunger, I think a policy that could probably be helpful is just, I guess, like capacity building. And this is because I predominantly sort of like ethnic minorities, and like, specifically Vietnamese American ones. Culturally competency is, is what drives our food program. Will it be nutritious that those are like, there's a lot of things that we think of when we provide and we make our pantry food staples staples. So I think like, probably like more investing, and I think, maybe having funding to fund more of a, rather than like a pantry staple program, a hot meals distribution program, because I think last year, we were lucky enough to obtain funding for three months to provide 50 hot meals a week for our seniors, and like the waiting list, like we sold up the 50 the 50 limit capacity real fast. Unfortunately, there was like a long waiting list because some of these seniors, like maybe they can't cook, they're not in condition to cook. And they also don't have caregivers. So they're going to have to, you know, like resort on eating, like going to restaurants, but even then, like maybe even access to the restaurants is something that is difficult for them. So I think maybe, you know you know, be able to contracting, like community based organizations to you know, you know, work with, you know, a culturally appropriate restaurant, that provide like, at least cuisines that the seniors are, at least the seniors like know of, or they're comfortable with, that would be really good too. Because that can address like issues to access or resources, because if you're going to be based organization, you're going to be located at one spot, and they're going to typically know this spot, and it's going to be possible for them. Secondly, they're going to have that in language access. And thirdly, the food's gonna be culturally competent, because it will be contracted from like a restaurant that they usually are familiar with, like the cuisine that they're familiar with. So I think I also don't really see a lot of these programs, where they provide on like hot meals, most of the food banks are just providing basic staples.


Ooh. Like, off the top of my head, I would just say like community based organizations, as long as they, and this is like a very necessary thing have the funding for it. In the nonprofit world, I mean, because you know, we're both a nonprofit, it is very difficult to find funding, it's such a competitive field out there. Like people always say, like, oh, there's money everywhere, there is not money, there is money everywhere. But are you you're the one allowed to, like touch the money. So I think that would providing the direct services through the committee based organization as long as they have the capacity and the funding to do so are usually the people that I would assume are like the best people to address this. As far as like backing with the government, like offices and like programs as well.


We also like to use age as well. And that is hard, though, because some of them I guess, in the Vietnamese community, like some of them like they do renting and like, they get scared of like when renters go out and ask for like their housing data. But I think those are like usually the ones that we usually use.


Thank you. And is there anyone else you think we should talk to,


um, I can refer you guys to our partners, Asian American Senior Center Service Center, man I literally like I just call them by the acronyms. I can't remember the full name, but I can get you into contact if you haven't yet I can get into into contact with one of them because they serve because we use our predominant the Vietnamese community, they serve  predominantly Chinese American community. So maybe there's like a different expertise for that as well.


Sure, yeah, I think we do have them as a contact. But I will definitely reach out if we do not get to talk to them as well.


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


In a minute, I'm going to share with you a list of common issues and concerns on my screen.


These are common issues and concerns impacting older adults. And they're listed in alphabetical order. So no ranking or no prioritization, just a list. And so I'd really like you to review the list. And whenever you're ready, let me know when you're ready to begin.


And for the context of today's interview, we're going to be asking you questions about older adults. And our definition of an older adult, uh, pertaining to the California master plan for aging is 60 years and older, okay. But when you ask you this questions, we want you to think as broadly as possible. So taking into consideration the older adults, their caregivers, their families, and the community at large. Okay, so I'm gonna go ahead and share my screen. And once again, take your time to review this list. And whenever you're ready, let me know the list is going to stay on the screen so you don't have to memorize anything.


But please take a moment to read it through.


Oh, currently, I am retired. So, um, but I have 32 years of Social Services Human Services experience. I was the previous Social Services Director for approximately three years, I had a total of 27 years of senior management position, within SSA, serving cross, basically all populations of Orange County and both the public assistance programs, Adult Protective Services in home supportive services, child welfare, etc. Thank you. And thinking about Orange County and looking at this list of common issues and concerns.


We've got the housing in here. And you've also got economic security, you've got behavioral mental health, you have


the big ones that in my experience have been direct. You've got elder abuse on this list. overall safety isolation.


I think the list is pretty encompassing, at least in general terms. Okay, great. There are some that I believe are higher than others. But yes. Oh, good. I'm just about to ask you that. I think economic security, behavioral mental health, because to me, that encompasses self isolation, anxiety, those kinds of things. I also think housing and homelessness should be combined into one because there is housing insecurity, not necessarily homelessness. And I believe that there is some preventative work that can be done to maintain stable housing for those that are currently housed. As well as finding more permanent sustainable housing for those that are currently in an on House status. I also think in that sort of housing, homelessness, there is the concept of safely maintaining in your home, not just it may be there may not be an economic factor, but that there may be some supportive services that are needed in order to maintain safety in that home environment.


Okay, great falls into the sort of, I put that in the health care sort of access. Okay, so just to repeat, you, you would say economic security is number one, followed by behavioral mental health. And number three, a very broad and encompassing housing and homelessness category. My past experience in my direct interaction with this population, those would be the three top ones that we would have responded to. Okay, wonderful. Okay. So I'm going to start asking you a series of questions and we're going to take them into under these categories one at a time. So first, let's start with economic security.


Say it's a fixed income issue. Most of the majority of most older adults are


As we age, you know and retire, you're on a fixed income, and that that the cost of living increases you may receive through that process is outpaced by inflation, and the general cost of living. So I think that's the issue, it's when you see that more, so, you know, we're talking 60 and older, right. And so a new retiree who's receiving their Social Security, their cost their pension, and they're living we hope or sort of aligned, right. But as that pension remains fixed and grows out of sequential amount, it comes to a point where that pension no longer meets cost of living. And so you see this really more broadly in the much older population that have been receiving Social Security for many years. And you know, at one point that 1600 a month, may have been sufficient to live on but that 1600 A month today is nearly impossible to live on. And so it's a progression of, I think, a challenge with fixed income, that does not keep pace with general cost of living and needs the cost of basic needs. Yep. Yeah, absolutely. That's,


Well, I think there's, there's a couple of things, you know, we worked with United Way who sort of did a, they use the public policy group to sort of do a


an evaluation of economic factors of our seniors, but also to do a deeper dive of what's why some of our seniors were not taking advantage of SNAP or food stamps, as we call it in California. And when we looked at that percentages, we saw that there's a couple of things, the biggest one, why seniors weren't taking advantage of some of the economic supports that they may be entitled to was a lack of information about those economic supports. So they didn't even know they existed. They didn't know that there was a food assistance program. Right. Yeah. And what that means. Yep.


So I think there's a couple of barriers, lack of information about what economic supports are available to them, then you add in the stigma and perceptions of these programs, I think we have a branding issue. And I think that's a state that's a federal branding issue, as well as the state and local. But then there's also the complexity of just applying for these programs. Or you going to do it online, then you have the digital divide, and the fact that most seniors,


You're dealing with a high regulatory environment.


may struggle in understanding and navigating that bureaucracy, I can tell you a 21 year old would never struggle to navigate.


We put them through right. Yeah. Yeah. So you add Stig, lack of information, stigma and nav difficult navigation. And that's like a perfect storm for why someone won't even won't access the supports that may be available to them. Yeah, yeah. No, I hear you.


There's a segment of the older adults that may never have an issue with their financial security or housing costs. And then there's a segment of population that are okay. They may not be doing really well, but they're sustaining right. And then you have the segment of you can't do a one size fits all for our older population. Because not every 60 year old is in the same situation. Not every 90 year old is in the same situation.


So and then there's family dynamics. And so you can't compartmentalize this, this population know, the same way. You can't compartmentalize an 18 year old. There's not 118 year old, that's the same as another 18 year old, right. And so I think that's a big mistake that we make in implementing programs. We like to do this one size fits all model. And I don't think that works in any population, but it definitely doesn't work in an aging population. Okay.


Yes. We've got our lowest socio economic, we got persons of color, right. So the disparities are there, and we can ignore them. So this population does not differ than any other population as far as the additional barriers that those disparities add to their day to day, right. But if you look at


Laguna Woods is a great example. Laguna Woods is considered higher affluent area, right. But there is a high level of food insecurity in Laguna Woods.


Right. So their disparity, this, this population suffers with disparities, just like any other population. And


but the need is across all spectrums. And so I want to make sure that


what I'm trying to say is, is that there are going to be population segments in this aging group that have a higher need, because they're already coming into their aging process with disparities, you know, low socio economic racism, whatever, you know, those aspects. So they were already struggling before hitting the age of 60. Right, with those societal barriers. But then you've got these other areas of population that are also experiencing the same hardships that are new to experiencing hardships. Yeah, absolutely. And that's why i That's why serving this population can't be a one size fits all. Yeah. Because whatever programs are designed, or whatever interventions are designed, it has to be individualized to the specific need of that aging person that we're coming in contact with. Yeah, yeah. Yeah. Yeah, yeah. Yeah. No, it has to be culturally sensitive. And it has to be customized, to what that particular individual needs. Like my mom, like, as an example. She is 79 years old. If it wasn't for me, and having her in my home, my mom would not be able to live in California at all. She has a very small fixed income. She's Hispanic in origin. So it I think there's a cross what my needs and my mother are offset by the fact that I am as a supportive family member able to intervene, right.


In other words, you know, like being recently retired,


Well, I think a lot of my responses to you was the, the aspects of the system of care that we needed to develop, but as a adult, who cares for an Senior mom who's a single parent, right.


As a child, who is caring for a parent, a lot of the areas that are pain points


are probably more visible as I've, you know,


been more involved in things like her health care or you know, making sure she's eating nutritional right physical ailments, as her mobility deteriorates, you know, all of those things a


little bit of, you know, memory loss, nothing diagnosed but so


And I have a lot of friends who are caring for their aging parents. And their pain points may be similar in some ways, very different in other ways, depending on the individualized circumstances.


If you're caring for a parent, you're gonna understand the perspective of the caregiver. That's just the way it's going to be. Yeah. And I do believe there is some that are generic, and then there are some that are very specific.


I think there's got to be a couple of factors. It's not a one, one answer to solve it. I think one, we need to look at how we share information on economic supports that may exist that someone doesn't. So I think there needs to be a branding educational issue. But then there needs to be trust, because someone may know a program. We see this a lot in the undocumented population, they know the programs are out there, but they fear the programs, or they don't believe they should, or they, you know, because they don't, there's fear. There's, you know, immigration concerns, right. So they don't always take advantage of the programs that are available to them out of that fear. So when you do fear and stigma, I think you need to look at access points. And we need to look at first points of contact.


So having a strange social worker show up at your door saying, hey, I want to talk to you about your eating, you know, you know, we've got to


report it. And we want to do that. It's not uncommon, where they won't let the the individual in, but you know, who they really know is their meals on wheels provider, because every time that provider shows up with their meals, they spend an extra few minutes. They talk to them, they they know them, right. So there's a trust built. And I think the


best option is to create individualized pathways for ease of access and navigation


through that first point of contact. Yeah. That's multifaceted.


It doesn't matter who reaches out to them first, but there is an access point. Yeah. That's all I'm trying to say is I think there's


I think there's some key stakeholders, that could be navigators, like, for example, in the you know, the public assistance side is a good example. That Home Health Network, who also makes connections, because they see that there's some economic families in the family.


again, I hate to say this, Katie, but it's not a one, one solution. Because also, let's face it, not every senior not every aging adult older adult who goes to a senior center needs me.


Because they're going to a senior center for different aspects. They're going there for socialization and their friends. They play cards every day, you know, those kinds of things. They don't need an intervention. They're doing fine.


Yeah, yeah. Okay, so I'm like making this much more complicated than it needs to be. No, no, no, you're doing great, you're doing great. And you know what, you probably above all have the wealth of knowledge and experience and touch points across this with a whole system of care that we really need to hear from. So I'm just grateful to you for sharing that today. So now I'm gonna move on to your second topic. You talked about behavioral mental health as your number two ranked priority for this population. And I will ask you the same questions that we just went through. I think the issue is, you've got a couple of things. Some of them are medically driven, you know, so you may have some dementia, starting sensibilities, you know, dementia, senility, Alzheimer's, so there's a maybe a physical aspect, but seniors tend to, there are some older adult population with self we know, we know, the study show self isolation is a problem for older adults.


Lack of transportation is an issue for that socialization, aspect.


cleaning your house, all of those things that some older adults, as they progress in their their aging process their aging process becomes a little bit more and more difficult for them. Right. Are there creative ways to build trust with his, with his population that may need us again, there are some older older adults that have a strong support network, who are very active in their community very close to their support systems, that this may not be an issue. But as their support systems begin to not be there, or for those who do not have a support system, then how do we


Yeah. Yeah. Well, I don't know. You know, barriers is such a strong word. I think there's, again, multi factors, I think biggest one is trust and lack a lack of, of


trust and connections. That's why we say trusted connections. They don't trust strangers. So are they Oh, you know, will, you know, if there's,


with anyone who may be struggling in this area doesn't matter your age, you need to trust the person who's intervening for you. Yeah.


It's going to be a family member, or it's going to be a doctor.


Because they've gone to this doctor for 20 years, they trust the doctor into their family member is caring for them. Or


it's going to be an observation made by their other older adults supports their friends, their neighbors, those kinds of things. Just just, I hope I'm articulating what I'm trying to say really clearly. So I think, I think trust is a big one and then connections. For those. There are some I'm going to give you an example.


APS went out on our call one of self neglect and self neglect means that individual is is


is now demonstrating their inability to self care, meaning to take care of themselves, right. So it's a call by neighbors the same we think this person is in crisis. When you reach when we reached the home, here's what we found. We found a


no adult children. The only family member was a distant niece, right that they don't really talk to regularly.


So this gentleman goes into depression over


he can no longer do groceries because in addition to this, his mobility is now deteriorating.


He's sitting in his house all by himself every day, seven days a week.


And the only way someone knew he was  in crisis was everyday, he used to take his dog out in the patio, and they hadn't seen him in a couple of days.


That is a prime example of how in some situations, there's an event that triggers


a need for support. And if there isn't a support system, then we find ourselves with an older adult in crisis. So that's one example. Or has always been,


as my aunt calls it, melancholy, we know he was depressed, right. He's always suffered from depression.


That as they age, now they're by themselves, they're part of their partners die, or their friends start to go, or worse, their sibling start to go, and they're now feeling more and more alone. Their children may not live nearby if they have them. Right.


So I think I think that making the connection and how to introduce new supports into some with someone who doesn't have a support system, the nonprofit's are really good because they have the they understand how to go in and just start having a conversation and building trust with someone. Right. And they're usually the best ones. To do an intervention.


Yeah, it's really to me trust and connections. Yeah. Got it. Got it.


Yeah. Yep. do so within the system. That depends. So let's talk about the reality of life. You become retired at 65, you now have to change your Medicare. Now you're on Medicare. And now on Medicare, you have to pick a new insurance plan. For many older adults, that means completely changing their health network.


Got it. That's what I mean by continuity of care, or helping with establishing and finding new providers. That's really, when my mom had to when I moved my mom out here from Massachusetts, and we had to put her in a Medicare Advantage plan in California, she had to start with all new doctors, she struggled with that. You know, I had to go with her to make introductions to all our new doctors, so she could build a new comfort for them. But that was very traumatizing for her. Yeah, I'm creating that new connective work. Yeah, yeah. So I'm trying to say that's, you know, it's not about a handoff, it's more about that falls into the health insurance category when their schedules because now, you know, they're either retired or they're on Medicare, and they have to pick a new Medicare Advantage plan. And the other thing that you can't stop is the Medicare Advantage plans. It's not uncommon that you'll get a letter in July saying, Oh, by the way, that group is no longer a Medicare Advantage plan, you need to pick a new group next year, or that doctor you've been going to is no longer available, because they've decided they're leaving the medical group that you're enrolled with. Yeah.


Yeah, that's very disruptive for sure. Or disruptive in the care. So that's kind of, you know, I'm talking behavioral mental health issues, but that same is through with the, you know, the health care and access. Sure, sure.


I don't know if I'm the right person to answer that question. Honestly. And then how did they maintain


a provider relationship. But I think that goes back to the connections like


Great. Okay. And I think it's a big issue of rents go up.


Their costs of living are going up. Their income isn't matching that. And so there is an


the other piece that impacts housing instability creates housing instability is if they do own a house, and they have adult children who have decided they want that inheritance early.


Though it comes back to that, you know, that abuse situation.


We've had situations where kids have sold a family home park, mom and on the lawn


and left her for the new owner. So and those are extreme cases. Katie, I don't want to I don't I want to be clear. Those are extreme cases that it happens. It happens. cases. But I think the number one factor,


impacting housing instability in our older population is very strict. It's easy math. You have a fixed income, and your expenditures are going up naturally. Yeah. All of your costs are going up your prescription costs. Now, your food costs, your utility costs. All of that impacts your ability, Something's gotta give. And you know, in some cases, it's your rent.


Oh, boy. I think we need more affordable housing. I think that's, again, I don't think these solutions know how about affordable senior housing.


You know, I don't know if I go that far. I mean, public housing was a failed experiment in the 60s, let's be honest, for the general population and created different techniques. I think, I think affordable housing that's community based with.


And when I say community based, I mean, embedded in the community, with other members of other representative members of their community. Yeah, like, we used to have a lot of we used to have a lot of senior affordable apartments, right, was an apartment building, had to  be over 55. And it was, you know, lower, lower rent.


And then they have their own little network in there, right, because it was just a senior apartment. Right. I also think the other issue for those older adults who require more medical support, but are not acute care, there is no asset. There are no board and care facilities that accept an SSI rate.


You know, that that will take a public assistance rate, public assistance, doesn't pay medical doesn't pay for the room and board at a at a boarding care facility.


And there are no affordable board and care beds available anywhere, not just in Orange County. That's an issue of boarding care facilities that are willing to take an SSI rate, which is the lower income. Right. Right. So I think lack of affordable senior housing is an issue. I think lack of affordable boarding care facilities for seniors who are in that lower socioeconomic factor. who can't afford the $6,000 a month a private boarding care will cost you. I also think there is a struggle with housing is not just an economic factor, but it's also being there safely. And there is definitely a shortage of viable caregiver options and who's going to pay for those caregivers. So you know, the average going rate for a home health care person is $35 an hour.


I don't know what the IHHS provider rate is right now. But it's not not it's not $35 an hour to be assessed.


It's about $1 and a half over minimum wage.


But they're not about to do it for others, because it doesn't pay well. And if they weren't going willing to be caregivers, for others, they're gonna go to an agency like Visiting Angels, where they're gonna get $35 an hour.


Just, that's a struggle. Yeah, our older population as their needs become higher, the older population that are in that lower socio economic group,


their support systems in their houses are going to continue to increase without an infrastructure there to address those issues.


It's fragmented. That response system is very fragmented. Every agency does the best they can, within the rules. Sure, I can go in, they can apply for IHSS. And if they're eligible, they can get you know, depending on the needs assessment, the hours authorized, but then it's up to that older adult to find their own caregiver and find someone who's willing to take that dollar more than minimum wage.


the income or family member who's willing to pay for it pay for that caregiver. I have someone right now who has their mom at home who needs care. That's a choice heard her family's made, but she pays she pays almost $5,000 a month in home health care for her mom.


Well, there's nothing really there to really provide that support. We can fragmented we can get IHSS. We can get interventions with the nonprofit's we can get meals and wheels to go in that home and make sure they're at least eating right, we can try and find a friend or a family member that's willing to intervene


but at some point, that person won't, will struggle with medication management. Right, as they progress. And there is no affordable board and care facilities out there. Yeah.


It's but it's not an apartment. It's just a single family. Yeah, it's a single home. But you know, it. We I think all solutions should be explored.


Similar to dependent foster care dependent group homes, right.


There is shared housing that could be explored. There is incentivizing people to build those single family add ons, you know, the grandma, what they used to call grandma flats. Yeah. Yeah. That's something that what LA County does. If you want to Grandma flat, there's, you know, you can get a certain amount. And so there's those things there is working with DHCS to find out why we don't have affordable boarding care facilities in California. Right, maybe encouraging some of those things to be revisited. Yeah.


Yeah, I think it's all you know, it's one of the other solutions, I think it was reading about the other day as seniors who own their own home and are struggling with housing insecurity, are actually taking other seniors in as roommate. Yeah, yeah. Right. If there's a senior who owns a three bedroom house, doesn't want to live by themselves, needs some additional funds for their housing, right. How do they


Look at some potential shared housing situations. Yeah, it's kind of like the the optimal Golden Girls episode.


So I have a couple of friends we've already said when I get there when we get there were two Golden Girls.


Because, one, it helps with a lot of things that helps with isolation. You got companionship, there's someone looking out for you another set of eyes, right. And it lowers your living expenditures. So I think those are I think you need to explore all of the I think there's not one. It always frustrates me that people that we look at these things in these problems with a one size fits all solution, however, I'm going to be honest, government can't be at all, there's no way. You can't.


Yeah, if it's alright, with you, I'm going to shift this a little bit to the homelessness issue. Right. So we have older adults who are homeless, yeah. What is


what are some barriers to solutions to address seniors who are homeless, same as barriers, distressing, homelessness in general, what we're seeing there, we're seeing lack of transitional housing, lack of permanent supportive housing, it goes back to that lack of transitional housing, lack of permanent supportive housing. Yeah. So the the challenges for this population is very similar to the rest of the population is where we put them.


As we build out our continuum of care for homelessness, we need to and this is something we've always talked about is we need, we can also just like in homelessness and housing individuals, there's differing needs in there.


That's a lot. And then one other I wanted to touch on the other thing that you mentioned, which is safely aging in place, I guess, right.


Um, you know, as we physically age our body ages with us, right, so at some point, I'm going to need assistance. You know, at some point, I expect my hearing won't be as great as it is today, right. So I think, but I can


I have you know, financially secure, I can maintain my financial economic, but how to, maybe I don't have a doctor, you know, how do I


where do I go if if my doctor tells me I probably need to, you know, so example


Or, Hey, I'm struggling with walking, I'm falling a lot. How do I work with my doctor to ensure that I have physical assessment of my gait is done to ensure what level of walking support I need to be done. Right, some of these things, some of these challenges. You know, I realized Katie, I'm Sadie pretty


I think they're just fragmented in nature. So like,


I'll just use my mom as a great example. I noticed that mom was struggling a little bit with walking. Right. Right. So we go to her doctor and I say, Hey, I think Mom, mom struggling with her knees a little bit. She's having some joint issues. I noticed, I think, I think she may need a cane. And the doctor says to me, You know what, let's send her to physical therapy. Let's do physical therapy. And then we'll have that physical therapist assess her gait. Okay, great. Physical therapy was three times a week, that's me driving her three times a week. Because you have to just have had a medical procedure for anyone that do physical therapy in your home.


Can't get hold in home physical therapy, unless you've had surgery, or you've had a recent medical challenge. Medicare won't approve it. Yeah. So you literally have to get to the physical location to do physical therapy.


it's doable. If I have an older adult who is paying for the cane is not an issue. It's not, it's not about the money. It's about logistics of getting you there.


you know, get who's who's going to take this older adults to, you know, do they do they still have their driver's license, great, but that's not an issue.


struggling to get to where they need to go in order to get the things they need to stay safely in the home. But then the progression of if you have a medical condition, or a you know, higher in need, who makes those connections for you. If I'm dying, I get to go to hospice.


Hospice comes in and they do an amazing job. They make the connections they get they order, you know, the hospital bed, the portable potty, if I need it, right, the oxygen if I need it, my medications come to me, that's because someone has determined that I'm going to pass away in six months.


I think that's, and that's not an Orange County ability to fix that's going to be that's, that's a whole healthcare system revamp, which is what the MPAA was hoping to do on the healthcare side.


And, oh, that's gonna take them up to somewhat there. But that takes a lot. You've got your managed care providers having to work with your medical group providers having to work with your pharmacy, with with older adults wanting to maintain their own control, privacy being a very specific issue for these population and fear. So and then, you know, this is


this, this is a challenge. Here's where it's funny. This is a challenge, that people's perspective is very much shaped on their personal experiences. Yeah, yeah.


It's the challenges I've experienced with my mom's care, right. It's the challenges my friend


experienced trying to make sure her mom didn't have to go into a skilled nursing facility because her culture, her culture is very much about you take care of your seniors at home, right. And so the idea of putting her mom in a sniff was, was not something she was even going to consider


the financial burden it's placed on her and her family to make sure Mom is there with a caregiver, because she needs it. So she's gonna tell you if you were asking her these questions, she told us health care and access, because that's her struggle.


That's what she's gonna tell you. I told


Um, you know, when when I told them, I wasn't going to put mom in a sniff, but I needed the supports the moment mom came home, they said, well, she's home, she doesn't need sniff level care. So all of that in house support went out the window. There is no financial support from the healthcare. Your insurances don't pay for that stuff.


They don't, they don't pay for home health care.


So those are the planning that has to happen. So you know, that's, that's what I'm saying. It's,


it's making sure that there's an assessment of need


But when a senior is being abused, that senior has the right as an adult to remain with the abuser. Hmm.


So the negotiation that happens to get that senior to agree to a safety plan is very different. Because an old, a senior has the ability to make their choices, right. And they, they really want control of their care. So that's the other piece too.


To have general navigators, uh, you know, I would love to see, you know, one of the things that happens really good with our low economic families is that pro matoro model, you know, because there's so good about going in the home, building trust, building relationships, making connections to the need, ensuring the family is, you know, doing that assessment, it would be great if we had a promontory model to go into to be available to specific aging populations, that can also make those connections in the older adult community.


And it would be good, it would be also to encourage key access points to want to have their own navigators, right. And the ability to assess, it would be great. If we worked with our medical community, like we've done so much in our child's community of ensuring that they understand socio economic, and there's still a lot of work to be done in the medical community as far as educating individual providers. Right. Yeah. What do you think, you know,


reimbursements for community health workers. Yeah. AKA could be parameterized as well. I think a carrier advocate would be good. I think anything you do to build those connections is something that needs to happen.


I also think there's a lot of advocacy work that needs to be happen with the insurance companies, right. Some of them are really great about home health, and then others are not. Right. Yeah,


we're not kind of solve, these major issues that exist in the United States. I think that's not going to happen.


But yes, I think any sort of exploring creative navigation models in this population would be a good use of time.


Okay, so what then those three areas that you highlighted, I'm going to ask you some more generic questions around health care, actually, the system of care. And then we're going to go into just a couple more questions after that. Just checking in on your time. I'm good with time I don't know about you. I'm retired, I get nothing.


That's why I put you at the end of the day because I knew I was gonna have a very fruitful conversation.


Okay, so in your capacity now, I'm going to ask you to wear your hat as the former SSA director in your capacity as the director. Can you please describe to me how accessible and adequate the following care


or services are in Orange County. So we're going to talk about GE geriatric care.


Know what, I'm not the right person to answer that question. Okay. That's fair.


I think the overall adequacy of access to that is very similar to the general population.


There may be one, I'm just not directly aware of one. Okay. And


I'm sure HCA would be able to tell you there's some Yeah, yeah. Okay, so now.


think we've done a lot of work to make it more accessible. And I know the department is working even harder to increase that accessibility and pathways. But there's always work to be done in that area. Okay. No, I'll tell you, it's that's true for all our families. I think the snap grant is way too low in California in California. I don't think our public assistance programs have kept up with the pace of inflation. Yeah. Yeah. fair. That's fair. Okay.


So I'm trying to think of myself in the next 10 years, and what I think my own challenges will face.


I think, again, I think the general cost of day to day living will continue to be an issue, I think, the issue of self self isolation will continue to grow. But I also think we are continuing to move more and more into a digital age. And I think that's going to create some barriers.


Oh, that's a loaded question, Katie. I know. It's not that it's just I just, you know, it's such a complex question to answer. I think government.


Oh, I want to say government tries, but we're not always good at it. Um, I think government's role is to,


really, because this is different for everyone. I've, you know, what healthcare can do versus SSA can do versus OCR versus, you know, Medicare versus, you know, these governmental agencies. I think the government's role is really about true program evaluation, coordination, and


individualized services, right. I think government has this is this is confidential, I'm just gonna lay it out because I'm on a soapbox this afternoon. Government has to have the courage to say that program A doesn't work. Or that program aid only works for this population. And then we evaluate if it's a big enough bang for their buck, but what government tends to do is throw money at symptoms versus looking at causal aspects of the true issues. But I think the one thing, the easiest thing for government to do is act as that coordinator point.


Spoken hub, we can be the center of that. Yeah, we can be the bolt, we can be the bolt that gets that wheel to turn with different spokes. That's what I'm saying. And I think the best thing government can do is sometimes stop thinking they know exactly what the problem is.


Because they don't know we like to think we do but we don't.


My personal aspects of my role as SSA and the challenges I saw my families go through, right.


Don't want to design a great program, what I'd like to tell you is I'd like to sit around the table and look at an individualized group and look at different segments of my older population and say to what level of interventions does this population need. And I'd like to have the people who actually meet and talk and spend time with these populations to get some ideas of what the end I'd actually like to talk to the population. Because you know, what, that populations got a lot to say, but what they need and feel and the way they want services to be provided. And I'd like government to have the courage to listen. Hmm, yeah.


Not necessarily be the doers. Government can't do it all. And in fact, if you look at any program where government tries to do it all, it's usually never met its true goal. Yeah.


That was pretty direct. That's powerful. That's powerful. Thank you for that.


I'm just gonna say that there's probably disparity in how we looking at this, I suspect that the aging population in the undocumented community has probably never been really looked at and what their needs are. Because guess what they do have needs they age just like the rest of us. You know, we age a like, it doesn't matter who you are we age alike, right.


You know, they stopped me from from doing a focus group on the undocumented population, because supposedly, these dollars are dollars from government. And I said, that's impossible for me to do assessment on the aging population without considering that.


But then we actually the silent population everywhere. Yeah. Yeah. Yeah, for sure. Okay. All right.


We talked about challenges with health care access. We talked about the whole


You I'm here to provide some examples, what other people have said, yeah, what have they said, somebody said, the fact that we don't properly prepare folks to age. So there's no aging plan. The fact that


older adults are not provided with respect and dignity.


Wow, they said it much more directly than I did.


You know, when I think I think all of those statements are true, that there is dignity and respect, that is lacking. I think there's also, you know, again, I'm going to go into a


you know, I did have some discussions with my mom, when I went through menopause. Like, you didn't tell me this was gonna happen. Right. So it's like,


we do that we prepare for most things. Yep. Right.


So we she just laughed. She's like, Well, do you think anyone told me and I'm like, I thought so. Yeah. If that's what they're mean by planning, yeah. Then I think there needs to be, oh, you know, what I think is missing. What caregiver support. I think we there's work that needs to be done.


Hospitalized as a teenager, severe bipolarism.


The pressure that care her care put on my family was very hard right this


Right. So we took this families to families class. And it was a six week class, it was one night a week. How to find their own support groups, if they need it.


One day you're gonna get, you're gonna think your mom is ignoring you, but it's really a hearing issue that you need to navigate. Right. I don't think they're preparing caregivers. I don't think they're I don't think we're doing enough to prepare family members.


The aging process of their family members. Yep. And the time and care and how to get their own support system. Yeah.


Yeah. I think that's a that's a big one.


okay, so I just have a couple more questions left for you. And this is now going to be drilling in on your specific expertise as a professional in this field. Okay.


SSA is doing a great job of getting themselves more involved with the community work and access they've done. They've, you know, it started before I left and and the new directors continued, and in fact expanded that of moving away from these large campuses and starting to look at sort of smaller, smaller satellite offices embedded in the community, the work they're doing with CalOptima. As far as SNAP and access, I think those are all things that they are doing really well. And with the recognition, that expecting the community to continue to come through your brick and mortar, your brick and mortar facilities doesn't work, and that you need to look at your access points, and you need to leverage your partnerships and your stakeholders. I think there's that recognition, and they're creating those infrastructures. And, you know, thing, I think where the agency struggles is the same struggle that I was there is the fact that the amount of resources that are needed to do this work timely and effectively, is challenged by the lack of funding and recognition of how important that work is at the statement.


Not the county. Oh, we had great support of the board. So I think the the the, at the county level, yes. But you know, you want to know what really makes a nonprofit really mad is when they took the time to submit an application. They want to know why you didn't approve it within 45 days, because they don't recognize that there's 20 other 1000 applications that you're also trying to improve. And there's just not enough bodies to get that work done. So that and I don't like hearing that.


Yeah, because it doesn't work that way. Because there's significant. So I think there's, I'm sorry, I think the workload, I don't think people recognize how high and big the volume really is. You know, I think that's a challenge. But a lot of addressing that volume, you know, it takes me it takes 10 weeks to train an eligibility technician to do eligibility.


Six of those weeks are just medical. Wow.


So it takes 10 weeks, so you're gonna hire 200 people, but it's going to be months before any of those 200 people are going to provide any work relief. And guess what, by the time I get that 200 to the line. There's 200 People that have either been promoted found a job


I wanted to help people. But this wasn't the scope. I was thinking. Yeah. Right. So you so the department, there's that challenge of this ever evolving rotating door and training and hiring and funding ongoing positions and honestly, and that there's, and that happened. The problem with that is the state has not looked at count the CalFresh methodology and how they fund counties for CalFresh work. So we're still using the methodology from over 10 years ago.


doesn't account for the current work, or the current volume. So and the state is never pays you prospectively, they always pay you retroactively. Hmm. They're always playing catch up. Yeah, we look at those things. Those add that resources, I think is going to be an ongoing challenge. And then I think, as the agency has moved into this new culture of community based work, there are some in that the majority of that agency loves it, especially the newbies. Some of the veterans probably struggling a little bit more, because they came from they grew up in that old welfare fraud environment. Right. You know, they're finally starting to leave us because they're retiring. But it's still that constant. And


that's all I'm saying. I think that's the biggest challenge for them. Yeah, yeah.


So with respect to those things that you just brought up what, what new or revised policies are needed.


I think the state needs to do a better job of


need to do a better job of working with the counties to really understand that there. But I also think the state also has a tendency, just like I said earlier, to throw money at a symptom and not look at a root cause. And I think the other advocacy work that needs to happen is the


flex there is more flexibility in the funding. The funding is very specific to one thing.


We need to create that single point of entry we all want.


That means everybody has to put in at least $1.


And with regards to all of this system of care to continuum of care issue,


No, they don't they you know, start the state. No.


I can see. But who is who's the right, let me do it. I think


I think the needs are so specific. I think the needs of this population are so specific to the community. Now lay seniors are not gonna, you know, they're gonna have different needs in Orange County, seniors in San Bernardino senior


Riverside seniors, I do think that the county plays a very extensive role in the coordination of that. But I do believe it needs to be fully funded by the state. I think the state says needs to be clear. This is what the state needs to be here. We're just going to advocate right now, the state needs to say, hey, counties, we want you to accomplish these three goals. These three, this is what I want you to do.


And each of these goals is going to get you this. Here's your money for these three goals. Take the money, take the goals, show me how you can do it, and then get the heck out of my way.


And only jump through hoops for that money in those goals.