substantial erosion at the coasts that cities are not planning for, they're going to have to retreat from the coast. And so yeah, they are not planning for that. And how is it how is it working, I would say is, I would say, 100%, in the category of not working, except for the people who are making money from creating the problem, like the people who work for, you know, the companies that create the problem. So the fossil fuel companies or real estate developers, it's all working fine for them, because they're still making money from it. But let's see what other sort of climate impacts that they are not, that are not working for them like currently today. Yeah, and then I would add, just the indoor air quality and outdoor air pollution, we also have the fact that transit wise, people are still, like electric vehicles are not accessible to everyone, they're less accessible to lower income folks, driving Orange County is very car dependent and car centric, and that is not that's very harmful to seniors, because that means in most areas, they're like, when they come when the time comes, when they can't drive, then they're, if they're not in a senior community, that means they're going to be isolated, they can't leave their home.


And that leads to significant mental health issues. And so if we could have, you know, transit systems that are accessible to everyone, where folks can take the bus or bike, you know, in the Netherlands, folks are able to bike and elderly people don't experience the same isolation that they do here, in large part because biking is always safe. And they, you know, biking infrastructure is amazing in


that in the Netherlands, in particular, and other European countries as well. But in Orange County, we have transportation systems that are like exclusive streets that are engineered exclusively around cars, and all other users of the street are incidental, and very much just subject to the harms that may be inflicted by cars. And we have there, they've been designed this way to create clear zones in case a motorist makes a mistake and you know, rolls up onto a sidewalk, they've cleared all of the trees, adding to the heat impacts, they've cleared the tree so as not to threaten the cars, when the car rolls off the road, without any thought of what is gonna happen to the person who's walking on the sidewalk who can't afford a car or the insurance that goes along with it, or, you know, or maybe it can't use a car at all. Not, you know, regardless of the costs, if they're senior, for example. So this is literally built into our streets. And so what is possible and what is done in other parts of the US also in the world is that we have spaces for everyone. And our streets like we have there, there's a sidewalk for walking, and then there's a protected bike lane, very importantly, where we have physical separation from cars where people can feel safe to bike. And data shows that when that folks feel safe biking, then they are more likely to bike. And so that would that would protect people


from those impacts as well. There's so much right answers to what new or revised policies are needed. This


so there's a policy that's very much available. It's called a complete streets plan. And that is where a street is planned or redesigned with everyone in mind where lanes are narrowed, which causes cars to drive slower, which which causes makes accidents less likely makes harms less likely and then also adds value to spaces. It makes it more likely that folks will actually stay where they are instead of commuting all over the place and so So complete streets and we need policies that promote urban density and mixed use of spaces. So where we can have, you know, walkable bikable neighborhoods where you can get to everything you need to use in your life, you know, then everything you you know where you're going to shop and where you're going to play and where you're going to go. And you can get there. Using your feet or using a bike it's also healthier for people lends itself less to obesity, and other health harms. So this is the way to more accessible Orange County and then also with less


and more trees and honest in planting trees again over streets instead of clearing them in order to create these clear zones for cars so they don't crash into them. We put in we add trees, and that provides shade and it makes it incentivizes people to walk and bike and brings down the temperature of a city


Complete Streets policies are available to every city council in Orange County and to the county itself for the areas that it's in charge of. And if the county did it, the county could adopt more policies that would also benefit.


county wide and agencies like Octa, there are measures that Octa could take to support those policies, such as increasing the frequency of a bus transit and things like that.


So yeah, every jurisdiction well, every city and the county how's it, it's available to them.


thank you so much. So what sources of data we can find relevant to the work.


let's see, oh, my goodness, what sources of data I have a lot of peer reviewed research and best practices established by other cities, there's been a lot of good work that's been done. In San Diego County, there's almost every city in San Diego County has a Climate Action Plan, and is planning for these impacts. And that's in large part because of the work of climate action campaign, my organization and our team, we started in San Diego, we've been working there for much longer than we have in Orange County, but we're trying to bring that kind of change to Orange County. Yeah, so we can look around and see examples or, let's see, I'm a fan of strong towns in terms of transportation. And this is, you know, an organization that champions, complete street policies and things like that. And then in terms


its sadly, it's hard to come by, in some ways. on the energy front, well Cal CCA in terms of community choice, energy. That's the Industry Association of Community Choice energy programs, that establishes best practices, and really focuses Community Choice energy programs on on creating these kinds of benefits for the community. So they are a good resource.


and without staff to ever even notice that this funding is available, like cities don't most Orange County cities do not have sustainability departments. They don't have grant writers, and certainly not climate glant grant writers with expertise


who are looking at these kinds of issues. And so yeah, so they won't even know that they're there. If they do know that they're there. When they go to make their application. They're gonna you know, the application is going to ask them for their related plans and their climate


action plans that are not going to have any to point to.


For the most part, thank you so much for sharing.


Have you talk to I assume you're talking to like religious groups,


I think of like the Jewish Community Center in Irvine.


You should think that those be good places for you to get.


Thank you so much. Yes, please. That'd be great. Thank you so much. And yeah, this was the interview. Thank you so much for your time. And everything our was like, very helpful. So.


So thanks. Good. Oh, yeah, let me stop recording. Now.


Okay, so the primary goal today is to identify what 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. And I'd like you to take a few minutes to read through this list. And let me know when you are ready to begin and take your time. And do let me know when you show up. You'll see what I mean. It's a it's a little small, try to fit everything on one page, but let me know if I need to enlarge or square down in question.


Okay, well, right now I am a supervising deputy Public Guardian, with the public guardians office, my experience with the older adult population, you know, I was just transferred to a unit new unit, I went now what's called I'm in the supervisor for the LPS unit, which is deals more with the mentally ill, I was transferred here to this unit, probably about three months ago. Before that, I was in the probate unit for 15 years, six, probably, almost seven years as a supervisor for the probate unit. And that's when I dealt most, mostly with the older adult population. And with the public guardians office in general, I've been here for 15 years. And previously coming to Orange County Public Guardian, I was with LA County Adult Protective Services for seven years. So I have at least 21 22 years experience dealing with the older adult population. And I have seen the changes, you know, starting from when I started dealing with the older adult population till now just how everything how a lot of things have evolved. That's why one of the things that I'm looking at on this list is this digital divide, I would say more tech, technology confusion, as you know, with older adults, even after past age 40, it's hard to keep up with the ever changing technology. And then, you know, I myself, I still haven't gotten gotten used to a smartphone, I still fumble around with it. I'm asking him how to do certain things on a smartphone.


Let's get to that list yet. Well, you know, there we go with my next question.


It's pretty it's pretty good. I would say if anything, accessibility to resources. I mean, I think a lot of older adults don't know that there are so many resources out there and I think either a they're intimidated by reaching out or just don't know how, you know, for example, something that I'm, I'm pretty sure Tammy, you probably got a lot of are those robot robot robot calls or whatever those automated calls and they're saying we're calling, it could be a message in another language. So I get all these phone calls that are in Chinese, sometimes their messages saying that they're the IRS and you can be arrested if you don't call us back or stuff like that. And there are older adults who really are intimidated by those phone calls. And they will and you know, these are scam these are scams. And I think instead of, you know reaching out maybe to some resource to find out, hey, Is this legit, these people will actually fall for the call, they will call back. And we know these scammers they they fall for these scammers hook line and sinker, these scammers know how to talk, they know how to woo or intimidate the older adults and eventually will get what they want.


Okay, now of the needs on this list, and including the ones that you just suggested, please read the top three that you feel are the most important.


Yeah, cuz a lot of them are really top three.


Wow. There's a lot of ties. Yeah, I'd have to say that the digital divide. But it goes a lot deeper than just what it says the lack of access or familiarity with technology. I mean, there's, that's why I hate to really call it the digital divide. I would rather just call it the technological divide.


I mean, we can't possibly list everything. That's why you know, we are going to doubt. Okay, you know, take a little bit of deep dive into each.


Let me ask you my next question. So I'm gonna ask a set of questions based on the top three that you just identified. Okay.


Well, a lot of older adults, they are on a fixed income, you know, and especially if they were in a dual income household where they're married, and then their spouse passes away. They, the surviving spouse, especially if children aren't around, or they're estranged, it really becomes difficult for them to maintain, you know, and in this society that we live in, I hate to say this, but it's really the rich, and the poor, that have the services that they need. It's really in the middle, which is the majority of the populace, especially the older adult population, where, you know, they don't have enough to afford certain things. And then they're too low income to get certain benefits. So that's where the real struggle is, and especially with, you know, just how much inflation there has been, and it seems everywhere you go is, you're really, I mean, to use a quote, you're looking at a menu, looking at the from right to left, you look at a price of something now as opposed to what the service is. And even caregiving services, they're just, they're not affordable. So that's why there's a lot of older adults now going out into placement, they're looking for facilities to move to because they just can't afford to live on their own granted, their property might be paid off. They might be living in a decent apartment, and they can afford their rent. But that cost of caregiving services at one time, caregiving services up even up to about 10 years ago was about $15 An hour $15 An hour is a minimum wage now and caregivers make more than minimum wage so and caregiving is out of pocket is an out of pocket expense. So it's not like insurance covers that you know, and it's just it's too much to bear and then it causes a chain reaction. So you have a an older adult who was already stressed out about A living alone, B wanting to live in their own home not wanting to be placed, but now they have to worry about okay, I in order to live home alone, I have to pay for a caregiver. Then they see how much it's gonna cost and It's just, it's just not feasible. So now there's that added stress. And then it's like I said, it's a chain reaction. Now it's like, okay, now I have to consider being placed in a facility somewhere where I don't want to go, you know, this older adult was so used to living independently for so many years. And it could be an individual who is not does not work well, living in a larger community, with others coming. It's like moving into a place with a whole bunch of strangers, you know, some people just aren't meant for that. And that is, has become a reality for them, that they that they will have to move into a place where there will be strangers walking around.


Well, of course, it all comes down to the costs, the cost of everything. And, depending on the older adult, I'm just generalizing here, but the barriers to accessing and knowing knowing what's out there, like I said, there's, the individual who has been living alone, independently for so many years, now has to make other decisions, decisions that they once did not have to do or dependent on a loved one to do for them. Now they have to make these decisions. And again, it's just adding to the stress that's already upon them. So now it's like, oh, I have to call these people and, or, you know, going on to the internet, and the older adults, some of them aren't as savvy, surfing the internet, knowing know what to look for, you know how to click around. And, again, that can cause stress to like when, for example, calling a certain agency and you get, you know, 20 something year old receptionist, that's on the other line telling the older adult say, Oh, just go to our website and, and look at the services that we have, you know, and a lot of times these older adults, they're gonna be like, either a, I don't have access to the internet, or I don't know how to do that, you know, back in the days, people would take trips, they were like, let's just say if the older adult wanted to check out the checkout facility, sometimes the facility would come pick them up, drive them, or somehow there would be transportation to get on there. Now facilities, they just go to our website, you can take a virtual tour, and you can see all the amenities on in the gallery. And, you know, it's just too difficult for certain older adults who, like I said, who either a don't have access to the internet or just don't know how to navigate the Internet.


Absolutely, yes, of course, older adults that have a greater support system, whether it be family, friends, they they have more, I guess more, they have a greater ability to do the research to have a knowledge of what is out there. You know, of course, then, and, you know, as far as far as economic status, I mean, there are some that are isolated, they, they do, they're well off, that are that are isolated, because that's just what they they're used to. And again, they still have their barriers to because they can't, you know, they just don't have the knowledge and expertise that maybe again, their spouse did for them. Sure. But of course, there are some that just like the ones that are well off the low income that they are so isolated, that they don't know what's out there. I mean, again, I think phone contact is direct. Yeah, phone contact has just gotten so difficult, you know, whereas before, that was the norm now it's like, send us an email, go to the website, go to our Facebook site, or Instagram, what have you, or come in, but coming in is might not be feasible for certain individuals, whether it be they don't know how to get there, they can't afford a ride or, you know, facilities just don't have the resources to provide the transportation. You know, it's really, it's really more of this. Do it on your own, you have to find a way, you know, this services just seems so limited. And, you know, I can't pinpoint exactly why things have changed why it's whether it be due to, again, either lack of funding or because everything is so high tech now. You know,


Well, I hate to say it comes down to funding again, I think there should be more funding to the the resources that provide assistance to the older adult population, they, they need to have more of a way to be able to, you know, one thing that's really hard to set up for older adults, and there is a waiting list is what's called a friendly Visitor Program. I know in Orange County, through the Orange County Council on Aging, they have they have that, but there's such a long waiting list for that. And all it is is just someone to come out and check on on these individuals. They don't provide any type of case management services, it's really just a friendly visitor to check up on them and see what kind of needs they have. And it helps though, it helps a lot. Because number one, it prevents the isolation of these clients. And then even though this friendly, the visitor they might not be, you know, an MSW or anything like that. They know if something they can tell if something, something else is going on in that house where they sit, they can go back and say, You know what, I think there's something more, and we need to do, you know, further outreach to this individual, but of course, time and money, it all that stuff costs time and money, you know, and then when you bring that up to these older adults, especially when you say, Oh, yes, there is a cost, I think because they're just they've just been so used to saying, No, thanks. No, thank you. They kind of see it as its solicitation. You know, there's that. And that's something that's been going on, you know, that's why you always see those signs on the doors. He knows no solicit solicitors not allowed, you know. But that's the funny thing, too. They'll put signs on the doors that says no solicit no solicitation, but then they'll get a call from a scammer, and they'll fall for the scam. So yeah, I think there should just be more, more and more invested into providing. And again, it doesn't have to be case management services, but one on one, to be able to go out and check on these especially isolated, older adults.


Yes, and I just have to identify the ones again, the ones that are kind of isolated that they don't have to be on their own. That could be a couple, I mean, this it's a very common situation where you get a couple that because they're starting to do to decompensate that simple tasks, your simple activities of daily living are just becoming so difficult cooking, you know, cooking, which was once such an easy, easy thing to do, and even enjoyable, has become a very difficult task. I had one case years ago, where it was an elderly couple, and they resorted to buying frozen chicken nuggets. And the way they warmed it up was they would just drop it into a pot of boiling water. You know, and especially And that was number one, it was a dangerous situation number one, because they both had dementia. And the water would basically sometimes not turn off the stove. So continue to have the water boil until it would evaporate, and they would just have a heating pot. Granted, they took out the, the chicken nuggets from it, but that was their their normal thing. And, you know, again, the just the lack of caring for bathing, right, you at a certain point, you become sort of frail, you're scared, you're scared to get in the shower. But as we know, hygiene is very important. And then they get scared Oh, well, what if I fall then we go to call 911. You know, it really it's, it's just again, this whole chain reaction of what if it could, it could lead to something I don't want, I want to die in my own home, I don't want to go anywhere. But because of that, they start to really it's kind of it's becomes counterproductive, because then they really neglect their care. And they in a sense, start to deteriorate in their own home. Like I said, the hygiene, the cooking, and what else even like paying bills, you know, at one point, yeah, at one time paying bills was simply writing a check, maybe they can't write a check no more, maybe the, the merchant doesn't accept checks anymore has to be an online payment, it has to be through Venmo, or PayPal, or Zell. And of course, a lot of these older adults, they don't even know what that is, or even how to access that or set it up. You know, there's so many, you know, even myself, I know every time like, I hear a new app, and you got to set it up. And then you have to go through a process. Oh my gosh, you know, even setting up like a family link. So I can monitor what my kids are doing on their tablets. I'm like, Oh my gosh, it's so it's so complicated. You know, and so I can only imagine these older adults, how they're just, they're just set, they're set in a way and it's a have to make a change to you know, keep up with technology and society is just become so difficult and and it could have an effect on their personal care. I mean, you know, what it says there as being able to take care of oneself that, I mean, that's such a broad statement. But it really is, it's, it's not just, you know, combing your hair and brushing your teeth, but it could fall into that too. I mean, there's so many houses that I've been to where you they opened, the client opens the door, and it looks like they they've been wearing the same clothes for years, you know, some have still been in a hospital gown that they that they used at the hospital, you know, so it's, it is an issue because, you know, no, especially if they're isolated, they're not, you know, they're not getting any attention. You know, I mean, it's, it's really, you know, the cases that we get, we get when we get a referral, especially when we're an adult, when I was in Adult Protective Services. They're just a small percentage of what's really out there, you know, thank God, this client had a, a nosy neighbor, I'll call them a concerned neighbor. And they, you know, and they would call, they would make a referral, and we would go check on them. But again, but again, even that, it's a small percentage, there are so many out there that we're not aware of.


Well, you almost ask answer the next question, which is what barriers exist to see improvement in this area.


And here's another thing, another thing too, because of and I'm not trying to put down, you know, there's new generation, the millennials and Gen Zers or anything like that, but they seem to be less concerned about it. You know, when I when I talked about nosy neighbors, I meant that in an actually a good way, because there was a time when, you know, you know, there's a saying that a lot of people neighbors became less social when the electric garage opener was invented. Because back then you'd have to actually come out of your car and manually manually open your garage and when you see your neighbor, you say hi and engage in small talk. Now everything is just so unengaging, you know, and you people just Have a lack of concern for other people, you know, we're just so focused and getting to do what we need to do, as opposed to, how are my neighbors like, even where I live, my neighbor, I've lived where I live for about almost three years. And I said hi to my neighbors, probably about twice, never engaged entirely, because everyone just seems so focused on themselves. So, you know, and you can't really expect older adults to do that as well. Because like I said, they become so set in their ways. And they're like, I'm not gonna go out. I'm, you know, and who knows what conditions they might have. They might be paranoid, too. They don't, I forgot what the condition is. But people that are scared, really scared of getting out of the house, but that is a real condition. And a lot of older adults might have had that or have some, something similar to that where they, they don't trust, they don't trust what's out there. It's always disaster tragedy, you know, and they're just like, oh, my gosh, all this going on, I'm not going to go out there. You know, and it becomes difficult when people aren't, because number one, they're either estranged for the family, or family is far away, or there's no concern, whatever. Then you got neighbors who aren't really concerned either. It's, it's unfortunate, sometimes it's it's not until it when it's too late, you know, the neighbor will smell something funny coming from that residence, or they might call the police say, you know, what, I haven't seen my neighbor in a month, you know, and I tried knocking on the door thing, you know, and then again, by that time, it's, it's just too late. So, yeah, because like I said, that the referrals that come in to us Public Guardian, and back at Adult Protective Service, it's just a small percentage.


You and are there different experiences for different groups of older adults, different backgrounds,


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


You know, Tammy, it's, it's all the, they're all the same, like I said, in, you know, more affluent communities you can get the same problems, as you would, you know, on a low income community its just on a different level. You know, because, like I said, an isolated individual is an isolated individual, no matter what background, you come from, where you live, you know, its just, of course, those that are that have more income, I mean, there have, they have more ability, they have more, I mean, they have more flexibility as far as what they can utilize to, you know, for, for assistance with their care, but that, and that's great. But if you if the individual, him or herself, does not want to reach out, or for some reason, you know, they still believe that they don't, they can't afford it. I've had clients where they had millions, and we'll talk about caregiving servers, they're like, I can't afford it. That's too expensive. You know, so there's something going on their mindset, where they were, they feel, I mean, whether it's a bad experience, or they it's just something that they were so used to maybe it was a spouse that kept telling them, we can't afford it. We can't afford it. They just got so used to that mindset, you know, and, again, when they're when they're isolated, they become stuck in those ways. You know, you know, because I also have seen these functional households, the elderly couple, they keep, they keep up, you know, they support each other, they keep up with the times and, and they're great. But then, of course you have, you know, individuals who like I said, certain way it was always had to be this way had to be it was so strict to a certain lifestyle. It's so hard to change their mindset from that, you know, and they might become so stubborn that they don't want help. You know, they're very prideful. A lot of people are very prideful. No, I don't need any help. I don't want any help. You're just, you know, interfering with my life. Because I'll tell you to him and I have seen hoarded homes, again, in affluent communities, and low income communities. But again, a hoarded home is a hoarded home. And it became that way, because of the mindset of the people of the individual living in that household. You know, and I hear the same excuses, hey, we can get you some help to clean this out. No, no, I don't I want it. You know, it's like, if you start touching their stuff, like, start cleaning up, I mean, we know that it's in their best interest, because it's number one, it's a health hazard to be living in hoarder conditions. But they see it as I need that I might need that later on. Oh, I've, you know, it's, it messes with their ya know with their way of living, because they got so used to it. And because I have seen clients lose it, when they're stuck when their home started to be clean. They got so it gave them such anxiety, because they were so used to how it was, you know, and even if it could have just been like, a National Geographic magazine from the 80s. And they're like, because they were so used to seeing that in that one spot and to take that away, it just threw a wrench into their life. If that makes sense. Yes.


Well, I think it's I think, being able to educate, educate these individuals, but that's but that's, that is a good question. But then that's the thing they have, but then how do you reach these people who are so but you know, I say this too. I'm so busy. I, I can't really get to know my neighbors. I don't know. Well, that's great, but I just don't have the time. I'm so busy. This is just fantasy. Okay. I will say there should be you know, for each city, they should have designated, you know, community representatives, whether, and you know that and I think a great way would be to even have volunteers. So, the ombudsman, if you know, the ombudsman program, they have their volunteers, these ombudsman that go to a facility that are assigned to facilities. I think there should be community ombudsman, too. There should be some type of I mean, that's the whole purpose of doing what's called the census, you know, use you determine where people of certain age are, you know, and they identify, you can do it and out, like an analysis says, Okay, this community has, you know, 20% of this community has an older adult population, let's assign a community ombudsman to check up on them, you know, or, you know, and let them be aware that there are services available, should should you need any, you know, older people are the older adult population, I think, are less inclined to reach out for help, again, for so many different reasons. But I think it'll help if they're like I said somebody reaches out to them, and at least makes them aware that hey, there is there are services for you, in case you ever need them. Okay. Like, yeah, of course, something like that. Again, that would need some type of funding to organize. Yeah, you know, I like that community ombudsman, you know, they have facility ombudsman, I think there should be community ombudsman. So.


Moving on to the third topic that you identify, which is digital divide. So How or why are older adults struggling with this issue.


And I don't mean to sound like sound like a broken record, but a lot of these answers that I'm providing, they're probably what I've already said. But older adults, again, their mindset, where they're too proud to get assistance, or they feel like they don't want to have their life interfered with, like I said, they're, they're so used to living a certain way. And any kind of disruption of that could cause them anxiety. You know, and especially with, you know, any other existing medical medical conditions they have, adding an extra stress could be a stressor on any other existing medical condition, like I see, there's, you know, on this list, heart disease and stroke. Next thing, you know, I mean, they already have that condition. Next thing, you may have somebody coming to their house and say, Hey, hi, I'm here, we're here to I'm here to help. You know, because it's so


yeah, right. So the next question, you know, you're always ahead of me.


Yeah, and this is something that I learned in grad school, this is what's called, we call  it the wicked problem, no matter what you do, it's not going to be resolved, you know, sort of, like, for example, there's a river, you can always build a bridge over a river, you can resolve that problem, but certain problems in society are never going to be resolved. Crime, politics, the differences of, you know, all the religions coming together and in harmony, you're not going to fix it, you can try. And that's one thing with servicing the older adult population, it's never going to be 100% resolved. So all we can do is really try there's, there's got to be I say this again again. But there has to be more funding to put in place into what can be done, how can we effectively reach the older adult population, because you know what, time's gonna continue technology there's going to be so there's going to be more, that's gonna make the aging population become more and more confused, and more and more separated from the outside world with what's going on, you know, the only again, the only connection isn't be what they see on TV. At one point. years ago, that was the norm, you know, and, and you were cool. If you also had a cable box to attach to it. Remember, at one time, it was just a TV, and you press the buttons, channels, two through 13 and 28. Then eventually came the cable box, then eventually came flat screen TVs and then even to the point where they said, after one point, there's not going to be antennas are going to be completely useless. Everything's going to go digital. So the old these older adults, you know, everything's just changing and it's, it makes life so confusing. And again, the chain reaction, it's going to cause stress, it's going to cause these this population to just start to deteriorate because they don't know what to do. They're, again, either they're, they have too much pride. They don't want any interference in their life, or whatever. I'm sorry, barriers.


Yeah, so there's got to be a way to You know, whether it be through the local senior centers, city programs, or what have you to find a way to give the older adult population comfort, comfort, and trust that, you know that they are not just going to be tossed aside, there's always someone that can help. I know, I know, a lot of senior centers, they do have classes they do have classes on, this is how you surf the internet. This is how you how you send an email. That, you know, that are like that, that have that mentality of I don't want it and I don't need it, you know, but in reality is it, you have to just keep up with the times ever changing times. And that's the only way you really be able to fulfill that, you know, fulfill that potential of what you what you can get, you know, like, like, it's like a veteran who was not reaching out to veterans services, you know, they're there. But maybe the veteran is just doesn't know, how does a want to who knows, but that veterans not getting all that they can not maximizing the potential of what they can get to benefit themselves. You know, same thing with these overalls they, they're just, for some reason, whether it be, again, whatever mental state they're in, they aren't maximizing their potential for living a higher quality of life.


Yeah, are they again, are there different experiences for different groups of older adults from different backgrounds, right, like, where they live that disability status. And


I think that's the only difference is just the status because like I said, I've seen both ends of the spectrum, experiencing the same issues. You know, I'm gonna say this, again, an isolated individual is an isolated individual, no matter what social status you're in.


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


I'm gonna say it again, community ombudsman, I love I want to patent that or something. But yeah, just the getting, just getting it out there that there are resources available. You know, because, again, both ends of both ends of the spectrums, you know, low low income area, where you have if you have people involved in your life, you know, the, the friendly neighbors, social system there, you're good. Same thing with the on, on the affluent one, you know, if you have a good support system, whether it be your neighbors, and friends, the community, then you're good, because you have people looking at after you. So that's why I say I mean, and again, they go through the same problems, too. They both get the same calls from the IRS, and the same scam calls. You know, it's just that the ones in the affluent community, there's a higher, higher chance of losing more because they have more, but again, even the low income they're targeted to. Yeah, I mean, scammers are indiscriminate.


Hey, okay, so that that's okay, so we're done with that those set of questions. Now moving on to the next one. I'm going to read out four subjects and you can we can go back to you you know, each one individually or you can just answer them in the aggregate.


Okay, let's start with the first one. The first one was


geriatric care. I think access the accessibility has greatly improved. The I mean, they Geriatric Care is out there. I mean, there's a there are a lot of there are a lot of organizations throughout the county throughout different you know, Different cities, they have different programs. You know, there's always that resource of calling 211 211 from a phone, you know, to find out what resources are available, because, yeah, geriatric care. I mean, I, when you talk about that to elderly, older adult population, that they start to have misconceptions of it, though. And like, No, not necessarily. But it probably be best for you, because you'll actually go somewhere where they specialize in providing, you know, day to day care for the older adult population. But I mean, geriatric care is that's that's such a broad term too. But I really don't see an issue in accessing it. And that might be the same answer to all four. So if I repeat myself,


if you could describe how accessible and adequate Long Term Care is in Orange County,


Long Term Care, I'd say is probably a little more difficult, because you know, there are a lot of them are full. A lot of facilities are they have a waitlist, and especially long term facilities that


are, you know, either funded by med by medical, or they are they accept Social Security. When you have, when you have the funds, if you have the funds, it's a lot easier. I mean, you can go to


a Silverado, Silverado care, that's $10,000 a month. And if you can afford that, they're always they usually have openings, because not many can afford that type of care. So I'll say what that is an area that is pretty difficult to access, because, like I said, not I mean, the majority of the adult older adult population are on a fixed income, and that they need that long term care. Like I said, there's that middle section, the middle class, where it's like, okay, I'm not rich enough to afford a nice facility. And I don't, I'm not low income enough that I can just be on long term care, medical and be placed in a, in a facility. You know, and, and besides, there's, it's not often that you get an older adult who says, Yes, I want to be placed in a long term care nursing home, you know, if anything, there might be willing to go to a lower level of care assisted living, or a residential care residential care facility for the elderly, or some type of boarding care, where they can still have some independence, but those are privately funded, you have to pay out your own pocket. And, you know, to get a lower rate, you'd have to get a shared bedroom, a lot of older adults don't want to share a bedroom, they don't want a roommate, you know, and then, and even with that, they're still pretty pricey. Again, these private pay facilities, it's hard, it's hard, almost impossible to find any facilities that will just that except Social Security, Social Security can be I mean, or SSI, could be anywhere between, you know, 1100 to, let's say, $1,900 a month, and which is kind of common for the overall population for their as far as their income. And that's, it's practically impossible to find a long term private pay facility to set that much. You'd have to start going, especially going out of Orange County to do that. That's one of our difficulties, because that's a lot of our, our target population that's about their average income. Now, we have to start looking facilities that are, you know, in questionable neighborhoods, in, you know, in Los Angeles area, North LA or even in the valley, we have some facilities in Sylmar and that's pretty far. I mean, considering that we have, you know, our client lives is an Orange County resident. Now we gotta go outside of Orange County to find a facility that they can afford, you know, San Bernardino, Riverside, it's not uncommon to have to, you know, place an Orange County resident out of county.


What about mental or behavioral health, substance substance use treatment, how adequate or accessible, accessible, those services are


definitely accessible. The only thing is with that tart with that target population, a lot of them, they don't know that they have a mental illness, or they refuse to believe that they have a mental illness, sometimes, and especially for our department for the Public Guardian, if they come to us, because they, you know, something happened, they were placed on an involuntary psychiatric hold, you know, and then eventually comes to us, because during that hold, they were not able to recover, or the facility felt that they were not safe to go to return home or go back to wherever they came from. And in a lot of the interviews that we do, that's how that's even those, those individuals that are on an involuntary hold, they say, nothing's wrong with me, you know, and again, these are the ones that have come to us, which is, again, the small, just a small percentage of what's really out there, you know, when you, especially when you walk around certain areas, you'll you'll see, people, you know, whether they be transient or not, it doesn't matter, because, you know, there are affluent affluent individuals, older adults who have a mental illness. And, you know, you'll see them talking to this to themselves doing bizarre things. And unless someone comes to them to do an assessment, or they reach out for help, they're just going to go continue on their merry way with no any no assistance, no type of treatment, but it's out there, there's, I think that's one area that has improved that access for mental health services. And I think it's because of some things that have happened, you know, within the past seven to 10 years of, you know, especially law enforcement not being quite educated of how to deal with the mentally ill. And sometimes, unfortunately, that those have resulted in tragedy, you know, not knowing that, you know, thinking that a mentally ill person was dangerous. Well, they weren't dangerous, they were just going through a manic episode. You know, so there's, you know, the services have improved, definitely, access is there. But once again, it falls to, if no one is reaching, yeah, reaching out to that type that population, then it comes down to that population reaching out for assistance. And again, a lot of times they don't, they don't, they don't do it, either. Because they don't feel they have a problem. They don't want anyone interfering with their lives, or what have you. So, yes, but it is there. And like I said, it's if the services aren't accessed, it could result in you know, something a little more extreme. Again, that's how we get our cases here.


Oh, absolutely. I mean, we have, there's the Orange County Mental Health, I mean, that's part of our agency, the health care agency, there are so many. But again, if you want to, if you want to actually say you'd have to go online, to go to a healthcare you see website and see what resources out there. Otherwise, I mean, I don't know how it works as far as just walking in to any type of facility, but again, that target population, there, maybe a small percentage of them, but most of them will not go out and say, Hey, I need some help. What can you you know, what can you do for me, you know, and especially if they are all on their own, you know, it's, it's easier, yes. When we have our younger clients who are still living with their parents, and the parents are aware of the mental illness, and they noticed that the, it's getting worse, so the parents will reach out, you know, they'll go, they can research what, you know, resources are available, but again, those individuals, the, the transients, the ones that are independent, are isolated, you know, that's those are the difficult ones, because will they reach out, you know, and it's, and it is a more difficult moment, the, the mentally ill population, it's, they do go out, you know, as opposed to, you know, the older adults who kind of isolate themselves at home, the mentally ill, I think they they go out more so it's I think it's good and it's bad. It's good in the sense that they are getting out there being exposed are they are able to, you know, walk into a facility if they have to. But it's bad too, because if they have a, you know, a manic episode out there on the street somewhere it could, you know, it could be dangerous to themselves or, or, you know, dangerous to others. And, again, if you get a first responder who doesn't really understand mental illness, then you know, they could it could get ugly.


Right. Okay. And lastly, human social services.


Oh, sorry, I'm sorry. And you know, that that one's gonna be the same answer for this last one about mental health services there. Again, social service, there are so many out there. Again, it's a matter of just reaching out. The problem I see, though, with social services is that depending on what is needed, again, if you need, like, if it comes down to personal personal care management, or personal personal care and management, there might be a cost to it. People get scared of cost, because everything is just so expensive these days. And then now to add a service of personal care management, its people will just shy away from it. But yeah, services are there. I mean, at least I know how to Google, you know, everything. If I typed up, you know, social services, a lot of stuff would come up, and I can I can navigate from there. You know, people have different abilities as far as doing that. But I think they are out there. Very accessible again, I'm starting to see more billboards or advertisements about calling 211, to see what services are available. But again, well people do that. Yeah.


Oh, the ever changing technology. To go back to that one it's like, and I think the changes could result in increased paranoia. But here's the thing with the, with the, with the baby boomers, it's going to be rough, if they live long enough to see just technology continue to improve it, and they're, they're just going to fall behind continue to fall behind. And then I'm going to, I'm sorry, I'm gonna say this, Tammy, I think they're, it's kind of to a point where they're just gonna wait around, wait around to just die, you know, because they just can't keep up. And again, I'm not generation bashing or anything. But you know, these younger generations, they're not too concerned about the elderly population, the older adults, you know, they're more focused on Yeah, they want to improve social media, they want to, they're, they're completely on board with all the new technology, and everything. But the older adults no, because they remember what remember what they grew up to, you know, what, it's what they were used to, it's what's familiar, and what's its what's comfortable. And then now it's taken away, it's become obsolete, you know, and and I think it, it causes them to fall into a depression, it causes anxiety. And again, then it just results in them and results in they're just deteriorating. And then without any community,  ombudsman type to come out and check on them and say, Hey, don't worry, we're, we're here. You know, we understand that it's difficult to keep up, but don't let that cause you to, you know, neglect your care. You know, you have people that are here to help you there are resources, you know, so that would be ideal, but again, to get that type of service comes down to funding for that. You know, I mean, even even with the public gardens office, we have one social worker we used to have four social workers now we only have one and I mean she herself is is an older adult so she can have she has a good she can relate to these older adults and we would love to have a whole but her name is Lynn we would love to have a whole bunch of Lynns to service our Clients, you know, but unfortunately, reality is we can, we can only have one. And again, she's only providing the service to our conserved clients, our Public Guardian clients. Because I mean, we love her, I would say, Lynn, you need to go out there and just, continue to make contact with these older adults. I mean, that would be ideal. I mean, we can have a lot of Lynns to be able to go out there and be able to relate to the adult older adult population. And at the same time, you know, give them comfort, because she is so comforting. And she's so you know, she helps our clients with their anxiety, you know, a lot of clients, they, they're experiencing anxiety, and she she soothes them, you know, and I think, you know, to be to use to use that term bluntly, yeah, we just need some type of service to sooth that older adult population who are having a such a difficult time keeping up with the times


Yeah, well, I mean, we're trying, I mean, we, you know, every county, okay, this is recording still, okay. And


Okay, then I'm gonna say this, every county, they all want to say we're doing this, we're doing that we're, we're providing all these services, you know, but sure, they're there. But that's all, that's all that's happening is, it's just there. So think of it as you have a you're, you're at a wedding, and there's a buffet table, okay, the food is all there, you can have different variety of food. But unless, you know, and then of course, there are some, you know, in the crowd there are, you know, well, and able bodied people to go up and get it and I don't know if you've ever been to a wedding where they, they have to call by table numbers, or else, you know, it becomes this rush. And of course, the ABLE well, and able bodied people are able to get there first and serve themselves. So, then you have the elderly who are slow, they might be in a walker wheelchair, they need help, they need help to get to the buffet table, you know, and unless somebody comes to get them, they're stuck, or it's unless somebody gets their food for them, you know, but again, if they're just all the services, all the food's there, okay, not all the services are there. But unless somebody brings that service to them or helps that that older person to the services, then it's pointless. If that makes sense, I don't know if my if my analogy just threw things off. But yeah, every every county, I mean, they all no matter where you go, no matter where you go, they're always say, Yes, we have the services available. We care. And and I'm not knocking, that's great. Orange County, I think Orange County does have resources available. You know, and that's again, that's where it comes to, like every community should have a community ombudsman. Yeah. Yeah, so we should make something of that, instead of just getting instead of just getting statistics. Okay, we got the stats, let's do something about it now.


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


I think those that I just talked about the ones that people aren't aware of, you know, we get, we get a lot of referrals from adult protective services, and Adult Protective Services found out about these individuals because people were there were concerned individuals, or they got a referral from a hospital. I mean, That's the only that's that's the only way that we found out about these individuals because there were concerned people. And I'm sorry, Tammy, I sound like a broken record. But that's how we do. We were sent out something in the mail to fill it out.


You know, again, if my experience is in my community, that everyone is like, my neighbors where, we're kind of just all to ourselves, and don't even bother to check up on each other or anything that might be throughout the entire community, you know, and there might be that one isolated, older adult who's just in there, and nobody really cares, or knows what condition they're living in, you know, so, yeah, to have really like a, like, a community ambassador or something like that, where they really know they like, you know, they like how police officers, they have their own, they patrol their their own reporting district. So they know, they know, the area, they know, the problem spots, you know, maybe we can have something like that where, you know. Yeah, but of course, that requires funding to have that, you know, because you an individual can only be assigned to so many communities to know, you know, I mean, you can have, yeah, you you fund for one person throughout the whole city. But they're not going to really, they're not going to be able to really be detailed with a certain area. You know, it's just too much for one person. Yeah. So maybe like little blocks of communities throughout the city. Yeah, but yeah, that would be there would be no need for that.


Well, once again, I just want to check I know initially, I sent an invitation for about for an hour or 30 minutes. I have a few more questions to go.


So as long as we finish 1035 Yeah, we should be okay. All right.


Let's try to do that. Let's try to get this done then. Okay. Again, just a few more questions. So thinking about what your topic which is protection from abuse, neglect, and exploitation what are some ways It is working or not working for older adults in in Orange County, this topic protection from abuse, neglect and exploitation.


yeah, ways that are working. Okay. So, look at programs like US Public Guardian, Adult Protective Services, I mean, that, I think has improved over time. And I think because the, you know, abusers, whether it be scammers, or, you know, family members who are taking advantage of the elderly, because they're starting to become more sophisticated. So I think we're just trying, we're trying to keep up with that as well, so that we can properly serve our target population. So in that sense, I think we're improving, there are a lot of programs. I mean, we're between you know, government agencies, and nonprofit and just any type of community community agencies, I think we're doing a really good job, Collab. Networking and collaborating. So, I'm part of the, it's called the well our, a lot of staff in our office are part of what's called the fast which is the financial abuse specialist team. And we meet every month, and it's, it's organized through the Council on Aging. And it's a opportunity to discuss difficult cases, we have guest speakers. And when we have this, these guest speakers, then it's sometimes like, oh, wow, I didn't know that this program existed. And now we have another available resource. So we have just this network of like minded professionals, and we will reach out to each other to say, Hey, I had this difficult situation, and some of these members of the fast, you know, they could be like, they could be realtors, you know, because a lot of times we deal with real property issues. So we'll reach out and say, Hey, I have this older adult who is going through this issue with their property, they might have signed a quitclaim deed, whatever, and we help each other. So I think that has improved greatly just the collaboration of different agencies to, you know, combat, the, whatever type of abuse is going on out there. Yeah, and I think as we we, you know, we gain knowledge from the meetings that we have. So when we go out and do our work our cases, we we can share it with our, with our clients, too. And we know, like, you know, if the client did go through something, they went through some type of, they're going through some type of a scam or whatever. We're knowledgeable about it. Yeah.


So again, if this is related to your area of expertise, so what new or revised policies are needed.


Policies. I mean, that can come in different ways. I mean, you're talking about as far as like, from a, like a, like a human resources perspective for our staff, or just, you want me to answer however, I feel fit.


gotcha. Okay. Well, I think that everyone that deals with our target population, really should have a good knowledge of how of, you know, knowing the types of abuses that are going on out there. And also how to access services to deal with those types of issues. I mean, that's ideally, you know, that's ideally who we want on board with us people that know how to that have had experience dealing with that and know how to, you know, direct our clients to the appropriate resource as the Office our Office as a whole


how to access more funding. For, again, more social workers. You know, we like I said, we only have one social worker for all of our clients, you know, and you can only do so much with limited time and resources. Our social worker also she's considered extra help, because she's a retired nurse. And she's only here part time. And with her position, we only fund it for one fiscal year at a time. You know, then we get into a quandary, do we give that position give up her position, to save that to be able to hire another deputy. You know, cuz that's, that's a tough one, you know, if you can only fund for one of those positions, whether it be a full time deputy, or a part time social worker, that's like, that's, that's a that's a difficult challenge. So if anything, I think just the prop, you know, this is this is way above my paygrade here, but proper budgeting for, you know, to be able to have sufficient staff to do the deputy work. And also the social the social work aspect to it too. Because it is kind of sad how, you know, the deputy, we do the work, we investigate, and then we petition for conservatorship were granted conservator. And then that's it. We're like, Okay, that's it, there's no more connection to the client anymore. I mean, it's, it's really hard. I mean, ideally, we visit the client every six months, maybe a year. But our social worker, she's, she's really the face of the public guardian, because she's the one that will go out regularly, regularly. And as needed, she'll go to the facilities visit the clients in, in the nursing homes, the morning cares, and they've become familiar with her. Sure. You know, they know that she's the go to person for that, you know, and it, it's difficult to, you know, she's only here part time, you know,


I mean, I guess I would have, I would have to talk to Jenny saw, it would be really our department, going to health care agency, which is our parent agency and saying, Hey, this is what we need. Because if we're going to properly serve our clients, and not just see them as a conserved individual and tossed into a facility, and we want to really be involved and connected to them. And yeah, we're gonna have to ask for a little more funding. So yeah, that would be Jenny's job.


Yeah, so I mean, we, all the referrals that come in to us, I mean, we do. That's our data, to see how many cases come in how many cases we petition on and are appointed as conservator. That's always the big one. Because, you know, the deputies can only handle so much of a caseload. We are at an extremely high caseload right now. And as far as staffing we're a little low on staff as well, because we had to factor in, you know, turnover to people retire, people will, you know, just move on in life. And it's the most difficult thing, when you you can't prepare for that. I mean, you can only prepare so much. But, you know, we're forces beyond our control, when the Human Resources says, well, we can't really do recruitment until the persons actually gone when they are physically gone. And then going, going through the recruitment process itself takes, you know, four to seven months. You know, that's four to seven months of like, Rush services. Now now, we're because, you know, deputies have to take on the extra caseload from the Department Deputy. And, you know, the only way to be able to properly manage because, you know, we are on time constraints is what we do have to report to the court. So because of that our attention for clients is not there, you know, I mean, we're just rush, rush rush, it becomes more of it's like our clients are on a conveyor belt and we're just like okay, done done done done, as opposed to let me give you more attention. Let's really talk about your plan. Let's see how what we're going to do for the conservatorship, you know, this is going to You know, and that's, and that's why, again, why the social worker is so important as well, because she helps they help us with that, to do the stuff that we normally won't have time to do, because we have to write reports, we have to submit petitions, we have to do declarations, we also have to pay their bills, all the invoices that come in, we have to apply for the help apply for their benefits. There's so many aspects of the conservative we basically become, you know, I mean, yeah, we're like, it's like taking care of a child, we're, we're a guardian, again, except just for an adult, you know. So, you know, all those administrative matters, it takes away from the whole social aspect, and that personal connection, and to have one social worker do it for all of our clients. Again, it's just really difficult, you know, and, you know, it's sad that, you know, sometimes the facilities, because the court, they also have their own court investigators to check up on how the conservator is doing. And I'll read the reports and say. We haven't seen the Public Guardian in like seven months. And it's like, it's not like we're doing it on purpose is that we don't have time, you know, so


Well, is there anyone else you think that we should talk to


the board, whoever can help us, whoever can help us with funding for, you know, just, even again, our certain social worker, again, she's, she's a part time, you know, even if we were to have one full time social worker, which yeah, like I said, when I, when I first came into the Public Guardian, we had four, four full time social workers. And those were, and even they were busy as it was, then they all got taken away, and the deputies had to do the social work. And that was probably one of the most difficult times, then we got, ended up getting one full time social worker. And that was a big improvement. But she moved on. And then again, we had no social worker again. And until we had now Lynn, come on our our extra help social worker, so yes, it's an improvement. But there just needs a lot more or else we're we are just as the department, not the deputies as a department We're just going to be so disconnected with our clients and the facilities that they're at.


Great. Now 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've done what you share, please feel free to reach out to us. Our contact information is available on our website, www dot advanced oct.com. And you can leave an anonymous voicemail on our telephone line at any time. And then of course, I always tell people you can always reach out to me if you think of anything else you'd like to add.


Okay, perfect. And likewise, if you have any follow up, you can shoot me an email Call me whatever.


Oh, wow. Thank you very much. You just stopped doing


I think Katie went over most of my questions. Okay.


Great, then I will just get started the primary.


So the finding of the needs of the community will, we'll be gathered together in aggregate at the very end of our research project. That will end approximately in February, and I believe you will be able to have access to that.


Okay. Okay, let me I just made a note of that, so I can remember it afterwards. Okay. Okay. Okay.


Feel free to interrupt me at any time. So the primary goal today is to identify what needs you think are most important to the older adult population that you serve, that is identified as 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 communities. So I'm going to share my screen so you can see a list of common issues impacting older adults. Please take a


minute mentioned caregivers, mentioned caregivers family as well as the adult any other areas


and their communities. Communities, okay. Yeah, okay, go ahead. Okay, thank you. So I will share this list


Great. So please take a few minutes to read through the list and let me know when you are ready to begin.


I will have a few questions on it. But I just wanted to give you time to read through it beforehand.


Okay. Thank you. So, first question is for our records. Can you please tell us your role and how you interact or engage with older adults.


I produce the programs at the Jewish Community Center for seniors. And so we have about 1500 seniors who are members of the community as well as public people who come to the JCC for programs and I provide programming for them to address some of the issues in here and for recreation and immunity, contact and lifelong learning and clubs and groups.


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


Um Gee, I I don't know, I'd have to give that a lot of thought


you covered a lot of areas. So I'd have to give that more thought I can't really answer that. Now that I mean, this is a pretty extensive list


I would say something I can think of is legal assistance with estates wills. Any kind of legal assistance that somebody would need. Lawyers are very expensive. I don't believe that was on there with it. I don't think it was. No, thank you. So that that would be important. Legal Aid, it's very hard to get something like that. And and it's all kinds of situations that have come across people being put in living situations that they don't agree to, and their children decide that for them. medical situations that were not done properly. And at what point is someone not appropriate to drive anymore, that's a very big issue that needs to be explored. I know, I think if you're over 70, they give you another driving test. And then if you cannot drive, I do see, there's transportation. There's limitations on the transportation available and very difficult to get. As far as our JCC, we've had many problems because we're off the route of the Orange County Transportation. And so the buses won't even come here. So for years, we've tried to work with them on this and we have not been successful. So we we have a great deal of difficulty with transportation. And also in addition to transportation, perhaps providing some kind of funding for buses that a senior center could use themselves to pick up people in the area who need transportation. So that's another aspect of people losing their license, not being on the route of the transportation line route, and then providing funding for that. So


yeah, sure. So of needs on the list, including the ones that you just suggested, Please rank the top three that you feel are most important.


Okay. There was one more, I think it's on there, though, housing affordable housing. The I've noticed that the housing, the affordable housing is very limited. And it's very difficult to get into there's long waiting lists. And even though the Irvine company says you can apply for affordable housing, if you can't afford to live in their very expensive apartments, it's most of those apartments say, oh, there's no spots left or we don't do that anymore. And their discounts are minuscule. So I actually think affordable housing is something that should be looked at increasing affordable housing.


Oh, caregiving is is is very important. Caregiver is very expensive if you have somebody coming in, I don't know how many people can afford that kind of fees every day for caregiving, but that seems to be a big financial problem and burden for people who want to remain in their homes. And in addition to that, were the people who are caregivers. While you probably know caregiver support, let me see, I would say transportation is a top one, caregiving. I'm going through the list now.


Disability is big. living with a disability vision and hearing loss, cognitive decline, that's a big problem. Reading through this along with health care, that kind of fits with transportation, people need transportation to to get their health care. I say housing, I'm taking notes myself. I'm almost at the bottom of the list. Um, you know, I think I think that's it. And then along with unintentional injuries, I had a situation where the husband all of a sudden got very ill, he had some brain disorder that just emerged, and then his wife was taking care of him. And then she fell and had to be hospitalized for a hip replacement. And it was nobody take care of him. And that goes back to the whole caregiver thing. Having access, especially in an emergency to caregivers, who are not exorbitantly expensive, and they the caregivers don't get paid a lot. But when you're talking about 12 hours a day, or 24 hours a day, it mounts up and it becomes very costly. So I think that, so I've kind of given you the top things that I've noticed.


Thank you. And correct me if I'm wrong, I noted the top three as caregiving, transportation and disability. I know you also mentioned housing.


Yes. Well, caregiving and disability kind of go together. Okay, I would put that together as people come disabled, then they need a caregiver, so So I would say transportation, housing, and disability, caregiving, and number four would be legal assistance, possibly, that you only want three. Okay, thank you. Okay, got it.


So the next set of questions, we will be going through each of these three needs that you have identified. I know you've discussed a little bit about it already, but I will just go through the questions.


Well, the people who have paid off their homes will want to stay in place and that's, that's okay. But the people who have not, don't have that situation, struggled to find apartments that they can afford on a low, you know, a retired income, or especially if it's a low income, I mean, people can't even live on Social Security. And and then if they need help, they have to go to a senior living facility. And those are exorbitantly expensive. You know, I've done some research on this. And, you know, they're 1000s 5000 a month for the worst places, and the nicest places go from 10 to 15,000 a month. So it's unaffordable, to go to these places and have the care you need. So there's nothing that's less expensive that I'm aware of, maybe there is and I'm just not aware of it. For people who either just need independent living or or need assisted living So I think that the housing is a dilemma unless people have a lot of money, but most people don't. So


I think it's a lack of funding and focus on developing these kinds of living situations. The real estate market is just into building and making money off of it. And there's very little left, I know that there's contracts with developers, if you're allowed to develop a certain area, then you have to have one low cost affordable housing senior facility in the area. But it's, it's so little and so limited. That That seems to be a barrier. I mean, I've seen beautiful new senior living facilities come up. But they're very, they're very expensive. So I think it's a lack of seeing a need for lower, more lower cost affordable housing.


I really think I think it has. If you have enough money, you can figure it out. But if you don't, so I think it's people who are less wealthy. And then the problem they encounter is there's long long waits, there's years of waits to get a spot. And that's, you know, the need is more urgent than that. So, and some of the places that they end up with it, which have somewhat expensive, are not very pleasant.


Think the developer companies that are making so much money on squeezing housing and apartments in should be putting more of their profits into more humanitarian care of seniors because the senior population is growing tremendously. And I think that need is growing as well. And, and some of their profits should be going instead of to other things to making a for developing more affordable housing. Nice, affordable housing in the


area. Thank you. Yes. Okay. Thank you. So now moving on, I


feel like I'm saying the same thing over and over. Go ahead.


Moving on to transportation. So I'll go through the same questions for transportation.


Because if they get more elderly and frail, and they lose their license they what I see happening is they have to get on a list, and there's a long waiting list. And then when they need the transportation, there's long waits for the transportation to come. And they only have limited places they go. Like I said, they they refuse to come to our JCC because was off the route and so people couldn't get rides here. So yeah, so that's a big problem.


increasing the availability, improving the routes, and providing buses, possibly for agencies, I know the the community centers, the senior centers that are funded by the cities and state have their own buses. But agency like ours doesn't have that kind of resource. So, you know, thinking about nonprofit agencies like ours, who could use some assistance in either funding buses, or specifying assigning certain buses to work with us, and picking up seniors. You know, I just want to say, what ended up happening here at our JCC is that we have two groups of seniors, we have the younger seniors who are like 60, to about 80, maybe 85, mostly 80. And then there's the older seniors 85, to 100. And the 85 to 100 are more frail and limited, and those are the ones that need the busing the and have a terrible time trying to get here. And they have to have people pick them up, they they, you know, if they're lucky, or they just give up, and then they are alone at home isolated. And although there was during COVID, there, there was some ability to get computers, so they come on Zoom, but that's a computer contact, it's not personal contact, the younger people can drive here and engage. So it's really more for the older seniors, there's, you know, as I said, there's a divide now it's younger seniors and older seniors. And, and it really makes a difference as people get more elderly and frail.


Thank you for sharing. Yeah. And are there different experiences for different groups of older adults from different backgrounds,


Um, pretty much I think backgrounds don't make much of a difference, except if a older senior has a family nearby, it does help. If they don't, it's, they rely on people in the community to help them. And so that's, you know, that the more older seniors are, who are who don't have family nearby, or are more at risk, and isolated.


Oh, wait, this is what I was thinking. This is the difference in backgrounds. Yep.


But I don't know, I came into that. I think I've said everything about this. Okay.


Thank you. So now moving on to caregiving.


Because there's two parts to it. If a family member takes care of them, the family member can live their own life and they are burdened and they become maybe unhappy or depressed themselves. And, you know, you hear all this bad caregiver support. So that's one aspect of it. It's hard being a family member, caregiver. And number two, if you have somebody come in, it costs a lot of money. And so that's a big problem. It's very expensive, and I don't know what the solution is, but


I don't know. I mean, the only thing is You know, assigning some kind of funding, or there's a certain amount people can get certain amount of care people can get through Medicare, but it's not like 24 hour help. You know, maybe it's somebody coming to see them for a few hours here and there, or somebody coming in dropping off a meal, you know, if Meals on Wheels. But, you know, in general, I think the cost is a big barrier, and maybe there needs to be some kind of, even if they came up with some kind of qualifying situation, I'm sure the list would be, you know, we're waiting six months or a year, there's no quick that the whole system is very slow, and large and complicated. And it's hard to get immediate care for somebody who might need it.


Well, we talked about the backgrounds already. So they Yeah, there are different kinds of experiences. I think the biggest issue is if you have family or very close friends nearby.


Um, maybe hiring, maybe the county, to I know there's agencies that charge money for a visitor to come and be with you, or drive you. But again, it costs money. But I guess, you know, getting funding for home visits, home visitors, home drivers, you know, pay actually paying seniors out of a government funding to go visit people and spend a little time with them, maybe bring them a meal, take them to a doctor's appointment or something like that. So assigning some funds for seniors, because what I'm concerned about is the senior population is growing. And people are living longer. And so we're getting more and more frail, elderly people who do need help. They need people in their lives. They need support, they need transportation. And I'm not sure I know there's funding going out for so many things. But our the situation for seniors is just going to get worse and worse. Because people are living easily to 100 these days. And they're probably pretty frail from 90 on.


Thank you. So there are a few more questions left but I will stop screen sharing. So the next question is can you please describe how accessible and adequate the following care or services are in Orange County starting with geriatric care


it's very, very difficult to get doctor's appointments. I know many people have to wait weeks when something comes up unless it's an emergency and they go to emergency room. And that's what the doctor's office says because you might not be able to get an appointment for several weeks or even a month when something comes up. So the that kind of doctor care is growing more and more difficult. More and more doctors are becoming concierge doctors. And the doctors that are not are booked to the hilt with appointments. It would be great if there was more geriatricians I've looked around for geriatricians in the area. There's not as many as I would hope. Who specialists specialize in care for elderly. the medication problem is one size fits all. Oh, you're depressed pop a pill. Oh, you're, you know, whatever it is. There's a pop a pill. The people are being over medicated. And half the time the doctors they see a list of medications and then they say oh well you have this pen. We'll just add one on so many people are taking so many medications, but it's affecting their brains their balance. I think there needs to be more of a specialty With older people I know some doctors have said, Oh no, I would never give that dosage to an older person, a younger person can handle it, but an older person needs half the dosage. So I think there needs to be more focus on, on training doctors to work specifically with this very old population, even the young seniors, but really, with the old seniors even more so that that, and then the hospitals are just factories, I just don't see great quality of care of medical care. And it's not to say the doctors, I just think the doctors also are just overworked and overburdened, too. So that's part of the problem, then. And that's such a much bigger problem than I could even imagine trying to handle.


Well, it gets back to assisted living, the, the not only the assisted living, where people who can function but the assisted living memory care places. They're just very expensive. The long term care, and the quality of life in the ones that are less expensive, are poor, in my opinion, the quality of food, the quality care, the environment, the activities, are poor. You know, if you have big money, and you go to these fancy places, you get more. But still, there's pieces missing, unless you have a personal caregiver. So long term care, is not very appealing for most people.


Well, there's two things, I know Medicare does provide psychotherapy, visits with a therapist, if somebody's able to get there. Because if they're, if they don't drive, and they're isolated, um, they're not going to be able to do that, and they probably wouldn't be able to get on Zoom to do online kind of session, it's still very lonely. So I just think mental health is really a problem because of isolation and loneliness, and lack of purpose, lack of social. So I don't know, I'm trying to think of what what can be done, except that, you know, in certain places, like, where I am, and some of the senior centers people meet, and they have group meetings and discussions, and that seems to be helpful. You know, for like my group, it's a younger group of seniors who meets and we have a kind of a support group. But for the older seniors, now, they can't even get here. So that's a big problem. So I don't know. I'm just trying to think more about I don't know about the solution for that, but it's definitely problem. I don't know. Maybe some other people can figure it out. Thank you. I don't know. Whatever. Okay.


Well, human and social services to me is the same thing. It's, it's mental health. Having enough food. I think that's it because we already talked about the housing thing. It's really having food because especially if people are alone, they're not even cooking for themselves. They're eating frozen dinners, if they can get those delivered or go to the market or, and. And like I said, in isolation, they're just that's part of human services, food and company, and the biggest I think


and what do you think will be the biggest challenge older adults So faced in the next 10 years,


we're having a boom in the amount of seniors. And as the seniors in their 60s and maybe 70s, age and keep on living a long life. It there's, I see the future is holding a lot of questions about the aging population, which is just increasing all the time.


I think they have to reevaluate funding. And recognize that this population is growing and becoming more and more needy, and find donors especially there's so many huge, wealthy companies of all kinds I, that I just got a newspaper from Irvine, and it was four pages of these tech companies and social media companies and all these major major companies, and they're making so much money, I think these companies ought to donate or be taxed to contribute to addressing the needs of the older seniors. And I think that I think the companies that are really doing well, I don't want to tax the people anymore. But certainly, you know, the Irvine company is making a huge amount of money, I think they should be helping with this supporting more housing, all these developers, Lamar, and all these developers that are coming in, should be supporting the housing, the companies that are doing really well here and growing. There's lots of entrepreneurs coming in starting companies in Irvine, it's the appealing place, there should be some kind of tax or charge. And these funds should be directed, not to the program director of you know, in the government, but to the, to the people and to creating programs that will improve the quality of life in all the areas that I mentioned, and that are on your list to older seniors.


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


I think that people who don't have transportation, who have some kind of disability, who are living alone, who have limited funds. That's it.


Oh, boy, that's a hard question. There's I don't know. I mean, I mentioned one here that I didn't see on your list, which was legal assistance because we mentioned all the others


I think the big thing that is being overlooked is affordable housing. I think that's a big thing. Legal Assistance is there but it's not the biggest I think affordable housing is and maybe food scarcity. I just think of people who you know, just aren't able to cook aren't able to shop. So yeah, that's it. Thank you, boy. upsetting, actually, yeah.


That concludes our interview. So thank you so much for your time.


Oh, good. Yeah, so I would like to get the results of what they come up with. So


No. Okay, so the primary goal today is to and identify the needs that you think are most important to the older adult population you serve. Those who are 60 and older. And we would like you to think as broadly as possible taken into consideration of older adults, caregiver, family and their community. I'm going to share my screen so you can see a list of common issue and concern impacting older adults. Please take a few minutes to read through this lesson. Let me know when you are ready to begin. And whenever you want me to scroll up and down, let me know.


Okay, I think we just have one more on the list. Okay. Well, I'll record can you please tell us your role and how you interact with older adults.


Sure, I am the manager of the emergency services at Saddleback Medical Center. I interact with our patient population, every day that I'm in office, I help facilitate education for our nurses, any policies or procedures that go into place that would impact our our older community. And then I'm on the floor in the ER every day interacting with with patients as they come in, be seen and treated and then discharged as well.


So thinking about Orange County and looking at the list of all common issue that impacting older adults is anything missing from the list


now that's a pretty comprehensive list, I think it hits all the highlights that I I had in mind already.


So up there next on the list, Please rank the top three that you feel are the most important I


think, for us, honestly, transportation, mobility is a huge one, we're having a lot of difficulty arranging transport for our older population, especially after hours at nighttime. So that would be currently number one on my list. And then after that is thinking the top there was one about caregivers finding appropriate caregivers so the patients can stay at home and still be well cared for in a safe manner. And then with behavioral and mental health do we are seeing a lot more patients with dementia come in that are quite challenging for family to care for. But then they're also not necessarily meeting criteria for long term placements. So they're kind of in this limbo state of where they can get the best cared for. We prefer them to go back to their home setting with with caregivers at home is ideal. That's right, that's one of our big challenges, too, is patient placement population.


So for the next set of questions, it will be a little bit repetitive as we dig deeper into the three topics that you selected. It's gonna let you know. So when you think about transportation, how or why older those struggling with this issue.


I think a lot of times they have another loved one is also elderly and either has difficulty providing transport. So if we have a patient that is getting discharged, said sometimes we get discharges at one in the morning. It's very difficult to find a loved one to give them a ride home. Then the next best option is private companies like Uber, they have an Uber assist that we use, sometimes that can help with discharges and then for ambulances charges that's not covered anymore under Medicare. So they get stuck with the bill if that's there. Only way of having transport home usually will provide them an area to stay in a comfortable area to stay until the morning when the loved one can drive. But sometimes they'll have a loved one that can't drive at nighttime.


I think if there could be more options for healthcare facilities, especially emergency departments for arranging transport home after the 8pm hour, it's kind of challenging to find a company that will provide a safe transport home, especially if there's any type of medical needs from the patient, whether it's oxygen or, or a wheelchair. Ideally, we always try to have a loved one provide that ride. It's not always appropriate or available. So we have a lot of difficulty finding transport home for these patients after hours.


Okay, different experiences for different group of older adults from different backgrounds.


I'm not sure No, I don't, I think that transport issue doesn't change at all based on their their demographics other than the age and how much family they have available in the area. It does become more challenging a younger population, sometimes our younger end of the geriatric spectrum like a 60 year old, they are already familiar with using an Uber or feel comfortable with a taxi. But it's not uncommon for us to take care of and discharge patients that are 80s 90s, even 100 years old sometimes. And that's when transportation becomes a little bit more unsafe in a faculty like Uber or a taxi.


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


if there was more private companies that could provide after hours transport that had trained staff to assist with medical devices, to ensure they get back into their home, where a caregiver caregivers their to receive them. And there's documentation of that, that would really benefit our I think the entire county.


When you think of caregiving how or why older adults struggling with this issue.


There's a lot of times, our elderly population, their caregivers, also another elderly spouse who's dealing with their own complex issues. And sometimes they can get sick all of a sudden, and then they don't have any backup for caregivers. So there's many times we have a patient, our ER, that's receiving care, but they're the primary caregiver to their loved one. And now we're we're working on social work and case manager to find resources not only for the patient being treated, but for their loved one that they're the primary caregiver for


what barrier assists to see improvement in this area.


Think access to community resources is a big one. We have a really good team of Social Work and case management that can help facilitate finding support for the patient as the primary caregiver to their loved one. But I don't know all the details around that I'd have to refer to our case managers and our social workers. But I know we do have trouble finding resources available all the time for for those type of scenarios.


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


i Yeah, actually for transportation, too. I wasn't thinking about the economic diversity. But yeah, for lower socio economic families, it is more challenging transportation when there's the cost of transportation will usually cover the cost of a taxi or Uber if they can't financially pay. But as for the ambulance, it's it's quite an expensive cost, if that's their only form of transportation home. And then same with resources in the community. It's it can be quite expensive to find caregivers.


I think having more partnership from acute care facilities with the resources that are available, whether it's at home caregivers or Respite homes. Like I said, our experts are case managers, our social worker, and I know they do have a lot of partnerships and connections in the community. But I think those could probably be increased, especially with how many older adults we see every year and with the population getting older and older.


When you think up behavior and mental health how or why older adults struggling with this issue


can be really complex with older adults, because we do see older adults come in with anxiety and depression. But then they also have layers of other health issues that getting them to appropriate psychiatric facilities can be challenging. So psychiatric facilities in Orange County, most of them are equipped to deal with the psychiatric emergency piece of it, but they're not well equipped to deal with chronic conditions like heart failure, diabetes, or COPD. So we end up having patients who have prolonged stay either in our ER or in our emergency department, because those facilities that have expertise and caring for mental health can't necessarily care for the complexities of somebody with several chronic conditions. So they kind of are stuck in the hospital, which isn't the best setting for their mental health crisis that they're having, but we need to care for their era, you know, chronic condition.


What barrier assists to see improvement in this area.


major barriers, just the options of places to send older adults that are having mental health crisis, there's really not a whole lot of psychiatric facilities in Orange County that specialize in geriatrics, like psychiatry, especially, there's really not a whole lot of facilities that can manage chronic conditions and the complexities of older adults with chronic conditions plus the mental health aspect.


Yeah, same with the other ones, you know, insurance socio economic status. Family support, yeah, there's some other factors that can weigh in, it doesn't really change, how we treat them at our hospital or how we try to arrange for them to go to the most appropriate facility. But yeah, the socio economic can be another factor for outpatient treatment and long term treatment for mental health to


If the county could put in additional resources for mental health for older adults, especially in South Orange County, there's not a whole lot of facilities or outpatient areas where we can refer these patient populations to I think, yeah, just support from the county and from the state to increase access to mental health. Practitioners.


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


You know, I can't speak for North County or I know South County we have what were our hospitals a Age Friendly Hospital and we're a geriatric emergency accredited department. So we have pretty good resources for geriatrics in South Orange County. I don't not sure about North County or, or across the county in general, but in this area around Saddleback, we do have geriatric specialists, we have outpatient areas for them. I think access in the acute care setting is I mean, they have a geriatric emergency department in in us in Laguna Hills, I'm not sure about the outpatient arena with specialists that have available appointments that are easy to get in with them. I can't really speak on that.


Once again, I actually don't have much experience with this aspect of the continuum of care. I think our case management social work department are the experts in that we do have there is challenges and finding Long Term Care for some of our older population, which prolongs their stay in the hospital. But I'm not really an expert to talk on accessibility of long term care.


I think the accessibility is not where it should be. I think we could improve the access for mental health and drug and substance abuse as well. There's barely pretty limited facilities that we can refer patients to especially in South Orange County.


Can you please describe how assessable and adequate human social services in Orange County


in a acute care setting, we do a great job we have social work available 24/7 Not sure what that looks like when they are discharged and leave our facility.


I think having enough practitioners and facilities that specialize in geriatric care because it's a really unique, complex area of medicine, just because the older adults have more chronic conditions they have more polypharmacy. They're on more medications in the standard and they just require more detailed workups from physicians and and I think there probably could be a lack in that in the future, especially with our population getting older and older. I'm not seeing as much emphasis on geriatric specialization in the medical field or in the nursing field as well.


I think providing additional resources or financial incentive to increase specialists in geriatrics whether that's physicians or nurse practitioners or or facilities that participate in geriatric programs.


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


I think probably the, the older end of the geriatric population that's also in the lower socioeconomic status. Just because they don't have they're not usually as established with physicians and outpatient care. And when they present to the hospitals. They're usually not as well cared for their medical conditions as someone from a higher socioeconomic status.


Let's see, I'm trying to think I once again, I think maybe the under the economic security bucket just access and current state of living for lower socio economic, geriatric population, especially ones that have limited families and social support.


Is there anybody that's serving older adults or any organization that you think that we should talk to, to get the input in the project,