I do believe though that mental health services are increasing and their access to mental health services will be greater that oh, that's a tough one. You know they will. Older adults will continue to And to age in place, I think that's, that's something that they're going to want to do. But I think, you know, maybe, yes, I might need to think about that for a minute. It's end of the day. I'm not as quick with my answers as I am at 9am. Yeah. Yeah, I may have to think about that when I think housing still going to be the number one issue, affordable housing that is,


Well, I'm really excited about the master plan for aging. And I think that's a step forward to doing that needs assessment within the community, and being able to meet those needs to fill in the gaps. You know, there, there is a lot of disparity with individuals, due to socio economic status, individuals who can afford caregiving, individuals who can afford Long Term Care, opposed to those who cannot. And even, you know, the have lost my train of thought, but yeah, it's like the day. No, I do see that, you know, equity, there could be a greater level. I do see, though, that even for individuals through through Medicare and Medicaid while trying to get any kind of long term care, that they're gonna look like reduce next year, they asset limit, which I think is going to be greatly beneficial for individuals, you know, to be able to receive long term care. So we're in a step to the right direction. But But first and foremost, I'm really excited about the master plan, I do feel that that is the beginning of something really incredible that will open up so many opportunities for older adults within California.


Right and thinking about older adult residents in Orange County, who was getting the least amount of attention.


Those who are isolated to we and the funny thing is, is we know they're there, but we don't know who they are. And they're homebound. There, they're maybe not aware of the services,  There could be mental health that is preventing them from receiving services, or translation. Maybe language is a barrier. So those again, we know, we know, you know who they are, we just don't know where they are. We did a survey and quite a few people came back saying we had no idea that that the city of Irvine had social workers. And we don't know that until many times it's Irvine Police Department giving us referrals that we're meeting individuals for the first time that I've lived in Irvine for 50 years and had no idea about any kind of outreach services. So I think the main, the main point there is the marketing and reaching those that that don't know who we are, and they don't know how to access service. One of the things that we do through outreach services is assist individuals through the application process, whether it's through social services, through affordable housing. So it is our application assistance program that provides translation services, as well as other you know, services navigating through some of these challenging whether it's a website or even the documents that they have to provide for receiving services. So, again, it's we we just don't know, we don't know where they are, or who they are.


I definitely think the hoarding is it's certainly in Irvine, but also through my experience with a county being overlooked is being really thrown in as a code enforcement issue and not any kind of behavioral health. And so it's being treated as such. And so I think that's, that's one big area that certainly is being overlooked. And I think it's just because how do you address something so large, you know, with there's really not funding allocated for individuals who are hoarding are on a limited income and, and can't, you know pay for somebody to assist them with the cleanup. So that's that's a big area that I would like to see addressed.


Okay. Well, this concludes our interview. Thank you so much for your time, you have been incredibly helpful to our research. And if you find that you have more to share, please contact me, our website events oc.com, or we have an anonymous voicemail that you can call anytime. 949-415-6898.


Wonderful. Thank you so much. Thanks, again, Denise.


And we'll be in touch with updates about you know, you know, next steps, of course, especially the part where we're going to outreach to the community because we want to get the input from those seniors in Irvine again, you know, I know they provide feedback for yours. Assessment, but we'll need their feedback for the county assessment as well.


Thanks again, and I look forward to meeting with you and your team.


Sounds great. Take care. Take care you too. Bye bye bye.


Okay, fantastic. No. Okay, so I'm going to show you a list that's going to be on your screen, a representative list of common issues and concerns impacting older adults. And they're just appearing in alphabetical order no ranking or anything like that. Otherwise, please take your time and read through it. You don't have to memorize, it'll be up on the screen the whole time. But, you know, in minute, I'll ask you to maybe rank your top three, most pressing need facing older adults. And so just kind of keep that in mind. And as you're reading this, and as we're talking about older adults, we mean to specify older adults who are 60 years and older. And we want you to think as broadly as possible, taking into consideration the older adults, their families or caregivers and the community. Okay, so I'm going to share my screen now. Once again, take your time and let me know when you're ready.


It looks like it's not all the way down.


that's the last, I tried to like, shrink it. So it fits on the screen. But sometimes it can be a little hard to read.


It's, that's difficult. Some of these really, really overlap.


Well, if you want to talk about it together, you can like I know, some people will say housing and homelessness is one category, we can do that.


Yeah, I mean, you know, I am a Houser. So I, I see housing as being the number one priority. But mainly, I mean, that's coming from a couple of angles for me to be honest. One is that housing is like the largest part of our of our budget, for the most part, it's what costs us the most every month, most, most rents have gone well beyond people who are living on Social Security. And, and so those folks who don't have a lot of savings, or, you know, a defined pension program or something like that, housing is becoming almost impossible for elderly people who have retired, a lot of them living with medical issues that prevent them from working. And, and their, their situation isn't going to improve. It's not like they're young adults who can get skills and hopefully, when they join the workforce there, their situation is not going to improve in that manner. And so I, I see housing as being kind of at the heart of a lot of a lot of issues. I see that, you know, especially when it comes to like long term care. I look at the Alzheimer's disease and dementia and behavioral mental health issues. And I see those as tying very tightly to the housing issue for older adults. I know that these issues are becoming more widespread among older adults in our society, the kinds of epidemic of diabetes, driving some of that, and causing a lot of dementia that we may not have seen, you know, 30, 40 years ago. So, and I know that like memory care, and those types of long term housing options where a person can be kept medically stable and safe. They're incredibly expensive. And there's not a lot of good programs to pay for all of that. And so I see all of those things being very much intertwined.


So, but if you had to pick and we're trying to rank so that we can prioritize needs for the community and isolate them, I heard you say housing would be possibly a number one for you.


I think housing is number one, because you say, you know, affordable affordability of housing, more housing options and long term care. So that's like a whole spectrum of housing. And I think that that is kind of just the, the key foundational problem for a lot of seniors. And then I see that I think that behavioral and mental health is probably second for me. The need for caregiver, memory loss, depression, we see that a lot. And I not just professionally but among a lot of people that I know, like, a lot of us have dealt with it or are dealing with it with family members as well. So I just kind of see it all around me.


difficult between economic security and emotional well being, I think that if you were to take care of some of the housing issues, that economic security might, might come along with it. So maybe emotional well being would be my third. Okay,


Sure, I am the Acting Housing Services Manager. For the City of Anaheim, I oversee our housing authority, which includes all of our rental assistance programs. I oversee several other programs on the other side of affordable housing, like monitoring, property acquisition, so I kind of see both sides, the development side and the housing side. I've been in I've worked for housing authorities for 17 years now. And we, in all of that time, we do focus a lot on seniors, and, and kind of the issues surrounding seniors both on the rental assistance side and the housing development side. So we're constantly looking at, you know, homelessness among seniors, the the amount of seniors that are, that we think are going to be falling off into homelessness in the next 10 years. So that's basically my role. I don't do client interface very much anymore, just usually when someone's angry.


But other than that, we're looking at like higher level numbers, you know, and how these things, these issues are impacting our seniors so that we can get ahead of them and be more proactive in terms of addressing housing shortages.


Not that I'm aware of it is missing. It's beyond my, my professional capacity to determine.


Yeah, it would be of Me too. Okay, so the three that you had mentioned and ranked, I'm going to ask you a series of questions. And we will go through them for each of the three that you've selected, so we'll have plenty of time to address them individually.


Like I mentioned before, if if a an older adult is not a homeowner, and without a mortgage payment and they have to either rent or continue paying a mortgage or in property taxes and things like that. But especially renters, the rental market is just getting so far beyond people living on fixed incomes. And there, I mean, granted, there are a lot of people living on fixed incomes that are pretty decent, you know, who have, who had really high paying jobs before they retire, they have a lot of, you know, investments and, and pensions, but we, the people we see are those living on Social Security as their main source of income. And social security just has not kept up with renting small apartments for I'd say, probably at least the last five to six years that we've seen, just a real, you know, market explosion, that where people who are on social security, I really don't know how they're doing it. And we're seeing more and more seniors living on couches, living, you know, sharing bedrooms and people's houses, because they cannot afford their own place. And they're not, they're not stable where they are. So that's how that's one side of it. And then the other side is also the long term care aspect. When seniors have serious health conditions, where it is very difficult for them to live on their own. And they need not just, you know, a place to live, but they need additional, like auxiliary care. And those things are incredibly expensive. And there's not a lot of programs that cover them.


Yeah. And what barriers exist to seeing improvements in this area. I think that


one of the barriers is that we tend to as government programs, we put up a lot of walls in between our programs. You can pay for this, but not this. And unfortunately, you know, humans don't live that way. We need, we need something that's going to address us as a whole person. Now, I think we've made some advancements in in that over the last couple of years in the state. I don't know where it will all lead. But we definitely need. We definitely need programs that are able to pay for housing, and able to pay for actual care, and will provide the amount of money that it's going to take to actually provide that care. I think about you know, the, you know, the question about diabetes, and also, you know, dementia and people who are living in assisted living facilities, they have to pay not only an exorbitant rate for assisted living, but they have to pay for a nurse to actually administer injections for them, which is very cost prohibitive to a lot of seniors. And yet, there's not a lot of programs that will pay for that whole that whole package for them. So I think that that's that's really the the issue with like the long term care side, too.


my answer would just be a guess, based on what I'm what I know about other types of things. So my, my answer would be that, I would assume, yes, especially because if a senior, like during their lifetime, if they owned a home, they built some wealth, maybe they were the beneficiary of generational wealth, where their parents or grandparents before them had to own homes. I'm sure their experiences are quite different from those who have not had that ability to build that kind of wealth, then they are just kind of left reliant completely on whatever the system can provide, which is not always the best. So and there are obviously groups in our society where they are less likely to own homes and build that generational wealth for a variety of reasons. So I would say that yes, I'm sure there. There is definitely a difference there. Yeah.


And so thinking about the housing problems you mentioned, what do you suggest is the best way to address this need


in In terms of Well, I think that there's probably there's probably a lot of answers to that. If you're just talking about a senior who is just happens to be, you know, 60 years old or older, they're pretty healthy, they live independently. I think just to an increase in rental assistance programs, to address the need right now, obviously, help for people in their younger years to help buy those homes and build that wealth that they can rely on when they get older is probably a more long term solution for that. But on the long term care side, I think there has to be better programs that help people live in better types of housing environments with that medical care that they need, where they're not necessarily confined to like a, like a long term skilled nursing facility, but maybe are living in a place where there is where they're a little bit more mainstreamed. I think that that that would really help.


When you say that, you know, build wealth as a younger person, maybe they, you know, can buy a house, or have a house reserved for them in some capacity. Well,


part of what I do here is oversee some programs, or we have a couple of programs through the state that allows us to develop more affordable housing, for purchase and supplement that with like Silent second, loan programs, that really helps people who are kind of the median income or lower than median income to be able to purchase a home so that they can start building that wealth. I see that, you know, expanding the role of those types of programs where the government has like incentives for developers to build more affordable units into their regular projects, where there's more money and fuse from the federal and state governments for, like loan assistance to help with the affordability of those homes.


All of that could help. Gotcha, gotcha. Okay, great. No, I think that's it. Okay. So now I want to move over to our your number two, which is behavioral mental health. And as you mentioned earlier, it was, you know, needing a caregiver and being very all encompassing. Well, I think just for the very


nature of getting older, our bodies are breaking down and sometimes are, and that includes sometimes our brains as well. I think that, from what I've seen, in my years of working in housing assistance, that there are a lot of seniors out there who are really struggling even when they are lucky enough to have a voucher and they live with their rent, primarily paid for by the government as their their physical and mental health declines. It is very difficult for them to get out and find someone who helps, who can help them if they don't already have family members who are willing to jump in and fill that role. Finding a caregiver who want who will do the job at all. Being able to afford the care like a true caregiver is very difficult because IHSS does not pay very well. Even the the programs that we tend to partner with under Cal Optima to help pay for supportive services, it doesn't pay for the kind of support that is often needed when someone is having a very serious mental health issue or is living with dementia. So I think that that is that's kind of why I see that being a real problem. We are facing it all the time now as housing providers. And even if people are able to physically come into an office or something like that, sometimes they are just not able mentally to advocate for themselves anymore. It's very difficult to have to have a caregiver dedicate the kind of time that they need to live independently. And to do that advocating for them.


think that we don't fund behavioral and mental health programs nearly like we need to, there's not, you know, just in my own personal experience with family members who have this kind of issue and who've had other physical disease issues that, you know, which they don't play well, together, when somebody is having a, you know, a mental health crisis. And then they also have a physical health issue that they need to also keep up on. There's not a lot of places where people can go to become medically stabilized to, you know, well, while other options are found for them. And we just don't have, we don't have the funding for it. We don't have enough professionals in the field anymore. I don't think we have had enough professionals in the field. But now after the pandemic, it has gotten so much worse. There's just a there's just a real crisis for everybody, not just seniors. But with seniors, you have the added issue of possibly a frailer, physical state of frailer mental state, and, and just not that ability to go out and advocate for themselves to do the work that it takes to find caregivers. And I I see that as kind of the main problem there. Yeah.


I don't know. I don't know. I don't have the I don't have the firsthand knowledge enough to speak on that. That is that is a good question. Obviously, we're more funding, more more program availability, the ability to actually go into people's homes, send caregivers into people's homes, the ability to fund full time caregivers at a decent wage where, you know, more people would be willing to go into that field. I think that probably more educational funding to expand educational programs for those treating mental health disorders would help. But also, I think that there's another barrier in that people don't have to take the services. And oftentimes they don't, because they don't necessarily have the the mental capacity anymore to see that there is definitely something wrong, and that they do need help. And that is that is a barrier that I don't know how we overcome that.


I think that, you know, as we grow older, you know, we start losing people. And the younger people in our lives, they have their own their own lives, and they don't understand the needs of the older, their older family members or friends. They get very busy and kind of forget. And also with more physical and mental frailty, you know, it's very hard for people to go out into the community and make connections. I used to work at a senior center where I saw people I saw seniors coming in every day, and they had great social connections. But I also saw a lot of them that could they volunteered with Meals on Wheels, because they knew that eventually that was going to be them and they hoped that there would be somebody there who would come in and they would tell me how they would go they drop off the meals but they would sit and talk to their their the people that they were assigned to and for an hour or two each time they got went there because most of the time that was the only social interaction that they had during the week. And, and I think that those are the barriers to the emotional well being. And I think it's very important because I'm a big believer in, like whole person body and mind connection. And with the decrease in emotional well being I do believe it opens the door for physical and mental health deterioration. Yeah,


you raised a good point in the fact that those volunteers from Meals on Wheels, spend time with them. And that's part of the emotional well being right, it's to have that social connection.


Yeah, no, I agree with you, they really do. And I think it's also really great, because a lot of meals on wheels, volunteers are seniors themselves. And so they are people that I think a lot of a lot of people you know, they don't, you know, it's just, we're just human. And so we tend to gravitate towards people who we feel we have shared experiences with. And so it's comfortable, I think, for people to have people around their own age to come in and be able to talk to them about, you know, those generational experiences that they're all familiar with, and, and everything. So it is appropriate is a program that you really don't you don't have that kind of emotional health outreach. I mean, I know they're delivering food, but they're delivering more than, than just food there. And they also don't have, you know, the other people that sometimes senior See, or the, like the medical caregivers that come in to, you know, check up on them administer shots, whatever it is that they do, they don't always have that same relationship with them, because they're maybe there to tell them things they don't want to hear or do things they don't want them to do. So the Meals on Wheels, workers really do have a very special function in bringing that emotional well being into the into the home.


Yeah, yeah. And what barriers do you see exist in seeing improvements in emotional wellbeing for older adults.


Just kind of what I was talking about earlier, I think a lot of, you know, seniors are house bound, that, in and of itself is going to be a huge barrier. Not necessarily understanding that there are places that people can go to make those connections, but also the fact that there is not a there's not a lot of places that that people can go to make those social connections. And despite the fact that I said, sometimes there's a comfort with people, you know, having people your own age to talk to you because you have shared experiences. I have known a lot of seniors, who, when, when we talked about this, this issue, and you know, I talked to them about well, you know, there's there's always day centers and and they don't want to go there a lot of a lot of seniors don't want to go to like senior day centers, they want to go places where they're going to be able to interact intergenerationally you know, they want to be around younger people so that it gives them energy and, and everything. So I think that is also kind of a barrier is that they they don't want to feel like they're just relegated to the senior sphere. They want to feel like they're, like a thriving part of the community still.


Yeah, yeah. And are there different experiences for different groups of people when it comes to emotional well being. Um,


like I said, Before, I don't, I don't have a ton of experience to be able to speak on this with with a lot of confidence. But I think that just in my everyday professional life, I have seen different cultural communities definitely take care of their seniors better than others. And especially when seniors are living in like intergenerational households, I think that there is always more of a feeling of still being integrated into the community into the family, and providing, you know, necessary contributions to the family, even, even if they can't get up and cook for the family anymore. They can still be there and kind of provide, you know, stories and wisdom to the younger generations and everything. And so I think that yes, probably there is a there is a big difference, depending on the type of cultural community that you are from and whether or not that you have more intergenerational connectivity. Yeah, yeah.


I know that the antithesis of social isolation is social integration. Oh, you know,


one of the things that we've done here in the city, and with our housing development is there is a there's there are two developments that sit right next to each other one is for formerly homeless families with children. And then the this development next door is for seniors, half of which are set aside for homeless seniors. And the and it was developed, by in large by the same developer, the two different projects. And what they try to do is they try to have intergenerational programming. So you know, they couldn't go back and forth between each other's projects, and do art and do just different kinds of programs where they are connecting with each other. And I think that probably having more focus on that intergenerational type programming in various ways, could be incredibly helpful. We're looking at doing that in a couple of other projects that are upcoming in the next few years. And we really do I mean, we know that there is the whole senior tsunami, the silver tsunami thing going on. But you know, and we know that more and more housing is needed for seniors. But we do want to make sure that there is a intergenerational component there so that seniors aren't, don't feel like they're just kind of living off on their own, they can socialize with each other, there's more programming to help socialization within the housing itself, but also intergeneration intergenerational socialization within the within the project to and I think that it's very important for that to happen at the, at the housing community level, because that way, they don't have to get into a car, they don't have to wait for a band or a bus to come pick them up. They can they can have that interaction just by walking down to a community room or, or something like that. So I think that that is that is definitely needed. And that's something that, you know, we do try to encourage our developers to reach out to different partners who specialize in that including the county in order to bring those programs right to the seniors doorsteps.


That's awesome. Yeah, exactly. Okay, well, that does it for this section of the interview. Next, we're gonna go on to just separate questions about the continuum of care for older adults, some of which you may or may not have, you know, knowledge of, if you don't, and you you know, one of just pass, we can do that, that's totally fine. But in the areas where you may have some insights, we would love to hear them. And then, you know, just and then later on, we're going to drill in a little bit deeper into housing, because that's your area of expertise. So I'll ask you some questions with that. And then after that, we will end the interview, I just want to kind of foreshadow what's ahead for you. Okay, I'm going to stop share now. I'll start with, we wanted to ask you to describe how accessible and how adequate the following care services are in Orange County for older adults. So the first one would be geriatric care.


Yeah. Yeah, health care. And you can think of it in terms of like, I don't know if you guys have had to refer people. Right.


We don't we don't refer anybody to for medical services. That's kind of beyond our, our ability. I think. Just looking at it from personal knowledge, I think that it can be very, very difficult for seniors, especially when they do have a lot of medical concerns that every everything's very kind of farflung and they can't, you know, they can't is going to receive all of the services they need in like a smaller radius. So it makes it very difficult for seniors who don't drive, who need transportation who rely on other people to get them to doctor's appointments and things like that. So while I think that there is good medical care available, I think that just kind of how spread out it is really presents a problem for a lot of people. Long term care, I don't think that there is there is enough, and especially not affordable long term care.


I think it's getting well. Substance. I don't think any of its adequate. I think that we just don't have enough mental health professionals in the field. I think that for substance abuse there, there's not enough like detox beds, and then places for them to go once they detox, and to help them kind of build back into being able to make those first steps out into living a normal life. I think it's hard to find services period, let alone affordable services if they don't have good insurance. So I think I'm pretty pessimistic on that whole system.


I am not aware. I'm sure there are but I'm not aware of them.


I think there are a lot of good organizations out there who do provide those services. I've seen them become very overwhelmed in the last few years. And you know, we've, a lot of us have received a lot of funding from various areas, especially with the Cares Act and everything, a lot of money has come flooding into the social services sector. However, we weren't necessarily prepared for IT staffing wise. And this is not the kind of this is not the kind of industry where you could just throw somebody out there and expect them to be proficient at serving somebody who's in desperate need of help. While that's what we've been doing. It's not it's not very effective. Yeah. Yeah. Okay.


Think housing is still going to be a huge problem, and probably even even worse problem than it is now with population growth. And with climate change. You know, I've I went on a tour of Santa Rosa a few years ago, that hit after the wildfires hit, and hundreds of housing units had been burned in an area that was already struggling with housing affordability and accessibility, and it wiped out hundreds of homes, both, you know, rich and poor alike were affected. And I see that happening more in the future. I think we need it's not just housing. It's like climate change, also impacting housing. I think that with the opioid epidemic that we've been dealing with, I think that our mental health challenges are just going to get worse. And because of that, I think homelessness will will get worse. I I'm not terribly I'm not terribly optimistic about what we're looking at for those things.


Yeah. And in your opinion, what do you think is is the government's role in meeting the needs of older adults.


I think that the government needs to be there more than it has than it has been. You know, I have felt like, as being part of like the sandwich generation myself, I have seen where the government has basically said, Take care of your parents take care of your children. And really, we're not going to provide you a lot of assistance on this. And it's hard to how do you save money for yourself so that your child, children don't have to worry about you. And it just seems to be an expanding problem down the generations. So I think that the government needs to provide better ways to save money, they need to provide better health care and housing options for people as they age. And that's not just including older adults, that's including younger people as they go through hard, those difficult times in their lives when their children are young, you know, better health, better childcare opportunities, so that they're not wiping out their ability to save for their older years. It just is a, these are issues that just kind of compound on each other and never really go away. So many of the older adults that we see on our program, and, and my rental assistance programs, about 30% of our 6300 households are senior your households. And a lot of those people are people that never really had much of a chance to prepare for their older years, because they were so busy throwing every dollar they made into taking care of their children, and that they had basically nothing to fall back on when they became older and couldn't work anymore. So those those issues, I think there's, there are things that the government needs to do to right now address those issues, including looking at the amount of money that they're paying for Social Security, looking at better programs to help subsidize housing for older adults, but also looking at how we are how we are helping younger people who are not making a lot of money, build some wealth, to take care of their children so that they can start saving for that. That eventuality of of becoming an older adults out of the workforce.


Can you see yourself personally struggling with housing and cost of living in


Well, I'm so if everything goes to plan. You never know. I do have a defined benefit pension. So that's always good. And I do own a home. So that's also something that's that will help me in the future. But you know, not everybody works for the government, you know, and nobody else offers defined benefit pensions, and even even those, I mean, they're teetering. So like I said, if everything goes according to plan, I should be okay.


And I hopefully won't have to put that burden on my children. But if you know, the pension system collapses or something like that, then yeah, absolutely. I can see that being a real real problem.


Yeah, yeah. No, it's it's very difficult only getting more difficult.


I'm going to speak from my own experience, and obviously I can only see one part of it, but to me, the older adults who can't advocate for themselves are the ones that aren't going to get the most attention. So I think, you know, we have on the on the ballot, we've had some some propositions in the years past that have been very much about protecting older adults and their tax liabilities going from property to property. And these are very much propositions meant to help protect adults who have already built a decent amount of wealth in their life and, and have assets to take care of themselves. Because they're terrified. There's not a lot of advocacy going on for those folks. They don't have they don't have the kind of political power that, you know, wealthier older adults have.


Yeah, yeah. Yeah, I read a statistic that said, like 2% of philanthropy, goes to older adults and their needs. So it's definitely, we need a lot more. Yeah. And then now thinking about all the issues facing older adults, I mean, we went through some of them in detail, but there were a lot of issues there.


Right now, I think it's the issue of more adults develop, I mean, as we're living a little longer, and I see that the issue of Alzheimer's and other dementia related disorders rising in our older adults, and I, myself have experienced in knowing what that looks like. And it is very, very difficult. When you're, you know, a person's family all has to work. And they can't truly take care of a person who, who might be a danger to themselves because of that. disorder. It's very difficult to pay for full time caregiver in the home, or to pay for for decent, long term care, that will keep that person safe. And I see that as becoming a real, you know, more and more of a problem in the future. Because I know, I just keep reading so many articles about how many more people are expected to get Alzheimer's and dementia related illnesses in the future. And knowing what I know about how trying to take care of someone like that. It is. It's very concerning for me, and what our what our society is going to look like in the next 10 to 20 years. Yeah, yeah.


Okay, so, gosh, we talked about a lot today, but I wanted to spend a little bit more time digging deeper into your area of expertise. So thinking about housing, and this doesn't have to be just for Anaheim. But thinking about housing.


Yeah, or maybe young people because you know, we're doing some prevention work, I'm sure right, as well.


I don't know if I would say it is working. There are some things that give me some hope that it might work better. I don't know, if I necessarily classified as working yet. Things are too new. I the thing that I'm most hopeful for is kind of that Money Follows the Person type of program with Cal Optima, where it does pay help pay for housing, housing, navigation, supportive services, all of those things. I, I see that as as possibly working more in the future. It's too new though, for me to know kind of the long term benefits, I do worry that we're not going to fund it properly, to provide the level of services that are going to be needed for many of the people that it is helping. I have some hope that the state is starting to really crack down on housing production for cities and counties and they're kind of holding our feet to the fire. However, I am always a little gun shy because that can change in an instant with a new governor or a new legislature. So I think that we have have


to be vigilant in the state about holding localities accountable for, for developing those those having those production numbers. And it's those the numbers seem


unrealistic. And sometimes I think they might be considering the fact that we have built out so much in our state already. And we have, you know, decreasing water resources and things like that. But I think that if that we could keep going in that direction, we might, we might start to see a change in our circumstances, but none of it is is a notice it's been going on long enough for me to say, Yeah, this is definitely making the impact that we want.


Think it takes too long to develop housing. And that's something that could be changed, if we change some of especially some of our federal laws. You know, anytime you touch federal dollars to develop housing, it comes with a whole host of requirements in terms of how much you have to pay those workers to work on the on the project. And it gets to the point now, where it's two to three times more expensive to develop affordable units than it is to develop a market rate unit. Which makes no sense at all, when you look at it from a higher level perspective, it should not be the case. And my thought is, is that while Yeah, people need to earn, you know, a good wage while working on on, you know, doing construction or whatever. If the market is paying a certain amount of money, then why can't we all just go with that would that payment and and get our production numbers going faster, but it takes like years for these developers to piece together the funding to be able to build something, you know, like these projects are in the pipelines for five years. And during that five years, we could have lost like hundreds of people on the street. So I think that that is that is the one of the biggest things that that is really holding us back. Are the these kind of antiquated, lopsided requirements for affordable housing versus market rate housing.


Yeah. So that you've mentioned a lot there. My next question may be redundant. Yeah, that. Yeah, I figured I figured, yeah. Okay,


that's desperately needed. Oh, and one other thing, too. There is, there are laws in place that require of affordable developments to go before like community groups for public comment and things like that. And I have to I just don't agree with that. It becomes a discriminatory issue, that very much that not in my backyard type of thing. And it's like, well, you're you only got this backyard, because you could afford it, or because your parents left it to you. But these people don't have a backyard or you know, they may be living on the street, or they may be on the verge of homelessness. And and all studies point to the fact that affordable housing improves property values, and yet we still allow community public comments to destroy our ability to build affordable housing. And it's just, it's just really, really, it's just wrong.


Yeah, it kind of sets us up for failure.


It absolutely does. You know, we had a project in our city a few years ago, that we were ready to run with and it was to serve homeless veterans. It would have been done by now. And we would have had a probably another 60 homeless veterans off the street and living in their own place, but it was destroyed by the surrounding community. They didn't they didn't want homeless people living near them. Even even though there were veterans and usually you can get past a lot of things by saying hey, these are veterans. These are people who fought for our country and a lot of people go okay, but


wow, yeah, that I heard so much so many, like such early praise for Esperanza Yeah, is that one of the projects you said you're kind of hopeful about that's kind of too early maybe, to tell


that is a, that is a good project, it has a lot of things going for it. We still need to work out some kinks and in keeping at least and things like that. So it's just one of it's just one of many types of projects and different ways of approaching things. We're always trying to kind of change it up a little bit, see what works the best. And so yeah, that is a it is a it is a great project. But, you know, we hope thank goodness, we didn't the community didn't shoot that one down. But our other one, you know, you think about the people you could have served and and now you you can't. Yeah,


yeah. Okay. So we talked about all the things, all the policy changes that need to happen, who or what entity is best suited to address this issue with housing and with all the barriers to housing.


Congress, the, our Federal Congress needs to address those issues. For the most part, there are some policy changes that can happen at the state level, to get rid of that, like the public participation requirement, and make it more of a by rights type of development, that can be addressed at the state level. The prevailing wage issue has to be addressed by Congress, though


Like, can you be a little more specific,


you know, like, I talked to some homeless organizations, and they say you should really dissect the HMIs data set, for example, right to really know how many older adults are in the system already. I mean, you don't have to have an answer. You can always email me like, hey, you know, I was using this today. And I thought of you. We could do that. For


four, we were looking to develop new projects, and we're trying to figure out whether or not we want to specify a certain type of population for that. And we're looking at, like, say homelessness. We do look at the PIT count. And in the years past, Anaheim has actually paid for its own PIT count. Yeah. So we can get more specific data, because it's not always readily available from the county.


I'm not sure. I'd have to get back to that.


Yeah. I would love to see it. Yeah. And also how it maybe is different from the county report.


Yeah, the last one. We did I do remember it being quite, quite different.


Okay. Okay. Be nice to know. You know, some other kind of structural change like that. Okay. Um,


probably no one that you haven't already thought of to be honest. Yeah, I, I, I really, I don't know. I wouldn't know.


Sorry. No, that's fine. And if you do think of anyone, because we do, not just these interviews, but following these interviews, we have a provider survey. And then we have focus groups. And so we divide the focus groups into priority populations, the populations that we feel are underserved, or maybe the most overlooked, right. And then we will go into issues and so we're always you know, kind of curating participants for those issues. So if you if you think of anyone just let us know. Okay, we'll do excuse me. All right. Well, thank you so much for your time. I know we went over like six minutes on this call, but I really appreciate your help. And, you know, if anything else comes up, please feel free to reach out. I will. Thank you. Thank you. Bye bye.


All right, great. All right. So here we go. So the primary goal today is to identify what needs you think are most important to the older adult population that you serve those who are 60 and older. Now, we want you to think as broadly as possible, taking into consideration the older adults, caregivers, families, and their community. Now, I already shared with you, you know, so you can see the list of common issues and concerns impacting older adults. Now, I'd like you to take a few minutes to read through this list. And let me know when you are ready to begin I'll follow up with some questions regarding this list. Okay.


So my name is Mark Paredes. I am the Senior Manager of our sales, sales and field engagement team at clever care health plan. It's a Medicare Advantage plan that serves the medi Medicare eligible folks, that includes the senior and each community.


Okay, now, I'm thinking about Orange County, and looking at this list of common issues that concerns impacting older adults.


I think it's pretty comprehensive. So yes, no, I don't do anything that comes out of mind. So I think it's comprehensive. Yes.


Great. Yeah. So of the needs on the list, you know, Please rank the top three that you feel are the most important.


Well, coming from my health perspective, and the work that I do, the health care access, and delivery is going to be one of the priorities that I kind of focus on. The the other piece that I think is the behavioral and mental health piece, and then the, I will probably say, I would go with respect. And I can do would you like me to go into detail with the


I'll ask you some follow up questions for each. Yes. Okay. Yeah. So I'm gonna follow up with a set of questions for each of the three that you just mentioned.


I would, I would share it. The population that I serve, is the Asian Pacific Islander community. And so a lot of the aged seniors, language and culturally sensitive materials is really important. So for example, that the health plan that we have, provides a lot of the in language materials, we provide in language, customer service and Member Services. And we were set up primarily for for that purpose, because we realize that there's a strong need for, for for that, because a lot of our age aged Asian Pacific Islander seniors struggle navigating healthcare when it's not in language.


The barriers is that there's still not enough caregivers, I mean, providers that have the language needs. So for example, if we're trying to link people up with mental health services or other programs, we may even say for example, transportation. Once we try to hand off to another organization that doesn't have the language capacity, then that senior still struggles in that. But, but yeah, I think a lot of it is the that would be that's why I think that the linguistic appropriate care and culturally sensitive stuff is really key, especially to the the vast, diverse population that Orange County serves. I think in terms of Maybe the Latino or the Spanish speaking, there might be more resources available. But when it comes to specially, say, for example, the Cambodian community Khmer, there's limited, there's limited services or language pieces to their, to their needs. And then even with the Chinese community, there's you got Mandarin, Cantonese speaking, folks. And it's, even though Mandarin is the written language, but the verbal senses a little bit different. So that's, so I think that's where I see some of the challenges and just navigating like the, the websites, when they're going to certain things, it's, it's hard for them to access that.


Um, yes. So there is a vast difference amongst the various API, Asian Pacific Islander groups, primarily because of their experiences. Some, some groups tend to be higher educated, they may have come through a program like a preferred visa program, right. And so they are educated background, while others have come in because of a refugee or fleeing some type of civil war. So these are things that kind of impact. And I think, for example, with the eye sight, the Cambodian and the Vietnamese community, in this, where you have a range in the Vietnamese community have a range of educated and and there's some that are, aren't as educated. And so they struggle a little bit more, but especially in the Cambodian community, when seniors at their seniors now but that when they fled the country, many of them were farmers or agrarian, and so they weren't as highly educated. So a lot of the communication in that to me may be more verbal, rather than written.


So when the way I look at it is, I think in in some ways, families still tend to rely on family members, for as kind of translation translators. This isn't actually an issue in terms of privacy, right, that I think we need to address. But this is the way that a lot of the Asian community kind of looks at things. I know that in the medical setting, that's not the most appropriate way. So it'd be it'd be best if there if organizations had that diverse language, but it's really hard to, it's really hard to, to have that. But I guess, the way that the way that organizations are getting around that is utilizing language light. So making sure that we have making sure that we have fundings for for groups that have language services.


Right. Okay. Now, so moving on to the second of the three issues that you'd identify. So that would be a behavior and mental health.


Oh, sure. This the realize like the behavioral and mental health, we we have been seeing in terms of just using the pandemic as the example here. A lot of isolation. And folks kind of staying away that social interaction, social interaction being important, especially when when someone retires and, and I think that this is something that, for example, I've covered care we we have a community center, and one of the reasons why we have our community center, we have games, we have activities, they have wellness activities going on at the community center, is because we want to reengage or try to engage seniors to have that social interaction. We're concerned that a lot of seniors go into this isolation, depression and, and so this is something that we're really trying To make sure that it's its address. So that's why I kind of highlighted the behavioral and mental health component. And then the other thing, too, is just, I think, in general, drug and alcohol addiction is prevalent in some of the AAPI communities. And so we need to make sure that just drug drugs and addiction is not just a, a young people problem, but it's a problem across the board to


Okay, and what barriers exist to see improvement in this area, where we find to be heavy on mental health.


In regards to mental health services, there's really a lack of, at least, from my perspective, trying to connect with mental health providers that are culturally sensitive, or linguistically linguistically capable. Just there's, there's, I think we need to try to increase the number of social workers the number of mental health providers out there, I don't think that there's enough that serving the AAPI community.


I think with each with each group, I I'd like to say yes, because each has different experiences. Some are dealing with Post Traumatic Stress Disorder coming when the really fled their their country situation. But then there's also that it's different levels. I think, for example, there's also the the people who leave their country, in their family to come to the United States, but can't seem to find a way back. And so that they too, are dealing with some depression at a different level.


I, like I shared with you I think the number of providers that meet the various languages in the community is lacking. For example, just in the Vietnamese community, I think there's only a handful of providers that's that have in language, mental health services. And so and that's a huge population and the Garden Grove, Westminster, and Fountain Valley area. Right. And so that that's where I think we need to kind of assess what resources do we have right now. And, and really try to recruit or increase the number of those providers that speak the language and also tap into and identify organizations that are already doing that type of work.


Okay, now, thanks for the questions for your third topic, which was respect.


Well, I think that this this almost ties in with with the behavioral health piece, as I shared with you, I think when seniors retire, the jobs usually tend to give people purpose, right. And when you retire and you're no longer working, you have to find other avenues that allows you to find value. So I know that there's probably newer programs out there that were kind of workforce, voluntary. I guess voluntary job placement, that if not, it allows seniors to to still be engaged in activities that gives them purpose. I know. For example, maybe at some senior centers, they may have assigned various roles to a senior to handle certain activities I think that the assigning those certain roles gives people purpose. There were programs in the past from what I remember, and I don't know if they're still around, and I don't, I think they may have cut them out where they, they provide funds to organizations to hire, or bring on individuals to who may be seniors to do services. I know at our health plan, we'd like to do something like an ambassador program, where maybe we could integrate a senior to be at our community center to greet and welcome people. Right. And I think that would add some of the dignity and feeling and being seen being heard and empower piece.


Right. Okay, you know, what barriers exist, you're seeing improvement in this area.


I think the barriers right now, it's, there's, there's no incentives, as I shared, I think there's a program in LA that allows folks to be able to utilize seniors and placed them in locations where seniors can have activities for them. I don't think we have that in LA in Orange County, or at least maybe look into putting something like that. So maybe identifying pot of money were organizations that work with seniors to give them roles and responsibilities in the community. Okay.


Did this one I'm, I'm gonna say I'm, I'm not I don't have a clear answer. I want to share that. I think, I think just a general understanding that I think everyone wants to feel that they have purpose. And so I that's where I think having that scope of activities that a senior can do, because and understand. I think also a lot of seniors, they have different life experiences. So some are coming from high level executive positions, while others were working in the service industry. So I think there's, there's, I probably will say, there's a wide range of not everyone wants to be a greeter or not, but but I think it's allowing people to have that option if they want.


I'm looking to programs as a shared there, there were programs in the past that were offered at the at the state and at the local level, maybe reinstating or bringing some funding back to, for organizations to possibly apply for and, and probably integrate that program for seniors to either participate or be part of, and I would I would push for working with nonprofit organizations, because their missions really tend to serve other other seniors in the community. So but yeah,


okay. Great. Right. Now moving on to the next set of questions.


Oh, wow. No, just if you could describe, I'll just repeat that. And I can also I read out a couple of definitions. So the question is, can you please describe how accessible and adequate the following care or services are in Orange County, and by accessible, we mean, access includes not only having insurance and be able to afford co pays premiums, but also having a primary care physician versus using urgent care or the ER, and being able to get timely appointments with various providers. So that's the question in the first one we're asking you to describe how accessible or adequate is geriatric care. And that we did. We defined that as the branch of health care that focuses on our unique needs as we age. Justice, pediatricians specialize in the health needs of children. geriatricians and fellow geriatrics health professionals specialize in the health needs of older people.


Um, I would say the access to geriatric care in Orange County is, is still low. I know that seniors when they're trying to set up appointments for doctors are still having lengthy wait times. And I think that's areas where we can improve care. I think the challenge there is, is providers, we just need certain providers, I think it varies from type of providers as well. As we get into more specialty care, it does get a little bit harder for for some folks, but more general carrier thinks a little bit better. And then in mental health services, I think there's as I shared, I think it's a little tougher. Okay,


I'll get to that part later, just a little bit. So the second one is long term care. And I could just say, you see, we defined that, as you probably know, but a long term care is a variety of services, which help meet both the medical and now medical needs of people with a chronic illness, or disability who cannot care for themselves for long periods.


So I think what when it comes to long term care, the challenge there is a cost. The, I don't think a lot of people have access to the long term care, through medical, how they are provided some in general, I think many people struggle with that. So I would probably say, still very tough for the senior community to receive long term care.


Do you have any idea as to how adequate either to geriatric or long term care,


I think when it comes to long term care, it, it really falls down to the home, the in home supportive services, right. And that usually relying on family, unfortunately, the the pay for in home supportive services is not so great. So if there is a possibility to increase in home supportive services, this, this actually is a better way to help solve some of the the costs, because it's much cheaper to take care of family member at a home with family than to have them in it in an institution, or a care facility.


Okay, and the next one asking you to assess or to describe the accessibility and inadequacy is mental slash behavior, health slash substance use treatment.


I think there's, when it comes to behavioral mental health and substance use, we need to have programs that identify in the Asian Pacific Islander community mental health, behavioral health services and drug topics aren't discussed. And in aren't really focused on. And I think we need to have more programs that are able to go and do outreach to the community to first of all, share with people that it's, it's okay, that they think about these issues. And it's nothing to be ashamed of. So I think programs that promote education, at the at the ground at the grassroots level is going to be very important. Only a handful of organizations tend to do that. So I would be supporting that. We it's not even assessing if we need more, we just need to ramp up our providers.


Yes, I mean, there's there's certain when when it comes to linking seniors up with the, the mental health services we rely on to one one, to identify what programs are available, but it also I think that's, that's that's the tool that I've been using to link people up with the service as a health plan. We have a list of providers contracted providers that we we we deal with. But those are for our members. Yeah. But when it comes to the at large to community at our community center who comes in there, we'd link them up to 211.


human social services. I believe that there's a lot of there are programs out there that really serve the social service aspect, faith based organizations, nonprofit, I think it's coordinating those services. That the one thing I will try and share, at, in looking at the resources, they're kind of concentrated in certain areas. So maybe they're more the services down in South County is limited. But then say, for example, there's a lot of services that happen in the Santa Ana region. So I think that that would be the the piece there that could really help. It's it's targeted areas, that I mean, there's targeted zones already, where there's a lot of services, but I think when you start going broader outside of the areas of like Santa Ana, and go go towards more of the outskirts, you don't have as much services. So okay. Sorry, go ahead.


No, no, you're fine. You think of anything, we can come back to this. But I'll just go ahead and ask you the next question. So what do you think will be the biggest challenges older adults will face in the next 10


We talked about the baby boomers coming in and retiring. And that huge number that just every year, turning 65, or 67, or seven years old, and there's gonna be less, more more, more individuals, but still the same amount of resources. So in order to, in order to help support these programs out there, whether they're providing services, whether they're providing education in the community, they're going to become more and more very, they're going to become more valuable. But, but it's unfortunate, I think sometimes we hear the comment, like, do more, do more with less. And so, but the reality is, is we're really stretched pretty thin already. And, and I think that's really, the that's what I kind of look at, as one of the big issues that and that, more and more, there's going to be a greater senior population that we have a bigger wave that will be coming over the next 10 years that we aren't ready for.


I think I think with the government's the government's role, should be ensuring that there are programs that exists to meet all these issues, whether it comes to homelessness, housing, that's why when I look at this list, and and you you mentioned to me, what are the big issues that tend to these are all big issues. I mean, transportation I could have put there's another big piece there and homelessness. I think government has to play a role in terms of supporting programs. EMS and, and ensuring that these organizations that do receive funding and support are actually doing the services are being asked to, to do. So.


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


I will, I will say the, the AAPI community, the Asian Pacific Islander community, I still struggle with trying to find resources. When I look at the county organization to county agencies, I think programs tend to be geared towards a more general population. I will push an advocate for the Asian Pacific Islander community cares. First of all, there's not enough. There's not enough programs and agencies out there. So that's where I would come in push for that.


Okay, an issue that's being overlooked. I think right now, homelessness is going to be one that gets to be overlooked. Because no one talks about no one talks about the older homeless community, they tend to generalize, they tend to generalize homelessness, from the better end to people have various drug, drug or mental health issues. But I haven't I haven't really seen so much or heard about, but I think that, at least in the similar centers that I've seen, I'm seeing a little bit more and more seniors dealing with homelessness out of the communities. Okay. Oh, but But can I ask I guess, I was just thinking about maybe looking at tying that with housing. If we're able to have greater affordable housing, for our aging seniors, I think that will really help address the homelessness issue. Orange County being a very expensive place to live, and cities, limiting, I guess, rent control or different things like that, or low income housing. I think that's something that we should actually look more into.


Okay, great. Now we're coming to the last part of our interview. So just a few more questions here. So thinking about, well, your topic, right, we kind of put you in the category of what we can help reimagine healthcare as we age.


Yeah. So um, so the question is thinking about this topic that, you know, you're you're discussing, which we kind of put you in, I guess I'll go back a little bit. So again, I apologize, you know, not sure how much you've learned from Katie or from others about what we're doing, right. So we're, we're doing just older adults needs assessment for the county. In all the data or the interview that we're collecting will eventually assist the county supervisors in creating their own master plan for aging, which, as you probably know, California just released its own plan. Right. So each county is doing their own. So under the California plan, their five what they call bold ideas. And one of which one of the five is it's the label health reimagined. So basically, it's healthcare. Right. So we're putting, you know, Clever Care and other, you know, hospitals or other health care provider under this, this idea, basically, this pillar.


I see. I think health health care is we're working towards a better we have a prevention preventing a lot of the some of the more chronic diseases. So I think in terms of information education about that is those topics are helping our community be a better part. I think in regard in regards to the additional things that are working with the healthcare landscape. I think we're getting, I believe we're improving on getting some of the education piece out there, through through various channels, whether it's participating at events in the community. But there's still a lot of work that needs to happen. I, for me, I don't know if I'm a little bit more, there's still a lot of things. I, I were taking small steps there, for example, for for the plant that I work for, and seeing other other health plants, too. They are also starting to incorporate language. In another, there's another help another plan that also focusing on some of the API communities. So I could kind of see where it's moving towards that direction. But I still think that there's so much more room there. I guess I struggled to answer this question, because we've, we have are taking the baby steps. But I wouldn't call it successful yet. If that makes sense. Yeah. I don't want to I don't want to discount the fact that we are moving in the right direction. But I also don't want to say like Mission accomplished, because there still needs to be a lot of work done in terms of language,


understood, you know, what a new or revised policies are needed.


I think when it comes to dealing with the various communities of color, we we still need to have some type of vehicle for for organizations to have representation for those communities. So it's more like an ongoing topic, right conversation. I think, I think it's evolves through time. And so I think that those, and then not only just having organizations, but including within this kind of framework, to have different players sit at the table, right, I would not want to have all nonprofits sitting together to discuss healthcare issues by themselves. I think it's important to have like, nonprofit organization sitting with health plans, sitting with the hospital system, sitting what the county together and really discussing it and therefore, having a more open table to come up with the solutions. Because I think what I've seen in the past has been really people talking about problems, but not having the groups. They're present. So if we're gonna, if we're going to address education, right, and access to children, for example, or we may need to have schools there. Yes. I think it's a collaborative that integrates all the key stakeholders at a table to address certain issues.


issues in terms of the, the things I've talked about, or Yeah,


yeah, we could talk about that and or, you know, maybe just healthcare in general right, because you know, this is really your area.


I think the there's the Office of Aging is a good, a good partner to have along there. When it comes to when it comes to the senior community. A Medicare plan. Cal Optima would be another key player there. because they they deal with the medical and Medicare population. I would include organization to just cover care or scam that also have a large population of seniors. But then there's also other key organizations that you might want to consider. There is one organization could be the, the Asian American Senior Citizen Service Center. They serve. They serve not only the API community, but they're based in Santa Ana serving Latino community. Caprica there. And another group that people can often overlook is the the labor groups. There's there's a there's a group, I believe it's called care. They are the retired. They're retired. Union, folks. Right. You also have a large body of folks who come from other sectors that that have certain issues. So I think those are some of the partners that I've seen and worked with that I think would really be good to have at the table.


Great. And yeah, well, I was I'm going to jump ahead to the next few questions.


is, I think in touch with that group. If you know GLORIA Alvarado, right, just dis reach out to her and find that maybe who would be the best person to connect with in that group. But that's the retired the retired group. Let me just ask somebody here.


Socially retired. Si, a ra. Let me let me look it up real quick. I'm sorry. No, no, no, I appreciate that. Because, yeah, I think they're a good group to connect with especially. I think they like they get off and we often we often overlook this group. So


yeah, let's say there's a lot of organization called care.


Ah, California Alliance for Retired Americans.


Yes. So. So So yes. There that like so for example, if you're working for the county, and then you go into, the reason is that they'll have a different set of issues, because they're probably not gonna be the ones that are going to be on your Medicare Medicaid programs, because they may have a pension programs or so but their experiences are going to be a little bit different. But then aside from just union workers, there's a wide spectrum, folks that are county workers, and then you also have the ones that are service workers that work in hotels. Right. And so they said that their retirement is a little bit different.


Okay, so they're this is an organization based in Oakland.


Yes, but they also have a, they have a chapter I believe in Orange County. Okay. So I think what you could do is if you'd like I can try to connect you with Gloria and And then so that that might be a useful thing.


Yeah, that will be great. So let's just finish the last couple of questions. And then I think once we hit that, you know, when I put out the recording, then we can go into a little bit what that order, maybe we can follow with an email. So just a really quick, really last question.


I said, So the data that I look for is data that's provided by the county in terms of just just general census data as well. Uh huh. Okay. I think, I think the the, the, when we when we're talking about data a, I also referred to like, the the CHIS data, the California data, nation. And, yeah, but but a lot of it is census, I look at information, primarily looking at the demographics of who we're trying to serve. I'd like to have I guess, more data that breaks it down by ethnicity. That's sometimes of a challenge, because we lump all the Asians together. Yeah. Because we all know that the API group is not a monolith, kind of a sum. So that's why I think it's Dana's there. But it needs to be broken down further.


Sure. You can reach out to me the telephone number that that is provided to us, you can still use it to.


Great while also this concludes our interview, thank you so much for your time, you have been incredibly helpful to our research. If you find that you have more to share, please feel free to reach out to us. You know, our contact information is available on our website, www dot jfn sosi.com and you can leave an anonymous voicemail or telephone anytime. And then of course, you can always reach out to me or reach out to Katie right. So let me stop recording. Okay Gosh


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


Please do let me know if you'd like me to enlarge it or move it around or


anything if you if you can enlarge it a little bit, please. Yeah, I


know it's, I try to fit down to one page. But I'll tell you what, I could just scroll down what you're done with.


I'll just just go ahead and take her to read through this. Yeah. And then I'll ask him questions about this list. Yeah, so when you're ready, and I'll scroll down when you're done with the very last item.


Okay, so I'm add in internationals injuries, okay.


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


So I'm with Adult Protective Services. So we are mandated to receive reports of allegation of abuse and neglect, including self neglect. And in the community, especially in law, only in Orange County, each county have their own adult protective services. So when those referrals came in, and will be assigned to our one of our senior social worker, they will respond to investigate that allegations, and then provide the seniors or depending adult with resources and linkages. One thing that I keep reminding the community is that even though we are state mandated to accept referrals, and mandated reporters are mandated to make the report if they suspect abuse or neglect, it is a voluntary services to our clients. So because we work with adults, they have the right to self determinations which means that every time we engage them, they have an opportunity to either accept or refuse our services.


Thanks for invitation. Well, I would say I think, you know, tobacco use is very specific, you know, I I did not see substance use. So I would I would, you know, expand you know, substance use when to include tobacco use. See, and then we have we I think we already have mental health. So yeah. And then we also need to consider that older adults that have intellectual disability. So I feel like there is a narrow focus on services that for individual with disability, intellectual disability, but once those individual age, there are other concerns and issues that are associated with aging. So you may have somebody that is diagnosed with, I don't know, autism, and then they're getting older and then you have the physical limitation, you have all the chronic condition that is associated with, you know, aging, and you may have dementia on top of it. And so, you know, just just make things a lot more complicated. What I see is that we have specific resources for those with intellectual disability and then we have specific aging resources. There, there shouldn't be some blended or bridge between those two because you know, same thing that would mental health. You know, we have very specific resource for mental health and then all the adults recently we do have some mental health agency that are catered specifically to adults with mental health. So that that's good.


Now of the needs on this list, including those that you just suggested, Please rank the top three that you feel are the most important.


Definitely housings all different type of supportive housing. Yes, care caregiving. Thank you.


And I will ask you a set of questions regarding each of the three that you just identified. So first one housing.


I think we all struggling with this issue. As housing get more expensive, and scare is put pressure and all level of residence. But you know, with older adults, you at the age of retirement, they live on very fixed income. And their income does not correlate with an increase in inflation. And we all know that housing increasing is surpassing the rate of inflation's. And so with that said it, the if we continue with this trajectory, we're gonna see more senior citizens, we are on fixed income or at risk of homelessness, if they don't have family support, not everybody had the fortunes to move in with families. And, you know, the older you we live, there is a higher chance of us outliving our support system. And I mean, spouses, children, you know, friends and things like that. And so that's why I think housing could be older adults is even more crucial, because of the the mere fact that you know, they're, they're on a fixed income, they they don't, they have more limit opportunity to to work to do to earn additional income, and they may have less available support system that can take them in.


This is ongoing conversation at all level, you know, at the federal or the state at the county in as we see a trend of homelessness, we also see a lot of money coming down for for different projects to tackle homelessness with people that address homelessness, the issue with these fundings, as generous as they are, they are meant for a stop gap, or transitional. But you can put all the money you you want in a stop gap. If they're not a surplus of permanent housings, then all the short term solution would not work because you have nowhere to safetly move people into. And that what we see right now, with our community partner is we try very hard, you know, to to navigate the housing environment and trying to link the client with shelter. Well, there are only a certain number of assisted living facility out there. And so yes, all of that is a barrier until we can have a more permanent solution. And I mean that in terms of more available availability in all types of housing, including assisted living.


Oh, absolutely. I mean, you know, we, we all have our challenges and our privileges. Like I said, the older adults that we work with are very vulnerable. They are the one that either lack family support, or may not make the best decision for themselves as they, you know, age and now they get into a crisis situation. They're low income or no income or Are there undocumented. And so those are the most vulnerable at risk population for homelessness and in the most need of housing. Now, if they are educated, and they have a lifelong successful career, that would lead them into a retirement fund or saving, or they own their own home and the home is paid off. Obviously, there is a very different category, we see a few of those individual, most of the time, the scenario that those cases come to us is financial abuse, because the client have money. And so they are also a different target of financial abuse by either scammer or their own families or their own acquaintances just because that they know that they have money. So it's really depends on it was, well, where the client live is depend on what kind of income that they have. So like, we have south County, we don't see as much housing insecurity in South County, a lot are concentrated in the central part in the northern part of the county, just just because of the financial stability that the people have


this city, why I have to say that based on my encounter, the cultural that for buy multi generation support. So for example, the Asian culture or some Hispanics culture to that provide multi generation support, there are multi generation household. And so even though the senior citizen may be low income, they have that support from their family. So you may have like eight people in a two bedroom apartment, but it is more stable than somebody who does not have that kind of family relationship. So in that situation, then you have the caregiver and stressed and then you have the other issue.


I know that there was a couple of layers, so I just want to


Okay. For me, you are getting 100. So not to worry. So what do you suggest is the best way to address this issue or this need


Well, this is not a popular opinion. But I think you know, the status have to build more housings. So there's bigger questions, and it's way above my head on that. But yeah, we we really need the government to really decide how they're going to invest the fundings. That's going to lead to more permanent housing, or public housing. Actually, that's the term public housing. We need a place where we can just refer people and it's rarely available. So I'm not sure is that feasible or even doable right now.


It's sadly, as we age, and this is dementia is not part of healthy aging, but it is a risk factors. In one or the adult, the dementia or Alzheimer's disease. Part of the dementia is there are more more vulnerable to abuse and neglect. They also more vulnerable to not how do I say there's a gimme, you know, of course for self for self care. So, that's, that's why I think that we need support area of educating the family educating the public on the disease progressions, and the adult itself, like, you know, more focused on prevention and because once you know we don't have the cure for Alzheimer yet. So unfortunately when the person is diagnosed with Alzheimer's disease or a different type of dementia and It just managing the progression and the support for that older adults in that family.


I feel we definitely doing better in Orange County. They're already two Alzheimer associations. And they're, they're doing a great job in terms of community outreach support group and linkages.


Not I'm not sure. I think that is it's linked to maybe not the disease itself, but it's linked to caregiving. Yeah, so it's more it being a caregiver is very challenging. But it's even more challenging to be the caregiver of somebody's who moderate or advanced on Alzheimer disease and dementia.


For example, you know, where they live, their disability status, income, education level, etc.


Well, again, you know, going back to the topic that you identify, right, which is dementia.


Um, like in increase access to, to medical, medical care, you know, look into not only medications, but also, we only I believe we only have one adult day health care that is focused on individual with dementia, so maybe expanding that service, so that the client will have reliable access to, you know, stimulating support group, engaging, you know, social engagement and also medication management, and also at the same time providing some relief or caregiver.


a caregiver, a paid caregiver is very expensive. And as as we age and start losing some of our independence, if we are fortunate enough to live longer than the cost of caregiving increases. And so again, same thing if those that have available family support, then you looking at how to support the caregiver to avoid caregiver burnout. But for those that don't have the family support, how do we you know, make caregiving more affordable. So, yeah, in general, you know, I'm already thinking about how I'm affording my caregiving. And I can tell you, with my income right now, I wouldn't be able to hire full time care. And that's just that's not very encouraging.


You know, childcare, l elder care, all caregiving is just very expensive. And it's expensive for a reason, because the people that doing the caregiving is hard work. And they need to be compensated in a living wage and benefit. And so if we talking about making the industry cheaper, that is not fair for the workers, and you're not going to get quality caregiving. But if you are making, you know, a worthwhile professions, for people to enter into caregiving and quality, caregiving is going to be very expensive. And we're already talking about our senior health and living fixed income. And if they're not low income enough to qualify for IN HOME supportive services, and they're not well off enough to afford, you know, overall care. So we have this gap of middle class, I would call them middle class seniors who work all their lives, save money and realizing that is not going to be enough. And how we're going to make caregiving quality caregiving more affordable and accessible.


Let's say I have the same answer for everything now. Because you know, obviously, different social economic, will play a factor, those with low income will qualify for some public assistance in term of caregiving, those that are more wealthy can afford their own, or they can pay into long term care insurance. And so then we have a middle populations, who's not qualified for public assistance, but not well off enough. And so you know, they are going to be struggling the most. And then you looking at the other families that are able to or willing to provide the caregiving. So then you look at, again, cultural perspective is that, for example, for the Vietnamese culture, there will be an expectation for you to take care of your parents, even though it's not a legal obligation is a cultural ethic obligation. And so we see that more. or individuals that live alone and their their spouse have died. They have no the children live in different states. Even Yes, so depending on their family dynamic, what the relationship they are with the family, what their economic security, I get they all tie together that will have impact on whether they have access to caregiving.


Think to address any of this issue will require more money. But again, it I would say expanding adult day health care, I know that the first things the state cuts in the budget is you know, adult day health care. But it's really is crucial in terms of having a supportive place for for the seniors to be socially engaged and to have access to meals and to care during the day and reduce the need of caregiving around the clock. And if they have family caregiving is reduced some of the stress and burnout and also, you know, in home supportive services is at their capacity. They have been very overwhelmed with the needs. And so maybe also a different program that is a bridge program from between in home supportive services.


Because I've heard that also from other folks. Okay. This is a case of this is the end of this set of questions. And the first one is geriatric care.


geriatric care and we define that as the branch of health care that focuses our unique needs as we age. Just as pediatricians specialize in the health needs of children. geriatricians and fellow geriatrics at geriatrics health professionals specialize in the health needs of older people.


I think it's, I mean, geriatric specialties has been around for a while. I'm not sure if all the medical groups have provide, you know, the primary care doctor most of the time or internalist. I'm sorry, I don't I don't think that this service is widely accessible yet.


Very good. You're the first person who's asking all these questions. Long Term Care is a variety of services, which helped meet both the medical and non medical needs of people with a chronic illness or disability who cannot care for themselves for long periods.


Very broad. In order for me to say its assessable, I need to know what agencies are offering long term care. I feel like there's bits and pieces that we put together. I mean, obviously, they're the aging and disability resource center, the ADRC. You know, we have the Council on Aging, the office and Aging. But, you know, and some of the medical group right now, you know, with Optima, they already have the case management in place. But honestly, a lot of those services are overlapping in the way that they are linkages surfaces. So they're like a portal to link out to different services. They're not direct service provider. Well, I mean, CalOptima offer healthcare. So I guess that isn't direct kind of ever. So


if you talk about long term long term care as in connecting to wraparound services, then yeah, that's that's the hard one. Because I'm not sure that that long term care if that's it's a definition is very broad.


We don't have enough all healthcare system in general is not enough. We have you know, we have this dilemma as a society where it's conflicting with mandatory for mandatory services to the client self to determinations. So all the services that he or need or the other services, actually not all services, most services available are voluntary services and mental health with the exception of a 5150 psychiatric hold of voluntary services. And there is a distinctions between mental health and dementia care services. So once somebody let's say they have a mental health diagnosis, and then they also have a dementia diagnosis. Well, The mental health agency would not accept that referral because of the dementia diagnosis. So again, we don't have on my knowledge, I'm very limited with an agency that have a cross over that offer both. And as we see an increase in this population, same thing that I was talking about intellectual disability, we need an agency that will cover all and right now is hard. So that's yes, that's what I need is an agency that can provide mental health to those that have dementia.


Yes, but once they know that the person have dementia, they will not take the referrals.


So social services in term of So okay, so social services, we have CalFresh, we have Medi Cal, we have like the benefits side of it. Well,


I would say like basic needs, like food, shelter, other human needs. And yeah,


I let me repeat the question. Feel free to answer how, however you feel.


Yeah, that's also very broad. So let's say I Okay, so if that's the case, then yes, it definitely a lot more accessible now, in the sense that there's a lot more agencies available. And they are trying to target the population. So I would say that for senior citizens they met, they may not know, everything that available, but I think that they have at least been touched by one program or another.


This is really your personal opinion, what you think


Well, you know, I think Housing and Economic securities kind of tie in together. So yeah. Yeah, probably economic security. If the inflation is continue, the way that we see is continue than they're not going to be able to afford the basic needs.


that is tricky. The government need to take a stand in terms of where they are, are we a socialist society or the capitalists, so it is a socialist society, then we talk about raising taxes, expanding your social safety net and building more public housing and providing, you know, more public services and expanding healthcare. But if we are not a socialist society, then it's come down to the individual responsibility. now I'm Not sure how I feel how I feel about that. Yeah. Because you know, we are we are standing in the middle, we try to provide some support, and it's not enough. But then when the person when the individual refused the services and make choices that not in their best interest, they have the right to self determination. And so where we are right now, that right to self determinations can be conflicting with their well being or, or their safety. And so I guess, as the society we have to decide which one is more, we value more self determinations. I don't have an answer for you, I'm sorry.


This is this is fine. We're thinking about all the older adults, older adult residents in Orange County, who was getting the least amount of attention.


It was the middle class. Older adult, I feel like we have the way that the safety net are designed right now that support low incomes. So if you are low income or medical, you qualify for Medi Cal, you will also qualify for CalFresh you know, for Foods support, then you qualify for IN HOME supportive services that provide caregiving. And then you know, also if they're lucky, and they're one of the lucky one that qualify for a housing voucher, then they already kind of encompass, encompass all of the special needs. And then you have the other spectrum where people are wealthy enough and you know, they pay for everything on their way in and so we have a group of people in the middle where they're not qualifying for services, public assistance, but they're not able to pay everything private even the nonprofit have a income threshold so I feel like the middle class are being left out in terms of needs or for for services


I think what it will come down to the emotional well being be prioritized prioritize basic needs, food, clothing and shelter, the physical needs. And a lot of agencies out there, whether it's government or community agencies are focused on those services. And we make great thrive in terms of healthcare and accessibility. But, you know, with the pandemic and you know, we are so focused on protecting the world We'll be the physical well being of the older adults with, you know, contacts and isolations and things like that, that sometimes we forget the emotional connection.


Okay, so we're almost there. The next set of question will focus, basically your area of expertise.


I think at the beginning, you already mentioned this, you know, is that to see you know, how to call or when to call to us. And I think that we, the volume of report that we received will indicate that there is an increase in popularity in among the community. And so, we actually received quite a number of seniors that calling for themselves calling for other. And so that's good. We tried our best to do all community outreach on just just to get the word out. Why it's a challenge, I wouldn't say not working, what is the challenge is that we cannot do it alone. And the reason why is that well Adult Protective Services when we respond to an allegation. And we addressing the allegations, is, and then we have a binding, whether it's confirm, and conclusive, unfounded, but the finding to me is the least important. Because what matter is how to get this person to a safer, more stable place. Whether it's confirm or unfounded, if the client is too vulnerable, and lack all of the resources mentioned, or have all these needs, then we're gonna still going to leave them where we found them, and we're not making their life any easier. But we as an agency cannot do all of this alone. And so what I've found in recent years, that the cases are more complex, not because of the boxes that you check in the allegation, but everything that's surrounding the vulnerable adults, like the housing insecurity, homelessness, you know, in combination with substance abuse in combinations with, you know, dementia or, or mental health, and then there's component of family dynamic. So all of those factor are something that we are not equipped to address alone as an agency. So yeah, and another challenge for us is getting the cases to prosecution. And so because we are social services, while social worker we don't do criminal investigation, for example, what we call physical abuse is an assault. In though there is also a criminal neglect, there's a penal code for that, what do we call financial abuse is either a scam or fraud or, you know, and we need our law enforcement partner to be more willing to investigate the criminal side of it. And our DEA too willing to bring the case to prosecutions.


I think we, we just need there is a penal code already in place for law enforcement, that is penal code 368. And to outline that is enhancements like you know, if they get called on an elder abuse because of neglect or physical abuse, you know, they they can put on that they can use that penal code to investigate and to bring the cases da thing, not that we need any policy in place, but more of the willingness to to take these cases seriously, I think that Elder abuse is competing with your murders, your, you know, Grand Theft, your burglary and all that serious crime. And like I said, it's it's difficult because those crime are serious, and they need law enforcement attention. But if law enforcement don't have the bandwidth, or the willingness to investigate and bring charges to elder abuse, then no matter what we do at Adult Protective Services, the perpetrator, the alleged abuser, there will be no consequences. So yeah, I think it's just a prioritizing. Looking at those cases at a different light, not that there are lesser than other crime,


or what entity is best suited to address this issue.


When we're talking about, you know, prosecution, probably going to go back to the DA, and the local law enforcement.


People track a lot of data also. You know, so


Is there anyone else you think that we should talk to you,


anybody that you can think of, you know, without, you know, giving what you have share with us and what we're doing right, in terms of doing just older adults needs assessment


so well, it's maybe already on your list, because I know that you guys have attended some of the meeting that I intended. I'm trying to think, because I Yeah.


Um, yeah. Okay. Public Authority, probably.


It's okay. I mean, it's just, it's just something that you know, as you think about these, because we're talking to so many different people, and you started seeing questions, and sometimes, oh, yeah, you should talk to this person in this agency. So we always want to ask if there's something, something that you feel like, Hey, you got to talk to this person, this expert or just, you know, whoever.


Yeah, you know, I went, I actually I would if you have not on your roster to reach out to the sheriff to the sheriff's department. You know, or, you know, another law enforcement agency. Yeah.


Well, this is, this is last question. We follow up with you if necessary.


So this concludes our interview. Thank you so much for your time, you have been incredibly helpful to our research. If you find that you have more to share, please feel free to reach out to us. Our contact information is available on our website, www dot events. osu.com. And you can leave an anonymous voicemail, or telephone line at any time and then of course, you can always reach out to me if you think of anything else, after this call that you want to add, please feel free to reach out to me


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


And please do let me know if I need to enlarge this in any way or move up or down. I'm just trying to fit it on a one on one page.